Nanna Lien

• Meshkovska, Biljana; Zolfaghari, Mahshid; Brandvik, Caroline Løvik; Klepp, Knut-Inge; Kopainsky, Birgit & Lie, Hanne Cathrine [Show all 7 contributors for this article] (2026). Adoption of the Norwegian School Fruit Program: A Qualitative Study on Barriers and Facilitators. Global Implementation Research and Applications. doi: 10.1007/s43477-026-00238-1. Full text in Research Archive Show summary

  The Norwegian School Fruit Program is financed by parents or local municipalities. The aim of this study was to explore contextual barriers and facilitators that influence the adoption of the program by schools using the Context and Implementation of Complex Interventions (CICI) framework. We conducted semi-structured interviews with 21 participants (mainly principals) from 20 lower secondary schools (classes 8–10). We analyzed the data using a deductive qualitative approach based on the CICI framework. We compared findings across schools offering the program (1) with no-parental-payment, (2) by parental subscription, and schools that (3) discontinued or (4) never offered the program. Economic costs were perceived as the main barrier to adoption across all schools. Although most schools recognized the need for such a program, some preferred to make their own arrangements. Except for schools offering the parental subscription option, many schools perceived asking parents to pay for the program as unfair, not in line with Norwegian values, and unlikely to allow the program to reach those who need it the most. Further barriers were the lack of legislation making the program obligatory and potential political changes causing uncertainty regarding the programme’s continuation from one year to the next. Social aspects of eating together were recognized as a facilitator. Food provision programs should be compatible with school priorities such as academic performance and mental health. Context and setting are dynamic and should be continuously evaluated to ensure they are in line with evolving school priorities and needs.

• Zolfaghari, Mahshid; Lien, Nanna; Brandvik, Caroline Løvik; Klepp, Knut-Inge; Kopainsky, Birgit & Lie, Hanne Cathrine [Show all 7 contributors for this article] (2025). Understanding the dynamics of implementing the Norwegian School Fruit Programme: integrating implementation science and system dynamics | Implementation Science Communications. Implementation Science Communications. p. 1–48. doi: 10.1186/s43058-025-00834-6. Full text in Research Archive Show summary

  Many implementation determinants of school nutritional interventions have been identified, but a deeper understanding of their interplay within a system is needed. The present study aimed to investigate how the Norwegian School Fruit Programme, particularly the No Parental Payment Programme (NPPP), is being implemented in schools and how it interacts with the school system structure and dynamics as perceived by school personnel and pupils. Moreover, it aimed to understand the dynamic interplay between the determinants of the Consolidated Framework for Implementation Research (CFIR) in the NPPP’s context. The overarching methodology was qualitative system dynamics modelling, with data collected through a series of group model building (GMB) workshops at four schools offering the NPPP. Using GMB scripts, facilitated discussions between school personnel and pupils were held for a better understanding of the NPPP’s implementation dynamics and to create diagrams illustrating how implementation determinants interact with each other and each school’s unique context. The individual school diagrams were compiled into a single diagram. The CFIR was subsequently mapped on to this diagram. Lack of communication with pupils, the food stores outside schools, and the NPPP’s design weakened the reinforcing mechanism that fostered pupils’ eating of fruit. Not eating enough of the fruit increased implementation costs because schools had to deal with leftover fruit and littering issues. Implementation costs caused schools to adopt implementation processes, like reflecting, engaging, and adapting to reduce the costs, although some of these did not work or counterintuitively decreased pupils’ eating of fruit. The success of these processes was contested by the design of the NPPP and mechanisms that were shaped by the goals and priorities of the schools. This research employed qualitative system dynamics to investigate NPPP implementation dynamics. Recommendations for improving implementation include aligning NPPP’s design with pupils’ preferences, monitoring eating of fruit, and involving internal stakeholders (pupils and school personnel) for gathering feedback, and external stakeholders (municipalities) for monitoring.

• Lam, Thao Minh; Aarestrup, Julie; Akker, Erica L. T. van den; Baker, Jennifer L.; Banik, Anna & Berntzen, Bram J. [Show all 56 contributors for this article] (2025). Advancing knowledge, maps and tools to address obesity and related socio-economic disparities in Europe: the OBCT project. Global health action. ISSN 1654-9716. 18(1). doi: 10.1080/16549716.2025.2517492. Full text in Research Archive Show summary

  The steady rise in overweight and obesity in Europe disproportionately affects people and communities with a lower socio-economic position (SEP). Many obesity prevention approaches exist, but these have had limited reach and unsatisfactory effects thus far, especially in low-SEP populations. In this context, there is a need for implementation of effective individual-level and population-based preventive strategies that also tackle health inequalities. Effective strategies require consideration of the complex and cross-domain obesity risk factors across the life course. Feasible and acceptable strategies require multisectoral collaborations and innovative approaches, including a whole-of community and systems perspective. With the Horizon Europe-funded OBCT project, we aim to quantify the relative contribution of biological, socio-cultural and built environment factors to obesity and the interactions of these risks within and across various life course stages; and translate the resulting knowledge into practical, equitable, and effective tools for action. These tools will include: a comprehensive obesity risk screener; a map of the obesogenicity of neighbourhood environments as well as trends in obesity prevalence of each European country; recommendations for lifestyle behaviours (diet, physical activity, sedentary behaviours) to prevent obesity during key life transition stages; a decision support dashboard for policy makers; and co-developed toolboxes to support implementation of policy recommendations in low-SEP communities. OBCT’s outputs will highlight the areas and domains in which obesity should be targeted and will empower the research community, policymakers, health professionals and residents in Europe to adapt and implement strategies to effectively reduce obesity risk, particularly in low-SEP communities.

• Zolfaghari, Mahshid; Meshkovska, Biljana; Brandvik, Caroline Løvik; Kopainsky, Birgit; Klepp, Knut-Inge & Lie, Hanne Cathrine [Show all 7 contributors for this article] (2025). A Systems Perspective on the Drivers of Adoption of the Norwegian School Fruit Scheme. Global Implementation Research and Applications. 5, p. 336–348. doi: 10.1007/s43477-025-00173-7. Full text in Research Archive Show summary

  Successful adoption of evidence-based primary prevention interventions by schools is important for public health but relies on multiple factors. Using a systems perspective enables the identification of the interconnectivity and feedback loops among these factors, which can facilitate or hinder adoption. This study aimed to conceptualize a system structure showing how adoption factors are interrelated, and which feedback loops influence schools’ decisions to adopt interventions, using the parent-paid Norwegian school fruit scheme (the parent-paid scheme) as a case. We interviewed principals and personnel (n = 7) from schools that adopted, de-adopted, or never adopted the parent-paid scheme. These interviews were analyzed using qualitative system dynamics modeling. The analysis resulted in a causal loop diagram representing a system structure driving schools’ adoption decisions. The preliminary results were validated during a workshop with new participants who hold decision-making roles in schools (n = 5). Due to previous experiences with a free scheme, some schools perceived the parent-paid scheme’s relative advantages as low, which, in synergy with schools’ preference to offer it for free to pupils, resulted in the parent-paid scheme never being adopted. Nevertheless, there were schools that adopted the parent-paid scheme, driven by feedback loops like perceived need and relative advantages. These feedback loops, however, weakened over time as de-adoption resulted from a lack of demand from parents and pupils. Taking a systems perspective offered a temporal view of adoption processes, revealing how past decisions, like de-adopting a free scheme, influence future decisions. It highlighted how reinforcing feedback loops, like perceived need, set schools on adoption paths. Finally, it identified gaps in information flow, including those necessary for adaptation, as potential missing feedback loops to continuous adoption. As such, the schools’ decision to adopt the parent-paid scheme is a dynamic process with systemic characteristics that should be considered when developing strategies to ensure adoption.

• Aguiar, Anaely; Rajah, Jefferson K.; Conway-Moore, Kaitlin; Savona, Natalie; Knai, Cécile & Vlad, Ioana [Show all 10 contributors for this article] (2025). Converging perspectives on the processes exacerbating adolescent obesity: An integrative systems approach. Social Science and Medicine. ISSN 0277-9536. 367. doi: 10.1016/j.socscimed.2025.117706. Full text in Research Archive Show summary

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

• Meshkovska, Biljana; Moerman, Gerben; Baillergeau, Evelyne; Bröer, Christian; Lien, Nanna & Luszczynska, Aleksandra [Show all 9 contributors for this article] (2025). Voices of youth: youth participation in the CO-CREATE project. BMC Public Health. 25, p. 1–12. doi: 10.1186/s12889-025-23097-1. Full text in Research Archive Show summary

  Introduction Applying youth participatory action research (YPAR) has become common practice in public health. However, there are challenges in applying YPAR and there is a need for improving the process by learning from youth that has participated in such projects. This study explores youth involvement in the CO-CREATE project which focused on developing overweight and obesity prevention policies. Methods This is a qualitative study, based on three data sources: 1) fieldnotes taken by project staff during observation of youth (approximately 150 observations) 2) semi-structured interviews with project staff (n = 12) 3) direct feedback from participating youth through feedback forms (n = 51). Data was analyzed in NVivo, following the principles of reflexive thematic analysis. Results Five themes were generated which showcase youth involvement in CO-CREATE: 1) an inspired and engaged youth; 2) insights through respectful interactions; 3) a strength of voice and call to action; 4) challenges in understanding project and disengagement; and 5) interpersonal conflict and pressure to participate. Conclusion Taking the time to build trust and create a feeling of equality is important. It is also important to allow youth to take the lead when they wish so and have clear ideas of how to do so. Voices of rebelliousness can be a show of strength and help reach the goals of the project. Participation in CO-CREATE may have contributed toward individual empowerment of youth.

• 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.

• 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.

• Randby, Jorunn Sofie; Ogden, Terje & Lien, Nanna (2024). Implementation and effectiveness of a school-based intervention to increase adherence to national school meal guidelines: A non-randomised controlled trial. Public Health Nutrition (PHN). ISSN 1368-9800. 27. doi: 10.1017/S1368980023002938. Full text in Research Archive Show summary

  Objective: Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. Design: The study was a school-based hybrid implementation effectiveness trial with a pre–post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. Setting: Primary schools and after-school services in two counties in south-east Norway. Participants: School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. Results: There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, se B = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school’s socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (rs = 0·48) with the change scores in the intervention group, indicating that principals’ support is important for gaining the largest intervention effects. Conclusions: A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.

• Baillergeau, Evelyne; Veltkamp, Gerlieke; Bröer, Christian; Helleve, Arnfinn; Kulis, Ewa & Lien, Nanna [Show all 12 contributors for this article] (2024). Democratising participatory health promotion: power and knowledge involved in engaging European adolescents in childhood obesity prevention. Health, Risk and Society. ISSN 1369-8575. 26(5-6), p. 201–221. doi: 10.1080/13698575.2024.2338120. Full text in Research Archive Show summary

  Public policy aimed at preventing undesired phenomena has increasingly sought to engage representatives of the target population. Little is known, however, about how power dynamics function to shape the processes and outcomes of risk governance engagement interventions. In order to study the ways in which, and the extent to which, power differentials can be reduced in participatory health promotion initiatives, we develop a conceptual framework synthetising theories of participatory action, phenomenology and governmentality. Based on the empirical research into youth participation in the EU project CO-CREATE, involving 15–19-year-old adolescents in five European countries (2019–2021), we show that diverse forms of knowledge may become available in engagement interventions. We analyse the use and relative inclusion and exclusion of these different forms of knowledge in terms of a three-level framework of different depths of democratisation in participatory health promotion: risk management, risk definition and risk negotiation. Advanced democratisation can only be achieved if risk negotiation is carried out in ways which embrace and encourage a range of different, and potentially conflicting forms of knowing.

• 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.

• Knai, Cécile; Savona, Natalie; Finegood, Diane; Rodriguez, Anaely Aguiar; Blanchard, Laurence & Conway-Moore, Kaitlin [Show all 13 contributors for this article] (2023). Learning from the CO-CREATE project: A protocol for systems thinking across research (STAR). Obesity Reviews. ISSN 1467-7881. 24(S2), p. 1–11. doi: 10.1111/obr.13624. Full text in Research Archive Show summary

  The CO-CREATE project aimed to work with young people to create, inform, and disseminate obesity-preventive evidence-based policies using a complex systems perspective. This paper draws lessons from this experience and proposes a protocol for embedding systems thinking within a research project. We first draw on existing systems thinking frameworks to analyze how systems thinking was translated across CO-CREATE, including the flow and relationship between the work packages and in the methods used. We then take the lessons from CO-CREATE and the principles of existing systems thinking frameworks—which focus on various points of intervention planning and delivery but not on research projects as a whole—to formulate a protocol for embedding systems thinking across a research project. Key lessons for future planning and delivery of systems-oriented research projects include incorporating “boundary critique” by capturing key stakeholder (adolescent) values and concerns; working to avoid social exclusion; ensuring methodological pluralism to allow for reflection and responsiveness (with methods ranging from group model building, Photovoice, and small group engagement); getting policy recipients to shape key questions by understanding their views on the critical drivers of obesity early on in the project; and providing opportunity for intraproject reflection along the way.

• Romanenko, Eduard; Homer, Jack & Lien, Nanna (2023). As simple as possible but not simpler: structural sensitivity testing of a dynamic model of adolescent overweight and obesity. System Dynamics Review. ISSN 0883-7066. 39(2), p. 125–139. doi: 10.1002/sdr.1732. Full text in Research Archive Show summary

  Abstract We recently published results from an SD model of adolescent overweight and obesity using data from 31 European countries that participate in the Health Behavior in School‐Aged Children (HBSC) study. During model development, we sought to identify a feedback structure with high explanatory power that avoided speculative relationships. Expert reviewers generally agreed with our modeling decisions, but two decisions did raise questions: (1) excluding the influences of food environment and built environment, for which HBSC provided no data; and (2) including five causal links that were supported statistically but might be considered disputable. To address the reviewers' questions, we created four possible model structures and performed automated calibration followed by intervention testing and ranking. We then compared the goodness‐of‐fit and intervention results. We discuss implications for how to move forward with the model, including through additional data gathering. © 2023 The Authors. System Dynamics Review published by John Wiley & Sons Ltd on behalf of System Dynamics Society.

• Samdal, Oddrun; Ljøsne, Isabelle Sylvie Budin; Haug, Ellen Merethe Melingen; Helland, Trond; Kjostarova-Unkovska, Lina & Bouillon, Claire [Show all 32 contributors for this article] (2023). Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects. Obesity Reviews. ISSN 1467-7881. 24(S2). doi: 10.1111/obr.13636. Full text in Research Archive Show summary

  The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

• Nwosu, Emmanuel; Makwambeni, Patricia; Herstad, Sondre Haugsbø; Etsebeth, Hanli; Hendricks, Gaironeesa & Rodriguez, Anaely Aguiar [Show all 11 contributors for this article] (2023). Longitudinal relationship between adolescents' mental health, energy balance-related behavior, and anthropometric changes. Obesity Reviews. ISSN 1467-7881. 24(2). doi: 10.1111/obr.13629. Full text in Research Archive Show summary

  Energy balance-related behaviors (EBRBs) are considered the immediate causes of adolescents' body weight increases, but adolescents have identified mental health as a contributor. Cross-sectional studies have reported associations between adolescents' mental health and obesity, but causal relationships and the role of EBRBs within this can only be established using longitudinal studies. This systematic review summarizes the findings of longitudinal studies investigating this relationship, in addition to the role of EBRB in the relationship. Multiple electronic databases were searched for longitudinal studies using keywords related to the adolescent population, mental health, EBRB, and body weight. In total, 1216 references were identified and screened based on previously defined eligibility criteria. Sixteen articles met the inclusion criteria. Most studies indicated that mental health-related measures like depression, anxiety, and body dissatisfaction were related to an increase in body weight later. As this review is focused on behavioral mediators, six studies reported associations between mental health—anthropometry dyad and EBRBs such as eating habits, screen time, physical activity, and sleep—as well as stressors like peer victimization. Future studies may focus on streamlining mental health measures and body weight outcomes to assess this relationship. Furthermore, more longitudinal investigations are needed to provide insight into the role of EBRBs in the mental health–body weight relationship during adolescence.

• Bröer, Christian; Ayuandini, Sherria; Baillergeau, Evelyne; Moerman, Gerben; Veltkamp, Gerlieke & Luszczynska, Aleksandra [Show all 11 contributors for this article] (2023). Recruiting and engaging adolescents in creating overweight and obesity prevention policies: The CO-CREATE project. Obesity Reviews. ISSN 1467-7881. 24(S1). doi: 10.1111/obr.13546. Full text in Research Archive Show summary

  The CO-CREATE project aims to collaborate with adolescents across Europe in developing policy ideas that contribute to overweight and obesity prevention. In this paper, we present the theoretical basis and methodological approach to recruitment and engagement in the project. The principles of youth-led participatory action research were employed to design Youth Alliances in which adolescents and adults could collaborate. These Alliances should serve to promote and support adolescent participation and to develop policy ideas that would contribute to obesity prevention. Alliance members were recruited in two local geographical areas per country with a focus on reaching out to underrepresented youth. We started with fieldwork to assess locally relevant forms of inclusion and exclusion. The methodology entailed a handbook combining existing tools which could be used flexibly, a collaborative organization, and budgets for the alliances. Engagement started in local organizations, that is, schools and scouts, and with peers. Health- and overweight-related challenges were addressed in their immediate surroundings and supported the inclusion of experiential knowledge. Adolescents were then supported to address the wider obesogenic system when designing policy ideas. The CO-CREATE Alliances provide a concrete example of how to engage youth in public health, in a manner that strives to be participatory, transformative, and inquiry based.

• 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.

• Banik, Anna; Knai, Cecile; Klepp, Knut Inge; Rutter, Harry; Rito, Ana & Lien, Nanna [Show all 11 contributors for this article] (2023). What policies are there and what policies are missing? A Photovoice study of adolescents' perspectives on obesity-prevention policies in their local environment. Obesity Reviews. ISSN 1467-7881. 24(2). doi: 10.1111/obr.13617. Full text in Research Archive Show summary

  Summary The aim of this study was to investigate adolescents' critical awareness of whether obesity prevention policies targeting physical activity (PA) and nutrition were operating in their local community. Participants were 41 adolescents (aged 16–18, 90% women) recruited from three communities in Poland. Prior to this study, they were involved in obesity‐prevention participatory initiatives (conducted within the CO‐CREATE project), where obesity‐related public policy limitations were analyzed in a youth‐led discussion. A Photovoice exercise was designed to capture obesity‐related public policies that were either present or absent in young people's local environments. The photographs ( N  = 213) were coded and mapped according to the policy themes they illustrated, using the MOVING and NOURISHING frameworks. The public policies represented in the photographs are most frequently related to: healthy retail or food service environments; food advertising or promotion; structures and surroundings that promote PA; and infrastructure and opportunities that support public or active transport. Adolescents are critically aware of the presence and lack of specific public policies operating in their local environment, particularly policies affecting structural aspects of food and PA environments. Policy‐oriented photovoice exercises may prompt critical awareness among adolescents and empower them to contribute to obesity prevention policy processes.

• Herstad, Sondre Haugsbø; Grewal, Navnit Kaur; Banik, Anna; Klepp, Knut Inge; Knai, Cecile & Luszczynska, Aleksandra [Show all 10 contributors for this article] (2023). Adolescents' capacity to take action on obesity: A concurrent controlled before-and-after study of the European CO-CREATE project. Obesity Reviews. ISSN 1467-7881. 24(2), p. 1–12. doi: 10.1111/obr.13622. Full text in Research Archive Show summary

  Summary This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth‐led participatory action research European initiative (CO‐CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before‐and‐after controlled study across five countries and took place between September 2019 and October 2020. Adolescents ( n  = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members ( n  = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group ( n  = 132) who completed the questionnaire twice were included in the main analysis. Two‐level linear mixed models controlling for country‐related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co‐creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.

• 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.

• Meshkovska, Biljana; Forberger, Sarah; Wendt, Janine; Scheller, Daniel A.; Castellari, Elena & Tiboldo, Giulia [Show all 8 contributors for this article] (2023). Barriers and Facilitators to Implementation of the EU School Fruit and Vegetables Scheme: Cross Country Study. Global Implementation Research and Applications. doi: 10.1007/s43477-023-00100-8. Full text in Research Archive Show summary

  Abstract The European Union (EU) School Fruit and Vegetables Scheme is a nutrition policy program. It has three actions: delivery of fruit and vegetables in schools, accompanying educational and information measures. The aim of this study is to identify barriers and facilitators to the implementation of the Scheme as perceived by implementers at government level. This work is a qualitative, exploratory study using the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis. Twenty-three semi-structured interviews were conducted with representatives ( n  = 29) from agriculture, health and education, across 10 EU member states and the EU. Qualitative data were coded inductively. Themes were mapped to constructs of the CFIR. We found content in regard to 19 out of 26 constructs of the CFIR. Some example constructs are: adaptability, external policy and incentives, networks and communications, knowledge and beliefs and executing. Flexibility in how the scheme is designed and implemented and newly established cooperation between implementing ministries are facilitators. However, the timing of the yearly budget allocation is a barrier. Taking EU funding for granted is a potential disincentive to improvement, although the EU funding facilitates sustainability. Despite agreement on what the overall goals of the Scheme are, there is ambiguity as to what the perceived primary goal is, which may be a barrier. Some goal ambiguity may be useful at the supranational level, enabling politically acceptable framing and continuation of the financing of the Scheme, but this translates into a potential barrier to design and implementation at country and school level.

• Klepp, Knut Inge; Helleve, Arnfinn; Brinsden, Hannah; Bröer, Christian; Ljøsne, Isabelle Sylvie Budin & Harbron, Janetta [Show all 18 contributors for this article] (2023). Overweight and obesity prevention for and with adolescents: The “Confronting obesity: Co-creating policy with youth” (CO-CREATE) project. Obesity Reviews. ISSN 1467-7881. 24(S1). doi: 10.1111/obr.13540. Full text in Research Archive Show summary

  The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16–18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures.

• Wendt, Janine; Scheller, Daniel A.; Flechtner-Mors, Marion; Meshkovska, Biljana; Luszczynska, Aleksandra & Lien, Nanna [Show all 10 contributors for this article] (2023). Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research–A cross-sectional study. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.935292. Full text in Research Archive Show summary

  Background Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated barriers and facilitators to the adoption of physical activity policies in elementary schools in Baden-Wuerttemberg, Germany, from the perspective of school principals. Methods A cross-sectional study was conducted between May and June 2021. School principals from elementary and special needs schools ( n = 2,838) were invited to participate in the study. The online questionnaire used was developed based on the CFIR and included questions on school characteristics and constructs of the CFIR domains inner setting, characteristics of individuals, and process. Logistic regression analyses were performed to examine associations between policy adoption and school characteristics as well as CFIR determinants. Results In total, 121 schools (4%) participated in the survey, of which 49 (40.5%) reported having adopted a policy to promote physical activity. Positive associations with policy adoption were found for general willingness among teaching staff [odds ratio (OR): 5.37, 95% confidence interval (CI): 1.92–15.05], available resources (OR: 2.15, 95% CI: 1.18–3.91), access to knowledge and information (OR: 2.11, 95% CI: 1.09–4.09), and stakeholder engagement (OR: 3.47, 95% CI: 1.24–9.75). Conclusions This study provides a first insight into potential barriers and facilitators at the organizational level of schools that may be relevant to the adoption of physical activity policies, from the perspective of school principals. However, due to a low response rate, the results must be interpreted with caution. A strength of this study includes theoretical foundation through the use of the CFIR. The CFIR could be well-adapted to the school setting and provided valuable support for developing the questionnaire and interpreting the study results.

• Ulloa, Manuela Aguirre; Nesrallah, Samantha; Shafafi, Pardis; Lamar, Angel; Gonçalves, Pedro Côrte-Real & Gonçalves, Mafalda [Show all 14 contributors for this article] (2023). Designing a youth-led Dialogue Forum tool: The CO-CREATE experience. Obesity Reviews. ISSN 1467-7881. 24(S2). doi: 10.1111/obr.13611. Full text in Research Archive Show summary

  Summary While obesity prevention represents an established field of research, the inclusion of young people, who are regularly cited as an important priority group, are rarely actioned in long‐term studies. This paper focuses on the development of a dialogue tool intended to tackle this issue, engaging, and eliciting insights on the theme of obesity prevention, by young people and for young people. As part of the CO‐CREATE project, this tool was co‐developed by designers, public health, and youth participation experts, researchers, and young people. Co‐creation is a key methodology in the design of the dialogue tool, as young people were involved in all stages of the development process. This paper elaborates on the process of co‐designing a dialogue tool that helps explore obesity prevention policy ideas from multiple perspectives, and describes the design principles that informed the process and the final versions of the tool. The purpose of the Dialogue Forum tool is for youth to engage policymakers and other relevant stakeholders to discuss and refine co‐created and youth‐initiated ideas for healthier food and physical activity environments. We analyze how specific design principles were integrated into different prototypes and the value of this within the project and the field.

• Rodriguez, Anaely Aguiar; Onal, Furkan; Hendricks, Gaironeesa; Blanchard, Laurence; Romanenko, Eduard & Fismen, Anne-Siri [Show all 16 contributors for this article] (2023). Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study. Obesity Reviews. ISSN 1467-7881. 24(S2). doi: 10.1111/obr.13628. Full text in Research Archive Show summary

  Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing—doubling on average for boys and girls and decreasing obesity prevalence by over 4%.

• Conway-Moore, Kaitlin; Cecile, Knai; Finegood, Diane; Johnston, Lee; Brinsden, Hannah & Rodriguez, Anaely Aguiar [Show all 18 contributors for this article] (2023). Co-creating obesity prevention policies with youth: Policy ideas generated through the CO-CREATE project. Obesity Reviews. ISSN 1467-7881. 24(S2). doi: 10.1111/obr.13623. Full text in Research Archive Show summary

  Despite growing recognition of the importance of applying a systems lens to action on obesity, there has only been limited analysis of the extent to which this lens has actually been applied. The CO-CREATE project used a youth-led participatory action research approach to generate policy ideas towards the reduction of adolescent overweight and obesity across Europe. In order to assess the extent to which these youth-generated policy ideas take a systems approach, we analyzed them using the Intervention Level Framework (ILF). The ILF ascribes actions to one of five system levels, from Structural Elements, the least engaged with system change, up to Paradigm, which is the system's deepest held beliefs and thus the most difficult level at which to intervene. Of the 106 policy ideas generated by young people during the CO-CREATE project, 91 (86%) were categorized at the level of Structural Elements. This emphasis on operational rather than systems level responses echoes findings from a previous study on obesity strategies. Analyzing the distribution of systems level responses using the ILF has the potential to support more effective action on obesity by allowing identification of opportunities to strengthen systems level responses overall.

• 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.

• Bröer, Christian; Veltkamp, Gerlieke; Ayuandini, Sherria; Baillergeau, Evelyne; Moerman, Gerben & Sauvage, Rein de [Show all 15 contributors for this article] (2023). Negotiating policy ideas: Participatory action research projects across five European countries. Ethics, Medicine and Public Health. ISSN 2352-5525. 28. doi: 10.1016/j.jemep.2023.100905. Full text in Research Archive Show summary

  Introduction Between 2019 and 2021, 199 adolescents collaborated with adults in 15 participatory action research projects, called Youth Alliances, to contribute to system-directed obesity prevention in five EU countries. We investigated if and how these Youth Alliances included diverse youth, enhanced engagement, generated policy proposals and changed problem perception. Theory We assessed the Youth Alliances from a micro-sociological perspective of negotiated order and attended to what we call third order effects: that participatory action provides time and space to renegotiate meaning. Methodology We used a case-comparative interpretive framework to attend to complexity. Based on collaborative and comparatively triangulated observations, documents and contextual data, we studied adaptations to Youth Alliances due to contextual demands and local contingencies in micro-interactions. Results Youth Alliances led to the involvement of adolescents from diverse backgrounds who participated meaningfully in a form of partnership, generated a wide variety of policy proposals, and learned about obesogenic systems, policies and participation in the process. Discussion and conclusion A focus on meaning-making and interaction reveals how one participation approach can have multiple and even contradictory outcomes depending on non-linear, emergent and contingent local interactions. Some of the outcomes represent well-known second order effects (e.g., changing power relations). But we also point to what we call third order effects: specific activities generated time and space for social interactions in which novel meaning could arise and consolidate.

• Wendt, Janine; Scheller, Daniel A.; Banik, Anna; Luszczynska, Aleksandra; Forberger, Sarah & Zeeb, Hajo [Show all 16 contributors for this article] (2023). Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour. BMC Public Health. 23(1). doi: 10.1186/s12889-023-15775-9. Full text in Research Archive Show summary

  Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation. As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports. Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy. The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.

• Romanenko, Eduard; Homer, Jack; Fismen, Anne-Siri; Rutter, Harry & Lien, Nanna (2022). Assessing policies to reduce adolescent overweight and obesity: Insights from a system dynamics model using data from the Health Behavior in School-Aged Children study. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.13519. Full text in Research Archive Show summary

  Adolescent overweight and obesity (AdOWOB) in Europe has proven to be a persistent and complex problem, and appropriate systems methods may help in evaluating potential policy options. This paper describes the development of a system dynamics model of AdOWOB as part of the EU-funded CO-CREATE project. The model was developed using literature and data from the Health Behavior in School-Aged Children (HBSC) study across 31 European countries. We identified 10 HBSC variables that were included as direct or indirect drivers of AdOWOB in the dynamic model, seven at the level of the individual, and three related to the social environment. The model was calibrated to 24 separate cases based on four gender and perceived wealth segments for each of the five CO-CREATE countries (The Netherlands, Norway, Poland, Portugal, and the UK) and for Europe overall. Out of 10 possible intervention points tested, exercise, fruit, life dissatisfaction, school pressure, and skipping breakfast were identified as the top five most influential ones across the 24 cases. These model-based priorities can be compared with the policy ideas suggested by the CO-CREATE adolescents.

• Hebestreit, Antje; Do, Stefanie; Wolters, Maike; Mensink, Gert BM; Garnica-Rosas, LIna & Abu-Omar, Karim [Show all 13 contributors for this article] (2022). Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations. European Journal of Public Health. ISSN 1101-1262. 32(4 S). doi: 10.1093/eurpub/ckac061. Full text in Research Archive Show summary

  Background The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. Methods In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. Results In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems’ use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. Conclusion We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process.

• Kamphuis, Carlijn B.M.; Forberger, Sarah; Lien, Nanna; Rehfuessk, Eva & Luszczynska, Aleksandra (2022). Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework. European Journal of Public Health. ISSN 1101-1262. 32(4 S). doi: 10.1093/eurpub/ckac068. Full text in Research Archive Show summary

  Background The Policy Evaluation Network (PEN) is a multidisciplinary Pan-European research consortium focussing on policies affecting dietary intake, physical activity and sedentary behaviour. At the start, the PEN consortium expressed the need for an overarching, system-based framework covering the complexities between the different domains of the policy process (design, implementation and outcomes) in order to execute all research activities in a coherent way. This article describes the PEN framework itself and its development process. Methods A staged approach to the development of a system-based framework was executed between February 2019 and February 2022. We started with a point-of-departure framework, made use of existing models, collected PEN outputs at different project stages (through online meetings, e-mail exchanges and workshops with PEN researchers) and drew updated versions of the framework, which resulted in the system-based PEN framework. Results The system-based PEN framework depicts the policy process as a complex system, visualizing the dynamic interrelations between and within policy domains (i.e. policy design, policy implementation and policy outcomes), the ways they interact with the context, and how to assure a focus on equity in each domain. Conclusions The system-based PEN framework may guide researchers and professionals involved in the evaluation of health- or sustainability-related policies to consider their evaluation in a comprehensive picture, including domain interactions, contextual influences and equity considerations, as these can have important implications for the scope of their research. The stage-based process as applied for the development of the PEN framework can serve as a template for other research projects wishing to develop their own framework.

• Kelly, Liam; Twohig, Cliona; Woods, Cathrine B.; Luszczynska, Aleksandra; Murrin, Celine M. & Lien, Nanna [Show all 14 contributors for this article] (2022). Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network. European Journal of Public Health. ISSN 1101-1262. 32(4). doi: 10.1093/eurpub/ckac147. Full text in Research Archive Show summary

  <p><i>Background -</i> An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the ‘Policy Evaluation Network’ (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. <p><i>Methods -</i> A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. <p><i>Results -</i> Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. ‘Outcome’ and ‘Impact’). A conceptual ‘Inter-relations in policy-related concepts’ diagram was developed to enable navigation through an online database with key terms. <p><i>Conclusions -</i>The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.

• Zolfaghari, Mahshid; Meshkovska, Biljana; Banik, Anna; Kamphuis, Carlijn B.M.; Kopainsky, Birgit & Luszczynska, Aleksandra [Show all 8 contributors for this article] (2022). Applying a systems perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme. European Journal of Public Health. ISSN 1101-1262. 32(4), p. iv107–iv113. doi: 10.1093/eurpub/ckac054. Full text in Research Archive Show summary

  Background For the past two decades, the percentage of European children who consume fruit daily has remained at around 40%, despite numerous school-based policy efforts and interventions. This study aimed to apply a systems approach to provide an integrated perspective of the mechanisms of the European School Fruit and Vegetable Scheme (the Scheme) to understand better how to increase its long-term impact on children’s fruit and vegetable consumption. Methods We developed a causal loop diagram by synthesizing peer-reviewed articles and national government documents related to the Scheme, following the conceptualization steps of system dynamics. The initial causal loop diagrams were then validated in three stages by consulting with experts (two individuals and a group) in school-based fruit and vegetable programmes, children's fruit and vegetable consumption and the Scheme, using disconfirmatory interview guidelines. Results The findings suggest that a central self-reinforcing mechanism through which children socialize during fruit and vegetable consumption is critical in the habituation process. Additionally, the initial increase in children’s fruit and vegetable consumption following the Scheme implementation is due to growth in three self-reinforcing loops related to motivation and capability mechanisms; however, this trend gradually slows and stops due to four balancing feedback loops with alternative goals related to opportunity mechanisms that reach their limits. Conclusions The scheme's design should incorporate activities that align the objectives of the implementers and recipients of the Scheme at all levels. This alignment should provide children with ongoing opportunities to consume fruits and vegetables and strengthen the motivation and capability mechanisms.

• 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.

• Grewal, Navnit Kaur; Klepp, Knut Inge; Banik, Anna; Bröer, Christian; Holbæk, Helene & Luszczynska, Aleksandra [Show all 9 contributors for this article] (2022). Assessing adolescents' readiness for action and attitudes toward obesity prevention: Instrument development and psychometric properties. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.13533. Full text in Research Archive Show summary

  Engaging adolescents in obesity prevention is a main objective of the CO-CREATE project. This paper presents the development of a questionnaire to assess readiness for action and attitudes toward obesity prevention among adolescents. The questionnaire was developed based on literature searches and internal discussions with experts in the CO-CREATE consortium. The questionnaire was translated, back translated, and pretested for time and comprehensiveness by adolescents from five countries (the Netherlands, Norway, Poland, Portugal, and the United Kingdom). Exploratory factor analysis was performed, and internal reliability of the resulting factors was determined using baseline data from Poland and Norway. Furthermore, test–retest reliability was assessed in a sample of Norwegian adolescents. The exploratory factor analysis on readiness for action identified four factors. Analysis on attitudes toward obesity prevention identified four factors on responsibility and five factors on drivers of behavior. Six of the factors had a Cronbach's alpha value above 0.70, five factors had a value between 0.60–0.70, whereas the remaining two factors were below 0.60. The test–retest correlation ranged from 0.46 to 0.87. The exploratory factor analyzes on readiness for action identified the same factors as hypothesized in the development of the questionnaire, whereas attitudes toward obesity prevention identified more factors than initially assumed. The questionnaire is considered reliable as a tool for measuring adolescents' readiness for action and attitudes toward obesity prevention.

• Meshkovska, Biljana; Scheller, Daniel A.; Wendt, Janine; Jilani, Hannah; Scheidmeir, Marie & Stratil, Jan M. [Show all 7 contributors for this article] (2022). Barriers and facilitators to implementation of direct fruit and vegetables provision interventions in kindergartens and schools: a qualitative systematic review applying the consolidated framework for implementation research (CFIR). International Journal of Behavioral Nutrition and Physical Activity. 19(11). doi: 10.1186/s12966-022-01246-8. Full text in Research Archive Show summary

  Background Although children’s intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR). Methods A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR. Results The following CFIR constructs were found relevant: 1) intervention characteristics domain: ‘design quality and packaging’, ‘adaptability’ ‘cost’; 2) outer setting: ‘cosmopolitanism’, ‘external policy and incentives’ ‘patients’ needs and resources’; 3) inner setting: ‘implementation climate’, ‘readiness for implementation’ and ‘structural characteristics’; 4) characteristics of individuals: ‘individual stage of change’, ‘knowledge and beliefs about the intervention’ 5) process: ‘engaging’, ‘executing’ and ‘reflecting and evaluating’. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts. Conclusions CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group. PROSPERO registration CRD42020167697.

• 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.

• Ljøsne, Isabelle Sylvie Budin; Ayuandini, Sherria; Baillergeau, Evelyne; Bröer, Christian; Helleve, Arnfinn & Klepp, Knut Inge [Show all 15 contributors for this article] (2022). Ethical considerations in engaging young people in European obesity prevention research: The CO-CREATE experience. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.13518. Full text in Research Archive Show summary

  Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and well-being. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15–19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time.

• Kristiansen, Anne Lene; Himberg-Sundet, Anne; Bjelland, Mona; Lien, Nanna; Holst, Rene & Andersen, Lene Frost (2021). Exploring intervention components in association with changes in preschool children’s vegetable intake: the BRA-study. BMC Research Notes. 14(214), p. 1–6. doi: 10.1186/s13104-021-05629-1. Full text in Research Archive Show summary

  Objective: The present study aimed to explore kindergarten staffs’ perceived usefulness of intervention components in association with changes in children’s vegetable intake and vegetables served in the kindergarten. Assessment of the perceived usefulness of intervention components consisted of a paper-based questionnaire for the kindergarten staff assessing usefulness of posters, supplementary material and 1-day inspirational course. Children’s vegetable intake in the kindergarten was assessed by direct observation, while vegetables served was assessed by a 5-day weighted vegetable diary. Results: Seventy-three kindergartens in two counties in Norway participated (response rate 15%) and parental consent was obtained for 633 children 3–5 years of age at baseline (response rate 39%). Mixed effect models indicated a tendency that posters were associated with increased child vegetable intake (P = 0.062). Surprisingly, a low degree of perceived usefulness of supplementary material was associated with the largest increase in child vegetable intake (P = 0.020). No significant associations between perceived usefulness of intervention components and vegetables served in the kindergarten were found. This study indicated a tendency that posters were associated with increased child vegetable intake; however, this may also be due to synergies between multiple intervention components.

• 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.

• Randby, Jorunn Sofie; Meshkovska, Biljana; Holbæk, Helene & Lien, Nanna (2021). An Exploration of Implementation Enablers and Barriers for Norwegian School Meal Guidelines. Global Implementation Research and Applications. 1, p. 122–134. doi: 10.1007/s43477-021-00010-7. Full text in Research Archive Show summary

  Abstract School meal guidelines can be important tools to promote children’s diets, but their implementation depends on several influencing factors. Understanding these is important for designing effective interventions to increase implementation. The aim of this study was to examine barriers to and enablers of implementation of the Norwegian national guideline on food and meals in schools by applying a school-based implementation framework to data collection and analysis. The Multi-level Quality Implementation Framework (MQIF) was used to develop semi-structured interview guides. At four schools, principals and after-school leaders were interviewed individually, whereas teachers ( n  = 27) and children ( n  = 26) participated in separate focus group interviews. The interviews were recorded, transcribed verbatim, and analyzed deductively according to predefined constructs in the MQIF. Most implementation barriers and enablers were identified at the school level and barriers dominated. Important barriers included a weak mandate to prioritize work on school meals; weak administrative leadership; the lack of a school culture around meal practices; a noisy classroom climate undermining social meals; limited facilities; and difficulties with the teacher–parent collaboration around packed lunches. Important enablers were engagement by the education authorities; coordinated action at a municipal level; whole-school discussions on meal practices; and teachers’ facilitation for social meals. The MQIF successfully guided us in identifying factors that influence school meal guideline implementation. Low priority of school meals and low implementation authority appeared as underlying reasons for some implementation barriers. The study indicates that, to overcome these barriers, schools need support for implementation.

• 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.

• Melbye, Elisabeth Lind; Hausken, Solveig Elisabeth Sand; Lien, Nanna & Bjelland, Mona (2021). Adolescent vegetable consumption: the role of socioemotional family characteristics. Public Health Nutrition (PHN). ISSN 1368-9800. 24(17), p. 5710–5719. doi: 10.1017/S1368980021001658. Full text in Research Archive Show summary

  Objective: To describe associations between adolescents’ frequency of vegetable consumption, food parenting practices and socioemotional family characteristics, and to explore potential mediated relationships that may contribute to an understanding of the family processes involved. Design: Cross-sectional survey among adolescents aged 13–15 years. Setting: A survey questionnaire including self-report measures on adolescents’ frequency of vegetable consumption, perceived food parenting practices (i.e. family dinner frequency, maternal/paternal healthy eating guidance (HEG), maternal/paternal social support for vegetable consumption) and socioemotional family characteristics (i.e. general family functioning and level of cohesion and conflict within the family) was distributed in a convenience sample of secondary school students. Participants: Four hundred forty students from five secondary schools in eastern Norway completed the questionnaire. Results: Results from multiple linear regression analysis revealed positive and statistically significant associations between adolescents’ frequency of vegetable consumption, maternal HEG and family cohesion. A partial indirect (mediated) association between family cohesion and adolescents’ frequency of vegetable consumption, working through maternal HEG, was also found. Conclusions: Results from the present study suggest that perceived family cohesion may influence adolescents’ frequency of vegetable consumption both directly and indirectly. However, there is a need for continued investigation of family-related factors influencing adolescent eating. In particular, the role of socioemotional family characteristics should be further scrutinised in future studies.

• 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.

• Kristiansen, Anne Lene; Medin, Anine Christine; Bjelland, Mona; Himberg-Sundet, Anne; Lien, Nanna & Holst, René [Show all 7 contributors for this article] (2020). Long-term effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable intake among Norwegian 3-5-year-olds: the BRA-study. BMC Research Notes. 13. doi: 10.1186/s13104-020-4892-x. Full text in Research Archive Show summary

  OBJECTIVE: To report on long-term effects of a cluster randomized controlled kindergarten-based intervention trial, which aimed to increase vegetable intake among Norwegian preschool children (3-5 years at baseline). The effects of the intervention at follow-up 1 (immediately post-intervention) have previously been published. This paper presents the effects of the intervention from baseline to follow-up 2 (12 months post-intervention). RESULTS: Parental consents were obtained for 633 out of 1631 eligible children (response rate 38.8%). The effects of the intervention from baseline to follow-up 2 were assessed by mixed-model analyses taking the clustering effect of kindergartens into account. Children's vegetable intake was reported by the parents at baseline (spring 2015), at follow-up 1 (spring 2016) and at follow-up 2 (spring 2017). No significant long-term effects in child vegetable intake were found. A mean difference of - 0.1 times per day (95% CI - 0.5, 0.2) (P = 0.44) was found for the daily frequency of vegetable intake. A mean difference of - 0.2 different kinds of vegetables eaten over a month (95% CI - 1.0, 0.7) (P = 0.70) was found and for daily amount of vegetables a mean difference of - 15.0 g vegetables (95% CI - 38.0, 8.0) (P = 0.19) was found. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered).

• Himberg-Sundet, Anne; Kristiansen, Anne Lene; Andersen, Lene Frost; Bjelland, Mona & Lien, Nanna (2020). Effects of a kindergarten intervention on vegetables served and staff’s food-related practices: results of a cluster randomised controlled trial–the BRA study. Public Health Nutrition (PHN). ISSN 1368-9800. 23(6), p. 1117–1126. doi: 10.1017/S1368980019003963. Full text in Research Archive Show summary

  Objective: The aim of the current study was to evaluate the effect on frequency, variety and amount of vegetables served and staff’s food-related practices in the multicomponent BRA intervention. Design: Cluster randomised controlled trial, conducted between Spring 2015 and Spring 2016. For allocation of the kindergartens, a stratified block randomisation was used. Data were collected in three ways: (i) a questionnaire for pedagogical leaders assessing the variety and frequency of vegetables served, including staff’s food-related practices assumed to be related to vegetable intake; (ii) a questionnaire for kindergarten assistants assessing staff’s food-related practices; (iii) a 5-d weighted vegetable diary assessing amount of vegetables served in a department. Setting: The target group for this study was public and private kindergartens in the counties of Vestfold and Buskerud, Norway. Participants: A total of seventy-three kindergartens participated. Results: At follow-up I, the amount of vegetables served increased by approximately 20 g per person per day (P = 0·002), and the variety in served vegetables increased by one-and-a-half kind per month (P = 0·014) in the intervention group compared to the control group. No effects on the frequency of vegetables served or on staff’s food-related practices were found. Conclusions: The BRA intervention was successful in increasing the amount and variety of vegetables served within intervention kindergartens. Further research is needed to understand the mechanisms that can affect the staff’s food-related practices.

• Randby, Jorunn Sofie; Holbæk, Helene & Lien, Nanna (2020). Implementation of the Norwegian school meal guideline: Development and reliability of two questionnaires to measure adherence. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/1403494820972590. Full text in Research Archive Show summary

  Aims: This article reports on the development and reliability of two questionnaires that measure adherence to the Norwegian National Guideline on Food and Meals in School among primary schools and after-school services. Methods: Questionnaires for school principals and after-school leaders were developed systematically, using the following steps: (a) selection of scope, questions and adherence values; (b) face validity testing through expert review of initial drafts; (c) content validity testing through 19 cognitive interviews; (d) assessment of test–retest reliability in samples of principals ( n = 54) and after-school leaders ( n = 47); and (e) development of adherence indices. Results: The cognitive interviews led to substantial revisions of the draft questionnaires, increasing content validity through improved relevance and clarity. Test–retest assessment showed that Cohen’s κ ranged from −0.03 to 1.0 for principals and from −0.05 to 0.98 for after-school leaders, with 64 and 53% of values rated as ‘substantial’ or better. Percentage agreement averaged 85% among principals and 82% among after-school leaders. Intraclass correlation for the adherence index scores was 0.84 for principals and 0.91 for after-school leaders. Guideline adherence had a wide range in our samples, with an average of 71% for schools and 76% for after-school services. Conclusion: The questionnaires for measuring adherence to the national school meal guideline among primary schools and after-school services are sufficiently reliable for future use in public health evaluation and research.

• 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
• 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.

• Hausken, Solveig Elisabeth Sand; Lie, Hanne Cathrine; Lien, Nanna; Sleddens, Ester F.C.; Melbye, Elisabeth Lind & Bjelland, Mona (2019). The reliability of the general functioning scale in Norwegian 13–15-year-old adolescents and association with family dinner frequency. Nutrition Journal. 18:20, p. 1–5. doi: 10.1186/s12937-019-0447-1. Full text in Research Archive Show summary

  Background Family environment is crucial to the development of health behaviors into adolescence and adulthood. The aims of this study were (1) to explore the reliability of the General Functioning Scale (GFS) among Norwegian 13-15-year-olds, and (2) to assess whether family functioning reported by adolescents was associated with family dinner frequency. Methods In total 440 secondary-school students were invited to participate in this cross-sectional web-based questionnaire survey, with 54 participating in the test-retest study. Test-retest and internal consistency were assessed for the 12-item GFS-scale. Associations between family functioning and family dinner frequency were tested using multiple logistic regression. Results The GFS had high internal consistency (corrected item-total correlations ranging from 0.40 to 0.65, Cronbach’s α = 0.85), and excellent test–retest reliability (intra-class correlation coefficient = 0.83). In the logistic regression model, a higher score on GFS (poorer family functioning) was associated with a reduced likelihood of having dinner together on a daily basis (i.e., 6–7 times per week, OR = 0.36, CI = 0.20–0-64) after adjusting for age, gender, ethnicity, living situation and parental education level. Conclusions The GFS had high reliability. As poorer family functioning was associated with less frequent family dinners, the family environment may be an important (contextual) target to influence adolescent health behaviors. It would be of interest to further explore the role of family functioning in relation to adolescents’ dietary habits, besides shared family meals, and to reveal the mechanisms underlying such relationships.

• Kristiansen, Anne Lene; Bjelland, Mona; Himberg-Sundet, Anne; Lien, Nanna; Holst, René & Andersen, Lene Frost (2019). Effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable consumption among Norwegian 3–5-year-olds: the BRA-study. BMC Public Health. 19(1), p. 1–10. doi: 10.1186/s12889-019-7436-3. Full text in Research Archive Show summary

  Background: Early childhood represents a critical period for the establishment of long-lasting healthy dietary habits. Limited knowledge exists on how to successfully increase vegetable consumption among preschool children. The overall aim of the present study was to improve vegetable intake among preschool children in a kindergarten-based randomized controlled trial. Methods: The target group was preschool children born in 2010 and 2011, attending public or private kindergartens in two counties in Norway. Data about child intake of vegetables were collected by three methods. First, parents filled in a web-based questionnaire of the child’s vegetable intake. Second, among a subsample, trained researchers observed children’s vegetable intake in the kindergarten. Thirdly, a parental web-based 24-h recall assessing the child’s vegetable intake was filled in. For allocation of kindergartens to intervention and control groups, a stratified block randomization was used. Multiple intervention components were implemented from September 2015 to February 2016 and components focused at influencing the four determinants availability, accessibility, encouragement and role modelling. The effect of the intervention from baseline (spring 2015) to follow-up 1 (spring 2016) was assessed by mixed-model analysis taking the clustering effect of kindergartens into account. Results: Parental consent was obtained for 38.8% of the children (633 out of 1631 eligible children). Based on the observational data in the kindergarten setting (n 218 in the control group and n 217 in the intervention group), a tendency to a small positive effect was seen as a mean difference of 13.3 g vegetables/day (95% CI: − 0.2, 26.9) (P = 0.054) was observed. No significant overall effects were found for the total daily vegetable intake or for the parental reported frequency or variety in vegetable intake. Conclusions: Based on the observational data in the kindergarten setting, a tendency to a small positive effect was seen with a mean difference of about 13 g vegetables/day, while no other effects on child vegetable intake were found. Additionally, further research to understand the best strategies to involve parents in dietary interventions studies is warranted.

• Sandvik, Camilla & Lien, Nanna (2019). Sosial ulikhet i helse og skolens rolle for å utjevne sosiale ulikheter i helse. In Holthe, Asle; Aadland, Eli Kristin & Viig, Nina Grieg (Ed.), Mat og helse i grunnskolelærerutdanningene. Fagbokforlaget. ISSN 9788245032901. p. 115–128. Full text in Research Archive Show summary

  Den vitenskapelige antologien "Mat og helse i lærerutdanningene" har et tydelig profesjonsrettet perspektiv og dreier seg om lærerutdanningsfagets hva, hvordan og hvorfor. Bidragene i antologien presenterer ny forskning med en tydelig fagdidaktisk innretning innenfor følgende tematiske områder: danning og didaktiske praksiser i skolens matlandskap, helsefremmende kosthold, bærekraftige matvaner og forbruk og mat og måltider som identitets- og kulturuttrykk. Boken henvender seg til lærerutdannere og masterstudenter i lærerutdanningene.

• Buck, Christoph; Loyen, Anne; Foraita, Ronja; Cauwenberg, Jelle Van; Craemer, Marieke De & Donncha, Ciaran Mac [Show all 12 contributors for this article] (2019). Factors influencing sedentary behaviour: A system based analysis using Bayesian networks within DEDIPAC. PLOS ONE. 14(1). doi: 10.1371/journal.pone.0211546. Full text in Research Archive Show summary

  Background Decreasing sedentary behaviour (SB) has emerged as a public health priority since prolonged sitting increases the risk of non-communicable diseases. Mostly, the independent association of factors with SB has been investigated, although lifestyle behaviours are conditioned by interdependent factors. Within the DEDIPAC Knowledge Hub, a system of sedentary behaviours (SOS)-framework was created to take interdependency among multiple factors into account. The SOS framework is based on a system approach and was developed by combining evidence synthesis and expert consensus. The present study conducted a Bayesian network analysis to investigate and map the interdependencies between factors associated with SB through the life-course from large scale empirical data. Methods Data from the Eurobarometer survey (80.2, 2013) that included the International physical activity questionnaire (IPAQ) short as well as socio-demographic information and questions on perceived environment, health, and psychosocial information were enriched with macro-level data from the Eurostat database. Overall, 33 factors were identified aligned to the SOS-framework to represent six clusters on the individual or regional level: 1) physical health and wellbeing, 2) social and cultural context, 3) built and natural environment, 4) psychology and behaviour, 5) institutional and home settings, 6) policy and economics. A Bayesian network analysis was conducted to investigate conditional associations among all factors and to determine their importance within these networks. Bayesian networks were estimated for the complete (23,865 EU-citizens with complete data) sample and for sex- and four age-specific subgroups. Distance and centrality were calculated to determine importance of factors within each network around SB. Results In the young (15–25), adult (26–44), and middle-aged (45–64) groups occupational level was directly associated with SB for both, men and women. Consistently, social class and educational level were indirectly associated within male adult groups, while in women factors of the family context were indirectly associated with SB. Only in older adults, factors of the built environment were relevant with regard to SB, while factors of the home and institutional settings were less important compared to younger age groups. Conclusion Factors of the home and institutional settings as well as the social and cultural context were found to be important in the network of associations around SB supporting the priority for future research in these clusters. Particularly, occupational status was found to be the main driver of SB through the life-course. Investigating conditional associations by Bayesian networks gave a better understanding of the complex interplay of factors being associated with SB. This may provide detailed insights in the mechanisms behind the burden of SB to effectively inform policy makers for detailed intervention planning. However, considering the complexity of the issue, there is need for a more comprehensive system of data collection including objective measures of sedentary time.

• Hebestreit, Antje; Thumann, Barbara F.; Wolters, Maike; Bucksch, Jens; Huybrechts, Inge & Inchley, Joanna [Show all 12 contributors for this article] (2019). Road map towards a harmonized pan-European surveillance of obesity-related lifestyle behaviours and their determinants in children and adolescents. International Journal of Public Health. ISSN 1661-8556. doi: 10.1007/s00038-019-01227-y. Full text in Research Archive Show summary

  Objectives To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. Methods Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. Results A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). Conclusions This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and—once in place—will facilitate health reporting and monitoring of national and international health targets.

• 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.

• Azevedo, Jose; Padrao, Patricia; Gregorio, Maria Joao; Almeida, Carla; Moutinho, Nuno & Lien, Nanna [Show all 7 contributors for this article] (2018). A Web-Based Gamification Program to Improve Nutrition Literacy in Families of 3- to 5-Year-Old Children: The Nutriscience Project. Journal of Nutrition Education and Behavior. ISSN 1499-4046. p. 1–9. doi: 10.1016/j.jneb.2018.10.008. Full text in Research Archive
• Craemer, Marieke De; Verloigne, Maïté; Ghekiere, Ariane; Loyen, Anne; Dargent-Molina, Patricia & Brug, Johannes [Show all 12 contributors for this article] (2018). Changes in children’s television and computer time according to parental education, parental income and ethnicity: A 6-year longitudinal EYHS study. PLOS ONE. doi: 10.1371/journal.pone.0203592. Full text in Research Archive Show summary

  Objectives: To investigate changes in children’s television and computer time according to three socio-economic status (SES) indicators. Methods: Data were drawn from the European Youth Heart Study and included longitudinal data collected in 1997 and 2003 in Denmark. Television and computer time were self-reported by children. Parental education, income and ethnicity were parent-reported. Baseline data were available for 549 children (47.0% boys, 9.6 years). Generalized linear mixed models analyzed whether changes in television and computer time from baseline to follow-up differed according to the SES-indicators. Result: TV viewing time increased with 25% over time (ExpB = 1.25, 95% CI = 1.04–1.50). At both time points, children with two higher educated parents viewed 25% less hours of television than children with no higher educated parents (ExpB = 0.75, 95% CI = 0.60–0.94) and one higher educated parent (ExpB = 0.75, 95%CI = 0.59–0.97). Among children with no higher educated parents the odds of being in a higher category of computer time increased with 80% over time (OR = 1.80, 95% CI = 1.24–2.60). Among children with two higher educated parents the odds of being in a higher category of computer time decreased with 45% over time (OR = 0.55, 95% CI = 0.32–0.94). The association with ethnicity showed that white children had 42% lower odds (OR = 0.58; 95% CI = 0.34–1.00) of being in a higher category of computer time than non-white children. No significant associations were found for parental income. Conclusions: The most important SES measure of screen-based behaviors in children was parental education. Ethnicity was only associated with computer time. Financial resources were less relevant for changes in television viewing and computer use.

• Stok, F. Marijn; Renner, Britta; Clarys, Peter; Lien, Nanna; Lakerveld, Jeroen & Deliens, Tom (2018). Understanding eating behavior during the transition from adolescence to young adulthood: A literature review and perspective on future research directions. Nutrients. 10(6). doi: 10.3390/nu10060667. Full text in Research Archive Show summary

  Introduction: Eating behavior often becomes unhealthier during the transition from adolescence to young adulthood, but not much is known about the factors that drive this change. We assess the available evidence on this topic through a literature review and pay special attention to the research designs employed in the studies available as well as the modifiability of the factors investigated in previous research. Method: We systematically conducted a scoping review by searching literature published in or after 2000 in three databases that described one or more factors associated with eating behavior or changes in eating behavior during the transition from adolescence to adulthood in the general population. Our search identified eighteen articles meeting these inclusion criteria. The socio-ecological DONE (Determinants of Nutrition and Eating) framework, a recently developed dynamic framework of factors shaping dietary behavior, was used to structure and categorize the factors identified. Results: Most factors identified in the literature were individual-level factors (67%) such as food beliefs, time constraints, and taste preferences; on the other hand, interpersonal-level factors (e.g., social support), environmental-level factors (e.g., product characteristics) and policy-level factors (e.g., market regulations) have been reported on less extensively. Furthermore, most factors discussed in the literature have been classified in the DONE framework as not easily modifiable. Moreover, previous studies largely used static research designs and focused primarily on one specific population (US freshmen). Discussion: This systematic scoping review identified several gaps in the available literature that hinder insight into the drivers of eating behavior (change) during the transition from adolescence to young adulthood. There is an urgent need for research on broader populations, employing dynamic repeated-measures designs, and taking modifiability of factors into account.

• Craemer, Marieke De; Chastin, Sebastien; Ahrens, Wolfgang; Bernaards, C; Brug, Johannes & Buck, Christopher [Show all 27 contributors for this article] (2018). Data on Determinants Are Needed to Curb the Sedentary Epidemic in Europe. Lessons Learnt from the DEDIPAC European Knowledge Hub. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 15(7). doi: 10.3390/ijerph15071406. Full text in Research Archive Show summary

  Societal and technological changes have resulted in sitting being the dominant posture during most activities of daily living, such as learning, working, travelling and leisure time. Too much time spent in seated activities, referred to as sedentary behaviour, is a novel concern for public health as it is one of the key lifestyle causes of poor health. The European DEDIPAC (Determinants of Diet and Physical Activity) Knowledge Hub coordinated the work of 35 institutions across 12 European member states to investigate the determinants of sedentary behaviour. DEDIPAC reviewed current evidence, set a theoretical framework and harmonised the available epidemiological data. The main results are summarised. The conclusion is that there is a dire lack of data that is exploitable across Europe to inform policy and intervention. There is an urgent need to develop international data collection compliant with FAIR (Findable, Accessible, Interoperable, Re-usable) and standardised surveillance systems for sedentary behaviour.

• Stok, F. Marijn; Renner, Britta; Allan, Julia; Boeing, Heiner; Ensenauer, Regina & Issanchou, Sylvie [Show all 13 contributors for this article] (2018). Dietary behavior: An interdisciplinary conceptual analysis and taxonomy. Frontiers in Psychology. 9, p. 1–12. doi: 10.3389/fpsyg.2018.01689. Full text in Research Archive Show summary

  Background: Dietary behavior encompasses many aspects, terms for which are used inconsistently across different disciplines and research traditions. This hampers communication and comparison across disciplines and impedes the development of a cumulative science. We describe the conceptual analysis of the fuzzy umbrella concept “dietary behavior” and present the development of an interdisciplinary taxonomy of dietary behavior. Methods: A four-phase multi-method approach was employed. Input was provided by 76 scholars involved in an international research project focusing on the determinants of dietary behavior. Input was collected from the scholars via an online mind mapping procedure. After structuring, condensing, and categorizing this input into a compact taxonomy, the result was presented to all scholars, discussed extensively, and adapted. A second revision round was then conducted among a core working group. Results: A total of 145 distinct entries were made in the original mind mapping procedure. The subsequent steps allowed us to reduce and condense the taxonomy into a final product consisting of 34 terms organized into three main categories: Food Choice, Eating Behavior, and Dietary Intake/Nutrition. In a live discussion session attended by 50 of the scholars involved in the development of the taxonomy, it was judged to adequately reflect their input and to be a valid and useful starting point for interdisciplinary understanding and collaboration. Conclusion: The current taxonomy can be used as a tool to facilitate understanding and cooperation between different disciplines investigating dietary behavior, which may contribute to a more successful approach to tackling the complex public health challenges faced by the field. The taxonomy need not be viewed as a final product, but can continue to grow in depth and width as additional experts provide their input.

• Winpenny, Eleanor; Sluijs, Esther M F van; White, Martin; Klepp, Knut Inge; Wold, Bente & Lien, Nanna (2018). Changes in diet through adolescence and early adulthood: longitudinal trajectories and association with key life transitions. International Journal of Behavioral Nutrition and Physical Activity. 15:86. doi: 10.1186/s12966-018-0719-8. Full text in Research Archive Show summary

  Background: Early adulthood is a period associated with poor diet and rapid weight gain. This is also an age of transition, including environmental, social and lifestyle changes which may be associated with changes in diet. We assess longitudinal associations between four early adulthood life transitions (leaving home, leaving education, entering employment, and cohabitation) and changes in consumption of fruit, vegetables, confectionery and sugar-sweetened beverages (SSBs). Methods: Participants (n = 1100) from the Norwegian Longitudinal Health Behaviour Study, reported data on diet and life transitions on up to eight occasions from age 14 to age 30. Diet data were self-reported in response to questions on intake of fruit, vegetables, confectionery and sugar-sweetened beverages. Growth models were developed to describe changing intake of each of the four diet indicators with age. Fixed-effects regression models assessed associations between the four life transitions and within-individual changes in diet indicators, with adjustment for the remaining transitions and parenthood. Results: Diet indicators showed quadratic trajectories with age: fruit and vegetable intakes declined from age 14 to ages 23 and 21 respectively, before increasing to age 30. SSB and confectionery intakes increased to age 18, before subsequently decreasing. Leaving the parental home was associated with a decrease in fruit intake of − 0.54 times/week (95% confidence interval (95%CI): -0.87;-0.22) and vegetable intake of − 0.43 times/week (95%CI: -0.70;-0.15). Leaving education was associated with increases in confectionery (0.33 times/week (95%CI: 0.04;0.62)) and SSB intakes (0.49 times/week (95%CI: 0.10;0.87). Conclusions: Leaving home and leaving education are associated with negative changes in diet and may present opportunities for effective diet and obesity intervention. Further study of these transitions is needed to understand the mechanisms mediating associations between life transitions and changes in diet.

• Vennerød, Frida Felicia; Nicklaus, Sophie; Lien, Nanna & Almli, Valerie Lengard (2018). The development of basic taste sensitivity and preferences in children. Appetite. ISSN 0195-6663. 127, p. 130–137. doi: 10.1016/j.appet.2018.04.027. Full text in Research Archive Show summary

  This study aims at understanding how preference and sensitivity to the basic tastes develop in the preschool years, and how the two relate to each other. To expand on the existing literature regarding taste preferences conducted in cross-sectional studies, a longitudinal design was applied with children from age four to six years old. During the springs of 2015, 2016, and 2017, 131 children born in 2011 were tested in their kindergartens. To investigate preferences for sweet, sour and bitter tastes, the children performed ranking-by-elimination procedures on fruit-flavored beverages and chocolates with three taste intensity levels. The beverages varied in either sucrose, citric acid, or the bitter component isolone. The chocolates varied in the bitter component theobromine from cocoa and sucrose content. Each year, the children also performed paired-comparison tasks opposing plain water to tastant dilutions at four concentrations. The stimuli consisted of the five basic tastes: sweet (sucrose) sour (citric acid monohydrate) umami (monosodium glutamate), salty (sodium chloride), and bitter (quinine hydrochloride dihydrate). Preference for sweetness levels increased with age, while preference for bitterness and sourness levels were stable. Concerning taste sensitivity, the children showed an increase in sensitivity for sourness and saltiness, a decrease for sweetness, and stability for umami and bitterness. A negative association was found between sweetness sensitivity and preference for sweetness. The study highlights different trajectories of sensitivity and preferences across tastes. On average, a reduction in sweetness sensitivity combined with an increase in preference for higher sweetness was observed from the age of four to six. The weak relationship between taste sensitivity and taste preference in our data suggests that taste preference development is shaped by a multitude of factors in addition to taste sensitivity.

• Himberg-Sundet, Anne; Kristiansen, Anne Lene; Bjelland, Mona; Moser, Thomas; Holthe, Asle & Andersen, Lene Frost [Show all 7 contributors for this article] (2018). Is the environment in kindergarten associated with the vegetables served and eaten? The BRA Study. Scandinavian Journal of Public Health. ISSN 1403-4948. 47(5), p. 538–547. doi: 10.1177/1403494818756702. Full text in Research Archive Show summary

  Aim: The aim of the present study was to explore the associations between the economic, political, sociocultural and physical environments in kindergartens, along with the frequency and variety of vegetables served, and the amount of vegetables eaten. Method: The BRA Study collected data through two paper-based questionnaires answered by the kindergarten leader and pedagogical leader of each selected kindergarten, and a five-day vegetable diary from kindergartens (n = 73) in Vestfold and Buskerud Counties, Norway. The questionnaires assessed environmental factors, and the frequency and variety of vegetables served. The non-parametric Mann–Whitney U and Kruskal–Wallis tests were used to explore the associations between factors in the kindergarten environments and vegetables served and eaten. Results: Kindergartens that included expenditures for food and beverages in the parental fees served a larger variety of vegetables (p = 0.046). A higher frequency of served vegetables (p = 0.014) and a larger amount (p = 0.027) of vegetables eaten were found in kindergartens where parents paid a monthly fee of 251 NOK or more. Similarly, the amount of vegetables eaten was higher (p = 0.017) in kindergartens where the employees paid a monthly fee to eat at work. Furthermore, a larger amount (p = 0.046) of vegetables was eaten in kindergartens that had written guidelines for food and beverages that were offered. Conclusions: This study indicates that the economic environment in a kindergarten seems to be positively associated with the vegetables served and eaten there. This is of high relevance for public health policy as vegetable consumption is an important factor in reducing the risk of non-communicable diseases.

• 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
• Kristiansen, Anne Lene; Bjelland, Mona; Himberg-Sundet, Anne; Lien, Nanna & Andersen, Lene Frost (2017). Associations between physical home environmental factors and vegetable consumption among Norwegian 3-5-year-olds: the BRA-study. Public Health Nutrition (PHN). ISSN 1368-9800. doi: 10.1017/S1368980016003396. Full text in Research Archive Show summary

  Objective: First, to explore item pools developed to measure the physical home environment of pre-school children and assess the psychometric properties of these item pools; second, to explore associations between this environment and vegetable consumption among Norwegian 3–5-year-olds. Design: Data were collected in three steps: (i) a parental web-based questionnaire assessing the child’s vegetable intake and factors potentially influencing the child’s vegetable consumption; (ii) direct observation of the children’s fruit, berry and vegetable intakes at two meals in one day in the kindergarten; and (iii) a parental web-based 24 h recall. Results: Principal component analysis on the thirteen-item pool assessing availability/accessibility resulted in two factors labelled ‘availability at home’ and ‘accessibility at home’, while the eight-item pool assessing barriers resulted in two factors labelled ‘serving barriers’ and ‘purchase barriers’. The psychometric properties of these factors were satisfactory. Linear regression of the associations between vegetable intake and the factors showed generally positive associations with ‘availability at home’ and ‘accessibility at home’ and negative associations with ‘serving barriers’. Conclusions: This age group has so far been understudied and there is a need for comparable studies. Our findings highlight the importance of targeting the physical home environment of pre-school children in future interventions as there are important modifiable factors that both promote and hinder vegetable consumption in this environment. This research was originally published in Public Health Nutrition. © 2016 Cambridge University Press

• Vennerød, Frida Felicia; Almli, Valerie Lengard; Berget, Ingunn & Lien, Nanna (2017). Do parents form their children’s sweet preference? The role of parents and taste sensitivity on preferences for sweetness in pre-schoolers. Food Quality and Preference. ISSN 0950-3293. 62, p. 172–182. doi: 10.1016/j.foodqual.2017.06.013. Full text in Research Archive Show summary

  Children generally have a high acceptance for sweetness, but differ in their preferences for the intensity of the taste. This study investigates how food exposure, parental attitudes and behaviours, and children’s taste sensitivity are associated with five-year olds’ preferences for sweetness. Preference data were collected from 135 children at ages four (Mean age: 46.3 months, SD: 3.4, 56% boys) and five years old (Mean age: 57.5 months, SD: 3.3; 58% boys) in a ranking by elimination procedure in the springs of 2015 and 2016. The taste carriers were fruit-flavoured beverages and dark chocolate, both with three levels of sugar content. Quantitative descriptive analysis testified three distinct levels of sweetness in each sample triad. The same children were also tested for sweetness and bitterness taste sensitivity in a paired comparison procedure. The protocols did not require the children to respond verbally, and included elements of gamification in order to engage the children. In addition, a parental questionnaire enquired about exposure to different foods, parental food attitudes and behaviours as well as socio-demographic characteristics. Path modelling using PLS-SEM indicated that differences in children’s preference for sweetness could be explained by differences in exposure to foods, including more frequent exposure to sweet foods and snacks associated with a higher sweet preference. More frequent exposure to fruit and bitter snacks, were associated with a lower sweet preference for the drink and chocolate, respectively. Parental attitudes and behaviours as well as children’s sensitivity to sweetness and bitterness were significantly associated with what foods the children were frequently exposed to, and to their sweetness preferences in beverages and chocolate.

• Altenburg, Teatske Maria; Singh, Amika Sonja; Velde, Saskia J. te; Bourdeaudhuij, Ilse De; Lien, Nanna & Bere, Elling [Show all 13 contributors for this article] (2017). Actual and perceived weight status and its association with slimming and energy-balance related behaviours in 10- to 12-year-old European children: the ENERGY-project. Pediatric Obesity. ISSN 2047-6302. 12(2), p. 137–145. doi: 10.1111/ijpo.12120. Full text in Research Archive
• Holdsworth, Michelle; Nicolaou, Mary; Langøien, Lars Jørun; Osei-Kwasi, Hibbah; Chastin, Sebastien F.M. & Stok, F.M. [Show all 16 contributors for this article] (2017). Developing a systems-based framework of the factors influencing dietary and Physical activity behaviours in ethnic minority populations living in Europe - a DEDIPAC study. International Journal of Behavioral Nutrition and Physical Activity. 14(1), p. 1–15. doi: 10.1186/s12966-017-0608-6. Full text in Research Archive Show summary

  Some ethnic minority populations have a higher risk of non-communicable diseases than the majority European population. Diet and physical activity behaviours contribute to this risk, shaped by a system of inter-related factors. This study mapped a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe, to inform research prioritisation and intervention development. A concept mapping approach guided by systems thinking was used: i. Preparation (protocol and terminology); ii. Generating a list of factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe from evidence (systematic mapping reviews) and ‘eminence’ (89 participants from 24 academic disciplines via brainstorming, an international symposium and expert review) and; iii. Seeking consensus on structuring, rating and clustering factors, based on how they relate to each other; and iv. Interpreting/utilising the framework for research and interventions. Similar steps were undertaken for frameworks developed for the majority European population. Seven distinct clusters emerged for dietary behaviour (containing 85 factors) and 8 for physical activity behaviours (containing 183 factors). Four clusters were similar across behaviours: Social and cultural environment; Social and material resources; Psychosocial; and Migration context. Similar clusters of factors emerged in the frameworks for diet and physical activity behaviours of the majority European population, except for ‘migration context’. The importance of factors across all clusters was acknowledged, but their relative importance differed for ethnic minority populations compared with the majority population. This systems-based framework integrates evidence from both expert opinion and published literature, to map the factors influencing dietary and physical activity behaviours in ethnic minority groups. Our findings illustrate that innovative research and complex interventions need to be developed that are sensitive to the needs of ethnic minority populations. A systems approach that encompasses the complexity of the inter-related factors that drive behaviours may inform a more holistic public health paradigm to more effectively reach ethnic minorities living in Europe, as well as the majority host population.

• Symmank, Claudia; Mai, Robert; Hoffmann, Stefan; Stok, F. Marijn; Renner, Britta & Lien, Nanna [Show all 7 contributors for this article] (2017). Predictors of food decision making: A systematic interdisciplinary mapping (SIM) review. Appetite. ISSN 0195-6663. 110, p. 25–35. doi: 10.1016/j.appet.2016.11.023. Full text in Research Archive
• 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.

• Lakerveld, Jeroen; Loyen, Anne; Schotman, Nina; Peeters, Carel F.W.; Cardon, Greet & Ploeg, Hidde P. van der [Show all 9 contributors for this article] (2017). Sitting too much: A hierarchy of socio-demographic correlates. Preventive Medicine. ISSN 0091-7435. 101, p. 77–83. doi: 10.1016/j.ypmed.2017.05.015. Full text in Research Archive
• 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.

• Stok, F. Marijn; Hoffmann, Stefan; Volkert, Dorothee; Boeing, Heiner; Ensenauer, Regina & Stelmach-Mardas, Marta [Show all 13 contributors for this article] (2017). The DONE framework: Creation, evaluation, and updating of an interdisciplinary, dynamic framework 2.0 of determinants of nutrition and eating. PLOS ONE. 12:e0171077(2), p. 1–23. doi: 10.1371/journal.pone.0171077. Full text in Research Archive Show summary

  The question of which factors drive human eating and nutrition is a key issue in many branches of science. We describe the creation, evaluation, and updating of an interdisciplinary, interactive, and evolving “framework 2.0” of Determinants Of Nutrition and Eating (DONE). The DONE framework was created by an interdisciplinary workgroup in a multiphase, multimethod process. Modifiability, relationship strength, and population-level effect of the determinants were rated to identify areas of priority for research and interventions. External experts positively evaluated the usefulness, comprehensiveness, and quality of the DONE framework. An approach to continue updating the framework with the help of experts was piloted. The DONE framework can be freely accessed (http://uni-konstanz.de/DONE) and used in a highly flexible manner: determinants can be sorted, filtered and visualized for both very specific research questions as well as more general queries. The dynamic nature of the framework allows it to evolve as experts can continually add new determinants and ratings. We anticipate this framework will be useful for research prioritization and intervention development.

• Klohe, Katharina; Costa, Clarissa Da; Lien, Nanna; Holmboe-Ottesen, Gerd; Rychlik, Michael & Haavardsson, Ingeborg K [Show all 11 contributors for this article] (2017). Nutrition – A global challenge for health. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.17.0679. Full text in Research Archive
• Kristiansen, Anne Lene; Bjelland, Mona; Himberg-Sundet, Anne; Lien, Nanna & Andersen, Lene Frost (2017). Associations between sociocultural home environmental factors and vegetable consumption among Norwegian 3?5-year olds: BRA-study. Appetite. ISSN 0195-6663. 117, p. 310–320. doi: 10.1016/j.appet.2017.06.031. Full text in Research Archive Show summary

  The home environment is the first environment to shape childhood dietary habits and food preferences, hence greater understanding of home environmental factors associated with vegetable consumption among young children is needed. The objective has been to examine questionnaire items developed to measure the sociocultural home environment of children focusing on vegetables and to assess the psychometric properties of the resulting factors. Further, to explore associations between the environmental factors and vegetable consumption among Norwegian 3–5 year olds. Parents (n 633) were invited to participate and filled in a questionnaire assessing the child's vegetable intake and factors potentially influencing this, along with a 24-h recall of their child's fruit and vegetable intake. Children's fruit and vegetable intakes at two meals in one day in the kindergarten were observed by researchers. Principal components analysis was used to examine items assessing the sociocultural home environment. Encouragement items resulted in factors labelled “reactive encouragement”, “child involvement” and “reward”. Modelling items resulted in the factors labelled “active role model” and “practical role model”. Items assessing negative parental attitudes resulted in the factor labelled “negative parental attitudes” and items assessing family pressure/demand resulted in the factor labelled “family demand”. The psychometric properties of the factors were for most satisfactory. Linear regression of the associations between vegetable intake and the factors showed, as expected, generally positive associations with “child involvement”, “practical role model” and “family demand”, and negative associations with “negative parental attitudes” and “reward”. Unexpectedly, “reactive encouragement” was negatively associated with vegetable consumption. In conclusion, associations between sociocultural home environmental factors and children's vegetable consumption showed both expected and unexpected associations some of which differed by maternal education – pointing to a need for further comparable studies.

• Méjean, Caroline; Hassen, Wendy Si; Gojard, Séverine; Ducrot, Pauline; Lampuré, Aurélie & Brug, Hans [Show all 12 contributors for this article] (2017). Social disparities in food preparation behaviours: A DEDIPAC study. Nutrition Journal. 16:62, p. 1–13. doi: 10.1186/s12937-017-0281-2. Full text in Research Archive Show summary

  The specific role of major socio-economic indicators in influencing food preparation behaviours could reveal distinct socio-economic patterns, thus enabling mechanisms to be understood that contribute to social inequalities in health. This study investigated whether there was an independent association of each socio-economic indicator (education, occupation, income) with food preparation behaviours. Participants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff (P < 0.0001). The lowest educated individuals were more likely to be non-cooks than those with the highest education level (Women: OR = 3.36 (1.69;6.69); Men: OR = 1.83 (1.07;3.16)) while female manual and office workers and the never-employed were less likely to be non-cooks (OR = 0.52 (0.28;0.97); OR = 0.30 (0.11;0.77)). Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff (P < 0.001 and P < 0.001). Women belonging to the lowest income group had a lower score of kitchen equipment (P < 0.0001) and were less likely to enjoy cooking meal daily (OR = 0.68 (0.45;0.86)) than those with the highest income. Lowest socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups. However, female manual and office workers used less raw or fresh ingredients to prepare meals than managerial staff. In the unfavourable context in France with reduced time spent preparing meals over last decades, our findings showed socioeconomic disparities in food preparation behaviours in women, whereas few differences were observed in men.

• Langøien, Lars Jørun; Terragni, Laura; Rugseth, Gro; Nicolaou, Mary; Holdsworth, Michelle & Stronks, Karien [Show all 8 contributors for this article] (2017). Systematic mapping review of the factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: A DEDIPAC study. International Journal of Behavioral Nutrition and Physical Activity. 14:99, p. 1–24. doi: 10.1186/s12966-017-0554-3. Full text in Research Archive Show summary

  Background: Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research. Methods: A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping. Results: Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters. Conclusion: Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions.

• 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.

• Chastin, Sebastien F.M.; Craemer, Marieke De; Lien, Nanna; Bernaards, C; Buck, Christopher & Oppert, Jean-Michel [Show all 13 contributors for this article] (2016). The SOS-framework (Systems of Sedentary behaviours): an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: a DEDIPAC-study. International Journal of Behavioral Nutrition and Physical Activity. 13(1). doi: 10.1186/s12966-016-0409-3. Full text in Research Archive Show summary

  Background Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. Methods A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. Results During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71 % consensus), Social and Cultural Context (59 % consensus), Built and Natural Environment (65 % consensus), Psychology and Behaviour (80 % consensus), Politics and Economics (78 % consensus), and Institutional and Home Settings (78 % consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89 % of the participants. Conclusion Through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time.

• Melbye, Elisabeth Lind; Bergh, Ingunn Holden; Hausken, Solveig Elisabeth Sand; Sleddens, Ester FC; Glavin, Kari & Lien, Nanna [Show all 7 contributors for this article] (2016). Adolescent impulsivity and soft drink consumption: The role of parental regulation. Appetite. ISSN 0195-6663. 96, p. 432–442. doi: 10.1016/j.appet.2015.09.040. Full text in Research Archive
• Altenburg, Teatske; Velde, Saskia J. te; Chiu, Kai-Jan; Moschonis, George; Manios, Yannis & Bourdeaudhuij, Ilse De [Show all 10 contributors for this article] (2016). Interrater reliability of the ENERGY photo-rating instrument for school environments related to physical activity and eating. Journal of Physical Activity and Health. ISSN 1543-3080. 13(4), p. 433–439. doi: 10.1123/jpah.2015-0025. Full text in Research Archive
• Osei-Kwasi, Hibbah; Nicolau, Mary; Powell, Katie; Terragni, Laura; Maes, Lea & Stronks, Karien [Show all 8 contributors for this article] (2016). Systematic mapping review of the factors influencing dietary behaviour in ethnic minority groups living in Europe: a DEDIPAC study. International Journal of Behavioral Nutrition and Physical Activity. 13:85. doi: 10.1186/s12966-016-0412-8. Full text in Research Archive Show summary

  Background Europe has a growing population of ethnic minority groups whose dietary behaviours are potentially of public health concern. To promote healthier diets, the factors driving dietary behaviours need to be understood. This review mapped the broad range of factors influencing dietary behaviour among ethnic minority groups living in Europe, in order to identify research gaps in the literature to guide future research. Methods A systematic mapping review was conducted (protocol registered with PROSPERO 2014: CRD42014013549). Nine databases were searched for quantitative and qualitative primary research published between 1999 and 2014. Ethnic minority groups were defined as immigrants/populations of immigrant background from low and middle income countries, population groups from former Eastern Bloc countries and minority indigenous populations. In synthesizing the findings, all factors were sorted and structured into emerging clusters according to how they were seen to relate to each other. Results Thirty-seven of 2965 studies met the inclusion criteria (n = 18 quantitative; n = 19 qualitative). Most studies were conducted in Northern Europe and were limited to specific European countries, and focused on a selected number of ethnic minority groups, predominantly among populations of South Asian origin. The 63 factors influencing dietary behaviour that emerged were sorted into seven clusters: social and cultural environment (16 factors), food beliefs and perceptions (11 factors), psychosocial (9 factors), social and material resources (5 factors), accessibility of food (10 factors), migration context (7 factors), and the body (5 factors). Conclusion This review identified a broad range of factors and clusters influencing dietary behaviour among ethnic minority groups. Gaps in the literature identified a need for researchers to explore the underlying mechanisms that shape dietary behaviours, which can be gleaned from more holistic, systems-based studies exploring relationships between factors and clusters. The dominance of studies exploring ‘differences’ between ethnic minority groups and the majority population in terms of the socio-cultural environment and food beliefs suggests a need for research exploring ‘similarities’. The evidence from this review will feed into developing a framework for the study of factors influencing dietary behaviours in ethnic minority groups in Europe.

• Hassen, Wendy Si; Castetbon, Katia; Cardon, Philippe; Enaux, Christophe; Nicolaou, Mary & Lien, Nanna [Show all 11 contributors for this article] (2016). Socioeconomic indicators are independently associated with nutrient intake in French adults: A DEDIPAC study. Nutrients. 8(3). doi: 10.3390/nu8030158. Full text in Research Archive Show summary

  Studies have suggested differential associations of specific indicators of socioeconomic position (SEP) with nutrient intake and a cumulative effect of these indicators on diet. We investigated the independent association of SEP indicators (education, income, occupation) with nutrient intake and their effect modification. This cross-sectional analysis included 91,900 French adults from the NutriNet-Santé cohort. Nutrient intake was estimated using three 24-h records. We investigated associations between the three SEP factors and nutrient intake using sex-stratified analysis of covariance, adjusted for age and energy intake, and associations between income and nutrient intake stratified by education and occupation. Low educated participants had higher protein and cholesterol intakes and lower fibre, vitamin C and beta-carotene intakes. Low income individuals had higher complex carbohydrate intakes, and lower magnesium, potassium, folate and vitamin C intakes. Intakes of vitamin D and alcohol were lower in low occupation individuals. Higher income was associated with higher intakes of fibre, protein, magnesium, potassium, beta-carotene, and folate among low educated persons only, highlighting effect modification. Lower SEP, particularly low education, was associated with lower intakes of nutrients required for a healthy diet. Each SEP indicator was associated with specific differences in nutrient intake suggesting that they underpin different social processes

• Schoeppe, Stephanie; Vandelanotte, Corneel; Bere, Elling; Lien, Nanna; Verloigne, Maïté & Kovacs, Eva [Show all 10 contributors for this article] (2016). The influence of parental modelling on children's physical activity and screen time: Does it differ by gender? European Journal of Public Health. ISSN 1101-1262. doi: 10.1093/eurpub/ckw182. Full text in Research Archive
• 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
• Bjelland, Mona; Hausken, Solveig E. Sand; Bergh, Ingunn Holden; Grydeland, May; Klepp, Knut Inge & Andersen, Lene Frost [Show all 8 contributors for this article] (2015). Changes in adolescents’ and parents’ intakes of sugar-sweetened beverages, fruit and vegetables after 20 months : results from the HEIA study - a comprehensive, multi-component school-based randomized trial. Food & Nutrition Research (FNR). ISSN 1654-6628. 59:25932. doi: 10.3402/fnr.v59.25932. Full text in Research Archive Show summary

  Background: Interventions conducted in school-aged children often involve parents, but few studies have reported effects on parents’ own behaviour as a result of these interventions. Objective: To determine if a multi-component, cluster randomized controlled trial targeting 11–13 year olds influenced their consumption of fruit, vegetables, sugar-sweetened soft drinks and fruit drinks, and to explore whether the results varied by gender, adolescent weight status or parental educational level. A final aim was to assess whether the parents’ intakes were affected by the intervention. Design: Participants were 1,418 adolescents, 849 mothers and 680 fathers. Baseline and post-intervention data from the 20 months intervention study HEIA (HEalth In Adolescents) were included. Data were collected assessing frequency (and amounts; beverages only). Results: No significant differences were found at baseline between the intervention and control groups, except for the parental groups (educational level and intakes). At post-intervention, the adolescents in the intervention group consumed fruit more frequently (P<0.001) and had a lower intake of sugar-sweetened fruit drinks compared to the control group (P=0.02). The parental educational level moderated the effect on intake of sugar-sweetened fruit drinks in adolescents. The intake was less frequent in the intervention groups compared to the control groups (P=0.02) for those who had parents with low and medium educational level. Furthermore, the intervention may have affected mothers’ fruit intake and the vegetable intake in higher educated fathers. Conclusion: Favourable effects in favour of the intervention group were found for intake of fruit and sugar-sweetened fruit drinks among the adolescents in the HEIA study. Our results indicate that it is possible to reduce adolescents’ intake of sugar-sweetened fruit drinks across parental education, and potentially affect sub-groups of parents.

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• Henjum, Sigrun; Torheim, Liv Elin; Løvhaug, Anne Lene; Lund-Iversen, Kaja; Eide, Wenche Barth & Lien, Nanna (2025). Mat og menneskerettigheter i ernæringsrelatert folkehelsearbeid. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 23(3), p. 191–199. Full text in Research Archive Show summary

  Hva retten til fullgod mat som menneskerettighet innebærer, har i stor grad blitt fortolket av norske akademikere innen samfunnsernæring og menneskerettighets-jus i nært samarbeid med internasjonale kollegaer og norske myndigheter. Arbeidet har til tider vært nært knyttet til utviklingen av sentrale dokumenter og prosesser i FN-systemet. Dette arbeidet danner grunnlaget for aktivitetene i Kompetansenettverket for mat og menneskerettigheter (KoMM). KoMM har som formål å bidra til økt kompetanse om hvordan ulike aktører kan bruke en menneskerettighetsbasert tilnærming i arbeid med mat, ernæring, matsikkerhet, og sunne og bærekraftige matsystemer for å oppfylle FNs bærekraftsmål – primært i Norge, men også gjennom at Norge opprettholder og viderefører sin aktivitet på de relevante globale arenaene.

• Aguiar, Anaely; Romanenko, Eduard; Hendricks, Gaironeesa; Fismen, Anne-Siri; Nwosu, Emmanuel & Savona, Natalie [Show all 12 contributors for this article] (2023). Mental health matters in obesity prevention: exploring the dynamic relationships between mental well-being and obesity-related behaviours in adolescents. Population Medicine. 5. doi: 10.18332/POPMED/164146. Full text in Research Archive
• Melbye, Elisabeth Lind; Hausken-Sutter, Solveig; Lien, Nanna & Bjelland, Mona (2020). Ungdommers grønnsakinntak: hvilken rolle spiller familiens sosioemosjonelle klima? Full text in Research Archive
• Roos, Gun; Langøien, Lars Jørun; Terragni, Laura; Rugseth, Gro; Nicolaou, Mary & Holdsworth, Michelle [Show all 8 contributors for this article] (2018). Systematic mapping review of factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study. Full text in Research Archive
• Brug, Johannes; Ploeg, Hidde P van der; Loyen, Anne; Ahrens, Wolfgang; Allais, Olivier & Andersen, Lene Frost [Show all 34 contributors for this article] (2017). Determinants of diet and physical activity (DEDIPAC): A summary of findings. International Journal of Behavioral Nutrition and Physical Activity. 14(1). doi: 10.1186/s12966-017-0609-5. Full text in Research Archive Show summary

  The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013–2016, was the first action taken by the ‘Healthy Diet for a Healthy Life’ European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC’s work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance

• Klepp, Knut Inge & Lien, Nanna (2017). Overvekt og fedme: den tunge folkehelseutfordringen. In Klepp, Knut Inge & Aarø, Leif Edvard (Ed.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. p. 255–270. Full text in Research Archive
• Vennerød, Frida Felicia; Monnery-Patris, Sandrine; Lien, Nanna & Almli, Valerie Lengard (2016). Children and sweet preferences. 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
• Vennerød-Diesen, Frida Felicia; Almli, Valerie Lengard & Lien, Nanna (2018). The development of taste preferances in children - A Longitudinal Study of Norwegian Preschoolers. Universitetet i Oslo. ISSN 9788283773279. Full text in Research Archive

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