Knut Inge Klepp

• Meshkovska, Biljana; Zolfaghari, Mahshid; Brandvik, Caroline Løvik; Klepp, Knut-Inge; Kopainsky, Birgit & Lie, Hanne Cathrine [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Armocida, Benedetta; Tolonen, Hanna; Rakovac, Ivo; Formenti, Beatrice; Farrington, Jill & Ekberg, Allison [Vis alle 26 forfattere av denne artikkelen] (2025). Strengthening non-communicable diseases monitoring systems in Europe through a multistakeholder collaborative approach: a key priority for advancing data-driven policymaking. The Lancet Regional Health - Europe. 61. doi: 10.1016/j.lanepe.2025.101553. Fulltekst i vitenarkiv
• Klepp, Knut-Inge; Helleve, Arnfinn; Høstrup, Emil; Blenkuš, Mojca Gabrijelčič; Karlsdóttir, Sólveig & Ollila, Eeva [Vis alle 12 forfattere av denne artikkelen] (2025). Scaling up non-communicable disease prevention and health promotion across Europe: The Joint Action PreventNCD. Scandinavian Journal of Public Health. ISSN 1403-4948. 53(Suppl. 3), s. 8–17. doi: 10.1177/14034948251352040. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Non-communicable diseases (NCDs) account for more than two thirds of the burden of disease in Europe. At the population level, substantial disparities exist based on socioeconomic status, geographical area, age, disability, gender, and ethnicity. A large part of this disease burden is preventable. The aim of the Joint Action PreventNCD is to support strategies, policies, and practices designed to reduce the burden of NCDs and their common risk factors. This is achieved through collaboration between Member States of the European Union, Iceland, Norway, and Ukraine acting on health determinants and increasing protective factors for health and wellbeing, both at a personal and societal level. A critical objective is to contribute to reduced social inequalities associated with NCDs. This paper presents the overall design and rationale behind PreventNCD, highlighting the efforts to provide strategic direction and guidance while fostering consolidated efforts to NCD prevention and health promotion. Methods: Methods include analyzing opportunities for implementing evidence-informed intersectoral policies for preventing NCDs, pilot-testing innovative practices, and scaling up best practices, including both population-based and targeted prevention efforts. Furthermore, methods include building monitoring capacity in the fields of NCD mortality and morbidity, exposure to risk factors, cost of NCD care, and the impact of health promotion and disease prevention efforts. Conclusions: This is an ambitious effort to strengthen the European Member States’ abilities and efforts related to NCD prevention. Key outputs include the identification and implementation of effective policies and practices, and long-term institutional mechanisms for sustained NCD prevention and health promotion.

• Zolfaghari, Mahshid; Lien, Nanna; Brandvik, Caroline Løvik; Klepp, Knut-Inge; Kopainsky, Birgit & Lie, Hanne Cathrine [Vis alle 7 forfattere av denne artikkelen] (2025). Understanding the dynamics of implementing the Norwegian School Fruit Programme: integrating implementation science and system dynamics | Implementation Science Communications. Implementation Science Communications. s. 1–48. doi: 10.1186/s43058-025-00834-6. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Meltzer, Helle Margrete; Lund-Iversen, Kaja; Helleve, Arnfinn; Abel, Marianne Hope; Løvhaug, Anne Lene & Morseth, Marianne S. [Vis alle 9 forfattere av denne artikkelen] (2025). NewTools: a novel collaboration across the Norwegian food system with the aim of developing tools for food system transformation. Public Health Nutrition (PHN). ISSN 1368-9800. 28(1), s. e134–e134. doi: 10.1017/s1368980025100785. Fulltekst i vitenarkiv Vis sammendrag

  Objective: The NewTools project aims to support the transformation of the food system by developing summary scores for the nutritional value and environmental and social sustainability of foods and exploring potential applications. In this conceptual paper, we present the governance, objectives, conceptualisation and expected outcomes of the NewTools project. Design: A cross-sector research partnership involving actors across the Norwegian food system. Setting: The need to transform food systems both globally, regionally and nationally. Participants: A broad constellation of twenty-eight project partners includes research institutions, governmental agencies, food industry and Non-governmental organization (NGO). Expected results: Outputs from the project will include the development and testing of a score for nutritional quality using the European Nutri-Score version 2023 as a starting point, identifying of indicators to measure social and environmental sustainability, proposing weighting of these into one or several summary scores, pilots testing potential applications of use for the scores and protocols for relevant spin-off projects. Conclusion: The multitude of perspectives represented by this unique variety of partners is seen as valuable to better understand the opportunities and limitations of the proposed tools designed to foster transformations towards a more resilient and sustainable food system.

• Zolfaghari, Mahshid; Meshkovska, Biljana; Brandvik, Caroline Løvik; Kopainsky, Birgit; Klepp, Knut-Inge & Lie, Hanne Cathrine [Vis alle 7 forfattere av denne artikkelen] (2025). A Systems Perspective on the Drivers of Adoption of the Norwegian School Fruit Scheme. Global Implementation Research and Applications. 5, s. 336–348. doi: 10.1007/s43477-025-00173-7. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Flodgren, Gerd Monika; Helleve, Arnfinn; Selstø, Annlaug; Fismen, Anne-Siri; Blanchard, Laurence & Rutter, Harry [Vis alle 7 forfattere av denne artikkelen] (2024). Youth involvement in policy processes in public health, education, and social work - A scoping review. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.13874. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Youth involvement in policy formulation may enhance its relevance, strengthen democratic practices, and contribute to youth development. This scoping review explored the nature, extent, and impact of adolescent involvement in policy processes aimed at improving adolescent health and well-being in the public health, education, and social work sectors. Methods Studies of adolescent involvement in policy processes focusing on health, and well-being, including obesity prevention were eligible. We searched seven databases, reference lists of included studies, and contacted key organizations. Standard scoping review methods were applied. The results were synthesized narratively, using descriptive statistics and visuals. Results We included 33 mostly qualitative studies, mainly from the public health sector in the USA and Europe, focusing on diet, physical activity, health & well-being, or sexual and reproductive health. Adolescents were consulted or collaborated with, mostly in identifying problems or policy solutions and less often in agenda-setting, decision-making, and evaluation. Various facilitators were used to improve participation (e.g. training, adult facilitators, monetary compensation). Data on adolescents' experiences of involvement and the impact on policies were limited. Conclusion Due to a paucity of impact studies, we could not determine whether adolescent involvement increased the relevance of policies or improved adolescent development. The extent to which adolescents were meaningfully involved, and had a material effect on decision-making, was largely unclear. Improved documentation, monitoring, and evaluation of youth involvement in policy using quantitative methods and standardized frameworks, can improve the evidence-based, involvement practices, and decrease inequities.

• Baillergeau, Evelyne; Veltkamp, Gerlieke; Bröer, Christian; Helleve, Arnfinn; Kulis, Ewa & Lien, Nanna [Vis alle 12 forfattere av denne artikkelen] (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), s. 201–221. doi: 10.1080/13698575.2024.2338120. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Aarø, Leif Edvard; Knapstad, Marit; Nilsen, Thomas Sevenius; Skogen, Jens Christoffer; Nes, Ragnhild Bang & Leino, Tony Mathias [Vis alle 14 forfattere av denne artikkelen] (2024). The Norwegian Counties Public Health Survey (NCPHS): a design study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948241287853. Fulltekst i vitenarkiv
• Aronsen-Kongerud, Helene; Bastien, Sheri & Klepp, Knut Inge (2024). The centrality of food in Norwegian adolescents' life; A photo elicitation study among Norwegian youth. Health Promotion International. ISSN 0957-4824. 39(3). doi: 10.1093/heapro/daae043. Fulltekst i vitenarkiv Vis sammendrag

  The purpose of the study was to explore how adolescents from a high school in Viken county define and interact with food systems in their immediate environments to understand if and how health and sustainability affect their food choices. A qualitative case study design and a participatory approach were employed. Data were collected through photo elicitation combined with group interviews. Pictures were analyzed in collaboration with participants, and the group interview through systematic text condensation. Results indicate that adolescents perceive food systems as being a substantial part of their everyday life, that they care about their health and that of the planet, and they wish to take sustainability and health into consideration when making food choices. Their food choices are affected by aspects such as family, friends, marketing, price, time, availability and accessibility. They perceive that their agency to influence their own diet and food systems is limited. Adolescents hold unique and important knowledge of their food-related behaviors and value their autonomy to make food choices. Future research and policies aiming to help adolescents make healthy and sustainable food choices should therefore actively include adolescents.

• Knai, Cécile; Savona, Natalie; Finegood, Diane; Rodriguez, Anaely Aguiar; Blanchard, Laurence & Conway-Moore, Kaitlin [Vis alle 13 forfattere av denne artikkelen] (2023). Learning from the CO-CREATE project: A protocol for systems thinking across research (STAR). Obesity Reviews. ISSN 1467-7881. 24(S2), s. 1–11. doi: 10.1111/obr.13624. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Samdal, Oddrun; Ljøsne, Isabelle Sylvie Budin; Haug, Ellen Merethe Melingen; Helland, Trond; Kjostarova-Unkovska, Lina & Bouillon, Claire [Vis alle 32 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Bröer, Christian; Ayuandini, Sherria; Baillergeau, Evelyne; Moerman, Gerben; Veltkamp, Gerlieke & Luszczynska, Aleksandra [Vis alle 11 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Vlad, Ioana; Oldrigde-Turner, Kate; Klepp, Knut Inge; Rutter, Harry; Mathisen, Jonas Rekdal & Helleve, Arnfinn [Vis alle 17 forfattere av denne artikkelen] (2023). The development of the NOURISHING and MOVING benchmarking tools to monitor and evaluate national governments' nutrition and physical activity policies to address obesity in the European region. Obesity Reviews. ISSN 1467-7881. 24. doi: 10.1111/obr.13541. Fulltekst i vitenarkiv
• Banik, Anna; Knai, Cecile; Klepp, Knut Inge; Rutter, Harry; Rito, Ana & Lien, Nanna [Vis alle 11 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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 [Vis alle 10 forfattere av denne artikkelen] (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), s. 1–12. doi: 10.1111/obr.13622. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Aarø, Leif Edvard; Leino, Tony Mathias; Vedaa, Øystein; Knapstad, Marit; Skogen, Jens Christoffer & Nilsen, Thomas Sevenius [Vis alle 8 forfattere av denne artikkelen] (2023). Behavioural precautions to avoid transmission of the COVID-19 virus – low educated groups are not always lagging behind. Journal of Health Inequalities. ISSN 2450-5927. 9(1), s. 16–28. doi: 10.5114/jhi.2022.123437. Fulltekst i vitenarkiv Vis sammendrag

  When COVID-19 started spreading in Norway in early 2020, the government, with strong support from the Directorate of Health and the Norwegian Institute of Public Health, launched the most comprehensive health education effort ever seen in Norway. Information about spread of the virus and precautions that needed to be taken were communicated continuously, in all possible media channels and with heavy appeal over several months. There were no obvious and visible disagreements among the central level communicators. From a health education research perspective it is interesting to examine the compliance with the recommendations advocated and its relationship with demographic factors. Knowledge about differences in compliance across population segments and insights into processes determining compliance are important for our ability to cope with future pandemics and health crises.

• Nesrallah, Samantha; Klepp, Knut Inge; Ljøsne, Isabelle Sylvie Budin; Luszczynska, Aleksandra; Brinsden, Hannah & Rutter, Harry [Vis alle 11 forfattere av denne artikkelen] (2023). Youth engagement in research and policy: The CO-CREATE framework to optimize power balance and mitigate risks of conflicts of interest. Obesity Reviews. ISSN 1467-7881. 24(S1). doi: 10.1111/obr.13549. Fulltekst i vitenarkiv Vis sammendrag

  SummaryIncluding youth in the co-creation of policies that affect them has proven to be par-ticularly impactful in public health. Using youth participatory action researchmethods, the CO-CREATE project engages European youth 16–18 years old in theco-creation of obesity prevention policies. To discuss the feasibility and implicationsof the policy, youth are invited to engage in an intergenerational dialogue. Given theyouth–adult dynamic and policy discussion, conflicts of interests (COIs) can arise andimpact the quality of the dialogue. COI frameworks are a tool that can help identify,mitigate, and address COIs. This paper presents a novel framework to mitigate COIsin intergenerational policy dialogues, with a focus on power imbalance. Following aseries of youth consultations, interviews, and examination of existing frameworks,our findings suggest that safe, participatory, and empowering dialogues can takeplace if appropriate measures are integrated into all phases of a dialogue. The selec-tion of stakeholders, use of accessible language, and youth moderation are all factorsthat can impact COI risks. Measures that promote mutual empowerment, such asequal representation of youth and adults, were deemed important. This frameworkprovides a roadmap to ensure that youth participation in the formulation of policiesis safe and empowering. KEYWORDS: conflicts of interest, overweight and obesity, policy, youth participation

• Klepp, Knut Inge; Helleve, Arnfinn; Brinsden, Hannah; Bröer, Christian; Ljøsne, Isabelle Sylvie Budin & Harbron, Janetta [Vis alle 18 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Aarø, Leif Edvard; Ohm, Eyvind; Skogen, Jens Christoffer; Nilsen, Thomas Sevenius; Knapstad, Marit & Vedaa, Øystein [Vis alle 9 forfattere av denne artikkelen] (2023). A cross-sectional study of the relationship between injuries and quality of life, psychological distress, sleeping problems, and global subjective health in adults from three Norwegian counties. Health and Quality of Life Outcomes. 21(1), s. 1–10. doi: 10.1186/s12955-023-02191-1. Fulltekst i vitenarkiv
• Ulloa, Manuela Aguirre; Nesrallah, Samantha; Shafafi, Pardis; Lamar, Angel; Gonçalves, Pedro Côrte-Real & Gonçalves, Mafalda [Vis alle 14 forfattere av denne artikkelen] (2023). Designing a youth-led Dialogue Forum tool: The CO-CREATE experience. Obesity Reviews. ISSN 1467-7881. 24(S2). doi: 10.1111/obr.13611. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Richardsen, Helene Kristin; Bere, Elling Tufte; Stea, Tonje Holte; Klepp, Knut Inge & Engeset, Dagrun (2023). Effect of Ending the Nationwide Free School Fruit Scheme on the Intake of Fruits, Vegetables, and Unhealthy Snacks in Norwegian School Children Aged 10–12 Years. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 20(3). doi: 10.3390/ijerph20032489. Fulltekst i vitenarkiv Vis sammendrag

  The Norwegian authorities started a nationwide free school fruit program in 2007, implemented in all secondary schools (grades 8–10) and combined schools (grades 1–10) in Norway. The program ended in 2014. This study evaluates the effect of ending the nationwide free school fruit program on the consumption of fruit, vegetables, and unhealthy snacks among Norwegian sixth and seventh graders. The study sample consists of pupils at 18 schools that participated in all data collections in the Fruits and Vegetables Make the Marks project (FVMM), initiated in 2001, with new data collections in 2008 and 2018. Four of the schools were combined schools, therefore children in sixth and seventh grade at these schools received free fruit in 2008 (intervention schools), and fourteen schools did not (control schools). Between 2008 and 2018, pupils at the intervention schools ate a lower proportion of fruits and vegetables per school week, and the consumption of unhealthy snacks increased compared to the control schools. Completion of the free fruit program was not significantly different for boys and girls, or low and high parental education. The results indicate that the end of the free school fruit program resulted in less healthy eating habits among children.

• Conway-Moore, Kaitlin; Cecile, Knai; Finegood, Diane; Johnston, Lee; Brinsden, Hannah & Rodriguez, Anaely Aguiar [Vis alle 18 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Bröer, Christian; Veltkamp, Gerlieke; Ayuandini, Sherria; Baillergeau, Evelyne; Moerman, Gerben & Sauvage, Rein de [Vis alle 15 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Hendricks, Gaironeesa; Savona, Natalie; Rodriguez, Anaely Aguiar; Alaba, Olufunke; Booley, Sharmilah & Malczyk, Sonia [Vis alle 11 forfattere av denne artikkelen] (2022). Adolescents’ Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(4). doi: 10.3390/ijerph19042160. Fulltekst i vitenarkiv Vis sammendrag

  Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents’ perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16–18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.

• Oldridge-Turner, Kate; Kokkorou, Margarita; Vlad, Ioana; Klepp, Knut Inge; Rutter, Harry & Helleve, Arnfinn [Vis alle 12 forfattere av denne artikkelen] (2022). Scan of physical activity policy actions in Europe: Lessons learned from populating the MOVING database. Obesity Reviews. ISSN 1467-7881. 24(51). doi: 10.1111/obr.13523. Fulltekst i vitenarkiv
• Klepp, Knut Inge; Helleve, Arnfinn; Fismen, Anne-Siri & Rutter, Harald Roderick (2022). Improving the health of adolescents: the Nordic countries can help fill the evidence gap. Scandinavian Journal of Public Health. ISSN 1403-4948. 50(7), s. 887–891. doi: 10.1177/14034948221124675. Fulltekst i vitenarkiv Vis sammendrag

  While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.

• Fismen, Anne-Siri; Galler, Martina; Klepp, Knut Inge; Chatelan, Angeline; Residori, Caroline & Ojala, Kristiina [Vis alle 17 forfattere av denne artikkelen] (2022). Weight Status and Mental Well-Being Among Adolescents: The Mediating Role of Self-Perceived Body Weight. A Cross-National Survey. Journal of Adolescent Health. ISSN 1054-139X. 71(2), s. 187–195. doi: 10.1016/j.jadohealth.2022.02.010. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Overweight and obesity are associated with poor mental health in adolescents. However, little is known about whether the influence of overweight and obesity on mental well-being is mediated by self-perceived body weight. Exploring the mechanisms underlying the relationships between obesity and mental well-being is of interest to policy makers and others working in the field of adolescent health. Methods This study was based on nationally representative data from adolescents (age 15 years) who participated in the 2017/2018 Health Behaviour in School-aged Children study (47 countries, N = 76,998). Mixed regression models that included gender and socioeconomic status as covariates were used to identify associations between weight status and mental well-being (life satisfaction and subjective health complaints) and to explore whether self-perceived body weight (feeling too thin or too fat) has a mediating effect. Associations between weight status, self-perceived weight, and mental well-being were further assessed country by country. Results Self-perceived body weight mediated the observed associations between overweight or obesity and mental well-being. Perceiving one's body weight as “too thin” or “too fat” was associated with poorer mental well-being, regardless of weight status. Self-perceived body weight varied by gender, socioeconomic status, and country. Discussion Self-perceived body weight may explain, to a greater extent than body mass index, variation in mental well-being among adolescents. These results are important to policy makers, clinicians, and others targeting adolescent health.

• Fismen, Anne-Siri; Mathisen, Jonas Rekdal; Vlad, Ioana; Oldridge-Turner, Kate; O'Mara, Jennifer & Klepp, Knut Inge [Vis alle 10 forfattere av denne artikkelen] (2022). Pilot test of the NOURISHING policy index—Assessing governmental nutrition policies in five European countries. Obesity Reviews. ISSN 1467-7881. 24(S1), s. 1–10. doi: 10.1111/obr.13532. Fulltekst i vitenarkiv Vis sammendrag

  The NOURISHING database is a repository of more than 1000 verified nutrition anddiet-related governmental policy actions currently in effect globally. The database isa unique and rich data source on governmental policy actions with a potential fordeveloping tools that capture the overall policy efforts in a country, identify policygaps, and enable cross-national comparisons. Policy actions from a sample of fiveEuropean countries have been benchmarked against aspirational standards using theNOURISHING benchmarking tool. This paper presents the results of the pilot testingfrom the benchmarking process for the construction of the NOURISHING policyindex. The development of the index was guided by existing tools for developingcomposite indicators. The findings from the pilot test indicate that the NOURISHINGpolicy index can identify both policy gaps and cross-national policy differences. Theseresults demonstrate that the policy index merits testing on a larger sample to identifypotential refinements.

• Oldridge-Turner, Kate; Kokkorou, Margarita; Sing, Fiona; Klepp, Knut Inge; Rutter, Harry & Helleve, Arnfinn [Vis alle 11 forfattere av denne artikkelen] (2022). Promoting Physical Activity Policy: The Development of the MOVING Framework. Journal of Physical Activity and Health. ISSN 1543-3080. 19(4), s. 292–315. doi: 10.1123/jpah.2021-0732. Fulltekst i vitenarkiv
• Grewal, Navnit Kaur; Klepp, Knut Inge; Banik, Anna; Bröer, Christian; Holbæk, Helene & Luszczynska, Aleksandra [Vis alle 9 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Savona, Natalie; Brown, Andrew; Macauley, Talia; Rodriguez, Anaely Aguiar; Hayward, Josh & Ayuandini, Sherria [Vis alle 14 forfattere av denne artikkelen] (2022). System mapping with adolescents: Using group model building to map the complexity of obesity. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.13506. Fulltekst i vitenarkiv Vis sammendrag

  Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development.

• Fismen, Anne-Siri; Smith, Otto Robert Frans; Helleve, Arnfinn; Haug, Ellen Merethe Melingen; Chatelan, Angeline & Kelly, Colette [Vis alle 14 forfattere av denne artikkelen] (2022). Cross-national variation in the association between family structure and overweight and obesity: Findings from the Health Behaviour in School-aged children (HBSC) study. SSM - Population Health. ISSN 2352-8273. 19. doi: 10.1016/j.ssmph.2022.101127. Fulltekst i vitenarkiv Vis sammendrag

  Background Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity. Methods The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years. Results Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12). Conclusion The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences.

• Ljøsne, Isabelle Sylvie Budin; Ayuandini, Sherria; Baillergeau, Evelyne; Bröer, Christian; Helleve, Arnfinn & Klepp, Knut Inge [Vis alle 15 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Gebremariam, Mekdes Kebede; Nianogo, Roch A.; Lien, Nanna; Bjelland, Mona; Klepp, Knut Inge & Bergh, Ingunn Holden [Vis alle 8 forfattere av denne artikkelen] (2021). The impact of hypothetical interventions on adiposity in adolescence. Scientific Reports. 11. doi: 10.1038/s41598-021-90415-z. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Buoncristiano, Marta; Spinelli, Angela; Williams, Julianne; Nardone, Paola; Rito, Ana I. & García-Solano, Marta [Vis alle 20 forfattere av denne artikkelen] (2021). Childhood overweight and obesity in Europe: Changes from 2007 to 2017. Obesity Reviews. ISSN 1467-7881. 22(56). doi: 10.1111/obr.13226. Fulltekst i vitenarkiv
• Flodgren, Gerd Monika; Helleve, Arnfinn; Lobstein, Tim; Rutter, Harry & Klepp, Knut Inge (2020). Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews. Obesity Reviews. ISSN 1467-7881. 21(11). doi: 10.1111/obr.13102. Fulltekst i vitenarkiv
• Øvrebø, Bente; Stea, Tonje Holte; Velde, Saskia J. te; Bjelland, Mona; Klepp, Knut Inge & Bere, Elling Tufte (2019). A comprehensive multicomponent school-based educational intervention did not affect fruit and vegetable intake at the 14-year follow-up. Preventive Medicine. ISSN 0091-7435. 121, s. 79–85. doi: 10.1016/j.ypmed.2019.02.015. Fulltekst i vitenarkiv Vis sammendrag

  The intake of fruit and vegetables is associated with beneficial health outcomes, and studies aimed at increasing fruit and vegetable intake lack long-term follow-up. The primary objective of this study was to evaluate the long-term (14-year) effects of a multicomponent school-based educational intervention targeted to increase fruit and vegetable intake in children. The secondary objective was to evaluate the potential synergistic effect between free school fruit and the educational program. A cluster randomized school-based intervention was initiated in 2001 in Norway, known as the Fruit and Vegetable Make the Marks study. In total, 38 schools were randomized; for the intervention (n = 18) and as control schools (n = 20). A subsample of the intervention schools (n = 9) were additionally given free school fruit, resulting in two intervention groups - one with and one without free fruit. Participants completed questionnaires in September 2001 (baseline, mean age 11.8), May 2002 (at the end of the intervention), May 2003, May 2005, September 2009 and throughout 2016 (mean age 26.5). Of 1950 participants, 982 (50.4%) completed the 14-year follow-up and were considered as the current study sample. Analysis yielded no 14-year effects of the educational program on fruit and vegetable intake. A synergistic effect between the educational program and free fruit was not observed either. Future studies might benefit from increased focus on more extensive parental involvement, increased home availability, and a longer intervention period. However, more long-term studies are needed to evaluate the effects of school-based interventions into adulthood.

• Hovdenak, Ingrid Marie; Stea, Tonje Holte; Twisk, Jos; Velde, Saskia J. te; Klepp, Knut Inge & Bere, Elling Tufte (2019). Tracking of fruit, vegetables and unhealthy snacks consumption from childhood to adulthood (15 year period): does exposure to a free school fruit programme modify the observed tracking? International Journal of Behavioral Nutrition and Physical Activity. 16(22). doi: 10.1186/s12966-019-0783-8. Fulltekst i vitenarkiv Vis sammendrag

  Background The rationale for promoting increased consumption of fruit and vegetables (FV) at an early age is based on results from previous tracking-studies, indicating that dietary habits learned in childhood sustain into adulthood. Previous tracking studies have several limitations (e.g. low study sample, few repeated measurements and/or short a follow-up period). In addition, to our knowledge, no study has shown that a dietary intervention initiated in childhood affects tracking of dietary behaviour. The main objectives in this study were therefore to assess tracking of FV and unhealthy snacks in a large sample with multiple follow-up surveys over 15-years, and whether exposure to free school fruit for one school year modified tracking. Method The longitudinal cohort-study, Fruit and Vegetables Make the Marks, included 38 randomly drawn schools in Norway; nine intervention schools received free fruit (or vegetable) in the school year 2001/2002 and 29 schools severed as control. The baseline sample included 1950 subjects, and 16–92% participated at five follow-up surveys (2002–2016). FV consumption and unhealthy snacks were measured by FFQ. Mixed models were applied to estimate overall tracking coefficients, and to assess whether the intervention modified tracking ((from baseline, from follow-up one (while intervention was running) and from follow-up two (after end of intervention)). Results Overall tracking coefficients were 0.33 for fruit, 0.36 for vegetables and differed by sex for unhealthy snacks: 0.46 males and 0.39 for females (interaction p = 0.065). Most analyses showed no significant difference in tracking between the intervention group and control group. However, from follow-up one, tracking coefficients were different for unhealthy snacks, 0.46 vs. 0.38 (interaction p = 0.036), and from follow-up two for vegetables, 0.35 vs 0.48 (p = 0.036), in the intervention group and control group, respectively. Conclusion Our results indicate low to moderate tracking of FV and unhealthy snacks from childhood to adulthood. We found little evidence that the free fruit intervention modified tracking of fruit, vegetables or unhealthy snacks. More research is needed on if or how we can influence the tracking of fruit, vegetables and unhealthy snacks consumption to improve public health.

• Katahoire, Anne Ruhweza; Banura, Cecily; Muhwezi, Wilson Winstons; Bastien, Sheri; Wubs, Annegreet Gera & Klepp, Knut Inge [Vis alle 7 forfattere av denne artikkelen] (2019). Effects of a school-based intervention on frequency and quality of adolescent-parent/caregiver sexuality communication: Results from a randomized-controlled trial in Uganda. Aids and Behavior. ISSN 1090-7165. 23(1), s. 91–104. doi: 10.1007/s10461-018-2249-4. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Stea, Tonje Holte; Tveter, Eline Tønnesson; Velde, Saskia J. te; Vik, Frøydis Nordgård; Klepp, Knut Inge & Bere, Elling Tufte (2018). The effect of an extra piece of fruit or vegetables at school on weight status in two generations - 14 years follow-up of the Fruit and Vegetables Makes the Marks study. PLOS ONE. 13:e0205498(10). doi: 10.1371/journal.pone.0205498. Fulltekst i vitenarkiv Vis sammendrag

  Background: The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants’ children. Methods: In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study “Fruits and Vegetables Make the Marks” (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents’ weight status, and the nested design (child/parent). Results: The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period. Conclusions: One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted.

• Stea, Tonje Holte; Hovdenak, Ingrid Marie; Rønnestad, Jannike Berggren; Rennestraum, Kjersti Hovland; Vik, Frøydis Nordgård & Klepp, Knut Inge [Vis alle 7 forfattere av denne artikkelen] (2018). Effects of 1 y of free school fruit on intake of fruits, vegetables, and unhealthy snacks: 14 y later. American Journal of Clinical Nutrition. ISSN 0002-9165. 108. doi: 10.1093/ajcn/nqy243. Fulltekst i vitenarkiv
• Bolt-Evensen, Kathrine; Vik, Frøydis Nordgård; Stea, Tonje Holte; Klepp, Knut Inge & Bere, Elling (2018). Consumption of sugar-sweetened beverages and artificially sweetened beverages from childhood to adulthood in relation to socioeconomic status - 15 years follow-up in Norway. International Journal of Behavioral Nutrition and Physical Activity. 15:8, s. 1–9. doi: 10.1186/s12966-018-0646-8. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: In Norway, social inequalities in health and health-related behaviors have been reported despite the well-developed welfare state. The objective of the present study was to analyze; (i) the development in frequency of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) from childhood to adulthood; (ii) socioeconomic inequalities in the consumption of SSB and ASB using different indicators of socioeconomic status (SES); (iii) time trends in potential disparities in SSB and ASB consumption among different socioeconomic groups to assess the development in socioeconomic inequality from childhood to adulthood. METHODS: This study uses data from the Fruits and Vegetables Make the Marks (FVMM) longitudinal cohort, including participants (n = 437) from 20 random schools from two Norwegian counties. Data from the first survey in 2001 (mean age 11.8) and follow-up surveys in 2005 (mean age 15.5) and 2016 (mean age 26.5) were used. Consumption of SSB and ASB were measured using a food frequency questionnaire, which the participants completed at school in 2001 and 2005, and online in 2016. Various indicators of SES were included; in 2001, parental education and income were measured, in 2005, participants' educational intentions in adolescence were measured, and in 2016, participants' own education and income were measured. The main analyses conducted were linear mixed effects analysis of the repeated measures. RESULTS: Between 2001 and 2016, a decrease in frequency of consumption of SSB (2.8 v 1.3 times/week; p = < 0.001) and an increase in frequency of consumption of ASB (1.1 v 1.6 times/week; p = 0.002) were observed. Participants with a higher educational level in adulthood and higher educational intentions in adolescence had a significantly lower frequency of consumption of SSB at all time points (2001, 2005 and 2016). No significant widening (or narrowing) of inequalities were observed from childhood to adulthood. CONCLUSIONS: A decrease in consumption of SSB and an increase in consumption of ASB from childhood to adulthood were found. Participants with high SES consumed in general less SSB (but not ASB), however, results varied depending on SES indicator used. The established inequalities persisted from childhood to adulthood.

• Totland, Torunn Holm; Knudsen, Markus Dines; Paulsen, Mari Mohn; Bjelland, Mona; Veer, Pieter van`t & Brug, Johannes [Vis alle 8 forfattere av denne artikkelen] (2017). Correlates of irregular family meal patterns among 11-year-old children from the Pro Children study. Food & Nutrition Research (FNR). ISSN 1654-6628. 61(1). doi: 10.1080/16546628.2017.1339554. Fulltekst i vitenarkiv Vis sammendrag

  Background: The importance of family meals to the consumption of healthful food choices has been stated in recent reviews. However, little information is available on barriers that interfere with regular family meal patterns during childhood. Objective: Describe family meal patterns among 11-year-old children across Europe and identify correlates of irregular family breakfast and dinner consumption. Design: Cross-sectional survey involving samples of 13,305 children from nine European countries in 2003. Results: The proportions of children who regularly ate family breakfast and dinner were 62% and 90%, respectively. Correlates of irregular family breakfasts and dinners were less vegetable consumption, and irregular family breakfasts were associated with more television viewing. Social differences in the consumption of family breakfasts were observed. Discussion: Strengths of this study are the large sample size and validated research method. Limitations are the cross-sectional design and self-reported data. Conclusion: The majority of 11-year-old children regularly ate breakfast and dinner with their families. More television viewing and less vegetable consumption were associated with irregular family breakfasts and dinners, respectively. Social differences were observed in the regularity of family breakfasts. Promoting family meals across social class may lead to healthier eating and activity habits, sustainable at the population level.

• Bakken, Inger Johanne; Wensaas, Knut-Arne; Grøneng, Gry Marysol; Fretheim, Atle; Stoltenberg, Camilla & Klepp, Knut Inge [Vis alle 8 forfattere av denne artikkelen] (2017). Russefeiring og eksamenstid – bruk av fastlege og legevakt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.17.0158. Fulltekst i vitenarkiv
• Muhwezi, Wilson Winstons; Katahoire, Anne Ruhweza; Banura, Cecily; Mugooda, Herbert; Kwesiga, Doris & Bastien, Sheri [Vis alle 7 forfattere av denne artikkelen] (2015). Perceptions and experiences of adolescents, parents and School administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda. Reproductive Health. 12:110. doi: 10.1186/s12978-015-0099-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Evidence suggests that in spite of some adolescents being sexually active, many parents do not discuss sex-related issues with them due to lack of age-appropriate respectful vocabulary and skills. The likelihood of parent-adolescent communication improving sexual and reproductive health outcomes appears plausible. The desire to understand parent-adolescent communication and how to improve it for promotion of healthy sexual behaviours inspired this research. The paper is meant to describe perceptions of adolescents, parents and school administrators about parent-adolescent communication on sexual issues; describe the content of such communication and identify factors that influence this communication. Methods The study was done among two urban and two rural secondary school students in their second year of education. Data were collected from 11 focus group discussions and 10 key Informants Interviews. Data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations are used to illustrate findings. Results Parental warmth and acceptability of children was perceived by parents to be foundational for a healthy adolescent- parent communication. Perceptions of adolescents tended to point to more open and frequent communication with mothers than fathers and to cordial relationships with mothers. Fathers were perceived by adolescents to be strict, intimidating, unapproachable and unavailable. While adolescents tended to generally discuss sexual issues with mothers, male adolescents communicated less with anyone on sex, relationships and condoms. Much of the parent-adolescent communication was perceived to focus on sexually transmitted infections and body changes. Discussions of sex and dating with adolescents were perceived to be rare. Common triggers of sexuality discussions with female adolescents were; onset of menstruation and perceived abortion in the neighbourhood. Discussion with male adolescents, if it occurred was perceived to be triggered by parental suspicion of having female ‘friends’ or coming home late. Peers at school and mass media were perceived to the main source of sexuality information. Conclusions Communication on sexuality issues between parents and their adolescent children was infrequent and critical elements like sex and specifics of protection against undesirable sexual behaviour consequences were avoided. Peers, schools and mass media should be creatively harnessed to improve parent-adolescent communication about sexuality issues.

• Bjelland, Mona; Hausken, Solveig E. Sand; Bergh, Ingunn Holden; Grydeland, May; Klepp, Knut Inge & Andersen, Lene Frost [Vis alle 8 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Bergh, Ingunn Holden; Skare, Øivind; Aase, Annalena; Klepp, Knut Inge & Lien, Nanna (2015). Weight development from age 13 to 30 years and adolescent socioeconomic status: The Norwegian Longitudinal Health Behaviour study. International Journal of Public Health. ISSN 1661-8556. doi: 10.1007/s00038-015-0748-x. Fulltekst i vitenarkiv
• Bere, Elling; Velde, Saskia J. te; Småstuen, Milada C; Twisk, Jos & Klepp, Knut Inge (2015). One year of free school fruit in Norway - 7 years of follow-up. International Journal of Behavioral Nutrition and Physical Activity. 12(1). doi: 10.1186/s12966-015-0301-6. Fulltekst i vitenarkiv Vis sammendrag

  Background It is important that health-promoting efforts result in sustained behavioural changes, preferably throughout life. However, only a very few intervention studies evaluate long term follow up. Objective The aim of the present study is to evaluate the overall and up to seven years effect of providing daily one piece of fruit or vegetable (FV) for free for one school year. Methods A total of 38 randomly drawn elementary schools from two counties in Norway participated in the Fruit and Vegetables Make the Marks project. Baseline (2001) and follow-up surveys were conducted in May 2002, 2005 and 2009 (n = 320 with complete data) to assess FV and unhealthy snack intake. Mixed models were used to analyze the data. Results Statistically significant adjusted overall effects of the intervention were revealed for FV intake (1.52 times/day) but this weakened over time. A significant adjusted overall effect (−1.54 consumptions/week) and a significant seven-year-follow-up effect (−2.02 consumptions/week) was found for consumption of unhealthy snacks for pupils of parents without higher education. Conclusion One year of free school fruit resulted in higher FV intake and lower unhealthy snack intake, however this weakened over time for FV intake and became stronger for snack intake. More follow-up studies with larger samples and lower attrition rates are needed in order to further evaluate the long-term effect.

• Grydeland, May; Bjelland, Mona; Anderssen, Sigmund Alfred; Klepp, Knut Inge; Bergh, Ingunn Holden & Andersen, Lene Frost [Vis alle 8 forfattere av denne artikkelen] (2014). Effects of a 20-month cluster randomised controlled school-based intervention trial on BMI of school-aged boys and girls: The HEIA study. British Journal of Sports Medicine. ISSN 0306-3674. 48(9), s. 768–773. doi: 10.1136/bjsports-2013-092284. Fulltekst i vitenarkiv Vis sammendrag

  Background: School-based interventions that target prevention of overweight and obesity in children have been tested with mixed results. Thus, successful interventions are still called for. The aim of the present study was to investigate effects of a multicomponent school-based intervention programme targeting physical activity, sedentary and dietary behaviours on anthropometric outcomes. Methods: A 20-month intervention was evaluated in a cluster randomised, controlled study of 1324 11-year-olds. Outcome variables were body mass index (BMI), BMI-for-age z-score (BMIz), waist circumference (WC), waist-to-height ratio (WTHR) and weight status (International Obesity Task Force's cut-offs). Weight, height and WC were measured objectively; pubertal status was self-reported and parental education was self-reported by the parents. Intervention effects were determined by one-way analysis of covariance and logistic regression, after checking for clustering effects of school, and moderating effects of gender, pubertal status and parental education. Results: Beneficial effects were found for BMI (p=0.02) and BMIz (p=0.003) in girls, but not in boys. While a beneficial effect was found for BMI (p=0.03) in participants of parents reporting a high level of education, a negative effect was found for WTHR in participants with parents reporting a low level of education (p=0.003). There were no intervention effects for WC and weight status. Conclusions: A multicomponent 20-month school-based intervention had a beneficial effect on BMI and BMIz in adolescent girls, but not in boys. Furthermore, children of higher educated parents seemed to benefit more from the intervention, and this needs attention in future interventions to avoid further increase in social inequalities in overweight and obesity.

• Bergh, Ingunn Holden; Stralen, Maartje M. van; Bjelland, Mona; Grydeland, May; Lien, Nanna & Klepp, Knut Inge [Vis alle 8 forfattere av denne artikkelen] (2014). Post-intervention effects on screen behaviours and mediating effect of parental regulation : the HEalth In Adolescents study – a multi-component school-based randomized controlled trial. BMC Public Health. 14(1). doi: 10.1186/1471-2458-14-200. Fulltekst i vitenarkiv Vis sammendrag

  Background: To improve effectiveness of future screen behaviour interventions, one needs to know whether an intervention works via the proposed mediating mechanisms and whether the intervention is equally effective among subgroups. Parental regulation is identified as a consistent correlate of screen behaviours, but prospective evidence as well as the mediation role of parental regulation is largely lacking. This study investigated postintervention main effects on screen behaviours in the HEIA-intervention – a Norwegian school-based multiplebehaviour study, as well as mediation effects of parental regulation by adolescents’ and parents’ report. In addition, moderating effects of gender and weight status on the intervention and mediating effects were explored. Methods: Participating schools were randomized to control (n = 25) or intervention (n = 12) condition. Adolescents (n = 908 Control; 510 Intervention) self-reported their weekday and weekend TV-viewing and computer/game-use. Change in adolescents’ behaviours was targeted through school and parents. Adolescents, mothers (n = 591 Control; 244 Interventions) and fathers (n = 469 Control; 199 Intervention) reported parental regulation of the screen behaviours post-intervention (at 20 month). The product-of-coefficient test using linear regression analysis was conducted to examine main and mediating effects. Results: There was no intervention effect on the screen behaviours in the total sample. Gender moderated effect on weekend computer/game-use, while weight status moderated the effect on weekday TV-viewing and computer/game-use. Stratified analyses showed a small favourable intervention effect on weekday TV-viewing among the normal weight. Parental regulation did not mediate change in the screen behaviours. However, stronger parental regulation was associated with less TV-viewing and computer/game-use with effects being conditional on adolescents’ versus parental reports. Parental regulation of the screen behaviours, primarily by the parental report, was associated with change in the respective behaviours. Conclusion: Multiple behaviour intervention may not affect all equally well, and the effect may differ by weight status and gender. In future interventions parents should be encouraged to regulate their adolescents’ TV-viewing and computer/game-use on both weekdays and weekends as parental regulation was identified as a determinant of these screen behaviours. However, future intervention studies may need to search for more effective intervention strategies targeting parental regulation.

• Aarø, Leif Edvard; Mathews, Catherine; Kaaya, Sylvia; Katahoire, Anne Ruhweza; Onya, Hans & Abraham, Charles [Vis alle 10 forfattere av denne artikkelen] (2014). Promoting sexual and reproductive health among adolescents in southern and eastern Africa (PREPARE): project design and conceptual framework. BMC Public Health. 14. doi: 10.1186/1471-2458-14-54. Fulltekst i vitenarkiv Vis sammendrag

  Background: Young people in sub-Saharan Africa are affected by the HIV pandemic to a greater extent than young people elsewhere and effective HIV-preventive intervention programmes are urgently needed. The present article presents the rationale behind an EU-funded research project (PREPARE) examining effects of community-based (school delivered) interventions conducted in four sites in sub-Saharan Africa. One intervention focuses on changing beliefs and cognitions related to sexual practices (Mankweng, Limpopo, South Africa). Another promotes improved parent-offspring communication on sexuality (Kampala, Uganda). Two further interventions are more comprehensive aiming to promote healthy sexual practices. One of these (Western Cape, South Africa) also aims to reduce intimate partner violence while the other (Dar es Salaam, Tanzania) utilises school-based peer education. Methods/design: A modified Intervention Mapping approach is used to develop all programmes. Cluster randomised controlled trials of programmes delivered to school students aged 12–14 will be conducted in each study site. Schools will be randomly allocated (after matching or stratification) to intervention and delayed intervention arms. Baseline surveys at each site are followed by interventions and then by one (Kampala and Limpopo) or two (Western Cape and Dar es Salaam) post-intervention data collections. Questionnaires include questions common for all sites and are partly based on a set of social cognition models previously applied to the study of HIV-preventive behaviours. Data from all sites will be merged in order to compare prevalence and associations across sites on core variables. Power is set to .80 or higher and significance level to .05 or lower in order to detect intervention effects. Intraclass correlations will be estimated from previous surveys carried out at each site. Discussion: We expect PREPARE interventions to have an impact on hypothesized determinants of risky sexual behaviour and in Western Cape and Dar es Salaam to change sexual practices. Results from PREPARE will (i) identify modifiable cognitions and social processes related to risky sexual behaviour and (ii) identify promising intervention approaches among young adolescents in sub-Saharan cultures and contexts.

• Lien, Nanna; Haerens, L; Velde, SJ Te; Mercken, L; Klepp, Knut Inge & Moore, L [Vis alle 9 forfattere av denne artikkelen] (2014). Exploring subgroup effects by socioeconomic position of three effective school-based dietary interventions: The European TEENAGE project. International Journal of Public Health. ISSN 1661-8556. 59(3), s. 493–502. doi: 10.1007/s00038-013-0524-8. Fulltekst i vitenarkiv
• Bere, Elling; Klepp, Knut Inge & Øverby, Nina Cecilie (2014). Free school fruit: Can an extra piece of fruit every school day contribute to the prevention of future weight gain? A cluster randomized trial. Food & Nutrition Research (FNR). ISSN 1654-6628. 58. doi: 10.3402/fnr.v58.23194. Fulltekst i vitenarkiv Vis sammendrag

  Background: Several school fruit programs are initiated with the aim to improve diet and thereby contribute to reduce the prevalence of overweight. To date, no published studies have demonstrated that school fruit schemes do prevent overweight. Objective: The aim of the present study was to assess if increased consumption of fruits and vegetables, due to free school fruit, have an impact on future weight status. Design: An intervention study including 10- to 12-year-old children from nine schools in two Norwegian counties (Hedmark and Telemark) participating in the Norwegian School Fruit Program for free during the school year 2001/2002 and children from 29 control schools. Follow-up studies were performed in 2005 and 2009. The cohort includes 1950 pupils (984 boys, 966 girls) at baseline, 1,602 participants in 2005 and 320 participants in the 2009 survey, of which 282 also had participated in 2005. Results: In 2005, there was no significant difference between the free fruit group and the control group regarding weight status, Body mass index, or perceived weight status. In 2009, a significant difference in prevalence of overweight was observed (15% vs. 25%, p=0.04). In the crude logistic analysis, the OR for being overweight was 0.52 (95% CI: 0.28-0.97) for the intervention group compared to controls. When adjusting for school, sex, grade level and parental education, the association was no longer statistically significant. Conclusions: These results indicate that free school fruit might contribute to prevent future excessive weight gain. However, the study results are limited by low participation rate.

• Grydeland, May; Bergh, Ingunn Holden; Bjelland, Mona; Lien, Nanna; Andersen, Lene Frost & Ommundsen, Yngvar [Vis alle 8 forfattere av denne artikkelen] (2013). Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 10. doi: 10.1186/1479-5868-10-17. Fulltekst i vitenarkiv Vis sammendrag

  Background: Although school-based interventions to promote physical activity in adolescents have been suggested in several recent reviews, questions have been raised regarding the effects of the strategies and the methodology applied and for whom the interventions are effective. The aim of the present study was to investigate effects of a school-based intervention program: the HEalth in Adolescents (HEIA) study, on change in physical activity, and furthermore, to explore whether potential effects varied by gender, weight status, initial physical activity level and parental education level. Methods: This was a cluster randomized controlled 20 month intervention study which included 700 11-year-olds. Main outcome-variable was mean count per minute (cpm) derived from ActiGraph accelerometers (Model 7164/GT1M). Weight and height were measured objectively. Adolescents reported their pubertal status in a questionnaire and parents reported their education level on the consent form. Linear mixed models were used to test intervention effects and to account for the clustering effect of sampling by school. Results: The present study showed an intervention effect on overall physical activity at the level of p = 0.05 with a net effect of 50 cpm increase from baseline to post intervention in favour of the intervention group (95% CI -0.4, 100). Subgroup analyses showed that the effect appeared to be more profound among girls (Est 65 cpm, CI 5, 124, p = 0.03) and among participants in the low-activity group (Est 92 cpm, CI 41, 142, p < 0.001), as compared to boys and participants in the high-activity group, respectively. Furthermore, the intervention affected physical activity among the normal weight group more positively than among the overweight, and participants with parents having 13--16 years of education more positively than participants with parents having either a lower or higher number of years of education. The intervention seemed to succeed in reducing time spent sedentary among girls but not among boys. Conclusions: A comprehensive but feasible, multi-component school-based intervention can affect physical activity patterns in adolescents by increasing overall physical activity. This intervention effect seemed to be more profound in girls than boys, low-active adolescents compared to high-active adolescents, participants with normal weight compared to the overweight, and for participants with parents of middle education level as opposed to those with high and low education levels, respectively. An implementation of the HEIA intervention components in the school system may have a beneficial effect on public health by increasing overall physical activity among adolescents and possibly among girls and low-active adolescents in particular.

• Totland, Torunn Holm; Lien, Nanna; Bergh, Ingunn Holden; Bjelland, Mona; Gebremariam, Mekdes & Klepp, Knut Inge [Vis alle 7 forfattere av denne artikkelen] (2013). The relationship between parental education and adolescents’ soft drink intake from the age of 11–13 years, and possible mediating effects of availability and accessibility. British Journal of Nutrition. ISSN 0007-1145. 110(5), s. 926–933. doi: 10.1017/S0007114512005946. Fulltekst i vitenarkiv
• Franchini, Bela; Poinhos, Rui; Klepp, Knut Inge & Almeida, Maria Daniel Vaz de (2013). Fruit and vegetables: intake and sociodemographic determinants among Portuguese mothers. Annals of Nutrition and Metabolism. ISSN 0250-6807. 63(1-2), s. 131–138. doi: 10.1159/000351987. Fulltekst i vitenarkiv
• Øverby, Nina Cecilie; Klepp, Knut Inge & Bere, Elling (2013). Changes in screen time activity in Norwegian children from 2001 to 2008: two cross sectional studies. BMC Public Health. 13. doi: 10.1186/1471-2458-13-80. Fulltekst i vitenarkiv Vis sammendrag

  Background: There has been an increase in screen-based communication, leading to concerns about the negative health effects of screen-based activities in children and adolescents. The present study aimed to (1) analyze changes in screen time activity in Norwegian children from 2001 to 2008, and (2) to analyze associations between the changes in screen time activity over time and sex, grade level and parental educational level. Methods: Within the project Fruits and Vegetables Make the Marks (FVMM), 1488 6th and 7th grade pupils from 27 Norwegian elementary schools completed a questionnaire including a question about time spent on television viewing and personal computer use in 2001 and 1339 pupils from the same schools completed the same questionnaire in 2008. Data were analyzed by multilevel linear mixed models. Results: The proportions of 6th and 7th grade pupils at the 27 schools that reported screen time activity outside school of 2 hours/day or more decreased from 55% to 45% (p<0.001) from 2001 to 2008 when adjusting for sex, grade level and parental education. The decrease was most evident in 6th graders (51% to 37%) and in children with highly educated parents (54% to 39%). Conclusion: The present study shows that there has been a marked reduction in screen time activity outside school in this group of Norwegian 10-12 year olds from 2001 to 2008.

• Totland, Torunn Holm; Gebremariam, Mekdes; Lien, Nanna; Bjelland, Mona; Grydeland, May & Bergh, Ingunn Holden [Vis alle 8 forfattere av denne artikkelen] (2013). Does tracking of dietary behaviours differ by parental education in children during the transition into adolescence? Public Health Nutrition (PHN). ISSN 1368-9800. 16(4), s. 673–682. doi: 10.1017/S1368980012003060. Fulltekst i vitenarkiv
• Bergh, Ingunn Holden; Bjelland, Mona; Grydeland, May; Lien, Nanna; Andersen, Lene Frost & Klepp, Knut Inge [Vis alle 8 forfattere av denne artikkelen] (2012). Mid-way and post-intervention effects on potential determinants of physical activity and sedentary behavior, results of the HEIA study - a multi-component school-based randomized trial. International Journal of Behavioral Nutrition and Physical Activity. 9. doi: 10.1186/1479-5868-9-63. Fulltekst i vitenarkiv Vis sammendrag

  Background: There is limited knowledge as to whether obesity prevention interventions are able to produce change in the determinants hypothesized to precede change in energy balance-related behaviors in young people. The aim of this study was to evaluate the effect of a multi-component intervention on a wide range of theoretically informed determinants of physical activity (PA) and sedentary behavior (SB). Moderation effects of gender, weight status and parental education level and whether the perceived intervention dose received influenced the effects were also explored. Methods: The HEIA study was a 20-month school-based, randomized controlled trial to promote healthy weight development. In total, 1418 11-year-olds participated at baseline and post-intervention assessment. Enjoyment, self-efficacy, perceived social support from parents, teachers and friends related to PA, perceived parental regulation of TV-viewing and computer/game-use and perceived social inclusion at schools were examined by covariance analyses to assess overall effects and moderation by gender, weight status and parental education, mid-way and post-intervention. Covariance analyses were also used to examine the role of intervention dose received on change in the determinants. Results: At mid-way enjoyment (p = .03), perceived social support from teachers (p = .003) and self-efficacy (p = .05) were higher in the intervention group. Weight status moderated the effect on self-efficacy, with a positive effect observed among the normal weight only. At post-intervention results were sustained for social support from teachers (p = .001), while a negative effect was found for self-efficacy (p = .02). Weight status moderated the effect on enjoyment, with reduced enjoyment observed among the overweight. Moderation effects for parental education level were detected for perceived social support from parents and teachers. Finally, positive effects on several determinants were observed among those receiving a high as opposed to a low intervention dose. Conclusion: The intervention affected both psychological and social-environmental determinants. Results indicate that social support from teachers might be a potential mediator of PA change, and that overweight adolescents might be in need of specially targeted interventions to avoid reducing their enjoyment of PA. Further studies should continue to assess how intervention effectiveness is influenced by the participants’ self-reported dose of intervention received.

• Mathews, Cathy; Aarø, Leif Edvard; Grimsrud, Anna; Flisher, Alan J.; Kaaya, Sylvia & Onya, Hans [Vis alle 10 forfattere av denne artikkelen] (2012). Effects of the SATZ teacher-led school HIV prevention programmes on adolescent sexual behaviour: cluster randomised controlled trials in three sub-Saharan African sites. International Health. ISSN 1876-3413. 4(2), s. 111–122. doi: 10.1016/j.inhe.2012.02.001. Fulltekst i vitenarkiv
• Kvaavik, Elisabeth; Glymour, Maria; Klepp, Knut Inge; Tell, Grethe S & Batty, G. David (2012). Parental education as a predictor of offspring behavioural and physiological cardiovascular disease risk factors. European Journal of Public Health. ISSN 1101-1262. 22(4), s. 544–550. doi: 10.1093/eurpub/ckr106. Fulltekst i vitenarkiv
• Franchini, B.; Poinhos, R.; Klepp, Knut Inge & Almeida, M.D.V. de (2012). Contribution of vegetable soup to total vegetables intake and its determinants among mothers in Portugal. British Food Journal. ISSN 0007-070X. 114(8-9), s. 1325–1338. doi: 10.1108/00070701211258853. Fulltekst i vitenarkiv
• Grydeland, May; Bergh, Ingunn Holden; Bjelland, Mona; Lien, Nanna; Andersen, Lene Frost & Ommundsen, Yngvar [Vis alle 8 forfattere av denne artikkelen] (2012). Correlates of weight status among Norwegian 11-year-olds: The HEIA study. BMC Public Health. 12. doi: 10.1186/1471-2458-12-1053. Fulltekst i vitenarkiv Vis sammendrag

  Background: The underlying mechanisms of overweight and obesity in adolescents are still not fully understood. The aim of this study was to investigate modifiable and non-modifiable correlates of weight status among 1103 Norwegian 11-year-old adolescents in the HEalth in Adolescents (HEIA) study, including demographic factors such as gender and parental education, and behavioral factors such as intake of sugar-sweetened beverages, snacks and breakfast consumption, watching TV and playing computer games, physical activity and sedentary time. Methods: Weight and height were measured objectively, body mass index (BMI) was calculated and International Obesity Task Force cut-offs were used to define weight status. Physical activity and sedentary time were measured by accelerometers. Other behavioral correlates and pubertal status were self-reported by questionnaires. Parental education was reported by the parents on the consent form for their child. Associations were investigated using logistic regressions. Results: There were gender differences in behavioral correlates of weight status but not for weight status itself. Adolescents with parents in the highest education category had a 46% reduced odds of being overweight compared to adolescents with parents in the lowest education category. Adolescents with parents with medium education had 42% lower odds of being overweight than adolescents with parents with the lowest education category. Level of parental education, breakfast consumption and moderate to vigorous physical activity were positively associated with being normal weight, and time watching TV was positively associated with being overweight for the total sample. Gender differences were detected; boys had a doubled risk of being overweight for every additional hour of watching TV per week, while for girls there was no association. Conclusions: The present study showed a social gradient in weight status in 11-year-olds. Both breakfast consumption and moderate to vigorous physical activity were inversely associated with weight status. No associations were found between intake of sugar-sweetened beverages and snacks, playing computer games and weight status. Watching TV was positively associated with weight status for boys but not for girls. Interventions are needed to gain more insight into the correlates of change in weight status.

• Øverby, Nina Cecilie; Klepp, Knut Inge & Bere, Elling (2012). Introduction of a school fruit program is associated with reduced frequency of consumption of unhealthy snacks. American Journal of Clinical Nutrition. ISSN 0002-9165. 96(5), s. 1100–1103. doi: 10.3945/ajcn.111.033399. Fulltekst i vitenarkiv

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• Klepp, Knut Inge; Skogen, Jens Christoffer & Aarø, Leif Edvard (2023). Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISBN 9788205584181. 394 s. Fulltekst i vitenarkiv
• Klepp, Knut Inge & Aarø, Leif Edvard (2017). Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISBN 9788205463981. 421 s. Fulltekst i vitenarkiv

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• Meltzer, Helle Margrete; Meyer, Haakon Eduard; Andersen, Lene Frost; Torheim, Liv Elin & Klepp, Knut-Inge (2025). Oppdatert: Fra hypotese til kostråd – veier, snarveier og blindveier. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 23(2), s. 79–89. doi: 10.18261/ntfe.23.2.4. Fulltekst i vitenarkiv Vis sammendrag

  Få fagfelt får mer medieoppmerksomhet enn kosthold og ernæring, og få fagfelt har flere selvoppnevnte eksperter. Mange blir forvirret i jungelen av kostråd, som via media kan virke vidt forskjellige. I pressen blir gjerne resultater fra enkeltstudier slått stort opp uten å bli vurdert i lys av øvrig kunnskap innen faget. Nye hypoteser kan begeistre både leg og lærd, men veien er som regel lang frem til en veldokumentert konklusjon og offisielle råd til befolkningen. Et funn må alltid vurderes mot den totale kunnskapen innen emnet før konklusjoner kan trekkes. Det har vært arbeidet både nasjonalt og internasjonalt for å finne frem til en felles forståelse av hvilke minstekrav man bør ha til dokumentasjon før kostråd gis. I denne artikkelen beskrives generelle trekk i prosessen som fører frem til offisielle kostråd i Norge.

• Klepp, Knut Inge (2024). Developing tools for food system transformaiton, including food summary scores for nutrition and sustainability - The NewTools project. Fulltekst i vitenarkiv
• Lund-Iversen, Kaja; Løvhaug, Anne Lene; Helleve, Arnfinn; Meltzer, Helle Margrete; Abel, Marianne Hope & Olsen, Hanne Fjerdingby [Vis alle 9 forfattere av denne artikkelen] (2024). Engagement and involvement of partners in a collaborative research project for a sustainable food system – experiences from NewTools. Fulltekst i vitenarkiv
• Aarø, Leif Edvard; Åstrøm, Anne-Kristine N & Klepp, Knut Inge (2023). Hva former ungdoms helserelaterte atferd, Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205584181. Fulltekst i vitenarkiv
• Helleve, Arnfinn; Flodgren, Gerd Monika; Blanchard, Laurence; Fismen, Anne-Siri; Rutter, Harry & Mathisen, Jonas Rekdal [Vis alle 7 forfattere av denne artikkelen] (2023). Youth involvement in policy processes in public health, education, and social work: Protocol for a scoping review. Obesity Reviews. ISSN 1467-7881. 24(S1). doi: 10.1111/obr.13544. Fulltekst i vitenarkiv
• Fismen, Anne-Siri; Arnfinn, Helleve,; Klepp, Knut Inge; Rutter, Harry; Mathisen, Jonas Rekdal & Vlad, Ioana [Vis alle 8 forfattere av denne artikkelen] (2022). Pilot test of the NOURISHING policy index-Assessing governmental nutrition policies in five European countries. Fulltekst i vitenarkiv
• Fismen, Anne-Siri; Arnfinn, Helleve,; Vlad, Ioana; Oldridge-Turner, Kate; Klepp, Knut Inge & Rutter, Harry (2022). A pilot study benchmarking physical activity policy actions in Europe: Lessons learned from the CO-CREATE project. Fulltekst i vitenarkiv
• Fismen, Anne-Siri; Helleve, Arnfinn; Klepp, Knut Inge; Mathisen, Jonas Rekdal; Rutter, Harry & Vlad, Ioana [Vis alle 10 forfattere av denne artikkelen] (2022). Pilot test of the NOURISHING policy index-Assessing governmental nutrition policies in five European countries. Fulltekst i vitenarkiv
• Bernhoft, Aksel; Andersen, Elise Regine; Bardalen, Arne; Birkemoe, Tone; Brantsæter, Anne Lise & Gjein, Harald Johannes [Vis alle 14 forfattere av denne artikkelen] (2022). Hvordan produsere nok sunn og trygg mat i samsvar med FNs bærekraftsmål? Harvest Magazine. Fulltekst i vitenarkiv
• Klepp, Knut Inge (2022). Hvordan gjøre det lettere for forbrukerne å velge bærekraftig mat? Fulltekst i vitenarkiv
• Klepp, Knut Inge (2021). Ungdom og kriser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(13). doi: 10.4045/tidsskr.21.0637. Fulltekst i vitenarkiv
• Fismen, Anne-Siri; Helleve, Arnfinn; Samdal, Oddrun; Smith, Robert; Haug, Ellen Merethe Melingen & Chatelan, Angeline [Vis alle 14 forfattere av denne artikkelen] (2021). Cross-national variation of the association between family structure and BMI: findings from the Health Behaviour in School-aged Children (HBSC) study. Fulltekst i vitenarkiv
• Klepp, Knut Inge; Hildonen, Christina & Andersen, Lene Frost (2017). Ungdom, kosthold og ernæring. I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 235–254. Fulltekst i vitenarkiv
• Klepp, Knut Inge & Lien, Nanna (2017). Overvekt og fedme: den tunge folkehelseutfordringen. I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 255–270. Fulltekst i vitenarkiv
• Klepp, Knut Inge; Stigen, Ole Trygve & Aarø, Leif Edvard (2017). Folkehelse og folkehelsearbeid blant barn og unge i Norge. I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 17–37. Fulltekst i vitenarkiv
• Aarø, Leif Edvard & Klepp, Knut Inge (2017). Hva former vår helserelaterte atferd? I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 38–62. Fulltekst i vitenarkiv
• Rossow, Ingeborg & Klepp, Knut Inge (2017). Rusmiddelforebyggende arbeid. I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 152–167. Fulltekst i vitenarkiv
• Helleve, Arnfinn & Klepp, Knut Inge (2017). Trådlaus og sårbar ungdom? Helserelevansen ved bruken av sosiale medium. I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 399–410. Fulltekst i vitenarkiv
• Aarø, Leif Edvard & Klepp, Knut Inge (2017). Bruk av tobakk: et tilbakelagt kapittel? I Klepp, Knut Inge & Aarø, Leif Edvard (Red.), Ungdom, livsstil og helsefremmende arbeid. Gyldendal Akademisk. ISSN 9788205463981. s. 185–207. Fulltekst i vitenarkiv
• Rønnestad, Jannike; Stea, Tonje Holte; Vik, Frøydis Nordgård; Klepp, Knut Inge & Bere, Elling (2017). One year of free school fruit. Results on unhealthy snacks fifteen years later. Fulltekst i vitenarkiv
• Tveter, ElineTønnesson; Stea, Tonje Holte; Velde, Saskia J. te; Vik, Frøydis Nordgård; Klepp, Knut Inge & Bere, Elling (2017). One year of free school fruit. Results on weight status of two generations fifteen years later, 15 years later. Fulltekst i vitenarkiv
• Bolt-Evensen, Kathrine; Vik, Frøydis Nordgård; Stea, Tonje Holte; Klepp, Knut Inge & Bere, Elling (2017). Consumption of artificially sweetened beverages from childhood to adulthood. Fulltekst i vitenarkiv
• Rennestraum, Kjersti Hovland; Stea, Tonje Holte; Vik, Frøydis Nordgård; Klepp, Knut Inge & Bere, Elling (2017). One year of free school fruit. Results on fruit and vegetable intake, 15 years later. Fulltekst i vitenarkiv
• Valle, Ann-Karin; Røysamb, Espen & Klepp, Knut Inge (2014). Positive Emotions, Sexual Self-Concepts and Contraceptive use among adolescent girls in Norway. Fulltekst i vitenarkiv
• Hausken-Sutter, Solveig Elisabeth Sand; Bjelland, Mona; Bergh, Ingunn Holden; Grydeland, May; Klepp, Knut Inge & Andersen, Lene Frost [Vis alle 8 forfattere av denne artikkelen] (2013). Changes in adolescents’ intake of sugar-sweetened beverages, fruit and vegetables after 20-months: results from the HEIA study – a comprehensive, multi-component school-based randomized trial. Fulltekst i vitenarkiv
• Totland, Torunn Holm; Lien, Nanna; Bergh, Ingunn Holden; Bjelland, Mona; Gebremariam, Mekdes Kebede & Klepp, Knut Inge [Vis alle 7 forfattere av denne artikkelen] (2013). Prediction of parental education on adolescents’ soft drink intake, and mediation effects of availability and accessibility at home. Fulltekst i vitenarkiv
• Grydeland, May; Bjelland, Mona; Anderssen, Sigmund Alfred; Klepp, Knut Inge; Bergh, Ingunn Holden & Andersen, Lene Frost [Vis alle 8 forfattere av denne artikkelen] (2013). Intervention effect on BMI in adolescent girls: The HEalth in Adolescents (HEIA) Study – A school-­based two-­year cluster randomized trial. Fulltekst i vitenarkiv
• Bastien, Sheri; Wubs, Annegreet Gera; Onya, Hans; Masatu, Melkiori C.; Helleve, Arnfinn & Klepp, Knut Inge (2012). Forced sex and HIV risk behaviors among secondary school students in South Africa and Tanzania. Fulltekst i vitenarkiv
• Velde, S te; Veerman, S.; Tak, Nannah I.; Bosmans, J.; Klepp, Knut Inge & Brug, J. (2012). Long term health outcomes and cost-effectiveness of two dietary school-based interventions among 11-year-old children. Psychology and Health. ISSN 0887-0446. 27, s. 127–128. Fulltekst i vitenarkiv
• Aarø, Leif Edvard; Vedaa, Øystein; Bruun, Tone; Nilsen, Thomas Sevenius; Johansen, Rune & Knapstad, Marit [Vis alle 8 forfattere av denne artikkelen] (2021). Koronaatferd og landbakgrunn i fire fylker. Etterlevelse og holdninger til offisiellesmittevernråd, opplevd engstelse, psykiske plager og endringer i sosiale kontakter etter landbakgrunn. Resultater fra undersøkelser i fire fylker under koronapandemien. Folkehelseinstituttet. ISSN 9788284062020. Fulltekst i vitenarkiv Vis sammendrag

  Hovedbudskap • Analyser presentert i denne rapporten viser at selvrapportert koronarelatert atferd kan deles inn i to brede grupper: (i) Koronahygiene og (ii) Sosial distanse. • En inndeling av land for å beskrive innvandreres landbakgrunn basert på Verdensbankens gruppering av land etter inntektsnivå ble funnet mest hensiktsmessig å benytte i dette materialet. Dette fordi de alternative måtene å dele inn land på ikke gav vesentlig ekstra informasjon og fordi Verdensbankens inndeling gir færre og større grupper og dermed mer presise estimater. • De som var født i lav- eller middelinntektsland rapporterte gjennomsnittlig en bedre koronahygiene enn de som var født i Vest-Europa eller rike land utenom Vest-Europa. Lav deltakelse blant de som er født i lav- og middelinntektsland gjør at vi ikke uten videre kan generalisere ut over det foreliggende materialet. • Når det gjelder det å holde avstand til andre (sosial distanse), rapporterte de som var født i lav- og middelinntektsland generelt like god etterlevelse som de øvrige gruppene. Lav deltakelse blant de som er født i lav- og middelinntektsland gjør at vi heller ikke her uten videre kan generalisere ut over det foreliggende materialet. • På de to enkeltutfallsmålene, «Har latt være å håndhilse eller klemme (andre enn mine nærmeste)» og «Har unngått å ta kollektivtransport», var det imidlertid en klar forskjell i favør av de som kom fra rike land. Blant de som var født i rike land var det høyere andeler som (i) alltid hadde latt være å håndhilse eller klemme (bort sett fra sine nærmeste) og (ii) alltid hadde unngått kollektivtransport. • De som hadde en landbakgrunn med høy forekomst av smitte og sykehusinnleggelser (dvs. Afghanistan, Irak, Pakistan, Somalia eller Tyrkia), ble skilt ut som egen gruppe og sammenlignet med de som var født i Norge og hadde norske foreldre. Blant de som var født i Norge og hadde norske foreldre var det høyere andeler som (i) alltid hadde latt være å håndhilse eller klemme (bort sett fra sine nærmeste) og (ii) alltid hadde unngått kollektivtransport. • Oppslutningen om myndighetenes koronatiltak var høy i alle grupper. Imidlertid var alle de gruppene som hadde en ikke-norsk landbakgrunn mer enige enn de som var født i Norge av norske foreldre i at myndighetene har grepet for sterkt inn med sine koronatiltak. Dette gjaldt også de som hadde en landbakgrunn assosiert med høye smittetall. • I alle grupper ble det rapportert om en økning i bruk av digitale medier, en sterk reduksjon i samvær med andre innendørs (besøk, kaféer, restauranter) og en reduksjon i samvær med andre utendørs. Nedgangen i samvær med andre utendørs var særlig sterkt blant de som kom fra lavinntekts- og middelinntektsland. • Sammenlignet med de som var født i Norge, Norden eller Vest-Europa, hadde de som var født i lav- eller middelinntektsland høyere skår på «Pessimisme og problemer med nattesøvnen» og på psykiske plager. Det samme gjaldt de som hadde en landbakgrunn assosiert med høye smittetall. Selv om analyser av seleksjon internt i materialet ikke gav holdepunkter for seleksjonseffekter, vet vi lite om hvordan en høyere deltakelse ville endret resultatene fra undersøkelsen. Det er nødvendig med nye undersøkelser der en sikrer en mye høyere deltakelse av utenlandsfødte fra mellom- og lavinntektsland før en kan si noe sikrere om koronaatferd og beslektede utfallsmål i disse gruppene.

• Klepp, Knut Inge; Lund-Blix, Nicolai Andre; Nystad, Wenche; Ekelund, Ulf; Andersen, SA & Belander, O [Vis alle 7 forfattere av denne artikkelen] (2017). Nasjonale landsrepresentative kartlegginger av fysisk aktivitet, fysisk form og tid i ro. Rapport fra arbeidsgruppen mars 2017. Folkehelseinstituttet. ISSN 9788280828453. Fulltekst i vitenarkiv

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