Skip to main content Accessibility help
×
Home

Mediators of the effectiveness of a kindergarten-based, family-involved intervention on pre-schoolers’ snacking behaviour: the ToyBox-study

  • Christina-Paulina Lambrinou (a1), Maartje M van Stralen (a2), Odysseas Androutsos (a1), Greet Cardon (a3), Marieke De Craemer (a3), Violeta Iotova (a4), Piotr Socha (a5), Berthold Koletzko (a6), Luis A Moreno (a7) (a8) and Yannis Manios (a1)...

Abstract

Objective

The present study aimed to explore the mediating role of family-related determinants on the effects of the ToyBox-intervention on pre-school children’s consumption of healthy and unhealthy snacks.

Design

The ToyBox-intervention was a kindergarten-based, family-involved intervention with a cluster-randomized design, aiming to promote healthy lifestyle behaviours to prevent obesity at pre-school age.

Setting

Kindergartens (n 309) in six European countries.

Subjects

A total of 6290 pre-schoolers and their families participated in the ToyBox-intervention in 2012–2013 and data from 5212 pre-schoolers/families were included in the current analyses.

Results

Even though the total effect of the ToyBox-intervention on healthy and unhealthy snacking was not significant, the ToyBox-intervention significantly improved parental rule setting on children’s unhealthy snack consumption (i.e. restriction of snacking while watching television and permission only at certain occasions) and parental consumption of unhealthy snacks, while it increased parental knowledge on snacking recommendations. Regarding healthy snacking, the ToyBox-intervention improved children’s attitude towards fruit and vegetables (F&V). All previously mentioned family-related determinants mediated the intervention effects on pre-schoolers’ consumption of healthy and unhealthy snacks. Almost all family-related determinants examined in the study were independently associated with pre-schoolers’ consumption of healthy and unhealthy snacks.

Conclusions

The intervention was effective in improving relevant family-related determinants. Interventions aiming to promote F&V consumption and limit the consumption of unhealthy snacks in pre-schoolers should target on these mediators, but also identify new family-, school- or peer-related determinants, to enhance their effectiveness.

Copyright

Corresponding author

*Corresponding author: Email manios@hua.gr

References

Hide All
1. Durao, C, Severo, M, Oliveira, A et al. (2015) Evaluating the effect of energy-dense foods consumption on preschool children’s body mass index: a prospective analysis from 2 to 4 years of age. Eur J Nutr 54, 835843.
2. Moschonis, G, Kalliora, AC, Costarelli, V et al. (2014) Identification of lifestyle patterns associated with obesity and fat mass in children: the Healthy Growth Study. Public Health Nutr 17, 614624.
3. World Health Organization (1990) Diet, Nutrition and the Prevention of Chronic Diseases. Joint WHO/FAO Expert Consultation . WHO Technical Report Series no. 916. Geneva: WHO.
4. Nicklas, T & Johnson, R (2004) Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years. J Am Diet Assoc 104, 660677.
5. Patterson, BH, Block, G, Rosenberger, WF et al. (1990) Fruit and vegetables in the American diet: data from the NHANES II survey. Am J Public Health 80, 14431449.
6. Dennison, BA, Rockwell, HL & Baker, SL (1998) Fruit and vegetable intake in young children. J Am Coll Nutr 17, 371378.
7. De Craemer, M, Lateva, M, Iotova, V et al. (2015) Differences in energy balance-related behaviours in european preschool children: the ToyBox-study. PLoS One 10, e0118303.
8. Kelder, SH, Perry, CL, Klepp, KI et al. (1994) Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. Am J Public Health 84, 11211126.
9. Lien, N, Lytle, LA & Klepp, KI (2001) Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21. Prev Med 33, 217226.
10. Whincup, PH, Gilg, JA, Papacosta, O et al. (2002) Early evidence of ethnic differences in cardiovascular risk: cross sectional comparison of British South Asian and white children. BMJ 324, 635.
11. Klesges, RC, Klesges, LM, Eck, LH et al. (1995) A longitudinal analysis of accelerated weight gain in preschool children. Pediatrics 95, 126130.
12. Moller, JH, Taubert, KA, Allen, HD et al. (1994) Cardiovascular health and disease in children: current status. A Special Writing Group from the Task Force on Children and Youth, American Heart Association. Circulation 89, 923930.
13. van Stralen, MM, te Velde, SJ, van Nassau, F et al. (2012) Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: a pooled analysis of six European studies. Obes Rev 13, Suppl. 1, 2941.
14. Bartholomew, LK, Parcel, GS & Kok, G (1998) Intervention mapping: a process for developing theory- and evidence-based health education programs. Health Educ Behav 25, 545563.
15. Manios, Y, Androutsos, O, Katsarou, C et al. (2014) Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study. Obes Rev 15, Suppl. 3, 513.
16. Pinket, AS, De Craemer, M, Huybrechts, I et al. (2016) Diet quality in European pre-schoolers: evaluation based on diet quality indices and association with gender, socio-economic status and overweight, the ToyBox-study. Public Health Nutr 19, 24412450.
17. Wilfley, DE, Kass, AE & Kolko, RP (2011) Counseling and behavior change in pediatric obesity. Pediatr Clin North Am 58, 14031424.
18. Manios, Y, Grammatikaki, E, Androutsos, O et al. (2012) A systematic approach for the development of a kindergarten-based intervention for the prevention of obesity in preschool age children: the ToyBox-study. Obes Rev 13, Suppl. 1, 312.
19. De Craemer, M, De Decker, E, De Bourdeaudhuij, I et al. (2013) Physical activity and beverage consumption in preschoolers: focus groups with parents and teachers. BMC Public Health 13, 278.
20. Androutsos, O, Katsarou, C, Payr, A et al. (2014) Designing and implementing teachers’ training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study. Obes Rev 15, Suppl. 3, 4852.
21. Huybrechts, I, De Backer, G, De Bacquer, D et al. (2009) Relative validity and reproducibility of a food-frequency questionnaire for estimating food intakes among Flemish preschoolers. Int J Environ Res Public Health 6, 382399.
22. Gonzalez-Gil, EM, Mouratidou, T, Cardon, G et al. (2014) Reliability of primary caregivers reports on lifestyle behaviours of European pre-school children: the ToyBox-study. Obes Rev 15, Suppl. 3, 6166.
23. MacKinnon, DP, Lockwood, CM & Williams, J (2004) Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav Res 39, 99.
24. Bekelman, TA, Bellows, LL & Johnson, SL (2017) Are family routines modifiable determinants of preschool children’s eating, dietary intake, and growth? A review of intervention studies. Curr Nutr Rep 6, 171189.
25. van Stralen, MM, Yildirim, M, te Velde, SJ et al. (2011) What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes (Lond) 35, 12511265.
26. Couch, SC, Glanz, K, Zhou, C et al. (2014) Home food environment in relation to children’s diet quality and weight status. J Acad Nutr Diet 114, 1569–1579.e1.
27. Freeman, R & Oliver, M (2009) Do school break-time policies influence child dental health and snacking behaviours? An evaluation of a primary school programme. Br Dent J 206, 619625.
28. Pinket, AS, De Craemer, M, Maes, L et al. (2016) Water intake and beverage consumption of pre-schoolers from six European countries and associations with socio-economic status: the ToyBox-study. Public Health Nutr 19, 23152325.

Keywords

Type Description Title
WORD
Supplementary materials

Lambrinou et al. supplementary material
Lambrinou et al. supplementary material 1

 Word (18 KB)
18 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed