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To examine energy drink consumption among adolescents in the UK and associations with deprivation and dietary inequalities.
Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis.
Quantitative data: nationally representative sample of 2587 adolescents aged 11–18 years. Qualitative data: 20 parents, 9 teachers and 28 adolescents from Hampshire, UK.
NDNS data showed adolescents’ consumption of energy drinks was associated with poorer dietary quality (OR 0·46 per sd; 95 % CI (0·37, 0·58); P < 0·001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1·40; 95 % CI (1·16, 1·69); P < 0·001; OR 0·98 per £1000; 95 % CI (0·96, 0·99); P < 0·001, respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (P = 0·04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents do not know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work.
This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents’ energy drink intake.
There is increasing interest in modelling longitudinal dietary data and classifying individuals into subgroups (latent classes) who follow similar trajectories over time. These trajectories could identify population groups and time points amenable to dietary interventions. This paper aimed to provide a comparison and overview of two latent class methods: group-based trajectory modelling (GBTM) and growth mixture modelling (GMM). Data from 2963 mother–child dyads from the longitudinal Southampton Women’s Survey were analysed. Continuous diet quality indices (DQI) were derived using principal component analysis from interviewer-administered FFQ collected in mothers pre-pregnancy, at 11- and 34-week gestation, and in offspring at 6 and 12 months and 3, 6–7 and 8–9 years. A forward modelling approach from 1 to 6 classes was used to identify the optimal number of DQI latent classes. Models were assessed using the Akaike and Bayesian information criteria, probability of class assignment, ratio of the odds of correct classification, group membership and entropy. Both methods suggested that five classes were optimal, with a strong correlation (Spearman’s = 0·98) between class assignment for the two methods. The dietary trajectories were categorised as stable with horizontal lines and were defined as poor (GMM = 4 % and GBTM = 5 %), poor-medium (23 %, 23 %), medium (39 %, 39 %), medium-better (27 %, 28 %) and best (7 %, 6 %). Both GBTM and GMM are suitable for identifying dietary trajectories. GBTM is recommended as it is computationally less intensive, but results could be confirmed using GMM. The stability of the diet quality trajectories from pre-pregnancy underlines the importance of promotion of dietary improvements from preconception onwards.
Large translational research initiatives can strengthen efficiencies and support science with enhanced impact when practical conceptual models guide their design, implementation, and evaluation. The National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) program brings together data from 72 ongoing maternal–child cohort studies – involving more than 50,000 children and over 1200 investigators – to conduct transdisciplinary solution-oriented research that addresses how early environmental exposures influence child health. ECHO uses a multi-team system approach to consortium-wide data collection and analysis to generate original research that informs programs, policies, and practices to enhance children’s health. Here, we share two conceptual models informed by ECHO’s experiences and the Science of Team Science. The first conceptual model illuminates a system of teams and associated tasks that support collaboration toward shared scientific goals. The second conceptual model provides a framework for designing evaluations for continuous quality improvement of manuscript writing teams. Together, the two conceptual models offer guidance for the design, implementation, and evaluation of translational and transdisciplinary multi-team research initiatives.
To identify the ways in which parental involvement can be incorporated into interventions to support adolescent health behaviour change.
Data from semi-structured interviews were analysed using inductive thematic analysis.
Southampton, Hampshire, UK.
A convenience sample of twenty-four parents of adolescents.
Parents consider themselves to play an important role in supporting their adolescents to make healthy choices. Parents saw themselves as gatekeepers of the household and as role models to their adolescents but recognised this could be both positive and negative in terms of health behaviours. Parents described the changing dynamics of the relationships they have with their adolescents because of increased adolescent autonomy. Parents stated that these changes altered their level of influence over adolescents’ health behaviours. Parents considered it important to promote independence in their adolescents; however, many described this as challenging because they believed their adolescents were likely to make unhealthy decisions if not given guidance. Parents reported difficulty in supporting adolescents in a way that was not viewed as forceful or pressuring.
When designing adolescent health interventions that include parental components, researchers need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents. Parental involvement in adolescent interventions could be helpful but needs to be done in a manner that is acceptable to both adolescents and parents. The findings of this study may be useful to inform interventions which need to consider the transitions and negotiations which are common in homes containing adolescents.
Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.
So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people’s logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.
Drawing on our team’s experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.
UK adolescents have poorer diets than other age groups. Improving adolescents’ diets has the potential to improve their health now and in later life, and the health of their future offspring. Established dietary assessment techniques can be difficult to use with adolescents due to high participant burdens. Robust and easy-to-implement techniques are required to assess adolescent diet in large-scale studies. This study aimed to identify the key indicator foods that contribute most to better quality dietary patterns in UK adolescents for use in a short food frequency questionnaire (FFQ).
Dietary data, collected using 4-day diet diaries, and nutritional biomarker data from waves 1–8 of the National Diet and Nutrition Survey rolling programme were used. Principal component analysis (PCA) was applied to 139 food groups to identify the key indicator foods that contribute most to better quality dietary patterns.
A 20-group diet score was calculated using coefficients for the 20 indicator foods from the 139-group PCA and multiplying by their standardised reported frequency of consumption. Scores were standardised to a mean of zero and a standard deviation (SD) of one.
The association and the agreement between the 139-group diet quality score and 20-group score were calculated using Spearman's correlation coefficient and Bland-Altman limits of agreement, respectively. Spearman's correlations were used to examine the associations between the two diet quality scores and nutritional biomarkers.
NDNS dietary data were available for 1282 boys and 1305 girls aged 11–18 years. The first PCA component explained 3.0% of variance in the dietary data. A high-quality diet was characterised by greater consumption of fruit, vegetables, beans and pulses, wholegrains, nuts, and tap water, plus lower consumption of sugar-sweetened beverages, chips, processed meats, white bread, crisps, whole milk, baked beans, and added sugar.
A correlation of 0.86 was observed between the full 139-group score and the 20-group score with the difference between being 0 SDs. Bland-Altman 95% limits of agreement were -0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between the 139-group score and all nutritional biomarkers (25-hydroxyvitamin D(rs = 0.14), vitamin C(rs = 0.30), total carotenoids(rs = 0.25), total serum folate(rs = 0.42), homocysteine(rs = -0.25) and vitamin B12(rs = 0.21)). Correlations with the 20-group score were only slightly attenuated.
The 20-group diet quality score showed reasonable agreement with the full 139-item score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in adolescents.
Introduction: Empirical evidence of the effects of product placement strategies on consumers’ dietary and purchasing behaviours is limited. A systematic review was conducted to collate the evidence, both observational and intervention, about how food and beverage product placement (availability and positioning) in food stores, influence dietary behaviours and sales.
Materials and Methods: Nine databases were systematically searched, using both MeSH and free text terms, for articles published between 2005 and February 2019. Titles and abstracts were screened by one reviewer. If eligible, two reviewers performed data extraction and assessed each article for risk of bias in relation to the research question based on predefined criteria according to guidelines from the Centre for Reviews and Dissemination. Results were synthesised using a vote counting technique which recorded the significance level and the direction of the effect in relation to the expected relationship with health improvement. This systematic review was registered with Prospero CRD: 42016048826.
Results: The search yielded 16,342 potential articles of which 38, 17 observational and 21 intervention articles, met the inclusion criteria. The heterogeneous nature of these studies meant meta-analyses were not possible.
Two observational studies were classified as having a high risk of bias, 6 moderate and 9 as low risk of bias. Two intervention studies were classified as having moderate risk of bias and the remaining 19 as high risk of bias.
For observation studies, six studies included sales outcomes, nine included diet outcomes and four included BMI outcomes. For intervention studies, 19 included sales outcomes, four included diet outcomes and one included BMI outcomes. 76 outcomes from observational studies and 89 outcomes from intervention studies were included in the vote counting synthesis. 76% of observational outcomes showed associations with placement strategies in the expected direction for health improvement with 41% being significant. 72% of intervention outcomes showed associations in the expected direction with 33% being significant.
Discussion: The evidence suggests food and beverage placement strategies in food stores have the potential to support healthier food-related behaviours. The difficulties in conducting high-quality intervention studies may be a contributing factor to the large number of non-significant results that have been published. This review provides evidence in support of the UK Government's updated Childhood Obesity Plan to restrict the prominent placement of unhealthy food in food stores.
Action to improve preconception nutrition is a collective, societal responsibility. We believe that the Developmental Origins of Health and Disease (DOHaD) society is ideally placed to facilitate the development of a global agenda for preconception nutrition which recognises the societal importance of nutrition for young women and men, and supports them in optimising their nutritional status for the benefit of the next generation. In this paper, we outline four key actions that can be taken by the members of DOHaDʼs international society located across 67 countries, and nine regional societies, to demonstrate this leadership role. The recommended actions to place preconception nutrition at the top of national and regional agendas include (i) continuing to build the scientific evidence, (ii) monitoring of progress made by governments and commercial companies, (iii) developing advocacy coalitions that unite individuals and organisations around common policy options and (iv) working with partners to develop an emotive and empowering preconception nutrition awareness campaign. Collectively, these actions hold the potential to develop into a preconception nutrition social movement to invoke high-level government support and across-sector policy action, while raising public demand for action and engaging corporate actors.
To explore associations between dietary quality and access to different types of food outlets around both home and school in primary school-aged children.
Cross-sectional observational study.
Children (n 1173) in the Southampton Women’s Survey underwent dietary assessment at age 6 years by FFQ and a standardised diet quality score was calculated. An activity space around each child’s home and school was created using ArcGIS. Cross-sectional observational food outlet data were overlaid to derive four food environment measures: counts of supermarkets, healthy specialty stores (e.g. greengrocers), fast-food outlets and total number of outlets, and a relative measure representing healthy outlets (supermarkets and specialty stores) as a proportion of total retail and fast-food outlets.
In univariate multilevel linear regression analyses, better diet score was associated with exposure to greater number of healthy specialty stores (β=0·025 sd/store: 95 % CI 0·007, 0·044) and greater exposure to healthy outlets relative to all outlets in children’s activity spaces (β=0·068 sd/10 % increase in healthy outlets as a proportion of total outlets, 95 % CI 0·018, 0·117). After adjustment for mothers’ educational qualification and level of home neighbourhood deprivation, the relationship between diet and healthy specialty stores remained robust (P=0·002) while the relationship with the relative measure weakened (P=0·095). Greater exposure to supermarkets and fast-food outlets was associated with better diet only in the adjusted models (P=0·017 and P=0·014, respectively).
The results strengthen the argument for local authorities to increase the number of healthy food outlets to which young children are exposed.
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