Targeting and measuring family processes that influence energy balance-related behaviours in school-based obesity prevention interventions

This post doc-project aimed at targeting and measuring family processes that influence energy balance-related behaviours in school-based prevention interventions, evaluating the effects of one Norwegian and one European school-based intervention. The Norwegian HEIA study evaluated an intervention program targeting diet and physical activity among 11-13 year olds and their parents. The European study UP4FUN was a five weeks intervention in 10-12 year olds, including Norwegian children. The goal was to reduce and break up sitting time both at school and at home, and to find strategies for how to involve families. Finally, as part of the post doctor project, new questionnaires for measuring family processes potentially related to diet has been developed and tested in the "Family & Dietary habits" project in 440 13-15 year olds and their parents. From the start of the post doc-project (January 2012) to October 2015 in total 21 articles have been published with Bjelland as a co-author, in which 15 were based on results from the HEIA-project. Five of the articles included long-term effects of the HEIA-study on school children?s and their parents' diet and health, and the effects were analyzed by gender, socioeconomic status and/or parental involvement. Bjelland was the first author of one, the second author of three and the co-author of the rest. The intervention program in HEIA increased the overall physical activity in the intervention group; the effect appeared to be more profound among girls and participants in the low-activity group, The children who had been most exposed to the components had a more positive effect on enjoyment, self-efficacy, support from friends and opportunities for being physical active. The children in the intervention group ate fruit more often and had a lower intake of cordials with sugar compared to the control group, and the intake of cordials with sugar was less frequent in the intervention groups for those who had parents with low and medium level of education. The intervention may have increased the mothers' intake of fruit, and the vegetable intake among higher educated fathers. Effects were found for BMI (body mass index) and BMI z-scores in girls but not in boys, and for BMI among children who had parents with high educational level. An UP4FUN article has been published in 2015. This article was based on data from the first data collection in UP4FUN. The aim was to investigate the role of rules and supportive versus controlling parental communication style related to children's screen time. The presence of parental rules was significantly associated with less time watching TV/DVD and use of computer/games console time in children. Moreover, the use of a parental autonomy-supportive style was negatively related to both time watching TV/DVD and use of computer/games console time among the children. The use of a parental controlling style was related positively to children's perceived excessive time used on TV/DVD and excessive time used on computer/games console. With a few exceptions, the results were similar across the five countries. One methodology article was published in 2014 and one research article in 2016, based on the "Family & Dietary habits" project, with Bjelland as the first and last author, respectively. The conceptual framework described in the method article includes psychosocial concepts such as family functioning, cohesion, conflicts, communication, work-family stress, parental practices and parental style. The physical characteristics of the home environment include accessibility/availability of different food items, while family meals are the sociocultural setting included. Individual characteristics included are dietary intake (vegetables and sugar-sweetened beverages) and adolescents' impulsivity. The questionnaires developed were tested in a test-retest and in a cross-sectional survey including 440 adolescents, mothers and fathers. The samples appear to be relatively representative for Norwegian adolescents and parents, and the reliability of the variables studied was satisfactory. The results indicate that the questionnaires are useful tools to assess family characteristics and adolescent's impulsivity. More articles are in process. Two articles based on data from UP4FUN are submitted, with Bjelland as the second author and as a co-author; one including a process evaluation of the UP4FUN study and one examining if the influence of parental modelling on children?s physical activity and screen time differ by gender. Bjelland is also the last author of an article submitted based on data from the family-study, exploring the mediating role of adolescents? perceived accessibility and rules in the association between parental education and the intake of vegetables and sugar rich beverages in 13-15 year olds. Two manuscripts built on the family-study are in preparation with Bjelland as the last author, as well as a master thesis supervised by Bjelland.

Inconsistent effects of school-based obesity prevention interventions may be related to how different subgroups perceive and receive them. Gender, socio-economic status (SES) and degree of parental involvement seem to influence the effects of intervention s. To develop intervention strategies that improve energy balance-related behaviours (EBRB), more research is needed investigating mediating factors in the family and home environment. Such factors may be parent-child communication and parenting practices as elements of parenting styles. The primary objective is to evaluate school-based obesity prevention interventions by gender, SES and parental involvement, and to assess family processes influencing EBRB. This project will build on two data sets. The lo ngitudinal, school-based intervention study HEIA (HEalth In Adolescents), which was aimed at healthy weight development from age 11 to 15. The HEIA study includes objectively measured anthropometric data (weight, height, waist and hip circumference) as we ll as measurements of social environmental factors, which have both been scarce in this age group so far. In addition, both fathers and mothers reported on their educational level on the consent form, and their own anthropometrics and EBRB through questio nnaires. In the ENERGY project a 5 weeks intervention aiming to reduce sitting time among 10-12 year olds in Europe will be pilot tested in Norway, Germany, Belgium, Greece and Hungary. The intervention is school-based with a special emphasis on finding s trategies to involve families. Finally, two new instruments measuring family processes will be developed, covering parent-child communication, parenting practices, including parental monitoring and family democracy, which are linked to the parenting style of the mother and the father. This study will bring the obesity prevention research field forward assessing the role of family processes and EBRB in social inequalities.