| 1. |
- Gustafsson, Jasmine, et al.
(författare)
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Role of early childhood educators' demographic characteristics and perceived work environment in implementation of a preschool health promotion intervention
- 2023
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Ingår i: Archives of Public Health. - : Springer Nature. - 0778-7367 .- 2049-3258. ; 81:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Research has indicated that the effectiveness of intervention programs is affected by how well these programs are implemented, but key gaps remain in our understanding of the factors that promote or inhibit implementation. This study examined how demographic characteristics and perceived work environment among early childhood educators were associated with implementation outcomes of the Increased Health and Wellbeing in Preschools (DAGIS) intervention, which was conducted as a cluster randomized trial.Methods: Participants included 101 educators from 32 intervention preschool classrooms. Data were analyzed at the classroom level, as the DAGIS intervention was delivered in preschool classrooms consisting of several educators instead of individual implementers. Linear regression was used to estimate the associations of educators' demographic characteristics and perceived work environment with different aspects of implementation (i.e., dose delivered; dose received - exposure; dose received - satisfaction; and perceived quality, as well as a total sum score based on these four dimensions). Municipality was controlled in the adjusted models.Results: Findings indicated that having a higher proportion of educators with a Bachelor's or Master's degree in education within the classroom was associated with higher dose received - exposure and higher total degree of implementation, and the significance of the models was unaffected by adjustment for municipality. Moreover, having a higher proportion of educators younger than 35 years within the classroom was associated with higher dose received - exposure. However, the association was non-significant when adjusted for municipality. No other educator factor (i.e., work experience in years and perceived support from coworkers, group work, and innovative climate) predicted implementation outcomes.Conclusions: Higher educational attainment and younger age among educators at the classroom level were associated with higher scores for some of the implementation outcomes. Educators' work experience in years at the current preschool and in early childhood education, support from coworkers, group work, and innovative climate were not significantly associated with any implementation outcomes. Future research should explore ways to improve educators' implementation of interventions aimed at promoting children's health behaviors.
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| 2. |
- Lehto, Reetta, et al.
(författare)
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Effects of the DAGIS randomized controlled trial on home environment and children's food consumption according to the degree of implementation
- 2022
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Combining process evaluation data with effectiveness data and examining the possible mediators of intervention effects elicits valuable knowledge about how and for whom these interventions are effective. The aim of this study was to examine whether the parental degree of implementation (DOI) of a home-involving preschool intervention affected children's food consumption via home mediators. Methods The five-month Increased Health and Wellbeing in Preschools (DAGIS) intervention involved 476 participating children aged 3-6 years and was conducted in 2017-2018. Parents reported children's food consumption (g/day) outside childcare hours, the availability of foods at home, role modelling of food consumption, and the norms related to food consumption. In addition, parents reported the extent to which they had implemented the intervention program at home. Mediation analyses were conducted to examine the effect of low and high DOI compared to control group on the change in children's consumption of fruit and vegetables (FV), sugary everyday foods, sugary treats, and sugar-sweetened beverages (SSB) via food availability in the home, parental role modelling and parental norms. Results Compared to the control group, there was a direct effect of a high DOI on diminishing consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No indirect effects were detected. In the high DOI group, a change in parental norm was associated with increased FV consumption showing an indirect effect (B 4.31, 95% CI 0.23, 10.59). In the low DOI group, there was an indirect effect via decreased food availability leading to decreased sugary everyday food consumption (B -2.17, 95% CI -5.09, -0.09). Conclusions Combining process evaluation and effectiveness data revealed a decrease in children's SSB consumption only in the high DOI group, as well as indirect effects on children's consumption of FV and sugary everyday foods. In order to gain more intervention effects, further studies are required in order to examine parental facilitators and barriers to the implementation of interventions and how to impact effectively the determinants of the targeted behavior.
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| 3. |
- Lehto, Reetta, et al.
(författare)
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The PRO GREENS intervention in Finnish schoolchildren : the degree of implementation affects both mediators and the intake of fruits and vegetables
- 2014
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Ingår i: British Journal of Nutrition. - 0007-1145 .- 1475-2662. ; 112:7, s. 1185-1194
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about the mediating effects of the determinants of fruit and vegetable (FV) intake in school-based interventions that promote FV intake, and few studies have examined the impact of the degree of implementation on the effects of an intervention. The present study examined whether the degree of implementation of an intervention had an effect on children's fruit or vegetable intake and determined possible mediators of this effect. The study is part of the European PRO GREENS intervention study which aimed to develop effective strategies to promote consumption of fruit and vegetables in schoolchildren across Europe. Data from 727 Finnish children aged 11 years were used. The baseline study was conducted in spring 2009 and the follow-up study 12 months later. The intervention was conducted during the school year 2009-2010. The effects were examined using multilevel mediation analyses. A high degree of implementation of the intervention had an effect on children's fruit intake. Knowledge of recommendations for FV intake and liking mediated the association between a high degree of implementation of the intervention and an increase in the frequency of fruit intake. Knowledge of recommendations for FV intake and bringing fruits to school as a snack mediated the association between a low degree of implementation of the intervention and an increase in the frequency of fruit intake. Overall, the model accounted for 34 % of the variance in the change in fruit intake frequency. Knowledge of recommendations acted as a mediator between the degree of implementation of the intervention and the change in vegetable intake frequency. In conclusion, the degree of implementation had an effect on fruit intake, and thus in future intervention studies the actual degree of implementation of interventions should be assessed when considering the effects of interventions.
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| 4. |
- Skaffari, Essi, et al.
(författare)
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Food consumption and nutrient intake of Finnish preschool children according to parental educational level
- 2024
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Ingår i: British Journal of Nutrition. - : Cambridge University Press. - 0007-1145 .- 1475-2662. ; 131:1, s. 113-122
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Tidskriftsartikel (refereegranskat)abstract
- We examined the association between parental educational level (PEL) and children’s food consumption and nutrient intake in a sample of Finnish 3- to 6-year-old preschoolers (n 811). The data were obtained from the cross-sectional DAGIS project, conducted in eight municipalities in Finland during 2015–2016. The food consumption and nutrient intake were assessed using food records. The highest educational level of the family was used as the indicator of socio-economic status. Differences in diet by PEL were analysed using a hierarchical linear model adjusted for energy intake. Compared with high PEL, low PEL was associated with a child’s lower consumption of fresh vegetables and salads, vegetarian dishes, berries, white bread, blended spread, skimmed milk and ice cream but higher consumption of milk with 1–1·5 % fat content, dairy-based desserts and sugar-sweetened soft drinks. Food consumption was also examined after disaggregating dishes into their ingredients. Low PEL was associated with lower consumption of vegetables, nuts and seeds, berries and fish but higher consumption of red meat. Children in the low PEL, compared with the high PEL group, had a lower intake of protein, fibre, EPA, DHA, vitamin D, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, potassium, phosphorous, Ca, Mg, Zn and iodine but a higher intake of fat and saturated, trans and MUFA. The observed diet-related disparities highlight the need for policy actions and interventions supporting healthy eating patterns such as high consumption of vegetables, nuts and berries in childhood, paying special attention to those with low PEL.
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| 5. |
- Vepsäläinen, Henna, et al.
(författare)
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How energy balance-related behaviours, temperament, stress and overweight associate : a cross-sectional study of Finnish preschoolers
- 2024
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 27:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to (1) examine the clustering of energy balance-related behaviours (EBRB) and (2) investigate whether EBRB clusters, temperament and hair cortisol concentration (HCC) associate with overweight.Design: We assessed food consumption using food records, screen time (ST) using sedentary behaviour diaries, sleep consistency and temperament (negative affectivity, surgency, effortful control) using questionnaires and HCC using hair samples. Accelerometers were used to assess physical activity (PA) intensities, sleep duration and sleep efficiency. Researchers measured each child's weight and height. We used finite mixture models to identify EBRB clusters and multilevel logistic regression models to examine the associations between EBRB clusters, temperament, HCC and overweight.Setting: The cross-sectional DAGIS survey, data collected in 2015-2016.Participants: Finnish 3-6-year-olds (n 864) recruited through preschools.Results: One-third of the participants were categorised into the cluster labelled 'Unhealthy diet, excessive screen time', characterised by unhealthy dietary choices (e.g. greater consumption of high-fat, high-sugar dairy products) and longer ST. Two-thirds were categorised into the second cluster, labelled 'Healthy diet, moderate screen time'. PA and sleep were irrelevant for clustering. Higher negative affectivity and lower effortful control associated with the 'Unhealthy diet, excessive screen time' cluster. EBRB clusters and HCC did not associate with overweight, but surgency was positively associated with overweight (OR = 1·63, 95 % CI 1·17, 2·25).Conclusions: Of the EBRB, food consumption and ST seem to associate. As temperament associates with EBRB clusters and overweight, tailored support acknowledging the child's temperament could be profitable in maintaining a healthy weight.
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| 6. |
- Lehto, Elviira, et al.
(författare)
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Do descriptive norms related to parents and friends predict fruit and vegetable intake similarly among 11-year-old girls and boys?
- 2015
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Ingår i: British Journal of Nutrition. - Cambridge, United Kingdom : Cambridge University Press. - 0007-1145 .- 1475-2662. ; 115:1, s. 168-175
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Tidskriftsartikel (refereegranskat)abstract
- We examined whether there are sex differences in children's fruit and vegetable (FV) intake and in descriptive norms (i.e. perceived FV intake) related to parents and friends. We also studied whether friends' impact is as important as that of parents on children's FV intake. Data from the PRO GREENS project in Finland were obtained from 424 children at the age 11 years at baseline. At baseline, 2009 children filled in a questionnaire about descriptive norms conceptualised as perceived FV intake of their parents and friends. They also filled in a validated FFQ that assessed their FV intake both at baseline and in the follow-up in 2010. The associations were examined with multi-level regression analyses with multi-group comparisons. Girls reported higher perceived FV intake of friends and higher own fruit intake at baseline, compared with boys, and higher vegetable intake both at baseline and in the follow-up. Perceived FV intake of parents and friends was positively associated with both girls' and boys' FV intake in both study years. The impact of perceived fruit intake of the mother was stronger among boys. The change in children's FV intake was affected only by perceived FV intake of father and friends. No large sex differences in descriptive norms were found, but the impact of friends on children's FV intake can generally be considered as important as that of parents. Future interventions could benefit from taking into account friends' impact as role models on children's FV intake.
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| 7. |
- Lehto, Elviira, 1953-, et al.
(författare)
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Mediation of parental educational level on fruit and vegetable intake among schoolchildren in ten European countries
- 2015
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Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 18:1, s. 89-99
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries.Design: Cross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses.Setting: Schools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden.Subjects: Eleven-year-old children (n 8159, response rate 72%) and their parents.Results: In five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents' education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree.Conclusions: Parental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.
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| 8. |
- Lehto, Elviira, et al.
(författare)
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Predicting gender differences in liking for vegetables and preference for a variety of vegetables among 11-year-old children
- 2015
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Ingår i: Appetite. - : Academic Press. - 0195-6663 .- 1095-8304. ; 95, s. 285-292
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Tidskriftsartikel (refereegranskat)abstract
- We studied the factors that predict liking for vegetables and preference for a variety of vegetables among schoolchildren. Additionally, we examined if there were gender differences in the predictors that explain the hypothesized higher scores in liking vegetables and preferences among girls. The data from the PRO GREENS project included 424 Finnish children (response rate 77%) aged 11 to 12. The children completed validated measures about social and environmental factors related to their liking for vegetables and preferences both at baseline 2009 and follow-up 2010. The associations were examined with regression and mediation analyses. The strongest predictors of both girls' and boys' liking and preferences were higher levels of eating vegetables together with the family, previous vegetable intake and a lower level of perceived barriers. Liking was additionally predicted by a lower level of parental demand that their child should eat vegetables. Girls reported higher levels of liking and preferences in the follow-up. This gender difference was mainly explained by girls' lower level of perceived barriers related to vegetable intake and girls' higher previous vegetable intake. Interventions that aim to increase the low vegetable intake among boys by increasing their liking for vegetables and preference for a variety of vegetables could benefit from targeting perceived barriers, namely boys' perception and values concerning the consumption of vegetables.
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| 9. |
- Lehto, Elviira, et al.
(författare)
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The ones with lowest fruit and vegetable intake benefitted of the intervention only moderately
- 2015
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Ingår i: Annals of Nutrition and Metabolism. - Basel : S. Karger. - 0250-6807 .- 1421-9697. - 9783318056310 ; 67:Suppl. 1, s. 360-361
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Infrequent fruit and vegetable (FV) intake is especially common among children with low parental educational level (PEL) and among boys.Objectives: Our aim was to examine whether a school-based intervention was efficient in increasing children’s FV intake especially among those whose FV intake is the lowest and which factors could explain the the group differences in the associations.Method / Design: In Finland 11-year-old (at baseline) children participated in the PRO GREENS intervention in winter 2009. In control schools were 424 and in intervention schools 386 children (response rate 77%). Children filled in validated food frequency questionnaire assessing FV intake (times/day) and a validated questionnaire about factors influencing FV intake (availability of FV, liking for FV, preferences, self-efficacy to eat FV, attitudes towards FV and knowledge of the recommendations) both at baseline May 2009 and follow-up May 2010. Parental educational level (low, middle, high) was reported by the parents. Associations were examined with linear regression and mediation analyses.Results: The intervention increased fruit intake among girls but not among boys. Intervention increased also children’s knowledge of the recommendations. Since knowledge had no impact on boys’ fruit intake, the increase in knowledge mediated only intervention’s effect on girls’ fruit intake. Intervention increased children’s fruit intake similarly in all PEL groups.Intervention increased vegetable intake only in the middle PEL group but no intervention effect was noted among children with low or high PEL. Knowledge, the only factor which mediated the intervention’s effect on children’s vegetable intake, could not explain PEL differences in the effectivity of the intervention.Conclusions: Increase in knowledge was not a sufficient prerequisite to increase FV intake among boys or the lowest PEL group. More in depth analyses are needed to find out which factors to target in interventions to reach an effect in the target groups.
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