To investigate clustering of risk behaviours in adolescents with excess weight.
Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption ...(fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and weekend days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographic data was collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure: multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression.
French PRALIMAP-INÈS trial.
Adolescents with excess weight.
A total of 1391 participants (13-18 years old, 58·2 % female) were included in the analysis, which resulted in the identification of four groups of participants, including, respectively, 543 (39·0 %), 373 (26·8 %), 246 (17·7 %) and 229 (16·5 %) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership.
Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.
Social differences among adolescents in physical activity and sedentary behaviour have been identified but are not well explained. The current study aimed to identify socioeconomic, family and ...school-related associated factors with physical activity and sedentary behaviour among high-school adolescents.
This was a cross-sectional analysis of T0 physical activity and sedentary behaviour of 2523 students 14 - 18 years old recruited for the PRALIMAP trial from 24 French state-run high schools. Data were collected by self-administered questionnaire at the start of grade 10. Adolescents completed the International Physical Activity Questionnaire for physical activity and sedentary behaviour and an ad hoc questionnaire for active commuting and sport participation. Statistical analyses involved linear and logistic regressions.
Socioeconomic, family or school variables were associated with levels of physical activity and sedentary behaviour for both boys and girls, but no factor, except perceived parental physical activity level, was associated with total energy expenditure (total physical activity) for either gender. Adolescents with privileged and less privileged socioeconomic status reported the same total amount of energy expenditure.
Total physical activity score alone is not sufficient to assess the physical activity of adolescents. These findings may have implications for better understanding of social inequalities in this context and recommendations to prevent overweight.
This trial is registered at ClinicalTrials.gov ( NCT00814554 ). The date of registration: 23 December 2008. Registration was not required at the time of the start of PRALIMAP for public health and prevention programmes and trials.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Despite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate ...whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents. Methods PRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs. Inclusion results The written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced. Discussion The PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school. Trial registration ClinicalTrials.gov (NCT01688453).
Although the outcomes of health promotion and prevention programmes may depend on the level of intervention, studies and trials often fail to take it into account. The objective of this work was to ...develop a framework within which to consider the implementation of interventions, and to propose a tool with which to measure the quantity and the quality of activities, whether planned or not, relevant to the intervention under investigation. The framework and the tool were applied to data from the diet and physical activity promotion PRALIMAP trial.
A framework allowing for calculation of an intervention dose in any health promotion programme was developed. A literature reviews revealed several relevant concepts that were considered in greater detail by a multidisciplinary working group. A method was devised with which to calculate the dose of intervention planned and that is actually received (programme-driven activities dose), as well as the amount of non-planned intervention (non-programme-driven activities dose).
Indicators cover the roles of all those involved (supervisors, anchor personnel as receivers and providers, targets), in each intervention-related groups (IRG: basic setting in which a given intervention is planned by the programme and may differ in implementation level) and for every intervention period. All indicators are described according to two domains (delivery, participation) in two declensions (quantity and quality). Application to PRALIMAP data revealed important inter- and intra-IRG variability in intervention dose.
A literature analysis shows that the terminology in this area is not yet consolidated and that research is ongoing. The present work provides a methodological framework by specifying concepts, by defining new constructs and by developing multiple information synthesis methods which must be introduced from the programme's conception. Application to PRALIMAP underlined the feasibility of measuring the implementation level. The framework and the tool can be used in any complex programme evaluation. The intervention doses obtained could be particularly useful in comparative trials.
PRALIMAP is registered at ClinicalTrials.gov under NCT00814554.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Overweight and Obesity Prevention for Adolescents Bonsergent, Emilie, MSc; Agrinier, Nelly, MD; Thilly, Nathalie, PhD ...
American journal of preventive medicine,
2013, January 2013, 2013-1-00, 2013-01, Letnik:
44, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Background Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority. Purpose To evaluate the 2-year effectiveness of ...three strategies aimed at preventing overweight and obesity among adolescents in a high school setting. Design PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006–2009 and analyzed in 2009–2011. Setting/participants A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial. Interventions The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of “healthy” dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management). Main outcomes measures The main outcome of interest was BMI; BMI z -score and prevalence of overweight/obesity were considered as secondary outcomes. Results Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI ( p =0.0303); a 0.04 greater decrease in BMI z -score ( p =0.0173); and a 1.71% greater decrease in overweight/obesity prevalence ( p =0.0386). Education and environment strategies were not more effective than no strategy intervention. Conclusions Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small. Trial registration This study is registered at www.clinicaltrials.gov NCT00814554.
Given the increase in overweight and obesity prevalence in adolescents in the last decade, effective prevention strategies for these conditions in adolescents are urgently needed. The PRALIMAP ...(Promotion de l'ALImentation et de l'Activité Physique) trial aims to evaluate the effectiveness for these conditions of 3 health promotion strategies--educational, screening and environmental--applied singly or in combination in high schools over a 2-year intervention period.
PRALIMAP is a stratified 2 × 2 × 2 factorial cluster randomised controlled trial including 24 state high schools in Lorraine, northeastern France, in 2 waves: 8 schools in 2006 (wave 1) and 16 in 2007 (wave 2). Students entering the selected high schools in the 4 academic years from 2006 to 2009 are eligible for data collection. Interventional strategies are organized over 2 academic years. The follow-up consists of 3 visits: at the entry of grade 10 (T0), grade 11 (T1) and grade 12 (T2). At T0, 5,458 (85.7%) adolescents participated. The educational strategy consists of nutritional lessons, working groups and a final party. The screening strategy consists in detecting overweight/obesity and eating disorders in adolescents and proposing, if necessary, an adapted care management program of 7 group educational sessions. The environmental strategy consists in improving dietary and physical activity offerings in high schools and facilities, especially catering. The main outcomes are body size evolution over time, nutritional behaviour and knowledge, health and quality of life. An evaluation process documents how each intervention strategy is implemented in the schools and estimates the dose of the intervention, allowing for a per protocol analysis after the main intention-to-treat analysis.
PRALIMAP aims at improving the prevention and management of overweight and obesity in adolescents by translating current evidence into public health practice. Particular attention is paid to clustering, multiple factorials and long-term duration to address common pitfalls in health promotion trials. The results should inform how best to implement, in a school environment, effective nutrition prevention programs targeting adolescents who are at a point their lives when they develop responsibilities and empowerment for health attitude behaviours.
This trial is registered at ClinicalTrials.gov under NCT00814554.
Interventions aiming to reduce social inequalities of weight status in adolescents usually focus on lifestyle behaviours, but their effectiveness is limited. This study analysed the effect of ...achieving levels of dietary intake (DI) and/or physical activity (PA) guidelines on reducing social inequalities in weight status among adolescents. We included adolescents from the PRomotion de l'ALIMentation et de l'Activité Physique - INÉgalité de Santé (PRALIMAP-INÈS) trial with weight status data available at baseline and 1-year follow-up (n=1130). PA and DI were measured using the International Physical Activity Questionnaire and a validated food frequency questionnaire, respectively. We estimated the likelihood of a 1-year reduction in body mass index z-score (BMIz) and population risk difference (PRD) under hypothetical DI and PA levels and socioeconomic status using the parametric G-formula. When advantaged and less advantaged adolescents maintained their baseline DI and PA, we found social inequalities in weight status, with a PRD of a 1-year reduction in BMIz of -1.6% (-3.0%; -0.5%). These inequalities were not observed when less advantaged adolescents increased their proportion of achieving DI guidelines by 30% (PRD=2.2% -0.5%; 5.0%) unlike the same increase in PA (PRD= -3.9% -6.8%; -1.3%). Finally, social inequalities of weight status were not observed when levels of achievement of both PA and DI guidelines increased by 30% (PRD= 2.2% -0.5%; 4.0%). Enhancing DI rather than PA could be effective in reducing social inequalities in weight status among adolescents. Future interventions aiming to reduce these inequalities should mostly target DI to be effective.
Abstract
Background
If boys and girls are known to have different levels of quality of life (HRQoL), less is known about behavioural factors such as physical activity (PA), sedentary behaviour (SB) ...that can explain it. We aimed to analyse the mediation effect of PA and SB on the association of sex and HRQoL among adolescents.
Methods
2448 adolescents (1378, 56.3% of Girls) from the PRALIMAP trial with 2-year follow-up were included. HRQoL (physical, mental, social and general dimension scores; range 0-100), PA (walking, moderate vigorous and total) and SB (sitting time) were assessed using the Duke Health profile and the IPAQ questionnaires, respectively. The 2-year mean PA and SB were calculated and categorized into high or low PA (? 1hour/day) or SB (2 hours/day out of school). We conducted a mediation analysis to investigate the causal mechanism of gender (reference=Girls) on HRQoL through PA and SB by estimating total effect (TE), natural direct effect (NDE), natural indirect effects (NIE) as well as proportion mediated (PM: proportion of sex-HRQoL relationship mediated by PA or SB).
Results
The direct relationship of gender and HRQoL (NDE) was significant whatever the HRQoL dimension. When using vigorous PA as mediator, PM was estimated at 13.7% (TE:11.0 9.5 to 12.5; NIE:1.50.9 to 2.1), 19.4% (TE: 12.3 10.6 to 14.1; NIE: 2.4 1.6 to 3.1), 70.0% (TE:4.6 3.1 to 6.2 ; NIE: 3.3 2.5 to 4.0) and 25.6% (TE: 9.3 8.1 to 10.5; NIE:2.4 1.8 to 2.9) for physical, mental, social and general HRQoL, respectively. Similar but less important mediation effect was observed for moderate and walking PA. For Total PA, PM was estimated 7.0%, 8.7%, 47.4% and 14.7% for physical, mental, social and general HRQoL while for SB, the mediation was inverse and less important (PM: -1.5%, -1.4%, -2.0% and -1.5% for physical, mental, social and general HRQoL respectively).
Conclusion
HRQoL is significantly higher in boys compared to girls among adolescents and this difference is shown to be partially mediated by differences in PA practice, especially vigorous PA. Additionally to the impact of adolescent PA in preventing non-communicable diseases in adulthood, it can also enhance their well-being.
Background The directionality of the association of physical activity (PA) and sedentary behaviour (SB) with health-related quality of life (HRQoL) remains unknown in adolescents. This study aimed to ...investigate the association of 2-year cumulative level of PA and SB with HRQoL and the reverse association. Methods We included 1445 adolescents in France from a 2-year longitudinal study with three follow-up times (PRALIMAP trial). At each follow-up, adolescents completed the International Physical Activity Questionnaire for PA and SB and the Duke Health Profile for HRQoL. Statistical analyses involved linear and logistic regressions adjusted for socio-demographic characteristics. Results The cumulative number of times an adolescent achieved the PA recommendations during the 2 years was associated with better physical, mental, social and general HRQoL (p for trend <0.0001). In contrast, high SB predicted low HRQoL for most dimensions except social HRQoL (p = 0.12). Combining PA and SB, the effect of recommended PA on HRQoL was offset in part by high SB. In the reverse association, high HRQoL predicted high PA (overall, vigorous, moderate and recommended PA), but was not associated with SB. Conclusions The association between PA and HRQoL was cumulative and bidirectional among adolescents, whereas low HRQoL seemed to be a consequence of high SB rather than a cause (cumulative but not bidirectional). Promoting recommended PA and low SB may help improve HRQoL among adolescents, with a possible virtuous cycle with regard to PA.
Abstract
Background
Interventions promoting healthy behaviors such as physical activity are effective to prevent overweight and obesity among adolescents. Following such interventions, body ...satisfaction change could be discrepant with weight change (e.g. less body satisfaction while having lost weight), and decrease sustainability of behaviors in the long-term. This study aimed to describe the discrepancy between body satisfaction change and weight change among adolescents following a 2-year school-based intervention, and to identify associated sociodemographic factors.
Methods
Adolescents from the 2-year school-based ‘Promotion de l'Alimentation et de l'Activité Physique’ study conducted in northeastern France from 2006 to 2009 were included. Body satisfaction change was assessed using a self-administered questionnaire at the end of the study. Weight change was measured by the difference of body mass index z-score at end and start of the study. Discrepancy between body satisfaction change and weight change was described with cross-tabulations and weighted Cohen's kappa. Sociodemographic factors associated with discrepancy were determined by multivariate logistic regression models.
Results
Among the 3279 adolescents included (mean ± standard deviation age= 15.2±0.6 years), the proportion of discrepancy between body satisfaction change and weight change was 74.8% (pessimism= 41.6%; optimism= 33.2%). The weighted Cohen's kappa indicated high discrepancy (?= 0.09; 95% confidence interval 0.07; 0.11). The likelihood of discrepancy, especially pessimism was higher in boys than in girls (odds ratio= 1.44, 95% confidence interval 1.19; 1.74, p= .0002), and higher in adolescents with high socioeconomic status than in those with low socioeconomic status (odds ratio= 1.82; 95% confidence interval 1.20; 2.74, p= .004)
Conclusions
Discrepancy between body satisfaction change and weight change was high among school-aged adolescents with increased likelihood for boys and adolescents with high socioeconomic status. Body satisfaction change should be considered in overweight and obesity prevention interventions alongside body weight change, and could be used as an indicator of long-term behavior maintenance.
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