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Knut-Inge Klepp

Publications and source records attributed to Knut-Inge Klepp.

At least 19 recordsLinked to original sources
PubMed2006

Determinants of fruit and vegetable intake among 11-year-old schoolchildren in a country of traditionally low fruit and vegetable consumption.

BACKGROUND: Fruit and vegetable consumption is traditionally low in Iceland. The results of the Pro Children cross-Europe survey showed that the consumption was lowest among children in Iceland. The aim of this study was to identify determinants of fruit and vegetable intake among 11-year-old schoolchildren in Iceland. METHODS: A cross-sectional survey was performed in Iceland in the autumn of 2003 as a part of the Pro Children cross-Europe survey. The survey was designed to provide information on actual consumption levels of vegetables and fruits by 11-year-old school children and to assess potential determinants of consumption patterns. A total of 1235 Icelandic children (89%) from 32 randomly chosen schools participated. Hierarchical regression analyses were performed to determine the explained variance of the children's fruit and vegetable intake. In these analyses socio-demographic background variables were entered as a first block, perceived physical-environmental variables as a second block, perceived socio-environmental variables as a third block and personal variables as a fourth block. RESULTS: 64% of the children ate fruit less than once a day, and 61% ate vegetables less than once a day. Respectively, 31% and 39% of the variance in children's fruit and vegetable intake was explained by the determinants studied. About 7% and 13% of the variance in fruit and vegetable intake was explained by the perceived physical-environmental determinants, mainly by availability at home. About 18% and 16% of the variance in fruit and vegetable intake was explained by the personal determinants. For both fruit and vegetable intake, the significant personal determinants were preferences, liking, knowledge of recommendations and self-efficacy. CONCLUSION: Interventions to increase fruit and vegetable intake among children should aim at both environmental factors such as greater availability of fruit and vegetables, and personal factors as self-efficacy and knowledge levels concerning nutrition.

Journal Article↗
PubMed2006

Personal, social and environmental correlates of vegetable intake in normal weight and overweight 9 to 13-year old boys.

BACKGROUND: The first aim of the present study was to investigate differences in correlates of vegetable intake between the normal weight and the overweight boys in the Pro Children Cross Sectional Study. The second aim was to explore whether the association between vegetable intake and potential correlates is different in overweight boys compared with normal weight boys. METHODS: Random samples of mainly 11-year old children were recruited in 9 European countries. The total sample size consisted of 3960 boys (16.5% overweight). A validated self-report questionnaire was used to measure vegetable intake, and personal, social and environmental factors related to vegetable intake in the classroom. Weight and height were reported by the parents of the children in parents' questionnaires. RESULTS: Regression analyses explained 23% to 28% of the variance in vegetable intake by potential correlates. Liking, self-efficacy and bringing vegetables to school were related to intake in both normal weight and overweight boys (beta's>0.10). Active parental encouragement and availability at home was only related to intake in overweight boys (beta's>0.10), whereas knowledge about recommendations was only related to vegetable consumption in normal weight boys (beta>0.10) CONCLUSION: Intervention strategies to increase vegetable intake should focus on increase in liking and preferences, increase in self-efficacy, and increase in bringing vegetables to school in both normal weight and overweight boys. Further research should investigate whether advising parents of overweight boys to encourage their child to eat vegetables every day, to insist as far as possible that their child eats vegetables regularly and to make vegetables easily available at home is effective in changing vegetable intake.

Journal Article↗
PubMed2006

Differences in fruit and vegetable intake and determinants of intakes between children of Dutch origin and non-Western ethnic minority children in the Netherlands - a cross sectional study.

BACKGROUND: Fruit and vegetable consumption is low in the Netherlands and a key target in healthy diet promotion. However, hardly any information is available on differences in fruit and vegetable consumption between Dutch children and ethnic minority children. Therefore, the aim of present study was to determine differences in usual fruit and vegetable intake between native Dutch and non-Western ethnic minority children and to study differences in and mediating effects of potential psychosocial and environmental determinants. METHODS: Ethnicity, usual fruit and vegetable consumption, psychosocial and environmental determinants and mothers' educational level were measured with a self-administered questionnaire during school hours in primary schools in Rotterdam, the Netherlands. Complete data was available for 521 10-11 year-old-children, of which 50.5% of non-Western origin. Differences between the groups regarding potential determinants and fruit and vegetable intake were assessed with Mann Whitney tests or multiple regression analyses. Multiple regression analyses were also conducted to assess mediating effects. RESULTS: Ethnic minority girls ate fruit more frequently (1.41 +/- 1.0 times/day) than Dutch girls (1.03 +/- 0.82 times/day); no differences in frequency of intake were found for vegetables or among boys. Ethnic differences were found for almost all potential determinants. The Dutch children reported lower scores on these determinants than the ethnic minority children, except for perceived self-efficacy and barriers to eat fruit and vegetables. Knowledge of recommendations and facilitating behaviors of the parents mediated the association between ethnicity and fruit consumption among girls. CONCLUSION: Ethnic minority girls in the Netherlands appear to have more favorable fruit intakes than Dutch girls, and ethnic minority children in general show more positive prerequisites for fruit and vegetable consumption. Interventions addressing multi-ethnic populations of children must take such differences into account.

Journal Article↗
PubMed2006

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: Quantitative studies.

BACKGROUND: In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents. METHODS: Papers were identified from Medline and PsycINFO by using all combinations of the search terms: "fruit(s) or vegetable(s)" and "children or adolescents". Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6-18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes. RESULTS: Ninety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-economic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake. CONCLUSION: The determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account. This paper is published as part of the special Pro Children series in the International Journal of Behavioral Nutrition and Physical Activity. Please see [http://www.ijbnpa.org/content/3/1/26] for the relevant editorial.

Journal Article↗
PubMed2006

Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory- and evidence-based intervention programme.

AIMS: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12-14 years. METHODS: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Minimum sample sizes were estimated for each site based on local data and taking into account that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. DISCUSSION: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. CONCLUSION: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.

Adolescent↗
PubMed2006

Socioeconomic status and health behaviour patterns through adolescence: results from a prospective cohort study in Norway.

BACKGROUND: In this paper, we investigate cross-sectional and prospective relationships between various socioeconomic indicators and different health behaviours among boys and girls at ages 13-21, and whether socioeconomic status (SES) is related to changes in health behaviour over time. METHODS: The study is based on a 10-year, two-generation prospective cohort study of health and lifestyle factors among a sample of Norwegian adolescents and their parents. Data presented here were collected at the ages of 13 (baseline), 15, 18 and 21. Parental and adolescent reports of socioeconomic factors were assessed along with a number of health-enhancing and health-compromising behaviours, both as single behaviours and as part of health behaviour indices. RESULTS: Relatively few significant relationships are observed between parental occupation and adolescents' reported health behaviour when the latter is analysed as single behaviours. A significant, but weak, social gradient in health-enhancing behaviour is observed when measuring health behaviour as composite indices rather than single forms of behaviour. This is apparent both when applying parental SES variables or adolescents' own educational aspirations as proxy measures of their socioeconomic status. CONCLUSION: Future investigations of the presence of a social gradient in adolescent health behaviour should focus on composite measures of health behaviour. Further research is needed on potential mediating mechanisms behind the SES-health behaviour relationships in youth.

Adolescent↗
PubMed2005

Changes in accessibility and preferences predict children's future fruit and vegetable intake.

BACKGROUND: Most children eat fewer fruits and vegetables than recommended. To be able to design effective interventions, understanding the aetiology of the behaviour is important. Accessibility and preferences have shown to be strong correlates of fruit and vegetable intake in several cross-sectional studies. The aim of this study was to identify predictors of future fruit and vegetable intake and to explore longitudinal patterns of interactions between accessibility and preferences. METHODS: Data presented are based on baseline (September 2001) and follow-up (May/June 2002) surveys of 20 control schools in the Norwegian intervention study Fruits and Vegetables Make the Marks. A total of 816 pupils (77%) completed both baseline and follow-up questionnaires. The average age of the sample at baseline was 11.8 years. The research instrument assessing potential predictor variables was guided by Social Cognitive Theory, and included Accessibility at home, Accessibility at school, Modelling, Intention, Preferences, Self-Efficacy and Awareness of the 5-a-day recommendations. Multiple regression analyses were performed. RESULTS: All independent variables (measured at baseline) were significantly correlated to future fruit and vegetable intake (measured at follow-up). When reported fruit and vegetable intake at baseline (past intake) was included in this model, the effect of the other independent variables diminished. Together with past intake, the observed change in the independent variables from baseline to follow-up explained 43% of the variance in the reported intake at follow-up. Past intake remained the strongest predictor, but changes in accessibility at home and at school, as well as changes in preferences for fruits and vegetables, also explained significant amounts of the variance in fruit and vegetable intake at follow-up. In addition, baseline accessibility was found to moderate the relationship between change in preferences and change in intake. CONCLUSION: Change in accessibility and preferences appear to be important predictors of future fruit and vegetable intake among school children. Interventions should focus on strategies to modify these factors.

Journal Article↗
PubMed2005

Personal, social and environmental factors regarding fruit and vegetable intake among schoolchildren in nine European countries.

BACKGROUND/AIMS: Children in Europe are consuming less fruit and vegetables than recommended. Knowledge about the potential determinants of fruit and vegetable intake is vital to understand discrepancies in intake and to guide interventions. The aim of the present study was to assess personal, social and environmental factors regarding fruit and vegetable intake among 11- to 12-year-old children in Europe. METHODS: A cross-sectional survey was undertaken, with nationally or regionally representative samples of in total 13,305 children (mean age 11.4 years) from nine European countries. Pupils in the classroom completed a self-administered questionnaire measuring fruit and vegetable intake and personal, social and environmental factors during one school lesson. Age-adjusted covariance analyses were carried out by gender, for the full sample and for each country separately. Proportions responding positively to the constructs are presented. RESULTS: Overall, European children held a positive attitude towards fruit and vegetable intake. For some constructs, large between-country differences were found. Children had a more positive attitude towards fruit than towards vegetables, and girls were on average more positive than boys. The children perceived their social environment as supportive towards fruit and vegetable intake. They reported good to very good availability of fruit and vegetables at home. However, availability at school and during leisure time activities seemed to be low, both for fruit and for vegetables. CONCLUSION: A large majority of the children reported positively to the personal and social factors regarding fruit and vegetable intake. As regards availability of fruit and vegetables at school and leisure time, and accessibility of fruit and vegetables at home, there is room for improvement.

Adolescent↗
PubMed2005

Psychosocial predictors of eating habits among adults in their mid-30s: the Oslo Youth Study follow-up 1991-1999.

BACKGROUND: The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later. METHODS: Two hundred and forty men and 279 women that participated in the Oslo Youth Study were followed from 1991 to 1999 (mean age 25 and 33 years, respectively). Questionnaires at baseline (1991) included the constructs of the TPB and dietary habits, and at follow-up (1999) questionnaires included demographic factors and diet. For the assessment of diet, a food frequency questionnaire (FFQ) with a few food items was used at baseline while an extensive semi-quantitative FFQ was used at follow-up. RESULTS: Among men, attitudes, subjective norms and previous eating behaviour were significant predictors of fruit and vegetable intake, while education and past eating behaviour were predictive of whole grain intake in multivariate analyses predicting dietary intake at follow-up. For women, perceived behavioural control, perceived social norms and past behaviour were predictive of fruit and vegetable intake, while subjective norms, education and past eating behaviour were predictive of whole grain intake. For total fat intake, intention was predictive for men and perceived behavioural control for women. Household income and past consumption of sugar-rich foods were significant predictors of added sugar intake among men, while past intake of sugar-rich foods was a significant predictor of added sugar intake among women. CONCLUSION: After adjusting for potential confounding factors, all psychosocial factors assessed among young adults appeared predictive of one or more eating behaviours reported eight years later. Results point to the influence of psychosocial factors on future eating behaviours and the potential for interventions targeting such factors.

Journal Article↗
PubMed2005

Promoting fruit and vegetable consumption among European schoolchildren: rationale, conceptualization and design of the pro children project.

BACKGROUND/AIMS: The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children's consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented. METHODS: Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year. CONCLUSION: The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.

Adolescent↗
PubMed2005

A qualitative exploration of determinants of fruit and vegetable intake among 10- and 11-year-old schoolchildren in the low countries.

BACKGROUND: For the development of fruit and vegetable promotion interventions, insight is needed into determinants of health behaviour. This study presents results of focus group interviews held with 10- to 11-year-old schoolchildren from Ghent (Belgium-Flanders) and Rotterdam (the Netherlands) to explore personal beliefs and motivations and environmental factors related to schoolchildren's fruit and vegetable intake, to inform the Pro Children intervention development. METHODS: Twelve focus groups were held with 92 schoolchildren. The interviews were recorded and transcribed and NVivo was used to analyse the transcripts. RESULTS: Positive health beliefs, taste preferences, lack of knowledge and practical barriers were identified as personal factors related to fruit and vegetable intake. Home and school availability of fruits and vegetables, as well as parenting practices were identified as important environmental factors. CONCLUSION: A fruit and vegetable promotion intervention should aim to increase fruit and vegetable accessibility and should include educational and motivational activities tailored to these personal and environmental factors. These indications should be further evaluated in quantitative research among representative samples.

Belgium↗
PubMed2005

Fruit and vegetable intake in a sample of 11-year-old children in 9 European countries: The Pro Children Cross-sectional Survey.

BACKGROUND/AIMS: An adequate fruit and vegetable intake provides essential nutrients and nutritive compounds and is considered an important part of a healthy lifestyle. No simple instrument has been available for the assessment of fruit and vegetable intake as well as its determinants in school-aged children applicable in different European countries. Within the Pro Children Project, such an instrument has been developed. This paper describes the cross-sectional survey in 11-year-olds in 9 countries. METHODS: The cross-sectional survey used nationally, and in 2 countries regionally, representative samples of schools and classes. The questionnaires, including a precoded 24-hour recall component and a food frequency part, were completed in the classroom. Data were treated using common syntax files for portion sizes and for merging of vegetable types into four subgroups. RESULTS: The results show that the fruit and vegetable intake in amounts and choice were highly diverse in the 9 participating countries. Vegetable intake was in general lower than fruit intake, boys consumed less fruit and vegetables than girls did. The highest total intake according to the 24-hour recall was found in Austria and Portugal, the lowest in Spain and Iceland. CONCLUSION: The fruit and vegetable intake in 11-year-old children was in all countries far from reaching population goals and food-based dietary guidelines on national and international levels.

Child↗
PubMed2005

Fruit and vegetable intake of mothers of 11-year-old children in nine European countries: The Pro Children Cross-sectional Survey.

OBJECTIVE: To describe and compare fruit and vegetable intakes of mothers of 11-year-old children across Europe. METHODS: Cross-sectional surveys were carried out in 9 European countries in October/November 2003. Self-administered questionnaires assessing fruit and vegetable consumption were used for data collection. The current paper presents dietary intake data obtained by a precoded 24-hour recall and a food frequency questionnaire. RESULTS: The consumption levels of fruit and vegetables (without fruit juice) were in line with World Health Organization recommendations of > or =400 g/day for only 27% of all participating mothers. Based on both instruments, the Pro Children results showed comparatively high average fruit intake levels in Portugal, Denmark and Sweden (211, 203 and 194 g/day) and the lowest intake in Iceland (97 g/day). High vegetable intake levels were found in Portugal and Belgium (169 and 150 g/day), the lowest in Spain (88 g/day). A south-north gradient could not be observed in the Pro Children study. CONCLUSION: Fruit and vegetable intakes are low in mothers of 11-year-olds across Europe. Especially vegetable consumption can be regarded as marginal in most of the studied European countries. A high percentage of mothers indicated to eat fruit and vegetables less than once a day. The results have shown that national and international interventions are necessary to promote fruit and especially vegetable consumption in the European population of mothers.

Adult↗
PubMed2005

The pro children intervention: applying the intervention mapping protocol to develop a school-based fruit and vegetable promotion programme.

BACKGROUND/AIMS: The importance of careful theory-based intervention planning is recognized for fruit and vegetable promotion. This paper describes the application of the Intervention Mapping (IM) protocol to develop the Pro Children intervention to promote consumption of fruit and vegetable among 10- to 13-year-old schoolchildren. METHODS: Based on a needs assessment, promotion of intake of fruit and vegetable was split into performance objectives and related personal, social and environmental determinants. Crossing the performance objectives with related important and changeable determinants resulted in a matrix of learning and change objectives for which appropriate educational strategies were identified. Theoretically similar but culturally relevant interventions were designed, implemented and evaluated in Norway, the Netherlands and Spain during 2 school years. RESULTS: Programme activities included provision of fruits and vegetables in the schools, guided classroom activities, computer-tailored feedback and advice for children, and activities to be completed at home with the family. Additionally, optional intervention components for community reinforcement included incorporation of mass media, school health services or grocery stores. School project committees were supported. CONCLUSION: The Pro Children intervention was carefully developed based on the IM protocol that resulted in a comprehensive school-based fruit and vegetable promotion programme, but culturally sensible and locally relevant.

Adolescent↗
PubMed2005

Social class, gender and psychosocial predictors for early sexual debut among 16 year olds in Oslo.

BACKGROUND: Variations in early sexual debut among 16 year olds were investigated by social level variables, parental occupation, gender, ethnicity, family structure, family functioning, and individual level variables, future aspirations, academic and social self-perception, and depressed moods. METHODS: The variations in sexual debut were investigated by examining proportions of 16 year olds reporting their first intercourse before age 16. The data were collected by self-reporting questionnaires administered to in-school-youth, in Oslo. Multivariate logistic regression analyses were used to test for associations. Gender interactions with all variables were tested. RESULTS: Overall, 25% reported early debut. Independent effect of social class on differences in proportions in early sexual debut were found. Gender interaction with social class, ethnicity and academic self-perception as they associate to proportions having had early sexual debut, were found. For girls the pattern of social class differences was linear and the highest proportions were found among working classes. For boys the pattern was U-shaped and upper managerial and manual working class youth had similar, higher proportions of early debutants. High scores of parental monitoring, future aspirations and academic self-concept and low scores of depressed moods, are protective factors. While high social self-perception is positively associated with early debut for both genders. CONCLUSION: Early sexual debut varies according to social class, following gender-specific patterns, among 16 year olds in Oslo. The negative association between early debut and academic self-perception are for boys less influenced by other social and individual level factors, than for girls.

Adolescent↗
PubMed2005

Surveys of Norwegian youth indicated that breast feeding reduced subsequent risk of obesity.

BACKGROUND AND OBJECTIVE: Breast-feeding protects against overweight in childhood, while it is uncertain if it is protective against adolescent and adult overweight. The objective of this study was to examine whether having been breast fed protects against adolescent and adult overweight and obesity. METHODS: Participants in the Oslo Youth study examined in 1979/1981 (n=635, mean age 13.1 years) and in 1999. Weight and height were measured in 1979/1981 and self-reported in 1999. Breast-feeding information was provided by the parents in 1979/1981. Potential confounders adjusted for included parents' body mass index and education, mother's smoking habits, participants' physical activity, smoking status, education and energy intake. RESULTS: Comparing those having been breast fed more than 3 months with those never breast fed, the adjusted odds ratios (95% confidence interval [CI]) between the two groups were 0.27 (0.13-0.56) for being overweight and 0.15 (0.03-0.72) for being obese in adolescent. In adulthood, the corresponding odds ratios were 0.64 (0.33-1.26) and 0.34 (0.12-1.01), respectively. CONCLUSION: Breast feeding during infancy appears to protect against adolescent overweight and obesity, while the effect on adult weight status is weaker. With increasing age, the impact of any protective physiologic mechanisms of breast feeding seen earlier in life tends to diminish.

Adolescent↗
PubMed2005

The Norwegian School Fruit Programme: evaluating paid vs. no-cost subscriptions.

BACKGROUND: This study reports the effect of providing Norwegian school children with free fruit or vegetables every school day and the effect of an existing fee-based School Fruit Programme. METHODS: Seventh grade pupils and their parents completed questionnaires at baseline (autumn 2001) and at follow-up (spring 2002). Nine schools participated in the School Fruit Programme for free (Free fruit), nine schools took part at standard conditions (Paid fruit), and 20 schools did not take part in the subscription programme (No fruit). A total of 795 7th graders (11 or 12 years old at baseline) participated both at baseline and at follow-up. RESULTS: At follow-up, pupils attending the Free fruit schools had significantly higher intake of fruit and vegetables at school than the pupils at the Paid fruit and No fruit schools (P < 0.001, mean intakes were 1.1, 0.4 and 0.2 portions, respectively). Subscribers at the Paid fruit schools had significantly higher intake than the non-subscribers at the same schools. CONCLUSIONS: Providing a free piece of fruit or a vegetable is an effective strategy to increase school children's fruit and vegetable intake. The existing School Fruit Programme appears to increase the intake among the subscribers, but thereby also tends to increase an existing difference in consumption patterns among subscribers and non-subscribers.

Adolescent↗