Publications by authors named "Mette Rasmussen"

115 Publications

Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017.

Obes Facts 2021 Nov 5:1-17. Epub 2021 Nov 5.

Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain.

Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions.

Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1.

Results: Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries.

Discussion/conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
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http://dx.doi.org/10.1159/000517586DOI Listing
November 2021

Are financial incentives more effective than health campaigns to quit smoking? A community-randomised smoking cessation trial in Denmark.

Prev Med 2021 Nov 3;154:106865. Epub 2021 Nov 3.

WHO-CC, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden. Electronic address:

The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.
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http://dx.doi.org/10.1016/j.ypmed.2021.106865DOI Listing
November 2021

Model Asphaltenes Adsorbed onto Methyl- and COOH-Terminated SAMs on Gold.

Langmuir 2021 Aug 5;37(32):9785-9792. Epub 2021 Aug 5.

Department of Chemistry, Aarhus University, 8000 Aarhus C, Denmark.

Petroleum asphaltenes are surface-active compounds found in crude oils, and their interactions with surfaces and interfaces have huge implications for many facets of reservoir exploitation, including production, transportation, and oil-water separation. The asphaltene fraction in oil, found in the highest boiling-point range, is composed of many different molecules that vary in size, functionality, and polarity. Studies done on asphaltene fractions have suggested that they interact via polyaromatic and heteroaromatic ring structures and functional groups containing nitrogen, sulfur, and oxygen. However, isolating a single pure chemical structure of asphaltene in abundance is challenging and often not possible, which impairs the molecular-level study of asphaltenes of various architectures on surfaces. Thus, to further the molecular fundamental understanding, we chose to use functionalized model asphaltenes (AcChol-Th, AcChol-Ph, and 1,6-DiEtPy[Bu-Carb]) and model self-assembled monolayer (SAM) surfaces with precisely known chemical structures, whereby the hydrophobicity of the model surface is controlled. We applied solutions of asphaltenes to these SAM surfaces and then analyzed them with surface-sensitive techniques of near-edge X-ray absorption fine structure (NEXAFS) and X-ray photoelectron spectroscopy (XPS). We observe no adsorption of asphaltenes to the hydrophobic surface. On the hydrophilic surface, AcChol-Ph penetrates into the SAM with a preferential orientation parallel to the surface; AcChol-Th adsorbs in a similar manner, and 1,6-DiEtPy[Bu-Carb] binds the surface with a bent binding geometry. Overall, this study demonstrates the need for studying pure and fractionated asphaltenes at the molecular level, as even within a family of asphaltene congeners, very different surface interactions can occur.
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http://dx.doi.org/10.1021/acs.langmuir.1c01338DOI Listing
August 2021

Perioperative Alcohol and Smoking Cessation Intervention: Impact on Other Lifestyles.

Semin Oncol Nurs 2021 02 6;37(1):151116. Epub 2021 Jan 6.

WHO-CC, Clinical Health Promotion Centre, the Parker Institute at Bispebjerg-Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark; Department of Urology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark. Electronic address:

Objective: Cigarette smoking and alcohol drinking are preventable risk factors in surgery. It is unknown whether intervening on these two risk factors also have an effect on other lifestyles. Therefore, the primary aim of this study was to compare the effect of an intensive alcohol and smoking cessation intervention on other lifestyles (malnutrition, obesity, and physical inactivity) with treatment as usual, among patients scheduled for radical cystectomy. The secondary aim was to evaluate associations between successful quitting and changes in other lifestyles.

Data Sources: Data on 94 patients with bladder cancer undergoing radical cystectomy originated from the STOP-OP study, a randomized intervention trial that enrolled patients from four Danish hospitals. Patients were enrolled between November 2014 and July 2017.

Conclusion: We found no significant differences regarding the three lifestyle factors; risk of malnutrition, obesity, and physical inactivity between patients in the intervention and standard care at the end of the intervention at 6 weeks, 3 months, 6 months, and 12 months. Also, there were no significant associations between successful quitters and non-quitters for alcohol and smoking and the other three lifestyles; risk of malnutrition, obesity, and physical inactivity.

Implications For Nursing Practice: Findings from this study show that cancer surgery is a good opportunity to address lifestyle changes and that more research into the effect of multimodal interventions are needed. Guidelines on how to support patients to change lifestyle in relation to surgery should be part of nursing practice.
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http://dx.doi.org/10.1016/j.soncn.2020.151116DOI Listing
February 2021

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017.

Obes Facts 2021 22;14(1):32-44. Epub 2020 Dec 22.

National Institute of Health Dr Ricardo Jorge I.P., Lisbon, Portugal.

Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing.

Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI).

Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration.

Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night.

Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.
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http://dx.doi.org/10.1159/000511263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983588PMC
July 2021

Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions.

Eur Addict Res 2021 20;27(2):123-130. Epub 2020 Oct 20.

Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.

Introduction: Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment.

Objective: The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction.

Methods: We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months.

Results: A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor.

Conclusions: Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
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http://dx.doi.org/10.1159/000510608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006577PMC
September 2021

Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions.

Eur Addict Res 2021 20;27(2):123-130. Epub 2020 Oct 20.

Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.

Introduction: Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment.

Objective: The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction.

Methods: We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months.

Results: A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor.

Conclusions: Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
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http://dx.doi.org/10.1159/000510608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006577PMC
September 2021

Recurrent abdominal pain among adolescents: trends and social inequality 1991-2018.

Scand J Pain 2021 01 7;21(1):95-102. Epub 2020 Sep 7.

University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark.

Objectives: The association between socioeconomic status and recurrent abdominal pain (RAP) among adolescents is an understudied issue. No study has examined whether such an association changes over time. The aim was to examine trends in RAP among adolescents in Denmark from 1991 to 2018, to examine whether there was social inequality in RAP and whether this inequality varied over time.

Methods: The study used data from the Danish part of the international Health Behaviour in School-aged Children (HBSC) study of nationally representative samples of 11-, 13- and 15-year-olds. This study pooled data from eight comparable surveys from 1991 to 2018, overall participation rate 88.0%, n=30,048. The definition of RAP was self-reported stomach-ache daily or several days per week during the past six months. We reported absolute inequality as prevalence difference in RAP between low and high socioeconomic status and relative inequality as odds ratio for RAP by socioeconomic status.

Results: In the entire study population, 5.6% reported RAP, 3.1% among boys and 7.8% among girls. There was a significant increase in RAP from 1991 to 2018 among boys and girls, test for trend, p<0.0001. The prevalence of RAP was significantly higher in low than high socioeconomic status, OR=1.63 (95% CI: 1.42-1.87). The absolute social inequality in RAP fluctuated with no consistent increasing or decreasing pattern.

Conclusions: The prevalence of RAP increased from 1991 to 2018. The prevalence was significantly higher among girls than among boys, and significantly higher in low socioeconomic status families. Professionals should be aware of RAP as common and potentially serious health problems among children and adolescents. In addition to clinical examination it is important to focus on improving the child's quality of life, reduce parents' and children's concerns about the seriousness of the condition, and consider supplements to medicine use.
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http://dx.doi.org/10.1515/sjpain-2020-0062DOI Listing
January 2021

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries.

J Adolesc Health 2020 06;66(6S):S81-S88

Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Purpose: Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups.

Methods: We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group.

Results: Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries.

Conclusions: The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged.
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http://dx.doi.org/10.1016/j.jadohealth.2020.03.013DOI Listing
June 2020

School Satisfaction and School Pressure in the WHO European Region and North America: An Analysis of Time Trends (2002-2018) and Patterns of Co-occurrence in 32 Countries.

J Adolesc Health 2020 06;66(6S):S59-S69

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Purpose: The purpose of the study was to examine the trends between 2002 and 2018 in school pressure and school satisfaction among 15-year-old students, across countries and by gender, in the WHO European region and North America, and explore whether there are variations between countries and by gender in the co-occurrence of school pressure and school satisfaction.

Methods: Data from the 32 countries that participated in the Health Behaviour in School-aged Children study (HBSC) study between 2002 and 2018 were used. Statistical analyses included t-tests, binary logistic regression analyses, and chi-square tests, as required by each of the study aims.

Results: School satisfaction tended to increase over the period 2002-2018 among boys, whereas school pressure increased among girls. Also, gender differences tended to dissipate in school satisfaction and generally increase in school pressure. The co-occurrence of school satisfaction and school pressure in 2017/2018 shows that the majority of students are found in the "not pressured-not highly satisfied" and "pressured-not highly satisfied" groups. There were more boys in the former group and more girls in the latter group.

Conclusion: Few students in the 32 countries belonged to the "not pressured-highly satisfied" group, which from a public health perspective may be seen as the most desirable group. The increases in school pressure in girls from 2002 to 2018 and their overrepresentation in the pressured groups require further attention.
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http://dx.doi.org/10.1016/j.jadohealth.2020.03.007DOI Listing
June 2020

Evaluation of Very Integrated Program: Health Promotion for Patients With Alcohol and Drug Addiction-A Randomized Trial.

Alcohol Clin Exp Res 2020 07 12;44(7):1456-1467. Epub 2020 Jun 12.

From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden.

Background: Compared to the general population, patients with alcohol and drug addiction have an increased risk of additional hazardous lifestyles and suffer from more chronic diseases, adding to their already significantly higher morbidity and mortality. The objective of this study was to test the efficacy of the Very Integrated Program (VIP) on treatment and health outcomes for patients diagnosed with alcohol and drug addiction.

Methods: Parallel randomized clinical trial with intervention as add-on to addiction care as usual. A total of 322 patients aged 18 years or older were identified, and the study requirements were fulfilled by 219 patients, 7 of whom participated in a pilot. The intervention was a 6-week intensive, tailored, educational program that included motivational interviewing, a smoking cessation program, dietary and physical activity counseling, and patient education. The main outcome measures were substance-free days, time to relapse, and treatment adherence assessed after 6 weeks and 12 months. Secondary outcomes were lifestyle factors, symptoms of comorbidity, and quality of life. Missing data were imputed conservatively by using data closest to the follow-up date and baseline values in patients with no follow-up.

Results: The 212 patients (intervention, n = 113; control, n = 99) were randomized, and 202 had complete data for primary outcomes. After 6 weeks, there were no significant differences between the groups regarding primary or secondary outcomes. At the 12-month follow-up, the patients in the control group had significantly more total substance-free days (139 days; ranging 0 to 365 vs. 265; 0 to 366, p = 0.021)-specifically among the patients with drug addiction-and higher physical and mental quality of life (45 vs. 58, p = 0.049 and 54 vs. 66, p = 0.037), but not in the per-protocol analysis (60 vs. 46, p = 0.52 and 70 vs. 66, p = 0.74). The sensitivity analyses did not support significant differences between the groups.

Conclusion: Overall, adding VIP intervention did not improve outcome of the alcohol or drug addiction care or the lifestyle compared to the addiction care alone. This patient group is still in need of effective programs, and new intervention research is required to develop that.
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http://dx.doi.org/10.1111/acer.14364DOI Listing
July 2020

Trends in social inequality in overweight and obesity among adolescents in Denmark 1998-2018.

Int J Public Health 2020 Jun 20;65(5):607-616. Epub 2020 Feb 20.

National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.

Objectives: The aim was to analyze trends in overweight and obesity in relation to socioeconomic position among Danish adolescents in the 20-year period 1998-2018.

Methods: The study used data on self-reported height and weight and parents' occupational social class (OSC) from 11-, 13- and 15-year-old schoolchildren in 1998, 2002, 2006, 2010, 2014 and 2018, n = 22,177. The analyses included absolute social inequality in overweight/obesity (prevalence difference between low and high OSC) and relative social inequality (OR for overweight/obesity).

Results: In the total sample, the prevalence of overweight and obesity was 9.7% and 1.4%, respectively, with significantly higher prevalence in low than high OSC. There were significantly increasing trends in both overweight and obesity 1998-2018 in low OSC and no significant increase in high OSC. The OR for overweight was 1.59 (1.42-1.74) in middle and 2.16 (1.89-2.46) in low OSC, OR for obesity 1.74 (1.29-2.34) in middle and 2.97 (2.15-4.11) in low OSC. Associations were not modified by survey year.

Conclusions: There was a persistent absolute and relative social inequality in overweight and obesity 1998-2018 among Danish adolescents.
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http://dx.doi.org/10.1007/s00038-020-01342-1DOI Listing
June 2020

Lasalocid Acid Antibiotic at a Membrane Surface Probed by Sum Frequency Generation Spectroscopy.

Langmuir 2020 03 20;36(12):3184-3192. Epub 2020 Mar 20.

Department of Chemistry, Aarhus University, 8000 Aarhus, Denmark.

Carboxyl polyether ionophores (CPIs) are widely used as veterinary antibiotics and to increase food utilization in ruminating animals. Furthermore, CPIs can target drug-resistant bacteria, but detailed knowledge about their mode-of-action is needed to develop agents with a reasonable therapeutic index. It has been suggested that ionophores bind to membranes and incur large structural changes to shield a bound ion from the hydrophobic environment of the lipid bilayer for transport. One crucial piece of information is missing, however: Is it necessary for the free ionophore to adsorb on the membrane surface before interacting with a cation to facilitate cross-membrane ion transport? To answer this question, we applied sum-frequency generation (SFG) vibrational spectroscopy and surface tensiometry to identify the interaction between the prototypical CPI lasalocid acid (LA) and a model membrane. Observed changes in the surface pressure demonstrate that the free LA undergoes a self-assembly process with the lipid monolayer. Spectra taken from the lipid monolayer show that the free acid inserts partially into the lipid monolayer and then after complexation with sodium chloride disrupts the lipid monolayer. Overall, this study strongly suggests that this must be the crucial step of LA and metal ion complexation that allows the ionophore to traverse a lipid membrane.
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http://dx.doi.org/10.1021/acs.langmuir.9b03752DOI Listing
March 2020

Intake of sugar sweetened soft drinks among adolescents: Trends and social inequality in Denmark 2002-2018.

Nutr Health 2020 Mar 22;26(1):3-8. Epub 2020 Jan 22.

University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark.

Background: Intake of sugar sweetened soft drinks (SSSD) has decreased among adolescents, but trends in social inequality in SSSD intake are unknown.

Aim: Examine trends in social inequality in SSSD intake among adolescents in Denmark during 2002-2018.

Methods: Five Health Behaviour in School-aged Children surveys with data on SSSD intake and parents' occupational social class (OSC) from nationally representative samples of 11, 13 and 15 year olds, =20,112.

Results: The overall prevalence of daily SSSD intake decreased from 10.1% in 2002 to 6.4% in 2018. The prevalence decreased in both high OSC (from 8% to 5%) and middle OSC (from 10% to 6%) but remained around 12% in low OSC. The odds ratio (OR) estimates of low compared with high OSC increased over the years around an overall OR of 2.01 (1.74-2.34).

Conclusions: Danish adolescents' SSSD intake decreased during 2002-2018 and was higher the lower the parents' OSC. Thus, social inequality increased during 2002-2018.
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http://dx.doi.org/10.1177/0260106019900742DOI Listing
March 2020

[Improvement of Danish children and adolescents' food and meal habits].

Ugeskr Laeger 2019 Oct;181(44)

Healthy food and meal habits can help promote and maintain good health throughout life. Only few 4-18-year-olds follow official Danish dietary recommendations, leaving room for improvement, notably among 13-18-year-old adolescents and children and adolescents of parents with short-term education. Specific focus areas for all families with children may help limit intake of sugary foods and beverages on weekends. Promotion of healthy food and meal habits among children and adolescents call for a comprehensive and well-coordinated approach with participation of main stakeholders in the field.
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October 2019

NEXAFS imaging to characterize the physio-chemical composition of cuticle from African Flower Scarab Eudicella gralli.

Nat Commun 2019 10 18;10(1):4758. Epub 2019 Oct 18.

Department of Chemistry, Aarhus University, 8000, Aarhus C, Denmark.

The outermost surface of insect cuticle is a high-performance interface that provides wear protection, hydration, camouflage and sensing. The complex and inhomogeneous structure of insect cuticle imposes stringent requirements on approaches to elucidate its molecular structure and surface chemistry. Therefore, a molecular understanding and possible mimicry of the surface of insect cuticle has been a challenge. Conventional optical and electron microscopies as well as biochemical techniques provide information about morphology and chemistry but lack surface specificity. We here show that a near edge X-ray absorption fine structure microscope at the National Synchrotron Light Source can probe the surface chemistry of the curved and inhomogeneous cuticle of the African flower scarab. The analysis shows the distribution of organic and inorganic surface species while also hinting at the presence of aragonite at the dorsal protrusion region of the Eudicella gralli head, in line with its biological function.
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http://dx.doi.org/10.1038/s41467-019-12616-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802387PMC
October 2019

Trends in socioeconomic differences in daily smoking among 15-year-old Danes 1991-2014.

Scand J Public Health 2020 Aug 10;48(6):667-673. Epub 2019 May 10.

University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark.

To examine trends in socioeconomic differences in daily smoking among 15-year-old Danes between 1991-2014, using occupational social class as indicator of socioeconomic status. : The study included 15-year-olds participating in seven Danish Health Behaviour in School-aged Children studies between 1991-2014, = 8,641. The analyses focused on absolute socioeconomic differences (prevalence difference between low and high occupational social class) and relative socioeconomic differences communicated by odds ratio for daily smoking. : The prevalence of daily smoking declined from 18.6% in 1991 to 4.5% in 2014. Across all surveys, the prevalence was 8.9% in high, 12.8% in middle and 16.5% in low occupational social classes ( < 0.0001). The absolute socioeconomic differences increased from 1991 to 2006 and declined thereafter. Across all survey years, the odds ratio (95% confidence interval) for daily smoking was 1.40 (1.19-1.65) in middle and 1.90 (1.56-2.32) in low versus high occupational social classes. The statistical interaction between occupational social class and survey year was significant ( = 0.0404), suggesting increasing relative socioeconomic differences from 1991 to 2014. : .
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http://dx.doi.org/10.1177/1403494819848284DOI Listing
August 2020

The Gut Microbiome on a Periodized Low-Protein Diet Is Associated With Improved Metabolic Health.

Front Microbiol 2019 4;10:709. Epub 2019 Apr 4.

Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.

A periodized (14 days on/14 days off) 5% low protein-high carbohydrate (pLPHC) diet protects against weight gain, improves glucose tolerance in mice and interacts with concurrent voluntary activity wheel training on several parameters including weight maintenance and liver FGF21 secretion. The gut microbiome (GM) responds to both diet and exercise and may influence host metabolism. This study compared the cecal GM after a 13.5-week intervention study in mice on a variety of dietary interventions ± concurrent voluntary exercise training in activity wheels. The diets included chronic chow diet, LPHC diet, 40 E% high protein-low carbohydrate (HPLC) diet, an obesigenic chronic high-fat diet (HFD) and the pLPHC diet. Our hypothesis was that the GM changes with pLPHC diet would generally reflect the improved metabolic health of the host and interact with concurrent exercise training. The GM analyses revealed greater abundance phylum Bacteroidetes and the genus on chronic and periodized LPHC and higher abundance of and on HFD. The differences in diet-induced GM correlated strongly with the differences in a range of host metabolic health-measures. In contrast, no significant effect of concurrent exercise training was observed. In conclusion, pLPHC diet elicits substantial changes in the GM. In contrast, only subtle and non-significant effects of concurrent activity wheel exercise were observed. The pLPHC-associated microbiome may contribute to the healthier host phenotype observed in these mice.
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http://dx.doi.org/10.3389/fmicb.2019.00709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458274PMC
April 2019

Cyberbullying and traditional bullying among Nordic adolescents and their impact on life satisfaction.

Scand J Public Health 2020 Jul 23;48(5):502-510. Epub 2019 Jan 23.

University of Southern Denmark, Denmark.

The aim of this study was to investigate the prevalence of cybervictimization in the six Nordic countries and to assess its overlap with traditional bullying. A further aim was to examine potential associations between life satisfaction, on the one hand, and traditional bullying and cyberbullying on the other. : Analyses were based on data from the 2013⁄2014 Health Behaviour in School-aged Children study. It included 32,210 boys and girls, aged 11, 13, and 15, living in the six Nordic countries. : The prevalence of cyberbullying by both pictures and by messages was around 2% in all the Nordic countries except Greenland. There it was considerably higher. The prevalence of being bullied in a traditional manner varied widely by country. For boys, this type of bullying was most frequent in the youngest age group and then decreased steadily in the older age groups. Girls were on average more likely to be cyberbullied. Cyberbullying was more common among 13- and 15-year-olds than 11-year-olds. Higher family affluence was unrelated to the risk of cyberbullying. However, it was related to traditional bullying and combined forms of bullying. Compared with intact families, cybervictimization was commoner among single-parent families and stepfamilies. Adjusting for age, gender, family affluence, and family structure, those subjected to cyberbullying had lower life satisfaction than those who were not bullied.
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http://dx.doi.org/10.1177/1403494818817411DOI Listing
July 2020

Long-lasting field-free alignment of large molecules inside helium nanodroplets.

Nat Commun 2019 01 11;10(1):133. Epub 2019 Jan 11.

Department of Chemistry, Aarhus University, 8000, Aarhus C, Denmark.

Molecules with their axes sharply confined in space, available through laser-induced alignment methods, are essential for many current experiments, including ultrafast molecular imaging. For these applications the aligning laser field should ideally be turned-off, to avoid undesired perturbations, and the strong alignment should last long enough that reactions and dynamics can be mapped out. Presently, this is only possible for small, linear molecules and for times less than 1 picosecond. Here, we demonstrate strong, field-free alignment of large molecules inside helium nanodroplets, lasting >10 picoseconds. One-dimensional or three-dimensional alignment is created by a slowly switched-on laser pulse, made field-free through rapid pulse truncation, and retained thanks to the impeding effect of the helium environment on molecular rotation. The opportunities field-free aligned molecules open are illustrated by measuring the alignment-dependent strong-field ionization yield of dibromothiophene oligomers. Our technique will enable molecular frame experiments, including ultrafast excited state dynamics, on a variety of large molecules and complexes.
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http://dx.doi.org/10.1038/s41467-018-07995-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329814PMC
January 2019

Decline in HPV-vaccination uptake in Denmark - the association between HPV-related media coverage and HPV-vaccination.

BMC Public Health 2018 Dec 10;18(1):1360. Epub 2018 Dec 10.

Division of Infectious Disease Preparedness, Statens Serum Institut, 2300, Copenhagen, Artillerivej 5, Denmark.

Background: In 2014, Denmark experienced a rapid decline in vaccination uptake for the human papillomavirus (HPV) vaccine after a successful introduction of the vaccine in 2009. Before the decline, the uptake of the first HPV vaccine was around 90% for girls born in the period 1998 to 2000, while it dropped to 54% for girls born in 2003. The decline followed negative public attention from 2013 coinciding with increasing suspected adverse-event reporting to the Danish Medicines Agency. The aim of this study is to describe the HPV-vaccination uptake, to quantify relevant HPV-related media coverage, and analyse the relation between media coverage and HPV-vaccination acceptance in Denmark in year 2009-2016.

Methods: Three types of data were used for the analysis: Immunisation data from 243,415 girls, media coverage (8524 news items) and Google search activity. We used changes in the correlation between media coverage and vaccination uptake to identify a changing point in their relationship. The relationship before and after the changing point was analysed determined on the interactions between vaccination uptake, media and search activity, with search activity as a proxy for public attention.

Results: We identified July 2013 as a changing point in the relationship between media coverage and vaccination uptake. We found no significant relationship between media coverage and vaccination uptake in the first part of the time series (June 2009 to June 2013), whereas from July 2013 and onwards there was a negative Pearson's correlation of - 0.52. The changing point coincides with both an increase in Google searches for "HPV side effects" and media coverage with negative content.

Conclusions: Following a successful launch of the HPV-vaccination programme, concerns about vaccine safety shifted the public opinion and the coverage by the media. The noticeable shift in correlation between vaccination uptake and media coverage before and after July 2013 could indicate that increased media coverage influenced the decline in vaccination uptake. Media monitoring may represent an important tool in future monitoring and assessment of confidence in vaccination programmes.
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http://dx.doi.org/10.1186/s12889-018-6268-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288961PMC
December 2018

Short report: persistent social inequality in poor self-rated health among adolescents in Denmark 1991-2014.

Eur J Public Health 2018 12;28(6):1114-1116

National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

The aim was to examine trends in social inequality in poor self-rated health (SRH) among adolescents in Denmark 1991-2014. The analysis included 18 996 11-15-year-old school children from the cross-sectional Health Behaviour in School-aged Children studies in 1991, 2002, 2006, 2010 and 2014. Across the five surveys, the prevalence of poor SRH was 14.2%, remaining almost unchanged from 1991 to 2014. The proportion with poor SRH was 12.2% in high, 14.3% in middle and 17.6% in low occupational social class. This social inequality in poor SRH was persistent during the entire study period, both in terms of absolute and relative social inequality.
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http://dx.doi.org/10.1093/eurpub/cky234DOI Listing
December 2018

Periodized low protein-high carbohydrate diet confers potent, but transient, metabolic improvements.

Mol Metab 2018 11 28;17:112-121. Epub 2018 Aug 28.

Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, 2100, Denmark. Electronic address:

Objective: Chronic ad libitum low protein-high carbohydrate diet (LPHC) increases health- and life-span in mice. A periodized (p) LPHC regimen would be a more practical long-term human lifestyle intervention, but the metabolic benefits of pLPHC are not known. Also, the interactions between LPHC diet and exercise training have not been investigated. Presently, we aimed to provide proof-of-concept data in mice of the efficacy of pLPHC and to explore the potential interactions with concurrent exercise training.

Methods: A detailed phenotypic and molecular characterization of mice undergoing different durations of 14 d LPHC (5 E% protein)/14 d control diet cycles for up to 4 months with or without concurrent access to activity wheels allowing voluntary exercise training.

Results: pLPHC conferred metabolic benefits similar to chronic LPHC, including increased FGF21 and adaptive thermogenesis, obesity-protection despite increased total energy intake and improved insulin sensitivity. The improved insulin sensitivity showed large fluctuations between diet periods and was lost within 14 days of switching back to control diet. Parallel exercise training improved weight maintenance but impaired the FGF21 response to pLPHC whereas repeated pLPHC cycles progressively augmented this response. Both the FGF21 suppression by exercise and potentiation by repeated cycles correlated tightly with Nupr1 mRNA in liver, suggesting dependence on liver integrated stress response.

Conclusion: These results suggest that pLPHC may be a viable strategy to promote human health but also highlight the transient nature of the benefits and that the interaction with other lifestyle-interventions such as exercise training warrants consideration.
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http://dx.doi.org/10.1016/j.molmet.2018.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197680PMC
November 2018

Brief Report: Trends in Social Inequality in Drunkenness Among Danish Adolescents, 1991-2014.

J Stud Alcohol Drugs 2018 07;79(4):561-566

University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark.

Objective: This study examined whether social inequality in frequent drunkenness among Danish adolescents changed from 1991 to 2014.

Method: We used data from the international Health Behaviour in School-aged Children (HBSC) study, which provided nationally representative samples of 15-year-olds from seven comparable cross-sectional studies in Denmark (N = 8,655). The students provided data about frequency of drunkenness and parents' occupation.

Results: In total, 38.6% reported to have been drunk at least four times, decreasing from 44.2% in 1991 to 21.2% in 2014. Most of the decrease took place in the latter part of the period. This decrease was found in all occupational social classes, but there was no change in absolute social inequality in drunkenness four or more times reported from 1991 to 2014. The sex- and yearadjusted odds ratio for frequent drunkenness was 0.80, 95% CI [0.70, 0.93] in low compared with high occupational social class. The statistical interaction between survey year and occupational social class was insignificant (p = .3601); that is, there was no change in relative social inequality in frequent drunkenness over time.

Conclusions: Drunkenness was more prevalent among adolescents from the high occupational social class, and this social inequality did not change from 1991 to 2014.
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July 2018

Low- and high-protein diets do not alter ex vivo insulin action in skeletal muscle.

Physiol Rep 2018 07;6(13):e13798

Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.

A low-protein high carbohydrate (LPHC) diet and a high-protein low carbohydrate (HPLC) diet have been reported to positively and negatively regulate whole-body glucose tolerance and insulin sensitivity, respectively. Skeletal muscle is quantitatively the most important tissue clearing glucose in the postprandial state, but it is unclear if LPHC and HPLC diets directly influence insulin action in skeletal muscle. To test this, mice were placed on control chow diet, LPHC and HPLC diets for 13.5 weeks at which time the submaximal insulin-stimulated glucose transport and insulin signaling were evaluated in ex vivo incubated oxidative soleus and glycolytic EDL muscle. At the whole-body level, the diets had the anticipated effects, with LPHC diet improving glucose tolerance and insulin-sensitivity whereas HPLC diet had the opposite effect. However, neither insulin-stimulated Akt/TBC1D4 signaling and glucose transport ex vivo, nor cell signaling in vivo were altered by the diets. These data imply that skeletal muscle insulin sensitivity does not contribute to the whole-body effects of LPHC and HPLC diets on glucose metabolism.
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http://dx.doi.org/10.14814/phy2.13798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041700PMC
July 2018

Low- and high-protein diets do not alter ex vivo insulin action in skeletal muscle.

Physiol Rep 2018 07;6(13):e13798

Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.

A low-protein high carbohydrate (LPHC) diet and a high-protein low carbohydrate (HPLC) diet have been reported to positively and negatively regulate whole-body glucose tolerance and insulin sensitivity, respectively. Skeletal muscle is quantitatively the most important tissue clearing glucose in the postprandial state, but it is unclear if LPHC and HPLC diets directly influence insulin action in skeletal muscle. To test this, mice were placed on control chow diet, LPHC and HPLC diets for 13.5 weeks at which time the submaximal insulin-stimulated glucose transport and insulin signaling were evaluated in ex vivo incubated oxidative soleus and glycolytic EDL muscle. At the whole-body level, the diets had the anticipated effects, with LPHC diet improving glucose tolerance and insulin-sensitivity whereas HPLC diet had the opposite effect. However, neither insulin-stimulated Akt/TBC1D4 signaling and glucose transport ex vivo, nor cell signaling in vivo were altered by the diets. These data imply that skeletal muscle insulin sensitivity does not contribute to the whole-body effects of LPHC and HPLC diets on glucose metabolism.
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http://dx.doi.org/10.14814/phy2.13798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041700PMC
July 2018

Effectiveness of the Gold Standard Programme (GSP) for smoking cessation on smokers with and without a severe mental disorder: a Danish cohort study.

BMJ Open 2018 06 11;8(6):e021114. Epub 2018 Jun 11.

Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

Objectives: We compared the effectiveness of an intensive smoking cessation intervention among smokers with and without a severe mental disorder (SMD) and identified factors associated with successful quitting. The main hypothesis was that smokers with an SMD would be less likely to stay continuously smoke-free for 6 months.

Design: A prospective cohort study.

Setting: In all, 302 smoking cessation clinics in Denmark from municipal clinics, pharmacies, hospitals, midwives, primary care facilities and other private providers who reported data to the national Danish Smoking Cessation Database from 2006 to 2016 participated in this study.

Participants: A total of 38 293 patients from the Danish Smoking Cessation Database. Patients with an SMD were identified by linking data to the Danish National Patient Register. Diagnoses of organic mental disorders (F0 chapter) or intellectual disabilities (F7 chapter) were not included. Smokers ≥18 years old who were attending a Gold Standard Programme (GSP) with planned follow-up were included. Smokers not wanting contact after 6 months were excluded.

Interventions: A comprehensive manual-based smoking cessation intervention comprising five meetings over a 6-week period (the GSP).

Main Outcome Measures: Self-reported continuous abstinence at the 6-month follow-up.

Results: In all, 69% of the participants participated in the follow-up after 6 months. The overall rate of successful quitting was high but significantly lower in SMD smokers (29% vs 38%; OR 0.74; 95% CI 0.68 to 0.80). Variables associated with successful quitting were compliance (defined as attending ≥75% of the planned meetings), older age and male gender as well as not being disadvantaged, heavy smoking or recommendation of intervention by health professionals.

Conclusions: Only 29% of smokers with an SMD successfully quit smoking which was significantly lower than the 38% of smokers without an SMD. Compliance was the most important predictor for successful quitting.
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http://dx.doi.org/10.1136/bmjopen-2017-021114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009564PMC
June 2018

Sociodemographic predictors are associated with compliance to a vaccination-reminder in 9692 girls age 14, Denmark 2014-2015.

Prev Med Rep 2018 Jun 23;10:93-99. Epub 2018 Feb 23.

Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.

We aimed to identify sociodemographic predictors of compliance after receiving a personalised reminder on lacking vaccinations against MMR (Measles, Mumps, Rubella) and/or HPV (Human Papilloma Virus) among parents of Danish adolescent girls. A nationwide register-based study, including all 14-year-old girls (15 May 2014-14 May 2015) lacking either MMR, HPV-vaccination or both. Vaccination-compliance following a postal reminder was modelled using multivariable logistic regression and included the following socio-demographic predictors: maternal age, education, employment and ethnicity. Birth order, number of siblings, family-structure, location of residence, and household income. The parents of 9692 girls received a reminder. Out of 4940 exclusively lacking an HPV-vaccine, 15.3% were subsequently vaccinated. Among 2026 only lacking an MMR vaccination, 8.5% were vaccinated. Among 2726 girls lacking both, 5% received an HPV, 4.4% an MMR and 5.4% received both vaccinations. We identified sociodemographic differences between reminderletter-compliers and non-compliers, also according to vaccination types. Non-western descendants were more likely to receive HPV-vaccination, although the association was only significant for those who only lacked HPV (OR 2.02, 95% 1.57-2.59). For girls only lacking an MMR, regional differences were identified. Among girls lacking both vaccines, girls of mothers with intermediate (OR 0.63, 0.42-0.95) or basic education (OR 0.43, 0.24-0.75) were less likely to be vaccinated compared to girls of higher educated mothers. Reminders were in particular effective in increasing HPV uptake among immigrants of non-Western ethnicity. We found reminders to be less effective among less educated mothers whose daughters lacked both vaccines. To increase the coverage in this group, additional interventions are needed.
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http://dx.doi.org/10.1016/j.pmedr.2018.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984205PMC
June 2018

Persistent social inequality in low intake of vegetables among adolescents, 2002-2014.

Public Health Nutr 2018 06 6;21(9):1649-1653. Epub 2018 Mar 6.

1University of Southern Denmark,National Institute of Public Health,Studiestræde 6, DK-1455 Copenhagen K,Denmark.

Objective: To examine the trend in social inequality in low intake of vegetables among adolescents in Denmark from 2002 to 2014 using occupational social class (OSC) as socio-economic indicator.

Design: Repeated cross-sectional school surveys including four waves of data collection in 2002-2014. The analyses focused on absolute social inequality (difference between high and low OSC in low vegetable intake) as well as relative social inequality (OR for low vegetable intake by OSC).

Setting: The nationally representative Health Behaviour in School-aged Children (HBSC) study in Denmark.

Subjects: The study population was 11-15-year olds (n 17 243).

Results: Low intake of vegetables was defined as less than weekly intake measured by food frequency items. OSC was measured by student reports of parents' occupation. The proportion of participants who reported eating vegetables less than once weekly was 8·9 %, with a notable decrease from 11·9 % in 2002 to 5·9 % in 2014. The OR (95 % CI) for less than weekly vegetable intake was 2·28 (1·98, 2·63) in the middle compared with high OSC and 3·12 (2·67, 3·66) in the low compared with high OSC. The absolute social inequality in low vegetable intake decreased from 2002 to 2014 but the relative social inequality remained unchanged.

Conclusions: The study underscores that it is important to address socio-economic factors in future efforts to promote vegetable intake among adolescents. The statistical analyses of social inequality in vegetable intake demonstrate that it is important to address both absolute and relative social inequality as these two phenomena may develop differently.
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http://dx.doi.org/10.1017/S136898001800040XDOI Listing
June 2018

Persistent social inequality in low intake of vegetables among adolescents, 2002-2014.

Public Health Nutr 2018 06 6;21(9):1649-1653. Epub 2018 Mar 6.

1University of Southern Denmark,National Institute of Public Health,Studiestræde 6, DK-1455 Copenhagen K,Denmark.

Objective: To examine the trend in social inequality in low intake of vegetables among adolescents in Denmark from 2002 to 2014 using occupational social class (OSC) as socio-economic indicator.

Design: Repeated cross-sectional school surveys including four waves of data collection in 2002-2014. The analyses focused on absolute social inequality (difference between high and low OSC in low vegetable intake) as well as relative social inequality (OR for low vegetable intake by OSC).

Setting: The nationally representative Health Behaviour in School-aged Children (HBSC) study in Denmark.

Subjects: The study population was 11-15-year olds (n 17 243).

Results: Low intake of vegetables was defined as less than weekly intake measured by food frequency items. OSC was measured by student reports of parents' occupation. The proportion of participants who reported eating vegetables less than once weekly was 8·9 %, with a notable decrease from 11·9 % in 2002 to 5·9 % in 2014. The OR (95 % CI) for less than weekly vegetable intake was 2·28 (1·98, 2·63) in the middle compared with high OSC and 3·12 (2·67, 3·66) in the low compared with high OSC. The absolute social inequality in low vegetable intake decreased from 2002 to 2014 but the relative social inequality remained unchanged.

Conclusions: The study underscores that it is important to address socio-economic factors in future efforts to promote vegetable intake among adolescents. The statistical analyses of social inequality in vegetable intake demonstrate that it is important to address both absolute and relative social inequality as these two phenomena may develop differently.
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http://dx.doi.org/10.1017/S136898001800040XDOI Listing
June 2018
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