The International Journal Of Behavioral Nutrition And Physical Activity[JOURNAL]
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200 papers
Not all steps are equal: independent prospective associations of stepping volume and patterns with incident type 2 diabetes mellitus in the Maastricht study.
Pulsford RM, Bakker EA, Ahmadi M … +10 more , Blodgett JM, Bosma H, Brocklebank L, Eussen SJ, Hamer M, Lear R, Metcalf B, Savelberg H, Stamatakis E, Koster A
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41257696 · Full text
BACKGROUND: Stepping has been associated with reduced risk for type 2 diabetes (T2D), but existing prospective studies focus largely on average stepping volume (steps per day or week) and ignore important differences in...
BACKGROUND: Stepping has been associated with reduced risk for type 2 diabetes (T2D), but existing prospective studies focus largely on average stepping volume (steps per day or week) and ignore important differences in how stepping is accumulated. Here, we examined independent associations of stepping volume and within and between day variability, with incident T2D. METHODS: Participants (n = 4594, 40-75y) without preexisting T2D from The Maastricht Study wore an activPAL3 accelerometer (6-7 days). Prospective associations of stepping volume (steps/day) with incident T2D were assessed using Cox proportional hazards models with restricted cubic splines, adjusted for age, sex, BMI, education, smoking, CVD, sedentary time and diet. Four indices of between-day (i-iii below) and within-day (iv below) stepping pattern were modelled alongside total steps/day. These were: (i) proportion of steps accumulated on the 2 most active days (%Active-2days), (ii) between-day step count variability (BDV) and (iii) inter-daily step count stability (IS), (iv) within-day variability in stepping (WDV) (variability in steps/hour). Higher values in %Active-2days, BDV and WDV indicate greater variation in stepping between or within days. Higher IS values indicate greater uniformity in hourly stepping pattern between days. RESULTS: Over 30,336 person-years of follow-up (mean 6.6y), 178 incident cases of T2D were recorded. A non-linear (p = 0.04) 'L-shaped' association was observed between stepping volume and T2D risk, with steeper risk reduction earlier in the steps/day distribution. Relative to accumulating ≤ 5000 steps/day, adjusted hazard ratios (95% CI) were 0.57 (0.34, 0.96) for 5000-7500 steps/day, 0.60 (0.65-0.94) for 7501-10,000 steps/day, 0.48 (0.25, 0.89) for 10,001-12,500 steps/day and 0.68 (0.37, 1.24) for > 12,501 steps/day. Higher %Active-2days, BDV, and lower IS, (cumulatively describing a stepping pattern which is variable between days and within days), were linearly associated with T2D risk independent of stepping volume. HRs per SD increase were: %Active-2days 0.70 (0.65, 0.97), BDV 0.69 (0.54, 0.89) and IS 1.32 (1.08, 1.63). CONCLUSIONS: Substantial reductions in T2D risk can be achieved by accumulating more steps during the day. Further, accumulating steps in a pattern possibly reflecting periodic larger doses of stepping may provide additional reductions in T2D risk. Future research regarding volume and optimum patterns of stepping could form the basis of the next generation of public health guidance and interventions to improve health through movement.
Are costs optimized as scale-up of Choose to Move-an effective health-promoting intervention for older adults-proceeds?
Szewczyk Z, Macdonald HM, Pinheiro MB … +3 more , Nettlefold L, Sims Gould J, McKay HA
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41233872 · Full text
BACKGROUND: Few studies have examined costs of implementing evidence-based interventions (EBIs) as scale-up proceeds. Across four phases, we co-adapted and scaled up an effective EBI designed to promote older adults’ hea...
BACKGROUND: Few studies have examined costs of implementing evidence-based interventions (EBIs) as scale-up proceeds. Across four phases, we co-adapted and scaled up an effective EBI designed to promote older adults’ health (Choose to Move; CTM). Following formative evaluation (2015), Phases 1–2 (2016-17) comprised the CTM pilot and early scale-up. For Phase 3 (2018-20), we adapted CTM to establish “best fit” and support broad scale-up. In response to COVID-19 (2020), we adapted CTM for virtual delivery. For Phase 4 (2020-22), we adapted CTM to reduce resource use. We aimed to (1) identify, measure, and value costs of implementing CTM across four phases (7 years) of scale-up; and (2) analyze change in implementation costs alongside changes in intervention effect sizes to assess cost-consequence trends from Phases 1–2 through Phase 4. METHODS: We conducted a trial-based cost and cost-consequence analysis of CTM Phases 1–2 through Phase 4 from a program provider perspective. Program costs were identified, measured, and valued using micro-costing techniques; variation in program cost was explored using scenario analyses. We compared Phase 4 intervention effects against those of Phases 1–2 and Phase 3 to examine how changes in implementation costs corresponded with changes in effect size. RESULTS: For Phases 1–2, total cost ($CDN, 2024) of CTM implementation was $863,559 for 55 programs (534 participants; $1,617/participant). Phase 3 costs were $1,564,446 for 165 programs (1668 participants; $938/participant). Phase 4 costs were $760,983 for 135 programs (1278 participants; $595/participant), a reduction of 63% and 37% compared with Phases 1–2 and Phase 3, respectively. Compared with Phases 1–2, Phase 4 had a greater positive effect on social isolation but effect sizes for physical activity, mobility and loneliness were reduced. Phase 4 had a greater positive effect on physical activity and mobility in all participants, and loneliness among those < 75 years, compared with Phase 3. CONCLUSIONS: Costs associated with broad scale-up of EBIs are rarely investigated. We sought innovative ways to maximize impact of a health-promoting EBI, while minimizing costs. Our analysis highlights how strategic adaptations can enhance cost efficiency while improving intervention outcomes; this represents an emergent application of economic analysis within scale-up science. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov, NCT05678985 (CTM Phase 4) and NCT05497648 (CTM Phase 3).
Interventions to reduce sedentary behaviour in community-dwelling older adults: a mixed-method review.
Tadrous R, Forster A, Farrin A … +2 more , Coventry P, Clegg A
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41225519 · Full text
BACKGROUND: Older adults are the fastest-growing and most sedentary group in society. As sedentary behaviour is associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. This mi...
BACKGROUND: Older adults are the fastest-growing and most sedentary group in society. As sedentary behaviour is associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. This mixed-methods systematic review aimed to systematically review quantitative and qualitative studies examining interventions to reduce sedentary behaviour in community-dwelling older adults (aged ≥ 65 years). METHODS: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Cinahl, SportDiscus, and PEDRO were searched from inception to July 2025. We included quantitative studies (randomised-controlled trials (RCTs) and cluster RCTs), qualitative studies (semi-structured interviews or focus groups), and mixed-method studies exploring interventions to reduce sedentary behaviour in community-dwelling older adults. Studies were appraised using the Mixed Method Appraisal Tool. Quantitative evidence was meta-analysed; qualitative evidence was thematically synthesised, with both combined in a mixed-method synthesis. The Behaviour Change Techniques employed were charted and analysed. RESULTS: Fifty-six studies (16 RCTs, 30 qualitative, and 10 mixed-method studies) were included. When pooled, interventions reduced sedentary behaviour by 27.53 min/day (95% CI: − 57.43 to 2.37), with greater reductions observed via self-report (–83.65 min/day) than device measures (–11.61 min/day). Using ≥ 11 BCTs (-24.01 min/day) was more effective than using 1–10 (9.24 min/day). Analytical themes included what sitting means to older adults, expectations of ageing, and social influence in older adults. The mixed-method synthesis identified that existing interventions are limited by recruited samples that are not representative of the wider population of older adults, and intervention design and outcome measurement selection that is not consistent with older adults’ priorities. CONCLUSIONS: Interventions to reduce sedentary behaviour in community-dwelling older adults are somewhat effective at reducing sedentary time. Future research should focus on inclusive recruitment strategies to recruit underrepresented populations, incorporate outcome measures valued by older adults, and align intervention content with their preferences. PROSPERO REGISTRATION NUMBER: CRD42021264954.
Economic evaluation of the national school food standards across secondary schools in the Midlands, UK (the FUEL study): methodological challenges of undertaking health economics research within non-health settings.
Pokhilenko I, Pallan M, Murphy M … +15 more , Adab P, Morrison B, Sitch A, Adamson A, Bartington S, Duff R, Griffin T, Hurley K, Lancashire E, McLeman L, Passmore S, Rowland M, Ravaghi V, Spence S, Frew E
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41225499 · Full text
BACKGROUND: Economic evaluations of complex public health interventions are becoming increasingly important. This presents health economists with challenges of adapting methodologies originally designed for healthcare to...
BACKGROUND: Economic evaluations of complex public health interventions are becoming increasingly important. This presents health economists with challenges of adapting methodologies originally designed for healthcare to other contexts, such as education. This study presents an economic evaluation of the UK School Food Standards (SFS), with a particular focus on the methodological challenges involved. METHODS: The economic evaluation was conducted alongside an observational study comparing the SFS-mandated secondary schools to non-mandated schools in the Midlands (UK). Costs of food provision and SFS implementation were collected directly from schools and supplemented by secondary data on schools' catering expenditure. The outcomes included dietary intake, dental health, health-related quality of life (HRQoL), and educational performance, collected from pupils and secondary data. The analysis comprised a micro-costing, cost-consequence, and an exploratory cost-utility analysis, from school and societal perspectives. RESULTS: Data were collected from 36 schools and 2,543 pupils. We found mandated schools spent less on food provision compared to non-mandated schools, and pupils attending mandated schools had marginally better HRQoL, dental health, and slightly worse nutritional intake. Mandated schools performed worse according to the educational outcomes. There were large amounts of missing cost data despite repeated data collection attempts, and the results of the cost-utility analysis were uncertain. DISCUSSION: We found no clear evidence on the cost-effectiveness of the SFS in secondary schools, likely due to substantial variation in implementation and compliance across both mandated and non-mandated schools, as well as multiple challenges, including the COVID-19 pandemic, difficulties in collecting cost data from schools, and the complexity of the study context. This study highlights the challenges of primary cost data collection for evaluating complex interventions and the need to balance data accuracy with the resources required. As economic evaluations of school-based interventions become more common, there is a growing need to refine methods for such evaluations.
Contributions of park-based activities to overall physical activity among adults living near recently renovated parks in low-income New York City neighborhoods: variations by race/ethnicity and sex.
Thompson RL, Olivera León LD, Hong H … +3 more , Maffei J, Wyka KE, Huang TT
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41225437 · Full text
BACKGROUND: Urban parks may promote physical activity (PA); however, little is known about whether renovated urban parks contribute to overall PA similarly across diverse sociodemographic groups. In this cross-sectional...
BACKGROUND: Urban parks may promote physical activity (PA); however, little is known about whether renovated urban parks contribute to overall PA similarly across diverse sociodemographic groups. In this cross-sectional study, we examined associations between park-based activities and overall PA among adults living near recently renovated parks in low-income New York City (NYC) neighborhoods, with particular attention to differences by race/ethnicity and sex. METHODS: A total of 1336 adult survey respondents who reported past-month use of a renovated park within 0.5 miles of their residence were included. Surveys captured past-month participation in activities at the renovated park (walking, exercising, taking children to the playground/park, relaxing, socializing, volunteering) and self-reported PA level during visits (sitting, light, moderate-to-vigorous). The outcome, overall past-week PA, was measured in metabolic equivalent of task (MET)-minutes using the International Physical Activity Questionnaire and log-transformed prior to analysis. Linear regression models estimated associations of park-based activities and park-based PA levels with log(MET-minutes) of overall PA in the full sample and stratified by race/ethnicity and sex. RESULTS: In the full sample, park-based activities explained 5.4% of the variability in overall PA of past-month renovated park users; self-reported park-based PA level explained 5.2% of the variability. Compared to past-month park users who did not engage in these activities, those who reported exercising at the study park had 47% higher overall PA and those who reported walking had 33% higher overall PA, while those who reported volunteering had 26% lower overall PA, after confounder adjustment. Activities at renovated parks explained more variability in overall PA among males (6.3%) compared with females (5.1%), and among minority groups (Latino/as = 6.5%, Blacks = 6.8%, other race/ethnicity = 11.2%) compared with Whites (4.3%). CONCLUSIONS: Among adults with past-month renovated park use in low-income NYC neighborhoods, park-based activities explained a significant proportion of the variability in overall PA, with stronger contributions among minorities and males. These findings highlight the importance of considering sociodemographic differences when assessing the role of renovated urban parks in promoting PA and suggest that investments in high-quality green spaces may be particularly impactful for minority groups facing disproportionate barriers to PA.
Co-creating the COMMUNICATE toolkit to support the communication of physical activity messages with adolescents in schools.
Grady CL, Murtagh E, Verloigne M … +4 more , McNally K, Bengoechea EG, Ng K, Woods CB
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41219966 · Full text
BACKGROUND: Communication campaigns within multi-component school-based interventions could improve knowledge and awareness about physical activity (PA) behavior. Guidance to implement such communication campaigns is lac...
BACKGROUND: Communication campaigns within multi-component school-based interventions could improve knowledge and awareness about physical activity (PA) behavior. Guidance to implement such communication campaigns is lacking. This paper presents the co-creation and evaluation processes that led to the development of the COMMUNICATE toolkit, which supports implementers to communicate PA messages. METHODS: Students and teachers from secondary schools enrolled in the Active School Flag (ASF) program were invited to participate. To provide a nuanced perspective on the communication of PA, ASF program implementers (i.e., coordinating teacher and adolescent peer leaders) and receivers (i.e., staff and students not involved in ASF delivery), together known as co-creators, engaged in three rounds of co-creation workshops to share ideas, provide feedback, and refine the toolkit. Workshop data were collected via activity recording sheets; written raw materials were photographed and later transcribed verbatim to generate a dataset. Inductive thematic analysis was conducted to organize and describe the toolkit components. A multi-stakeholder research steering group (n=7) was established to design, facilitate, and evaluate the co-creation process. The toolkit was refined between rounds of workshops. Throughout the co-creation process, the facilitator reflected after each workshop to improve its’ participatory nature. After the final workshop, co-creators completed a process evaluation questionnaire. Additional consultations with experts were held to bridge the gap in expertise. A logic model was developed to understand the theory of change behind the toolkit. RESULTS: Eight teachers and 38 students from four ASF schools participated in the co-creation workshops. All 14 aspects of the process evaluation were mainly positive (86.7-100%). Common reasons for negative responses included co-creators not engaging, too much moving around during workshops, teachers’ involvement, and working with strangers. The final version of the toolkit included resources for program implementers to i) raise awareness about PA and the program, ii) plan the promotion of PA, and iii) develop key communication skills. CONCLUSIONS: The COMMUNICATE toolkit, informed by multi-stakeholder voices, emphasizes a multi-level, multi-stakeholder approach to communicating PA messages with adolescents in schools. It provides tools and resources for program implementers to improve communication efforts. The COMMUNICATE toolkit could be adapted to other peer-led school-based programs.
Identifying behaviour change techniques within precision health interventions that use continuous glucose monitoring: a secondary analysis of a scoping review.
Bohlen LC, Crawshaw J, Jospe MR … +3 more , Richardson KM, Konnyu KJ, Schembre SM
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41199295 · Full text
BACKGROUND: Continuous glucose monitoring (CGM) is increasingly being used within precision health interventions to motivate behaviour change. However, there is considerable variability and complexity in the design of be...
BACKGROUND: Continuous glucose monitoring (CGM) is increasingly being used within precision health interventions to motivate behaviour change. However, there is considerable variability and complexity in the design of behaviour change interventions that incorporate CGM-based biofeedback, making it challenging to disentangle the intervention components that are driving intervention effects. The objective of this review is to identify the behaviour change techniques and mechanisms of action commonly implemented alongside CGM-based biofeedback. METHODS: We conducted secondary analyses of a scoping review to identify health behaviour interventions (RCTs) that provided CGM-based biofeedback to promote behaviour change in adults. Two researchers applied the 93-item Behaviour Change Techniques (BCT) Taxonomy (v1) to independently code intervention content in all trial arms (i.e., intervention and comparison arms) dependent upon their targeted behaviour of CGM use, glucometer use, diet, physical activity, or medication adherence. BCTs were analysed individually and according to their corresponding category. We performed univariate linear regression analyses to examine whether the presence of individual BCTs and target behaviours influenced pre-post changes in HbA1c within CGM-based intervention arms. RESULTS: Thirty-one RCTs comprising 35 intervention arms and 29 comparison arms were included. Theory was reported in 4 studies (13%), most commonly Self-Efficacy Theory. Mechanisms of action (MoAs) were specified in 5 studies (16%), typically targeting beliefs about capabilities. We identified 40 (of 93 possible) unique BCTs, with intervention arms employing an average of 7.1 BCTs (SD: 4.8) compared to 5.3 BCTs (SD: 4.3) in comparison arms. The most frequently implemented BCT categories in CGM-based biofeedback interventions were 'Feedback and monitoring' (n = 35/35, 100%), 'Shaping knowledge' (n = 28/35, 80%), and 'Social support' (n = 22/35, 63%). Commonly used BCTs supporting CGM use and promoting dietary and physical activity changes included 'Biofeedback' (n = 35/35; 100%), 'Instruction on how to perform the behaviour' (n = 19/35; 54%), and 'Credible source' (n = 14/35; 40%). Univariate linear regressions did not identify any individual BCTs or targeted behaviours that significantly moderated HbA1c outcomes. CONCLUSIONS: RCTs using CGM to change behaviour in adult populations include a range of BCTs, focusing predominantly on BCTs that support the implementation of CGM itself. Future research should examine whether BCTs operate through distinct MoAs when supporting CGM uptake and use versus when promoting broader health behaviour change in conjunction with CGM-based biofeedback.
Effectiveness of booster strategies to promote physical activity maintenance: a systematic review and meta-analysis.
Tarantino G, Ntoumanis N, Neville R … +7 more , Cimenti C, Petersen AP, Pfeffer K, Mazéas A, Larsen MN, Krustrup P, Thøgersen-Ntoumani C
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41194192 · Full text
BACKGROUND: Physical activity (PA) is essential for physical and mental health, yet sustaining long-term PA engagement remains a challenge. Booster strategies-follow-up contacts delivered after the end of interventions-h...
BACKGROUND: Physical activity (PA) is essential for physical and mental health, yet sustaining long-term PA engagement remains a challenge. Booster strategies-follow-up contacts delivered after the end of interventions-have been proposed as a strategy to support PA maintenance, but their effectiveness remains unclear. The primary objective of this systematic review and meta-analysis was to classify the boosters used in PA interventions depending on their type and number. The secondary objective was to explore the efficacy of boosters in supporting participants' PA maintenance. METHODS: A systematic search was conducted across seven databases, up to February 2025. Randomised controlled trials were included if they incorporated boosters and reported PA outcomes. Risk of bias was assessed using the RoB 2 tool. Meta-analysis examined changes in moderate-to-vigorous physical activity (MVPA) from baseline to the last available follow-up, and moderation analysis explored the effects of booster type, number of boosters administered, and follow-up duration on changes in MVPA. Studies not suitable for meta-analysis were synthesised narratively. RESULTS: Forty studies were included in the systematic review. The most common types of boosters used were phone calls and text messages, which were employed either alone or in combination with other types. 16 studies provided data for inclusion in the meta-analysis. There was conclusive evidence that including a booster in the intervention led to sustained increases in PA levels at follow-up. The estimated added effect of the booster over the intervention alone was a 6% increase. There was also conclusive evidence of increased MVPA for interventions with more boosters, and interventions that used remote and mixed-format delivery (vs in-person only) boosters. Finally, results showed conclusive evidence of increased MVPA for interventions that assessed MVPA using self-reported measures. CONCLUSIONS: Our findings suggest a trend indicating that boosters may support the maintenance of PA. Higher number of boosters and delivery through remote or mixed formats showed promising trends. Future research should also explore optimal booster numbers and formats to clarify their role in sustaining PA. REGISTRATION: PROSPERO (CRD42024510018); Protocol also available on Open Science Framework (OSF): https://osf.io/6abkw/?view_only=915375148520427db3dca76d2c32934d .
Predicting diet quality and food consumption at eating occasions using contextual factors: an application of machine learning models.
Tran NR, Zhang Y, Leech RM … +1 more , McNaughton SA
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41188922 · Full text
BACKGROUND: Eating occasions (EOs) are important moments for dietary decision-making. Tailoring nutrition interventions to individuals’ behaviours and environmental contexts offers a promising way to modify eating habits...
BACKGROUND: Eating occasions (EOs) are important moments for dietary decision-making. Tailoring nutrition interventions to individuals’ behaviours and environmental contexts offers a promising way to modify eating habits at EOs and enhance diet quality. While machine learning (ML) is a useful tool for predicting behaviours, its potential in understanding food choices at EOs remains underexplored. This study uses ML to investigate whether contextual factors can predict food consumption at EOs and overall daily diet quality. METHODS: Cross-sectional data from the Measuring Eating in Everyday Life Study (MEALS) were analysed. Participants (18-30y, n = 675) recorded intakes for 3–4 non-consecutive days using a Smartphone food diary app. EO-level contextual factors at each EO were recorded via the app while person-level contextual factors were collected via an online survey. Intakes were calculated as servings of vegetables, fruits, grains, meat, dairy, and discretionary foods, in accordance with the Australian Dietary Guideline. Diet quality was assessed via Dietary Guideline Index (DGI, 0-120). Gradient boost decision tree and random forest algorithms were used for hurdle prediction models, with lowest mean absolute error (MAE) as best performing. Mean absolute SHapley Additive exPlanations (SHAP) values were used to interpret the impact of each factor in explaining food consumption predictions. RESULTS: Predictive models performed robustly, with MAE below half a serving for various food groups: 0.3 servings for vegetables, 0.75 for fruit, 0.28 for dairy, 0.55 for grains, 0.4 for meat, and 0.68 for discretionary foods per EO. This indicates small deviations between the model’s predictions and actual intakes. For overall daily diet quality, the model predictions deviated by 11.86 DGI points from the actual score. From mean absolute SHAP values, the importance of predictive factors varied across the six food groups, while for diet quality, the most influential factors were cooking confidence, self-efficacy, food availability, perceived time scarcity, and activity during consumption. CONCLUSION: ML provided valuable insights into predicting food consumption based on contextual factors. Future research should explore how ML can assist identify key factors that, when adjusted for individual behaviour patterns, encourage healthier eating habits.
Longitudinal associations between food fussiness and parental feeding behaviors in Chinese children: between- and within-person effects.
Qu F, Chen Y, Song X … +8 more , Wei X, Zhao Z, Wu C, Wu R, Wang J, Tang X, Chen J, Zhu D
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41188907 · Full text
BACKGROUND: The directionality of longitudinal associations between children's food fussiness and parental feeding behaviors remains contested. This study aimed to assess the dynamic relationship between children's food...
BACKGROUND: The directionality of longitudinal associations between children's food fussiness and parental feeding behaviors remains contested. This study aimed to assess the dynamic relationship between children's food fussiness and feeding behaviors. METHODS: To disentangle these effects, this study employed cross-lagged panel models (CLPMs) and random-intercept cross-lagged panel models (RI-CLPMs) using longitudinal data from 588 Chinese children (Mean age = 3.7 years, SD = 0.3, 51.7% boys) across three waves over two years. CLPMs capture between-person associations, while RI-CLPMs isolate within-person dynamics over time. Within-person effects represent how temporary deviations predict subsequent changes beyond stable traits, whereas between-person effects reflect enduring cross-family differences. RESULTS: Analyses revealed distinct patterns depending on the feeding behavior and model type: for restrictions, the CLPM showed parent-driven effects (restrictions at 3.7 years→ fussiness at 4.8 years, β = -0.104, p = 0.003), whereas the RI-CLPM identified child-driven effects (fussiness at 4.8 years → restrictions at 5.7 years, β = 0.179, p = 0.033). Both models consistently revealed child-driven effects for pressure to eat (CLPM: β = 0.151, p = 0.002; RI-CLPM: β = 0.218, p = 0.013). Food as a reward showed bidirectionality in CLPM (reward at 4.8 years → fussiness at 5.7 years: β = 0.112, p < 0.001; fussiness at 4.8 years→ reward at 5.7 years: β = 0.144, p = 0.005) but no significant cross-lagged paths in the RI-CLPM. Notably, the multi-group analysis revealed no moderating effect of child sex. CONCLUSIONS: After accounting for stable between-person differences, RI-CLPM findings reveal that child food fussiness prospectively drives increases in parental use of restriction and pressure to eat at the within-person level. This suggests that these specific feeding behaviors may function more as reactive responses to children's eating behaviors than as caregiver-initiated strategies.
Effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: a modified Delphi study.
Barrett S, Begg S, Dunford AR … +22 more , O'Halloran P, Breckon J, Denniss E, Rodda K, Hardcastle S, Marshall PW, Anstiss T, Kwasnicka D, Bohman B, Atkinson C, Taylor NF, Randall C, Greaves C, Hall K, Kunstler B, Lakerveld J, Goodwin D, Harrison C, Devlieger R, Halliwell D, Faustino-Silva D, Kingsley M
Int J Behav Nutr Phys Act · 2025 Nov · PMID 41185033 · Full text
BACKGROUND: There are high levels of ill health across the world, largely due to lifestyle risk factors such as inadequate physical activity, unhealthy diet, and smoking. Behaviour change interventions are widely recomme...
BACKGROUND: There are high levels of ill health across the world, largely due to lifestyle risk factors such as inadequate physical activity, unhealthy diet, and smoking. Behaviour change interventions are widely recommended for addressing many of these risk factors. While integrated motivational interviewing and cognitive behavioural therapy (MI-CBT) is increasingly used to support behaviour change, there is currently no established consensus on its core effective components. The aim of this study was to establish expert consensus on the essential elements of MI-CBT interventions for lifestyle behaviour change. METHODS: A modified Delphi study comprised of three iterative online surveys involving international experts in MI-CBT and lifestyle behaviour change was conducted. Using key literature and practice guides, a list of 63 commonly used components in individually delivered motivational interviewing (MI) and cognitive behavioural therapy (CBT) interventions were developed. In each round, experts rated their agreement with each component using a Likert scale. Components reaching at least 80% agreement in Rounds 2 or 3 were included in the final list of essential MI-CBT components. RESULTS: Thirty experts with a median of 13 years of experience in behaviour change intervention design and delivery participated in Round 1, with 28 (93%) completing Round 2, and 25 (83%) completing Round 3. Consensus was achieved for 26 components. Of these, eight were relational components which included open-ended questions, affirmations, reflections, summaries, emphasising autonomy and offering emotional support. Sixteen components were based on cognitive behavioural content, and included exploring change expectations, identifying and exploring avoidant behaviour, identifying past successes, and technical strategies such as activity scheduling and relapse prevention. Finally, two process components emphasised the importance of scheduling sessions flexibly based on client needs, and ensuring that the therapist meets recognised standards for MI-CBT training and practice. CONCLUSIONS: Expert consensus was established regarding the essential elements of MI-CBT interventions for lifestyle behaviour change. This consensus provides guidance on essential elements to include in integrated MI-CBT interventions, which may strengthen MI-CBT training, improve intervention fidelity, and enhance real-world and research applications targeting physical activity, dietary intake, and smoking cessation. The proposed consensus framework offers a foundation for future trials assessing the effectiveness and implementation of integrated MI-CBT interventions.
Profiling users and non-users of meal delivery services in Belgium using latent class analysis.
Oostenbach LH, Keeble M, Vanoutrive T … +4 more , Poelman MP, Kamphuis CBM, Van Lippevelde W, Thornton L
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41168878 · Full text
BACKGROUND: Ready-to-eat meal delivery services have become increasingly popular in recent years, with potential detrimental health implications as the majority of food promoted and sold is energy-dense and nutrient-poor...
BACKGROUND: Ready-to-eat meal delivery services have become increasingly popular in recent years, with potential detrimental health implications as the majority of food promoted and sold is energy-dense and nutrient-poor. However, limited research has examined who uses these services and why. This study explores the profiles of different users and non-users of meal delivery services and further describes the socio-demographic and health characteristics of these profiles. METHODS: Data were from 1086 adults who completed the online 2024 Meal Delivery Survey conducted in the Flanders and Brussels regions of Belgium. Users of meal delivery services reported on usage indicators (e.g., valuing fast delivery, ordering to avoid traffic) and non-users reported on reasons for non-use (e.g., lacking trust in meal hygiene, finding it bad for the environment). Latent class analysis categorised users based on patterns of indicator endorsement. Amongst non-users, reasons for non-use were examined descriptively for both former users and never users. Socio-demographic and health characteristics were compared across profiles. RESULTS: Over 66% of the sample (n = 720) were users and 34% (n = 366) non-users. Latent class analysis identified two user profiles. Efficiency-focused users (48% of user sample) solely prioritised fast and affordable service. Variety- and convenience-driven users (52% of user sample) endorsed a wider range of indicators, including the ability to try different cuisines, avoid supermarkets, and have more leisure time. The latter group included more frequent users. Amongst non-users, both former users (52% of non-user sample) and never users (48% of non-user sample) most commonly reported preferences for in-store food shopping and home cooking as reasons why they did not order meals for delivery. Profiles differed in socio-demographic and health characteristics. For example, variety- and convenience-driven users reported poorer health than efficiency-focused users. Non-users (former and never) were older than users, with never users having the oldest age profile. CONCLUSIONS: This study provides a better understanding of determinants of use and non-use of meal delivery services, informing public health action aimed at improving food behaviours and reducing the burden of diet-related diseases. Results can support the development of targeted interventions addressing main drivers of meal delivery service use.
Correction to: Secular trends and sociodemographic disparities in physical activity among adults in eleven African countries: WHO STEPS 2003-2020.
Oyeyemi AL, Araujo RHO, Hassan UA … +3 more , Ofori E, Stecher C, Werneck AO
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41168738 · Full text
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The "Eat Less Meat" one-month challenge: a randomized controlled trial of a meat reduction pledge intervention among French university students.
Marty L, Biehlmann M, Louveau A … +2 more , Poquet D, Robinson E
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41146183 · Full text
BACKGROUND: Encouraging the shift towards more plant-based diets in new generations is one of the major current challenges to preserve population and planetary health. Personal pledges to reduce meat consumption could mo...
BACKGROUND: Encouraging the shift towards more plant-based diets in new generations is one of the major current challenges to preserve population and planetary health. Personal pledges to reduce meat consumption could motivate behaviour change, but have received limited scientific testing. We examined the effect of a "Eat Less Meat" one-month challenge on immediate and long-term meat consumption of university students. METHODS: In January 2023, 366 university students (21 ± 3.2 years old) consented to participate in the "Eat Less Meat" one-month challenge and were randomized to the intervention group (n = 187, challenge in February 2023) or the wait list control group (n = 179, challenge in June 2023). Neither participants nor investigators were masked to group assignment. Participants chose between three meat reduction objectives: consuming meat 0, 3, or 6 times a week. They received a meat-free recipe book and followed an Instagram account where motivational information was posted daily during one month. All the participants completed a food frequency questionnaire in January (T0, before), February (T1, during), and May 2023 (T2, three months after the challenge) and data on meat consumption were analysed using linear mixed models. RESULTS: The participants in the "Eat less meat" one-month challenge reduced their meat consumption by -67 g/day (95% CI [-82; -53]) during the challenge and by -50 g/day (95% CI [-68; -31]) three months later. The decrease was greater than in the control group by -34 g/day (95% CI [-55; -14]) during the challenge, but there was no significant difference between intervention and control group at three months follow-up. CONCLUSIONS: The "Eat Less Meat" one-month challenge may be a promising strategy to drive short-term reductions in meat consumption and further work to improve longer-term effectiveness is now warranted. TRIAL REGISTRATION: The trial was pre-registered prior to data collection at Clinicaltrials.gov (NCT05752786).
Byte into sustainability: a scoping review of digital food environment attributes that shape consumers' sustainability perceptions, attitudes, intentions, and behaviours.
Boen H, Glenisson L, Hallez L … +1 more , Smits T
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41146148 · Full text
BACKGROUND: Current food systems harm both planetary and human health. Meanwhile, our food choices are increasingly influenced by the digital food environment: spaces where digital actors (such as influencers) engage in...
BACKGROUND: Current food systems harm both planetary and human health. Meanwhile, our food choices are increasingly influenced by the digital food environment: spaces where digital actors (such as influencers) engage in food-related activities (like sharing content) across various platforms (for example, on social media). The digital food environment offers potential to promote more sustainable diets in several ways; for instance, influencers may encourage followers to reduce meat consumption, and supermarket apps can highlight the carbon footprint of different products. However, research on how specific features of the digital food environment, referred to here as digital attributes, affect sustainable food outcomes remains scattered. This scoping review aims to address this gap by: (1) mapping the scope and volume of current research on the relationship between the digital food environment and consumers’ sustainable food outcomes; and (2) identifying digital attributes that influence these outcomes. Consumers’ sustainable food outcomes are defined as consumers’ perceptions, attitudes, intentions, or behaviours related to social, economic, or environmental aspects of food sustainability. METHODS: A systematic search was conducted in Web of Science, PubMed, and Scopus for peer-reviewed studies published between 2014 and 2024, following PRISMA-ScR guidelines. Studies were included if they examined the relationship between digital attributes and sustainable food outcomes. A total of 57 articles met the inclusion criteria. RESULTS: Publications focusing on the relationship between the digital food environment and sustainable food outcomes have been on an upward trend since 2014. Most studies originate from high-income countries (46.9%) and are predominantly quantitative (91%), focusing on general adult populations (88.3%). Across five types of digital media, 86 unique digital attributes were identified. E-commerce emerged as the most frequently studied medium (57.9%), with attributes primarily related to informative messaging and platform design. Social media followed (28.1%). Social media attributes were mainly centred on social media marketing. Other digital media, such as documentaries (7%), were explored far less. CONCLUSION: This review highlights growing academic interest in the links between digital attributes and consumers’ sustainable food outcomes. Future research should broaden its scope to include other digital media, consumer experiences, and underrepresented populations.
Development of the Canadian food intake screener for adolescents based on Canada's Food Guide 2019 healthy eating recommendations.
Tugault-Lafleur C, Desgreniers V, Bessette G … +5 more , Kazzi RA, Jacob R, Hernandez K, St-Pierre S, Haines J
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41121352 · Full text
BACKGROUND: Assessing adolescents' dietary intakes in relation to Canada's Food Guide 2019 (CFG-2019) recommendations on healthy food choices is a critical component to public health surveillance efforts. The study aimed...
BACKGROUND: Assessing adolescents' dietary intakes in relation to Canada's Food Guide 2019 (CFG-2019) recommendations on healthy food choices is a critical component to public health surveillance efforts. The study aimed to develop a brief self-administered screener to assess food intake based on CFG-2019 food choices recommendations among English- and French-speaking adolescents aged 10-17 years living in Canada. METHODS: The development and assessment of the content validity of the tool was undertaken in collaboration with Health Canada advisors and informed by external content experts, including nutrition researchers and practitioners. Following a rapid review of screeners used among children aged 6-17 years, an initial draft was developed, and content validity was assessed by an expert panel with expertise in public health nutrition and questionnaire validation (English n = 13, French n = 7). Two rounds of cognitive interviews were then conducted with adolescents (English n = 15, French n = 14) to assess comprehension and further refine the screener items. Cognitive testing using a direct probing approach was conducted iteratively in two phases to assess understanding of questions and incorporate feedback from adolescents to improve the clarity and wording of the items at each phase. RESULTS: Following the expert panel and iterative discussions with Health Canada advisors, four items were removed from the initial 14-item screener as these items were deemed not sufficiently reflective of the CFG recommendations and one item asking about water intake was tested. Cognitive testing revealed that the items were well understood overall, and feedback at each interview round enabled additional refinements to improve comprehension. The resulting screener includes 10 items designed to rapidly assess food intake based on CFG-2019 recommendations on healthy food choices for adolescents aged 10 to 17 years. CONCLUSIONS: The Canadian Food Intake Screener for Adolescents/Questionnaire court canadien sur les apports alimentaires des adolescents is designed to rapidly assess dietary intake over the past week among children aged 10 to 17 years. Before it can be used for research and population-level nutrition surveillance, further research is needed to develop a scoring system and evaluate the screener's construct validity and reliability.
The association between exposure to food marketing and dietary intake among youth in six countries.
Vergeer L, Gillis G, Rynard VL … +5 more , Vanderlee L, White CM, Nieto C, Hammond D, Potvin Kent M
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41121155 · Full text
BACKGROUND: While food marketing to youth is associated with harmful behavioural and dietary outcomes, few studies have assessed differences in this relationship between countries. This study examined the association bet...
BACKGROUND: While food marketing to youth is associated with harmful behavioural and dietary outcomes, few studies have assessed differences in this relationship between countries. This study examined the association between exposure to food marketing and dietary intakes among youth in six countries. METHODS: A cross-sectional analysis of International Food Policy Study 2023 Youth Survey data examined the relationship between self-reported exposure to marketing for less healthy (fast food, sugary drinks, sugary cereals, snacks, desserts/treats) and healthy (fruits, vegetables) food categories across various media/settings in the past 30 days and consumption of these foods yesterday among youth 10-17 years-old in Canada, Australia, Chile, Mexico, the United Kingdom and the United States (n=9057). Associations of food consumption with exposure to marketing of food categories and marketing techniques (e.g., characters, famous people) in food advertisements, and differences in associations between countries, were examined using binary and ordinal logistic regression. RESULTS: In all countries, youth reporting more frequent exposure to marketing of all less healthy food categories had higher odds of having consumed those foods yesterday (p < 0.05 for all), except snacks in Mexico. Compared with no exposure to marketing techniques, exposure to ≥ 1 marketing technique(s) in less healthy food advertisements was associated with higher odds of having consumed sugary drinks (AOR: 1.44; 95% CI: 1.21, 1.72), fast food (AOR: 1.69; 95% CI: 1.40, 2.03), sugary cereals (AOR: 1.26; 95% CI: 1.05, 1.51) and desserts/treats yesterday (AOR: 1.42; 95% CI: 1.18, 1.71) among youth in all countries. Consumption of snacks was associated with exposure to ≥ 1 marketing technique(s) in less healthy food advertisements in Australia (AOR: 1.61; 95% CI: 1.09, 2.34), Chile (AOR: 1.63; 95% CI: 1.12, 2.36) and Mexico (AOR: 2.13; 95% CI: 1.39, 3.26). Positive associations between frequency of exposure to marketing of fruits and vegetables and the number of times these foods were consumed yesterday were observed in all countries (p < 0.05), except vegetable consumption in the UK. CONCLUSIONS: These results support the association between exposure to food marketing and consumption of marketed foods. Findings were similar between countries, reinforcing the need for global implementation of restrictions on food marketing to youth.
Behavioural and cognitive changes in young adults towards food and nutrition after exposure to digital food communication: a mixed-methods systematic review.
Parks S, Kaur A, Renzella J … +5 more , Malouf R, Moreno-Mattar O, Albury C, Rayner M, Scarborough P
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41116178 · Full text
BACKGROUND: Young adults (18-25) face significant risk for weight gain and transitioning to a higher body mass index category when compared to other adult groups. As active internet users, they encounter food-related con...
BACKGROUND: Young adults (18-25) face significant risk for weight gain and transitioning to a higher body mass index category when compared to other adult groups. As active internet users, they encounter food-related content across digital platforms, yet little is known about their behavioural and cognitive responses to this compound exposure. METHODS: This pre-registered mixed-methods systematic review features primary studies about participants aged 18 to 25 exposed to digital food communication and assessed for behavioural or cognitive responses towards food and nutrition. We evaluate consumption and food purchase as behavioural responses; intentions to consume and/or purchase, and attitudes towards food and nutrition as cognitive responses. We searched PubMed, PsycINFO, Global Index Medicus, and Business Source Ultimate for studies published from database inception to August 1, 2024. Quality appraisals were conducted using a modified version of the Newcastle-Ottawa Quality Assessment Form, the ROB1 Tool for randomised trials, the JBI Quasi-Experiment Checklist for quasi-experiments and the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies. We used a three-pronged method for analysis. Meta-analyses combined findings from randomised trials for behavioural and cognitive responses, while observational studies were summarised narratively. The thematic synthesis approach informed our qualitative synthesis of young adults' narratives of their responses after exposure to digital food communication. Finally, a cross-study matrix synthesised analytical qualitative themes and quantitative findings. RESULTS: Of the 6132 studies identified, 45 are included in the systematic review, representing 8,914 young adults in 16 countries. Meta-analyses on behavioural and cognitive responses demonstrate statistical significance with effect sizes of 0.34 (95% CI: 0.18-0.50) and 0.19 (95% CI: 0.10-0.28), respectively. Observational studies confirmed the findings of the meta-analyses. Difficulty deciphering what represents good nutrition, critical distinctions when engaging with content viewed as helpful versus misleading and balancing intentions versus actual behaviours were barriers to the effectiveness of digital food communication. Using a cross-study synthesis matrix, we developed ten recommendations to improve digital dietary interventions and their assessed implementation by experimental studies in the review. CONCLUSIONS: Our results illustrate the need to approach digital food communication as a digital determinant of dietary health for young adults, shaping behaviours and cognition.
Normative values for the physical activity scale for the elderly in community-dwelling men and women 45 to 85 years old: an analysis from the CLSA.
D'Amore C, Mayhew A, Griffith LE … +3 more , Raina P, Richardson J, Beauchamp MK
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41088431 · Full text
BACKGROUND: Monitoring and improving physical activity levels is essential for promoting healthy aging. The objective of this study was to create age-specific normative values for the Physical Activity Scale for the Elde...
BACKGROUND: Monitoring and improving physical activity levels is essential for promoting healthy aging. The objective of this study was to create age-specific normative values for the Physical Activity Scale for the Elderly (PASE) among community-dwelling women and men aged 45-85 years old. METHODS: 36,701 participants (47% female) aged 45-85 years old, free of any mobility limitation or activities of daily living disability from the Canadian Longitudinal Study on Aging (CLSA) were included. Best fitting models were identified using Generalized Akaike Information Criteria values and cross-validation. Seasonal differences for males and females were also explored. RESULTS: Separate models for males and females are presented, providing a range of percentile values (5-95%) in charts and tables. Total PASE scores were highest in 45-year-olds and decreased with age. Seasonal differences were not substantial or consistent at the population level. CONCLUSIONS: The age- and sex- specific normative values provided can improve the interpretability of PASE scores among middle-aged and older adults. In addition to PA guideline cut-offs, normative values provide further information for monitoring physical activity by allowing for more personalized observations that account for healthy variation.
The effect of telehealth-based medical nutrition therapy on cardiovascular disease risk factors in a rural population: a secondary analysis of outcomes related to nutrition, health and well-being from the healthy rural hearts randomised controlled trial.
Schumacher TL, Clarke ED, Herbert J … +12 more , Jansson A, Oldmeadow C, Rollo ME, Milson P, Alderton C, Brown LJ, May J, Williams A, Guppy M, Ramanathan S, Attia J, Collins CE
Int J Behav Nutr Phys Act · 2025 Oct · PMID 41084048 · Full text
BACKGROUND: Adults in rural Australia are at elevated risk of cardiovascular disease (CVD). To date, no intervention trials have evaluated the impact of dietitian delivered nutrition therapy using telehealth exclusively...
BACKGROUND: Adults in rural Australia are at elevated risk of cardiovascular disease (CVD). To date, no intervention trials have evaluated the impact of dietitian delivered nutrition therapy using telehealth exclusively in patients recruited in the primary care setting. The primary aim was to assess effectiveness of telehealth delivered Medical Nutrition Therapy (MNT) on change in dietary intake energy, reported as percent energy derived from nutrient-dense (core) foods. Secondary aims included assessment of the intervention effects on percentage weight loss, quality of life, health literacy and patient engagement in their health (patient activation). METHODS: This was a secondary data analysis of a pragmatic cluster Randomised Controlled Trial (RCT). Adults from rural areas within the New England North West and Upper Hunter regions of New South Wales, Australia, were identified by their general practitioner (GP) following a Heart Health Check, as being at moderate-to-high risk of CVD and invited to participate. General practices were randomised into intervention or usual care groups. Intervention participants received five personalised telehealth MNT consultations over 6 months. Usual care received stand-alone personalised nutrition reports. All participants were managed by their GP and followed up after 12 months. Primary and secondary outcomes were analysed using Bayesian linear mixed models. Models included fixed categorical effects for time, group, group-by-time interaction, age, and sex, with additional predetermined adjustment for variables determined by the literature. RESULTS: Mean baseline to 12-month increase in percentage of energy from core foods was 7.0% (9.4 SD) for the intervention group and 1.3% (9.6 SD) for usual care group, with an estimated adjusted difference in mean change of 5.9% (95%CI 0.5-11.2). Significant improvements in quality of life (0.04, 95%CI 0.01-0.07) and patient activation were also observed (6.44, 95%CI 0.99-11.83) favouring the intervention group. CONCLUSION: A personalised telehealth MNT intervention delivered by dietitians significantly improved percentage energy from nutrient-dense foods amongst rural adults at an elevated risk of CVD. Future research is required to support implementation of telehealth MNT into general practice in rural Australia. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12621001495819).
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