Objective: We examined associations between fast-food intake and perceived and objective fast-food outlet exposure. Design: Information from the Health Behaviours in School-aged Children Study was linked to fast-food outlets in seventy-five school neighbourhoods. We used multivariate multilevel logistic regression analyses to examine associations between at least weekly fast-food intake and perceived and objective fast-food outlet measures. Subjects: Data represent 4642 adolescents (aged 11-15 years) in Denmark. Results: Boys reporting two or more fast-food outlets had 34 % higher odds consuming fast food at least weekly. We detected higher odds of at least weekly fast-food intake among 15-year-old 9th graders (OR all = 1·74; 95 % CI 1·40, 2·18; OR boys = 2·20; 95 % CI 1·66, 2·91; OR girls = 1·41; 95 % CI 1·03, 1·92), Danish speakers (OR all = 2·32; 95 % CI 1·68, 3·19; OR boys = 2·58; 95 % CI 1·69, 3·93; OR girls = 2·37; 95 % CI 1·46, 3·84) and those travelling 15 min or less to school (OR all = 1·21; 95 % CI 1·00, 1·46; OR girls = 1·44; 95 % CI 1·08, 1·93) compared with 11-year-old 5th graders, non-Danish speakers and those with longer travel times. Boys from middle-(OR = 1·28; 95 % CI 1·00, 1·65) and girls from low-income families (OR = 1·46; 95 % CI 1·05, 2·04) had higher odds of at least weekly fast-food intake compared with those from high-income backgrounds. Girls attending schools with canteens (OR = 1·47; 95 % CI 1·00, 2·15) had higher odds of at least weekly fastfood intake than girls at schools without canteens. Conclusions: The present study demonstrates that perceived food outlets may impact fast-food intake in boys while proximity impacts intake in girls. Public health planning could target food environments that emphasize a better understanding of how adolescents use local resources.

BackgroundMulti-component interventions combining educational and environmental strategies have proved effective in increasing children and adolescents’ fruit and vegetable intake. However such interventions are complex and difficult to implement and several studies report poor implementation. There is a need for knowledge on the role of dose for behaviour change and for assessment of intervention dose to avoid conclusions that intervention components which are not implemented are ineffective. This study aimed to examine 1) the association between dose of a class curriculum and adolescents’ fruit and vegetable intake in a school-based multi-component intervention, 2) if gender and socioeconomic position modify this association.MethodsWe carried out secondary analysis of data from intervention schools in the cluster-randomized Boost study targeting 13-year-olds’ fruit and vegetable intake. Teacher- and student data on curriculum dose delivered and received were aggregated to the school-level and class-level (only possible for student data). We analysed the association between curriculum dose and students’ (n 995) self-reported fruit and vegetable intake (24-h recall questionnaire) after finalization of the intervention using multi-level analyses. Potential moderation was examined by analyses stratified by gender and socioeconomic position.ResultsAverage dose received at class-level was significantly associated with students’ fruit and vegetable intake (10 g (CI: 0.06, 20.33) per curricular activity received). In stratified analyses the association remained significant among boys only (14 g (CI: 2.84, 26.76) per curricular activity received). The average dose delivered and received at the school-level was not significantly associated with students’ intake.ConclusionsWe found a dose—response relationship between number of curricular activities received and adolescents’ fruit and vegetable intake. The results indicate that curriculum dose received only mattered for promotion of fruit and vegetable intake among boys. Future studies should explore this gender difference in larger samples to guide the planning of school-based curricular interventions with regards to the optimal number of curricular activities required to promote behavioural change in subgroups with low fruit and vegetable intake at baseline.Trial registrationCurrent Controlled Trials ISRCTN11666034.

Knowledge of the association between implementation of different intervention components and the determinants they are tailored to change may contribute to evaluating the effects and working mechanisms of multi-component interventions. This study examined 1) the effect of a Danish multi-component school-based intervention (2010 − 2011) on key determinants of adolescents' fruit and vegetable intake and 2) if dose of curricular activities was positively associated with change in these determinants. Using multi-level linear and logistic regression analyses stratified by gender and socioeconomic position, we analyzed survey data from the cluster-randomized Boost study targeting Danish 13-year-olds' fruit and vegetable intake. We examined 1) differences in knowledge of recommendations, taste preferences and situational norms between students from 20 intervention (n = 991) and 20 control (n = 915) schools at follow-up; and 2) associations between curriculum dose received and delivered (student and teacher data aggregated to school- and class-level) and these determinants among students at intervention schools only. At follow-up, more students from intervention than control schools knew the recommendation for vegetable intake (OR 1.56, CI:1.18, 2.06) and number of fruits liked (taste preferences) increased by 0.22 (CI:0.04, 0.41). At class-level, curriculum dose received was positively associated with proportion of students knowing the recommendation for vegetable intake (OR 1.06, CI:1.002, 1.13). In stratified analyses, this association was only significant among students from high social class (OR 1.17, CI:1.04, 1.31). The Boost intervention succeeded in improving students' taste preferences for fruit and knowledge of recommendation for vegetable intake, but only the latter determinant was positively associated with curriculum dose.Trial registration: ISRCTN11666034

BackgroundBased on the assumption of parental influence on adolescent behavior, multicomponent school-based dietary interventions often include a parental component. The effect of this intervention component is seldom reported and the evidence is inconsistent. We conducted a systematic process evaluation of the parental component and examined whether the leveal of parental involvement in a large multi-component intervention: the Boost study was associated with adolescents’ fruit and vegetable (FV) intake at follow-up.MethodsThe Boost study was targeting FV intake among 1,175 Danish 7th graders (≈13- year-olds) in the school year 2010/11. The study included a school component: free FV in class and curricular activities; a local community component: fact sheets for sports- and youth clubs; and a parental component: presentation of Boost at a parent-school meeting, 6 newsletters to parents, 3 guided student-parent curricular activities, and a student-parent Boost event. Study population: Students whose parent replied to the follow-up survey (n = 347). Data: Questionnaire data from students, parents and teachers at 20 intervention schools. Process evaluation measures: dose delivered, dose received, appreciation and level of parental involvement. Parental involvement was trichotomized into: low/no (0–2 points), medium (3 points) and high (4–6 points). The association between level of parental involvement and self-reported FV intake (24-h recall), was analyzed using multilevel regression analyses.ResultsThe Boost study was presented at a parent-school meeting at all intervention schools. The dose delivered was low to moderate for the three other parental elements. Most parents appreciated the intervention and talked with their child about Boost (83.5 %). High, medium and low parental involvement was found among 30.5 %, 29.6 % and 39.4 % of the students respectively. Parental involvement was highest among women. More men agreed that the parental newsletters provided new information.Students with a medium and high level of parental involvement ate 47.5 and 95.2 g more FV per day compared to students with low level/no parental involvement (p = 0.02).ConclusionsStudents with a high level of parental involvement ate significantly more FV at follow-up compared to students with a low level/no parental involvement. Parental involvement in interventions may improve adolescents’ FV intake if challenges of implementation can be overcome.Trial registration ISRCTN11666034. Registered 06/01/2012. Retrospectively registered.

AIM The aim of this study was to examine how fever during pregnancy is associated with motor development in the child.METHOD This cohort study was based on data from females and their children, from the Danish National Birth Cohort, who took part in an 18-month and/or 7-year follow-up study. Information regarding fever (number of episodes, temperature, duration, and pregnancy week) was obtained around gestation week 12 and at the end of pregnancy. Assessments of motor development in early childhood were based on the ages at which the motor milestones 'sitting unsupported' (n=44 256) and 'walking unassisted' (n=53 959) were attained. The Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07) was used to identify children with indication of developmental coordination disorder (DCD) at age 7 years (n=29 401). Any associations between the exposure to fever during pregnancy and motor development were estimated using Cox regression and logistic regression analyses.RESULTS Fever during pregnancy was reported by 15 234 (28.0%) participants in the 18-month follow-up and by 7965 (26.9%) participants in the 7-year follow-up. Adjusted analyses showed no association between prenatal exposure to fever and either 'sitting unsupported' or 'walking unassisted'. The proportion of children with indication of DCD was 3.1%. The odds ratio of indication of DCD if children were exposed to fever in utero was 1.29 (95% CI 1.12-1.49). However, no dose-response association was found. INTERPRETATIONWe found a significant association between maternal fever during pregnancy and DCD in children at age 7 years. The lack of a dose-response association might suggest that this association is explained by the underlying causes of the fever.Fever during pregnancy is suspected to increase the risk of several adverse outcomes in the developing fetus.1 In human studies, associations have been reported between prenatal fever exposure and neural tube defects, 1,2 congenital malformations including oral clefts, 3 and heart defects. 4A recent systematic review provides support for an adverse health impact on children after exposure to fever in utero; however, the authors conclude that the evidence of associations is insufficient for several of the outcomes addressed, and more cohort studies are needed. 5 In addition, results from animal studies have shown that exposure to hyperthermia in utero produces adverse outcomes in offspring. In 1967, Edwards 6 reported an increased incidence of fetal resorption and congenital malformations in guinea pigs exposed to hyperthermia during fetal life. Since then, animal studies have shown that hyperthermia is associated with fetal death, cardiovascular malformations, and a delayed myogenesis. [7][8][9] The development of the central nervous system appears to be particularly sensitive to elevated body temperatures, 7,10,11 and hyperthermia has been associated with the disruption of the production and migration of neuronal precursor cells and, thus, may result in abnormal brain development. 10A child's motor ab...