Purpose: Bourdieu’s capital theory offers potential to further understand socioeconomic inequalities in physical activity (PA). Although Bourdieu emphasized that economic, social, and embodied cultural capital interact to shape inequalities, existing empirical research mainly considered separate effects of the forms of capital on health behavior. Our aim was to investigate how economic, social, and embodied cultural capital are conditional on each other in their influence on adults’ PA.

Methods: Cross-sectional, self-reported data from the 2014 GLOBE survey of 2,812 adults aged 25 and over residing in Eindhoven, the Netherlands, were used. Step-wise multiple logistic regression models included economic, social, and embodied cultural capital (operationalized as relative capital levels divided into quartiles) and confounders (age, gender, birth country, employment type). The models estimated the log odds and 95% confidence intervals (CI) of main associations, two-way interactions, and three-way interactions of the forms of capital on three PA outcomes: engaging in at least 30 minutes per week of (1) walking and cycling to and from work (yes/no), (2) walking and cycling in leisure time (yes/no), and (3) sports participation (yes/no).

Results: Embodied cultural capital was positively associated with all types of PA (for instance, the log odds of engaging in at least 30 minutes of sports per week for those with embodied cultural capital in the highest versus lowest quartile were 0.61, 95% CI: 0.28-0.95). Social capital was positively associated with walking and cycling in leisure time and sports participation and was negatively associated with walking and cycling to and from work. Economic capital was positively associated with sports participation. The interaction between economic and social capital positively influenced walking and cycling to and from work and sports participation. No other interaction effects were observed.

Conclusions: While economic and social capital do not appear to be conditional on embodied cultural capital, these findings suggest that economic and social capital may be conditional on each other, boosting adults’ engagement in certain types of PA. Policy and interventions that consider the interaction between economic and social capital may be more effective in increasing PA levels than those targeting each form of capital in isolation.

Purpose: Primary care physicians are well-situated to promote physical activity (PA) among their patients. However, gender differences may exist in the receipt of such preventive care. These differences have not been widely examined in Latin America, where gender roles are strongly culturally embedded. The purpose of this research is to examine differences in the receipt of PA counselling between women and men.

Methods: This was a secondary, cross-sectional analysis of data collected among Mexican primary care physicians and their inactive patients. Patient sociodemographic characteristics, self-reported receipt of counselling and PA levels were collected through questionnaires. PA counselling was broken down into the 5As: Assess, Advise, Assist, Agree, Arrange. Logistic regression models adjusted for age and education were used to estimate the probability of receiving counselling for women and men, and to examine differences in these probabilities according to patient-physician gender-concordance. 

Results: Thirty-six Mexican primary care physicians (mean age=44 years, 53% women) and 359 of their patients (mean age=50 years, 77% women) were included in analyses. The probability of men reporting their physicians Arranged for a PA referral was 70% lower than that of women (AOR=0.30, 95% CI: 0.13-0.69, p=0.005). Further, the probability of patients reporting their physician Assisted them in setting a PA goal was 39% lower in gender-concordant patient-physician dyads than in gender-discordant dyads (AOR=0.61, 95% CI: 0.39-0.95, p=0.03).

Conclusions: Receipt of PA counselling differs between women and men, suggesting that disparities exist in the delivery of preventive care in the Mexican primary care context. Although the drivers of these disparities are not well-established, one explanation is that physicians may perceive women as more likely to follow-through with referrals. Identifying and addressing such disparities is imperative to offer gender-responsive primary care in Latin America.

Purpose: To accelerate sustainable nutrition transition, one driver is a rebalance of animal and plant food consumption. Thus, a better understanding of actual changes in food behaviors is necessary. The transtheoretical model (TTM) enables to identify the stage of change in food behavior at which an individual is. For the first time, this longitudinal study aims to investigate the associations between the changes in animal and plant food consumption over time and the stages of change for reducing meat consumption in a population of French adults. Another objective was to describe motives associated to these stages.
Methods: This study included 25,143 non-vegetarian participants of the web-based NutriNet-Santé cohort with a median follow-up of 6.2 years. Dietary data were obtained from at least two sets of two 24-hour dietary records over the 2009-2019 period. The contribution of meat to total energy intake and a score measuring the contribution of healthy plant foods to the diet were computed. A questionnaire completed in 2018 allowed us to identify the five stages of change of the TTM (Precontemplation, Contemplation, Preparation, Action, Maintenance) and 12 motives related to meat reduction. Associations between changes in meat consumption, as well as healthy plant foods, and stages of change were assessed using linear mixed models, adjusted for potential confounders such as sociodemographic, geographic, and anthropometric factors. Motives were described according to the stages of change.
Results/findings: The Action and Maintenance stages were significantly associated with a decrease in meat consumption (β_Action=-0.062, p< 0.0001, β_Maintenance=-0.079, p< 0.0001, reference = Precontemplation) and an increase of the healthy plant food consumption score (β_Action= 0.154, p< 0.0001, β_Maintenance= 0.119, p< 0.0001) over time. The Contemplation and Preparation stages were not associated to consumption changes over time. For Action and Maintenance, the most frequently reported motives related to meat reduction were health (79.1 and 80.4%, respectively), nutrition (75.0 and 75.5%), and environment (67.4 and 70.4%).
Conclusions: This longitudinal study documented that individuals in the effective meat reduction stages of change have adopted healthier and more sustainable food behaviors. Stages of change towards meat reduction identified through the TTM reflected actual consumption changes.

Purpose: To assess preliminary efficacy of Families Preparing the New Generation Plus (FPNG+), a 10-week parenting intervention promoting healthy eating and youth substance use prevention among low-income, Hispanic families on diet outcomes.

Methods: Dyads (n=239) of one parent (40.2±6.1 years; 89% female) and one 6^th-8^th grade adolescent child (12.4±0.9 years; 40% female) were recruited from 12 middle schools in Phoenix, Arizona. Participants were randomized (school level) to one of three arms: the FPNG+ intervention, a substance use prevention only intervention (FPNG Original), or a control intervention (academic achievement), all delivered exclusively to parents. Parent and adolescent diets were assessed using the Diet Screener Questionnaire at baseline (T1), after intervention completion (T2), and 12-16 weeks post-intervention completion (T3). Standardized effects were estimated using baseline-adjusted regression models, adjusting for school-level random effects, and applying Full Information Maximum Likelihood for missing data. Effect sizes (Cohen’s ds) were calculated for all diet intake estimates

Results: Relative to the control group, adolescents in FPNG+ had greater intake of fruit and vegetables (including legumes; FVL) at T2 (+0.114 cup equivalents; d=0.295; p<0.01) and T3 (+0.170 cup equivalents; d=0.350; p<0.01), and greater fiber intake at T3 (+0.121 g; d=0.247; p<0.05).  Parents in FPNG+ had greater intake of FVL at T2 (+0.195 cup equivalents; d=0.404; p<0.05), a trend towards greater intake of FVL at T3 (+0.083 cup equivalents; d=0.169; p<0.1), and greater fiber intake at T3 (+0.136 g; d=0.279; p<0.05). FPNG+ parents also consumed more whole grains at T3 (+0.197 oz equivalents; d=0.408; p<0.001) and less added sugars at T2 (-0.217 tsp equivalents; d=0.451; p<0.05), relative to control parents. Adolescents in the FPNG Original group consumed more FVL than those in the control group at T3 (+0.081 cup equivalents; d=0.166; p<0.05). Differences in the intake of dairy, calcium, or added sugars from sugar-sweetened beverages were not different among groups at T2 or T3.

Conclusions: Results suggest that FPNG+ contributed to favorable, albeit small, diet changes in parents and adolescents, some of which remained beyond intervention completion. Findings provide preliminary evidence to support the use of parenting as a strategy to improve adolescent diet quality.

Purpose: This study aimed to use hybrid multilevel regression models to explore 1) the effects of psychosocial factors (i.e., self-efficacy, attitude, social support, motivation) on physical activity in adults with physical disabilities and/or chronic diseases followed up to one year after rehabilitation, both between persons and within a person over time, and 2) whether a person’s stage of change modifies these effects of the psychosocial factors on physical activity.

Method: 1256 Adults with physical disabilities and/or chronic diseases were included from the prospective cohort study Rehabilitation, Sports and Active lifestyle (ReSpAct). Self-reported physical activity, self-efficacy, attitude, motivation, social support and stage of change were measured with questionnaires 3-6 weeks before discharge (T0) and 14 (T1), 33 (T2), 52 (T3) weeks after discharge from rehabilitation. Multivariable hybrid multilevel regression models (corrected for age, sex, BMI, education level, diagnosis) analyzed the between-subject and within-subject effects of psychosocial factors on physical activity on average over time, and potential influence of stage of change on these effects (effect modification).

Results/findings: Significant between-subject effects were found for self-efficacy (β=43.27 [95%CI 17.35, 69.18]) and intrinsic motivation (β=599.97 [95%CI 170.56, 1029.41]). Significant within-subject effects were found for identified regulation (β=-472.96 [95%CI -852.38, -93.48]) and intrinsic motivation (β=505.00 [95%CI 183.23, 816.43]). Effect modification of stage of change was found for the within-subject effect of identified regulation, which had a positive effect on physical activity in people in the precontemplation and contemplation stage and a negative effect on physical activity in people in the preparation, action and maintenance stage.

Conclusion: Using novel hybrid multilevel regression models to disentangle the between-subject and within-subject effects, we found that adults with physical disabilities and/or chronic diseases with better self-efficacy and who are more intrinsically motivated are more physically active up to one year after rehabilitation. However, to improve physical activity over time after rehabilitation within individuals, it appears that intrinsic motivation should be improved. Improving identified regulation can be a strategy in people in the precontemplation and contemplation stage, but appears to have negative effects on physical activity in people in the stage of change preparation and beyond.

Purpose: Metabolic health of urban Ugandans, mostly women, has increasingly become sub-optimal due to the escalating prevalence of overweight and obesity. Improving fruit and vegetable intake and physical activity (PA) could optimise metabolic health. Objective: assess the effect of an intervention aimed at increasing fruit and vegetable intake and PA on metabolic health among women of reproductive age in urban Uganda.

Methods: A cluster-randomized controlled two arm trial with a 1:1 allocation involving 132 participants from six church communities in Kampala was undertaken (https://clinicaltrials.gov/ct2/show/NCT04635332). Eligible participants were aged 18-45 years, with a waist circumference ≥80cm and no cardio-metabolic related disease. The study included three-month intervention, followed by three-month post follow-up phase. The intervention arm was exposed to infographics and face to face group sessions while the comparison arm received only infographics. Primary outcome was a reduction in waist circumference. Secondary outcomes included optimization of PA, fruit and vegetable intake, FBG, SBP, DBP, TC, LDL, HDL, TG, body composition. Intention-to-treat analyses were performed using linear mixed models.

Results: At end-line and post follow-up, 118 and 100 participants respectively were included in the analysis. At end-line, a reduction trend was observed in waist circumference (-1.48cm (-3.05; 0.10), p=0.060) in the intervention arm. Apart from FBG (-6.95mg/dl (-13.37; -0.53) p=0.034), other cardio-metabolic parameters did not change. Participants in the intervention arm consumed more fruits (62.60g (1.86; 123.34) p=0.046) and vegetables (66.15g (25.47; 106.83) p = 0.002). Physical activity increased with no notable differences across the groups. At post follow-up, the intervention only influenced waist circumference (-1.87 cm (-3.32; -0.44), p=0.011), FBG (-6.48mg/dl (-12.76; -0.21) p=0.043), DBP (-6.67mm/Hg (-11.24; -2.11) p=0.004) and TC (-11.74mg/dl (-20.47; -3.01) p=0.009). Fruit consumption was sustained, 29.72g ((5.75; 53.69) p=0.015) but no difference was observed for vegetables. Participants in the intervention group were more active 2675.06 MET- mins/week (1045.68; 4304.44) p=0.001.

Conclusion: The intervention improved and sustained PA, fruits and vegetables intake but these changes did not translate in to substantial cardiometabolic health improvements. The intervention has potential to improve PA, fruit and vegetables intake. However, substantial effects on metabolic health may necessitate a direct focus on weight loss.