title: Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study.
abstract: BACKGROUND
  Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status.
  
  
  METHODS
  This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6-8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann-Whitney U test and Pearson's chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country.
  
  
  RESULTS
  Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large.
  
  
  CONCLUSIONS
  Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied.
authors.affiliation: Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands. k.mantziki@vu.nl.
authors.forename: Krystallia
authors.initials: K
authors.lastname: Mantziki
authors.affiliation: Department of Agricultural Economics and Rural Development, Agricultural University of Athens, Athens, Greece.
authors.forename: Achilleas
authors.initials: A
authors.lastname: Vassilopoulos
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Radulian
authors.affiliation: EPODE European Network Coordinating Team, Proteines, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Borys
authors.affiliation: EPODE European Network Coordinating Team, Proteines, Paris, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Du Plessis
authors.affiliation: Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Gregório
authors.affiliation: Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.|Directorate General of Health, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Graça
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: De Henauw
authors.affiliation: Bulgarian Association for the study of Obesity and related diseases, Sofia, Bulgaria.
authors.forename: Svetoslav
authors.initials: S
authors.lastname: Handjiev
authors.affiliation: Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.|Research Centre for the Prevention of Overweight, Windesheim University of Applied Sciences Zwolle & VU University, Zwolle, The Netherlands.
authors.forename: Tommy Ls
authors.initials: TL
authors.lastname: Visscher
authors.affiliation: Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Seidell
mesh_terms: D000328:Adult; D002253:Carbonated Beverages; D002648:Child; D004032:Diet; D004522:Educational Status; D004734:Energy Metabolism; D005060:Europe; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D008297:Male; D050177:Overweight; D010290:Parents; D063766:Pediatric Obesity / Q000209:etiology*; D011446:Prospective Studies; D012890:Sleep; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires