The HEalth In Adolescence (HEIA) study

Anthropometric measures were taken by same-sex project staff in a suitable room in the schools. The height was measured to the nearest 0.1 cm, using a wall-mounted tape with the child standing upright against the wall and without shoes. The weight was measured with the child in light clothing, to the nearest 0.1 kg using Tanita scales (TBF-300; Tanita Corporation of America, Illinois, USA). The scales were new at the start of the study and were not recalibrated during the project. Waist circumference was measured to the nearest 0.1 cm with a flexible measuring tape between the lower rib and the iliac crest at the end of a normal expiration. Hip circumference was measured at the widest circumference of the hip. The pubertal scale utilised is based on the Pubertal Category Scores and included body hair growth (both genders), voice and facial hair (boys), and breast development and menarche (girls).

Potential negative consequences of the intervention were assessed in the questionnaire by two questions on weight-related cognitions (perception of own weight, its importance to self-esteem), two on receiving weight-related comments (frequency and by whom), and two on slimming behavior (frequency question and a open-ended question inquiring what they had done to slim) for those who had tried to lose or maintain weight in the last year.

Self-reported height and weight, waist, and hip circumferences were obtained from the parents/guardians through the questionnaires. Parents were provided with a measurement tape and written instructions on how to measure waist and hip circumference. The same behaviors as for the children were assessed for each of the parents. In additon, they were asked about whether encouragement of weight loss was practised among the family members. Perceived barriers and facilitators influencing their child’s level of physical activity and consumption of unhealthy foods/drinks were assessed. Finally, a food shelf inventory in the mother’s questionnaire assessed the availability of 71 items/categories of food, drinks, and dietary supplements.

Intake of beverages was assessed by frequency and amount (in glasses) for weekdays and by
amount for weekends. Soft drinks and squash with sugar were the main behaviors, but other
beverages (such as light soft drinks, light squash, ice tea, water, juice, nectar) were monitored to see whether decreases of the former were accompanied by increases in the latter. Frequency of consumption of fruit and raw and cooked vegetables was assessed by one question for each. In addition, frequency of consumption of sweets/chocolate, salty snacks, sweet cookies, buns/muffins, and five meals/snacks was assessed by nine questions.

Physical activity on weekdays was measured with regards to frequency and length of time spent on active transport to/from school, during recess, in PE class, and after school to assess context specific physical activity. For weekends, there was one question on frequency and one on length of time. Four questions assessed the number of hours spent on watching TV/DVDs and on surfing the internet or playing electronic games separately for weekdays and weekends.

Physical activity was also measured objectively by accelerometers to assess intensity and total
physical activity. The children wore accelerometers (GT1 M/CSA model 7164; ActiGraph, Fort
Walton Beach, FL, USA) for 5 consecutive days and were instructed to wear the monitor continuously all awake hours except when doing water activities. The output was sampled every 10 seconds for 2 weekdays and 2 weekends. The criteria defined for acceptable use of the monitor were that activity should be registered during a minimum of 3 days and at least for 8 hours each day.