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BMC Public Health. 2015 Dec 2;15:1203. doi: 10.1186/s12889-015-2540-5.

Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study.

Author information

Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Department of Agricultural Economics and Rural Development, Agricultural University of Athens, Athens, Greece.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
EPODE European Network Coordinating Team, Proteines, Paris, France.
Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
Directorate General of Health, Lisbon, Portugal.
Department of Public Health, Ghent University, Ghent, Belgium.
Bulgarian Association for the study of Obesity and related diseases, Sofia, Bulgaria.
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.



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.


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.


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.


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.

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