Article
Changes in Eating Behaviours among Czech Children and Adolescents from 2002 to 2014 (HBSC Study) Jaroslava Voráˇcová *, Erik Sigmund † , Dagmar Sigmundová † and Michal Kalman † Received: 22 October 2015; Accepted: 10 December 2015; Published: 15 December 2015 Academic Editor: María M. Morales Suárez-Varela Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Tr. Miru 117, Olomouc 77111, Czech Republic;
[email protected] (E.S.);
[email protected] (D.S.);
[email protected] (M.K.) * Correspondence:
[email protected]; Tel.: +420-702-275-523; Fax: +420-585-636-462 † These authors contributed equally to this work.
Abstract: Many children skip breakfast, consume soft drinks/sweets and do not eat the recommended amounts of fruit and vegetables. Poor eating habits in children tend to be carried over into adulthood. The changes in eating behaviours of Czech 11-, 13- and 15-year-old children were examined by frequency of breakfast (on weekdays and weekends), fruit, vegetable, sweet and soft drink consumption using data obtained from the Health Behaviour in School-aged Children (HBSC) surveys in 2002, 2006, 2010 and 2014. Logistic regression was used to analyze changes in eating behaviours. The findings showed a significant increase (only in girls, p ď 0.001) in prevalence of breakfast consumption (on weekdays) and a decrease in daily consumption of soft drinks (in boys and girls, p ď 0.001), sweets (in boys and girls, p ď 0.01) and fruit (in boys, p ď 0.01; in girls, p ď 0.001) between 2002 and 2014. Daily vegetable and breakfast on weekends consumption remained statistically unchanged over time. More frequent daily fruit, vegetable and breakfast (on weekends) consumption was reported by girls and younger children, whereas daily soft drink intake was more prevalent in boys and older children. There is a need for re-evaluation of current policies and new initiatives to improve the eating habits of Czech children. Keywords: changes; eating habits; eating behaviours; children; adolescents; HBSC; Czech Republic
1. Introduction An unhealthy diet is one of the major risk factors for chronic diseases [1–3] that are the leading causes of death globally [1]. Recent evidence shows that even though the prevalence of non-communicable diseases is not very common among youth, there is early onset of risk behaviours in adolescents [4,5]. Healthy eating habits such as high fruit and vegetable intake, reduced soft drink consumption and eating breakfast regularly are the key elements to prevent chronic disease and promote health [6–8]. Several studies have shown that health risk behaviours such as eating habits established in childhood and adolescence tend to be maintained into adulthood [9–13]. Recent longitudinal data also indicate associations between unhealthy dietary patterns during adolescence and the prevalence of obesity in adulthood [14–16]. Overweight and obesity in childhood and adolescence is linked to premature mortality and physical morbidity in adulthood [17]. Positive associations are documented between increased intake of sugar-sweetened beverages [18–21], irregular breakfast eating [19,22], inadequate consumption of fruit and vegetables [23], high fat food intake [21] and development of overweight and obesity in youth. Furthermore, diets high in fat and sugar lead to higher intake of energy and lower intakes in protein, polyunsaturated fat, fiber, β-carotene equivalents, folate, vitamin C, zinc, and potassium [24]. Implementing effective,
Int. J. Environ. Res. Public Health 2015, 12, 15888–15899; doi:10.3390/ijerph121215028
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Int. J. Environ. Res. Public Health 2015, 12, 15888–15899
sustainable dietary interventions such as school-based education programs have been proven as a possible solution to reduction in body weight [25], as well as improvement of overall health and well-being. Prior to implementing such programs it is crucial to first identify the current situation and trends and patterns in the eating behaviours of youth. In the Czech Republic and other European countries, dietary trends have changed over the past decade [4,5,26,27]. There is also wide variation in eating habits across countries [28,29] that may be attributable to cultural practices and socioeconomic factors [4] as well as different national policies and practices at schools [30]. Data from longitudinal studies monitoring dietary patterns in children and adolescents over time have demonstrated deterioration in regular consumption of breakfast [31,32], fruit and vegetables, as well as intake of sweetened beverages [32]. In addition, evidence using cluster analysis among children showed that, while children do change their diet, they are more likely to follow the same eating pattern (healthy or unhealthy) at a later age [12]. The evidence suggests that girls consume more vegetables and less sweetened drinks compared to boys [12,32]. Furthermore, several cross-sectional studies across the world have evaluated long-term changes in eating habits in children and adolescents. An increase in daily fruit and vegetable intake between 2002 and 2010 was found in the majority of countries of Europe and North America [5,29,33]. Based on the current findings, girls and younger children were more likely to consume fruit and vegetables than boys and older children [29]. In addition, in most Western countries, children and adolescents are reported to eat far less than the recommended amounts of fruit and vegetables [28]. Patterns and trends in sweet-beverage and soft drink consumption also differ across countries. Decreased consumptions of soft drinks were reported in Norway [34], Scotland [33], the USA [35] and the Netherlands [36], however, an increased consumptions were found in Lithuania [3] and Ireland [37]. Older children and boys reported consuming soft drinks more frequently [5]. To our knowledge there is limited number of cross-sectional studies that have monitored trends in breakfast consumption during weekdays [31,33,38–41] and only one study addressed changes on weekends [31]. Current data suggests that even though there might be slight improvements in breakfast eating in some countries [41], others show a decline [31,40] and the breakfast consumption prevalence remains low among children and adolescents [4]. Boys and younger children tend to eat breakfast more frequently [4]. In addition breakfast skipping was reported to be more frequent on weekend days than on weekdays [31]. School intervention programs can be used as an effective tool to improve breakfast eating [38]. Even though a few studies have addressed the dietary pattern trends among schoolchildren, none of them monitored all six eating behaviours (breakfast on weekdays and weekends, fruit, vegetable, sweet and soft drink consumption) over an extended period. Monitoring trends in dietary habits is crucial for planning future intervention programs and the formulation and evaluation of national policies and nutritional guidelines [42]. The eating habits of Czech children and adolescents seem to be worse or similar than of those in other European countries [4]. In the Czech Republic, the data on trends in overweight/obesity, physical activity and screen time among children and adolescents is known [43], however, we do not have a good understanding of the changes in eating behaviours and their impact on youth’s health and well-being. Also, little is known about these trends in relation to gender and age. Therefore, the aim of this study was to provide an insight into dietary changes among Czech children and adolescents aged 11–15 years in relation to their age and gender between 2002 and 2014. The changes in eating habits were examined by frequency of breakfast, fruit, vegetable, sweet and soft drink consumption using data obtained from the Health Behaviour in School-aged Children (HBSC) study. 2. Methods The data from a Czech cross-sectional survey of the HBSC study collected in 2002, 2006, 2010 and 2014 was used. The HBSC research study is done in collaboration with the WHO Regional Office for Europe [4] and is currently administered in 43 countries and regions across Europe and
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North America [44]. The HBSC collects data every four years to provide a better understanding of health behaviours, health and well-being in the social context of 11-, 13- and 15-year old children and adolescents [42]. This study followed the standardized international research protocol and procedures developed by the HBSC Research Network members [42]. 2.1. Survey Design and Sample Data were collected through self-completed questionnaires administered in the classroom. Participants were 11-, 13- and 15-year-old boys and girls attending 5th, 7th and 9th grades of primary school. Stratified cluster sampling by region and district was used to select the participants and the primary sampling unit was the school class. Only students at state-funded schools were included in the study. Questionnaires were administrated in the school classroom by the principal or deputy in each of the participating schools. Participants were provided with a verbal description of the study and were given the chance to ask questions prior to participation. The questionnaire was anonymous. Only participants who provided the consent forms signed by their parents/guardians were included into the study. Upon completion of the data collection, all files were exported to the HBSC International Data Bank at the University of Bergen for cleaning and compiling into an international data set [42]. Data were then returned to the Czech Republic for further statistical processing. Response rates were between 75% and 85% in all four years. The number of participants eligible for the analysis was 4058 in 2002, 4149 in 2006, 3950 in 2010 and 4380 in 2014. During each year of the study, the survey was carried out in the spring, between April and June. All students participated on a strictly volunteer basis and all data collected were confidential. Only the investigators had access to the data, which were coded with ID numbers to remove any identifying information about the participants. The Ethical Committee of Palacký University in Olomouc approved the study prior to administration of the surveys (No. 17/2013). 2.2. HBSC Questionnaire The questionnaire contained a wide range of questions assessing participants’ health and health behaviours, social background, family relations, eating habits, etc. [42]. In this study only questions pertaining to eating behaviours were used. The source language of all questions was English. The questionnaire was translated into Czech and then back translated by the study coordinator/administrator. The same questions were used each year of the study. 2.3. Eating Behaviours Five eating behaviours (consumption of breakfast, fruit, vegetables, soft drinks and sweets) were assessed by the frequency of weekly consumption. Breakfast consumption was assessed by two questions relating to weekdays and weekends: “How often do you usually have breakfast (more than a glass of milk or fruit juice)?” The response options for weekdays were “I never have breakfast during weekdays/one day/two days/three days/four days/five days” and for weekends “I never have breakfast during the weekend/I usually have breakfast on only one day of the weekend (Saturday or Sunday)/I usually have breakfast on both weekend days (Saturday and Sunday)”. Regular breakfast eaters were students who reported consuming breakfast on five weekdays and on both days on the weekend. Consumption of fruit, vegetables, soft drinks and sweets was assessed by the question “How many times a week do you consume fruit/vegetables/sweetened soft drinks/sweets?” with response options “never/less than once a week/two to four times a week/five to six times a week/once a day/more than once a day”. Regular consumers were students who reported consuming each item at least every day or on more than once a day. 2.4. Statistical Analysis All statistical analyses were processed in IBM SPSS v. 19.0 (IBM, Armonk, NY, USA). Frequencies of consumption of breakfast, fruit, vegetables, soft drinks and sweets were calculated for both gender 15890
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and age categories for each year of the study. Descriptive data was calculated for each variable for all survey years (Table 1). Changes in eating behaviours were analyzed by using logistic regression (Enter method) analyses for each eating behavior and gender and age, with survey year 2002 as reference group. Likelihood of daily consumption of each behaviour (regular daily consumers) for each gender and age was described by Odds Ratios (ORs) with 95% confidence intervals (CIs), where boys were the reference group for gender and 11 years for age. All variables set at p < 0.05 were considered statistically significant. Table 1. Descriptive characteristics of the samples, health behaviour in school-aged children study, Czech Republic 2002–2014.
n= Age category § 11 years 13 years 15 years Gender Eating behaviours * Daily soft drinks Daily sweets Daily fruit Daily vegetables Daily breakfast (weekday) Daily breakfast (weekend)
2002 Boys Girls (1918) (2140) % %
2006 Boys Girls (2099) (2050) % %
2010 Boys Girls (1885) (2065) % %
2014 Boys Girls (2127) (2253) % %
34.3 32.0 33.7 47.3
33.6 33.6 32.8 52.7
32.0 33.7 34.3 50.6
32.0 33.5 34.5 49.4
34.2 31.2 34.6 47.7
30.7 34.8 34.5 52.3
30.5 33.6 35.9 48.6
31.6 34.3 34.1 51.4
30.4 25.5 37.0 23.4 58.0 84.9
26.1 24.9 49.0 31.1 44.7 86.1
34.3 30.1 33.1 23.8 51.7 82.8
27.1 29.9 45.2 31.6 45.0 85.2
24.6 26.5 37.3 26.0 57.6 80.7
19.9 28.2 47.1 37.6 49.5 85.1
17.2 21.0 33.1 24.2 60.2 83.1
14.2 21.5 41.8 31.3 54.3 87.2
Notes: § 11 years (11.00–11.99 years, 5th grade), 13 years (13.00–13.99 years, 7th grade), 15 years (15.00–15.99 years, 9th grade); * Expressed in percentage of participants who perform the eating behaviour at least daily.
3. Results The descriptive characteristics of the participants are shown in Table 1. The HBSC questionnaire was completed by a total of 19,931 children: 4998 in 2002, 4751 in 2006, 4409 in 2010 and 5773 in 2014 (data not shown). After removing subject that did not meet the age requirements, total sample eligible for analysis was 16,537 children and adolescents of age 11 years (32.4%), 13 years (33.3%) and 15 years (34.3) (Table 1). 3.1. Overall Changes in Eating Behaviours From 2002 to 2014, the data showed an improvement in the percentages of daily consumers of sweets, soft drinks and breakfast during weekdays among Czech children and adolescents. On the contrary, the findings also indicated a decline in daily intake of fruit and no significant change in daily vegetable consumption and breakfast eating on weekends. Overall, reported consumption of sweets, soft drinks and fruit decreased significantly by 15% (p < 0.01), 45% (p < 0.001) and 13% (p < 0.01), respectively, and breakfast consumption on weekdays increased by 11% (p < 0.01) over the time period (data not shown). 3.2. Gender and Age Specific Changes in Eating Behaviours Disparities were found in changes of dietary patterns by gender and age over the 12-year period. Changes in the prevalence of six eating behaviours according to age and gender are shown in Table 2.
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Public Health 2015, 12 Disparities Disparities found were in changes found Disparities inof ofbehaviours changes dietary were of patterns found dietary in by patterns changes gender by and of gender dietary age over and patterns the age 12-year over by gender the period. 12-year and age period. over the 12-year period. 13 years 31.1 23.2 15.3 0.44 *** 0.34 0.57 between 2002–2014. between 2002–2014. between 2002–2014. between 13were years 34.3 26.6 18.9 057 *** 0.44 0.74 229.0 2 2002–2014. 1 sweets Changes inChanges the prevalence inBoys Changes the prevalence of six in Changes the eating prevalence of six in the eating prevalence of behaviours six according eating of behaviours six according to eating age and behaviours according to gender age and are according to gender shown age and are inand to gender Table shown age and 2. are in6and gender Table shown 2.are inand Table shown 2.in Table 2. 25.5 30.1 26.5 21.0 0.79 ** 0.67 0.90 Daily Daily sweets Daily soft drinks ♯ ♯ of 3.2. Gender 3.2. and Gender Age Specific and Age Changes Specific in Changes Eating Behaviours in Eating Behaviours Table 2. Changes Table 2. in Changes Table prevalence 2. in Changes Table prevalence of six 2. eating in Changes prevalence of six behaviours eating in prevalence of six behaviours in eating Czech six behaviours children in eating Czech and behaviours children in adolescents Czech children in adolescents Czech children adolescents adolescents ♯ 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 20060.52 vs. 2002 2014 2010 2014 vs. 2002 2014 2014 vs. 2002 2014 vs. 2002 26.4 15.5 26.4 13.2 15.5 13.2 *** 0.39 0.52 *** 0.69 0.39 0.69 years 11 years 22.5 22.5 Int. J. between Environ. Int. J. Res. Environ. Public Int. J. Res. Environ. Health Public Int. J. 2015, Res. Environ. Health Public 12 2015, Res. Health Public 12 2015, Health 12 2015, 12 6 gender 6 the 6 Table 11 20.7 30.7 21.4 22.4 1.11 0.85 1.44 Disparities Disparities were found Disparities were in changes found Disparities were in changes found dietary were patterns changes found dietary in by of patterns changes gender dietary and of patterns gender dietary age over by and patterns gender the age 12-year over by and gender the age period. 12-year over and the age period. 12-year over period. 12-year period. ∧of by 2002–2014. between 2002–2014. between 2002–2014. ∧of in 7of 23.9 20.9 14.0 0.44 *** 0.34 0.58 15 years 26.8 Changes in Changes the prevalence in the prevalence of six Changes eating of behaviours six in the eating prevalence behaviours according six according to eating age and behaviours to gender age and are according gender shown are in to Table shown age and 2. in Table 2. are shown in 2. 6 33.8 28.5 17.3 0.40 *** 0.31 0.52 15 years 34.2 11 years 20.7 21.4 22.4 1.11 0.85 1.44 30.7 ∧ ♯ 3.2. Gender and Age Specific Changes in 12 Eating Behaviours Table 2.Boys Changes Table 2.Boys in Changes Table prevalence 2.Odds in Changes Table prevalence of six 2.Odds eating in Changes prevalence of six behaviours eating in prevalence of six behaviours in31.1 eating Czech of six behaviours children in2006 eating Czech and behaviours children in adolescents Czech and children in adolescents Czech and children adolescents adolescents 25.5 30.1 25.5 26.5 30.1 21.0 26.5 0.79 21.0 ** 0.67 0.79 ** 0.90 0.67 0.90 30.4 34.3 24.6 17.2 0.48 *** 0.41 0.55 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 vs. 95% 2002 2014 2010 2014 vs. 95% 2002 2014 2014 vs. 95% 2002 2014 vs. 95% 2002 Int. J.2002–2014. Environ. Int. J. Res. Environ. Public Res. Health Public 2015, Health 12 2015, 6and 6 Table 2. 13 years 29.1 31.1 29.1 23.2 15.3 23.2 0.44 15.3 *** 0.34 0.44 *** 0.57 0.34 0.57 between between 2002–2014. between 2002–2014. between 2002–2014. CI CI CI CI Odds Ratio to13 Odds Ratio toBoys Ratio to Ratio to years 27.4 28.3 27.9 21.8 0.74 * 0.57 0.95 2 Changes in Changes the prevalence in Changes the prevalence of six in Changes the eating prevalence of behaviours six in the eating prevalence of behaviours six according eating of behaviours six according to eating age and behaviours according to gender age and are according to gender shown age and are in to gender Table shown age and 2. are in gender Table shown 2. are in Table shown 2. in ∧ ♯a a 14.2 aprevalence aChanges aprevalence aeating a% aeating a 0.47 a of achildren aeating a OR%and achildren aadolescents achildren 13 years 27.4 28.3 27.9 21.8 0.74 * 2002 0.57 0.95 Daily sweets 19.9 *** 0.40 0.54 Girls 26.1 27.1 3.2. Gender and Age Specific Changes inchanges Eating Behaviours Table 2. Changes Table 2. in Changes Table prevalence 2.11 in Changes Table six 2.2002 eating in of six behaviours in of six behaviours in Czech six behaviours in Czech behaviours in Czech in adolescents Czech and children adolescents andCIadolescents % % % % % OR % % % % OR %and OR % % % % ♯prevalence ♯ 22.4 in 2002 2006 2010 2006 2014 2010 2002 2014 2014 2006 vs.by 2002 2010 2014 vs. 2014 vs. 95% 2002 Int. J. Environ. Res. Public 2015, 12 6 11 years years 20.7 30.7 20.7 21.4 30.7 21.4 22.4 0.85 1.11 1.44 0.85 1.44 Disparities Disparities were found were in♯of found of changes patterns dietary patterns gender and gender age over and the age 12-year over the period. 12-year period. ∧ ∧of 0.46 by 1.11 11 years 27.9 35.0 18.7 15.3 *** 0.35 0.61 between 2002–2014. between 2002–2014. between 2002–2014. between 2002–2014. 95% CI 95% CI 95%2014 CI 1−6 1−6 1−6dietary 1−6 Odds Ratio to Odds Ratio toOdds Ratio toOdds toa26.8 ♯Ratio 7 Health 23.9 20.9 23.9 14.0 20.9 0.44 14.0 *** 0.34 0.44 *** 0.58 0.34 0.58 years 15 years 26.8 Reach the Variables Reach the Variables Reach the Variables Reach the Variables Upper Lower Upper Lower Upper Lower Upper 31.3 30.3 18.9 0.59 0.46 0.76 15 28.3 aAge aChanges a a aprevalence aEating a Czech a OR a of aEating aeating aLower achildren aadolescents a in 15 years 31.3 30.3 18.9 0.59 ***2002 0.46 0.76 28.3 ♯of 3.2. J. Gender 3.2. and Gender Age 3.2. Specific and Gender Age Changes 3.2. Specific and Gender in Changes Eating Specific and Age Behaviours in Changes Eating Specific Behaviours in Changes Behaviours in Behaviours Table 2. Changes Table 2. in Changes prevalence in Table prevalence six 2. eating of six behaviours eating in behaviours in six children in Czech and behaviours and adolescents Czech children andCI adolescents % % % % % % % % % OR % % OR % OR % % % % Boys 25.5 30.1 26.5 21.0 0.79 ** 0.67 0.90 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 2006 vs. 2002 2014 2010 2014 vs. 2014 2014 vs. 2002 2014 vs. 2002 26.4 15.5 13.2 0.52 *** 0.39 0.69 11 years 22.5 Int. Environ. Res. Public Health 2015, 12 6 Disparities were found in changes of patterns by gender and age over the 12-year period. between 2002–2014. between 2002–2014. between 2002–2014. between 2002–2014. 1−6 to 1−6 1−626.6 1−6dietary 95% CI 95% CI 95% Odds Ratio to Odds Ratio Odds Ratio to 13 years 13 years 27.4 28.3 27.4 27.9 28.3 21.8 27.9 0.74 21.8 * 0.57 0.74 * 0.95 0.57 0.95 13 years 29.0 34.3 18.9 057 *** 0.44 0.74 2 2 Reach the Variables Reach the Variables Reach the Variables Reach the Variables Lower Upper Lower Upper Lower Upper Lower Upper 1 1 1 1 Changes in Changes the prevalence in the prevalence of six eating of behaviours six eating behaviours according according to age and to gender age and are gender shown are in Table shown 2. in Table 2. aAge aChanges aprevalence aeating a prevalence aEating aeating a of achildren a 0.83 aadolescents achildren 24.9 29.9 28.2 21.5 0.83 ** 2002 0.72 0.95 sweets sweets softGirls drinks soft drinks soft drinks soft drinks Girls 24.9 29.9 28.2 21.5 ** 0.72 0.95 3.2. Gender 3.2. and Gender Age Specific and Specific in Changes Eating Behaviours in1−612 Behaviours Changes Table 2.Daily in Changes Table prevalence 2.Daily in Changes Table prevalence of six 2.Daily eating in of six behaviours in of six behaviours in Czech six behaviours in Czech and behaviours children in Czech in adolescents Czech children adolescents andCIadolescents % % % % % OR %*** %eating OR % %and OR % % % ♯ Health 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 2006 vs. 2002 2014 2010 2014 vs. 2014 2014 vs. 95% 2002 2014 vs. 95% 2002 Int.Disparities J. Table Environ. Int.2.Daily J. Res. Environ. Public Int. J. Res. Environ. Health Public Int. J. 2015, Res. Environ. Health Public 12 2015, Res. Health Public 12 2015, 2015, 12 6and 6 6 11 years 20.7 30.7 21.4 22.4 1.11 0.85 1.44 were found in changes ofChanges dietary patterns gender and age over the 12-year period. between 2002–2014. between 2002–2014. between 2002–2014. 13 years 29.1 31.1 23.2 0.44 0.34 0.57 1−6 1−6 95% CI 95% CI CI Odds Ratio to15 Odds to15 Odds Ratio toOdds toa28.3 ♯Ratio ♯ 15.3 71by Reach the Variables Reach the Variables Reach the Variables Lower Upper Lower Upper Upper2. 1 Ratio 1∧ 1 Changes in the prevalence of six eating behaviours according to age and are shown in6 Table 31.3 30.3 31.3 18.9 30.3 0.59 18.9 *** 0.59 *** 0.76 0.46 0.76Lower years years 28.3 33.8 28.5 *** 0.52 15 years 34.2 aAge a a∧ aEating a ♯a 0.40 a∧ Behaviours a% a 0.31 a% a 0.46 agender 11 years 28.4 21.6 18.9 0.59 *** 0.46 0.75 25.3 ∧ 21.0 ♯ 17.3 Daily soft drinks Daily soft drinks Daily soft Specific drinks Daily soft drinks ♯a a∧ ♯a 0.79 ♯ 0.79 3.2. Gender and Changes in % % % % % % OR % % OR % OR % OR % % % % 25.5 30.1 25.5 26.5 30.1 21.0 26.5 ** 0.67 ** 0.90 0.67 0.90 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 2006 vs. 2002 2014 2010 2014 vs. 2002 2014 2014 vs. 2002 2014 vs. 2002 25.3 21.6 18.9 0.59 0.46 0.75 11 years 28.4 Boys Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 *** 24.6 34.3 0.41 0.48 17.2 *** 24.6 0.55 0.41 0.48 17.2 *** 0.55 0.41 0.48 *** 0.55 0.41 0.55 ∧ Disparities Disparities were found Disparities were in changes found Disparities were in of changes found dietary were of patterns changes found dietary by of patterns changes gender dietary by and of patterns gender dietary age over by and patterns gender the age 12-year over by and gender the age period. 12-year over and the age period. 12-year over the period. 12-year period. in in between 2002–2014. between 2002–2014. between 2002–2014. between 2002–2014. 95% CI 95% CI 95% CI 95% CI 1−6 1−6 1−6 1−6 Odds Ratio to Odds Ratio to Odds Ratio to Odds Ratio to 13 years 27.4 28.3 27.9 21.8 0.74 * 0.57 0.95 23.9 20.9 14.0 0.44 *** 0.34 0.58 15 years 26.8 Reach the Variables Reach the Variables Reach the Variables Reach the Variables Lower Upper Lower Upper Lower Upper Lower Upper 1 1 1 ∧ softaccording Changes in the prevalence ofsoft six eating behaviours to age shown in Table 2.*** ♯a a∧ 14.2 aprevalence a∧ a24.9 a28.2 aeating a∧and agender a Czech a Czech achildren years 23.0 32.6 32.8 24.0 1.06 0.83 1.34 ∧ are Daily soft13 drinks Daily drinks Daily drinks ♯ ♯a 0.47 ♯a 0.83 ♯ 0.83 Girls Girls 24.9 29.9 29.9 28.2 21.5 **achildren 0.72 ** 0.95 0.72 0.95 19.9 *** 0.40 0.54 Girls 26.1 27.1 3.2. Gender and Age Specific Changes Eating Behaviours Table 2. Changes Table 2.Boys in Changes ina years six eating six behaviours behaviours in in and adolescents adolescents % % % % % % OR % % % OR % % OR % OR % % % % ♯ ♯ ♯ 21.5 2002 2006 2002 2010 2006 2014 2010 2002 2014 2014 2006 vs. 2002 2010 2014 vs. 2002 2014 2014 vs. 95% 2002 CI ♯ in prevalence ♯of ♯of by Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 *** 24.6 34.3 0.41 0.48 17.2 *** 24.6 0.55 0.41 0.48 17.2 *** 0.55 0.41 0.48 0.55 0.41 0.55 Int. J. Environ. Res. Public Health 2015, 12 6and 20.7 30.7 20.7 21.4 30.7 22.4 21.4 1.11 22.4 0.85 1.11 1.44 0.85 1.44 Disparities Disparities were found were in changes found in of changes of patterns by patterns gender and gender age over and the age 12-year over the period. 12-year period. 13 23.0 32.6 32.8 24.0 1.06 0.83 1.34 11 years 11 years 11 27.9 years 35.0 11 27.9 18.7 35.0 15.3 18.7 35.0 27.9 0.46 15.3 *** 18.7 35.0 0.35 0.46 15.3 *** 18.7 0.61 0.35 0.46 15.3 *** 0.61 0.35 0.46 *** 0.61 0.35 0.61 95% CI 95% CI CI 1−6 1−6 1−6dietary 1−6dietary Odds Ratio to Odds Ratio toOdds Ratio toOdds toa27.9 ♯Ratio 7of 2 prevalence Reach the Variables Reach the Variables Reach the Variables Reach the Variables Upper Lower Upper Lower Upper Lower Upper 1 soft 1 soft 1 1 behaviours Changes inChanges the prevalence in15 Changes the of six in Changes the eating prevalence behaviours six in the eating behaviours six according eating six according to eating age behaviours according to age are according to shown age and are in to Table shown age and 2.95% are in gender Table shown 2.2002 are in Table shown 2.in Table 2. 31.3 30.3 18.9 0.59 *** 0.76 15 years 28.3 aof aprevalence a∧ a% a ♯a OR a♯ and agender a aLower agender a 0.46 agender years 31.8 30.1 21.5 0.91 0.71 1.16 23.3 Daily sweets ∧and ♯of soft drinks Daily drinks Daily drinks Daily soft drinks ♯a a∧ ♯ 0.59 ♯ in Age % % % % % % % % OR % % OR % OR % % % % 3.2. JGender and Gender Age 3.2. Specific and Gender Age Changes 3.2. Specific and Gender Age Changes Eating Specific and Behaviours in Changes Eating Specific Behaviours in Changes Eating Behaviours in Eating Behaviours Table 2. Changes in prevalence of six eating behaviours in Czech children and adolescents ♯ ♯ ♯ ♯ 25.3 21.6 25.3 18.9 21.6 0.59 18.9 0.46 *** 0.75 0.46 0.75 11 years 11 years 28.4 28.4 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 2006 vs. 2002 2014 2010 2014 vs. 2002 2014 2014 vs. 2002 2014 vs. 95% Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 17.2 24.6 30.4 0.48 17.2 *** 34.3 0.41 0.48 *** 24.6 0.55 0.41 17.2 0.55 0.48 *** 0.41 0.55 26.4 15.5 13.2 0.52 0.39 0.69 11 years 22.5 In Env3.2. ron Res Pub c Hea h 2015 12 6 ♯Ratio Disparities were found in changes of patterns by gender and age over the 12-year period. 11 years 11 years 11 27.9 years 35.0 11 27.9 years 18.7 35.0 27.9 15.3 18.7 35.0 27.9 0.46 15.3 *** 18.7 35.0 0.35 0.46 15.3 *** 18.7 0.61 0.35 0.46 15.3 *** 0.61 0.35 0.46 *** 0.61 0.35 0.61 1−6 1−6 1−626.6 1−6dietary 95% CI 95% CI CI between 2002–2014. between 2002–2014. Odds Ratio to Odds Ratio to Odds to 13 13 27.4 28.3 27.4 27.9 28.3 21.8 27.9 0.74 21.8 * 0.57 0.74 * 0.95 0.57 0.95 31.8 30.1 21.5 0.91 0.71 1.16 15 23.3 3 13 years years 29.0 years 34.3 13 29.0 years 34.3 29.0 18.9 26.6 34.3 29.0 057 18.9 *** 26.6 34.3 0.44 057 18.9 *** 26.6 0.74 0.44 057 18.9 *** 0.74 0.44 057 *** 0.74 0.44 0.74 Reach the Variables Reach the Variables Reach the Variables Reach the Variables Lower Upper Lower Upper Lower Upper Lower Upper 1 1 1 1 Changes in Changes the prevalence in the prevalence six eating of behaviours six eating behaviours according according to age and to gender age and are shown are in Table shown 2. in Table 2. aofsoft a a∧ a ♯a ∧ % a28.2 a ♯ OR a∧ 21.5 a % a 0.83 a 0.72 agender Daily fruit ∧ Daily soft drinks Daily soft drinks Daily drinks Daily soft drinks ♯ ♯ Girls 24.9 29.9 ** 0.95 % % % % % OR % % OR % % % Table 2. Changes in prevalence of six eating behaviours in Czech children and adolescents 25.5 30.1 26.5 21.0 0.79 ** 0.67 0.90 ♯of Pub Hea ♯ patterns by ♯and Boys Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 ***32.8 24.6 34.3 0.41 0.48 17.2 ***24.6 0.55 0.41 0.48 17.2 *** CI 0.55 0.41 0.4895% *** 0.55 0.41 95% CI 0.55 In Disparities J Env ronOdds Res Pub In J cyears Env Hea h15 2015 Res 12 cyears htoa29.0 2015 12 6 shown 13 13 years 23.0 32.6 23.0 32.8 32.6 24.0 1.06 24.0 0.83 1.06 1.34 0.83 1.34 found in changes dietary gender age over the 12-year period. 11 years 11 years 27.9 35.0 11 27.9 18.7 35.0 18.7 27.9 0.46 15.3 *** 35.0 0.35 0.46 *** 18.7 0.61 0.35 15.3 0.61 0.46 *** 0.35 0.61 1−6ron 1−6 1−6 95% CI 95% CI between 2002–2014. 13 29.1 31.1 23.2 15.3 0.44 0.34 0.57 Ratio to15 Odds Odds Ratio toOdds ♯Ratio ♯ 18.9 ∧ 1 ∧ ∧ 3 to 13were years 13 13 29.0 years 34.3 13 29.0 26.6 34.3 34.3 057 18.9 *** 34.3 0.44 057 18.9 *** 0.74 0.44 057 18.9 *** 0.74 0.44 057 *** 0.74 0.44 0.74 Reach the Variables Reach the Variables Reach the Variables Lower Upper Lower Upper Lower Upper2. 6 1 Ratio 1∧ Changes in the prevalence of six eating behaviours according to age and are inand Table 31.3 30.3 31.3 30.3 0.59 0.46 0.59 0.76 0.46 0.76 28.3 28.3 a1 soft drinks a years a∧ a26.6 a29.0 a∧ a26.6 a 0.31 a26.6 a 0.31 agender 33.8 28.5 33.8 17.3 28.5 33.8 17.3 *** 28.5 33.8 *** 28.5 0.52 17.3 *** 0.52 0.31 0.40 *** 0.52 0.31 0.52 15 years years 34.2 years 15 34.2 years 34.2 34.2 fruit Boys 37.0 33.1 37.3 33.1 0.82 ** 0.72 0.94 ∧ 17.3 Daily soft drinks Daily soft drinks Daily Daily soft drinks ♯a a∧ ♯a 0.40 ♯a 0.40 ♯ 0.40 ♯prevalence % % % % % % OR % % % OR % % OR % OR % % % % 3.2. Gender and Age Specific Changes in Eating Behaviours Table 2. Changes Table 2. in Changes Table prevalence 2. in Changes Table prevalence of six 2. eating in Changes prevalence of six behaviours eating in of six behaviours in eating Czech of six behaviours children in eating Czech and behaviours children in adolescents Czech and children in adolescents Czech and children adolescents adolescents ♯ ♯ ♯ ♯ ♯ 2002 2006 2002 2010 2006 2014 2010 2014 2014 vs. 2002 2014 vs. 2002 Boys Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 *** 24.6 34.3 0.41 0.48 17.2 *** 24.6 0.55 0.41 0.48 17.2 *** 0.55 0.41 0.48 *** 0.55 0.41 0.55 25.3 21.6 18.9 0.59 0.46 0.75 11 years 28.4 In J between Envinron Res Pub cyears Hea InVariables hDisparities J2015 Env 12 ron Res Pub Hea hage 2015 12 6 the 6 ♯of ♯of 20.7 30.7 21.4 22.4 1.11 0.85 1.44 ∧of Disparities Disparities Disparities in changes found were in changes found dietary were patterns changes found dietary by patterns changes gender dietary by and of patterns gender dietary age over by and patterns gender the age 12-year over by and gender the age period. 12-year over and age period. 12-year over the period. 12-year period. 11 yearsthefound 11 years 11 27.9 years 35.0 11 27.9 years 18.7 35.0 27.9 15.3 18.7 35.0 27.9 0.46 15.3 *** 18.7 35.0 0.35 0.46 15.3 *** 18.7 0.61 0.35 0.46 15.3 *** 0.61 0.35 0.46 *** 0.61 0.35 0.61 in cin 1−6 1−6 1−6 1−6 2002–2014. ∧ ∧ ∧ 057 31.8 30.1 31.8 21.5 30.1 0.91 21.5 0.71 0.91 1.16 0.71 1.16 15were 15 years 23.3 23.3 13were 13 29.0 34.3 13 29.0 years 26.6 34.3 18.9 26.6 29.0 18.9 *** 34.3 0.44 057 *** 26.6 0.74 0.44 18.9 0.74 057 *** 0.44 0.74 23.9 20.9 14.0 *** 0.34 0.58 15 years 26.8 Reach Variables Reach the Reach Variables Reach the Variables Upper Upper Lower Upper Lower Upper 1 soft 1 ∧the the prevalence of six eating behaviours according to gender shown in Table 2. ∧ soft ∧ ∧and ∧ are ♯ ∧ ♯ 0.44 ♯Lower ♯Lower 33.8 28.5 33.8 17.3 28.5 33.8 0.40 17.3 *** 28.5 33.8 0.31 0.40 17.3 *** 28.5 0.52 0.31 0.40 17.3 *** 0.52 0.31 0.40 *** 0.52 0.31 0.52 15 years 15 years 15 34.2 years 15 34.2 years 34.2 34.2 1 of years 42.9 37.6 42.2 40.8 0.92 0.74 1.14 ∧ ∧ ∧ Daily soft11 drinks drinks Daily drinks ♯ ♯ ♯ ♯ 24.9 29.9 24.9 28.2 29.9 28.2 0.83 0.83 ** 0.95 0.72 0.95 19.9 19.9 0.47 14.2 *** 19.9 0.40 0.47 14.2 *** 19.9 0.54 0.40 0.47 14.2 *** 0.54 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 26.1 27.1 3Changes 2 JGender and Age Spec cRatio Changes Ea ng Behav ours Table 2.Daily Changes Table 2.Girls in Changes prevalence in six eating six behaviours eating behaviours in Czech children in Czech and children adolescents adolescents Boys 37.0 33.1 37.3 33.1 0.82 ** 0.72 0.94 ♯ n 12 prevalence ♯of ♯ 14.2 ♯ 21.5 21.5 Boys Boys 30.4 34.3 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 24.6 34.3 0.41 0.48 17.2 24.6 0.55 0.41 0.48 17.2 0.55 0.41 0.48 0.55 0.41 0.55 2002 2006 2010 2014 2014 vs. 95% 2002 In EnvinChanges ron Res Pub cyears Hea hto 2015 6and 112002–2014. years 11 years 11 27.9 years 35.0 11 27.9 years 18.7 35.0 27.9 15.3 18.7 35.0 27.9 0.46 15.3 *** 18.7 35.0 0.35 0.46 15.3 *** 18.7 0.61 0.35 0.46 15.3 *** 0.61 0.35 0.46 *** 0.61 0.35 0.61 13 23.0 32.6 32.8 24.0 1.06 0.83 1.34 95% CI CI between between between 2002–2014. between 2002–2014. Odds Odds Ratio toBoys ∧ ∧ behaviours ∧18.9 13 27.4 28.3 27.9 21.8 0.74 **** 0.57 0.95 3eating 3eating 7and years 13 13 29.0 years 34.3 13 29.0 years 26.6 34.3 29.0 18.9 26.6 34.3 29.0 057 *** 26.6 34.3 0.44 057 18.9 *** 26.6 0.74 0.44 057 18.9 *** 0.74 0.44 057 *** 0.74 0.44 0.74 2 2002–2014. 1 1 1 1 ∧ ∧ ∧ ∧ Changes the prevalence in Changes the prevalence of six in Changes the prevalence of behaviours six in the prevalence of six according eating of behaviours six according to eating age behaviours according to gender age and are according to gender shown age and are in to gender Table shown age and 2. are in gender Table shown 2. are in Table shown 2. in Table 2. ♯ ♯ ♯ ♯ a a a a a a a a 33.8 28.5 33.8 17.3 28.5 0.40 17.3 33.8 0.31 0.40 *** 28.5 0.52 0.31 17.3 0.52 0.40 *** 0.31 0.52 15 years 15 years 34.2 15 34.2 years 34.2 Daily fruit Daily fruit 13 years 38.3 36.5 32.8 0.78 * 0.63 0.98 ∧ ∧ ∧ 40.0 Daily sweets soft3Spec drinks drinks drinks Daily soft drinks ♯ ♯ ♯ ♯ ♯ng ♯ 0.47 ♯soft prevalence ♯c ♯of ♯Behav 2002 19.9 14.2 19.9 0.47 14.2 19.9 0.40 0.47 14.2 19.9 0.54 0.40 14.2 *** 0.54 0.40 0.47 0.54 0.40 0.54 Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 26.1 % % % % % OR % OR % % 27.1 Table Changes inng eating behaviours in0.55 Czech children adolescents 3In2Disparities and Age 2Girls Gender csoft Changes and Age n1−612 Ea Spec Behav Changes ours n six Ea ours ♯ ♯ ♯ 25.3 21.6 25.3 18.9 21.6 0.59 18.9 0.46 0.59 0.75 0.46 0.75 28.4 28.4 Boys Boys 30.4 34.3 30.4 24.6 34.3 17.2 24.6 30.4 0.48 17.2 *** 34.3 0.41 0.48 *** 24.6 0.41 17.2 0.55 0.48 *** 0.41 0.55 2002 2006 2010 2014 2014 vs. 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 15.5 26.4 0.39 0.52 13.2 15.5 0.69 0.39 0.52 13.2 *** 0.69 0.39 0.52 0.69 0.39 0.69 11were years 11 22.5 years 11 22.5 years 22.5 22.5 11 42.9 37.6 42.2 40.8 0.92 0.74 1.14 JGender Env ron Res Pub cyears Hea h2.Girls 2015 6andCI ♯ patterns 27.9 35.0 27.9 18.7 35.0 27.9 15.3 18.7 35.0 27.9 0.46 15.3 *** 18.7 35.0 0.35 0.46 15.3 ***26.6 18.7 0.61 0.35 0.46 15.3 0.61 0.35 0.4695% *** 0.61 0.35 0.61 found in changes of dietary by gender and age over the 12-year period. 1−626.6 between between 2002–2014. Odds toBoys ♯Ratio ∧ ∧ 057 13 years 13 years 13 29.0 years 34.3 13 29.0 years 34.3 29.0 18.9 26.6 34.3 29.0 18.9 *** 26.6 34.3 0.44 *** 0.74 0.44 057 18.9 *** 0.74 0.44 057 *** 0.74 0.44 0.74 31.8 30.1 21.5 0.91 0.71 1.16 152002–2014. 23.3 Reach Variables the Variables Upper Lower Upper ∧∧ ∧∧ ∧ 18.9 31.3 30.3 18.9 0.59 0.46 0.76 years 28.3 ♯ a ♯a 057 ♯Lower a 0.31 a19.9 33.8 28.5 33.8 17.3 28.5 33.8 0.40 *** 28.5 33.8 0.40 17.3 *** 28.5 0.52 0.31 0.40 17.3 *** 0.52 0.31 0.40 *** 0.52 0.31 0.52 15 years 15 34.2 years 15 34.2 years 34.2 34.2 ♯ 17.3 15 years 29.8 25.3 29.6 25.6 0.81 0.64 1.02 ∧ ∧ ∧ ∧ ♯ ♯ ♯ng ♯ ♯ ♯ ♯c21.0 19.9 14.2 19.9 0.47 14.2 *** 0.40 0.47 *** 0.54 0.40 14.2 0.54 0.47 *** 0.40 0.54 Girls Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 % % % OR % 3In2DJGender and Age Spec cthe Changes 3ron 2hReach Gender n Ea and ng Spec ours Changes n Ea ours Boys Boys 37.0 33.1 37.0 37.3 33.1 33.1 37.3 0.82 33.1 ** 0.72 0.82 ** 0.94 0.72 0.94 Table 2.15 Changes in prevalence six eating behaviours in Czech children and adolescents ♯of Age ♯Behav ♯ 24.0 Behav 25.5 30.1 26.5 0.79 ** 0.67 0.90 Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 24.6 34.3 0.41 0.48 17.2 24.6 0.55 0.41 0.48 17.2 *** 0.55 0.41 0.48 0.55 0.41 0.55 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 2006 vs. 2002 2014 2010 2014 vs. 2002 2014 2014 vs. 2002 2014 vs. 2002 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 15.5 26.4 0.39 0.52 13.2 *** 15.5 0.69 0.39 0.52 13.2 0.69 0.39 0.52 *** 0.69 0.39 0.69 years years 11 22.5 years 22.5 years 22.5 22.5 by ♯ Env ron Res Pub In J c Env Hea 2015 Res Pub 12 c Hea h 2015 12 6 6 23.0 32.6 23.0 32.8 32.6 32.8 1.06 24.0 0.83 1.06 1.34 0.83 1.34 11 11 27.9 35.0 11 27.9 18.7 35.0 18.7 27.9 0.46 *** 35.0 0.35 0.46 18.7 0.61 0.35 0.61 0.46 0.35 0.61 spar es were found n changes of d e ary pa erns gender and age over he 12-year per od 1−6 between 2002–2014. 95% CI 13 years 13 years 13 29.1 years 31.1 13 29.1 years 23.2 31.1 29.1 15.3 23.2 31.1 29.1 0.44 15.3 23.2 31.1 0.34 0.44 15.3 *** 23.2 0.57 0.34 0.44 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 Odds Ratio to 36.5 40.0 32.8 0.78 ****26.6 0.63 0.98 38.3 ∧the Variables ∧ ∧18.926.6 ∧18.9 057 057 05718.9 29.0 34.3 29.0 26.6 34.3 29.0 34.3 29.0 *** 26.6 34.3 0.44 18.9 *** 0.74 0.44 *** 0.74 0.44 057 *** 0.74 0.44 0.74 3eating Reach Lower Upper 1 1 ∧ ∧ ∧ ∧ Changes in the prevalence of six behaviours according to age and gender are shown in Table 2. ♯ ♯ ♯ ♯ 33.8 28.5 33.8 17.3 28.5 33.8 0.40 17.3 *** 28.5 33.8 0.31 0.40 17.3 28.5 0.52 0.31 0.40 17.3 *** 0.52 0.31 0.40 *** 0.52 0.31 0.52 15 years 15 years 15 34.2 years 15 34.2 years 34.2 34.2 a a a a Daily fruit Girls 49.0 45.2 47.1 41.8 0.74 *** 0.66 0.83 soft drinks soft drinks 24.9 29.9 28.2 21.5 **12 0.72 0.95 ♯of ♯of prevalence ♯of 2014 19.9 14.2 19.9 0.47 14.2 *** 19.9 0.40 0.47 14.2 *** 19.9 0.54 0.40 0.47 14.2 *** 0.54 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 26.1 0.83 ♯ 27.1 0.52 0.69 3In2DJGender and Age Spec cRatio Changes nfound Ea ng Behav ours % % % OR % Table 2.Girls Changes Table 2. inChanges Table prevalence 2.Daily in Changes Table prevalence six 2. eating in Changes six behaviours eating in of six behaviours in31.1 eating Czech six behaviours children in eating Czech and behaviours children in adolescents Czech and children in adolescents Czech and children adolescents andCI adolescents ♯prevalence ♯ ♯ ♯ 2002 2006 2002 2010 2006 2014 2010 2014 vs. and 2002 2014 vs. 2002 26.4 15.5 26.4 13.2 15.5 0.52 13.2 *** 26.4 0.39 *** 15.5 0.39 13.2 0.69 0.52 *** 0.39 0.69 11were years years 22.5 11 22.5 years 22.5 11 11 years 42.9 37.6 42.9 42.2 37.6 40.8 42.2 0.92 40.8 0.74 0.92 1.14 0.74 1.14 Env ron Res Pub c Hea In h J 2015 Env 12 ron Res Pub h 2015 6 6 ♯Ratio ♯of 20.7 30.7 21.4 22.4 1.11 0.85 1.44 27.9 35.0 27.9 18.7 35.0 27.9 18.7 35.0 27.9 0.46 18.7 35.0 0.35 0.46 18.7 0.61 0.35 0.46 0.61 0.35 0.46 0.61 0.35 0.61 ∧ ∧ ∧ ∧ spar es found D spar n changes es were of d e ary pa changes erns by gender d e ary and pa erns age over by gender he 12-year age per over od he 12-year per od n c Hea 057 ∧ 057 0.44 1−6 years years 13 29.1 years 31.1 29.1 years 23.2 31.1 29.1 15.3 23.2 29.1 0.44 15.3 *** 23.2 31.1 0.34 0.44 15.3 *** 23.2 0.57 0.34 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 95% CI 95% CI 95% CI 95% between 2002–2014. Odds Ratio to Odds to Odds Ratio to Odds to ∧ ∧ ∧ 31.8 30.1 31.8 21.5 30.1 0.91 21.5 0.71 0.91 1.16 0.71 1.16 23.3 23.3 13 13 29.0 34.3 13 29.0 26.6 34.3 18.9 26.6 29.0 18.9 *** 34.3 0.44 *** 26.6 0.74 0.44 18.9 0.74 057 *** 0.44 0.74 23.9 20.9 23.9 14.0 20.9 23.9 0.44 14.0 *** 20.9 23.9 0.34 0.44 14.0 *** 20.9 0.58 0.34 0.44 14.0 *** 0.58 0.34 0.44 *** 0.58 0.34 0.58 15 years 15 years 15 26.8 years 15 26.8 years 26.8 26.8 Reach the Variables 1 Upper 25.3 29.6 25.6 0.81 1.02 29.8 ∧ ∧and ∧ are n and he preva ence ofc sChanges x ea ng behav ours accord o54.7 age shown na Tab evs.22002 ♯a a∧ ♯a 0.40 ♯aLower ♯ 0.40 33.8 28.5 33.8 17.3 28.5 33.8 28.5 33.8 0.40 28.5 0.52 0.31 17.3 0.52 0.31 0.40 0.52 0.31 0.52 34.2 34.2 a ang a∧ a34.2 a19.9 a34.2 a∧ agender a 0.31 a 0.64 years 54.8 48.4 50.4 0.84 0.68 1.03 ng Daily ♯ ♯ ♯ ♯soft ♯ ♯ 17.3 17.3 19.9 14.2 0.47 14.2 *** 19.9 0.40 0.47 14.2 *** 19.9 0.54 0.40 0.47 14.2 *** 0.54 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls Girls 26.1 27.1 26.1 27.1 26.1 27.1 26.1 27.1 3Changes 2DGender Age11 Spec n1−6Ea ours % % % % % % OR % % % OR % % OR % OR % % % % 37.0 33.1 37.3 33.1 0.82 **a23.2 0.72 0.94 Boys Boys 30.4 34.3 30.4 24.6 34.3 17.2 24.6 0.48 17.2 *** 0.41 0.48 *** 0.55 0.41 0.55 25.3 21.6 18.9 0.59 0.46 0.75 28.4 2002 2006 2010 2014 2014 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 *** 15.5 26.4 0.39 0.52 13.2 15.5 0.69 0.39 0.52 13.2 0.69 0.39 0.52 *** CI 0.69 0.39 0.69 11were years 112002–2014. years 11 22.5 years 11 22.5 years 22.5 22.5 Behav by ♯ 0.44 ∧ age ♯ 0.44 erns ∧ ∧ spar es found nRatio changes D spar of ddrinks es eGirls were ary pa found erns n∧♯ 18.9 changes gender and of dgender ea ary over pa he 12-year by gender per od and age over he 12-year per od 95% CI 95% 1−6 3 to 1−6 1−6 13 years 13 years 29.1 31.1 13 29.1 years 23.2 31.1 15.3 23.2 29.1 15.3 *** 31.1 0.34 *** 0.57 0.34 15.3 0.57 0.44 *** 0.34 0.57 between 2002–2014. between between 2002–2014. between 2002–2014. Odds Odds Ratio to 36.5 40.0 36.5 32.8 40.0 0.78 32.8 **** 0.63 0.78 **** 0.98 0.63 0.98 years 38.3 38.3 ∧ ∧ ∧ 27.4 28.3 27.9 21.8 0.74 * 0.57 0.95 7and 13 29.0 29.0 26.6 34.3 29.0 26.6 34.3 29.0 057 18.9 *** 26.6 34.3 0.44 057 18.9 *** 26.6 0.74 0.44 057 18.9 *** 0.74 0.44 057 *** 0.74 0.44 0.74 334.3 23.9 20.9 23.9 14.0 20.9 23.9 0.44 14.0 20.9 23.9 0.34 0.44 14.0 20.9 0.58 0.34 0.44 14.0 0.58 0.34 0.44 0.58 0.34 0.58 15 years 15 15 years 15 years 26.8 2 years 226.8 226.8 226.8 Reach the Variables Reach the Variables Reach the Variables Reach Variables the ng Lower Upper Lower Upper Lower Upper Lower Upper 1 ∧ ∧ ∧ ∧ ♯ ♯ ♯ ♯ Changes n he preva Changes ence of s n x he ea preva ng behav ence ours of s accord x ea ng behav o age ours accord ng are o shown age and n gender Tab e 2 are shown n Tab e 2 33.8 28.5 33.8 17.3 28.5 0.40 17.3 *** 33.8 0.31 0.40 28.5 0.52 0.31 17.3 0.52 0.40 *** 0.31 0.52 34.2 34.2 34.2 a a a a a a a Daily fruit Daily fruit 40.9 13 years 47.4 46.4 0.77 * 0.63 0.94 45.9 ∧ sweets sweets Daily sweets 45.2 47.1 41.8 0.74 0.66 0.83 49.0 ♯ 0.47 soft drinks ♯of ♯c ♯ ♯ 2014 ♯Behav 2002 19.9 14.2 19.9 0.47 14.2 *** 19.9 0.40 14.2 *** 19.9 0.54 0.40 0.47 14.2 *** 1.14 0.54 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls 26.1 27.1 26.1 27.1 26.1 27.1 26.1 % % % % % OR % OR % % 27.1 3 2DGender and Age 3Spec 2Girls Gender Changes and Age n1−6six Ea ng Behav Changes ours n gender Ea ng ours Tablees 2.Daily Changes in prevalence eating behaviours in31.1 Czech children and adolescents ♯ Boys 30.4 34.3 24.6 17.2 0.48 *** 0.41 0.55 2002 2006 2010 2014 vs. 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 *** 15.5 26.4 0.39 0.52 13.2 *** 15.5 0.69 0.39 0.52 13.2 0.69 0.39 0.52 *** CI 0.69 0.39 0.69 11were years 11 years 11 22.5 years 11 22.5 years 22.5 22.5 42.9 37.6 42.2 40.8 0.92 0.74 ∧ ∧ pa ∧ 11 years 11 years 27.9 35.0 27.9 18.7 35.0 18.7 0.46 0.35 0.46 0.61 0.35 0.61 23.0 32.6 32.8 24.0 1.06 0.83 1.34 spar ncsweets changes of dSpec eGirls ary erns and age over 12-year per ∧ by 0.44 0.44 1−623.2 95% 13 years found 13 13 29.1 31.1 13 29.1 years 31.1 29.1 15.3 *** 23.2 31.1 0.34 15.3 *** 23.2 0.57 0.34 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 Odds to 15.3 ∧ 0.44 he ∧ ♯Ratio 23.9 20.9 23.9 14.0 20.9 14.0 *** 23.9 0.44 *** 20.9 0.58 0.34 14.0 0.58 0.44 *** 0.34 0.58 15 years 15 15 years 26.8 2 years 226.8 226.8 229.1 Reach the Variables Reach the Variables Upper Lower Upper 1 soft 1∧ 1 1 ng 25.3 29.6 25.3 25.6 29.6 0.81 25.6 0.64 0.81 1.02 0.64 1.02 15 years 29.8 29.8 ∧ ∧ are ♯ a∧ ♯a 0.44 ♯Lower 31.3 30.3 18.9 0.59 0.46 0.76 28.3 ne and he preva ence of sChanges Changes xdrinks ng behav he preva ours accord ence of sChanges x23.2 o40.6 ea age ng behav gender accord shown ng n oTab age evs.and 2od gender are shown n Tab e 2 33.8 28.5 33.8 17.3 28.5 33.8 0.40 17.3 28.5 33.8 0.31 0.40 17.3 28.5 0.52 0.31 0.40 17.3 *** 0.52 0.31 0.40 0.52 0.31 0.52 34.2 34.2 34.2 34.2 a 0.34 a19.9 and ours 15 years 40.8 34.1 0.64 *** 0.52 0.79 sweets sweets sweets ∧ soft drinks Daily Daily soft drinks Daily drinks ♯ ♯of Age ♯soft ♯ Behav 19.9 14.2 19.9 0.47 14.2 *** 0.40 0.47 *** 0.54 0.40 14.2 0.54 0.47 *** 0.40 0.54 Girls Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 % % % OR % 3Changes 2DGender Age Spec csweets 3 2ea Gender nnsron Ea and ng Spec ours n Ea ng ours 37.0 33.1 37.0 37.3 33.1 33.1 37.3 0.82 33.1 0.72 0.82 0.94 0.72 0.94 Tab 2Daily Changes preva ence x44.8 ea ng behav n Czech ch dren and ado escen s 48.4 54.7 50.4 0.84 0.68 1.03 54.8 ♯c21.0 ♯ 21.0 Boys Boys 25.5 30.1 Boys 25.5 26.5 30.1 25.5 26.5 30.1 25.5 0.79 ** 26.5 30.1 0.67 0.79 21.0 ** 26.5 0.90 0.67 0.79 21.0 ** 0.90 0.67 0.79 ** 0.90 0.67 0.90 Boys 30.4 34.3 24.6 17.2 0.48 *** 0.41 0.55 2002 2006 2002 2010 2006 2002 2014 2010 2006 2002 2014 2010 2014 2006 vs. 2002 2014 2010 2014 vs. 2002 2014 2014 2002 2014 vs. 2002 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 15.5 26.4 0.39 0.52 13.2 *** 15.5 0.69 0.39 0.52 13.2 *** 0.69 0.39 0.52 *** 0.69 0.39 0.69 11 years 11nRes years 11 22.5 years 11 22.5 years 22.5 22.5 Behav ours ♯ ♯ In J Env ron Pub In J c Env Hea h 2015 Res Pub 12 c Hea h 2015 12 6 6 ∧ ∧ ∧ ∧ 11 years 27.9 35.0 18.7 0.46 0.35 0.61 spar es were found n changes of d e ary pa erns by gender and age over he 12-year per od 1−6 13 years 13 years 13 29.1 31.1 13 29.1 years 23.2 31.1 29.1 15.3 23.2 31.1 29.1 0.44 15.3 *** 23.2 31.1 0.34 0.44 15.3 *** 23.2 0.57 0.34 0.44 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 95% CI between 2002–2014. Odds Ratio to 36.5 40.0 32.8 0.78 ****20.9 0.63 0.98 38.3 4ng 13 13 29.0 34.3 29.0 26.6 18.9 26.6 057 18.9 *** 0.44 057 *** 0.74 0.44 0.74 31.8 30.1 21.5 0.91 0.71 23.3 23.9 20.9 23.9 20.9 23.9 0.44 14.0 *** 20.9 0.34 0.44 14.0 0.58 0.34 0.44 14.0 *** 0.58 0.34 0.44 0.58 0.34 0.58 15 preva years 15 15 years 15 26.8 years 26.8 2 years 226.8 2a26.8 Reach the Variables ng 14.0 and 23.9 1.16 Lower Upper 1 sweets ∧ ∧ ∧ Changes ne he ence of s xedrinks ea behav accord oxn34.3 age gender are shown n ch Tab e 2 *** ♯ ♯ ♯ ♯ a1 ♯soft a ours a19.9 Daily vegetables Daily sweets sweets Daily 45.2 47.1 45.2 41.8 47.1 0.74 41.8 0.66 0.74escen 0.83 0.66 0.83 49.0 49.0 ∧ ∧ ∧ ∧ Daily soft Daily drinks ♯ ∧ ♯ ♯ 0.79 ♯ 0.79 ♯ ♯ 21.0 24.9 29.9 28.2 21.5 0.83 ** 0.72 0.95 19.9 14.2 0.47 14.2 *** 19.9 0.40 0.47 14.2 *** 19.9 0.54 0.40 0.47 14.2 *** 0.54 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 26.1 27.1 n % % % OR % ♯ Tab 2 Changes n Tab preva 2 ence Changes of s x ea n preva ng behav ence ours of s ea Czech ng behav ch dren ours and ado Czech s dren and ado escen s ♯ ♯ ♯ ♯ 25.5 30.1 25.5 26.5 30.1 25.5 21.0 26.5 30.1 25.5 0.79 ** 26.5 30.1 0.67 21.0 ** 26.5 0.90 0.67 21.0 ** 0.90 0.67 0.79 ** 0.90 0.67 0.90 ♯ Boys Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 *** 24.6 34.3 0.41 0.48 17.2 *** 24.6 0.55 0.41 0.48 17.2 *** 0.55 0.41 0.48 *** 0.55 0.41 0.55 26.4 15.5 26.4 13.2 15.5 0.52 13.2 26.4 0.39 0.52 15.5 0.69 0.39 13.2 0.69 0.52 0.39 0.69 11 years 11 years 22.5 11 22.5 years 22.5 42.9 37.6 42.9 42.2 37.6 40.8 42.2 0.92 40.8 0.74 0.92 1.14 0.74 1.14 46.4 45.9 40.9 0.77 * 0.63 0.94 47.4 ∧ ∧ ∧of 11 years 11 20.7 years 30.7 11 20.7 years 21.4 30.7 20.7 22.4 21.4 30.7 20.7 1.11 22.4 21.4 30.7 0.85 1.11 22.4 21.4 1.44 0.85 1.11 22.4 1.44 0.85 1.11 1.44 0.85 1.44 by 0.44 ∧ 0.44 057 11 years 27.9 35.0 18.7 0.46 *** 0.35 0.61 D spar es were found D spar n changes were of found d e ary n pa changes erns gender d e ary and pa erns age over by gender he 12-year and age per over od he 12-year per od 13 13 13 29.1 31.1 13 29.1 23.2 31.1 29.1 15.3 23.2 31.1 29.1 15.3 23.2 31.1 0.34 15.3 *** 23.2 0.57 0.34 0.44 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 1−6 es 95% CI 95% CI 95% CI 95% CI be ween 2002–2014 Odds Ratio to Odds Ratio to Odds Ratio to Odds Ratio to ∧ ∧ ^ ^ 13 29.0 34.3 26.6 18.9 *** 0.44 0.74 3 23.9 20.9 23.9 14.0 20.9 23.9 0.44 14.0 *** 20.9 23.9 0.34 0.44 14.0 *** 20.9 0.58 0.34 0.44 14.0 *** 0.58 0.34 0.44 *** 0.58 0.34 0.58 15 years 15 years 15 26.8 years 15 26.8 years 26.8 26.8 2 2 2 2 Reach the Variables 1 sweets Upper 25.3 29.6 25.6 0.81 1.02 29.8 Changes ne he preva ence of s x ea ng behav accord ng o26.0 age gender are shown na Tab e 2 ** 33.8 33.8 17.3 28.5 0.40 17.3 *** 0.31 0.40 *** 0.52 0.31 0.52 15nyears 15 years 34.2 a a ours a a34.2 a a∧ a a% a 0.64 fruit Boys 23.8 1.03 0.89 1.19 % a28.5 and Daily sweets Daily sweets sweets Daily Daily soft ♯a 0.79 ♯aLower ♯ ♯ ♯ ♯ % % % % % OR % % % OR % OR % OR % % % % Tab 213 Changes preva ence Tab sedrinks x23.4 2e13 ea Changes behav na a∧♯^preva ours n28.3 ence Czech sadch x24.2 dren and behav ado ours escen n1.44 sCzech ch dren andhe ado escen per s od ♯ ng ♯ ∧ ♯ ng 48.4 54.7 48.4 50.4 54.7 0.84 50.4 0.68 0.84 1.03 0.68 1.03 54.8 54.8 Boys 25.5 30.1 Boys 25.5 26.5 30.1 21.0 26.5 25.5 21.0 ** 30.1 0.67 ** 26.5 0.90 0.67 21.0 0.90 0.79 0.67 0.90 ♯of ♯ ♯of Boys Boys 30.4 34.3 30.4 24.6 34.3 17.2 24.6 0.48 17.2 *** 0.41 0.48 *** 0.55 0.41 0.55 25.3 21.6 18.9 0.59 0.46 0.75 28.4 2002 2006 2010 2014 2014 vs. 2002 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 *** 15.5 26.4 0.39 0.52 13.2 15.5 0.69 0.39 0.52 13.2 0.69 0.39 0.52 *** 0.69 0.39 0.69 11were years 11 years 11 22.5 years 11 22.5 years 22.5 22.5 ♯ 0.44 ♯ 0.79 erns ∧ 20.7 30.7 20.7 21.4 30.7 20.7 22.4 21.4 30.7 20.7 1.11 22.4 21.4 30.7 0.85 1.11 22.4 21.4 1.44 0.85 1.11 22.4 0.85 1.11 1.44 0.85 1.44 0.74 11 yearsthefound 11 years 11 27.9 years 35.0 11 27.9 years 18.7 35.0 27.9 18.7 35.0 27.9 0.46 *** 18.7 35.0 0.35 0.46 15.3 18.7 0.61 0.35 0.46 *** 0.61 0.35 0.46 0.61 0.35 0.61 D spar nthe spar of were ary pa found erns by n∧∧♯♯ 18.9 changes gender and of age eea ary over pa he 12-year by per and age over 12-year 13 13 29.1 31.1 13 29.1 23.2 31.1 15.3 23.2 29.1 15.3 31.1 0.34 0.44 *** 23.2 0.57 0.34 15.3 0.57 0.44 *** 0.34 0.57 1−6 D 1−6des 1−6 be ween 2002–2014 be ween 2002–2014 36.5 40.0 36.5 32.8 40.0 0.78 32.8 0.63 0.78 0.98 0.63 0.98 38.3 38.3 40.8 40.6 34.1 0.64 0.52 0.79 44.8 ^ 13 13 27.4 28.3 27.4 27.9 28.3 27.4 21.8 27.9 27.4 0.74 21.8 **** 27.9 28.3 0.57 0.74 21.8 **** 27.9 0.95 0.57 21.8 **** 0.95 0.57 0.74 **** 0.95 0.57 0.95 7of 29.0 34.3 26.6 057 *** 0.44 0.74 23.9 20.9 23.9 14.0 20.9 23.9 0.44 14.0 20.9 23.9 0.34 0.44 14.0 20.9 0.58 0.34 0.44 14.0 *** 0.58 0.34 0.44 0.58 0.34 0.58 15 years 15 15 years 15 years 26.8 2 years 226.8 226.8 226.8 Reach Variables Reach Variables Reach the Variables Reach the Variables sweets ng Lower Upper Lower Upper Lower Upper Lower Upper 1 sweets ∧ ∧ ♯ ours ♯ Changes n3ees he preva Changes ence of schanges n3xSpec he ea preva ng∧cof behav ence ours sn1−6 accord xEa ea behav o29.4 age accord gender ng are oshown age and ngender gender Tab e 2od are shown n Tab e2 33.8 28.5 17.3 0.40 0.31 0.52 15 years 34.2 ng 11 years 25.9 28.7 1.01 0.79 1.29 28.5 sweets Daily Daily sweets Daily ∧and 45.2 47.1 41.8 0.74 0.66 0.83 49.0 ♯ Daily soft drinks 19.9 14.2 19.9 0.47 14.2 *** 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls 26.1 27.1 26.1 27.1 ♯ 0.79 30.1 ♯ng 0.90 37.0 33.1 37.3 33.1 0.82 0.72 0.94 Tab 2 Changes n preva ence s x ea ng behav ours n Czech ch dren and ado escen s 2 Gender and Age 2 Gender Changes and Age Spec ng c Behav Changes ours n Ea Behav ours ♯ ♯ ♯ ♯ ♯ Boys Boys 25.5 30.1 Boys 25.5 26.5 30.1 25.5 21.0 26.5 30.1 25.5 21.0 ** 26.5 0.67 0.79 21.0 ** 26.5 0.67 0.79 21.0 ** 0.90 0.67 0.79 ** 0.90 0.67 0.90 Boys 30.4 34.3 24.6 17.2 0.48 *** 0.41 0.55 2002 2006 2010 2014 2014 v 2002 46.4 45.9 46.4 40.9 45.9 0.77 40.9 * 26.6 0.63 0.7718.9 * 1.44 0.94 0.63 0.94 13 years 13 years 47.4 47.4 ∧ ∧ 11 years 20.7 30.7 11 20.7 years 21.4 30.7 22.4 21.4 20.7 1.11 22.4 30.7 0.85 1.11 21.4 1.44 0.85 22.4 1.11 0.85 1.44 11 11 27.9 35.0 27.9 18.7 35.0 18.7 0.46 0.35 0.46 0.61 0.35 0.61 ∧ 0.74 0.74 132002–2014 23.0 32.6 32.8 24.0 1.06 0.83 1.34 29.1 31.1 29.1 23.2 31.1 29.1 15.3 23.2 31.1 29.1 0.44 15.3 *** 23.2 31.1 0.34 0.44 15.3 *** 23.2 0.57 0.34 0.44 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 95% CI 34.3 057 be ween be ween 2002–2014 Odds Ratio to ∧ ♯ ♯ ♯ ♯ 4 13 13 13 27.4 28.3 13 27.4 27.9 28.3 27.4 21.8 27.9 28.3 27.4 21.8 * 27.9 28.3 0.57 0.74 21.8 * 27.9 0.95 0.57 21.8 * 0.95 0.57 0.74 * 0.95 0.57 0.95 ^ ^ 7 29.0 years 34.3 29.0 26.6 34.3 29.0 18.9 26.6 34.3 29.0 057 18.9 *** 26.6 0.44 18.9 *** 0.74 0.44 057 *** 0.74 0.44 057 *** 0.74 0.44 0.74 23.9 20.9 23.9 14.0 20.9 0.44 14.0 *** 23.9 0.34 0.44 *** 20.9 0.58 0.34 14.0 0.58 0.44 *** 0.34 0.58 15 years 15 years 26.8 15 26.8 years 26.8 2 2 2 2 1 soft 1 soft 1 ng 25.3 29.6 25.3 25.6 29.6 0.81are 25.6 0.64 0.81 1.02 0.64 1.02 29.8 29.8 ∧and ♯ ours Changes ne he preva ence of s Changes x ea ng behav nsdrinks he ours accord ence of s ax26.5 o27.3 age ng behav gender accord shown ng n oTab age ev and 22002 gender n Tab e 2 31.3 30.3 31.3 18.9 30.3 31.3 0.59 18.9 30.3 31.3 0.46 0.59 18.9 *** 30.3 0.76 0.46 0.59 18.9 *** 0.76 0.46 0.59 *** 0.76 0.46 are shown 0.76 15Changes years 15 years 15 28.3 years 15 28.3 years 28.3 Daily vegetables 33.8 28.5 17.3 *** 0.31 0.52 34.2 a1 soft apreva a28.3 26.1 23.9 1.11 0.86 1.44 13drinks years sweets sweets sweets 0.40 ∧ soft Daily drinks ♯ ♯sweets ♯ 19.9 14.2 0.47 *** 0.40 0.54 Girls 26.1 27.1 % % % OR % Tab preva ence of x22.0 ea behav nea Czech ch dren and ado escen s0.85 ♯ ng ♯ ∧ 21.0 ♯ 2002 Boys Boys 25.5 30.1 Boys 25.5 26.5 30.1 25.5 30.1 25.5 ** 26.5 0.67 21.0 ** 26.5 0.90 0.67 0.79 21.0 ** 0.90 0.67 0.79 ** 0.90 0.67 0.90 48.4 54.7 50.4 0.84 0.68 1.03 11nRes 54.8 ♯ 21.0 Boys 30.4 34.3 24.6 17.2 0.48 *** 0.41 0.55 26.4 15.5 26.4 13.2 15.5 0.52 13.2 *** 0.39 0.52 ***2014 0.69 0.39 0.69 years 11 years 22.5 22.5 2002 2006 2010 2002 2014 2006 2010 2014 v 2014 0.79 30.1 0.79 42.9 37.6 42.2 40.8 0.92 0.74 1.14 ∧ ∧ ∧ 11 years 11 20.7 30.7 11 20.7 years 21.4 30.7 20.7 22.4 21.4 30.7 20.7 1.11 22.4 21.4 30.7 0.85 1.11 22.4 21.4 0.85 1.11 22.4 1.44 1.11 1.44 0.85 ♯ In 2Daily J2002–2014 Env ronoDaily Pub Indrinks J cyears Env Hea ron hDaily 2015 Res Pub 12 c♯ ours Hea h26.8 2015 12 6 1.44 6 11 years 27.9 35.0 18.7 15.3 0.46 *** 0.35 0.61 1−6 C1.44 be ween Odd Ra ♯ ♯ ♯ 21.8 ♯ 18.9 40.8 40.6 40.8 34.1 40.6 0.64 34.1 0.52 0.6421.8 0.79 0.52 0.79 15 15 44.8 44.8 ∧ ∧ ∧ 13 13 27.4 28.3 13 27.4 27.9 28.3 27.9 27.4 0.74 21.8 **** 28.3 0.57 0.74 **** 0.95 0.57 0.95 0.74 0.57 0.95 95% 057 13 29.0 34.3 29.0 34.3 26.6 057 18.9 *** 0.44 *** 0.74 0.44 0.74 31.8 30.1 21.526.6 0.91 0.71 1.16 15 23.3 23.9 20.9 23.9 14.0 20.9 23.9 0.44 14.0 *** 20.9 23.9 0.34 0.44 14.0 ***27.9 20.9 0.58 0.34 0.44 14.0 *** 0.58 0.34 0.44 ***1.32 0.58 0.34 0.58 years 26.8 years 2 years 226.8 226.8 ∧ Reach the Lower Upper ∧ 31.3 30.3 31.3 18.9 30.3 31.3 0.59 18.9 30.3 31.3 0.46 0.59 18.9 30.3 0.76 0.46 0.59 18.9 0.76 0.46 0.59 **** 0.76 0.46 0.76 15 15 15 28.3 15 28.3 28.3 28.3 ∧ ∧ ♯ 33.8 28.5 33.8 17.3 28.5 33.8 0.40 17.3 28.5 33.8 0.31 0.40 17.3 28.5 0.52 0.31 0.40 17.3 *** 0.52 0.31 0.40 0.52 0.31 0.52 years years 34.2 years 34.2 years 34.2 34.2 15oVariables years 19.8 19.3 21.3 20.0 1.02 0.78 Daily sweets Daily sweets Daily sweets 45.2 47.1 45.2 41.8 47.1 0.74 41.8 0.66 0.74 0.83 0.66 0.83 Girls Girls 49.0 49.0 ∧ ∧ ∧ ∧ ♯ ♯ ♯ 0.83 ♯ 0.83 ♯of 24.9 29.9 Girls 24.9 28.2 29.9 24.9 21.5 28.2 29.9 24.9 0.83 21.5 28.2 29.9 0.72 21.5 28.2 0.95 0.72 21.5 0.95 0.72 0.83 0.95 0.72 0.95 19.9 14.2 0.47 *** 0.40 0.54 Girls 26.1 27.1 Boys 23.4 23.8 26.0 24.2 1.03 0.89 1.19 % % % OR % ♯ ♯ ♯ ♯ ♯ Tab e 2 Changes n Tab preva e 2 ence Changes of s x ea n preva ng behav ence ours s x n ea Czech ng behav ch dren ours and n ado Czech escen ch s dren and ado escen s 25.5 30.1 25.5 26.5 30.1 25.5 21.0 26.5 30.1 25.5 0.79 21.0 ** 26.5 30.1 0.67 0.79 21.0 ** 26.5 0.90 0.67 0.79 21.0 ** 0.90 0.67 0.79 ** 0.90 0.67 0.90 ♯ Boys Boys Boys 30.4 34.3 Boys 30.4 24.6 34.3 30.4 17.2 24.6 34.3 30.4 0.48 17.2 *** 24.6 34.3 0.41 0.48 17.2 *** 24.6 0.55 0.41 0.48 17.2 *** 0.55 0.41 0.48 *** 0.55 0.41 0.55 26.4 15.5 13.2 0.52 0.39 0.69 11 years 22.5 2002 2006 2010 2014 2002 2014 2006 v 2002 2010 2014 2014 v 2002 changes offound ♯ erns years 11 20.7 30.7 11 20.7 years 21.4 30.7 20.7 22.4 21.4 30.7 20.7 1.11 22.4 21.4 30.7 0.85 1.11 22.4 21.4 1.44 0.85 1.11 22.4 1.44 0.85 1.11 1.44 0.85 1.44 46.4 45.9 40.9 0.77 * 0.63 0.94 13 years 47.4 11 27.9 35.0 18.7 15.3 0.46 *** 0.35 0.61 years 29.1 31.1 29.1 23.2 31.1 15.3 23.2 0.44 15.3 *** 0.34 0.44 *** 0.57 0.34 0.57 spar es were found D spar n es were d e ary n pa changes by of gender d e ary and pa erns age over by gender he 12-year and age per over od he 12-year per od be weenD 2002–2014 95% C 95% C Odd Ra o o Odd Ra o o 36.5 40.0 32.8 0.78 0.63 0.98 years 38.3 ∧ ∧ ♯ ♯ ♯ 4 4 ^ ^ 13 13 years 13 27.4 28.3 13 27.4 years 27.9 28.3 27.4 21.8 27.9 28.3 27.4 0.74 21.8 * 27.9 28.3 0.57 0.74 21.8 * 27.9 0.95 0.57 0.74 21.8 * 0.95 0.57 0.74 * 0.95 0.57 0.95 years 29.0 34.3 26.6 18.9 057 *** 0.44 0.74 3 2 2 2 2 Reach he Var Upper 1 esweets ∧ ∧ ∧ 31.3 30.3 31.3 18.926.5 30.3 0.59 18.9 *** 31.3 0.46 0.59 30.3 0.76 0.46 18.9 0.76 0.59 *** *** 0.46 and0.90 0.76 15 years 15 years 28.3 28.3 years 28.3 vegetables vegetables ♯ 0.83 ♯Lower ♯ 0.83 33.8 28.5 33.8 17.3 28.5 0.40 17.3 *** 0.31 0.40 *** 0.52 0.31 0.52 15 years 34.2 34.2 fruit Girls 31.1 31.6 37.6 1.00 1.14 sweets Daily Daily sweets Daily sweets soft drinks ♯ ♯ ♯ 24.9 29.9 24.9 28.2 29.9 24.9 21.5 28.2 29.9 24.9 21.5 ** 28.2 29.9 0.72 0.83 21.5 ** 28.2 0.95 0.72 21.5 ** 0.95 0.72 0.83 ** 0.95 0.72 0.95 ∧ ♯ ♯ 19.9 14.2 19.9 0.47 14.2 *** 19.9 0.40 0.47 14.2 *** 19.9 0.54 0.40 0.47 14.2 *** 0.54 0.40 0.47 0.54 0.40 0.54 Girls Girls Girls 26.1 27.1 Girls 26.1 27.1 26.1 27.1 26.1 27.1 ♯ ng ♯ ♯ ng % % % % OR % % OR % % Tab e 2Daily Changes nab preva ence Tab 215 eaChanges behav n♯ ∧∧♯♯^preva ours n31.1 ence Czech sch x31.3 ea dren and behav ado ours escen n1.44 sCzech ch dren ado escen s Boys Boys 25.5 30.1 Boys 25.5 26.5 30.1 25.5 0.79 21.0 30.1 0.67 0.79 26.5 0.90 0.67 21.0 0.90 0.79 0.67 48.4 54.7 48.4 50.4 54.7 0.84 50.4 0.68 0.84 1.03 0.68 1.03 11 years 54.8 54.8 ♯of se x ♯ ♯ 21.0 ♯of 25.3 21.6 25.3 18.927.9 21.6 25.3 0.59 18.9 21.6 25.3 0.46 0.59 18.9 *** 21.6 0.75 0.46 0.59 18.9 *** 0.88 0.75 0.46 0.59 *** 0.75 0.46 95% C1.44 0.75 28.4 11 28.4 years 28.4 28.4 2002 2006 2010 2014 2014 v 2002 26.4 15.5 13.2 0.52 *** 0.39 0.69 112002–2014 years 22.5 11 years 28.5 25.9 29.4 28.7 1.01 0.79 1.29 20.7 30.7 20.7 21.4 30.7 20.7 22.4 21.4 30.7 20.7 1.11 22.4 21.4 30.7 0.85 1.11 22.4 21.4 0.85 1.11 22.4 0.85 1.11 **** 1.44 0.85 ∧ ∧ 0.74 11 years 11 years 11 27.9 years 35.0 11 27.9 years 18.7 35.0 27.9 15.3 18.7 35.0 27.9 0.46 15.3 18.7 35.0 0.35 0.46 *** 18.7 0.61 0.35 0.46 15.3 0.61 0.35 0.46 0.61 0.35 0.61 13 29.1 23.2 15.3 0.44 *** 0.34 0.57 28.3 C1.44 be ween be 2002–2014 Odd Ran oVar o13 Odd oence o26.8 ∧ ♯Ra 26.6 ♯ 18.9 ♯ 21.8 13 27.4 28.3 13 27.4 27.9 28.3 27.4 21.8 27.4 **** 27.9 28.3 0.57 0.74 21.8 **** 27.9 0.95 0.57 0.74 21.8 **** 0.95 0.57 0.74 0.95 0.57 0.95 40.8 40.6 34.1 0.64 0.52 0.79 15ab 44.8 ^ 95% 7e years 29.0 34.3 *** 0.44 0.74 23.9 20.9 23.9 14.0 20.9 0.44 14.0 0.34 0.44 *** 0.58 0.34 0.58 years years 26.8 Reach e ween Reach ab 25.3 29.6 25.6 0.81 0.64 1.02 29.8 Upper Lower Upper ∧ ∧ ∧ ∧ ∧ ∧ ♯ 057 ♯Lower 31.3 30.3 31.3 18.9 30.3 31.3 0.59 18.9 *** 30.3 31.3 0.46 0.59 18.9 30.3 0.76 0.46 0.59 18.9 0.76 0.46 0.59 *** 0.76 0.46 0.76 15 years 15 15 28.3 15 28.3 years 28.3 28.3 33.8 28.5 17.3 0.40 0.31 0.52 years 34.2 Changes he Changes ence of♯♯c she nxVar he ea preva ng ours sChanges accord x26.5 ea ng behav o2014 age ours accord gender ng are oshown age and** n gender Tab e 2are shown n Tab e 2 35.2 1.03 0.82 1.28 11drand years 33.9 43.1 34.6 ∧ ♯Age ♯of ♯ ng ♯ and Da y ohe nkpreva ♯ng Girls 24.9 29.9 Girls 24.9 28.2 29.9 21.5 28.2 24.9 0.83 21.5 29.9 0.83 28.2 0.95 0.72 21.5 0.95 0.83 0.72 0.95 ♯ behav ♯c ♯ 21.0 19.9 14.2 19.9 0.47 14.2 *** 0.40 0.47 *** 0.54 0.40 0.54 Girls Girls 26.1 27.1 26.1 27.1 23.4 23.8 23.4 26.0 23.8 24.2 26.0 1.03 24.2 0.89 1.03 1.19 0.89 1.19 ♯ ♯ ♯ ♯ ♯ 0.90 37.0 33.1 37.3 33.1 0.82 0.72 0.94 % % % OR % % % OR % % 3 2 Gender Age 3 Spec 2 Gender Changes and n Ea Spec Behav ours n Ea ng Behav ours Boys Boys 25.5 30.1 Boys 25.5 26.5 30.1 25.5 21.0 30.1 25.5 0.79 ** 26.5 30.1 0.67 0.79 21.0 ** 26.5 0.67 0.79 21.0 ** 0.90 0.67 0.79 0.90 0.67 0.90 25.3 21.6 25.3 18.9 21.6 25.3 0.59 18.9 21.6 25.3 0.46 0.59 18.9 21.6 0.75 0.46 0.59 18.9 0.75 0.46 0.59 0.75 0.46 0.75 28.4 28.4 28.4 28.4 ∧ ∧ Boys 30.4 34.3 24.6 17.2 0.48 *** 0.41 0.55 2002 2006 2010 2014 v 2002 ♯ 26.4 15.5 26.4 13.2 15.5 26.4 0.52 13.2 15.5 26.4 0.39 0.52 13.2 *** 15.5 0.69 0.39 0.52 13.2 *** 0.69 0.39 0.52 *** 0.69 0.39 0.69 11 years 11 years 11 22.5 years 11 22.5 years 22.5 22.5 20.7 30.7 20.7 21.4 30.7 22.4 21.4 20.7 1.11 22.4 30.7 0.85 1.11 21.4 1.44 0.85 22.4 1.44 1.11 0.85 1.44 46.4 45.9 46.4 40.9 45.9 0.77 40.9 * 0.63 0.77 * 0.94 0.63 0.94 13 years 13 47.4 47.4 ∧ 057 23.0 years 32.6 23.0 years 32.8 32.6 23.0 24.0 32.8 32.6 23.0 1.06 24.0 32.8 32.6 0.83 1.06 24.0 32.8 1.34 0.83 1.06 24.0 1.34 0.83 1.06 1.34 0.83 1.34 years 29.1 31.1 23.2 15.3 0.44 *** 0.34 0.57 95% C 26.1 27.3 23.9 0.86 22.0 be ween13 2002–2014 be ween 2002–2014 Odd Ra o o ♯ ♯ ♯ ♯ 13 13 27.4 28.3 13 27.4 27.9 28.3 27.4 21.8 27.9 28.3 27.4 0.74 21.8 * 27.9 28.3 0.57 0.74 21.8 * 27.9 0.95 0.57 0.74 21.8 * 0.95 0.57 0.74 * 0.95 0.57 0.95 ∧ 4 ^ ^ 7 years years 29.0 34.3 29.0 years 26.6 34.3 29.0 18.9 26.6 34.3 29.0 057 18.9 *** 26.6 34.3 0.44 18.9 *** 26.6 0.74 0.44 057 18.9 *** 0.74 0.44 057 *** 0.74 0.44 0.74 23.9 20.9 14.0 0.44 *** 0.34 0.58 15 years 26.8 2 2 sweets Reach ab esweets Reach he 28.5 Var ab♯ e17.3 Upper Lower 0.76 Upper ∧ *** 31.3 30.3 31.3 31.3 0.59 30.3 31.3 0.46 0.59 ***30.3 0.76 0.46 0.59 0.76 0.46 0.59 ***1.22 0.76 0.46 15 15 28.3 15 28.3∧ 28.3 28.3 ♯Lower vegetables 33.8 0.40 0.31 0.52 yearshe 34.2 32.8 29.6 0.98 0.78 13Var years 30.1 Daily Daily 33.5 45.2 47.1 41.830.3 0.74 0.66 0.83 Girls 49.0 ♯ ♯ ∧ ∧ ∧29.9 ∧0.95 Da y o dr 11 nkyears Da o dr34 nk ♯ ♯ 21.5 Girls Girls 24.9 29.9 Girls 24.9 28.2 29.9 24.9 28.2 29.9 24.9 **28.2 0.72 21.5 **28.2 0.72 0.83 21.5 ** 2014 0.95 0.72 0.83 ** 0.95 0.72 0.95 0.83 0.83 19.9 14.2 0.47 *** 0.40 0.54 Girls 26.1 27.1 % % % OR % ♯ ♯ ♯ 48 21.5 ♯ 2002 ♯ 25.3 21.6 25.3 18.9 21.6 0.59 18.9 25.3 0.46 0.59 21.6 0.75 0.46 18.9 0.75 0.59 *** 1.34 0.46 0.75 11 years 28.4 28.4 28.4 Boy 30 4y∧ 3years 24 622.5 17 223.2 00.46 *** 00.35 00.61 55 26.4 15.5 26.4 13.2 15.5 0.52 13.2 *** 0.39 0.52 *** 0.69 0.39 0.69 years 22.5 2002 2006 2010 2002 2014 2006 2010 2014 v41 2014 v 2002 28.5 25.9 28.5 29.4 25.9 28.7 29.4 1.01 28.7 0.79 1.01 1.29 0.79 1.29 0.44 42.9 37.6 42.2 40.8 0.92 0.74 1.14 11 20.7 30.7 11 20.7 years 21.4 30.7 20.7 22.4 21.4 30.7 20.7 1.11 22.4 21.4 30.7 0.85 1.11 22.4 21.4 1.44 0.85 1.11 22.4 1.44 0.85 1.11 1.44 0.85 1.44 ♯ ♯ ♯ ♯ 13 years 13ab years 13 23.0 years 32.6 13 23.0 32.8 32.6 23.0 24.0 32.8 32.6 23.0 1.06 24.0 32.8 32.6 0.83 1.06 24.0 32.8 0.83 1.06 24.0 1.34 0.83 1.06 0.83 1.34 11 years 27.9 35.0 18.7 15.3 ***23.2 0.74 28.3 29.1 31.1 29.1 23.2 31.1 29.1 31.1 29.1 0.44 15.3 31.1 0.34 15.3 *** 23.2 0.57 0.34 15.3 *** 0.57 0.34 0.44 *** 0.57 0.34 0.57 C1.34 Odd Ra oVar o15 ♯ ♯ ♯ 21.8 ♯ 21.8 27.4 28.3 27.9 28.3 27.4 **** 0.57 0.74 **** 27.9 0.95 0.57 0.95 0.74 0.57 0.95 40.8 40.6 40.8 34.1 40.6 0.64 34.1 0.52 0.6421.8 0.79 0.52 0.79 15 years 15 years 44.8 44.8 ∧ ∧ ∧ ∧ 95% 0.44 31.8 30.1 31.8 21.527.9 30.1 31.8 0.91 21.5 30.1 31.8 0.71 0.91 21.5 30.1 1.16 0.71 0.91 21.5 1.16 0.71 0.91 **** 1.16 0.71 1.16 23.3 23.3 23.3 23.3 227.4 23.9 20.9 14.0 0.44 *** 0.34 0.58 26.8 19.3 21.3 20.0 1.02 0.78 1.32 19.8 Reach e Lower Upper 31.3 30.3 31.3 18.9 30.3 31.3 0.59 18.9 30.3 31.3 0.46 0.59 18.9 30.3 0.76 0.46 0.59 18.9 0.76 0.46 0.59 0.76 0.46 0.76 15 years 15 28.3 years 15 28.3 years 28.3 28.3 ∧ ∧ ♯ 0.83 33.8 28.5 33.8 17.3 28.5 33.8 0.40 17.3 28.5 33.8 0.31 0.40 17.3 28.5 0.52 0.31 0.40 17.3 *** 0.52 0.31 0.40 0.52 0.31 0.52 years 34.2 34.2 34.2 34.2 15 28.5 28.0 36.2 29.2 1.03 0.82 1.30 Daily ∧ ∧ sweets ♯y∧ ♯preva ♯ ours ♯ ng Girls Girls 24.9 29.9 Girls 24.9 28.2 29.9 24.9 28.2 29.9 24.9 21.5 ** 28.2 29.9 0.72 0.83 21.5 ** 28.2 0.95 0.72 0.83 21.5 ** 0.95 0.72 0.83 ** 0.95 0.72 0.95 Da y ohe dryears nkChanges Da o dr nk ♯ 21.5 19.9 14.2 0.47 *** 0.40 0.54 Girls 26.1 27.1 23.4 23.8 26.0 24.2 1.03 0.89 1.19 % % % OR % Boys Boys 25.5 30.1 25.5 26.5 30.1 21.0 26.5 0.79 21.0 ** 0.67 0.79 ** 0.90 0.67 0.90 48.4 54.7 50.4 0.84 0.68 1.03 11 years 54.8 Tab e 2 n Tab preva e 2 ence Changes of s x ea n ng behav ence of s x n ea Czech behav ch dren ours and n ado Czech escen ch s dren and ado escen per s od ∧ ∧ ∧ ∧ 25.3 21.6 25.3 18.9 21.6 25.3 0.59 18.9 21.6 25.3 0.46 0.59 18.9 *** 21.6 0.75 0.46 0.59 18.9 0.75 0.46 0.59 *** 0.75 0.46 0.75 11 years 28.4 11 28.4 years 28.4 28.4 ♯ ♯ Boy Boy 30 4 34 3 24 6 30 4 17 2 34 3 0 48 *** 24 6 0 41 17 2 0 55 0 48 *** 0 41 0 55 26.4 15.5 13.2 0.52 0.39 0.69 11 years 22.5 2002 2006 2010 2014 2002 2014 2006 v35 2002 2010 2014 2014 vover 2002 he ∧ ♯ n erns ♯Ra ♯offound ♯ 21.8 ♯of ∧ ∧ ∧ 23.0 32.6 23.0 32.8 32.6 24.0 32.8 23.0 1.06 24.0 32.6 0.83 1.06 32.8 1.34 0.83 24.0 1.34 1.06 0.83 1.34 11 yea 27 9 35 0 18 7 15 3 0 46 *** 0 0 61 29.1 31.1 29.1 23.2 31.1 15.3 23.2 0.44 15.3 *** 0.34 0.44 *** 0.57 0.34 0.57 D spar es were found D spar n changes es were d e ary pa changes by gender d e ary and pa erns age over by gender he 12-year and age per od 12-year 26.1 27.3 26.1 23.9 27.3 1.11 23.9 0.86 1.11 1.44 0.86 1.44 years years 22.0 22.0 95% C 95% C Odd Ra o o Odd o o ♯ ♯ ♯ 36.5 40.0 32.8 0.78 0.63 0.98 years 38.3 13 13 13 27.4 28.3 13 27.4 years 27.9 28.3 27.4 27.9 28.3 27.4 0.74 21.8 * 27.9 28.3 0.57 0.74 21.8 * 27.9 0.95 0.57 0.74 21.8 * 0.95 0.57 0.74 * 0.95 0.57 0.95 4 4 31.8 30.1 31.8 21.5 30.1 31.8 0.91 21.5 30.1 31.8 0.71 0.91 21.5 30.1 1.16 0.71 0.91 21.5 1.16 0.71 0.91 1.16 0.71 1.16 15 15 years 15 23.3 years 15 23.3 23.3 23.3 ∧ ∧ 5 29.0 34.3 26.6 18.9 057 *** 0.44 0.74 3 Daily 3 Daily 323.9 323.9 14.020.9 20.9 23.9 0.44 14.0 *** 20.9 23.9 0.34 0.44 14.0 *** 20.9 0.58 0.34 0.4421.5 14.0 *** 0.58 0.34 0.44 *** 0.58 0.34 0.58 26.8 26.8 26.8 26.8 2 ab Reach he Var e Lower Upper 31.3 30.3 31.3 30.3 0.59 18.9 31.3 0.46 0.59 30.3 0.76 0.46 18.9 0.76 0.59 0.46 0.76 years 28.3 28.3 years 28.3 ∧ ∧ ∧ ∧ vegetables vegetables ♯ ♯ ♯ ♯ fruit fruit fruit Daily fruit 31.6 37.6 31.3 1.00 0.88 1.14 Girls 31.1 Daily breakfast (weekday) Daily sweets ♯ ♯ ♯ ♯ ∧ ∧ Girls Girls 24.9 29.9 Girls 24.9 28.2 29.9 24.9 21.5 28.2 29.9 24.9 0.83 21.5 ** 28.2 29.9 0.72 0.83 21.5 ** 28.2 0.95 0.72 0.83 ** 0.95 0.72 0.83 ** 0.95 0.72 0.95 Da y o dr nk ∧ ∧ ♯ ♯ 0 19.9 14.2 19.9 0.47 14.2 *** 19.9 0.40 0.47 14.2 ***21.6 19.9 0.54 0.40 0.47 14.2 *** 0.54 0.40 0.47 *** 1.44 0.54 0.40 0.54 Girls 26.1 27.1 26.1 27.1 26.1 26.1 27.1 ♯ 4822.4 ♯ ♯ % 27.1 % % % OR % % OR % % Boys 25.5 30.1 26.5 21.0 0.79 ** 0.67 0.90 25.3 21.6 25.3 18.9 21.6 25.3 0.59 18.9 21.6 25.3 0.46 0.59 18.9 0.75 0.46 0.59 18.9 0.75 0.46 0.59 0.75 0.46 0.75 11 years 11 28.4 years 11 28.4 years 28.4 28.4 Boy 30 4 34 Boy 3 24 6 17 2 30 4 *** 34 0 3 41 24 0 6 55 17 2 0 48 *** 0 41 0 55 26.4 15.5 13.2 0.52 0.39 0.69 11 years 22.5 28.5 25.9 29.4 28.7 1.01 0.79 1.29 11 years 11 years 20.7 30.7 20.7 21.4 30.7 21.4 1.11 22.4 0.85 1.11 1.44 0.85 46.4 45.9 40.9 0.77 * 0.63 0.94 13 47.4 ∧ ∧ ♯ ♯ ♯ years 13 13 23.0 32.6 13 23.0 years 32.8 32.6 23.0 24.0 32.8 32.6 23.0 1.06 24.0 32.8 32.6 0.83 1.06 24.0 32.8 1.34 0.83 1.06 24.0 1.34 0.83 1.06 1.34 0.83 1.34 11 yea 27 yea 35 18 27 9^∧ 15 35 000.59 *** 18 7 0.71 00.46 35 15 330.1 00.76 61 01.02 4618.9 00.46 35 *** 1.32 00.76 61 29.1 15.3 0.44 *** 1.16 0.34 0.57 ♯Ra 26 31.1 C1.16 C1.16 Odd Ra oVar o15 Odd oence o26726.8 ♯ ween ♯ 18 ♯ 14.0 be ween be 2002–2014 ∧ ^46 ^ 95% 31.8 30.1 31.8 21.5 30.1 0.91 21.5 31.8 0.91 0.71 21.5 0.91 23.3 23.3 23.3 3he 3 15 3he 323.9 13 yea 09of 34 30ab 93x28.2 *** 02 44 0Upper 74 20.9 23.9 20.9 0.44 14.0 *** 0.34 0.44 *** 0.58 0.34 0.58 years years 2 2002–2014 229 226.8 19.3 21.3 19.3 20.0 21.3 1.02 20.0 0.78 1.32 0.78 19.8 19.8 Reach esweets Reach 25.3 29.6 25.6 0.81 0.64 29.8 Lower Lower Upper 31.3 30.3 31.3 18.9 30.3 31.3 18.9 ***23.2 30.3 31.3 0.59 18.9 30.3 0.46 0.76 0.59 0.46 0.76 15 years 28.3 15 28.3 years 28.3 28.3 ∧ ∧ ∧ Changes nBoys preva Changes ence shenxVar ea preva ng behav s accord ea ng behav o∧∧60 age ours accord gender ng are oshown age and** n gender Tab e 295% are shown n Tab e 2 33.8 28.5 17.3 0.40 0.31 0.52 34.2 ♯sweets fruit fruit fruit fruit 0.59 58.0 51 7ours 57 6♯ 057 11.02 08 01.19 95 1 1.19 220.71 Daily Daily Daily Daily ♯ e ♯of ♯ ng ♯ and ∧ Girls Girls 24.9 29.9 Girls 24.9 28.2 29.9 21.5 24.9 0.83 ** 29.9 0.72 0.83 ** 28.2 0.95 0.72 21.5 0.95 0.83 ** 0.72 0.95 Da y sweets ohe dr nkab ♯sweets ♯ ♯ 21.0 ♯ 21.5 23.4 23.8 23.4 26.0 23.8 24.2 26.0 1.03 24.2 0.89 1.03 0.89 33.9 43.1 35.2 0.82 1.28 11 years 34.6 ♯ % % % OR % % % OR % % Boys Boys 37.0 33.1 Boys 37.0 37.3 33.1 37.0 33.1 37.3 33.1 37.0 0.82 33.1 37.3 33.1 0.72 0.82 33.1 ** 37.3 0.94 0.72 0.82 33.1 ** 0.94 0.72 0.82 0.94 0.72 0.94 Boys 25.5 30.1 26.5 0.79 ** 0.67 0.90 25.3 21.6 25.3 18.9 21.6 25.3 0.59 18.9 21.6 25.3 0.46 0.59 18.9 *** 21.6 0.75 0.46 0.59 18.9 *** 0.75 0.46 0.59 *** 0.75 0.46 0.75 11 years 11 28.4 years 11 28.4 28.4 28.4 Boy 30 4 34 3years 24 622.5 17 232.8 000.52 48 *** 000.34 41 000.57 26.4 15.5 26.4 13.2 15.5 26.4 13.2 15.5 26.4 0.39 0.52 13.2 15.5 0.69 0.39 0.52 13.2 0.69 0.39 0.69 11 years 22.5 22.5 22.5 ∧ 32.6 11 years 20.7 30.7 21.4 22.4 1.11 0.85 1.44 ∧ ♯ ♯ ♯ 15.3 ♯ 21.8 13 13 23.0 32.6 13 23.0 years 32.8 32.6 23.0 24.0 23.0 1.06 24.0 32.8 1.06 24.0 0.83 1.06 24.0 0.83 1.06 1.34 0.83 1.34 0.74 11 yea 27 35 11 18 15 27 9 46 ***26 35 35 18 755 61 15 3 1.34 00.52 00.39 35 00.69 61 13 years 29.1 31.1 23.2 0.44 26.1 27.3 23.9 1.11 0.86 1.44 years years 27.4 27.4 28.3 27.9 21.8 * 932.8 0.57 0.74 **** 0.95 0.57 0.95 40.8 40.6 34.1 0.64 0.52 0.79 15 44.8 ∧18 ∧32.6 ∧1.34 31.8 30.1 31.8 21.5 30.1 31.8 0.91 21.5 30.1 31.8 0.71 0.91 21.5 30.1 1.16 0.71 0.91 21.5 1.16 0.71 0.91 1.16 0.71 1.16 years 15ab 15 23.3 15 23.3 years 23.3 23.3 3 13 3 13 328.3 e 40 13 yea yea 092y∧ 34 380yea 26 65726.8 29 0 93327.9 34 3057 *** 6 0.83 08 44 18 0Upper 74 057 *** 00.83 4446 *** 05274 23.9 20.9 14.0 0.44 0.34 0.58 229 222.0 sweets ∧ Reach he Var esweets Reach he Var Lower Lower Upper ∧ ♯ab 33 28 17 0 *** 0 31 0 52 15 yea 34 Daily fruit fruit Daily fruit 31.6 37.6 31.6 31.3 37.6 1.00 31.3 0.88 1.00 1.14 0.88 1.14 Girls Girls 31.1 31.1 55 8 67 1 20 0 96 1 11 years 63 7 Daily Daily 68 2 ♯ ♯ ♯ 45.2 47.1 41.8 0.74 0.66 0.83 Girls 49.0 ∧ 24.9 29.9 Girls 24.9 28.2 29.9 24.9 21.5 28.2 29.9 24.9 0.83 21.5 ** 28.2 29.9 0.72 0.83 21.5 ** 28.2 0.95 0.72 0.83 21.5 ** 0.95 0.72 ** 0.95 0.72 0.95 ∧ ∧ ∧ ∧ Da y o dr nk Da o dr nk ♯ ♯ 19.9 14.2 0.47 ***32.8 0.40 0.54 26.1 27.1 ♯ 0.79 21.0 30.1 48 21.0 30.1 21.0 0.90 0.79 1.29 37.0 33.1 37.0 37.3 33.1 37.0 33.1 37.3 33.1 37.0 0.82 33.1 37.3 33.1 0.72 0.82 33.1 37.3 0.94 0.72 0.82 33.1 0.94 0.72 0.82 0.94 0.72 0.94 ♯ Boys Boys Boys 25.5 30.1 Boys 25.5 26.5 30.1 25.5 26.5 25.5 ** 26.5 0.67 0.79 ** 26.5 0.67 21.0 ** 0.90 0.67 0.79 ** 0.90 0.67 0.90 25.3 21.6 25.3 18.9 21.6 0.59 18.9 25.3 0.46 0.59 *** 21.6 0.75 0.46 18.9 0.75 0.59 *** 0.46 0.75 11 years 11 28.4 11 28.4 years 28.4 Boy 30 4 34 3 24 6 17 2 0 *** 0 41 0 55 28.5 25.9 28.5 29.4 25.9 28.7 29.4 1.01 28.7 0.79 1.01 0.79 1.29 2002 2006 2010 2002 2014 2006 2010 2014 v 2002 2014 2014 v 2002 32.8 33.5 29.6 0.98 0.78 1.22 13 years 30.1 11 11 42.9 years 37.6 11 42.9 years 42.2 37.6 42.9 40.8 42.2 37.6 42.9 0.92 40.8 42.2 37.6 0.74 0.92 40.8 42.2 1.14 0.74 0.92 40.8 1.14 0.74 0.92 1.14 0.74 1.14 ♯ ♯ ♯ ♯ 11 years 20.7 30.7 21.4 22.4 1.11 0.85 1.44 13 13 23.0 32.6 13 23.0 32.8 32.6 23.0 24.0 32.8 32.6 23.0 1.06 24.0 32.6 0.83 1.06 24.0 32.8 1.34 0.83 1.06 24.0 1.34 0.83 1.06 1.34 0.83 1.34 ∧ yea 27 35 0yea 18 15 00.91 4615.3 ***27.9 00.34 35 00.57 61 ∧ 0.44 34 13 years 29.1 31.1 23.2 29.1 15.3 31.1 29.1 23.2 31.1 15.3 *** 23.2 0.34 0.44 15.3 0.57 0.34 0.44 *** 1.16 0.57 0.34 0.57 ♯ ♯ 18 years 27.4 28.3 0.74 **** 0.57 0.95 4 31.8 30.1 31.8 21.5 30.1 31.8 21.5 30.1 31.8 0.71 0.91 21.5 30.1 0.71 0.91 21.5 0.71 0.91 0.71 1.16 15 15 23.3 15 23.3 years 23.3 23.3 ^ 21.8 3 15 331.1 13 yea 29 092 ∧ 34 13 657nk 93323.2 29 0 *** 03 30.44 44 26 0626 74 9 11.16 057 *** 0 44 0 74 229.1 23.9 20.9 0.44 *** 0.34 0.58 15 years 26.8 19.3 21.3 20.0 1.02 0.78 1.32 19.8 31.3 30.3 31.3 18.9 30.3 0.59 18.9 *** 0.46 *** 0.76 years 15 28.3 ∧ Daily ∧ ∧ ∧ ♯fruit ♯ 14.0 33 28 17 33 000.59 40 *** 28 5Czech 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3494 ∧ fruit 3 15 45.2 47.1 0.74 0.66 0.83 Girls 49.0 133 years 82 9♯19 4∧ 86 88 11.29 01.19 ∧ ∧ ∧ ∧83 ∧ ∧ ∧ ∧ G yea 24years 29 9yea 2619.8 245 0001.01 29 0001 72 00029918 95 52 ∧ ** 1 1.29 72 95 ♯fruit 86 ♯fruit28 ♯ 21 ♯ 50.4 Boys Boys 23.4 23.8 Boys 23.4 26.0 23.8 23.4 24.2 26.0 23.4 1.03 24.2 26.0 23.8 0.89 1.03 24.2 26.0 1.19 0.89 1.03 24.2 0.89 1.03 1.19 0.89 1.19 19 928.5 14** 221 19 0 405922 14*** 0 87 54 47 0 85 40 0 44 54 G G 263 1 27 26 Boys 37.0 33.1 37.3 33.1 0.82 0.72 0.94 48.4 54.7 48.4 54.7 0.84 50.4 0.68 0.84 1.03 0.68 1.03 11 years years 11 years 54.8 54.8 ∧ ∧ ∧23.8 ∧27 ∧4740.8 ∧1.29 25 3 21 18 09429.4 25 59 *** 6 00.79 46 18**** 928 75 *** 0011.01 4683 06175 yeafruit 28 yea 28 ♯0 ♯31 06 ♯70 11 years 11 years 28.5 25.9 11 28.5 years 29.4 25.9 28.5 28.7 25.9 28.7 29.4 25.9 1.01 28.7 29.4 0.79 1.01 28.7 0.79 11 years 42.9 37.6 42.2 0.92 0.74 1.14 yea 20 74 30 78years yea 21 4138.3 22 20 71 11 30 85 21 434 44 4 11 *** 00.79 11.29 13 years 23 04 32 6 32 8 24 83 1 26.1 27.3 26.1 23.9 27.3 1.11 23.9 26.1 0.86 1.11 27.3 1.44 0.86 23.9 1.44 1.11 0.86 1.44 13 22.0 13 22.0 22.0 36.5 40.0 36.5 32.8 40.0 0.78 32.8 0.63 0.78 0.98 0.63 0.98 years 38.3 28.0 36.2 29.2 1.03 0.82 1.30 15 28.5 40.8 40.6 40.8 34.1 40.6 40.8 0.64 34.1 *** 40.6 40.8 0.52 0.64 34.1 *** 40.6 0.79 0.52 0.64 34.1 *** 0.79 0.52 0.64 *** 0.79 0.52 0.79 15 15 44.8 15 44.8 44.8 44.8 4 4 13 yea 13 27 yea 4 28 3 27 9 27 4 21 8 28 3 0 74 * 27 9 57 21 8 0 95 0 74 * 0 57 0 95 31 30 5 91 0 71 1 16 23 3 ∧ ∧ ∧ ∧ ∧ ∧ ∧ ∧ ^ 19.3 21.3 19.3 20.0 21.3 19.3 1.02 20.0 21.3 19.3 0.78 1.02 20.0 21.3 1.32 0.78 1.02 20.0 1.32 0.78 1.02 1.32 0.78 1.32 19.8 19.8 19.8 19.8 25.3 29.6 25.3 25.6 29.6 25.3 0.81 25.6 29.6 25.3 0.64 0.81 25.6 29.6 1.02 0.64 0.81 25.6 1.02 0.64 0.81 1.02 0.64 1.02 15 years 15 years 15 29.8 years 15 29.8 years 29.8 29.8 ∧ ∧ ∧41.8 ∧ ∧31.3 ∧ ∧ ∧ Daily Daily vegetables Daily vegetables 31 3 3081 354.8 18 5937.3 01.03 59 ***37.3 02 46 0 03 76 yeavegetables 28 39 31.6 37.6 31.6 31.3 37.6 31.6 1.00 37.6 31.6 0.88 1.00 31.3 37.6 1.14 0.88 1.00 31.3 1.14 0.88 1.00 1.14 0.88 1.14 Girls Girls 31.1 Girls 31.1 31.1 31.1 15 years 80 8 9 80 1 81 1 0 79 1 33 45.2 47.1 0.74 *** 0.66 0.83 Girls 49.0 Da y wee Da y wee ∧ ∧ ∧ ∧83 ∧ ∧ 33.1 ∧ ∧ G 24 29 9 28 2 21 0 0 72 0 95 ♯ ♯ ♯ ♯ 23.4 23.8 23.4 26.0 23.8 23.4 24.2 26.0 23.8 23.4 24.2 26.0 23.8 0.89 1.03 24.2 26.0 1.19 0.89 1.03 24.2 1.19 0.89 1.03 1.19 0.89 1.19 ♯ ♯ Boys Boys Boys 37.0 33.1 Boys 37.0 37.3 33.1 37.0 33.1 33.1 37.0 0.82 33.1 ** 33.1 0.72 0.82 ** 37.3 0.94 0.72 0.82 33.1 ** 0.94 0.72 0.82 ** 0.94 0.72 0.94 48.4 54.7 50.4 0.84 0.68 1.03 11 years ∧ ∧ 40.8 ∧46.4 ∧59 ∧25 ∧5228.7 ∧1.29 ∧1.29 25 3 21 6 18 9 0 *** 0 46 21 0 6 75 18 9 59 46 75 yea 28 4 28 4 ♯4 0 ♯61 28.7 ♯1 11 28.5 25.9 11 28.5 years 29.4 25.9 28.5 28.7 29.4 25.9 28.5 1.01 29.4 25.9 0.79 1.01 29.4 0.79 1.01 28.7 0.79 1.01 1.29 0.79 1.29 ♯3 26 15 5 13 2 26 4 0 *** 15 5 0 39 13 2 0 69 0 52 *** 0 39 0 69 yea 22 yea 5 22 5 11 years 42.9 37.6 42.2 0.92 0.74 1.14 46.4 45.9 40.9 45.9 0.77 40.9 * 0.63 0.77 * 0.94 0.63 0.94 13 years 13 years 47.4 47.4 yea 23 yea 0 32 6 32 8 23 24 0 32 06 32 8 0 83 24 0 1 34 06 0 83 1 34 26.1 27.3 26.1 23.9 27.3 26.1 1.11 23.9 27.3 26.1 0.86 1.11 23.9 27.3 1.44 0.86 1.11 23.9 1.44 0.86 1.11 1.44 0.86 1.44 13 years 13 years 13 22.0 years 13 22.0 years 22.0 22.0 36.5 40.0 32.8 0.78 * 0.63 0.98 38.3 4 4 4 27 28 33 27 91328 27 4 74 ****29.6 31.00 57 00.83 916 95 8 **** 1.14 00.66 57 00.83 95 ∧ ∧ ∧21 ∧25.3 ∧25.6 ∧28 ∧1 ∧1.02 31 8yea 30 91 71 15 23 19.3 21.3 19.3 20.0 21.3 1.02 20.0 19.3 0.78 1.02 21.3 1.32 0.78 20.0 1.32 1.02 0.78 1.32 years 19.8 15 19.8 years 19.8 25.3 29.6 0.81 25.6 0.64 0.81 0.64 1.02 15 years years 29.8 29.8 ∧ ∧ ∧ ∧ ∧ Daily Daily vegetables Daily Daily 3 0 31 3031.6 18 589543.1 31 3001.00 59 30 3 00.88 46 18*** 927 5921 *** 001.00 4674 0 76 15 yea 15 28 34394 ∧ ∧ ∧ ∧ ∧ Dayea y vegetables ru ♯ ♯ ♯ ♯ 31.6 37.6 31.3 37.6 37.6 37.6 0.88 1.00 31.3 0.88 0.88 1.14 Girls Girls Girls 31.1 Girls 31.1 31.1 31.1 45.2 47.1 45.2 41.8 47.1 45.2 0.74 41.8 47.1 45.2 0.66 0.74 41.8 47.1 0.74 41.8 0.66 0.74 0.83 49.0 49.0 49.0 49.0 ∧∧ ∧ ∧31.6 ∧83 ∧31.6 ∧ 31.3 ∧1.14 ∧1.14 G 24yea 29 28 2647.4 ** 000 72 000576 95 ♯vegetables ♯vegetables ♯ 21 ♯ 31.3 ´´ Boys Boys 23.4 23.8 Boys 23.4 26.0 23.8 24.2 26.0 23.4 24.2 23.8 0.89 26.0 24.2 0.89 ♯ 33.9 43.1 33.9 35.2 33.9 35.2 43.1 33.9 0.82 35.2 43.1 1.28 0.82 1.03 35.2 1.28 0.82 1.28 0.82 1.28 11 years years 34.6 years 11 34.6 years 34.6 34.6 48.4 54.7 50.4 0.84 0.68 1.03 54.8 ∧ ∧ ∧37.6 ∧59 ∧30 ∧7940.8 ∧1.19 ∧1.19 25 21 18 923 01.03 *** 46 75 yea 28 40 o Boy Boy 25639years 5 30 1per 26 5222.0 25 5 0329.4 1001.03 ** 26 000.66 67 21 030da 000.83 90 0011.03 79 ** 0o83 67 00 34 90 ♯0 21 ♯6 ♯ 1.01 28.5 25.9 28.5 29.4 25.9 28.5 28.7 29.4 25.9 28.5 1.01 28.7 25.9 0.79 1.01 28.7 29.4 1.29 0.79 28.7 1.29 1.01 1.29 0.79 1.29 ♯1 11 years 11 years 11 42.9 years 37.6 11 42.9 years 42.2 37.6 42.9 40.8 42.2 42.9 0.92 40.8 42.2 37.6 0.74 0.92 42.2 1.14 0.74 0.92 40.8 1.14 0.74 0.92 1.14 0.74 1.14 No es %11 percen 11 age ado32 escen s who ormed he ea ng behav our a0.89 eas y00.79 OR da y 11.19 46.4 45.9 40.9 0.77 **** 0.63 0.94 yea 23 32 8 0 23 1 0 06 32 0 83 32 1 8 34 24 06 0 24 26.1 27.3 26.1 23.9 27.3 26.1 1.11 23.9 27.3 26.1 0.86 1.11 23.9 27.3 1.44 0.86 1.11 23.9 1.44 0.86 1.11 1.44 0.86 1.44 13 years 13 years 13 22.0 years 13 22.0 22.0 yea 29 yea 1 31 29 1 15 31 1 44 *** 23 2 34 15 57 44 *** 34 57 36.5 40.0 32.8 0.78 * 0.63 0.98 38.3 40.8 40.6 40.8 34.1 40.6 0.64 34.1 0.52 0.64 0.79 0.52 0.79 15 15 44.8 44.8 ∧ ∧ ∧ ∧ ∧ ∧ 31 8 30 1 21 5 31 8 0 91 30 1 0 71 21 5 1 16 0 91 71 1 16 yea 23 yea 3 23 3 19.3 21.3 19.3 20.0 21.3 19.3 1.02 20.0 21.3 19.3 0.78 1.02 20.0 21.3 1.32 0.78 1.02 20.0 1.32 0.78 1.02 1.32 0.78 1.32 15 years 15 years 19.8 15 19.8 years 19.8 19.8 25.3 29.6 25.6 0.81 0.64 1.02 15 years 29.8 ∧ ∧ ∧ ∧ ∧ ∧ ∧1.14 ∧ 31 3yea 3023.8 18 51943.1 59 ***28 31 0 31.03 46 30 0394 76 18*** 9 *** 1.19 0 46 0 76 28 28 3 ∧ ∧ ∧83 ∧ 21 ♯ ♯ ♯ 21 ♯ 24.2 Dayea y ru 31.6 37.6 31.6 31.3 37.6 1.00 31.3 31.6 0.88 1.00 37.6 0.88 31.3 1.14 1.00 0.88 1.14 Girls 31.1 Girls 31.1 31.1 45.2 47.1 45.2 41.8 47.1 0.74 41.8 *** 0.66 0.74 0.83 0.66 0.83 Girls Girls 49.0 49.0 ∧ ∧ ∧ ∧23.8 ∧ ∧1.19 ♯ ♯ ♯ G G30.1 24behav 29 28 2330.1 24 9 2930.1 90001.03 2LR 543.1 95 01.03 8324.2 **OR 001.03 7259 ra 0 95 Boys Boys Boys 23.4 23.8 Boys 23.4 26.0 23.4 24.2 26.0 23.4 26.0 0.89 26.0 0.89 0.89 0.89 ∧ ∧ ♯ ♯ ♯ 33.9 43.1 33.9 35.2 33.9 35.2 43.1 33.9 0.82 1.28 35.2 1.28 0.82 1.28 11 years 11 years 11 34.6 years 11 34.6 years 34.6 34.6 Boy 37 03409 33 37 33 82 ** 00.63 72 00.94 ♯ 48.4 54.7 48.4 50.4 54.7 48.4 0.84 50.4 54.7 48.4 0.68 0.84 50.4 54.7 1.03 0.68 0.84 50.4 1.03 0.68 0.84 1.03 0.68 1.03 54.8 54.8 54.8 54.8 ∧ ∧ ∧23.8 ∧ ∧ 24.2 ∧1.19 25 39years 21 18 59 46 75 yea 28 28.5 25.9 28.5 29.4 25.9 28.7 28.5 1.01 28.7 25.9 0.79 1.01 29.4 1.29 0.79 28.7 1.29 1.01 0.79 1.29 consump on or each our og s c32 regress on929.4 En er me hod 2014 vs odds o1.28 re erence 111.19 ♯7 ♯1 ∧ ♯71 ♯ 2002 ∧1 32.8 33.5 32.8 29.6 33.5 32.8 0.98 29.6 33.5 32.8 0.78 0.98 29.6 33.5 1.22 0.78 0.98 29.6 1.22 0.78 0.98 1.22 0.78 1.22 30.1 46.4 45.9 40.9 0.77 47.4 yea 23 32 61 836122.0 06 83 11 yeavegetables 11 20 yea 30 20 30 1135.2 00.82 85 22 11 000.82 85 26.1 27.3 26.1 23.9 27.3 26.1 1.11 23.9 26.1 23.9 27.3 0.86 1.11 23.9 1.44 0.86 0.86 1.44 13 years 13 years 13 22.0 years 13 22.0 ∧ 36.5 40.0 36.5 32.8 40.0 36.5 0.78 32.8 ***** 40.0 36.5 0.63 0.78 32.8 ****21 40.0 0.98 0.63 0.78 32.8 0.98 0.63 0.78 0.98 0.63 0.98 38.3 38.3 38.3 38.3 40.8 40.6 34.1 0.64 0.52 0.79 44.8 4 ∧ ∧ ∧ ∧24 ∧ ∧22 ∧ ∧1 ∧ 31 8yea 30 21 0521 91 31 000.86 71 30 11.44 16 21**** 91 **** 1.44 71 16 yea 23 34y 23 0 19.3 21.3 19.3 20.0 21.3 19.3 1.02 20.0 21.3 19.3 0.78 1.02 20.0 21.3 1.32 0.78 1.02 20.0 1.32 0.78 1.02 1.32 0.78 1.32 years 15 19.8 years 15 19.8 years 19.8 19.8 23 9 20 9422.0 14 0427.3 23 99801.11 44 20 94134 0 34 21 14 045 0 44 58 011.11 44 34 00 44 58 yea 26 87 26 8739 25.3 29.6 25.6 0.81 0.64 1.02 15 29.8 Daily Daily ∧ ∧ ∧ ∧ ∧ ∧ ♯ ♯ ♯ Dayears y ru s 15 Da ru 95% 31.6 37.6 31.6 31.3 37.6 1.00 37.6 0.88 1.00 37.6 0.88 1.00 31.3 0.88 1.00 1.14 0.88 1.14 Girls Girls Girls 31.1 Girls 31.1 31.1 31.1 45.2 47.1 41.8 0.74 *** 0.66 0.83 49.0 ∧ ∧ ∧31.6 ∧83 ∧31.6 ∧ 31.3 ∧1.14 ∧1.14 ♯vegetables ♯ ♯erva ♯ 31.3 G 24 9 29 G 9 28 2 21 5 24 0 29 28 2 95 5 0 83 ** 0 72 95 33.9 43.1 33.9 35.2 43.1 1.03 35.2 33.9 0.82 1.03 43.1 1.28 0.82 35.2 1.28 1.03 0.82 1.28 11 years 11 years 34.6 11 34.6 years 34.6 ♯ ♯ ♯ ♯ Boy 37 0 33 1 37 3 33 1 82 ** 0 72 0 94 48.4 54.7 48.4 50.4 54.7 0.84 50.4 0.68 0.84 1.03 0.68 1.03 years 54.8 54.8 ∧ ∧ ∧ ∧ ∧ ∧ group a cohor o 2002 C confidence n * p < 0 05 ** p < 0 01 *** p < 0 001 Age d erence—bo d ♯ ♯ ♯ 25 3 21 6 18 9 25 3 0 59 *** 21 6 46 18 9 75 0 59 *** 0 46 0 75 yea 28 yea 4 28 4 11 28.5 25.9 28.5 29.4 25.9 28.5 28.7 29.4 25.9 28.5 1.01 28.7 29.4 25.9 0.79 1.01 28.7 29.4 1.29 0.79 1.01 28.7 1.29 0.79 1.01 1.29 0.79 1.29 32.8 33.5 32.8 29.6 33.5 32.8 0.98 29.6 33.5 32.8 0.78 0.98 29.6 33.5 1.22 0.78 0.98 29.6 1.22 0.78 0.98 1.22 0.78 1.22 13 years 13 years 13 30.1 years 13 30.1 years 30.1 30.1 11 years 42 930 37 42 40 92 74 14 46.4 45.9 46.4 40.9 45.9 46.4 0.77 40.9 **** 46.4 0.63 0.77 40.9 45.9 0.94 0.77 40.9 *8 0.63 0.77 0.94 47.4 47.4 47.4 yea 23 32 68yea 32 82147.4 24 11.11 06 000.86 83 11.44 26.1 27.3 26.1 23.9 27.3 23.9 26.1 27.3 0.86 23.9 0.86 1.44 22.0 22.0 28.0 36.2 28.0 29.2 36.2 28.0 1.03 29.2 36.2 28.0 0.82 1.03 29.2 36.2 1.30 0.82 1.03 29.2 1.30 0.82 1.03 1.30 0.82 1.30 28.5 28.5 28.5 28.5 4 40.8 40.6 34.1 0.64 0.52 0.79 44.8 ∧ ∧ ∧ ∧19.3 ∧21 ∧ ∧ ∧1.44 31 30 21 08527 71 16 yea 23 13 yea 13 27 4 28 3 922.0 27 4 845.9 301.11 7420.0 ** 27 934 00.63 57 21 00.94 95 01.11 74 ** 1.14 00.63 57 00.94 95 1.02 19.3 21.3 19.3 21.3 1.02 21.3 19.3 0.78 1.02 21.3 1.32 0.78 20.0 1.32 0.78 1.02 1.32 0.78 1.32 15 15 years 15 19.8 years 15 19.8 years 19.8 19.8 25.3 29.6 25.3 25.6 29.6 25.3 0.81 25.6 29.6 25.3 0.64 0.81 25.6 29.6 1.02 0.64 0.81 25.6 1.02 0.64 0.81 1.02 0.64 1.02 29.8 29.8 29.8 29.8 ∧ ∧ ∧28 ∧1 Daily 0 ∧ ∧ ∧ ∧91 ∧ ∧ ♯vegetables ♯ ru ♯ 20.0 ♯ 20.0 31.6 37.6 31.6 31.3 37.6 31.6 1.00 31.3 37.6 31.6 0.88 1.00 31.3 37.6 1.14 0.88 1.00 31.3 1.14 0.88 1.00 0.88 1.14 Girls Girls 31.1 Girls 31.1 31.1 31.1 Da y ru 45.2 47.1 41.8 0.74 *** 0.66 0.83 Girls 49.0 Da y wee Da y wee ∧ ∧ ∧ ∧ ∧ ∧ Boys Boys 23.4 23.8 23.4 26.0 23.8 24.2 26.0 24.2 0.89 1.19 0.89 1.19 ♯ ♯ ♯ ♯ 33.9 43.1 33.9 35.2 43.1 33.9 1.03 35.2 43.1 33.9 0.82 1.03 35.2 43.1 1.28 0.82 1.03 35.2 1.28 0.82 1.03 1.28 0.82 1.28 11 years 11 years 11 34.6 years 11 34.6 years 34.6 34.6 Boy Boy 37be 0940 33 1years 37 3 37 33 18927.3 1101.11 82 ** 37 3 00.86 0 72 33 121 0survey 94 00.84 8223.9 ** 00.63 7259 00.94 94 48.4 54.7 50.4 0.68 1.03 54.8 s gn fican d erence ween 11 and 15 year o d boys and g r s year a p < 0 05 Gender ∧ ∧ ∧33 ∧59 ∧25 ∧ each ∧1.22 ∧1.22 ♯ 0 ♯6 ♯3or ♯1 25 3 21 6 18 *** 46 6 75 18 9 0 *** 0 46 0 75 28 yea 28 4 32.8 33.5 32.8 29.6 33.5 0.98 29.6 32.8 0.78 0.98 33.5 0.78 29.6 0.98 0.78 1.22 30.1 30.1 30.1 11 yea 42 37 42 2 40 92 74 14 46.4 45.9 46.4 40.9 45.9 0.77 40.9 * 0.63 0.77 * 0.94 47.4 47.4 23 yea 32 6 32 8 23 0 24 0 32 06 32 8 83 24 0 1 34 06 0 83 1 34 26.1 27.3 26.1 23.9 26.1 23.9 27.3 26.1 1.11 23.9 27.3 1.44 0.86 1.11 1.44 0.86 1.11 1.44 0.86 1.44 13 years 13 years 13 22.0 years 13 22.0 22.0 22.0 28.0 36.2 28.0 29.2 36.2 28.0 1.03 29.2 36.2 28.0 0.82 1.03 29.2 36.2 1.30 0.82 1.03 29.2 1.30 0.82 1.03 1.30 0.82 1.30 15 28.5 28.5 28.5 36 58yea 40 0128.5 32 78 **** 63 00.79 98 38 3 40.8 40.6 40.8 40.6 40.6 0.52 0.64 34.1 *** 40.6 0.52 0.64 34.1 0.79 0.52 0.64 *** 0.79 0.52 0.79 44.8 44.8 44.8 44.8 4 ∧ ∧ ∧34.1 ∧40.8 ∧34.1 ∧40.8 ∧1 ∧1.32 31 30 21 5837.6 00.64 91 00.88 71 23 19.3 21.3 19.3 20.0 21.3 1.02 20.0 19.3 0.78 1.02 21.3 1.32 0.78 20.0 1.02 0.78 1.32 15 years 15 years 19.8 15 19.8 years 19.8 1.00 ^9p Daily ∧ ∧ ∧31.6 ∧ ∧ ∧5931.3 ∧1.14 31 3 30 328 18 943.1 31 301.00 ***43.1 30 316 0 46 18*** 0 1.6) were found in Denmark, England, Norway, Ukraine, USA, Wales and Scotland [29]. A significant increase in vegetable consumption was found in Spain, Denmark, Hungary, England, Wales, Greece and Austria (OR > 1.6) [29]. More frequent consumption of fruit and vegetables in these countries could be explained by many factors such as the implementation of nation-wide policies, programmes and government strategies to improve the eating habits of young people as well as cultural differences and socioeconomic factors. For example, in 2007, the Norwegian government implemented the nation-wide free school fruit scheme in all secondary elementary schools (grades 8–10) and all combined schools (grades 1–10) in order to improve fruit and vegetable intake [48–50]. The evaluation of this programme showed long-term effects of the free school fruit programme that resulted in a great increase in students’ intake from 2001 to 2008 [48]. In addition, several countries such as the USA, Great Britain, Sweden and New Zealand have implemented breakfast clubs at school where free breakfast is provided in the morning prior to classes [51–54]. Regular participation in breakfast clubs was associated with improved school attendance, academic performance and diet quality (especially in families with low socioeconomic status) [51–54]. Scotland is another example of a country that implemented initiatives to establish lifelong healthy eating habits of their children. The Scottish Government developed new nutritional requirements for school meals and drinks via the Schools (Health Promotion and Nutrition) Act 2007 and in 2010 also introduced Curriculum for Excellence that included health and wellbeing and programmes such as free fruit initiatives and breakfast clubs [33]. Such as nation-wide initiatives and school-based interventions have been proven to have an important impact on eating habits of children via increasing the children’s and parents’ knowledge of the recommendations for fruit and vegetable intake [36,48,49,55]. Unfortunately, the Czech Republic has not implemented many nation-wide policies or guidelines regarding nutritional requirements for schools encouraging healthy eating habits of children that can be carried into adult life. However, some attempts to increase the knowledge of healthy eating have already been administered which might have contributed to improvement of some eating behaviours (Table 2). One of the most recent efforts of the Czech Ministry of Health is an adjustment of the Educational Act that regulates sales of unhealthy food and drinks in school vending machines and cafeterias [56]. This Act became effective in September 2015, however, the specific information on the “banned” food and drinks have not been published yet. Therefore, the significant improvement in percentage of daily consumers of soft drinks and sweets between 2002 and 2014 could be explained by promotional strategies of various non-government agencies and nutrition organizations that use marketing through social media (TV, newspaper, internet, Facebook, etc.) to affect school management [57–59]. Currently, it is within the competence of school principals to decide what food/drinks will be offered in vending machines or cafeterias. Another current effort of the Czech government is a school-based trial programme announced by the Ministry of Education, Youth and Sports in March 2013 [60]. This trial programme is targeted to make changes in current primary school curriculum in areas of physical activity and nutrition. The trial is currently being tested in several pilot schools and involves primary schools (grades 1–5), teachers and parents’ involvement. Monitoring trends of eating habits in Czech children and adolescents could be important tool for developing and optimizing such initiatives. As shown in Table 2, the fluctuation could be observed in some of the eating behaviours (fruit and vegetables) over time. Between 2002 and 2006, percentage of daily fruit (vegetable) consumers
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decreased (did not changed, respectively) which was followed by an increase in 2010 and another decrease in 2014. These inconsistent trends in fruit and vegetable consumptions could be explained by the implementation of a “free fruit (renamed to free fruit and vegetable) at school programme” which is a nation-wide programme supported by European Union [61]. Students attending the participating primary schools (grades 1–5) are entitled to receive a free piece of fruit or vegetable while at school. This programme is to increase awareness of the importance of eating fruit and vegetables and to encourage better eating practices. Currently, more that 85% of Czech primary schools are participating in the project [61]. In the Czech Republic, the programme became effective in autumn 2009 which might be, together with more vigorous enforcement by the school staff at the early stages, the result of improvement in fruit and vegetable consumption in 2010. The downward trend observed in the following years might be due to the lower reinforcement of the programme as well as a low budget allocation per child per year (currently 333 Czech crowns) that does not cover the cost of providing a piece of fruit or vegetable every school day as in some other countries [48,62]. Czech students are entitled to receive free fruit or vegetables a minimum of twice per month and it is unclear whether this frequency will be enough to establish long-term positive changes in food habits. Also, according to yearly evaluations of the programme, fruit and vegetable provision was the most common during breaks between classes and the least common during the class that could result in inadequate motivation of children to consume provided fruit and vegetables [61]. 5. Strengths and Limitations The strengths of the present study are its use of a representative sample for the Czech Republic, including different age groups and genders, and using a standardized research protocol of a large cross-national study which data could be used for comparison with other countries in Europe and North America. However, there are some limitations that need to be considered. First, the use of a self-reported questionnaire could be a source for recall and social desirability bias, errors in self-observation and bias in trends due to on-going initiatives. Despite the potential for errors, the HBSC food frequency questionnaire (FFQ) has shown high test-retest reliability and validity compared to 24 h food behavior checklist (FBC) and a 7-day food diaries (FD) [63] as well as good to moderate agreement (percent agreement 0.70–0.87, kappa 0.43–0.65) between frequency and 7 times a 24-h recall measures for breakfast [64]. Fair agreement (percent agreement 0.53–0.84, kappa 0.26–0.54) was documented for lunch meal and different results were found for evening meal (high percent agreement 0.83–0.95 but poor kappa 0.14–0.19) [64]. Second, only frequencies of intakes were used to describe the eating behaviours. This data did not provide information on portion sizes, amounts of food consumed and whether children met the dietary recommendations. A 24-h recall food behaviour checklist might be the better way to collect this information [42]. Third, the data collected could be affected by seasonal bias. In the Czech Republic, the lowest likelihood of fruit consumption was indicated during the spring months [47,65], compared with October and December [47,65]. The lowest likelihood of soft drink intake was in January to February (compared with May to June). Since our survey was administered in the spring (April-June), the frequencies of fruit and vegetables could be underestimated. Fourth, the questionnaire related problems could be a source of another potential error [66]. Due to the limited space in the questionnaire, the food items (e.g., fruit, vegetables, sweetened soft drinks, breakfast, etc.) were not defined and could be misinterpreted. Last, but not least, the data was not adjusted for parental socio-economic status. Family affluence scale (FAS) that has been used to identify socioeconomic inequalities in adolescents in the HBSC studies was calculated in different way (questionnaire items) in 2002, 2006, 2010 and 2014. Therefore, it is difficult to analyze trends in the same dietary habits in view of different kind of calculated FAS scale. However, there is the lack of studies addressing this issue in the Czech Republic and future research should focus on describing current adolescent eating habits controlled for socio-economic status.
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6. Conclusions In summary, this study provides an insight into the current food consumption habits of Czech children and adolescents and describes the changes of these behaviours from 2002 to 2014. An improvement was found in consumptions of daily soft drinks and sweets for all ages and both genders (except 13-year old girls). However, fewer children reported eating fruit every day and there was almost no change in vegetable intake over time. Moreover, daily breakfast consumption on weekdays increased among all children (except 15-year old boys) but a significant change was reported only among girls and 13-year-old boys. In 2014, fewer boys but more girls reported eating breakfast on weekends compared to 2002. These findings indicate the need for a re-evaluation of current national policies, initiatives and nutritional requirements and regulations in schools along with health promotion strategies to improve diet of children at home-based and community settings. Future research should continue monitoring trends in the Czech Republic to further evaluate effectiveness of on-going changes in national policies and other intervention programmes. In addition, it would be useful to investigate dietary intakes including amounts of food items and the frequencies of consumptions. Acknowledgments: This study was supported by the research grant of Czech Science Foundation “Trends in overweight and obesity, physical activity and sedentary behaviour among Czech schoolchildren: HBSC study between 2002 and 2014”, reg. No. GA14-02804S. Author Contributions: Jaroslava Voráˇcová and Erik Sigmund designed and drafted the manuscript with input from Dagmar Sigmundová and Michal Kalman. Michal Kalman was responsible for data collection and Dagmar Sigmundová analyzed the data. All authors approved the final version. Conflicts of Interest: The authors declare no conflict of interest.
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