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Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Study protocol

Active Living: development and quasi-experimental evaluation of a school-centered physical activity intervention for primary school children

Authors: Dave H. H. Van Kann, M. W. J. Jansen, S. I. de Vries, N. K. de Vries, S. P. J. Kremers

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

The worldwide increase in the rates of childhood overweight and physical inactivity requires successful prevention and intervention programs for children. The aim of the Active Living project is to increase physical activity and decrease sedentary behavior of Dutch primary school children by developing and implementing tailored, multicomponent interventions at and around schools.

Methods/design

In this project, school-centered interventions have been developed at 10 schools in the south of the Netherlands, using a combined top-down and bottom-up approach in which a research unit and a practice unit continuously interact. The interventions consist of a combination of physical and social interventions tailored to local needs of intervention schools. The process and short- and long-term effectiveness of the interventions will be evaluated using a quasi-experimental study design in which 10 intervention schools are matched with 10 control schools. Baseline and follow-up measurements (after 12 and 24 months) have been conducted in grades 6 and 7 and included accelerometry, GPS, and questionnaires. Primary outcome of the Active Living study is the change in physical activity levels, i.e. sedentary behavior (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and counts-per-minute (CPM). Multilevel regression analyses will be used to assess the effectiveness of isolated and combined physical and social interventions on children’s PA levels.

Discussion

The current intervention study is unique in its combined approach of physical and social environmental PA interventions both at school(yard)s as well as in the local neighborhood around the schools. The strength of the study lies in the quasi-experimental design including objective measurement techniques, i.e. accelerometry and GPS, combined with more subjective techniques, i.e. questionnaires, implementation logbooks, and neighborhood observations.

Trial registration

Current Controlled Trials ISRCTN25497687 (registration date 21/10/2015), METC 12-4-077, Project number 200130003
Literature
1.
go back to reference Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385(9986):2510–20.PubMedPubMedCentralCrossRef Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385(9986):2510–20.PubMedPubMedCentralCrossRef
2.
go back to reference Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4–85.PubMedCrossRef Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4–85.PubMedCrossRef
3.
go back to reference Schönbeck Y, Talma H, van Dommelen P, Bakker B, Buitendijk SE, HiraSing RA, et al. Increase in Prevalence of Overweight in Dutch Children and Adolescents: A Comparison of Nationwide Growth Studies in 1980, 1997 and 2009. PLoS ONE. 2011;6(11):e27608.PubMedPubMedCentralCrossRef Schönbeck Y, Talma H, van Dommelen P, Bakker B, Buitendijk SE, HiraSing RA, et al. Increase in Prevalence of Overweight in Dutch Children and Adolescents: A Comparison of Nationwide Growth Studies in 1980, 1997 and 2009. PLoS ONE. 2011;6(11):e27608.PubMedPubMedCentralCrossRef
4.
go back to reference Brennan LK, Brownson RC, Orleans CT. Childhood Obesity Policy Research and Practice: Evidence for Policy and Environmental Strategies. Am J Prev Med. 2014;46(1):e1–e16.PubMedCrossRef Brennan LK, Brownson RC, Orleans CT. Childhood Obesity Policy Research and Practice: Evidence for Policy and Environmental Strategies. Am J Prev Med. 2014;46(1):e1–e16.PubMedCrossRef
5.
go back to reference Ahrens W, Pigeot I, Pohlabeln H, De Henauw S, Lissner L, Molnar D, et al. Prevalence of overweight and obesity in European children below the age of 10. Int J Obes. 2014;38(S2):S99–S107.CrossRef Ahrens W, Pigeot I, Pohlabeln H, De Henauw S, Lissner L, Molnar D, et al. Prevalence of overweight and obesity in European children below the age of 10. Int J Obes. 2014;38(S2):S99–S107.CrossRef
6.
go back to reference Parsons TJ, Power C, Logan S, Summerbell CD. Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord. 1999;23(S8):S1–107.PubMed Parsons TJ, Power C, Logan S, Summerbell CD. Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord. 1999;23(S8):S1–107.PubMed
7.
go back to reference Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88.PubMedCrossRef Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88.PubMedCrossRef
8.
go back to reference Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.PubMedCrossRef Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.PubMedCrossRef
9.
go back to reference Mitchell JA, Pate RR, Beets MW, Nader PR. Time spent in sedentary behavior and changes in childhood BMI: a longitudinal study from ages 9 to 15 years. Int J Obes. 2013;37(1):54–60.CrossRef Mitchell JA, Pate RR, Beets MW, Nader PR. Time spent in sedentary behavior and changes in childhood BMI: a longitudinal study from ages 9 to 15 years. Int J Obes. 2013;37(1):54–60.CrossRef
10.
go back to reference Pearson N, Braithwaite RE, Biddle SJH, van Sluijs EMF, Atkin AJ. Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis. Obes Rev. 2014;15(8):666–75.PubMedPubMedCentralCrossRef Pearson N, Braithwaite RE, Biddle SJH, van Sluijs EMF, Atkin AJ. Associations between sedentary behaviour and physical activity in children and adolescents: a meta-analysis. Obes Rev. 2014;15(8):666–75.PubMedPubMedCentralCrossRef
11.
go back to reference Saunders TJ, Chaput J-P, Tremblay MS. Sedentary Behaviour as an Emerging Risk Factor for Cardiometabolic Diseases in Children and Youth. Can J Diabetes. 2014;38(1):53–61.PubMedCrossRef Saunders TJ, Chaput J-P, Tremblay MS. Sedentary Behaviour as an Emerging Risk Factor for Cardiometabolic Diseases in Children and Youth. Can J Diabetes. 2014;38(1):53–61.PubMedCrossRef
12.
go back to reference Andersen L, Harro M, Sardinha L, Froberg K, Ekelund U, Brage S, et al. Physical activity and clustered cardiovascular risk in children: A cross-sectional study (The European Youth Heart Study). Lancet. 2006;368:299–304.PubMedCrossRef Andersen L, Harro M, Sardinha L, Froberg K, Ekelund U, Brage S, et al. Physical activity and clustered cardiovascular risk in children: A cross-sectional study (The European Youth Heart Study). Lancet. 2006;368:299–304.PubMedCrossRef
13.
go back to reference Biddle SJH, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci. 2004;22(8):679–701.PubMedCrossRef Biddle SJH, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci. 2004;22(8):679–701.PubMedCrossRef
14.
go back to reference Fedewa AL, Ahn S. The Effects of Physical Activity and Physical Fitness on Children’s Achievement and Cognitive Outcomes. Res Quart Exerc Sport. 2011;82(3):521–35.CrossRef Fedewa AL, Ahn S. The Effects of Physical Activity and Physical Fitness on Children’s Achievement and Cognitive Outcomes. Res Quart Exerc Sport. 2011;82(3):521–35.CrossRef
15.
go back to reference Panter J, Jones A, van Sluijs E. Environmental determinants of active travel in youth: A review and framework for future research. Int J Behav Nutr Phys Act. 2008;5(1):34.PubMedPubMedCentralCrossRef Panter J, Jones A, van Sluijs E. Environmental determinants of active travel in youth: A review and framework for future research. Int J Behav Nutr Phys Act. 2008;5(1):34.PubMedPubMedCentralCrossRef
16.
go back to reference Hume C, Timperio A, Salmon J, Carver A, Giles-Corti B, Crawford D. Walking and Cycling to School: Predictors of Increases Among Children and Adolescents. Am J Prev Med. 2009;36(3):195–200.PubMedCrossRef Hume C, Timperio A, Salmon J, Carver A, Giles-Corti B, Crawford D. Walking and Cycling to School: Predictors of Increases Among Children and Adolescents. Am J Prev Med. 2009;36(3):195–200.PubMedCrossRef
17.
go back to reference Rush E, Simmons D. Physical Activity in Children: Prevention of Obesity and Type 2 Diabetes. In: Goedecke JH, Ojuka EO, editors. Diabetes and Physical Activity. Volume 60. Basel: Med Sport Sci, Karger; 2014. p. 113–21. Rush E, Simmons D. Physical Activity in Children: Prevention of Obesity and Type 2 Diabetes. In: Goedecke JH, Ojuka EO, editors. Diabetes and Physical Activity. Volume 60. Basel: Med Sport Sci, Karger; 2014. p. 113–21.
18.
go back to reference Dobbins M, Husson H, DeCorby K, LaRocca R. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2. Dobbins M, Husson H, DeCorby K, LaRocca R. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2.
19.
go back to reference Kriemler S, Meyer U, Martin E, van Sluijs E, Andersen L, Martin B. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45:923–30.PubMedCrossRef Kriemler S, Meyer U, Martin E, van Sluijs E, Andersen L, Martin B. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45:923–30.PubMedCrossRef
20.
go back to reference Story M, Nanney M, Schwartz M. Schools and obesity prevention: creating school environments and policies to promote healthy eating and physical activity. Milbank Q. 2009;87:71–100.PubMedPubMedCentralCrossRef Story M, Nanney M, Schwartz M. Schools and obesity prevention: creating school environments and policies to promote healthy eating and physical activity. Milbank Q. 2009;87:71–100.PubMedPubMedCentralCrossRef
21.
go back to reference Koplan JP, Liverman CT, Kraak VI. Preventing childhood obesity: Health in the balance: Executive summary. J Am Diet Assoc. 2005;105(1):131–8.PubMedCrossRef Koplan JP, Liverman CT, Kraak VI. Preventing childhood obesity: Health in the balance: Executive summary. J Am Diet Assoc. 2005;105(1):131–8.PubMedCrossRef
22.
go back to reference Pate RR, Davis MG, Robinson TN, Stone EJ, McKenzie TL, Young JC. Promoting Physical Activity in Children and Youth: A Leadership Role for Schools: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in Collaboration With the Councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation. 2006;114(11):1214–24.PubMedCrossRef Pate RR, Davis MG, Robinson TN, Stone EJ, McKenzie TL, Young JC. Promoting Physical Activity in Children and Youth: A Leadership Role for Schools: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in Collaboration With the Councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation. 2006;114(11):1214–24.PubMedCrossRef
23.
go back to reference Broekhuizen K, Scholten A-M, de Vries S. The value of (pre)school playgrounds for children’s physical activity level: a systematic review. Int J Behav Nutr Phys Act. 2014;11(1):59.PubMedPubMedCentralCrossRef Broekhuizen K, Scholten A-M, de Vries S. The value of (pre)school playgrounds for children’s physical activity level: a systematic review. Int J Behav Nutr Phys Act. 2014;11(1):59.PubMedPubMedCentralCrossRef
24.
go back to reference Escalante Y, García-Hermoso A, Backx K, Saavedra JM. Playground Designs to Increase Physical Activity Levels During School Recess: A Systematic Review. Health Educ Behav. 2014;41(2):138–44.PubMedCrossRef Escalante Y, García-Hermoso A, Backx K, Saavedra JM. Playground Designs to Increase Physical Activity Levels During School Recess: A Systematic Review. Health Educ Behav. 2014;41(2):138–44.PubMedCrossRef
25.
go back to reference Ridgers N, Salmon J, Parrish A, Stanley R, Okely A. Physical activity during school recess: a systematic review. Am J Prev Med. 2012;43(3):320–8.PubMedCrossRef Ridgers N, Salmon J, Parrish A, Stanley R, Okely A. Physical activity during school recess: a systematic review. Am J Prev Med. 2012;43(3):320–8.PubMedCrossRef
26.
go back to reference Parrish A, Okely A, Stanley R, Ridgers N. The effect of school recess interventions on physical activity: a systematic review. Sports Med. 2013;43:287–99.PubMedCrossRef Parrish A, Okely A, Stanley R, Ridgers N. The effect of school recess interventions on physical activity: a systematic review. Sports Med. 2013;43:287–99.PubMedCrossRef
27.
go back to reference Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An Ecological Approach to Creating Active Living Communities. Annu Rev Public Health. 2006;27:297–322.PubMedCrossRef Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An Ecological Approach to Creating Active Living Communities. Annu Rev Public Health. 2006;27:297–322.PubMedCrossRef
28.
go back to reference Gubbels J, Van Kann D, de Vries N, Thijs C, Kremers S. The next step in health behavior research: the need for ecological moderation analyses - an application to diet and physical activity at childcare. Int J Behav Nutr Phys Act. 2014;11(1):52.PubMedPubMedCentralCrossRef Gubbels J, Van Kann D, de Vries N, Thijs C, Kremers S. The next step in health behavior research: the need for ecological moderation analyses - an application to diet and physical activity at childcare. Int J Behav Nutr Phys Act. 2014;11(1):52.PubMedPubMedCentralCrossRef
29.
go back to reference Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999;29(6 Pt 1):563–70.PubMedCrossRef Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999;29(6 Pt 1):563–70.PubMedCrossRef
30.
go back to reference Knol F. Statusontwikkeling van wijken in Nederland 1998–2010 [Status development of neighborhoods in the Netherlands 1998–2010]. The Hague: The Netherlands Institute for Social Research (SCP); 2012. Knol F. Statusontwikkeling van wijken in Nederland 1998–2010 [Status development of neighborhoods in the Netherlands 1998–2010]. The Hague: The Netherlands Institute for Social Research (SCP); 2012.
31.
go back to reference De Vries SI, Chorus AMJ. Bewegen in Nederland: jeugdigen van 4–17 jaar (Physical activity in the Netherlands: youngsters aged 4–17 years). In: Hildebrandt VH, Chorus AMJ, Stubbe JH, editors. TNO Trendrapport Bewegen en Gezondheid. Leiden: De Bink; 2010. p. 57–76. De Vries SI, Chorus AMJ. Bewegen in Nederland: jeugdigen van 4–17 jaar (Physical activity in the Netherlands: youngsters aged 4–17 years). In: Hildebrandt VH, Chorus AMJ, Stubbe JH, editors. TNO Trendrapport Bewegen en Gezondheid. Leiden: De Bink; 2010. p. 57–76.
32.
go back to reference Ooijendijk W, Wendel-Vos W, de Vries S. Consensus Vragenlijsten Sport en Bewegen [Consensus Questionnaires on Sports and Physical Activity]. Leiden: TNO; 2007. Ooijendijk W, Wendel-Vos W, de Vries S. Consensus Vragenlijsten Sport en Bewegen [Consensus Questionnaires on Sports and Physical Activity]. Leiden: TNO; 2007.
33.
go back to reference Timperio A, Crawford D, Telford A, Salmon J. Perceptions about the local neighborhood and walking and cycling among children. Prev Med. 2004;38(1):39–47.PubMedCrossRef Timperio A, Crawford D, Telford A, Salmon J. Perceptions about the local neighborhood and walking and cycling among children. Prev Med. 2004;38(1):39–47.PubMedCrossRef
34.
go back to reference Rodenburg G, Oenema A, Pasma M, Kremers SPJ, van de Mheen D. Clustering of food and activity preferences in primary school children. Appetite. 2013;60:123–32.PubMedCrossRef Rodenburg G, Oenema A, Pasma M, Kremers SPJ, van de Mheen D. Clustering of food and activity preferences in primary school children. Appetite. 2013;60:123–32.PubMedCrossRef
35.
go back to reference Sleddens EF, Kremers SP, de Vries NK, Thijs C. Measuring child temperament: Validation of a 3-item Temperament Measure and 13-item Impulsivity Scale. Eur J Develop Psych. 2013;10(3):392–401.CrossRef Sleddens EF, Kremers SP, de Vries NK, Thijs C. Measuring child temperament: Validation of a 3-item Temperament Measure and 13-item Impulsivity Scale. Eur J Develop Psych. 2013;10(3):392–401.CrossRef
36.
go back to reference Timperio A, Ball K, Salmon J, Roberts R, Giles-Corti B, Simmons D, et al. Personal, family, social, and environmental correlates of active commuting to school. Am J Prev Med. 2006;30(1):45–51.PubMedCrossRef Timperio A, Ball K, Salmon J, Roberts R, Giles-Corti B, Simmons D, et al. Personal, family, social, and environmental correlates of active commuting to school. Am J Prev Med. 2006;30(1):45–51.PubMedCrossRef
37.
go back to reference Davison KK, Li K, Baskin ML, Cox T, Affuso O. Measuring parental support for children’s physical activity in white and African American parents: The Activity Support Scale for Multiple Groups (ACTS-MG). Prev Med. 2011;52(1):39–43.PubMedPubMedCentralCrossRef Davison KK, Li K, Baskin ML, Cox T, Affuso O. Measuring parental support for children’s physical activity in white and African American parents: The Activity Support Scale for Multiple Groups (ACTS-MG). Prev Med. 2011;52(1):39–43.PubMedPubMedCentralCrossRef
38.
go back to reference De Vries SI, Hopman-Rock M, Bakker I, Hirasing RA, Van Mechelen W. Built Environmental Correlates of Walking and Cycling in Dutch Urban Children: Results from the SPACE Study. Int J Environ Res Public Health. 2010;7(5):2309–24.PubMedPubMedCentralCrossRef De Vries SI, Hopman-Rock M, Bakker I, Hirasing RA, Van Mechelen W. Built Environmental Correlates of Walking and Cycling in Dutch Urban Children: Results from the SPACE Study. Int J Environ Res Public Health. 2010;7(5):2309–24.PubMedPubMedCentralCrossRef
39.
go back to reference Saelens B, Sallis J, Frank L. Environmental correlates of walking and cycling: Findings from the transportation, urban design, and planning literatures. Ann Behav Med. 2003;25(2):80–91.PubMedCrossRef Saelens B, Sallis J, Frank L. Environmental correlates of walking and cycling: Findings from the transportation, urban design, and planning literatures. Ann Behav Med. 2003;25(2):80–91.PubMedCrossRef
40.
go back to reference Centraal Bureau voor de Statistiek (CBS). Statline: Nabijheid voorzieningen; afstand locatie, wijk- en buurtcijfers 2013. Voorburg/Heerlen: CBS; 2014. Centraal Bureau voor de Statistiek (CBS). Statline: Nabijheid voorzieningen; afstand locatie, wijk- en buurtcijfers 2013. Voorburg/Heerlen: CBS; 2014.
41.
go back to reference Evenson K, Catellier D, Gill K, Ondrak K, McMurray R. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26(14):1557–65.PubMedCrossRef Evenson K, Catellier D, Gill K, Ondrak K, McMurray R. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26(14):1557–65.PubMedCrossRef
42.
go back to reference Dessing D, Pierik F, Sterkenburg R, van D, Maas J, De Vries S. Schoolyard physical activity of 6–11 year old children assessed by GPS and accelerometry. Int J Behav Nutr Phys Act. 2013;10:97.PubMedPubMedCentralCrossRef Dessing D, Pierik F, Sterkenburg R, van D, Maas J, De Vries S. Schoolyard physical activity of 6–11 year old children assessed by GPS and accelerometry. Int J Behav Nutr Phys Act. 2013;10:97.PubMedPubMedCentralCrossRef
43.
go back to reference Klinker C, Schipperijn J, Christian H, Kerr J, Ersboll A, Troelsen J. Using accelerometers and global positioning system devices to assess gender and age differences in children’s school, transport, leisure and home based physical activity. Int J Behav Nutr Phys Act. 2014;11(1):8.PubMedPubMedCentralCrossRef Klinker C, Schipperijn J, Christian H, Kerr J, Ersboll A, Troelsen J. Using accelerometers and global positioning system devices to assess gender and age differences in children’s school, transport, leisure and home based physical activity. Int J Behav Nutr Phys Act. 2014;11(1):8.PubMedPubMedCentralCrossRef
44.
go back to reference Klinker CD, Schipperijn J, Kerr J, Ersbøll AK, Troelsen J. Context-specific outdoor time and physical activity among school-children across gender and age: Using accelerometers and GPS to advance methods. Front Public Health. 2014;2:20.PubMedPubMedCentralCrossRef Klinker CD, Schipperijn J, Kerr J, Ersbøll AK, Troelsen J. Context-specific outdoor time and physical activity among school-children across gender and age: Using accelerometers and GPS to advance methods. Front Public Health. 2014;2:20.PubMedPubMedCentralCrossRef
45.
go back to reference McKenzie T, Marshall S, Sallis J, Conway T. Leisure-time physical activity in school environments: an observational study using SOPLAY. Prev Med. 2000;30:70–7.PubMedCrossRef McKenzie T, Marshall S, Sallis J, Conway T. Leisure-time physical activity in school environments: an observational study using SOPLAY. Prev Med. 2000;30:70–7.PubMedCrossRef
46.
go back to reference McIver KL, Brown WH, Pfeiffer KA, Dowda M, Pate RR. Assessing Children’s Physical Activity in Their Homes: The Observational System for Recording Physical Activity in Children-Home. J Appl Behav Anal. 2009;42(1):1–16.PubMedPubMedCentralCrossRef McIver KL, Brown WH, Pfeiffer KA, Dowda M, Pate RR. Assessing Children’s Physical Activity in Their Homes: The Observational System for Recording Physical Activity in Children-Home. J Appl Behav Anal. 2009;42(1):1–16.PubMedPubMedCentralCrossRef
Metadata
Title
Active Living: development and quasi-experimental evaluation of a school-centered physical activity intervention for primary school children
Authors
Dave H. H. Van Kann
M. W. J. Jansen
S. I. de Vries
N. K. de Vries
S. P. J. Kremers
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2633-1

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