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Open Access Debate

The next step in health behavior research: the need for ecological moderation analyses - an application to diet and physical activity at childcare

Jessica S Gubbels12, Dave HH Van Kann134, Nanne K de Vries124, Carel Thijs45 and Stef PJ Kremers12*

Author Affiliations

1 Department of Health Promotion, Maastricht University, PO Box 616, Maastricht, MD, 6200, the Netherlands

2 NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University, PO Box 616, Maastricht, MD, 6200, the Netherlands

3 Academic Collaborative Centre for Public Health Limburg, Regional Public Health Service, PO Box 2022, Geleen, HA, 6160, the Netherlands

4 Caphri, School of Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD, 6200, the Netherlands

5 Department of Epidemiology, Maastricht University, PO Box 616, Maastricht, MD, 6200, the Netherlands

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:52  doi:10.1186/1479-5868-11-52

Published: 17 April 2014



The ecological perspective holds that human behavior depends on the interaction of different environmental factors and personal characteristics, but it lacks validation and operationalization. In the current paper, an ecological view was adopted to examine the interactive impact of several ecological systems on children’s dietary intake and physical activity at childcare or similar facilities. The ecological view was operationalized into three types of interaction: 1) interaction between types of childcare environment (physical, social, political, economic); 2) interaction between micro-systems (the childcare and home environment) in meso-systems; and 3) interaction between childcare environment and child characteristics. The predictive value of each of these interactions was tested based on a systematic review of the literature.


Several studies support the hypothesis that the influence of the childcare environment on children’s physical activity and diet is moderated by child characteristics (age, gender), but interaction between environmental types as well as between micro-systems is hardly examined in the field of behavioral nutrition and physical activity. Qualitative studies and general child development research provide some valuable insights, but we advocate quantitative research adopting an ecological perspective on environmental influences.


Empirical studies operationalizing a true ecological view on diet and physical activity are scarce. Theorizing and assessment of interaction is advocated to become common practice rather than an exception in behavioral nutrition and physical activity research, in order to move the field forward.

Childcare; Diet; Ecological perspective; Environment; Interaction; Meso-system; Moderation; Overweight; Physical activity; Preschoolers