Direct and indirect association between environmental factors and fruit intake, mediation by psychosocial factors: the Pro Children study

Objectives: To explore direct associations between home and school availability of fruit and fruit intake, and the mediating role of attitude towards fruit, liking, perceived barriers and self-efficacy. Design: Cross-sectional study. Setting: Primary schools in nine European countries. Subjects: Within the Pro Children study, data were collected on perceived home and school availability of fruit, psychosocial factors related to fruit intake and its frequency among 13 305 11-year-old schoolchildren. Results: Significant overall associations were found between child-reported home availability of fruit and fruit intake in all countries and in the total sample. School availability of fruit was associated with fruit intake in the pooled sample and in country-specific analyses in Sweden and the Netherlands. Liking (13?2–49?4%) and self-efficacy (14?0–25?1%) were the strongest mediators in the home availability– fruit intake relationship, but there was also a direct association between home availability and fruit intake, except in Spain and the Netherlands. Mediating pathways of the school availability–fruit intake relationship could only be assessed for Norway, Sweden and the total sample. Attitude was a significant mediator in Norway (80?4%) and in Sweden (25?3%), while in the total sample also liking (38?7%) and self-efficacy (23?0%) were identified as significant mediators. Conclusions: The association between home availability of fruit and fruit intake is at least partly mediated by personal factors such as liking and self-efficacy indicates that fruit intake is not a complete automatic or unconscious behaviour.