{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T03:00:47Z","timestamp":1773889247735,"version":"3.50.1"},"reference-count":62,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2014,10,30]],"date-time":"2014-10-30T00:00:00Z","timestamp":1414627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"International Grant Agency of the Ministry of Healt in the Czech Republic","award":["grant IGA NS\/9832-4"],"award-info":[{"award-number":["grant IGA NS\/9832-4"]}]},{"DOI":"10.13039\/501100004504","name":"Research Council of Lithuania","doi-asserted-by":"publisher","award":["grant SIN-17\/2012"],"award-info":[{"award-number":["grant SIN-17\/2012"]}],"id":[{"id":"10.13039\/501100004504","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007\/2008 and 2009\/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children\u2019s weight and height;  BMI-for-age (BMI\/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children\u2019s BMI\/A Z-scores was calculated.  Results: Large between-country differences were found in the availability of food items  on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and  school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria,  Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (\u22650.70) countries were Ireland, Malta, Norway, Portugal,  Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria,  Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI\/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI\/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the \u201cunhealthy\u201d school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.<\/jats:p>","DOI":"10.3390\/ijerph111111261","type":"journal-article","created":{"date-parts":[[2014,10,30]],"date-time":"2014-10-30T11:53:25Z","timestamp":1414670005000},"page":"11261-11285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in  Primary Schools"],"prefix":"10.3390","volume":"11","author":[{"given":"Trudy","family":"Wijnhoven","sequence":"first","affiliation":[{"name":"Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe,  UN City, Marmorvej 51, DK-2100 Copenhagen \u00f8, Denmark"}]},{"given":"Joop","family":"Van Raaij","sequence":"additional","affiliation":[{"name":"Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and  the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands"},{"name":"Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen,  The Netherlands"}]},{"given":"Agneta","family":"Sj\u00f6berg","sequence":"additional","affiliation":[{"name":"Department of Food and Nutrition and Sport Science, University of Gothenburg, P.O. Box 300,  SE-405 30 Gothenburg, Sweden"}]},{"given":"Nazih","family":"Eldin","sequence":"additional","affiliation":[{"name":"Health Promotion Department, Health Service Executive, Railway Street, Navan, County Meath, Ireland"},{"name":"National Nutrition Surveillance Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin 4, Ireland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-279X","authenticated-orcid":false,"given":"Agneta","family":"Yngve","sequence":"additional","affiliation":[{"name":"School of Hospitality, Culinary Arts and Meal Science, \u00d6rebro University, Campus Grythyttan, P.O. Box 1, SE-712 60 Grythyttan, Sweden"}]},{"given":"Marie","family":"Kune\u0161ov\u00e1","sequence":"additional","affiliation":[{"name":"Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694 Prague 1, Czech Republic"}]},{"given":"Gregor","family":"Starc","sequence":"additional","affiliation":[{"name":"Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia"}]},{"given":"Ana","family":"Rito","sequence":"additional","affiliation":[{"name":"National Health Institute Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisbon, Portugal"}]},{"given":"Vesselka","family":"Duleva","sequence":"additional","affiliation":[{"name":"Department of Food and Nutrition, National Centre of Public Health and Analyses, 15 Akad. Ivan Evstatiev Geshov Blvd., 1431 Sofia, Bulgaria"}]},{"given":"Maria","family":"Hassapidou","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, P.O. Box 14561, 54101 Thessaloniki, Greece"}]},{"given":"\u00c9va","family":"Martos","sequence":"additional","affiliation":[{"name":"National Institute for Food and Nutrition Science, Albert Florian \u00dat 3\/a, 1097 Budapest, Hungary"}]},{"given":"Iveta","family":"Pudule","sequence":"additional","affiliation":[{"name":"Centre for Disease Prevention and Control, 22 Duntes Street, LV-1005 Riga, Latvia"}]},{"given":"Ausra","family":"Petrauskiene","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Lithuanian University of Health Sciences, Eiveniu Str. 4, 50009 Kaunas, Lithuania"}]},{"given":"Victoria","family":"Sant'Angelo","sequence":"additional","affiliation":[{"name":"Primary Health Care Department, 7 Harper Lane, Floriana FLR 1940, Malta"}]},{"given":"Ragnhild","family":"Hovengen","sequence":"additional","affiliation":[{"name":"Department of Health Statistics, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen,  N-0403 Oslo, Norway"}]},{"given":"Jo\u00e3o","family":"Breda","sequence":"additional","affiliation":[{"name":"Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe,  UN City, Marmorvej 51, DK-2100 Copenhagen \u00f8, Denmark"}]}],"member":"1968","published-online":{"date-parts":[[2014,10,30]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization Why Does Childhood Overweight and Obesity Matter?. Available online: http:\/\/www.who.int\/dietphysicalactivity\/childhood_consequences\/en\/."},{"key":"ref_2","unstructured":"Branca, F., Nikogosian, H., and Lobstein, T. Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0010\/74746\/E90711.pdf."},{"key":"ref_3","unstructured":"Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0006\/96459\/E90143.pdf."},{"key":"ref_4","unstructured":"Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0020\/237035\/WHO-European-Ministerial-Conference-on-Nutrition-and-Noncommunicable-Diseases-in-the-Context-of-Health-2020.pdf."},{"key":"ref_5","unstructured":"(2014). EU Action Plan on Childhood Obesity 2014\u22122020, European Commission."},{"key":"ref_6","unstructured":"Wijnhoven, T., van Raaij, J., and Breda, J. Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0004\/258781\/COSI-report-round-1-and-2_final-for-web.pdf?ua=1."},{"key":"ref_7","unstructured":"Wijnhoven, T., and Branca, F. (2008). WHO European Childhood Obesity Surveillance Initiative. Protocol, Version January 2008, WHO Regional Office for Europe."},{"key":"ref_8","unstructured":"(2010). WHO European Childhood Obesity Surveillance Initiative. Protocol, Version August 2010, WHO Regional Office for Europe."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/obr.12142","article-title":"A systematic review of the influence of the retail food environment around schools on obesity-related outcomes","volume":"15","author":"Williams","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/j.1467-789X.2009.00611.x","article-title":"Characterizing the obesogenic environment: The state of the evidence with directions for future research","volume":"11","author":"Kirk","year":"2010","journal-title":"Obes. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1038\/oby.2007.300","article-title":"Designer schools: The role of school space and architecture in obesity prevention","volume":"15","author":"Gorman","year":"2007","journal-title":"Obesity"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1038\/sj.ijo.0801938","article-title":"Obesity prevention: The case for action. Public Health Approaches to the Prevention of Obesity (PHAPO) working group of the International Obesity Task Force (IOTF)","volume":"26","author":"Kumanyika","year":"2002","journal-title":"Int. J. Obes. Relat. Metab. Disord."},{"key":"ref_13","unstructured":"European Commission Directorate-General for Agriculture and Rural Development School Fruit Scheme. Available online: http:\/\/ec.europa.eu\/agriculture\/sfs\/eu-countries\/index_en.htm."},{"key":"ref_14","unstructured":"Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/80149\/1\/9789241504782_eng.pdf."},{"key":"ref_15","unstructured":"Available online: http:\/\/www.who.int\/dietphysicalactivity\/SPF-en-2008.pdf."},{"key":"ref_16","unstructured":"Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0020\/101684\/E90191.pdf."},{"key":"ref_17","unstructured":"Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0019\/152218\/E89501.pdf."},{"key":"ref_18","unstructured":"Available online: http:\/\/www.who.int\/school_youth_health\/resources\/information_series\/FINAL%20Final.pdf."},{"key":"ref_19","unstructured":"World Health Organization, Food and Agriculture Organization of the United Nations, and Education International Available online: http:\/\/www.who.int\/school_youth_health\/media\/en\/428.pdf?ua=1."},{"key":"ref_20","unstructured":"World Health Organization, United Nations Educational, Scientific and Cultural Organization, United Nations Children\u2019s Fund, Education Development Center, World Bank, Partnership for Child Development, and Education International Available online: http:\/\/www.who.int\/school_youth_health\/media\/en\/physical_sch_environment_v2.pdf?ua=1."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/j.2047-6310.2012.00090.x","article-title":"WHO European childhood obesity surveillance initiative 2008: Weight, height and body mass index in 6\u20139-year-old children","volume":"8","author":"Wijnhoven","year":"2013","journal-title":"Pediatr. Obes."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wijnhoven, T.M., van Raaij, J.M., Spinelli, A., Starc, G., Hassapidou, M., Spiroski, I., Rutter, H., Martos, \u00c9., Rito, A.I., and Hovengen, R. (2014). WHO European childhood obesity surveillance initiative: Body mass index and level of overweight among 6\u20139-year-old children from school year 2007\/2008 to school year 2009\/2010. BMC Public Health., 14.","DOI":"10.1186\/1471-2458-14-806"},{"key":"ref_23","unstructured":"Available online: http:\/\/www.cioms.ch\/publications\/guidelines\/guidelines_nov_2002_blurb.htm."},{"key":"ref_24","unstructured":"European Commission Directorate-General for Agriculture and Rural Development The European School Milk Programme. Available online: http:\/\/ec.europa.eu\/agriculture\/drinkitup\/index_en.htm."},{"key":"ref_25","unstructured":"Available online: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0019\/191125\/e96859.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Van den Berg, S.W., Mikolajczak, J., and Bemelmans, W.J. (2013). Changes in school environment, awareness and actions regarding overweight prevention among Dutch secondary schools between 2006\u22122007 and 2010\u22122011. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-672"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jneb.2012.01.009","article-title":"Associations among school characteristics and foodservice practices in a nationally representative sample of U.S. schools","volume":"44","author":"Thomson","year":"2012","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.amepre.2008.05.022","article-title":"The school food environment: Associations with adolescent soft drink and snack consumption","volume":"35","author":"Timperio","year":"2008","journal-title":"Amer. J. Prev. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1177\/0193945911401430","article-title":"Ecological risk factors of childhood obesity in Korean elementary school students","volume":"34","author":"Kim","year":"2012","journal-title":"West. J. Nurs. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1089\/chi.2012.0047","article-title":"Local wellness policy strength and perceived implementation of school nutrition standards across three states","volume":"8","author":"Wall","year":"2012","journal-title":"Child. Obes."},{"key":"ref_31","unstructured":"Available online: http:\/\/who.int\/dietphysicalactivity\/summary-report-09.pdf?ua=1."},{"key":"ref_32","unstructured":"Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/37003\/1\/WHO_TRS_854.pdf."},{"key":"ref_33","first-page":"660","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. WHO"},{"key":"ref_34","unstructured":"Bl\u00f6ssner, M., Siyam, A., Borghi, E., Onyango, A., and de Onis, M. Available online: http:\/\/www.who.int\/growthref\/tools\/who_anthroplus_manual.pdf."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1037\/h0023189","article-title":"Large-sample multiple comparison","volume":"65","author":"Marascuilo","year":"1966","journal-title":"Psychol. Bull."},{"key":"ref_36","first-page":"113","article-title":"Pairwise multiple comparison procedures with unequal N\u2019s and\/or variances: A Monte Carlo study","volume":"1","author":"Games","year":"1976","journal-title":"J. Educ. Stat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.jand.2012.04.017","article-title":"Slow progress in changing the school food environment: Nationally representative results from public and private elementary schools","volume":"112","author":"Turner","year":"2012","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_38","unstructured":"Schools for Health in Europe Available online: http:\/\/upload.sitesystem.ch\/B2DBB48B7E\/5B4613A676\/83EF2D5F63.pdf."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/1757913913517976","article-title":"The association between organic school food policy and school food environment: Results from an observational study in Danish schools","volume":"134","author":"He","year":"2014","journal-title":"Perspect. Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1017\/S136898001300027X","article-title":"The impact of the food-based and nutrient-based standards on lunchtime food and drink provision and consumption in secondary schools in England","volume":"16","author":"Nicholas","year":"2013","journal-title":"Public Health Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Scholtens, S., Middelbeek, L., Rutz, S.I., Buijs, G., and Bemelmans, W.J. (2010). Differences in school environment, school policy and actions regarding overweight prevention between Dutch schools. A nationwide survey. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-42"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1038\/sj.ejcn.1602068","article-title":"School food policy at primary and secondary schools in Belgium-Flanders: Does it influence young people\u2019s food habits?","volume":"59","author":"Vereecken","year":"2005","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S96","DOI":"10.1111\/obr.12079","article-title":"Monitoring foods and beverages provided and sold in public sector settings","volume":"14","author":"Schermel","year":"2013","journal-title":"Obes. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Van Ansem, W.J., Schrijvers, C.T., Rodenburg, G., Schuit, A.J., and van de Mheen, D. (2013). School food policy at Dutch primary schools: Room for improvement? Cross-sectional findings from the INPACT study. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-339"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1093\/heapro\/dap040","article-title":"Local school policies increase physical activity in Norwegian secondary schools","volume":"25","author":"Haug","year":"2009","journal-title":"Health Promot. Int."},{"key":"ref_46","unstructured":"Ministry of Health V\u00fd\u017eiva ve V\u00fdchov\u0115 ke Zdravi (Nutrition in Health Education). (in Czech)."},{"key":"ref_47","unstructured":"Regional Health Pardubice Region V\u00fdchova ke Zdravi (Health Education). (in Czech)."},{"key":"ref_48","unstructured":"Regional Department of Public Health North Programa Alimenta\u00e7\u00e3o Saud\u00e1vel em Sa\u00fade Escolar (Healthy Eating in School Health Program). (in Portuguese)."},{"key":"ref_49","unstructured":"Ministry of Agriculture and the Environment Shema \u0160olskega Sadja in Zelenjave (School Fruit and Vegetables Scheme). (in Slovene)."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jegh.2012.06.002","article-title":"Perinatal and family factors associated with preadolescence overweight\/obesity in Greece: The GRECO study","volume":"2","author":"Risvas","year":"2012","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Keane, E., Layte, R., Harrington, J., Kearney, P.M., and Perry, I.J. (2012). Measured parental weight status and familial socio-economic status correlates with childhood overweight and obesity at age 9. PLoS One, 7.","DOI":"10.1371\/journal.pone.0043503"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1111\/j.1467-789X.2011.00959.x","article-title":"Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: A pooled analysis of six European studies","volume":"13","author":"Brug","year":"2012","journal-title":"Obes. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.2047-6310.2012.00075.x","article-title":"Socioeconomic factors and childhood overweight in Europe: Results from the multi-centre IDEFICS study","volume":"8","author":"Bammann","year":"2013","journal-title":"Pediatr. Obes."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ypmed.2008.10.018","article-title":"Do school based food and nutrition policies improve diet and reduce obesity?","volume":"48","author":"Jaime","year":"2009","journal-title":"Prev. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.ypmed.2013.01.011","article-title":"The effect of participation in school-based nutrition education interventions on body mass index: A meta-analysis of randomized controlled community trials","volume":"56","author":"Silveira","year":"2013","journal-title":"Prev. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ypmed.2013.02.024","article-title":"Educational interventions in childhood obesity: A systematic review with meta-analysis of randomized clinical trials","volume":"56","author":"Sbruzzi","year":"2013","journal-title":"Prev. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"415","DOI":"10.3945\/ajcn.112.035378","article-title":"Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: A systematic review","volume":"96","author":"Verstraeten","year":"2012","journal-title":"Amer. J. Clin. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/j.1467-789X.2009.00711.x","article-title":"School-based interventions promoting both physical activity and healthy eating in Europe: A systematic review within the HOPE project","volume":"12","author":"Spittaels","year":"2011","journal-title":"Obes. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.jadohealth.2013.06.002","article-title":"School and neighborhood nutrition environment and their association with students\u2019 nutrition behaviors and weight status in Seoul, South Korea","volume":"53","author":"Park","year":"2013","journal-title":"J. Adolesc. Health"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/S0031-3955(05)70347-3","article-title":"Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight","volume":"48","author":"Birch","year":"2001","journal-title":"Pediatr. Clin. North. Am."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4278\/ajhp.130214-QUAN-70","article-title":"Associations between childhood obesity and the availability of food outlets in the local environment: A retrospective cross-sectional study","volume":"28","author":"Miller","year":"2013","journal-title":"Amer. J. Health Promot."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/0038040711417011","article-title":"Competitive food sales in schools and childhood obesity: A longitudinal study","volume":"85","author":"Altman","year":"2012","journal-title":"Sociol. Educ."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/11\/11261\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:17:36Z","timestamp":1760217456000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/11\/11261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,30]]},"references-count":62,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2014,11]]}},"alternative-id":["ijerph111111261"],"URL":"https:\/\/doi.org\/10.3390\/ijerph111111261","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,10,30]]}}}