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With a focus on obesity strategy, this paper examines and explains questions of ethics and equity in public health policy. We identify and explain the dynamics at play in assigning individual and social/political responsibility for health, in the context of policies that rely heavily on the exercise of individual agency. The paper builds on an earlier scientific study by one of the authors, expanding the analysis through reference to public health ethics, and social ethics more broadly.

With a focus on obesity strategy, this paper examines and explains questions of ethics and equity in public health policy. We identify and explain the dynamics at play in assigning individual and social/political responsibility for health, in the context of policies that rely heavily on the exercise of individual agency. The paper builds on an earlier scientific study by one of the authors, expanding the analysis through reference to public health ethics, and social ethics more broadly.

With a focus on obesity strategy, this paper examines and explains questions of ethics and equity in public health policy. We identify and explain the dynamics at play in assigning individual and social/political responsibility for health, in the context of policies that rely heavily on the exercise of individual agency. The paper builds on an earlier scientific study by one of the authors, expanding the analysis through reference to public health ethics, and social ethics more broadly.

Objective. To conduct a rapid scoping review to explore the hypothesis that socioeconomic affluence is associated with a more advanced stage of change for health behaviors. Data Source. Key-word searches of MEDline, Embase, PyschINFO, and www.google.com were conducted. Study Inclusion and Exclusion Criteria. Studies identified by the searches were included if they were published between 1982 and September 2003, written in English, and reported information on the distribution of the stages of change for any health behavior according to a marker of socioeconomic position (SEP). Data Extraction. Data on the behavior studied, the sample studied, the measure of SEP used, the definitions of the stages of change used, and the distribution of the stages of change according SEP were extracted by a single reviewer. Data Synthesis. As far as possible, data were reanalyzed by the chi-square test to determine if there was evidence that the distribution of the stages of change varied according to SEP. A formal meta-analysis was not appropriate. Results. Twenty-one studies reporting data on 30 samples and 188,850 individuals were included. Significant variations in the distribution of the stages of change were found according to SEP, in the expected direction, in 16 (53%) samples representing 171,183 (91%) individuals. Conclusions. There is substantial published evidence that more-affluent people tend to be in more-advanced stages of change than are more-deprived people.

SummaryChildhood adversity has been associated with accelerated menarcheal and reproductive timing in females. The relationship between family- and neighbourhood-level measures of childhood adversity, menarcheal timing and intended reproductive timing was investigated in a sample of 354 English adolescent girls. The data were collected from March to June 2012. In total 90 of the participants had reached menarche. Frequent residential relocations increased the likelihood of reaching menarche (HR 1.11; 95%CI 1.02–1.22). Girls who had moved house one to four times or five or more times, were respectively, more than twice (HR 2.14; 95%CI 1.23–3.73) and more than three times (HR 3.20; 95%CI 1.44–7.10) as likely to have reached menarche than girls who had never moved house. Frequent residential relocations were associated with stepfather co-residence, increased number of half/stepsiblings and reduced feelings of family support. Menarche was also accelerated by the presence of half/stepsisters. There was no relationship between menarcheal timing and intended reproductive timing. Frequent residential relocations may indicate instability in a young person's life, which is often outside of their control. Extending childhood adversity measures to include residential relocations could be important in better understanding the role early life events play in accelerating menarche.

$\textbf{Background:}$ Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. $\textbf{Methods:}$ We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. $\textbf{Results:}$ Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI - including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. $\textbf{Conclusions:}$ There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions. ; This work is produced under the terms of a Career Development Fellowship research training fellowship issued by the NIHR to JA, grant number: CDF-2011- 04-001. When this work was conceived, JA & ELG were funded in part, and FFS in full by Fuse: the Centre for Translational Research in Public Health, a UKCRC Public Health Research Centre of Excellence. JA is currently funded by the Centre for Diet & Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding for Fuse and CEDAR from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Abstract Background Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. Methods We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Results Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. Conclusions There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions.

Background Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. Methods We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Results Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. Conclusions There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions.

BACKGROUND: While foodwork (tasks required to access food, including home food preparation) in the UK declined toward the end of the 20th century, it is not known whether this trend has continued into the 21st century. While evidence suggests many people feel they lack the time to cook, it is not known whether this is attributable to increasing demands on their time. METHODS: Analysis of repeat cross-sectional data from three UK time use surveys: 1983, 2000 and 2014; participants aged 19+ (N = 14,810). We analysed changes in foodwork participation across survey years using linear regression, adding interaction terms to determine whether trends varied between different socio-demographic groups. We categorized time use over 24 h into eight parts, forming a composition: (1) personal care; (2) sleep; (3) eating; (4) physical activity; (5) leisure screen time; (6) work (paid and unpaid); (7) socialising and hobbies; and (8) foodwork. We examined whether the time-use composition varied across survey years, testing for interactions with socio-demographic characteristics. RESULTS: Foodwork declined significantly between 1983 and 2014. However, a concurrent increase in time spent on work was not observed. Instead, time spent on sleep and screen time increased significantly. The decline in foodwork was significant among women but not among men. CONCLUSION: While many people in the UK continue to allocate time to foodwork on a daily basis, foodwork has continued to decline into the 21st century, though there was no concurrent increase in time being allocated to work, suggesting external and non-discretionary demands on time have not increased. Practitioners seeking to address a lack of time as a barrier to foodwork may wish to accommodate a broad definition of what this could mean. ; CCA, TLP and JA were funded for this work by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. LF was funded by the National Institute for Health Research (NIHR) (16/137/64) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. The funders of this work had no involvement in study design, data collection, analysis and interpretation, and the writing of this report.

Noncommunicable diseases (NCD) are an increasing global threat. Utilising public policy to address NCDs can reduce incidence and prevalence. However, NCD-relevant public policy action is minimal in many countries as changing public policy is difficult and multifactorial. Two factors that may influence this process is the message people receive and the messenger delivering it. To date, much health communication research has focused on message content, with limited research on messengers that are trusted by policymakers and the public to communicate NCD matters. We aimed to review the literature to characterise who the public and policymakers consider to be trustworthy and/or credible for NCD messaging, and why this might be the case. Arksey and O'Malley's scoping review methodology guided the review. A systematic search of three databases up to June 2021 combined with hand searching of review reference lists was undertaken. Nineteen articles were included. Data extraction focused on study design, issue being influenced, spokesperson studied, and measures of trust. Results showed health professionals were the most-frequently trusted sources of information. Other spokespeople, such as government sources or religious leaders, were only trustworthy in some contexts, and even distrusted in others. Reasons why spokespeople were trusted included technical expertise, strategic engagement with stakeholders, and reputation. However, we also found the nature of trust and credibility of spokespeople is dependent on the studied population and context. Overall, characteristics of influential messengers were nonspecific. Thus, trusted messengers and their characteristics in NCD-messaging must be better understood to develop and maintain the trust of the public and policymakers. ; This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. However, Jean Adams was supported by the MRC Epidemiology Unit, University of Cambridge [grant number MC/UU/00006/7].