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Abstract Background The beneficial effect of physical activity for the prevention of a range of chronic diseases is widely acknowledged. These conditions are most prevalent in low-income groups where physical activity levels are consistently lower. Social marketing is the government's recommended approach to promoting physical activity but evidence of its effectiveness is limited. The purpose of this study was to examine the effect of a social marketing campaign on the monthly recruitment, attendance and retention levels at a community-based physical activity programme in a low income area. Methods A six-month social marketing campaign was designed and delivered in a highly-deprived suburban neighbourhood. Analysis of variance was used to assess effects on recruitment and attendance. χ 2 tests of independence were used to compare dropouts and adherers and effectiveness of recruitment mechanisms. Percentages were used to compare adherence rates at intervention, pre-existing sessions in the intervention area and control area sessions. Results Attendance data were collected weekly and presented and analysed monthly to provide a view of changing participation over the six month intervention period, as compared to attendance at pre-existing sessions in the intervention area and in a control area. Recruitment into intervention sessions was significantly greater than into pre-existing and control area sessions in Month 1 (18.13v1.04 p = .007, 18.13v.30 p=.005), Month 5 (3.45v.84 p=.007, 3.45v.30 p<.001) and Month 6 (5.60v.65 p<.001, 5.60v.25 p<.001). Attendance at intervention sessions was significantly greater in all six months than at pre-existing and control area sessions; Month 1 (38.83v7.17 p<.001, 38.83v4.67, p<.001), Month 2 (21.45v6.20 p<.001, 21.45v4.00, p<.001), Month 3 (9.57v6.15 p<.001, 9.57v3.77, p<.001), Month 4 (17.35v7.31 p<.001, 17.35v4.75, p<.001), Month 5 (20.33v8.81 p=.007, 20.33v4.54 p<.001) and Month 6 (28.72v8.28 p<.001, 28.72v.4.00 p<.001). Drop-out rates in the intervention area were similar to the control area (66.2%v69.9%), and considerably lower than in pre-existing sessions (83%). In months one and two, traditional marketing techniques (posters/outdoor banners/flyers) had the greatest influence on recruitment compared to word of mouth communication (84.5%v15.5%). In months five and six word of mouth influenced 57.5% of new recruits. Conclusions Direct comparisons with other programmes were difficult due to a lack of standard definitions of recruitment and adherence and limited reporting of findings. However when compared to pre-existing sessions and sessions delivered in a control area, monthly .

Abstract Background The beneficial effect of physical activity for the prevention of a range of chronic diseases is widely acknowledged. These chronic conditions are most pronounced in economically disadvantaged groups where physical activity levels are consistently lower, yet this group is particularly difficult to recruit and retain in physical activity programmes. This study examined the perceptions of participants, non-participants, and exercise leaders in a low-income area regarding barriers, motives, and enabling factors for organised physical activity with a view to improving recruitment and retention. Methods A mixed methods research approach was adopted to guide data collection and analysis. A survey, incorporating the Motivation for Physical Activity Measure - Revised (MPAM-R), was used to assess the motivations of 152 physical activity session participants in a highly deprived suburban neighbourhood. The MPAM-R data were analysed using t tests, analyses of variance to estimate age, body mass index, and activity mode differences and Pearson's correlation coefficient to address associations. Semi-structured interviews were also conducted with 33 local residents who did not participate in activity sessions and with 14 activity session leaders. All interviews were audio-taped, transcribed verbatim and analyzed using an inductive thematic approach. Results Participants reported cost, childcare, lack of time and low awareness as barriers to joining activity classes. The need for support, confidence and competence in order to take up activity was widely expressed, particularly among women. Once people are active, high levels of social interaction, interest and enjoyment are associated with improved levels of retention, with different types of physical activity scoring differently on these factors. Conclusions This study suggests that some factors such as cost, the fear of 'walking in alone', accessibility of facilities, and appropriate communication strategies may be of particular importance to increasing recruitment of low income groups. Interventions targeting this group should consider low cost sessions and childcare; activities popular with the target group and associated with good recruitment and retention; sessions held at accessible times; a focus on fun and socialising; well-researched and designed communications strategies; targeting of friendship groups; clearly branded beginners' sessions, and the potential of social marketing as strategies. The evidence presented here suggests that the current UK government approach designed to 'enable and guide people's choices' may not be sufficient if low-income groups are to be effectively supported in changing their health behaviours.

Purpose. Examine associations among observed, self-reported, and Geographical Information Systems (GIS) environmental features and physical activity among adolescent males. Design. Cross-sectional study. Setting. Boy Scout troops and neighborhoods in Houston, Texas. Subjects. Two hundred and ten 10- to 14-year-old Boy Scouts. Measures. Accelerometry to obtain minutes of sedentary, light, and moderate to vigorous activity per day. GIS sources were used to identify the numbers of parks, gymnasiums, trails, bus stops, grocery stores, and restaurants within a 1-mile radius of participant residences as well as residential density, connectivity, and crime. Participants provided a self-report of their environment. Analysis. Principal component analysis was used to reduce the number of GIS and self-reported items. Four factors were previously obtained from direct observations of the neighborhoods. Correlations were conducted among factors and physical activity. Regression models were run in which minutes of sedentary behavior, light, or moderate to vigorous physical activity were the dependent variables and environmental factors were the independent variables. Nonsignificant variables were removed in a backward deletion process. Results. Three GIS factors, Parks, Crime, and Gyms, were obtained as were two self-reported factors: difficulty and access and safety. Factor scores were interrelated and associated with the four observed factors. Only observed sidewalk characteristics were correlated with physical activity and were retained in the regression models. Conclusion. Environmental factors were interrelated. Only sidewalk characteristics were associated with sedentary behavior and light intensity physical activity.

Background Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe. Methods Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2¬–18 years) from 18 different European countries. Results Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age. Conclusions Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.

Objective Explore employees' perceptions of ability to follow the Mediterranean diet (MedDiet), preferences for setting goals if asked to follow the MedDiet, and expectations of an Internet-based, workplace MedDiet intervention. Design Seven focus groups to guide intervention development. Setting Four workplaces (business/professional services, government branches) in Southwest England. Participants Employees (n = 29, 51.7% women), ages 24–58 years. Phenomenon of Interest Ability to follow the MedDiet; preferences for goal-setting if asked to follow the MedDiet; intervention content. Analysis Data were analyzed with the use of thematic analysis. Results Participants perceived that adhering to some MedDiet recommendations would be challenging and highlighted cost, taste, and cooking skills as adherence barriers. Behavior change preferences included a tailored approach to goal-setting, reviewing goal progress via a website/smartphone app, and receiving expert feedback via an app/website/text/face-to-face session. Desirable features of an Internet-based MedDiet application included recipes, interactivity, nutritional information, shopping tips, cost-saving information, and a companion smartphone app. Engaging in social support was deemed important to facilitate adherence. Conclusions and Implications An Internet-based, workplace MedDiet intervention should address adherence barriers, utilize a tailored approach to setting and reviewing goals, and activate social support to facilitate adherence. These findings provide insights to planning to promote the MedDiet in non-Mediterranean regions

Background: Regular physical activity improves physical and mental health, yet children's physical activity levels were low in England's 2014 Report Card. Within this paper, we update the 2014 Report Card to assess current information for the 9 indicators of physical activity. Methods: A search for nationally representative data on 9 indicators of physical activity was conducted and the data were assessed by an expert panel. The panel assigned grades [ie, A, B, C, D, F, or INC (incomplete)] to each indicator based on whether children across England were achieving specific benchmarks. The 2016 Report Card was produced and disseminated. Results: The following grades were awarded: Overall Physical Activity Levels: D-; Organized Sport Participation: D; Active Play: INC; Active Transportation: C-; Sedentary Behaviors: INC; Family and Peers: INC; School: B+; Community and the Built Environment: B; Government Strategies and Investment: INC. Conclusions: The grades have not improved since the 2014 Report Card and several gaps in the literature are still present. While children's physical activity levels remain low alongside competing sedentary choices, further national plans and investment with local actions are urgently needed to promote physical activity especially via active play, active transport, and family support.

INTRODUCTION: Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the "commercial determinants of obesity," but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. METHODS: Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty‐one articles met the inclusion criteria: they were published in a peer‐reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. RESULTS: The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action—political and legal; production, processing and design; and marketing and preference shaping—which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. CONCLUSIONS: In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for ...

Introduction Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the "commercial determinants of obesity," but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. Methods Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty-one articles met the inclusion criteria: they were published in a peer-reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. Results The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action- political and legal; production, processing and design; and marketing and preference shaping -which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping . Conclusions In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for primary prevention by anticipating industry responses and by discouraging corporate practices that harm health.

Background: To suppress the transmission of coronavirus, many governments, including that of the island of Ireland, implemented a societal lockdown which included school closures, limits on social gatherings and time outdoors. This study aimed to evaluate changes in physical activity (PA), mental health, sleep and social media use among adolescent girls during lockdown. Methods: 281 female pupils (12-14 years) taking part in the ongoing Walking In Schools (WISH) Study on the island of Ireland self-reported PA, mental health, sleep and social media use before (Sept-Oct 2019), and during lockdown (May-June 2020), via questionnaires. These were supplemented with open-ended structured interviews conducted with 16 girls during lockdown. Results: During the period of lockdown and school closures, pupils tried new forms of PA and undertook PA with family but there was no significant change in self-reported PA. There was a decline in health-related quality of life and motivation for exercise; however, self-efficacy for walking and happiness with appearance increased. There was no change in sleep quality or social media usage. Conclusions: Despite the many challenges that schools face as they reopen, there is a need to continue to prioritise PA and motivation for exercise to support health and wellbeing in adolescent girls.

Introduction: Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behavior and obesity, and their practices have broadly been labeled as the "commercial determinants of obesity," but there is a lack of definitions and conceptualizations for these terms. This review aimed to synthesize literature on the commercial determinants of dietary behavior associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behavior, and it examines the prevalence of certain narratives within papers that focus on children and adolescents. Methods: Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. Eighty-one articles met the inclusion criteria: they were published in a peer-reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behavior or obesity. Data were integrated using critical interpretative synthesis. Results: The commercial determinants of dietary behavior are conceptualized in terms of three corporate spheres of action-political and legal; production, processing and design; and marketing and preference shaping-which enable powerful food industry to successfully pursue their business, market, and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. Conclusions: In the included literature, the commercial determinants of dietary behavior associated with obesity have been conceptualized as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for primary prevention by anticipating industry responses and by discouraging corporate practices that harm health.

Introduction: Unhealthy diet is an important preventable risk factor for overweight and obesity. Identifying the key drivers of an unhealthy diet is an important public health aim. "Big Food" has been identified as an influential factor shaping dietary behaviour and obesity, and their practices have broadly been labelled as the "commercial determinants of obesity" but there is a lack of definitions and conceptualisations for these terms. This review aimed to synthesise literature on the commercial determinants of dietary behaviour associated with obesity. It presents the development of an integrative definition and a conceptual framework involving potential influences on dietary behaviour and it examines the prevalence of certain narratives within papers that focus on children and adolescents. Methods: Four electronic databases (Ovid MEDLINE, PubMed, Web of Science, and Scopus) were searched up to December 2020. 81 articles met the inclusion criteria: they were published in a peer-reviewed academic journal, described a practice from the food/beverage industry in relation to dietary behaviour or obesity. Data were integrated using critical interpretative synthesis. Results: The commercial determinants of dietary behaviour are conceptualised in terms of three corporate spheres of action – political and legal; production, processing and design; and marketing and preference shaping – which enable powerful food industry to successfully pursue their business, market and political objectives. The most frequently reported sphere of action targeting children and adolescents was marketing and preference shaping. Conclusions: In the included literature, the commercial determinants of dietary behaviour associated with obesity have been conceptualised as being part of a complex system where corporate practices are enabled by power structures. The proposed framework can facilitate a structured identification and systematic study of the impact of specific aspects of food industry's strategies and increase opportunities for ...

Background: Most adolescent girls in the UK do not meet government physical activity recommendations and effective interventions are needed. This study reports the results of a feasibility trial of PLAN-A, a novel school-based peer-led physical activity intervention for adolescent girls. Methods: A two-arm cluster randomised controlled feasibility study was conducted in six English secondary schools (4 intervention & 2 control). Year 8 (age 12-13) girls were eligible and randomisation was at school-level. The intervention involved training Year 8 girls (out of school for two consecutive days, plus one top-up day 5 weeks later), who were identified by their peers as influential, to provide informal support to their friends to increase their physical activity. Feasibility of the intervention and the research was examined, including: recruitment, training attendance and data provision rates, evidence of promise of the intervention to affect weekday moderate-to-vigorous physical activity (MVPA), intervention cost and estimation of the sample size for a definitive trial. Accelerometer and questionnaire data were collected at the beginning of Year 8 (Time 0), the end of Year 8 (10-weeks after peer-supporter training) and the beginning of Year 9 (Time 2). Results: 427 girls were recruited (95% recruitment rate). 55 girls consented to be a peer-supporter and 53 peer-supporters were trained (97% of those invited). Accelerometer return rates exceeded 85% at each time point and wear time criteria was met by 83%, 71% and 62% participants at Time 0, 1 and 2 respectively. Questionnaire data were provided by >91% of participants at each time point. Complete-case adjusted linear regression analysis showed evidence of a 6.09 minute (95% CI = 1.43, 10.76) between-arms difference in weekday MVPA at Time 2 in favour of the intervention arm. On average PLAN-A cost £2685 per school to deliver (£37 per Year 8 girl). There were no adverse events. A trial involving 20 schools would be adequately powered to detect a between-arms difference in weekday MVPA of at least six minutes. Conclusions: The PLAN-A intervention adopts a novel peer-led approach, is feasible, and shows evidence of promise to positively affect girls' physical activity levels. A definitive trial is warranted. Trial registration: ISCTRN, ISRCTN12543546, Registered on 28/7/2015, URL of registry record: http://www.isrctn.com/ISRCTN12543546

Background and Aims: Given the costs of alcohol to society, it is important to evaluate whether local alcohol licensing decisions can mitigate the effects of alcohol misuse. Robust natural experiment evaluations of the impact of individual licensing decisions could potentially inform and improve local decision-making. We aimed to assess whether alcohol licensing decisions can be evaluated at small spatial scale in three English local areas (1,000 – 15,000 people) by using a causal inference framework. Design: This study described three natural experiments Setting: General population Measurements: Timeseries data were obtained on emergency department admissions, ambulance call-outs, and alcohol-related crime at the Lower or Middle Super Output geographical aggregation level. Intervention and comparator: The case study interventions were (i) the closure of a nightclub following reviews; (ii) closure of a restaurant/nightclub following reviews, and (iii) implementation of new local licensing guidance (LLG). Trends in outcomes were compared to synthetic counterfactuals created using Bayesian structural timeseries. Findings: Closure of the nightclub lead to temporary, 4-month, reductions in anti-social behaviour (-18%; 95% Credible Interval -37%, -4%), with no change on other outcomes. Closure of the restaurant/nightclub did not lead to measurable changes in outcomes. The new licensing guidance lead to small reductions in drunk and disorderly behaviour (9 of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of 2 incidents per month. Conclusions: The impact of local alcohol policy, even at the level of individual premises, can be evaluated using this causal framework. Local government actions such as closure or restriction of venues and licensing may have a positive impact on health and crime in the immediate surrounding area.

Anti-social behaviour (ASB) has been a major preoccupation of New Labour's project of social and political renewal, with ASBOs a controversial addition to crime and disorder management powers. Thought by some to be a dangerous extension of the power to criminalise, by others as a vital dimension of local governance, there remains a concerning lack of evidence as to whether or not they compound social exclusion. This collection, from an impressive panel of contributors, brings together opinion, commentary, research evidence, professional guidance, debate and critique in order to understand the phenomenon of anti-social behaviour. It considers the earliest available evidence in order to evaluate the Government's ASB strategy, debates contrasting definitions of anti-social behaviour and examines policy and practice issues affected by it. Contributors ask what the recent history of ASB governance tells us about how the issue will develop to shape public and social policies in the years to come. Reflecting the perspectives of practitioners, victims and perpetrators, the book should become the standard text in the field

Funder: Public Health Agency of Canada ; Funder: Government of Norway ; BACKGROUND: In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. METHODS: The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. RESULTS: Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. CONCLUSIONS: Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.