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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.

ObjectiveTo understand how public health practitioners (PHPs) are using parental guidance on talking to children in their work with parents. In 2021, evidence-based guidance was produced for parents of young children to facilitate these conversations, but it is unclear how this guidance is being promoted to parents or used by PHPs.DesignQualitative study, consisting of in-depth, semistructured interviews.SettingLocal authority, National Health Service or other healthy weight service providers in the UK.ParticipantsParticipants were PHPs working on children’s healthier lifestyles programmes in the UK as part of the UK’s National Child Measurement Programme (NCMP). Invitations to participate were distributed via the Department of Health and Social Care and regional and national networks.Results24 participants were interviewed. Practice varied between organisations with the guidance being used in NCMP letters to parents, in follow-up phone calls with parents and in training NCMP staff and other health or education professionals. Participants valued the evidence-based guidance and its compassionate tone, feeling it gave them and parents, confidence in addressing a sensitive topic. Some felt it was too lengthy for parents with learning disabilities or low literacy levels. Others identified a need for similar guidance for older children. Though helpful, participants acknowledged the guidance was only one small part of a necessary systems-wide approach to promoting healthy weight.ConclusionsThe guidance is a useful tool but needs systematic promotion to increase use and effectiveness. Further work is warranted to develop adapted versions for other populations.

ObjectivesSystems approaches aim to change the environments in which people live, through cross-sectoral working, by harnessing the complexity of the problem. This paper sought to identify: (1) the strategies which support the implementation of We Can Move (WCM), (2) the barriers to implementation, (3) key contextual factors that influence implementation and (4) impacts associated with WCM.DesignA multi-methods evaluation of WCM was completed between April 2019 and April 2021. Ripple Effects Mapping (REM) and semi-structured interviewers were used. Framework and content analysis were systematically applied to the dataset.SettingWCM—a physical activity orientated systems approach being implemented in Gloucestershire, England.Participants31 stakeholder interviews and 25 stakeholders involved in 15 REM workshops.ResultsA white-water rafting analogy was developed to present the main findings. The successful implementation of WCM required a facilitative, well-connected and knowledgeable guide (ie, the lead organisation), a crew (ie, wider stakeholders) who’s vision and agenda aligned with WCM’s purpose, and a flexible delivery approach that could respond to ever-changing nature of the river (ie, local and national circumstances). The context surrounding WCM further strengthened and hampered its implementation. Barriers included evaluative difficulties, a difference in stakeholder and organisational perspectives, misaligned expectations and understandings of WCM, and COVID-19 implications (COVID-19 also presented as a facilitative factor). WCM was said to strengthen cohesion and collaboration between partners, benefit other agendas and policies (eg, mental health, town planning, inequality), and improve physical activity opportunities and environments.ConclusionsThis paper is one of the first to evaluate a systems approach to increasing physical activity. We highlight key strategies and contextual factors that influenced the implementation of WCM and demonstrate some of the wider benefits from such approaches. Further research and methodologies are required to build the evidence base surrounding systems approaches in Public Health.

BackgroundMany adolescent girls experience body dissatisfaction and have low levels of physical activity. Secondary school physical education (PE) offers opportunities for girls to build self-confidence and stay active; however, PE uniforms can be a barrier to participation.ObjectivesTo explore how secondary school PE uniform policies influence body image attitudes and PE engagement (participation and enjoyment) among adolescent girls, and how these policies could be co-developed in future.DesignA qualitative study involving focus groups and interviews.Participants and settingForty-four 12–13 year-old girls and six PE staff members from six mixed-sex secondary schools in England.Data collection and analysisUsing topic guides and participatory activities to aid discussions, we explored PE uniform preferences and the influence on body image attitudes and PE engagement with adolescent girls, as well as the PE uniform policy development process with PE staff. Data were analysed using reflexive thematic analysis, supported by NVivo V.14.ResultsThree themes were generated. Theme 1, ‘Striking the right balance between choice, comfort and uniformity’, describes the challenges of developing PE uniform policies that offer pupils choice to maximise comfort, while maintaining uniformity to ensure smartness, and to reduce social comparison. Theme 2, ‘PE uniforms are “made for boys”’ reflects that current policies can often provide unisex uniforms that do not fit the female body, or gendered options that limit girls’ choices over style and fit. Theme 3, ‘Self-confidence influences comfort in wearing PE uniform, and in turn PE engagement’ suggests girls with high self-confidence may be less concerned about others’ opinions and how they look, leading to greater PE enjoyment, whereas girls with lower self-confidence described feeling self-conscious, especially in communal changing rooms, which could impact their comfort and PE engagement.ConclusionsOur findings suggest that developing PE uniform policies, which allow pupils to choose their own bottoms, wear additional layers and wear PE uniform all day may improve comfort and inclusivity among girls, facilitating better PE engagement.

ObjectivesTo explore socioeconomic differences in screen-viewing at ages 6 and 9, and how these are related to different media uses.DesignLongitudinal cohort study.SettingChildren recruited from 57 state-funded primary schools in Southwest England, UK.Participants1299 children at ages 5–6, 1223 children at ages 8–9, including 685 children at both time points.Outcome measuresChildren’s total screen-viewing time (parent-reported) and time spent using multiple screen devices simultaneously (multiscreen viewing), for weekdays and weekends.MethodsNegative binomial regression was used to model associations between socioeconomic variables (highest household education and area deprivation) and total screen-viewing at age 6 and the change from age 6 to 9. We additionally adjusted for child characteristics, parental influences and media devices in the home. Multiscreen viewing was analysed separately.ResultsHousehold education was associated with children’s screen-viewing at age 6 with lower screen-viewing in higher socioeconomic groups (21%–27% less in households with a Degree or Higher Degree, compared with General Certificate of Secondary Education: GCSE). These differences were explained by the presence of games consoles, parental limits on screen-viewing and average parent screen-viewing. Between ages 6 and 9, there were larger increases in screen-viewing for children from A level and Degree households (13% and 6%, respectively, in the week) and a decrease in Higher Degree households (16%), compared with GCSE households. Differences by household education remained when adjusting for media devices and parental factors.ConclusionsChildren’s screen-viewing patterns differ by parental education with higher levels of viewing among children living in households with lower educational qualifications. These differences are already present at age 6, and continue at age 9. Strategies to manage child sedentary time, and particularly screen-viewing, may need to take account of the socioeconomic differences and target strategies to specific groups.

Background Schools are an important setting for health promotion. In England, around one third of publicly funded schools have become independent of local authorities since 2000 and are now academies, run by an academy trust. The aim of this research was to examine attitudes towards health promotion held by academy trust leaders and senior staff. The research questions were: 1. How do academy trusts in England perceive their role in health promotion amongst students? 2. How are decisions around health promotion made in academy trusts? 3. What factors inhibit and encourage health promotion in academy schools? 4. How might public health academics and practitioners best engage with academy schools to facilitate health promotion activity and research? Methods Qualitative study utilising semi-structured interviews. Twenty five academy and school leaders were purposively sampled to achieve variation in trust size and type. In addition, five respondents were recruited from public and third-sector agencies seeking to work with or influence academy trusts around health promotion. Framework analysis was used to determine emergent themes and identify relationships between themes and respondent type. Early findings were triangulated at a stakeholder event with 40 delegates from academia, local authority public health teams, and third sector organisations. Results There is wide variation amongst senior academy and trust leaders in how they perceive the role of academies in promoting health and wellbeing amongst students. There is also variability in whether academy trusts responsible for more than one school adopt a centralised strategy to health promotion or allow individual schools autonomy. This was dependent on the trust leaders’ attitude and interest in health promotion rather than any perceived external accountability. Identified barriers to health promotion include financial constraints, a narrow focus on educational outcomes and school performance, and limited understanding about effective health interventions. Conclusion In the current absence of national policy or guidance around health promotion in schools, health has variable status in academies in England. There is a need to better engage all academy trusts in health promotion and support them to implement a strategic approach to health promotion.

ObjectivesThe benefits of physical activity (PA) and the negative impacts of sedentary time (SED) on health in youth are well established. However, uncertainty remains surrounding how PA and SED jointly influence cardiometabolic risk (CMR) factors. The aim of this study was to determine the joint influence of SED, light-, moderate- and vigorous-intensity PA (LPA, MPA and VPA), and sleep on CMR factors using five-part compositional analyses.MethodsData were pooled from 16 cohort studies comprising 22 474 children and adolescents from the International Children’s Accelerometery Database. PA was measured using hip-mounted accelerometers with sleep self-reported. CMRs included body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure, fasting high- and low-density lipoprotein cholesterol, triglycerides, insulin and glucose. Time spent for sleep, SED, LPA, MPA and VPA was analysed using a compositional linear regression model.ResultsThe overall PA composition explained between 3.0 and 27.0% of the variance in CMR factors after accounting for age, sex, ethnicity and seasonal variation. However, when movement behaviours were explored in isolation, only sleep was associated with all CMR factors. In girls, compositions with 10 min more VPA were associated with a 2.5–4.4% greater BMI and WC. However, 10 min reallocations of time in boys had no impact on any CMR factor.ConclusionThese findings highlight that sleep and VPA are significantly associated with all CMR factors in youth, and therefore specific recommendations are needed to improve the current, and future, health of children and adolescents.

In 2021, Bristol became the first local authority outside London to introduce restrictions on advertisements for high fat, salt and sugar products and other unhealthy commodities (alcohol, gambling and payday loans) on local authority advertising sites (including bus shelters and some billboards). This research explored how the policy was implemented and what learnings may support other councils seeking to adopt a similar policy. Fourteen semi-structured interviews with key stakeholders, including policy-makers (n=5), other local authority employees (n=3), employees of government organisations (n=1), third-party organisations (n=3) and those from the advertising industry (n=2) were carried out online. Interviews explored: policy implementation, policy acceptability across different stakeholder groups, support of the wider policy context, impacts and unanticipated impacts on the system, barriers and facilitators to implementation, considerations for other councils and the future plans of the policy. Data were analysed using framework analysis which allowed for both inductive and deductive coding. Our preliminary analyses suggest that widespread cross-council support for the policy facilitated its implementation. Having clear assessment criteria in place to examine product adherence to the policy was also deemed important as well as learnings from other third-party organisations and other local authorities. Interviewees expressed that outcomes of the policy include: improving public health, delivering clear and consistent messaging to the public regarding public health issues, reducing health inequalities across the city, influencing other local authorities to implement similar polices and springboarding for further restrictions. To enhance the sustainability of the policy, interviewees noted that further communication across the council and with industry is needed. Lastly, interviewees stated that the policy would benefit from stronger internal auditing processes to prevent policy violations. Lessons for other local authorities intending to pursue similar policies primarily include: improved internal auditing system, communication across departments and continued learnings from other local authorities. This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (Award ID: NIHR152114) and supported by the NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust. The views expressed in this abstract are those of the authors and do not necessarily represent those of the funders.

Dietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual's diet. The present study examined the UKDDQ's repeatability and relative validity compared with 4 d food diaries. The UKDDQ was completed twice with a median 3 d gap (interquartile range=1-7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen's weighted kappa (κ w). South West of England. Adults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m2; participants were 91 % White British. The UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κ w ranged from 0·43 ('savoury pastries') to 0·87 ('vegetables'). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for 'alcohol' (κ w=0·71) and 'breakfast cereals' (κ w=0·70), with no agreement for 'vegetables' (κ w=0·08) or 'savoury pastries' (κ w=0·09). The UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management.

ObjectiveTo assess how lifestyle weight management programmes for children aged 4–16 years in England are commissioned and evaluated at the local level.DesignThis was a mixed-methods study comprising an online survey and semistructured telephone interviews.SettingAn online survey was sent to all local authorities (LAs) in England regarding lifestyle weight management services commissioned for children aged 4–16 years. Online survey data were collected between February and May 2016 and based on services commissioned between April 2014 and March 2015. Semistructured telephone interviews with LA staff across England were conducted between April and June 2016.ParticipantsCommissioners or service providers working within the public health department of LAs.Main outcome measuresThe online survey collected information on the evidence base, costs, reach, service usage and evaluation of child lifestyle weight management services. The telephone interviews explored the nature of child weight management contracts commissioned by LAs, the type of outcome data collected and whether these data were shared with other LAs or organisations, the challenges faced by these services, and the perceived ‘markers of success’ for a programme.ResultsThe online survey showed that none of the participating LAs was aware of any peer-reviewed evidence supporting the effectiveness of their specific commissioned service. Despite this, the telephone interviews revealed that there was no national formal sharing of data to enable oversight of the effectiveness of commissioned services across LAs in England to help inform future commissioning decisions. Challenges with long-term data collection, service engagement, funding and the pressure to reduce the prevalence of obesity were frequently mentioned.ConclusionsRobust, independent, cost-effectiveness analyses of obesity strategies are needed to determine the appropriate allocation of funding to lifestyle weight management treatment services, population-level preventative approaches or development of whole system approaches by an LA.