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The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16–18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures. publishedVersion

ImportanceObservational studies have reported an association between the use of eye protection and reduced risk of infection with SARS-CoV-2 and other respiratory viruses, but, as with most infection control measures, no randomized clinical trials have been conducted.ObjectivesTo evaluate the effectiveness of wearing glasses in public as protection against being infected with SARS-CoV-2 and other respiratory viruses.Design, Setting, and ParticipantsA randomized clinical trial was conducted in Norway from February 2 to April 24, 2022; all adult members of the public who did not regularly wear glasses, had no symptoms of COVID-19, and did not have COVID-19 in the last 6 weeks were eligible.InterventionWearing glasses (eg, sunglasses) when close to others in public spaces for 2 weeks.Main Outcomes and MeasuresThe primary outcome was a positive COVID-19 test result reported to the Norwegian Surveillance System for Communicable Diseases. Secondary outcomes included a positive COVID-19 test result and respiratory infection based on self-report. All analyses adhered to the intention-to-treat principle.ResultsA total of 3717 adults (2439 women [65.6%]; mean [SD] age, 46.9 [15.1] years) were randomized. All were identified and followed up in the registries, and 3231 (86.9%) responded to the end of study questionnaire. The proportions with a reported positive COVID-19 test result in the national registry were 3.7% (68 of 1852) in the intervention group and 3.5% (65 of 1865) in the control group (absolute risk difference, 0.2%; 95% CI, −1.0% to 1.4%; relative risk, 1.10; 95% CI, 0.75-1.50). The proportions with a positive COVID-19 test result based on self-report were 9.6% (177 of 1852) in the intervention group and 11.5% (214 of 1865) in the control group (absolute risk difference, –1.9%; 95% CI, −3.9% to 0.1%; relative risk, 0.83; 95% CI, 0.69-1.00). The risk of respiratory infections based on self-reported symptoms was lower in the intervention group (30.8% [571 of 1852]) than in the control group (34.1% [636 of 1865]; absolute risk difference, –3.3%; 95% CI, −6.3% to −0.3%; relative risk, 0.90; 95% CI, 0.82-0.99).Conclusions and RelevanceIn this randomized clinical trial, wearing glasses in the community was not protective regarding the primary outcome of a reported positive COVID-19 test. However, results were limited by a small sample size and other issues. Glasses may be worth considering as one component in infection control, pending further studies.Trial RegistrationClinicalTrials.gov Identifier: NCT05217797

Ana Rito - Departamento de Alimentação e Nutrição, INSA. Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and wellbeing. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15–19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time. European Commission, Grant/Award Number: 774210; European Union info:eu-repo/semantics/publishedVersion

Background The World Cancer Research Fund International's (WCRF International) analysis of global research shows a strong link between diet, physical activity, and risk of cancer. To address this, WCRF International has developed a package of policy resources to promote healthy diets and physical activity to support reporting, categorising and monitoring of policy actions. The MOVING policy framework was developed as a complement to the well-established NOURISHING framework of diet-related policies-outlining a comprehensive set of areas in which governments should take action to promote physical activity. The new framework forms the basis for the MOVING database of implemented policy actions. Methods For the MOVING framework, literature reviews were undertaken, and the results were distilled into policy categories on which academics and policy experts provided feedback. The framework is the basis for a specific inclusion criteria and search strategy to determine how policy actions will be collected, reviewed and categorised for the MOVING database. A comprehensive scanning methodology was designed to identify all relevant policies across the MOVING policy areas. Relevant policies are then verified with in-country experts and uploaded to the database. This methodology was tested, refined and will be applied to 27 European countries. Results The MOVING policy framework comprises six policy areas within four policy domains and details the areas where governments should take action to promote physical activity. The framework forms the structure for a new database of global physical activity policies, which was launched in the summer of 2020. The MOVING database currently includes 234 policy actions from 12 countries. The MOVING database is a logical and practical tool, allowing users to search for policy actions categorised in the structure of the MOVING framework. Conclusion The MOVING physical activity framework and database are innovative tools that support reporting, categorising and monitoring of physical activity policy actions that will work alongside the NOURISHING framework and database. These physical activity policy tools allow stakeholders such as researchers, civil society organizations and policy makers to quickly identify both gaps and strengths in government action and therefore assess where there is scope for improvement within and across countries.

Background Global research shows a strong link between physical activity and risk of developing non-communicable diseases. To increase physical activity levels, governments must design and implement a comprehensive set of policy actions across a range of areas. To aid governments in this process, the MOVING benchmarking tool was developed to assess the strength of policies across three domains that make up a comprehensive approach to physical activity policy. Methods The MOVING benchmarking tool, which was developed using a consultative process that reviewed evidence on physical activity policy design and existing benchmarking tools, built on the policy areas of the MOVING framework. It values the strength of policy design, based on evidence-informed and aspirational attributes of effective policy-making that impacts health-related behaviours, with a focus on adolescents. The tool was applied to a set of physical activity policies from five countries: Netherlands, Norway, Poland, Portugal and UK. These countries were selected based on their participation in the EU-funded CO-CREATE project, which focuses on prevention of overweight and obesity among adolescents. Relevant physical activity policies in each participating country were identified based on a comprehensive scan, with a set methodology. Results The MOVING benchmarks assessed the strengths and weaknesses in the design of policies across the policy areas of the MOVING policy framework. They produced an overall assessment of policy environments for physical activity across the five countries, as well as an assessment of each individual policy area within the framework, such as walking and cycling infrastructure and active transport. Further, by allowing a fast assessment of many physical activity policies, the benchmarking tool enabled an analysis of the interplay of single policies and drawing conclusions about the overall policy environment in the five countries. Conclusion The MOVING benchmarking tools can identify gaps and assess the strength of actions taken by national governments to promote physical activity, and can be used by policymakers, researchers and civil society to inform advocacy for and design of policies. The scores generated by the benchmarking tool will be amalgamated into an overall policy index for 27 European countries.

Background Global research shows a strong link between physical activity and risk of developing non-communicable diseases. To increase physical activity levels, governments must design and implement a comprehensive set of policy actions across a range of areas. To aid governments in this process, the MOVING benchmarking tool was developed to assess the design and strength of countries' policies in promoting physical activity, as well as gaps in policy action. Methods The MOVING benchmarking tool was developed using a consultative process that reviewed evidence on physical activity policy design, existing benchmarking tools and built on the policy areas of the MOVING framework. The tool values the strength of policy design based on policy attributes that are evidence-based and aspirational - regardless of whether any countries have implemented them. The tool was applied to a set of physical activity policies from five countries participating in? CO-CREATE?, a European Commission-funded project: Netherlands, Norway, Poland, Portugal and UK. Physical activity policies that are currently implemented in these countries were identified based on a comprehensive country scan, with a set methodology. A set of policies from each country corresponding to benchmarks on access to quality public open space and green spaces and community and mass participation initiatives were analysed. The policies were assessed by applying the benchmark corresponding to the relevant policy area Results The benchmarking tools easily identified the strengths and weaknesses in the design of each policy. Thus, the benchmarking tool identified where there was scope for improvement in specific policy area for each country, such as walking and cycling infrastructure and active transport. It also allowed comparisons between countries for specific policy areas. Further, by allowing a fast assessment of many physical activity policies, the benchmarking tool enabled an analysis of the interplay of single policies and draw conclusions about the overall policy environment in the selected countries. Conclusion The MOVING benchmarking tool can inform the development and implementation of policies which promote physical activity. It can be used by government policy-makers, researchers and civil society organisations to identify areas of physical activity policy that require government action. The scores generated by the benchmarking tool will be amalgamated into an overall policy index for 27 European countries.

This document is an addition to the detailed research protocol for The effect of working at home versus at the office on risk of transmission of SARS-CoV-2 and other respiratory agents. The RCT has been registered in clinical trials (NCT05298488). This document was posted online before the analysis of the data and the unblinding took place.

BackgroundObservational studies have reported an association between use of eye protection and reduced risk of SARS-CoV-2 infection and other respiratory viruses, but as for most non-pharmaceutical interventions for infection control, no randomized trials have been conducted. We conducted a randomized trial to evaluate the effectiveness of recommending the use of glasses in public as protection against being infected with SARS-CoV-2 and other respiratory viruses.Methods and findingsThis was a pragmatic, randomized, trial in Norway from 2 February to 24 April 2022 where all adult members of the public who did not regularly wear glasses, had no symptoms of COVID-19 and no COVID-19 in the last 6 weeks, were eligible. Participants randomized to the intervention group were asked to wear glasses (e.g. sunglasses) for 2 weeks when close to others in public spaces. The primary outcome was positive COVID-19 test result notified to the Norwegian Surveillance System for Communicable Diseases (MSIS). Secondary outcomes included positive COVID-19 test result based on self-report and episode of respiratory infection based on self-report of symptoms. We randomized 3717 participants. All were identified and followed up in the registries and 87% responded to the end of study-questionnaire. The proportions with a notified positive COVID-19 test in the national registry were 3.7% in the intervention group (68/1852) and 3.5% (65/1865) in the control group (95% CI for risk difference -1.0% to 1.4%; relative risk 1.10, 95% CI 0.75 to 1.50). The proportions with a positive COVID-19 test based on self-report were 9.6% and 11.5% (95% CI for risk difference -3.9% to 0.1%; relative risk 0.83, 95% CI 0.69 to 1.00). The risk of respiratory infections based on self-reported symptoms was lower in the intervention group (31% vs. 34%; 95% CI for risk difference -3.3% to -0.3%; relative risk 0.90, 95% CI 0.82 to 0.99).ConclusionsOur results indicate that asking people to wear glasses may protect the public against respiratory infections, but the findings are not certain, and the study needs replication. Although the evidence is uncertain, and the effect probably modest at best, wearing glasses may be worth considering as one component in the infection control toolbox since it is a simple, low burden, and low-cost intervention, with few negative consequences.Trial registrationClinicalTrials.gov Identifier: NCT05217797FundingThe costs of running the trial were covered by the Centre for Epidemic Interventions Research (CEIR), Norwegian Institute of Public Health. The authors received no specific funding for this work

Background: Considering the large health burden of physical inactivity, effective physical activity promotion is a “best buy” for noncommunicable disease and obesity prevention. The MOVING policy framework was developed to promote and monitor government policy actions to increase physical activity as part of the EU Horizon 2020 project “Confronting Obesity: Co-creating policy with youth (CO-CREATE).” Method: A scanning exercise, documentary review of key international policy documents, and thematic analysis of main recommendations were conducted. Themes were reviewed as part of a consultation with physical activity experts. Results: There were 6 overarching policy framework areas: M—make opportunities and initiatives that promote physical activity in schools, the community, and sport and recreation; O—offer physical activity opportunities in the workplace and training in physical activity promotion across multiple professions; V—visualize and enact structures and surroundings that promote physical activity; I—implement transport infrastructure and opportunities that support active societies; N—normalize and increase physical activity through public communication that motivates and builds behavior change skills; and G—give physical activity training, assessment, and counseling in health care settings. Conclusions: The MOVING framework can identify policy actions needed, tailor options suitable for populations, and assess whether approaches are sufficiently comprehensive.

BackgroundA systematic review of observational studies indicated that eye protection may be an effective measure to prevent SARS-CoV-2 infections. Randomized trials are needed to assess whether the observed associations are caused by protection of the eye or confounding factors such as other systematic differences between users and non-users of eye protection, co-interventions, or changes in COVID-19 incidence when comparisons were done over time.MethodsPragmatic, virtual, parallel group, 1:1 randomized, superiority trial. We will recruit and randomize participants via an online portal. The trial will be fully remote and virtual without any personal interaction between investigators and participants. All members of the public are eligible who confirm that they are at least 18 years of age, do not regularly wear glasses, have not contracted COVID-19 since December 15th 2021, and are willing to be randomized to wear, or not wear glasses in public when close to other people, for a 2-week period. Persons who are dependent on visual aids but typically use contact lenses are eligible. The participants will be randomized (1:1) to wear glasses (sunglasses or other types of glasses) in public spaces when close to others (public transport, shopping centers etc.), or to the control group. The control group will be asked not to wear glasses in public spaces when close to others. The primary outcome is positive test for COVID-19. We aim to include about 25,000 participants to have a statistical power of 80% to detect a relative risk reduction of 25% for the primary outcome.DiscussionMany have easy access to sunglasses or other glasses. Wearing glasses may provide eye protection and repurposing sunglasses for infection control could be a simple, readily available, environmentally friendly, safe, and sustainable infection prevention measure.Trial registrationNCT05217797 (Clinicaltrials.gov)

The NOURISHING database is a repository of more than 1000 verified nutrition anddiet-related governmental policy actions currently in effect globally. The database isa unique and rich data source on governmental policy actions with a potential fordeveloping tools that capture the overall policy efforts in a country, identify policygaps, and enable cross-national comparisons. Policy actions from a sample of fiveEuropean countries have been benchmarked against aspirational standards using theNOURISHING benchmarking tool. This paper presents the results of the pilot testingfrom the benchmarking process for the construction of the NOURISHING policyindex. The development of the index was guided by existing tools for developingcomposite indicators. The findings from the pilot test indicate that the NOURISHINGpolicy index can identify both policy gaps and cross-national policy differences. Theseresults demonstrate that the policy index merits testing on a larger sample to identifypotential refinements. Pilot test of the NOURISHING policy index—Assessing governmental nutrition policies in five European countries

While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.

Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČ–VO EÚ 00023761; Denmark: Danish Ministry of Health; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of Kazakhstan and WHO Country Office; Kyrgyzstan: World Health Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO; Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro; Norway: Ministry of Health and Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russian Federation: WHO; San Marino: Health Ministry, Educational Ministry; Serbia: This study was supported by the World Health Organization (Ref. File 2015-540940); Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank. The CO-CREATE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 774210. info:eu-repo/semantics/publishedVersion