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Background Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity. Methods The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years. Results Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12). Conclusion The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences. publishedVersion

[No abstract available] HBSC is an international study carried out in collaboration with the WHO/EURO. The International Coordinator is Dr Jo Inchley, University of Glasgow, UK, and the Data Bank Manager is Professor Oddrun Samdal, University of Bergen, Norway. The authors thank and acknowledge the contributions of past and present members of the HBSC Youth Engagement Advisory Group. The HBSC survey is conducted by principal investigators in 50 member countries. HBSC teams are funded by government organizations within their own country peer-reviewed

Arsenic (As) groundwater contamination is common yet spatially heterogeneous within most environments. It is therefore necessary to measure As concentrations to determine whether a water source is safe to drink. Measurement of As in the field involves using a test strip that changes color in the presence of As. These tests are relatively inexpensive, but results are subjective and provide binned categorical data rather than exact determinations of As concentration. The goal of this work was to determine if photos of field kit test strips taken on mobile phone cameras could be used to extract more precise, continuous As concentrations. As concentrations for 376 wells sampled from Araihazar, Bangladesh were analyzed using ICP-MS, field kit and the new mobile phone photo method. Results from the field and lab indicate that normalized RGB color data extracted from images were able to accurately predict As concentrations as measured by ICP-MS, achieving detection limits of 9.2μg/L, and 21.9μg/L for the lab and field respectively. Data analysis is most consistent in the laboratory, but can successfully be carried out offline following image analysis, or on the mobile phone using basic image analysis software. The accuracy of the field method was limited by variability in image saturation, and variation in the illumination spectrum (lighting) and camera response. This work indicates that mobile phone cameras can be used as an analytical tool for quantitative measures of As and could change how water samples are analyzed in the field more widely, and that modest improvements in the consistency of photographic image collection and processing could yield measurements that are both accurate and precise.

Internationally, subjective health complaints have become increasingly prevalent in children. Thus, a comprehensive understanding of the determinants of health complaints is needed to inform effective policies and strategies. This study explores if meeting physical activity and total screen time (TST) recommendations are associated with the risk of reporting health complaints weekly or more. The 2014 Irish Health Behaviour in School-aged Children study collected questionnaire data from 10,474 10-17year olds. Children reported how often they experienced eight health complaints as less than weekly or weekly or more. Children who met moderate-to-vigorous physical activity recommendations were active for 60min/day in the past seven days. Three types of screen based activity were categorised to reflect if children met TST recommendations of ≤2h/day. Poisson regression examined the association between meeting recommendations and the risk of health complaints. The prevalence of individual health complaints ranged from 20.4-44.3% in girls and from 10.1-35.4% in boys. Overall, 5.1% (4.5-5.6%) of girls and 8.7% (7.8-9.5%) of boys met both (physical activity and TST) recommendations, while two thirds of girls (67.3%, 66.1-68.5%) and over half of boys (55.0%, 53.5-56.6%) met neither recommendation. Not meeting TST recommendations was significantly associated with the risk of reporting health complaints while associations with physical activity were less apparent. Children who did not meet either recommendation had a significantly increased risk for six of the health complaints when compared to those who met both recommendations. As health complaints and poor lifestyle behaviours were common in children, population level measures are warranted.

Adolescence, with its change in dietary habits, is likely to be a vulnerable period in the onset of obesity. It is considered that peers have an important role to play on adolescents' diet, however, limited research has examined the role of peers in this context. This study examined the relationship between self-efficacy for healthy eating, parent and peer support for healthy and unhealthy eating and food intake patterns. Participants were 264 boys and 219 girls (N=483), aged 13-18years, recruited from post-primary schools in Ireland. Self-report measures assessed self-efficacy, parent and peer support for healthy eating, and for unhealthy eating. Dietary pattern analysis, a popular alternative to traditional methods used in nutritional research, was conducted on a FFQ to derive food intake patterns. Two patterns were identified labelled 'healthy food intake' and 'unhealthy food intake'. Multi-group modelling was used to evaluate whether the hypothesized model of factors related to dietary patterns differed by gender. The multi-group model fit the data well, with only one path shown to differ by gender. Lower self-efficacy for healthy eating and higher peer support for unhealthy eating were associated with 'unhealthy food intake'. Higher self-efficacy was associated with 'healthy food intake'. Prevention programs that target self-efficacy for eating and peer support for unhealthy eating may be beneficial in improving dietary choices among adolescents.

Background Childhood obesity is an urgent global concern with a complex multifactorial aetiology. Infant feeding behaviours are a potential target for childhood obesity prevention. However, evidence for the effectiveness of interventions to improve infant feeding behaviours is inconsistent, and knowledge of how interventions have been implemented, what aspects work, and why, is lacking. This review aimed to synthesise qualitative evidence about parents' and health-care professionals' views and experiences of infant feeding interventions, and identify factors influencing intervention implementation. Methods A systematic review and synthesis of qualitative evidence was conducted. CINAHL, Medline, PsycINFO, Embase, and SCOPUS were searched from database inception to Sept 25, 2017, for English-language qualitative studies reporting the implementation of infant feeding interventions from the perspectives of health-care workers, parents, or both. 4794 studies were screened using a-priori inclusion and exclusion criteria. Two reviewers independently extracted data and judged quality. A framework synthesis was conducted and GRADE-CERQual was used to assess confidence in findings. This review is registered with PROSPERO, number CRD42016039652. Findings Of 4794 screened studies, 13 UK, US, and Australian-based studies were included. Supportive relationships and environments were integral to the successful implementation of infant feeding interventions for both health-care professionals and parents. Issues with capacity (ie, time and resources) negatively influenced implementation by health-care professionals; for parents, a focus on practical elements and sustainability beyond the intervention was crucial to ensure success. Interpretation This review provides valuable information to enable informed and robust decisions about future infant feeding interventions and policy development, ensuring that these decisions are guided by stakeholder experiences and are cognisant of previous implementation challenges or successes. Methodologically, this study provides an innovative example of using qualitative evidence synthesis to explore factors influencing intervention implementation and engagement from both provider and participant perspectives. This review provides deeper insight into potential interactions between provider and participant experiences, and a comprehensive holistic overview of factors that are important to consider for future infant feeding interventions. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026.

Background Modifiable parental feeding behaviours are implicated in the development of childhood obesity. A lack of outcome standardisation across trials of infant feeding interventions limits examination of intervention effects and mechanisms of change. Core outcome sets (COS) are an agreed-upon minimum set of outcomes that should be measured in trials of a specific health condition. The aim of this research was to develop an infant feeding core outcome set to be evaluated in trials of infant feeding interventions to prevent childhood obesity. Methods Development of the infant feeding COS was conducted in four stages. First, a systematic review identifying all infant feeding outcomes in the extant literature was done. The databases Embase, Medline, CINAHL, CENTRAL, and PsycINFO, were searched for English-language papers, from database inception to Feb 1, 2017, using search terms related to infants (eg, infant), early feeding (eg, complementary feeding), and study design (eg, randomised controlled trial, cohort). Second, a small-group expert stakeholder meeting was held to clarify and discuss identified outcomes. Third was an international e-Delphi outcome prioritisation survey. Fourth, a consensus meeting of expert stakeholders was held. Expert stakeholders included researchers, health-care professionals, parents, and child-care professionals. Findings The systematic review identified 82 infant feeding outcomes. Outcomes were discussed and clarified with 13 stakeholders at the small-group meeting. The e-Delphi study was completed by 79 international stakeholders who rated outcomes for importance of inclusion in the COS. Seven expert stakeholders participated in the consensus meeting. 26 of the identified outcomes from the following nine domains were identified as crucial for inclusion in the COS: breast and formula feeding, introduction of solids, parent feeding practices and styles, parent knowledge and beliefs, practical feeding, food environment, dietary intake, perceptions of infant behaviour and preferences, and child weight outcomes. Interpretation The developed COS is the minimum that should be measured and reported in trials of infant feeding interventions to prevent childhood obesity. Use of this COS will facilitate better synthesis and understanding of intervention effects and is essential to inform development and evaluation of future infant feeding interventions to prevent childhood obesity. Funding Health Research Board Interdisciplinary Capacity Enhancement Award 2015-1026, Irish Research Council New Foundations Award, Health Research Board Trials Methodology Research Network Summer Student Scholarship.

This study evaluated the effects of substituting dietary saturated fatty acids (SFAs) with monounsaturated fatty acids (MUFAs) on postprandial chylomicron (triacylglycerol (TAG), apolipoprotein B-48 (apo B-48) and retinyl ester (RE)), chylomicron particle size and factor VII (FVII) response when subjects were given a standard meal. In a controlled sequential design, 51 healthy young subjects followed an SFA-rich diet (Reference diet) for 8 weeks after which half of the subjects followed a moderate MUFA diet (n=25) and half followed a high MUFA diet (n=26) for 16 weeks. Fasting lipoprotein and lipid measurements were evaluated at baseline and at 8-week intervals during the Reference and MUFA diets. In 25 of the subjects (n=12 moderate MUFA, n=13 high MUFA), postprandial responses to a standard test meal containing RE and 13C-tripalmitin were investigated at the end of the Reference and the MUFA diet periods. Although there were no differences in the postprandial lipid markers (TAG, RE, 13C-TAG) on the two diets, the postprandial apo B-48 response (incremental area under the curve (IAUC)) was reduced by 21% on the moderate MUFA diet (NS) and by 54% on the high MUFA diet (P