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There currently are no mandatory vaccines in Switzerland. However, Swiss federal legislation allows for vaccination mandates in settings where the risk of transmission to vulnerable groups is high, such as healthcare professionals (HCPs) working with vulnerable patients. Since HCPs are trusted information sources, a priority population for COVID-19 vaccination, and potentially subjected to mandates, we investigated HCP perspectives on mandates.A national online survey was administered to HCPs (October 2020-March 2021), including vaccine mandates questions concerning patients (measles) and HCPs (influenza). We qualitatively investigated HCP mandate perspectives through: (1) 34 interviews with HCPs, HCP professional society representatives, and health authorities; (2) a focus group discussion (FGD) with complementary medicine (CM) and biomedical physicians, and Swiss Federal Vaccination Commission members.1933 participants (496 physicians, 226 pharmacists, 607 nurses, 604 midwives) responded to the survey. Quantitative results show all professional groups preferred shared parent-HCP measles vaccine decisions (65%, 54%, 50%, 48%, respectively; p for trend 0.001). Midwives (87%) and nurses (70%) preferred individual influenza vaccination decisions for HCPs, while physicians (49%) and pharmacists (44%) preferred shared employee-employer decisions (p for trend 0.001). Physicians (p .001) and pharmacists (p .01) with CM training favored individual influenza vaccination decisions. Qualitative results show general HCP opposition to vaccine mandates, mainly because participants argued how other approaches, such as HCP training and better information, could encourage uptake. Arguments against COVID-19 mandates included insufficiently documented long-term safety/efficacy data. From participants' perspectives, mandated vaccination should be used as a last resort. Some participants expressed fear that with mandates, notably for influenza and COVID-19, some HCPs might leave their jobs. HCPs were unsure what vaccine mandates would concretely look like in practice, particularly regarding sanctions for non-compliance and enforcement.In Switzerland, HCPs generally were opposed to vaccination mandates. Clarity and guidance are needed from health authorities to better inform discussions around vaccine mandates.

Objectives: Health care professionals (HCPs) play an important role for patients’ vaccination decisions. To counsel patients/clients appropriately, HCPs need current factual knowledge about vaccines and strong communication skills.Methods: We conducted an online survey with physicians, pharmacists, nurses, and midwives in Switzerland (01.11.2020–31.03.2021). We evaluated: 1) interest in vaccination knowledge and counseling training; 2) vaccination recommendation practices; 3) experience with vaccination counseling/administration; 4) comfort level in addressing vaccine hesitancy (VH); 5) perspectives on patient/client VH, delays, and refusals.Results: In total, 1,933 practicing HCPs responded (496 physicians, 226 pharmacists, 607 nurses, 604 midwives). 43% physicians, 31% pharmacists, 15% nurses, and 23% midwives felt comfortable counseling VH patients/clients. 96% physicians, 98% pharmacists, 85% nurses, and 91% midwives were interested in additional vaccination-related training. All professionals mentioned safety, efficacy, and side effects as topics of most interest for additional training.Conclusion: Results demonstrate a high interest among HCPs for additional vaccination-related training. In addition to factual information about vaccination, such training will likely benefit from a communication component, given the low rates of comfort reported by HCPs when counseling VH patients/clients.

Background: Navigating in the COVID-19 “infodemic” and adhering to preventive measures is especially challenging for young people. The use of information sources and political ideology are empirically important factors for adherence behavior. How these two are interconnected and if political ideology on its own contributes to adherence is not yet well established in young people. Objective: This study investigates what role political ideology and political extremism, use of information sources, trust and risk perception play for adhering to preventive measures in young people. Methods: Cross-sectional online survey in a representative random sample of young people aged 15–34 in two German-speaking and one Italian-speaking canton of Switzerland. The hypotheses were tested with logistic regression and multivariate regression analysis. Results: The odds for using the following information sources decreases for young people positioning themselves towards the right pole of the ideology scale: health-based sources 0.90 (CI: 0.84–0.97), news sources 0.93 (CI 0.87–0.997) and other websites 0.83 (CI: 0.75–0.92). In contrast, the odds of using broadcasting sources increases for young people positioning themselves towards the right pole of the ideology scale (OR: 1.08, CI 1.01–1.15). The odds of using social media decreases with higher political extremism (OR 0.88, CI 0.78–0.99). Political extremism was related with lower adherence to preventive measures in young people with low trust in the government, scientists, and journalists. Conclusion: Young peoples' use of information sources is associated with their political ideology and political extremism needs to be taken in account in conjunction with low trust.

In January 2021, the Swiss government introduced the first COVID-19 vaccines and prioritized allocation to at-risk individuals and professionals working with them. Despite this opportunity, vaccine uptake among staff employed in retirement homes and institutes for people with disabilities was suboptimal. This study aimed to capture real-time decision-making about COVID-19 vaccine among staff employed in nursing homes and institutes for people with disabilities in Southern Switzerland. We conducted semi-structured phone-interviews with 25 staff employed in retirement homes and institutes for people with disabilities between February and May 2021, i.e., when participants had to decide whether they wanted to adhere to the priority vaccination programme. Among participants, 21 either signed up for the COVID-19 vaccination or were fully or partly vaccinated at the time of the interview. For most participants, the vaccination choice was a challenging process: information appeared to be lacking and conflicting; numerous moral principles were at stake and contradictory; the way vaccination was organized clashed with the health values to which respondents had been previously exposed; finally, the fear of discrimination for those who decided not to get vaccinated loomed over the vaccination choice. Participants decided for or against vaccination based on principles, traditions, emotions, and a reflexive assessment of the personal vs. collective benefit of the vaccination, the latter being the most common within the investigated sample. This study shows that deciding to get vaccinated against COVID-19 is a nuanced process and that individuals cannot simply be categorized as "novax" or "provax" based on their vaccination decision.

Objectives: Global environmental challenges demand sustainable behaviours and policies to protect human and planetary health. We aimed to summarize the evidence about the factors related to Sustainable Food Consumption (SFC) behaviours of university students, and to propose an operational categorization of SFC behaviours.Methods: Seven databases were searched for observational studies evaluating Sustainable Food Consumption (SFC) among university students and that reported at least one behavioural outcome measure. Qualitative synthesis was conducted, and PRISMA guidelines for reporting were followed.Results: Out of 4,479 unique references identified, 40 studies were selected. All studies examined personal factors, while 11 out of 40 also measured social or situational factors. Except for food waste, females had higher levels of SFC behaviours, but situational factors moderated this association. Knowledge and attitudes showed mixed results. Overall, sustainable food consumers reported healthier lifestyles.Conclusions: Healthy lifestyle of sustainable food consumers suggests possible synergies between human health and sustainability in terms of motivations for food choice. Moderation effects of social and situational factors on personal factors reveal opportunities to design and examine the effects of choice architecture interventions.

Background The Covid-19 pandemic is causing unprecedented disruption and suffering to people across the globe, with a disproportionate toll on the elderly. The development and equitable distribution of a vaccine seems to be the most promising and sustainable route ahead. The goal of this study was to explore older adults’ attitudes towards and beliefs regarding the Covid-19 vaccination in Southern Switzerland. Methods We conducted a qualitative study employing telephone interviews to understand older adults’ attitudes towards and beliefs about the Covid-19 vaccine. No Covid-19 vaccine had yet been approved at the moment of data collection. A convenience and snowball sample of 19 participants was recruited. Participants had to be at least 65 years old, without any hearing impairments, and be resident in the Canton of Ticino. Results Most participants were women (n = 12), Swiss nationals (n = 14), retired (n = 18), resident in urban areas (n = 14), and had obtained a secondary school degree (n = 14). The average age was 75 (SD = 6.04; range = 64–85). We found that the majority of participants were in favor of the vaccination and highlighted its positive consequences, such as the abandonment of current freedom-limiting protective measures. Those participants who were against or unsure about the vaccination had concerns regarding the novelty of the vaccine and its impact on its safety and efficacy, stated they would prefer other protective measures rather than the vaccination, and identified contextual and individual drivers of their concerns. Conclusions Independently from the outbreak’s trajectory, efforts to foster vaccination acceptance should focus on the benefit of relapsing freedom-limiting protective measures. Vaccination strategies should be grounded in an evidence-based, participatory approach, ongoing community engagement, trust-building activities, and communication about vaccine developments and how the vaccine will be combined with other outbreak response measures.

Background Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. Methods Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. Results 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). Conclusion Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

The emergence of the International Social Marketing Association (iSMA) and its affiliated regional associations is a key indicator that social marketing is maturing, both as a community of practice and as a profession. Through these associations, the international social marketing community has developed a consensus definition of the discipline and a consensus list of basic competencies for social marketing certificate programs. The associations are currently working on certification programs and a code of ethics. Continued movement toward professionalization can help social marketers be recognized and valued more highly for their relevant skills, knowledge, expertise, trustworthiness and altruism. At the same time, the discipline must address a number of key challenges and opportunities, to stay relevant and thrive.

We tested whether objectively assessed neighbourhood characteristics are associated with moderate-to vigorous physical activity (MVPA) and cycling in Swiss children and adolescents and assessed the mediating role of the perception of the environment. The cross-sectional analyses were based on data of 1306 participants aged 6–16 years of the population-based SOPHYA study. MVPA was measured by accelerometry, time spent cycling and the perceived environment by questionnaire. Objective environmental parameters at the residential address were GIS derived. In all analyses, personal, social and environmental factors were considered. MVPA showed significant positive associations with perceived personal safety and perceived access to green spaces but not with respective objective parameters. Objectively assessed main street density and shorter distance to the next public transport were associated with less cycling in adolescents. Parents’ perceptions did not mediate the observed associations of the objectively assessed environment with MVPA and cycling. Associations between the environment and physical activity differ by domain. In spatial planning efforts to improve objective environments should be complemented with efforts to increase parental sense of security.

Objectives: This study examined factors associated with COVID-19 vaccination intention at the very beginning of the vaccination campaign in a representative sample of the population in southern Switzerland.Methods: In March 2021, we measured vaccination intention, beliefs, attitudes, and trust in a sample of the Corona Immunitas Ticino study.Results: Of the 2681 participants, 1933 completed the questionnaire (response rate = 72%; 55% female; meanage = 41, SD = 24, rangeage = 5–91). Overall, 68% reported an intention to get vaccinated. Vaccination intention was higher in social/healthcare workers, and increased with age, trust in public health institutions, and confidence in the vaccine efficacy. Prior infection of a family member, predilection for waiting for more evidence on the safety and efficacy of the vaccine, and for alternative protective means were negatively associated with intention.Conclusion: In view of needs of COVID-19 vaccine boosters and of suboptimal vaccination coverage, our results have relevant public health implications and suggest that communication about vaccine safety and efficacy, and aims of vaccination programs, should be bi-directional, proportionate, and tailored to the concerns, expectations, and beliefs of different population subgroups.

Background In 2019, the World Health Organization (WHO) flagged vaccine hesitancy as one of the top 10 threats to global health. The drivers of and barriers to under-vaccination include logistics (access to and awareness of affordable vaccines), as well as a complex mix of psychological, social, political, and cultural factors. Increasing vaccine uptake There is a need for effective strategies to increase vaccine uptake in various settings, based on the best available evidence. Fortunately, the field of vaccine acceptance research is growing rapidly with the development, implementation, and evaluation of diverse measurement tools, as well as interventions to address the challenging range of drivers of and barriers to vaccine acceptance. Annual Vaccine Acceptance Meetings Since 2011, the Merieux Foundation has hosted Annual Vaccine Acceptance Meetings in Annecy, France that have fostered an informal community of practice on vaccination confidence and vaccine uptake. Mutual learning and sharing of knowledge has resulted directly in multiple initiatives and research projects. This article reports the discussions from the 7th Annual Vaccine Acceptance Meeting held September 23–25, 2019. During this meeting, participants discussed emergent vaccine acceptance challenges and evidence-informed ways of addressing them in a programme that included sessions on vaccine mandates, vaccine acceptance and demand, training on vaccine acceptance, and frameworks for resilience of vaccination programmes.

In October 2019, scientists and practitioners gathered in a workshop on Children’s Dietary Measurement and Promotion in Bern, Switzerland. The workshop aimed to establish partnerships for childhood nutrition promotion, monitoring, and measurement in Switzerland. Synergies between research and practice exist, but collaborations are lacking due to the multi-language makeup of the country and to reduced funding. Efforts are needed to bring research, practice, and policy together, to stimulate the valid and affordable measurement of nutrition and eating behavior, and to promote healthier eating in Swiss children. This is timely, given the now century old tradition of Public Health in Switzerland, and the growing importance of lifestyle across the life course. The study of nutrition must move beyond the clinical context to include understanding of the ways in which children eat, what they eat, and what determines such behavior. Combined with clinical data, these measures should provide public health and medical stakeholders the information needed to implement programs helping children and families to obtain and consume a higher-quality diet. In this position paper, we provide an overview of nutrition promotion, monitoring, and measurement in Switzerland, highlighting gaps and opportunities for the way forward.

Novel strategies are needed to address vaccine hesitancy (VH), which correlates with complementary and alternative medicine (CAM). In Switzerland, CAM providers play important roles in vaccine counseling of vaccine hesitant (VH) parents, and traditional vaccination messaging tends to overlook CAM provider perspectives. In the setting of a Swiss national research program on VH, our key strategy has been to work together closely with CAM providers. To assess the feasibility of generating educational human papillomavirus (HPV) vaccine materials that would interest VH healthcare providers (HCPs), we invited four CAM providers to co-author two HPV vaccine review articles for general practitioners. We conducted thematic analysis of CAM provider comments to identify patterns that could complement and improve vaccination messaging from CAM perspectives. We identified several themes and generated an inventory of CAM provider messaging recommendations related to language use, presentation of background information, nuanced statements regarding HPV vaccine efficacy and safety, and communication tools that would be important to VH HCPs. Contrary to our initial expectations, and in an inclusive, respectful atmosphere of open dialogue, we were able to productively finalize our manuscripts. In the opinion of the CAM co-authors, the manuscripts effectively considered the communication needs and perspectives of VH HCPs. Engaging with CAM providers appears to be a feasible and innovative avenue for providing vaccine information and designing communication tools aimed at VH healthcare providers.

Background: In the UK, African communities are a focus of public health efforts to increase uptake of HIV testing. Mobile phone interventions may be an innovative way of reaching migrant groups who are known to face multiple obstacles in accessing mainstream health services. This paper presents findings from a feasibility study that used participatory approaches to investigate the use of a text messaging intervention to encourage HIV testing among migrant African communities. Methods: Participants were recruited in the city of Nottingham by a team of community researchers. They were sent two text messages per week (one on HIV and one on general health) for 12 weeks. Baseline and follow-up questionnaires were completed to measure HIV testing behaviour, HIV-related knowledge and attitudes and general health. Participants’ views on the intervention were solicited. Results: One hundred and sixty-nine participants were enrolled in the study. Follow-up data on HIV testing were obtained for 76 participants (45%) and complete follow-up measures were available from 60 participants (36%). Eight reported seeking an HIV test during the study period. There were statistically significant positive changes in attitudes about HIV and a trend towards increased knowledge about HIV. One-third of participants reported improvements in physical activity levels, diet and stress management following the intervention. The intervention messages and structure were positively evaluated. Conclusion: Well-designed mobile phone messaging proved to be a feasible and acceptable intervention to promote both HIV testing and lifestyle behaviours among African migrant communities in the UK. When co-constructed with communities, they hold considerable promise for overcoming some of the health-related barriers faced by migrant populations in new countries. Future research and service development should focus on exploiting and evaluating this potential in relation to other key health priorities.

Food advertising is widely believed to influence children9s food preferences, although the evidence is not conclusive. This research examined the effects of visual communication on children9s healthy food choices. The children in the study liked foods displayed as cartoons the most, not the drawn foods, but they wanted to consume the foods represented by photos. To motivate healthy-food consumption by children, therefore, it may be more effective to use photos rather than cartoons or other animations. Healthy-food advertisements using a mix of visualizations may maximize the attention to and adoption of healthy food marketed to children.

Objectives: This study explored views of Moroccan migrant women on barriers and facilitators to the organized breast cancer screening program in Brussels (Belgium), and the potential of targeted printed invitations to increase this population's attendance to the program. Methods: We conducted one expert interview with the breast cancer screening program coordinator on current practices and challenges with regards to inviting Moroccan migrant women in Brussels for screening. Secondly, we held focus groups with Moroccan women aged 26-66. Sessions focused on perspectives on breast cancer screening and the existing generic program invitations. Directed content analysis of transcripts was based on the Health Belief Model. Alternative communication packages were developed based on barriers and suggestions from the focus groups. A second round of focus groups looked at the alternative communication packages and their potential to encourage Moroccan migrant women in Brussels to participate in the organized breast cancer screening program. Results: Alternative packages were appreciated by some, but a number of adjustments did not catch participants' attention. Printed communication delivered by post does not appear to be the preferred means of communication to encourage breast cancer screening for Moroccan migrant women in Brussels, nor does it seem appropriate to address the barriers to screening found in this study. Conclusions: The benefit of targeted postal invitation packages for Moroccan migrant women in Brussels seems limited for a variety of reasons. For future research, a large-scale study analyzing the topic in a cross-cultural perspective is warranted.

Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith’s (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370–9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization’s (WHO) NCD Global Action Plan 2013–20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.

Background Evidence for the context-specific influence of parental modelling on physical activity (PA) in childhood remains inconclusive. This nationwide Swiss study assessed the cross-sectional association between objectively measured PA of parents and their children and whether it varied across different levels of sociodemographic and environmental factors. In a second step a structural equation-model (SEM) was used to assess, whether associations between children’s PA and sociodemographic and environmental factors are mediated by the parental PA behaviour. Methods The population-based sample of the SOPHYA-study consisted of 889 children aged 6 to 16 years living in Switzerland and 1059 parents. PA was measured using accelerometers. Information on sociodemographics, sports behaviour, family characteristics, and perceived environment was obtained by telephone interview and parental questionnaire. Objective environmental data was allocated to each family’s residential address using GIS (geographic information system). A structural equation model tested these factors for both independent associations with children’s PA and associations mediated through the parental PA behaviour. Results Parental moderate to vigorous physical activity (MVPA) was associated with MVPA of their children in general (p

Background Monitoring eating behavior of children is critical to understanding risks for developing nutrition-related diseases in later life. While accurately assessing children’s food intake is important, collecting reliable data about children’s food intake remains challenging. Limited validated tools exist, and issues of dietary intake assessment such as recall accurateness, portion size estimation, and participant burden persist. In a previous study conducted in Switzerland, a 7-day food diary assessing eating behavior of school-aged children was developed and tested for reliability, showing high levels of agreement between parents and children. In this study, a shorter, 2-day food consumption record was developed and tested. The objective of this study was to compare the reliability of the two instruments, measuring the level of agreement between children and their parents when reporting a child’s food consumption. Methods A cross-sectional study was conducted in Switzerland (April–June 2014) among 589 children and one of their parents, where 299 completed a 7-day diary and 290 completed a 2-day tick box record. Children and parents independently reported what the child ate at six eating occasions. To assess agreement, Cohen’s Kappa, Kendall’s tau-b and Spearman’s non-parametric correlations were used. Lin’s concordance correlation coefficient and corresponding 95% confidence interval was also computed. Results With the 2-day food record, Kendall’s tau-b correlations ranged from 0.66 (whole grains) to 0.85 (proteins). Kappa values showed moderate to substantial agreement for all food categories, ranging from 0.47 for dairy products to 0.75 for fat meat and fast food. Agreement between child’s and parent’s reporting was similar for both genders. Large Kendall’s tau-b and Spearman’s correlations were found for almost all foods in all school grades. Conclusions The 2-day tick box food record showed a higher level of agreement between parents and children of all ages (7–14) and for both genders as compared to the 7-day food diary. Moreover, the 2-day food record tool simplifies data collection and data entry procedures, while providing reliable data about children’s food intake. Thus, this instrument could be used to reliably collect food intake directly from children without parental involvement.

Peru is undergoing a nutrition transition and, at the country level, it faces a double burden of disease where several different conditions require dietary changes to maintain a healthy life and prevent complications. Through semistructured interviews in rural Peru with people affected by three infectious and noninfectious chronic conditions (type 2 diabetes, hypertension, and neurocysticercosis), their relatives, and focus group discussions with community members, we analyzed their perspectives on the value of food and the challenges of dietary changes due to medical diagnosis. The findings show the various ways in which people from rural northern Peru conceptualize good (buena alimentaci&oacute, n) and bad (mala alimentaci&oacute, n) food, and that food choices are based on life-long learning, experience, exposure, and availability. In the context of poverty, required changes are not only related to what people recognize as healthy food, such as fruits and vegetables, but also of work, family, trust, taste, as well as affordability and accessibility of foods. In this paper we discuss the complexity of introducing dietary changes in poor rural communities whose perspectives on food are poorly understood and rarely taken into consideration by health professionals when promoting behavior change.

Background The FAN Social Marketing program was developed to improve dietary and physical activity habits of families with children in Ticino, Switzerland. The aim of this study was to examine if the effects of the program on children’s food intake differed by intervention group. Methods Effects of the FAN program were tested through a Randomized Controlled Trial. The program lasted 8 weeks, during which participants received tailored communication about nutrition and physical activity. Families were randomly allocated to one of three groups, where the parent received the intervention by the Web (G1), Web + e-mail (G2) or Web + SMS (G3). Children in all groups received tailored print letters by post. Children’s food consumption was assessed at baseline and immediate post intervention using a 7-day food diary. Generalized linear mixed models with child as a random effect and with time, treatment group, and the time by treatment interaction as fixed effects were used to test the impact of the intervention. Results Analyses were conducted with a sample of 608 children. After participating in FAN the marginal means of daily consumption of fruit changed from 0.95 to 1.12 in G1, from 0.82 to 0.94 in G2, and from 0.93 to 1.18 in G3. The margins of the daily consumption of sweets decreased in each group (1.67 to 1.56 in G1, 1.71 to 1.49 in G2, and 1.72 to 1.62 in G3). The change in vegetable consumption observed from pre to post intervention in G3 (from 1.13 to 1.21) was significantly different from that observed in G1 (from 1.21 to 1.17). Conclusions A well-designed Web-based Social Marketing intervention complemented with print letters can help improve children’s consumption of water, fruit, soft drinks, and sweets. The use of SMS to support greater behavior change, in addition to Web-based communication, resulted only in a small significant positive change for vegetables, while the use of e-mail in addition to Web did not result in any significant difference. Trial registration The trial was retrospectively registered in the ISRCTN registry (ID ISRCTN48730279). Electronic supplementary material The online version of this article (10.1186/s12937-018-0334-1) contains supplementary material, which is available to authorized users.

The people and places children eat with can influence food consumption. This study investigates the people and places Swiss school-aged children ate with over a 7-day period and analyses the effects of eating at home with family on food consumption. Children completed a 7-day food diary documenting the foods they consumed, the people with whom they ate, and the place where they ate. Analyses were conducted for all meals and included 9911 meal occasions. Most meals (80.5%) were consumed at home with family. Generalized estimating equations were used to model the effects of the home-family dyad on the child's chance of consuming a certain food while controlling for age, gender and BMI of the child, education, nationality and BMI of the parent. Compared to eating in other dyads (e.g. school-peers or restaurant-family), eating in the home-family dyad was associated with higher consumption of vegetables (+66% and +142% at weekday lunch and dinner and +180% and +67% at weekend lunch and dinner), lower consumption of sweets (-45% and -49% at weekday lunch and dinner; -43% and -49% at weekend lunch and dinner), and fewer soft drinks (-37% and -61% at weekday lunch and dinner; -66% and -78% at weekend lunch and dinner). This study shows the positive influence of eating at home with the family on food consumption in a sample of Swiss children. Interventions and policies that encourage children and parents to eat together at home could serve as effective prevention against a poor diet.

Table S1. Relation between children’s MVPA and parental MVPA in bouts of ≥10 min (linear regression models). (DOCX 21 kb)

Table S1. Total count and percentage of “I do not know” answers by children and their parents (PDF 141 kb)

Comparison of children with and without valid parental measurements. (DOCX 15Â kb)

Some children are inactive on weekends but active on weekdays. Correlates of such behavior remain to be clarified. We assessed school, out-of-school and family correlates of compliance with physical activity (PA) recommendations during weekdays among weekend non-compliant youth in Switzerland. Cross-sectional data collected in 2013–2015 from the SOPHYA study. PA was objectively measured during one week using waist-worn accelerometers. Compliance with PA recommendations (≥ 60 min/day of moderate-to-vigorous PA) was assessed separately for weekend and weekdays. Data on school sport, transport to school, sports club participation, household income, parent's PA and education were collected by phone interview and questionnaires. Data from 540 youth (316 girls) aged 6–16 years were available for analysis. Participants who were compliant to recommendations during weekdays were more frequently boys (50.3% vs. 31.4%, p, Highlights • Correlates of weekday activity among weekend inactive Swiss youth are studied. • 540 children and adolescents measured by waist-worn accelerometry during 7 days. • Sports club participation or having physically active parent related to week activity. • Sports club should be promoted to combat week inactivity among weekend inactives.

Table S2. Consumption of foods stated by children and their parents (PDF 13Â kb)

The launch of two landmark publications on the quality of care in the world's poorest populations, including The Lancet Global Health Commission on high-quality health systems in the Sustainable Development Goals era (September, 2018), is a welcome addition to the ongoing discourse on improving the quality of care that these populations receive. The authors of these reports rightly highlight that the push for universal health coverage in low-income and middle-income countries, as well as the setting of disease-specific targets, will not achieve their desired impact on health outcomes without a focus on improving quality. As such, improving quality of care is essential to meet the health-related targets of the Sustainable Development Goals...

Background: There is a public health need to tackle high levels of undiagnosed (or late diagnosed) HIV amongst the UK's African communities. This research aimed to assess the feasibility and acceptability of using a text messaging intervention to encourage uptake of HIV testing amongst this population in a UK city. Methods: Participatory research adopting a mixed-methods design. Four distinct stages included: [1] Formative Research: Six focus group discussions (FGDs) were conducted with diverse sections of the African community to assess perceptions about HIV and to inform message development (n=48). The Health Belief Model (HBM) was used as an organising framework for data analysis and interpretation. [2] Message Development: SMS messages were developed based on HBM constructs, existing HIV campaigns and FGD findings, and tailored according to language, gender and religion. 12 HIV-related and 12 generic health-related text messages were developed and piloted using elicitation interview processes. [3] Intervention and outcomes: 172 participants were recruited. They received 2 messages per week for 12 weeks. Data was collected in pre and post questionnaire surveys assessing uptake of HIV testing, HIV-related attitudes and knowledge and perceived general health. [4] Evaluation: Acceptability and meaningfulness of the intervention were explored via semi-structured telephone interviews (n=21). Data were analysed using thematic content analysis.

Background: To accomplish the aims of public health practice and policy today, new forms of communication and education are being applied. Social media are increasingly relevant for public health and used by various actors. Apart from benefits, there can also be risks in using social media, but policies regulating engagement in social media is not well researched. This study examined European public health-related organizations' social media policies and describes the main components of existing policies. Methods: This research used a mixed methods approach. A content analysis of social media policies from European institutions, non-government organizations (NGOs) and social media platforms was conducted. Next, individuals responsible for social media in their organ- ization or projects completed a survey about their social media policy. Results: Seventy-five per cent of institutions, NGOs and platforms had a social media policy available. The primary aspects covered within existing policies included data and privacy protection, intellectual property and copyright protection and regulations for the engagement in social media. Policies were intended to regulate staff use, to secure the liability of the institution and social responsibility. Respondents also stressed the importance of self-responsibility when using social media. Conclusions: This study of social media policies for public health in Europe provides a first snapshot of the existence and characteristics of social media policies among European health organizations. Policies tended to focus on legal aspects, rather than the health of the social media user. The effect of such policies on social media adoption and usage behaviour remains to be examined.

Purpose. Increase physical activity in health care employees using health messaging, and compare e-mail with mobile phone short-message service (SMS) as delivery channels. Design. Randomized controlled trial Setting. U.K. hospital workplace. Subjects. Two hundred ninety-six employees (19–67 years, 53% of study Web site visitors). Intervention. Twelve-week messaging intervention designed to increase physical activity and delivered via SMS (n =147) or e-mail (n =149); content tailored using theory of planned behavior (TPB) and limited to 160 characters. Measures. Baseline and 6, 12, and 16 weeks. Online measures included TPB constructs, physical activity behavior on the Global Physical Activity Questionnaire, and health-related quality of life on the Short-Form 12. Analysis. General linear models for repeated measures. Results. Increase in duration (mean h/d) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks. Short-lived increase in frequency (d/wk) of vigorous recreational activity from baseline to 6 weeks. Increase in duration and frequency of active travel from baseline to 16 weeks. E-mails generated greater changes than SMS in active travel and moderate activity (work and recreational). Conclusion. Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure, which is maintained up to 1 month after messaging ends. Both channels were useful platforms for health communication; e-mails were particularly beneficial with hospital employees.

Keywords: behavior change; digital technology; health communication; health education; mobile communication; self-management and monitoring; surveillance

Purpose – The purpose of this paper is to investigate the reasons for participating and not participating in an e-health workplace physical activity (PA) intervention. Design/methodology/approach – Semi-structured interviews and two focus groups were conducted with a purposive sample of employees who enrolled and participated in the intervention and with those who did not complete enrolment, hence did not participate in it. Data were examined using thematic analysis according to the clusters of “reasons for participation” and for “non-participation”. Findings – Reported reasons for participation included a need to be more active, to increase motivation to engage in PA, and to better manage weight. Employees were attracted by the perceived ease of use of the programme and by the promise of receiving reminders. Many felt encouraged to enrol by managers or peers. Reported reasons for non-participation included lack of time, loss of interest towards the programme, or a lack of reminders to complete enrolment. Practical implications – Future e-health workplace behavioural interventions should consider focusing on employees’ needs and motivators to behaviour change, provide regular reminders for participants to complete enrolment and ensure that procedures are completed successfully. Barriers to participation could be identified through formative research with the target population and feasibility studies. Originality/value – This study combines a qualitative analysis of the reasons why some employees decided to enrol in a workplace PA intervention and why some others did not. This study highlights factors to consider when designing, implementing and promoting similar interventions and that could inform strategies to enhance participation in workplace PA interventions.

Purpose The benefits of an active lifestyle are widely documented, yet studies show that only a small proportion of adults engage in sufficient levels of physical activity. The workplace presents an ideal avenue for delivering initiatives to promote physical activity, overcoming commonly cited barriers such as a ‘lack of time’ and providing access to a large intersection of society. The purpose of this study was to (1) explore the types of interventions workplaces implement to promote physical activity among staff, (2) describe the characteristics of those interventions, (3) understand whether these interventions positively impact on activity levels, and (4) assess the methodological quality of studies. Methods A systematic review of workplace physical activity interventions published up to April 2011 was conducted to identify types of interventions and their outcomes. Results Of the 58 studies included, the majority utilized health promotion initiatives. There were six physical activity/exercise interventions, 13 counselling/support interventions, and 39 health promotion messages/information interventions. Thirty-two of these studies showed a statistically significant increase in a measure of physical activity against a control group at follow-up. Conclusions While the studies included in this review show some evidence that workplace physical activity interventions can be efficacious, overall the results are inconclusive. Despite the proliferation of research in this area, there is still a need for more well-designed studies to fully determine the effectiveness of workplace interventions for increasing physical activity and to identify the types of interventions that show the most promise.

Introduction Dietary guidelines aim to inform people of the types of foods and quantities they should consume each day or week to promote and maintain health. The aim of this study was to describe children's dietary behaviors in terms of adherence to the Swiss Society for Nutrition (SSN) dietary guidelines and possible determinants. Methods A cross-sectional study was conducted in September 2010 with 568 children aged 6–12 years old living in Ticino Switzerland. Food intake was collected using 7-day food logs. Adherence with the dietary guidelines from the SSN was assessed according to age group. Results With the exception of fish and cereal/potato intake (adherence rates of 68.5% and 47.9%, respectively), adherence to SSN guidelines was low: 26.9% for meat; 22.7% for eggs; 10.4% for fruit; 9.5% for sweets, snacks & soft drinks; 3.5% for milk & dairy, and 0% for vegetables. Multivariate analysis showed no consistent association between the child or their parent's socio-demographic characteristics and adherence to SSN guidelines. Girls had a higher likelihood of adhering with fruit and meat guidelines: multivariate adjusted odds ratio (95% confidence interval) 1.98 (1.10–3.56) and 1.80 (1.08–2.99), respectively. Children aged 10 to 12 had a lower likelihood of adhering with cereals and potatoes 0.48 (0.29–0.78), and a higher likelihood of adhering with the guideline for eggs 1.78 (1.00–3.15). Conclusion Dietary intake of Ticinese children shows poor adherence with SSN guidelines. Given the lack of specific socio-demographic factors associated with adherence, population-wide interventions to improve dietary intake are necessary., Highlights • Adherence to dietary guidelines of Swiss children aged 6–12 is low. • One out of ten children adheres with fruit intake, none with vegetable intake. • (Non)adherence rates are evenly distributed between socio-economic strata. • 6 to 9 year old children are more likely to meet dairy and cereals guidelines. • Overall adherence to guidelines is not significantly associated with a child's BMI.

We provide a comprehensive review of simple and advanced statistical analyses using an intuitive visual approach explicitly modeling Latent Variables (LV). This method can better illuminate what is assumed in each analytical method and what is actually estimated, by translating the causal relationships embedded in the graphical models in equation form. We recommend the graphical display rooted in the century old path analysis, that details all parameters of each statistical model, and suggest labeling that clarifies what is given vs. what is estimated. We link in the process classical and modern analyses under the encompassing broader umbrella of Generalized Latent Variable Modeling, and demonstrate that LVs are omnipresent in all statistical approaches, yet until directly ‘seeing’ them in visual graphical displays, they are unnecessarily overlooked. The advantages of directly modeling LVs are shown with examples of analyses from the ActiveS intervention designed to increase physical activity.

Increases in pediatric overweight and obesity throughout the European Union (EU) generate concern because of the many associated co-morbidities, psychosocial effects, and economic costs. A variety of policy approaches have been implemented, but counteracting weight gain has proven challenging. Do differences in public opinion about policy options to fight the problem exist among EU countries? We obtained data for our study from the Eurobarometer and include representative samples from all EU Member States plus four prospective countries. Our results suggest strong consistency among EU countries in support for two policies: providing information to parents and more physical activity in schools. For improving children's diets, our data show widespread support for providing parents with information, education programs in schools, and restrictions on advertising. For reducing childhood obesity, more physical activity in schools received the most support followed by education and advertising restrictions. There was very little support for imposing taxes on unhealthy food.