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Background Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. Methods Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the ‘best fit’ framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). Results Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs ‘Consumer Needs & Resources’ (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and ‘Compatibility’ with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs ‘Relative Advantage’ of menu labelling (e.g. improved business image/reputation) and ‘Consumer Needs & Resources’ (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. Conclusion This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration Systematic review registration: PROSPERO CRD42017083306.

BackgroundLittle is known about the impact of being a bystander to bullying. This study compared health outcomes among bullies, victims and bystanders, and investigated actions taken by bystanders when they saw bullying.MethodParticipants included 7522 students aged 12–18 years that completed self-report questionnaires in the 2013/2014 Health Behaviour in School-aged Children survey. Binary logistic regression models (controlled for bully, victim, bystander status and demographic variables) were used to investigate the associations between participation in bullying as a bully, victim and bystander and health outcomes.ResultsOverall, 13.3% of adolescents reported being a bully, 25.1% reported being a victim and 30.5% reported that they saw bullying, in the last couple of months. Bystanders were significantly more likely to experience psychological symptoms (OR 1.355), somatic symptoms (OR 1.392) and low life satisfaction (OR 1.268) than those who were not bystanders. Helping the victim was significantly associated with experiencing psychological symptoms (OR 1.240), somatic symptoms (OR 1.251) and low life satisfaction (OR 1.198). Being a bully was significantly associated with experiencing psychological symptoms (OR 1.382) and not having excellent health (OR 1.252). Victims were significantly more likely to experience psychological symptoms (OR 2.437), somatic symptoms (OR 2.364), low life satisfaction (OR 2.564) and not having excellent health (OR 1.559).ConclusionIn Ireland, being a bystander to bullying is more prevalent in schools than bullying perpetration or victimisation. The impact of being a bystander to bullying needs to be highlighted and included in intervention development.

Objectives: Active transport is documented to have various health benefits for adolescents, but it is not fully understood how it impacts different aspects of mental well-being. We explored whether modes of transport (cycling, walking, public transport or private vehicle) between home and school are associated with mental well-being in children aged 10–17 years, participating in the Irish Health Behaviour in School-aged Children (HBSC) study. Methods: Scores on the WHO-5 Well-being Index, Mental Health Inventory five-item version, self-reported life satisfaction, happiness with self, body satisfaction, excellent self-rated health, and multiple health complaints of 9,077 schoolchildren (mean age: 13.99±1.91 years, percentage girls: 52.2%) were compared across modes of transport, unadjusted and adjusted for gender, age, family affluence and area of residence. Results: Those who reported using public transport (25.3%) reported poorer mental well-being than those who cycled (3.3%), walked (25.0%), or commuted by private vehicle (46.4%) to and from school. The effects were significant, but effect sizes varied, and sociodemographic variables, particularly age, accounted for most of the differences in mental well-being outcomes, since both mental well-being outcomes and patterns of mode of transport were significantly associated with age. The only exception was excellent health, where children who cycled outperformed the other three groups, even when controlling for sociodemographic variables. Conclusions: Cycling has the potential to contribute to self-reported good health in children. Implementing cycle-friendly infrastructure, cycling training, and promoting family cycling could increase the number of children who benefit from using bicycles on the way to and from schools. However, such initiatives need to consider social and environmental determinants and inequalities which influence adolescents’ and their parents’ decisions on modes of transport between home and school.

High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe., info:eu-repo/semantics/published

Understanding the nutritional challenges of low-income families became urgent, even though public health restrictions inhibited face-to-face research. Photovoice, whereby participants use cameras to document their surroundings(4), has been employed in pre-pandemic public health research to understand individuals’ nutritional considerations and habits(5,6). Five distinct themes emerged from the photo-elicited discussions which addressed various stages of the food-related decision-making process: 1) planning, 2) shopping, 3) preparing, 4) eating at home and 5) eating outside the home;and the impact of lockdown on each of them.

Background: Standardisation of outcomes measured and reported in trials of infant-feeding interventions to prevent childhood obesity is essential to evaluate and synthesise intervention effects. The aim of this study is to develop an infant-feeding core outcome set for use in randomised trials of infant-feeding interventions, with children ≤1 year old, to prevent childhood obesity. Methods: Core outcome set development followed four stages: (1) systematic review of outcomes reported in the extant literature; (2) meeting with national and international stakeholders to discuss and clarify identified outcomes; (3) e-Delphi study with national and international stakeholders to prioritise outcomes; (4) meeting with national and international stakeholders to reach consensus on outcomes. Stakeholders in stages 2–4 were paediatricians, general practitioners, nurses, midwives, non-clinician researchers, parents, dieticians, nutritionists, and childcare providers. Results: Twenty-six outcomes were identified for inclusion in the core outcome set. These were grouped in nine outcome domains: ‘breastfeeding 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’. Conclusions: The core outcome set identified in this study is the minimum that should be measured and reported in trials of infant-feeding interventions to prevent childhood obesity. This standardisation of outcomes will enable more comprehensive examination and synthesis of the effects of infant-feeding interventions to prevent childhood obesity.

© 2020 Wiley Periodicals LLC., Objective: (1) To give adolescents and youth a voice and listen to the impact of coronavirus disease 2019 (COVID‐19) in their lives; (2) to identify their coping strategies; (3) present lessons learned to be better prepared for future pandemics. Methods: Six hundred and seventeen participants from 16 to 24 years old (M = 19.2 years; F = 19.1 years) answered the online questionnaire during the pandemic lockdown. Sociodemographic data were analyzed with SPSS version 26 and qualitative data with MAXQDA 2020. Engel's Biopsychosocial model supported the analysis and data presentation. Results: in terms of impacts, stands out: biological—headaches and muscle pain; psychological—more time to perform pleasant and personal development activities, but more symptoms of depression, anxiety, and loneliness, longer screen time, and more substance use; social—increase of family conflicts and disagreements, loss of important life moments, contacts, and social skills, but it allows a greater selection of friendships. Regarding coping strategies, the importance of facing these times with a positive perspective, carrying out pleasurable activities, keeping in touch with family and friends, and establishing routines are emphasized. As lessons for future pandemics, the importance of respecting the norms of the Directorate‐General for Health, the need for the National Health System to be prepared, as well as teachers and students for online learning, and studying the possibility of establishing routines with the support of television. Conclusions: This study illustrates adolescents and young people's perception of the impacts of the pandemic upon them, as well as their competence to participate in the issues that directly affect them. Priorities to mitigate the impact of future pandemics are presented.

Background Childhood obesity is a significant public health challenge that affects approximately one in five children worldwide. Infant feeding practices are implicated in the aetiology of childhood obesity. Infant feeding interventions for childhood obesity are increasingly popular but outcome reporting is inconsistent across trials. Lack of standardisation limits examination of intervention effects and mechanisms of change. The aim of the current project is to develop a core set of infant feeding outcomes for children ≤ 1 year old, to be evaluated in childhood obesity intervention trials. Methods This project will use similar methodology to previous core outcome development research. An infant feeding core outcome set (COS) will be developed in four stages: (1) a systematic review of the literature, (2) discussion and clarification of outcomes in a meeting involving multiple stakeholder perspectives, (3) prioritisation of outcomes using the Delphi technique with an expert panel of stakeholders, and (4) achieving consensus on the COS using the nominal group technique (NGT) consensus meeting. An online Delphi survey will be conducted following the NGT meeting to prioritise outcomes identified in the systematic review. An NGT meeting will be conducted with groups of health professionals, non-clinician researchers, and parents of infants ≤ 1 year old, to achieve final consensus on the infant feeding COS. Discussion This study aims to develop a core outcome set of infant feeding outcomes for randomised infant feeding studies to prevent childhood obesity. This research will improve examination and syntheses of the outcomes of such studies to prevent and reduce childhood obesity. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2180-4) contains supplementary material, which is available to authorized users.

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.

Objectives and design There is growing recognition of the need for effective behaviour change interventions to prevent chronic diseases that are feasible and sustainable and can be implemented within routine health care systems. Focusing on implementation from the outset of intervention development, and incorporating multiple stakeholder perspectives to achieve this, is therefore essential. This study explores the development of the Choosing Healthy Eating for Infant Health (CHErIsH) childhood obesity prevention intervention and implementation strategy to improve infant feeding behaviours. Methods Five qualitative and quantitative evidence syntheses, two primary qualitative studies, and formal/informal consultations were conducted with practice, policy, research, and parent stakeholders. The Behaviour Change Wheel was used to guide the integration of findings. Results The CHErIsH intervention targets parent-level behaviour change and comprises (1) brief verbal messages and (2) trustworthy resources, to be delivered by health care professionals (HCPs) during routine infant vaccination visits. The implementation strategy targets HCP-level behaviour change and comprises (1) a local opinion leader, (2) incentivized training, (3) HCP resources and educational materials, (4) electronic delivery prompts, (5) awareness-raising across all primary care HCPs, and (6) local technical support. Conclusions This study provides a rigorous example of the development of an evidence-based intervention aimed at improving parental infant feeding behaviours, alongside an evidence-based behaviour change strategy to facilitate implementation and sustainability in primary care. This approach demonstrates how to systematically incorporate multiple stakeholder perspectives with existing literature and move from multiple evidence sources to clearly specified intervention components for both the intervention and implementation strategy. Statement of Contribution What is already known? Incorporating insights from practice, policy, and public/patient stakeholders plays a key role in developing behaviour change interventions that are feasible and sustainable and can be implemented within routine health care systems. However, there are limited examples that provide in-depth guidance of how to do this using a systematic approach. What this study adds? This study describes an innovative use of the Behaviour Change Wheel to integrate multiple sources of evidence collected from practice, policy, research, and parent stakeholders to concurrently develop an evidence-based intervention to improve parental infant feeding behaviours and an implementation strategy to facilitate sustainable delivery by health care professionals in routine primary care.

Background: Promotion of good nutrition is essential for reducing the risk of chronic disease and premature death. Evidence shows menu labeling interventions should be implemented in workplaces as part of a comprehensive approach to improve employees’ dietary habits; however, implementation challenges have arisen. This article describes a protocol for a multiple case study to explore the factors that impact on implementation of a calorie menu labeling policy in Irish public hospitals. Methods: Using a multiple case study design, comprising four Irish acute public hospitals, this study will draw on multiple perspectives and sources of evidence (observations followed by interviews, focus groups, and documentary analysis) to allow for a comprehensive depth and breadth of inquiry. Data collection and analysis will be guided by the Consolidated Framework for Implementation Research, bringing together constructs from implementation theories to understand the complexity of implementing policies. Hospitals will be categorized into high and low implementers of the policy based on quantitative data obtained from structured observations. Using framework analysis, within- and cross-case analyses will be performed to identify factors influencing policy implementation and to identify distinguishing patterns across high and low implementers and across hospital direct and indirect stakeholders. Strategies will be employed to ensure rigorous case study research, for example, triangulation, audit trail, reflexivity, and thick descriptions. An integrated knowledge translation approach, where researchers work with stakeholders throughout the research process, will be adopted to facilitate the translation of research into policy and practice. Discussion: This protocol highlights methodological insights in utilizing case study research to gain a greater understanding of the menu labeling implementation process. Study findings will be relevant to policy makers and other stakeholders involved in the rollout of such interventions and will provide a foundation to select and tailor implementation strategies to assist with scale-up of calorie menu labeling across the health service.

Introduction Childhood obesity is a public health challenge. There is evidence for associations between parentsâ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysis This protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged â ¤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infantâ s 2, 4, 6, 12 and 13â month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A costâ outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and dissemination This study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations. The authors would like to thank Charlotte Griffin, Lisa Delaney and Jennifer Cooney who worked as research assistants on this project. We would like to thank the staff at the Mallow Primary Healthcare Centre, in particular Ms Ruth Haugh, Mr Carl Beame and Mr Conor Healy. We would like to thank Dr Phil Jennings and Ms Anne Pardy from the HSE National Healthy Childhood Programme, and Ms Joanne O Halloran from the HSE for their assistance in development and refinement of the infant feeding messages. We would like to thank Holly McGrath for her graphic design work on the intervention materials. We would also like to thank all the attendees of the 2018 CHErIsH Steering Committee meeting for their feedback and input on the project. peer-reviewed

The initiation of complementary feeding (CF; introducing infants to food/drink other than milk) is recommended close to 6 months and not before 4 months of age. Low socio‐economic status (SES) is a determinant of nonadherence to CF recommendations, but there is an evidence gap around reasons for nonadherence among these parents. This study investigated knowledge, attitudes, and practices of disadvantaged families (in terms of SES and social support) and use of guidance for CF, in the Republic of Ireland and Northern Ireland. Parents of infants aged 3–14 months were recruited via community groups. Semistructured focus groups aided by vignettes were used. Data were analysed using an inductive thematic approach. Nineteen focus groups took place with parents (n = 83). A range of factors influence parents when introducing solids. Sources of guidance extend to family, friends, the internet, and commercial resources. Parents experience uncertainty and anxiety during this time, driven by lack of knowledge and conflicting advice. Five major themes were identified: (a) more guidance that is accessible, timely, and respectfully needed; (b) the challenge of choosing safe, nutritious food; (c) “everybody has an opinion”; (d) feelings of inadequacy, embarrassment, and guilt; and (e) decisions are ultimately based on individual circumstances. CF advice should be culturally appropriate, practical, and empowering, emphasising the rationale behind updates to recommendations and consequences of nonadherence. Future training of health professionals for delivery of CF advice and guidance should consider these findings. Compliance with CF recommendations is influenced by health professionals, the wider family, and the commercial baby‐food sector.

MH is a PhD Scholar funded by the Health Research Board under SPHeRE/2013/1. The Health Research Board had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. KC is funded by a grant from the Australian Government’s Medical Research Future Fund. MM received a grant number 2017/24744-0, from the Sao Paulo Research Foundation (FAPESP), Brazil. The authors are solely responsible for the opinions, hypotheses and conclusions or recommendations expressed in this publication, and they do not necessarily reflect FAPESP’s vision. MW holds grants from the UK Medical Research Council to develop guidance on managing interactions between researchers and commercial food and drink companies; and with the UK National Institute of Health Research (NIHR) to evaluate the UK’s Soft Drinks Industry Levy. MW is also funded as Director of NIHR’s Public Health Research Programme.

peer-reviewed Synthesis of effects of infant feeding interventions to prevent childhood obesity is limited by outcome measurement and reporting heterogeneity. Core outcome sets (COSs) represent standardised approaches to outcome selection and reporting. The aim of this review is to identify feeding outcomes used in infant feeding studies to inform an infant feeding COS for obesity prevention interventions. The databases EMBASE, Medline, CINAHL, CENTRAL, and PsycINFO searched from inception to February 2017. Studies eligible for inclusion must examine any infant feeding outcome in children ≤1 year. Feeding outcomes include those measured using self‐report and/or observational methods and include dietary intake, parent–child interaction, and parental beliefs, among others. Data were extracted using a standardised data extraction form. Outcomes were assigned to outcome domains using an inductive, iterative process with a multidisciplinary team. We identified 82 unique outcomes, representing nine outcome domains. Outcome domains were “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.” Heterogeneity in definition and frequency of outcomes was noted in reviewed studies. “Introduction of solids” (59.5%) and “breastfeeding duration” (55.5%) were the most frequently reported outcomes. Infant feeding studies focus predominantly on consumption of milks and solids and infant weight. Less focus is given to modifiable parental and environmental factors. An infant feeding COS can minimise heterogeneity in selection and reporting of infant feeding outcomes for childhood obesity prevention interventions. ACCEPTED peer-reviewed

Background Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices. Methods This review will use the ‘best fit’ framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed. Discussion Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide. Systematic review registration PROSPERO CRD42017083306 Electronic supplementary material The online version of this article (10.1186/s13643-018-0752-3) contains supplementary material, which is available to authorized users.

ObjectiveTo investigate weight concerns among adolescent boys and relationships with health indicators and family factors.DesignAnalysis of the 2010 Health Behaviour in School-aged Children survey of 10–17-year-olds.SettingSchools in the Republic of Ireland.ResultsAmong 6187 boys, 25·1 % reported a desire to lose weight (weight ‘loss’ concern) and 7·7 % reported a desire to gain weight (weight ‘gain’ concern). Both types of weight concerns were associated with poor self-rated health, life satisfaction and happiness, and with more frequent emotional and physical symptoms. Family factors were associated with boys’ weight concerns. In adjusted analyses, the risk of weight ‘loss’ concerns decreased with daily family breakfasts (OR=0·80; 95 % CI 0·66, 0·97). The risk of weight ‘gain’ concerns decreased with frequent family evening meals (OR=0·77; 95 % CI 0·60, 0·99). Ease of communication with mother was associated with a decreased risk of weight ‘loss’ and weight ‘gain’ concerns among boys (OR=0·74; 95 % CI 0·60, 0·90 and OR=0·61; 95 % CI 0·44, 0·82, respectively). An open father–son relationship and having a father present in the home decreased the risk of weight ‘loss’ concerns (OR=0·69; 95 % CI 0·57, 0·82 and OR=0·81; 95 % CI 0·67, 0·98, respectively).ConclusionsBody weight concerns were reported by a sizeable minority of boys and were associated with negative health outcomes. The findings support the need to promote frequent family meals and facilitate open communication in families.

In response to the public health crisis that childhood obesitypresents (1) and in line with policies in other countries(2–4), the Irish government is currently piloting a school-based programme to measure weight and height periodi-cally in all children. While this is notionally a surveillanceinitiative, overweight children will have feedback providedtotheirparents,withleafletsandonlineresourcesthatfocuson healthy lifestyle practices, while obese children will beinvited to a supervised lifestyle programme. Thus, the pro-gramme goes beyond the routine collection of population-level data to describe changes in overweight prevalence overtime and constitutes screening, not surveillance. The dis-tinctionisimportant.Therationaleforsurveillanceissoundand several such initiatives are already well establishednationally (1,5). However, the evidence base for screeningfor childhood obesity is not strong. Definitive adoption of anational screening policy should occur only after carefulconsideration of its potential benefits and harms, recogniz-ing the paucity of scientific evidence.

This study aimed to explore the associations of traditional and cyberbullying victimisation with self-reported health and life satisfaction, and to examine whether involvement in risk behaviours contributes to these health outcomes.We asked questions on involvement in traditional and cyberbullying, risk behaviours, self-reported health and life satisfaction to school children. In total, 318 students aged from 15 to 18 years old in 8 post-primary schools in Ireland completed the survey.Children who were victims of bullying were more likely to report poor health, low life satisfaction and engaging in risky behaviours. Although not statistically significant, we found that cyber victimisation was positively associated with increased reporting of poor health and low life satisfaction.Traditional bullying is the most common type of bullying among school children in Ireland, and overall, seems to have a stronger association with poor health. However, a sizable proportion of children are victims of cyberbullying or of both cyberbullying and traditional bullying. It is, therefore, important to acknowledge, identify and address all types of bullying to improve the health outcomes of children.

Purpose Perceiving oneself as overweight is common and strongly associated with adolescents' subjective well-being. The prevalence of overweight perceptions and their impact on well-being may have increased over the past decade due to an increase in the salience of weight-related issues. This study examines trends (2002–2014) in the prevalence of adolescent overweight perceptions and their association with psychosomatic complaints. Methods Data from 15-year-old adolescents were obtained between 2002 and 2014 in four rounds of the Health Behaviour in School-aged Children study in 33 countries in Europe and North America (N = 187,511). Design-adjusted logistic regressions were used to quantify changes in overweight perceptions over time. Linear modeling was used to assess change in the association between perceived overweight and self-reported psychosomatic complaint burden, adjusting for overweight status. Results Among boys, 10 of 33 countries saw an increase in overweight perceptions between 2002 and 2014, with Russia, Estonia, and Latvia showing the most pronounced year-on-year increases. Only England, France, Germany, and Norway saw an increase in the positive association between overweight perceptions and psychosomatic complaints among boys. Among girls, most countries (28/33) saw no change in the prevalence of overweight perceptions, with the prevalence over 40% in most nations. However, in 12 countries, the association between overweight perceptions and psychosomatic complaints increased among girls, with particularly strong changes seen in Scotland and Norway. Conclusions Evidence is presented which suggests that for adolescent girls in 12 Northern and Western European countries and for boys in four perceiving oneself as overweight may be increasingly deleterious for psychosomatic health. peerReviewed

Few studies have investigated the relative validity of FFQ in young children and no study has investigated the relative validity of changes in children's food intake in a longitudinal context. The aim of the present study was to compare the FFQ of the longitudinal Family Influences on Food Intake study, assessing children's food intake in the previous 3 months, with a 3 d online food record when children were 3 and 7 years old, as well as to investigate the relative validity of changes in food group intake over a 4-year period. Parents (n 89) completed the FFQ and an online food record over three non-consecutive days on two separate occasions (January–April 2008 and 2012). Wilcoxon signed-rank tests and Spearman's correlations were used to compare food group intake and changes in intake assessed using both methods. In 2008, the intake of eleven of the twenty-two food groups was overestimated and that of four food groups underestimated in the FFQ in comparison with the online tool; in 2012, the intake of four food groups was overestimated and that of seven food groups underestimated. Nevertheless, changes in intake did not differ significantly between the two methods for eighteen food groups. Correlations in 2008 and 2012 were, on average, 0·47; correlations between the changes in dietary intake were, on average, 0·26. The results suggest that despite the significant differences between the two methods for a number of food groups at both baseline and/or follow-up, the FFQ can be used to monitor changes in dietary intake for groups of young children.

ObjectiveTo describe the prevalence of ‘graded thinness’ in children aged 11, 13 and 15 years in eleven developed countries and to identify trends in the prevalence of ‘thinness’ (BMI < 17 kg/m2 at age 18 years) by age and gender.DesignCross-sectional study using data collected through self-reported questionnaires.SettingData were taken from the 1997/1998, 2001/2002 and 2005/2006 surveys of the Health Behaviours in School-aged Children (HBSC) Study.SubjectsChildren and adolescents from ten European countries and the USA (n 158 000).ResultsPrevalence of grades 1, 2 and 3 of thinness was higher among 11-year-old students compared with the 13- and 15-year-olds in all countries. A higher prevalence of thinness was observed in girls than in boys. Since 1998 the prevalence of thinness decreased steadily in Czech boys and girls, while it increased for French girls. In the total European sample of females, thinness decreased from 1998 to 2006 (χ2 for trend, P < 0·01). Age-adjusted logistic regression analysis showed that Czech boys and girls, and Flemish and American girls were less likely to be thin in 2006 than in 1998; while a noteworthy increment, even if borderline significant, was observed for French girls with a 41 % increase in the likelihood to be thin.ConclusionsOur findings suggest that thinness is an important overlooked phenomenon with wide variation in prevalence and trends across developed countries. It deserves further longitudinal studies in a multinational context that could increase the understanding of the factors associated with thinness and contribute to developing preventive and nutritional programmes targeted at controlling obesity and chronic diseases, while monitoring thinness.

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.

BACKGROUND: Fruit and vegetable consumption is linked to many positive health outcomes, nevertheless many adolescents do not consume fruit and vegetables on a daily basis.METHODS: Data of 488,951 adolescents, aged 11-, 13- and 15- years, from 33 mainly European and North American countries/regions participating in the cross-sectional Health Behaviour in School-aged Children surveys in 2002, 2006 and 2010, were used to investigate trends in daily fruit and vegetable consumption between 2002 and 2010.RESULTS: Multilevel logistic regression analyses showed an increase in daily fruit and vegetable consumption between 2002 and 2010 in the majority of countries for both genders and all three age groups. A decrease in consumption was noticed in five countries for fruit and five countries for vegetables.CONCLUSION: Overall, a positive trend was noticed, however increases in daily fruit and vegetable consumption are still indicated.

BACKGROUND: The purpose of this study was to assess recent changes in the prevalence of overweight (including obesity) among 11-, 13- and 15-year-olds in 33 countries from 2002 to 2010.METHODS: Data from 25 countries from three consecutive survey cycles (2002, 2006 and 2010) that had at least 80% response rate for self-reported height, weight and age were analysed using logistic regression analysis.RESULTS: Overweight prevalence increased among boys in 13 countries and among girls in 12 countries; in 10 countries, predominantly in Eastern Europe, an increase was observed for both boys and girls. Stabilization in overweight rates was noted in the remaining countries; none of the countries exhibited a decrease over the 8-year period examined. In the majority of countries (20/25) there were no age differences in trends in overweight prevalence.CONCLUSION: In over half of the countries examined overweight prevalence did not change during 2002-2010. However, increasing overweight prevalence was noted in many Eastern European countries over this time period. Overweight prevalence remained high in several countries in Europe and North America. These patterns call for continued research in youth overweight and highlight the need to understand cross-national differences by examining macro-level indicators. Such research should feed into developing sound translations and practices to prevent and reduce overweight in youth.

Background Low to moderate agreement between self-reported and directly measured anthropometry is shown in studies for adults and children. However, this issue needs further evaluation during puberty, a period marked by several transitions. We examined the correspondence of BMI status based on self-reported versus measured anthropometric data among Estonian adolescents with a specific focus on gender and age differences. Methods Self-reported height and weight were determined in a national representative sample of Estonian schoolchildren collected within the framework of the HBSC (health behaviour of school-aged children) survey. Self-reported and directly measured height and weight were collected from 3379 students (1071 aged 11, 1133 aged 13 and 1175 aged 15 years). The standardized HBSC questionnaire was used for collecting self-reported data; direct anthropometric measures were taken after the HBSC questionnaires were completed. The accuracy of the self-reported values by age and gender groups were determined by comparing mean differences, Bland–Altman plots with limits of agreement, Kappa statistics, and by estimation of the sensitivity and positive predictive value for detecting overweight. Results Mean self-reported weight, height and body mass index (BMI) values were significantly lower than corresponding values obtained using direct measurements. Mean differences between self-reported and directly measured weight, height and BMI were largest among 11-year-olds and smallest among students aged 15 years. Underestimation of overweight prevalence (includes obese) showed a graded trend which decreased in older age groups; the difference was greater among girls than boys in all age groups. The mean underestimation of overweight prevalence based on self-reported anthropometry was 3.6 percentage points. The positive predictive value was 72.3 % for boys and 63.4 % for girls. Conclusion A distinct age-related pattern in underestimation of weight, height and prevalence of overweight was found; the bias decreased with increasing age. The mean underestimation of overweight prevalence based on self-reports was small, 3.6 %. Self-reported height and weight remain the method of choice in large surveys for practical and logistical reasons. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1587-9) contains supplementary material, which is available to authorized users.

Summary Effecting positive dietary change is one of the major health challenges facing the government and health professionals and is likely to be influenced by an understanding of the factors that shape food choice. On behalf of the Food Standards Agency, the British Nutrition Foundation recently completed an in-depth, critical review of the factors that influence food choice, attempting to identify effective mechanisms and highlight existing gaps in the evidence base. This article provides a summary of the findings and recommendations of that review.

Objective:The British Nutrition Foundation was recently commissioned by the Food Standards Agency to conduct a review of the government's research programme onAntioxidants in Food. Part of this work involved an independent review of the scientific literature on the role of antioxidants in chronic disease prevention, which is presented in this paper.Background:There is consistent evidence that diets rich in fruit and vegetables and other plant foods are associated with moderately lower overall mortality rates and lower death rates from cardiovascular disease and some types of cancer. The ‘antioxidant hypothesis’ proposes that vitamin C, vitamin E, carotenoids and other antioxidant nutrients afford protection against chronic diseases by decreasing oxidative damage.Results:Although scientific rationale and observational studies have been convincing, randomised primary and secondary intervention trials have failed to show any consistent benefit from the use of antioxidant supplements on cardiovascular disease or cancer risk, with some trials even suggesting possible harm in certain subgroups. These trials have usually involved the administration of single antioxidant nutrients given at relatively high doses. The results of trials investigating the effect of a balanced combination of antioxidants at levels achievable by diet are awaited.Conclusion:The suggestion that antioxidant supplements can prevent chronic diseases has not been proved or consistently supported by the findings of published intervention trials. Further evidence regarding the efficacy, safety and appropriate dosage of antioxidants in relation to chronic disease is needed. The most prudent public health advice remains to increase the consumption of plant foods, as such dietary patterns are associated with reduced risk of chronic disease.

The British Nutrition Foundation recently completed a critical review of the Food Standards Agency's Antioxidants in Food program. The projects funded as part of this program, which addressed biomarkers of oxidative damage, gene expression, supplementation with dietary antioxidants and bioavailability of dietary antioxidants, were evaluated and set within an international context. This paper summarises the findings and recommendations of this review. Although there is a substantial body of evidence that a diet rich in plant foods (particularly fruit and vegetables) conveys health benefits, intervention trials have been unable to demonstrate any causal link between antioxidant supplementation and chronic disease. Difficulties in undertaking such trials with long-term disease endpoints, as is the case with cancer and cardiovascular disease, has led to considerable interest in the identification of robust biomarkers of oxidative damage. However, the relevance of these biomarkers to disease risk remains an issue and little is known about what might be regarded as a normal level of endogenous oxidative damage. The review concluded that the research program should focus on a wider scope of potential mechanisms, rather than antioxidant mechanisms alone. It also recommended that more research is needed on the bioavailability and tissue distribution of antioxidants and the impact of factors such as genotype, age and illness before embarking on a multicentre intervention trial.

Summary It has been hypothesised that high iron stores increase the risk of diseases such as coronary heart disease and cancer. In summary, in spite of the theoretical possibilities that high exposure to either dietary or systemic iron might increase heart disease or cancer risk, the evidence suggests that this is not the case in healthy individuals. However, some questions remain unanswered including the risk of colon cancer in individuals with high dietary iron intakes (either via a high intake of red meat, fortified foods or frequent supplement use). It is probable that much of the non-haem iron will remain unabsorbed, which potentially may damage the colonic mucosa and increase the risk of large bowel cancer. Furthermore, the risk of cardiovascular disease and cancer in individuals who carry a mutation of HFE, the gene for haemochromatosis, many of whom may be asymptomatic, may be greater than the general population, particulary when dietary iron intake is high. This paper summarises the basis of iron metabolism and examines the theoretical reasons for an association between iron and cardiovascular disease (CVD; includes coronary disease, vascular disease & myocardial infarction) and cancer. It also revisits the studies designed to investigate the role of iron in CVD and cancer.

One of the features of FLAIR-FLOW Europe 4 (flairflow.com) is the production of ‘synthesis’ reports that are essentially focussed summaries of a particular topic. Different synthesis reports are written for health professionals, consumer groups and SMEs (food industry) each with an appropriate focus. In the first of a series of 6 synthesis reports for health professionals, this synthesis report provides an overview of dietary fat and cardiovascular disease.

Brigid McKevith and colleagues consider the evidence for the nutritional benefits of antioxidants

Background Positive wellbeing, including high life-satisfaction can buffer against negative outcomes such as psychological disorders. Modifiable lifestyle factors including diet may be associated with maintaining positive wellbeing however; this association is not extensively researched in adolescents. Fruit and vegetables are markers of healthy diet quality whereas sugar sweetened beverages are markers of poor diet quality. This study investigates whether markers of diet quality are associated with wellbeing in adolescents aged 12–18. Methods A cross-sectional, nationally representative sample of adolescents aged 12–18 from the Irish, 2014, Health Behaviour in School-aged Children (HBSC) study (n = 8,995). A two-staged sampling strategy was employed, the sampling frame was post-primary schools across Ireland and schools were randomly selected from 8 geographical regions as the primary sampling units. Classes within schools were the secondary sampling units. School and pupil level response rates were 59% and 84.5% respectively. Adolescents self-completed a health and lifestyle questionnaire. Diet was assessed by consumption frequency of fruit, vegetables and soft drinks that contain sugar. Response options were on a 7 point scale ranging from never to everyday more than once (dichotomised as daily vs. less than daily consumption). Adolescents reported general health as good (excellent/good) or poor (fair/poor). Life-satisfaction was assessed on a scale of 0–10 using the Cantril ladder and defined as high (≤7) or low ( Results Just over one-quarter of adolescents rated their life-satisfaction as low (26.9% (95% CI: 26.0% to 27.8%) and 13.4% (12.6% to 14.1%) rated their general health as poor. Overall, 39.0% (95% CI: 38.0% to 40.0%) of adolescents reported daily consumption of fruit, 44.7 (43.7% to 45.7%) consumed vegetables and 12.8% (12.1% to 13.5%) consumed soft drinks daily. In fully adjusted models, adolescents who did not eat fruit (OR (95% CI:) 1.35 (1.18 1.54)) or vegetables (1.34 (1.18 1.53)) daily and those who consumed soft drinks daily (1.45 (1.20 1.76)) had a significantly higher odds of reporting low life-satisfaction. Similar associations were observed for poor general health. Conclusion Consuming a good quality diet is protective of wellbeing. Though this study is cross-sectional, prior longitudinal research found that diet precedes wellbeing. Daily consumption of fruit/veg is worryingly low. Thus creating supportive environments may increase healthy dietary choices which are important for good general health and wellbeing.

Food choices established during childhood and adolescence tend to persist into adulthood with consequences for long-term health. Yet, to date, relatively little research has examined factors that influence the food choices of children and adolescents from their perspectives. In this article, previous research is extended by examining developmental differences between children's and adolescents' perceptions of factors influencing their food choices. Focus group discussions were conducted with 29 young people from three age groups (9-10, 13-14 and 16-18 years). An inductive thematic analysis identified three key factors as influencing food choices. These factors included intra-individual factors: the link between food preferences and awareness of healthy eating; intra-familial factors: the role of the home food environment; and extra-familial factors: eating away from the home. Findings indicate that there were developmental differences between children's and adolescents' perceptions of factors influencing food choice. Among adolescents, parental control began to diminish and adolescents exercised increased autonomy over their food choices compared with children. To develop effective nutrition interventions, it is important to gather child and adolescent input regarding factors perceived as influencing their food choices. Author has checked copyright DM, 12/12/2013

ObjectiveTo investigate the relationships between weight reduction behaviour among non-overweight schoolchildren and dietary habits, perception of health, well-being and health complaints.DesignAnalysis of the 2006 Health Behaviour in School-aged Children survey, a cross-sectional study involving schoolchildren aged 10–17 years.SettingSchools in the Republic of Ireland.ResultsThe proportion of children (n3599) engaged in weight reduction behaviour (‘dieting’ among non-overweight students) was 10·3 %. Older children, females and those from higher social classes (SC) were more likely to report such behaviour. Non-overweight schoolchildren who reported weight reduction behaviour were less likely than those not engaged in such behaviour to frequently consume sweets, soft drinks, crisps and chips/fried potatoes (OR from 0·39 (95 % CI 0·17, 0·89) to 0·72 (95 % CI 0·53, 0·99)); were more likely to consume diet soft drinks (OR 1·50 (95 % CI 1·03, 2·18); and were more likely to miss breakfast during the week (OR 0·62 (95 % CI 0·48, 0·80). The risk of subjective health complaints increased (OR from 1·47 (95 % CI 1·13, 1·91) to 1·92 (95 % CI 1·48, 2·49)); as did body dissatisfaction (OR 9·17 (95 % CI 6·99, 12·02)), while perception of health and well-being decreased (OR 0·47 (95 % CI 0·36, 0·61)) to 0·54 (95 % CI 0·41, 0·70)). All analyses were controlled for age, gender and SC.ConclusionsWeight reduction behaviour among non-overweight schoolchildren is associated with considerable risk to physical health and emotional well-being. Since the risks associated with such behaviour varies by weight status, health professionals and researchers need to consider these issues in parallel.

Objective: The objective of the study is to examine the relationship between weight-control behaviors and selfreported sociodemographic characteristics, weight status, and perception of body weight in a large, representative sample of adolescents in the West Bank and Gaza Strip territories of Palestine. Method: Self-report measures of sociodemographic characteristics, body weight perception, height and weight, and weight-control behaviors were completed by 8,885 male and female students aged 12–18 years from 405 randomly selected schools as part of the 2003/2004 Palestinian Health Behavior in School-aged Children Study (HBSC). Results: In both genders, dieting to lose weight was common among adolescents and significantly higher among overweight than among underweight or normal weight adolescents. Extreme weight-control behaviors (vomiting, diet pills, or laxatives) and smoking were more common among boys than girls, and extreme weight-control behaviors were particularly common among underweight boys. Older adolescents were less likely than younger adolescents to engage in weight-control behaviors. Perception of body weight as too fat was an influential factor in following an unhealthy diet to lose weight. Discussion: Practices to control weight, particularly extreme and unhealthy weight-control behaviors, are common among adolescents in the Palestinian territories. These findings suggest the need to design appropriate prevention and early intervention programs for adolescents in Palestine.

The Travelling community are an indigenous ethnic group of Irish people with a distinct culture and history of nomadism. Travellers differ from the general population in many aspects, including their lifestyle, culture and treatment by society(1). Based on the most recent census (2006) it is estimated there are 22 435 Travellers in Ireland, of these, 50.8% (11 398) are aged £ 18 years(2). The health status of Travellers is poor in comparison with the general population(3), but there is little information about Travellers¿ dietary habits. Furthermore, there appear to be no published studies investigating the diet of Traveller children in Ireland. Thus, data from the 2006 Irish HBSC Survey were employed to investigate reported food behaviour of school-going Traveller children. peer-reviewed

In 2005 an action plan for educational inclusion, Delivery Equality of Opportunity in Schools (DEIS) was launched in Ireland to ensure the educational needs of children and adolescents from disadvantaged communities are prioritised and effectively addressed. One of the core elements comprise a new integrated School Support Programme (SSP) that will bring together, and build upon, existing interventions for schools and school communities with a concentrated level of educational disadvantage. The School Meals programme is an existing scheme that will continue to provide funding towards provision of food services for disadvantaged schoolchildren. To investigate the dietary habits and related food behaviours of children attending schools that receive support under the SSP, data from the 2006 Health Behaviour in School-aged Children (HBSC) survey was examined. The overall aim of the HBSC survey is to gain insight into and improve the understanding of the health behaviour and well-being of children and adolescents. HBSC is a school-based survey with data collected through self-completion questionnaires administered in the classroom. HBSC Ireland collected data in 2006 from children aged 9‐18 years in primary and post-primary schools (n 10 334). Ethical approval was granted for the study and consent was obtained from schools, parents and children. Schools that took part in the 2006 HBSC survey were checked against the SSP list provided by the Department of Education and Science (1) , resulting in twenty-eight primary and twenty-four post-primary schools. These schools were then matched with schools from the general HBSC sample according to school size, type (e.g. community school) and location (urban or rural). Diet and related lifestyle variables were analysed and compared using c 2 tests.

Factors influencing the food choices of children and adolescents need to be better understood in order to develop effective nutrition interventions to improve food consumption patterns. To date, a comprehensive approach to studying factors influencing children’s and adolescents’ food choices is lacking. In an effort to better understand young people’s perceptions of factors influencing their food consumption, qualitative research was conducted with children and adolescents. Schools were randomly selected from the Department of Education and Science published list of schools in the Western region of Ireland. The schools were based in broad catchment areas that reflect a good demographic mix. One youth centre was also selected. Participants were recruited from, and divided into, three distinct age groups (9‐10 years, 13‐14 years, 16‐18 years) covering late-childhood to-late-adolescence, to allow a consideration of the developmental differences in food choice across childhood and adolescence. These age groups were chosen in recognition that as children grow older and become more independent, lifestyle, social, environmental and developmental influences come into play which can change reverse or alter food consumption patterns established in the home (1) . Ethical approval for the study was received from the Research Ethics Committee of the National University of Ireland, Galway. Six semi-structured focus-group discussions of single-gender groups of boys or girls ranging from 9 to 18 years were employed (N = 29). Each focus group lasted between 40 to 60 minutes. The inductive thematic analysis method was used for analysis of qualitative data (2) . This method permits data analysis to provide a rich and detailed account of data and the themes emerging are strongly linked to the data themselves. Eight key factors were identified as important influences on food consumption. These factors included food preferences, perceptions of healthy eating, family environment, peer influence, school influence, food advertising, lifestyle characteristics and control & choice. Within the broader theme of home food environment, sub-themes of family meal patterns, family food practices, home food availability and food purchasing decisions were identified. There was great variation among the focus groups relating to the frequency and occurrence of family meals. Some children reported that family meals were part of a daily routine, whereas for many adolescents, family meals did not occur on a regular basis. Major barriers to having family meals together included busy schedules of parents and adolescents, extracurricular activities, spending time with friends and the adolescents’ increased desire for autonomy. Among the adolescents, parental control began to diminish and adolescents gained more independence in relation to their food choices. There were also important developmental differences in influences on food choice between children and adolescents of varying ages. Developmental differences refer to the impact of maturational processes and experience on behaviour. For example, peers appeared to be particularly influential in adolescents’ food consumption, however, children did not perceive their friends as an important influence on food choice. The findings suggest that if programs to improve young people’s nutrition are to be effective, they need to gather children’s and adolescents’ views about the factors influencing their food choices and address a broad range of factors. The findings also support the growing body of literature that suggests that family and social environmental factors play an important role in the development of young people’s food consumption patterns (3) .

ObjectivesTo investigate the relationships between food poverty and food consumption, health and life satisfaction among schoolchildren.DesignAnalysis of the 2002 Health Behaviour in School-aged Children (HBSC) study, a cross-sectional survey that employs a self-completion questionnaire in a nationally representative random sample of school classrooms in the Republic of Ireland.SubjectsA total of 8424 schoolchildren (aged 10–17 years) from 176 schools, with an 83% response rate from children.ResultsFood poverty was found to be similarly distributed among the three social classes (15.3% in the lower social classes, 15.9% in the middle social classes and 14.8% in the higher social classes). It was also found that schoolchildren reporting food poverty are less likely to eat fruits, vegetables and brown bread, odds ratio (OR) from 0.66 (95% confidence interval (CI) 0.45–0.87) to 0.81 (95% CI 0.63–0.99); more likely to eat crisps, fried potatoes and hamburgers, OR from 1.20 (95% CI 1.00–1.40) to 1.62 (95% CI 1.39–1.85); and more likely to miss breakfast on weekdays, OR from 1.29 (95% CI 0.33–1.59) to 1.72 (95% CI 1.50–1.95). The risk of somatic and mental symptoms is also increased, OR from 1.48 (95% CI 1.18–1.78) to 2.57 (95% CI 2.33–2.81); as are negative health perceptions, OR from 0.63 (95% CI 0.43–0.83) to 0.52 (95% CI 0.28–0.76) and measures of life dissatisfaction, OR from 1.88 (95% CI 1.64–2.12) to 2.25 (95% CI 2.05–2.45). Similar results were found for life dissatisfaction in an international comparison of 32 countries. All analyses were adjusted for age and social class.ConclusionsFood poverty in schoolchildren is not restricted to those from lower social class families, is associated with a substantial risk to physical and mental health and well-being, and requires the increased attention of policy makers and practitioners.

Cardiovascular disease (CVD) is a leading cause of premature death in the UK and a major cause of ill health and disability. Whilst death rates from CVD have been falling since the late 1970's in the UK, levels of morbidity (such as angina) do not seem to be falling and may even be rising in some age-groups, especially as the population ages. There is broad consensus that lifestyle factors, including physical activity and diet, are fundamental determinants of heart disease risk. Current recommendations to reduce cardiovascular risk include maintaining a healthy body weight, eating five or more portions of fruit and vegetables each day, reducing intake of fat (particularly saturated fatty acids), reducing salt intake and eating one portion of oily fish per week. Although some improvements have been made in recent years (e.g. a reduction in total fat intake), national studies suggest that more effective campaigns are required to increase awareness of the benefits of these dietary changes. The present paper will discuss how the dietary messages relating to CVD are best communicated to the general public and will identify some of the main barriers to their implementation.

The aim of the present study was to compare the response of a range of atherogenic and thrombogenic risk markers to two dietary levels of saturated fatty acid (SFA) substitution with monounsaturated fatty acids (MUFA) in students living in a university hall of residence. Although the benefits of such diets have been reported for plasma lipoproteins in high-risk groups, more needs to be known about effects of more modest SFA-MUFA substitutions over the long term and in young healthy adults. In a parallel design over 16 weeks, fifty-one healthy young subjects were randomised to one of two diets: (1) a moderate-MUFA diet in which 16 g dietary SFA/100 g total fatty acids were substituted with MUFA (n25); (2) a high-MUFA diet in which 33 g dietary SFA/100 g total fatty acids were substituted with MUFA (n26). All subjects followed an 8-week run-in diet (reference diet), with a fatty acid composition close to the UK average values. There were no differences in plasma lipid responses between the two diets over 16 weeks of the study with similar reductions in total cholesterol (PPPPPPPPP

In 2001, the British Nutrition Foundation (BNF) was contracted to evaluate projects from the Antioxidants in Food research programme, now funded by the Food Standards Agency and previously the Ministry of Agriculture, Fisheries and Food. The programme aimed at testing the 'antioxidant hypothesis'.The evaluation was conducted with support and guidance from a Steering Group of experts. The final report sets out BNF's recommendations for the future of the Antioxidants in Food research programme.It was recommended that future research should consider a wider scope of potential mechanisms of action of substances within foods; more emphasis should be placed on studying bioavailability of a range of plant derived substances, and the impact of genotype, age and disease should be investigated.The research programme has been important as it has focused attention on disease prevention rather than on treatment, and has helped progress identification of biomarkers. From human observational and intervention studies there is evidence of an association between a diet rich in plant foods (particularly fruit and vegetables) and health benefits. However, as there is no evidence that any particular nutrient or class of bioactive substances makes a special contribution, currently the most prudent public health advice is to increase vegetable and fruit consumption.

Background Unintentional injury and physical inactivity together are the leading causes for disability and chronic illness in young people. Although the benefits of physical activity are well documented, there is evidence highlighting the risk for injury imposed by physical activity, potentially acting as a barrier for active lifestyle. This study aims to investigate characteristics in the local area that could both provide safe environment associated with decreased risk for injury and increased level of participation in physical activity. Methods Nationally representative data from 10 146 students aged 10–17 years were collected as part of the Irish Health Behaviour in School-aged Children (WHO-HBSC) study. All participating children completed a questionnaire during class time. The questionnaire included questions on injury, participation in physical activity, and their perceptions of the area where they live. Associations between local area perceptions and physical activity and injury are expressed in odds ratios from logistic regression models. Results and Conclusions 43% of Irish children reported a medically attended injury in the previous 12 months and 28% reported that they are physically active for 60 min or more every day. While most local area perceptions were not significantly associated with physical activity or injury, perceptions of safeness of the local area were associated with lower level of injury and higher level of participation in physical activity. These findings highlight the need for safe environment for children to play and live, environment that promotes physical activity, and at the same time, are associated with fewer injuries.