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Purpose: Dietary behaviours may be influenced by perceptions of barriers to healthy eating. Using data from a large cross-European study (N = 5900), we explored associations between various perceived barriers to healthy eating and dietary behaviours among adults from urban regions in five European countries and examined whether associations differed across regions and socio-demographic backgrounds.Methods: Frequency of consumption of fruit, vegetables, fish, fast food, sugar-sweetened beverages, sweets, breakfast and home-cooked meals were split by the median into higher and lower consumption. We tested associations between barriers (irregular working hours; giving up preferred foods; busy lifestyle; lack of willpower; price of healthy food; taste preferences of family and friends; lack of healthy options and unappealing foods) and dietary variables using multilevel logistic regression models. We explored whether associations differed by age, sex, education, urban region, weight status, household composition or employment.Results: Respondents who perceived any barrier were less likely to report higher consumption of healthier foods and more likely to report higher consumption of fast food. ‘Lack of willpower’, ‘time constraints’ and ‘taste preferences’ were most consistently associated with consumption. For example, those perceiving lack of willpower ate less fruit [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.50-0.64], and those with a busy lifestyle ate less vegetables (OR 0.54; 95% CI 0.47-0.62). Many associations differed in size, but not in direction, by region, sex, age and household composition.Conclusion: Perceived ‘lack of willpower’, ‘time constraints’ and ‘taste preferences’ were barriers most strongly related to dietary behaviours, but the association between various barriers and lower intake of fruit and vegetables was somewhat more pronounced among younger participants and women. [ABSTRACT FROM AUTHOR]

What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions., Presence of a north-south gradient with the highest level of overweight found in southern European countries., Intercountry comparisons of overweight and obesity in primary-school children in Europe based on measured data lack a similar data collection protocol., What this study adds Unique dataset on overweight and obesity based on measured weights and heights in 6-9-year-old children from 12 European countries using a harmonized surveillance methodology., Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries., It demonstrates wide variations in overweight and obesity prevalence estimates among primary-school children between European countries and regions., Background Nutritional surveillance in school-age children, using measured weight and height, is not common in the European Region of the World Health Organization ( WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative. Objective To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes. Methods Weight and height were measured in 6-9-year-old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z-scores of anthropometric indices of height, weight and body mass index were calculated. Results A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3−49.0% of boys and 18.4−42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi-country comparisons suggest the presence of a north-south gradient with the highest level of overweight found in southern European countries. Conclusions Overweight among 6-9-year-old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans. [ABSTRACT FROM AUTHOR]

Competing Interests: AB reports unrelated research grants from Boehringer Ingelheim and Astra Zeneca, consulting fees paid to her institution from Boehringer Ingelheim, speaker fees paid to her institution from Hologic and General Electrics Healthcare, and is an advisory board member for Inventiva. PB reports speaker fees from Chiesi Farmaceutici and is a member of advisory boards for Sandoz, Biotest, and Kedrion. MB reports unrelated research grants from Gilead, consulting fees from Gilead, GSK, AbbVie, and Altimmune and speaker fees from Gilead, AbbVie, and Altimmune. PC reports unrelated research grants from Intercept and ANRS/MIE and INCA. PG reports unrelated grants from Gilead and Grifols, consulting fees from Gilead, RallyBio, SeaBeLife, MSD, Ocelot Bio, and Behring, and lecture fees from Pfizer. SH reports research grants from the National Institute for Health and Care Research, UK, and Public Health Scotland, NHS Scotland, and meeting support from EASL. THK reports consulting fees from MSD, Falk Pharma, and Albireo, speaker fees from Gilead, and he has owned stocks in Ultimovacs (unrelated to this topic). AK reports unrelated research grants from Novo Nordisk Foundation, Astra Zeneca, EU Horizon 2020, Innovationfund Denmark, Danish National Research Foundation, and Region of Southern Denmark, consulting fees from Resalis Therapeutics, AlphaSights, Takeda, and Zealand Pharma, royalties from Gyldendal, patents from Region of Southern Denmark and University of Southern Denmark, speaker fees from Norgine, Siemens, Novo Nordisk, and Nordic Bioscience, is an advisory board member for Norgine, Novo Nordisk, Boehringer Ingelheim, and Siemens, is a board member and co-founder of Evido (a small university spinout company developing data models for detection of chronic liver disease in primary care; he has no revenue in the company and receives no payment), and declares receipt of drugs, equipment, or services from Norgine, Siemens, Echosense, and Nordic Bioscience. MPM reports consulting fees from Assembly Bio, Bristol Myers Squibb, Falk Pharma, Gilead, GSK, Inventiva, MSD, Novartis, Otsuka/Visterra, Precision Biosciences, and Preglem/Gedeon Richter, speaker fees from AbbVie, Bristol Myers Squibb, Falk Pharma, Gilead, and MSD, unrelated travel support from AbbVie, Bristol Myers Squibb, Falk Pharma, Gilead, Merck (MSD), and Novartis, and is an advisory board member for Falk Pharma, Gilead, MSD, and Novartis. GS reports lecture fees from Otsuka Lundbeck. SZ-S reports consulting fees from Siemens and unrelated travel support from AbbVie. SK is the Deputy Editor of The Lancet. All other authors declare no competing interests. AK is Secretary General, MB is Public Health Councillor, and SZ-S is Public Health Councillor elect of EASL. The Commissioners are Harry Rutter, Patrizia Carrieri, Shira Zelber-Sagi, Eivind Engebretsen, Sharon Hutchinson, Kristin Voigt, Neil Guha, Annalisa Berzigotti, Georg Schomerus, Pere Gines, Maria Buti, Patrizia Burra, Michael P Manns, Aleksander Krag, Phil Newsome, Vlad Ratziu, Philippe Mathurin, Nuria Fabrellas, Michele Cecchini, Erika Duffell, Volkan Yomuk, Thomas Berg, Achim Kautz, Marcelo Naveira, Liana Gheorghe, and Tom H Karlsen. A Steering Committee governs the work of the Commission, formed by Aleksander Krag, Sabine Kleinert, Patrizia Burra, Michael P Manns, Maria Buti, and Shira-Zelber Sagi, and chaired by Tom H Karlsen.

Adequate levels of physical activity are important for population health. Policy databases can track, monitor, and compare the development and implementation of physical activity policy actions and are populated by different methods. The new MOVING database, developed through the Confronting Obesity: Co-creating Policy with Youth (CO-CREATE) project, collates governmental policy actions designed to increase physical activity and is populated by an in-depth scan of implemented national policy actions. This paper presents lessons learned from conducting the policy scan across 27 European countries. Policy actions were identified using a structured search protocol from preselected sources, assessed against pre-specified inclusion criteria and verified by an in-country expert. 625 eligible national implemented policy actions were identified. Challenges included policy actions falling out of scope, a lack of available information on policy actions, difficulty in identifying policy actions using specific search terms, and increased resource requirements for translation of policy actions into English. The scan indicated improvements, which informed protocol modifications. Identifying the challenges and opportunities around conducting a policy scan is necessary to understand and assess the reliability, validity, and utility of a policy database. The policy scan will help to deliver a comprehensive picture of physical activity policy actions across Europe., (© 2022 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Competing Interests: Declarations of interests IG received support from Fundacion de Investigacion sanitaria and was cofunded by Instituto Carlos III for the present manuscript; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences, Intercept, and AbbVie; and support for attending meetings or travel from Intercept and Gilead Sciences. EB received grants or contracts from Gilead Sciences; received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences and Novo Nordisk; and participated on Data Safety Monitoring Boards or advisory boards for Bristol Myers Squibb, Boehringer Ingelheim, Gilead Sciences, Intercept, Inventiva, and Novo Nordisk. MC received grants or contracts and support for attending meetings or travel from the OECD programme of work for public health. RF received grants or contracts from Gilead Sciences, AbbVie, Roche, and Merck Sharp & Dohme; consulting fees from Gilead Sciences, AbbVie, Janssen, and Pfizer; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences, AbbVie, Merck Sharp & Dohme, and AdamedPG; and support for attending meetings or travel from Gilead Sciences, AbbVie, and Merck Sharp & Dohme. JVL received grants or contracts from AbbVie, Gilead Sciences, Merck Sharp & Dohme; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AbbVie, Gilead Sciences, Intercept, Janssen, and Merck Sharp & Dohme. AL received grants or contracts from the OECD programme of work for public health, which is supported by Ministries of Health, National Governmental Institutions, and intergovernmental organisations, as well as support to present results from OECD analyses to meetings, seminars, and workshops. CL received grants or contracts from the University of Oxford, UK National Centre for Smoking Cessation and Training, and Horizon 2020 of the European Commission; received royalties or licenses from and has patents planned, issued, or pending with Olvos Science (Cretan Iama); received payment for expert testimony from WHO and the European Commission; and participated on Data Safety Monitoring Boards or advisory boards for Merck Sharp & Dohme, Pfizer Hellas, Vianex. MPM received grants or contracts from AbbVie, Eiger BioPharmaceuticals, Bristol Myers Squibb, Dr Falk Pharma, Gilead Sciences, Intercept, Merck Sharp & Dohme, and Roche; received consulting fees from AbbVie, Bristol Myers Squibb, Dr Falk Pharma, Gilead Sciences, Intercept, Merck Sharp & Dohme, Novartis, and Roche; received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AbbVie, Bristol Myers Squibb, Dr Falk Pharma, Gilead Sciences, Merck Sharp & Dohme, and Roche; received support for attending meetings or travel from AbbVie, Bristol Myers Squibb, Dr Falk Pharma, Gilead Sciences, Merck Sharp & Dohme, and Roche; participated on Data Safety Monitoring Boards or advisory boards for Eiger, Dr Falk Pharma, Gilead Sciences, and Roche; and is Associate Editor for Clinical Gastroenterology and Hepatology. NKM received grants or contracts from Merck Sharp & Dohme and Gilead Sciences. MN received grants or contracts from Gilead Sciences, Merck Sharp & Dohme, AbbVie, and Janssen; and was President of the World Hepatitis Alliance (2018–20). CYP received grants or contracts from Takeda, Pliant, and Gilead Sciences; consulting fees from Pliant and Shire (Takeda); and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Takeda, Tillotts Pharma, and Pfizer. BSa received grants or contracts from Bristol Myers Squibb and Sirtex Medical; received consulting fees from Adaptimmune, AstraZeneca, Bayer, Bristol Myers Squibb, BTG, Sirtex Medical, TERUMO, H3 Biomedicine, Incyte, Ipsen, Lilly, and Roche; received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Bayer, Bristol Myers Squibb, Sirtex Medical, TERUMO, Incyte, and Ipsen; and participated on Data Safety Monitoring Boards or advisory boards for Adaptimmune, AstraZeneca, Bayer, Bristol Myers Squibb, BTG, Sirtex Medical, TERUMO, H3 Biomedicine, Incyte, Ipsen, Lilly, and Roche. CS received grants or contracts from BiomX and Galapagos; consulting fees from BiomX; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Falk Foundation. NSc received grants or contracts from Gilead Sciences. MS-B received grants or contracts from the European Commission. CT received grants or contracts from Merck Sharp & Dohme; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences and AbbVie. RB received consulting fees from WHO. HC-P received consulting fees from Orphalan; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Orphalan, Novo Nordisk, GENFIT, Promethera Biosciences, and Intercept. GD received consulting fees from Aligos Therapeutics, Roche, Arbutus Biopharma, Gilead Sciences, Shionogi, Antios Therapeutics; received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences; and participated on Data Safety Monitoring Boards or advisory boards for Janssen, Pharmaceuticals, GlaxoSmithKline, and Aligos Therapeutics. THK received consulting fees from Engitix and Intercept; has stock or stock options in Ultimovacs; received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences, Novartis, and AlfaSigma; and is on the board of the Biomedical Alliance in Europe. ES received consulting fees from Albireo, Mirum, and Alexion; received support for attending meetings or travel from Astellas; participated on Data Safety Monitoring Boards or advisory boards for Albireo, Alexion, and Mirum; and received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Albireo. PB received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Kedrion Biopharma, Biotest, and Chiesi Farmaceutici. MB received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences and AbbVie. SJH received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead Sciences. NF participated on Data Safety Monitoring Boards or advisory boards for Intercept in relation to NAFLD. GM participated on Data Safety Monitoring Boards or advisory boards for Gilead Sciences, Novartis, Pfizer, and AstraZeneca. All other authors declare no competing interests.

Background: To make effective progress towards a global reduction in obesity prevalence, there needs to be a focus on broader structural factors, beyond individual-level drivers of diet and physical activity. This article describes the use of a systems framework to develop obesity prevention policies with adolescents. The aim of this research was to use the group model building (GMB) method to identify young people's perceptions of the drivers of adolescent obesity in five European countries, as part of the EU-funded Co-Create project., Methods: We used GMB with four groups of 16-18-year-olds in schools in each of the five European countries (The Netherlands, Norway, Poland, Portugal and the UK) to create causal loop diagrams (CLDs) representing their perceptions of the drivers of adolescent obesity. The maps were then merged into one, using a new protocol., Results: Two hundred and fifty-seven participants, aged 16-18 years, engaged in 20 separate system mapping groups, each of which generated 1 CLD. The findings were largely congruent between the countries. Three feedback loops in the merged diagram particularly stand out: commercial drivers of unhealthy diets; mental health and unhealthy diets; social media use, body image and motivation to exercise., Conclusions: GMB provides a novel way of eliciting from young people the system-based drivers of obesity that are relevant to them. Mental health issues, social media use and commercial practices were considered by the young people to be key drivers of adolescent obesity, subjects that have thus far had little or no coverage in research and policy., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: Respiratory syncytial virus (RSV) infection in older adults is recognised as an important health issue. We aimed to assess the community burden of RSV in Europe in older adults aged ≥60 years., Methods: This international, prospective, observational cohort study is part of work by the REspiratory Syncytial virus Consortium in EUrope (RESCEU). Participants were recruited through general practitioners' (GPs) offices before two independent RSV seasons. Participants reported weekly about symptoms of acute respiratory tract infection (ARTI) during one RSV season. ARTI patients were tested for RSV during home visits and completed a daily symptom diary. RSV illness included PCR-confirmed ARTI and those showing seroconversion over the season. RSV ARTI was based on PCR alone (ClinicalTrials.gov, NCT03621930)., Results: We recruited 1040 participants (527 in season 2017-2018 and 513 in season 2018-2019) with a median age of 75 years (range 60-100 years). Of these, 1023 (99%) lived independently at home at baseline. RSV illness incidence was 22 out of 527 (4.2%) and 37 out of 513 (7.2%) in the respective seasons. RSV illness did not affect frailty or cardiopulmonary status during the course of the study. No patients were hospitalised or died from RSV illness. In the 36 patients with PCR confirmed RSV ARTI, symptom duration averaged 19 days, while a doctor's visit took place in 11 out of 36 cases (31%). RSV ARTI could not be differentiated clinically from all other ARTIs based on symptoms., Conclusion: This European study showed that RSV is prevalent in community-dwelling older adults and rarely causes severe disease. This suggests that watchful waiting, using a continuity of care approach to identify those who do need more intensive care, is often justified when RSV is suspected in family practice., Competing Interests: Conflict of interest: K. Korsten has nothing to disclose. Conflict of interest: N. Adriaenssens has nothing to disclose. Conflict of interest: S. Coenen reports grants and non-financial support from European Union (EU) Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA) Innovative Medicines Initiative 2 (IMI-2) Joint Undertaking (grant: 116019), during the conduct of the study. Conflict of interest: C. Butler reports grants from the National Institute for Health Research (NIHR) (as NIHR Senior Investigator), grants from the EU Horizon 2020 programme to support the study, grants from the NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance, grants from the NIHR Health for the MedTech and In Vitro Diagnostics Cooperative for innovative diagnostics and monitoring technology to enhance community healthcare, during the conduct of the study; personal fees for advisory board work from Pfizer and Roche Molecular Systems; and grants from Roche Molecular Diagnostics. Conflict of interest: B. Ravanfar has nothing to disclose. Conflict of interest: H. Rutter has nothing to disclose. Conflict of interest: J. Allen has nothing to disclose. Conflict of interest: A. Falsey reports grants from Janssen, Merck, Sharpe and Dohme, and Pfizer, as well as non-financial support for meeting attendance from Sanofi Pasteur, outside the submitted work. Conflict of interest: J-Y. Pirçon is an employee of GlaxoSmithKline Vaccines. Conflict of interest: O. Gruselle is an employee of GlaxoSmithKline. Conflict of interest: V. Pavot is an employee of Sanofi Pasteur. Conflict of interest: C. Vernhes is an employee of Sanofi Pasteur. Conflict of interest: S. Balla-Jhagjhoorsingh is an employee of Janssen Vaccines & Prevention. Conflict of interest: D. Öner is an employee of Janssen Pharmaceutica NV and reports grants from the IMI-2 Joint Undertaking (grant: 116019), during the conduct of the study. Conflict of interest: G. Ispas is an employee of Janssen Pharmaceutica NV. Conflict of interest: J. Aerssens is an employee of Janssen Pharmaceutica NV. Conflict of interest: V. Shinde has nothing to disclose. Conflict of interest: T. Verheij reports grants from Janssen Pharmaceuticals, Becton Dickinson, Abbott and Biomerieux, outside the submitted work. Conflict of interest: L. Bont has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits; however, University Medical Center Utrecht has received major funding for investigator-initiated studies from AbbVie, MedImmune, Janssen, the Bill and Melinda Gates Foundation, Nutricia (Danone) and MeMed Diagnostics; has received major cash or in kind funding as part of the public–private partnership, IMI-2 funded REspiratory Syncytial virus Consortium in EUrope (RESCEU) project from GlaxoSmithKline, Novavax, Janssen, AstraZeneca, Pfizer and Sanofi; has received major funding from Julius Clinical for participating in the INFORM study sponsored by MedImmune; has received minor funding for participation in trials by Regeneron and Janssen from 2015–2017; and has received minor funding for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, Novavax, Pfizer and Janssen. L. Bont is also the founding chairman of the ReSViNET Foundation. Conflict of interest: J. Wildenbeest has nothing to disclose., (Copyright © ERS 2021.)

Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing., Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI)., Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration., Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night., Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.

Background: Car driving is a form of passive transportation associated with higher sedentary behaviour, which is associated with morbidity. The decision to drive a car is likely to be influenced by the 'drivability' of the built environment, but there is lack of scientific evidence regarding the relative contribution of environmental characteristics of car driving in Europe, compared to individual characteristics. This study aimed to determine which neighbourhood- and individual-level characteristics were associated with car driving in adults of five urban areas across Europe. Second, the study aimed to determine the percentage of variance in car driving explained by individual- and neighbourhood-level characteristics., Methods: Neighbourhood environment characteristics potentially related to car use were identified from the literature. These characteristics were subsequently assessed using a Google Street View audit and available GIS databases, in 59 administrative residential neighbourhoods in five European urban areas. Car driving (min/week) and individual level characteristics were self-reported by study participants (analytic sample n = 4258). We used linear multilevel regression analyses to assess cross-sectional associations of individual and neighbourhood-level characteristics with weekly minutes of car driving, and assessed explained variance at each level and for the total model., Results: Higher residential density (β:-2.61, 95%CI: - 4.99; -0.22) and higher land-use mix (β:-3.73, 95%CI: - 5.61; -1.86) were significantly associated with fewer weekly minutes of car driving. At the individual level, higher age (β: 1.47, 95%CI: 0.60; 2.33), male sex (β: 43.2, 95%CI:24.7; 61.7), being employed (β:80.1, 95%CI: 53.6; 106.5) and ≥ 3 person household composition (β: 47.4, 95%CI: 20.6; 74.2) were associated with higher weekly minutes of car driving. Individual and neighbourhood characteristics contributed about equally to explained variance in minutes of weekly car driving, with 2 and 3% respectively, but total explained variance remained low., Conclusions: Residential density and land-use mix were neighbourhood characteristics consistently associated with minutes of weekly car driving, besides age, sex, employment and household composition. Although total explained variance was low, both individual- and neighbourhood-level characteristics were similarly important in their associations with car use in five European urban areas. This study suggests that more, higher quality, and longitudinal data are needed to increase our understanding of car use and its effects on determinants of health.

Objective: To explore the associations of absolute and relative measures of exposure to food retailers with dietary patterns, using simpler and more complex measures., Design: Cross-sectional survey., Setting: Urban regions in Belgium, France, Hungary, the Netherlands and the UK.ParticipantsEuropean adults (n 4942). Supermarkets and local food shops were classified as 'food retailers providing healthier options'; fast-food/takeaway restaurants, cafés/bars and convenience/liquor stores as 'food retailers providing less healthy options'. Simpler exposure measures used were density of healthy and density of less healthy food retailers. More complex exposure measures used were: spatial access (combination of density and proximity) to healthy and less healthy food retailers; density of healthier food retailers relative to all food retailers; and a ratio of spatial access scores to healthier and less healthy food retailers. Outcome measures were a healthy or less healthy dietary pattern derived from a principal component analysis (based on consumption of fruits, vegetables, fish, fast foods, sweets and sweetened beverages)., Results: Only the highest density of less healthy food retailers was significantly associated with the less healthy dietary pattern (β = -129·6; 95 % CI -224·3, -34·8). None of the other absolute density measures nor any of the relative measures of exposures were associated with dietary patterns., Conclusions: More complex measures of exposure to food retailers did not produce stronger associations with dietary patterns. We had some indication that absolute and relative measures of exposure assess different aspects of the food environment. However, given the lack of significant findings, this needs to be further explored.

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children ( n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.

A considerable proportion of European adults report little or no interest in physical activity. Identifying individual-level and environmental-level characteristics of these individuals can help designing effective interventions and policies to promote physical activity. This cross-sectional study additionally explored associations between level of interest and physical activity, after controlling for other individual and environmental variables. Measures of objective and perceived features of the physical environment of residence, self-reported physical activity and other lifestyle behaviors, barriers towards physical activity, general health, and demographics were obtained from 5205 European adults participating in the 2014 online SPOTLIGHT survey. t-Tests, chi-square tests, and generalized estimating equations with negative binomial log-link function were conducted. Adults not interested in physical activity reported a higher BMI and a lower self-rated health, were less educated, and to a smaller extent female and less frequently employed. They were more prone to have less healthy eating habits, and to perceive more barriers towards physical activity. Only minor differences were observed in environmental attributes: the non-interested were slightly more likely to live in neighborhoods objectively characterized as less aesthetic and containing more destinations, and perceived as less functional, safe, and aesthetic. Even after controlling for other individual and environmental factors, interest in physical activity remained a significant correlate of physical activity, supporting the importance of this association. This study is among the first to describe characteristics of individuals with reduced interest in physical activity, suggesting that (lack of) interest is a robust correlate of physical activity in several personal and environmental conditions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Sleep restriction is a risk factor for weight gain and obesity. Few studies have formally investigated the mediating role of energy balance-related behaviours in the sleep - obesity association. The aim of this study was to explore the mediating role of physical activity, sedentary behaviours and dietary habits in the association of sleep duration with obesity in adults in five European urban regions. Data on self-reported sleep duration, energy balance-related behaviours, height and weight and other covariates were collected between February and September 2014 from participants to the SPOTLIGHT survey (N=5900, mean age 52years). Participants were recruited from 60 urban neighbourhoods in Belgium, France, Hungary, the Netherlands and the United Kingdom. Multilevel logistic regression analyses were used to assess the associations of sleep duration, energy balance-related behaviours and obesity and mediating effects were calculated using MacKinnon's product-of-coefficients method. Results indicated that a 1h increase in sleeping time was associated with a 14% lower likelihood of being obese (OR=0.86, 95%CI=0.80; 0.93). Only work-related sedentary behaviour was identified as a statistically significant mediator in the association between sleep duration and obesity for the total sample, and youngest and oldest age group. We did not find evidence for a mediating role of dietary habits and physical activities., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM)., Methods/design: SPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed., Discussion: SPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.

There is growing evidence of social disparities in overweight among European children. This paper examines whether there is an association between socioeconomic inequality and prevalence of child overweight in European countries, and if socioeconomic disparities in child overweight are increasing. We analyse cross-country comparisons of household inequality and child overweight prevalence in Europe and review within-country variations over time of childhood overweight by social grouping, drawn from a review of the literature. Data from 22 European countries suggest that greater inequality in household income is positively associated with both self-reported and measured child overweight prevalence. Moreover, seven studies from four countries reported on the influence of socioeconomic factors on the distribution of child overweight over time. Four out of seven reported widening social disparities in childhood overweight, a fifth found statistically significant disparities only in a small sub-group, one found non-statistically significant disparities, and a lack of social gradient was reported in the last study. Where there is evidence of a widening social gradient in child overweight, it is likely that the changes in lifestyles and dietary habits involved in the increase in the prevalence of overweight have had a less favourable impact in low socio-economic status groups than in the rest of the population. More profound structural changes, based on population-wide social and environmental interventions are needed to halt the increasing social gradient in child overweight in current and future generations.