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Background: In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity., Objectives: It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children., Method: Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed., Results: The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies., Conclusion: The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Background: This cross-sectional study aims to assess the 12-month prevalence of major and minor depression in the Latvian population, and to evaluate associated health care utilization., Methods: Trained interviewers conducted face-to-face interviews with a multistage stratified probability sample of the Latvian general population, ages 15-64 (n=3003). Participants were interviewed using the depression module of the Mini International Neuropsychiatric Interview. Self-reported health care utilization and somatic illness were also assessed. Multinomial logistic regressions were applied., Results: The 12-month prevalence of major depression was 7.9% (95%CI 7.0-8.9), while for minor depression it was 7.7% (95%CI 6.8-8.7). We did not find a substantial difference in the relative risk ratio (RRR 1.7 for female) for having major depression by gender. RRR of having major depression was higher for those who had used healthcare services six or more times (RRR 2.0), those who had three or more somatic disorders during the past 12 months (RRR 2.3), those who perceived their health status as being below average (RRR 8.3), and those who were occasional smokers (RRR 3.0). RRR of having minor depression was increased for those who had at least three somatic disorders (RRR 2.3), those who received disability pension (RRR 1.9), and those who perceived their health status to be below average (RRR 3.0)., Limitations: The study was cross-sectional. Other psychiatric comorbidity was not assessed., Conclusions: This is the first population based study reporting the 12-month prevalence of depression in Latvia. Certain factors associated with depression have been found., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Aims: Suicide rates in Latvia are among the highest in the EU. Among 18-25 year-old young adults, it is the second leading cause of death. This study investigates the prevalence of self-reported suicide attempts in young adults and examines its association with neglect or violence of a physical, emotional or sexual nature., Methods: A questionnaire was administered to 1259 young adults 18-25 years of age, selected by targeted quota sampling from secondary and vocational schools., Results: The prevalence of self-reported suicide attempts was 6.1%. Physical and emotional adverse experiences showed clear associations with attempted suicide. Although prevalence of reported physical neglect was higher than for physical violence (27.0% versus 16.3%, respectively) the latter posed a higher risk for attempted suicide (OR = 4.0; 95% CI, 2.4-6.6). Conversely, emotional violence had a higher prevalence than emotional neglect (31.5% vs. 23.6%, respectively), but neglect showed a stronger association with attempted suicide (OR = 4.4; 95% CI, 2.6-7.3). CONCLUSIONS THE HIGH OR FOR ATTEMPTED SUICIDE ASSOCIATED WITH EMOTIONAL NEGLECT, TOGETHER WITH FINDINGS THAT EMOTIONAL VIOLENCE HAD THE HIGHEST PREVALENCE, AND THAT EMOTIONAL NEGLECT AND EMOTIONAL VIOLENCE SHOWED THE HIGHEST POPULATION ATTRIBUTABLE RISK FRACTION POPAR% OF 468 AND 404, RESPECTIVELY, SUGGESTED THAT EMOTIONAL FACTORS MERIT SPECIAL ATTENTION IN FURTHER INVESTIGATIONS OF ATTEMPTED SUICIDE AMONG YOUNG ADULTS IN LATVIA THE TARGETED QUOTA SAMPLING METHOD FROM FIVE CITIES REPRESENTING ALL REGIONS OF LATVIA AND 438% OF ITS POPULATION, ENSURE NATIONAL RELEVANCE OF OUR FINDINGS FOR POLICY AND PROGRAM DEVELOPMENT BY LEGISLATIVE, EDUCATIONAL AND PUBLIC HEALTH INSTITUTIONS., (© 2016 the Nordic Societies of Public Health.)

Background: The fact that Latvia is among the countries with the highest suicide mortality rates in the European Union highlights the importance of research in this field., Aims: The aims of the study were to determine the 2010 prevalence of self-reported suicidal behaviours in Latvia, to identify sociodemographic risk factors and to examine sequences for reporting of suicidal behaviours., Methods: Computer assisted personal interviews were carried out to gather information on a representative sample of the Latvian population aged 18 to 64 (n = 2816). The study sample was selected using a combination of stratified random sampling and quota methods., Results: Last year prevalence of any type of suicidal behaviour was 18.5% - nearly threefold lower than observed in 2000 (52.6%). Middle age, non-cohabitation status and lower level of education were significant risk factors for serious types of suicidal behaviour (suicidal ideation, suicidal plans, suicide attempts) among men, but only lower level of education was for women. Risk factors regarding mild types of suicidal behaviour (life-weariness, death wishes) were the same for men and women: older and middle aged, non-cohabitation status, and lower level of education. A total of 79.6% reported a continuous pattern of suicidal behaviours., Conclusions: Several sociodemographic risk factors for suicidal behaviours have been found. Further research is needed to clarify additional risk factors, especially in the high-risk groups studied and specific determinants contributing to reduction in prevalence of suicidal behaviours and suicide mortality in Latvia.

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention., Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries., Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated., Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed., Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

Objective: To evaluate the association between adverse childhood experiences - e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration - and the health of young adults in eight eastern European countries., Methods: Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10,696 respondents - 59.7% female - aged 18-25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide., Findings: Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of health-harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval, CI: 1.32-2.15) - for physical inactivity - to 48.53 (95% CI: 31.98-76.65) - for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population., Conclusion: Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in eastern European.

Background: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010., Methods: Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses., Results: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from -0.4 to +0.3) and BMI-for-age Z-scores (range: from -0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway., Conclusions: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation.

Aims: The main aim of this paper was to investigate whether ethnic heath inequalities exist in self-rated health and risk-taking behaviours (smoking, drunkenness, use of cannabis) between ethnic majority (Estonian, Latvian, Lithuanian) and minority (Russian) population groups of school-aged children in three Baltic countries., Methods: Investigation was carried out in the framework of Health Behaviour in School-aged Children (HBSC) study. Randomly selected students aged 11, 13, and 15 years answered questionnaires in the classroom in 2006. In total, 14,354 questionnaire forms were selected for analysis., Results: Russian boys were more likely (p<0.05) to evaluate their self-rated health positively in schools with Russian teaching language. Odd ratios for current smoking and drunkenness were significantly lower among Russian boys in the schools with Russian language of instruction (p<0.05) in comparison with the reference group. Russian girls did not differ significantly (the exceptions were smoking in Estonia and cannabis use in Latvia) from the majority population girls by self-rated health as well as by the risk of smoking, drunkenness, and use of cannabis., Conclusions: The study found some differences in self-rated health and in risk-taking behaviours between Russian minority and ethnic majority students as well as between students of schools with different language of instruction (majority language vs. Russian) in Estonia, Latvia, and Lithuania. Being a member of minority group was not related with poor self-rated health or involvement in risk-taking behaviours in school-aged children in the Baltic countries.

Background: Childhood obesity is now firmly on the political agenda in western Europe but has received rather less attention in the eastern region of the European Union. This is a situation that cannot continue forever, especially in the light of evidence of the future social and economic cost of failure to act., Methods: Semi-structured interviews with key stakeholders in Latvia were conducted in October 2004 to understand the Latvian response to childhood obesity and, specifically, to soft drink consumption as one of its key risk factors. Analysis was undertaken using the established principles of stakeholder analysis to assess the position and influence of the stakeholders on consumption of soft drink consumption within broader efforts to curb obesity in children., Results: Twenty interviews were conducted and no one refused to be interviewed. Most stakeholders were concerned or convinced of the importance of restricting soft drinks consumption as part of initiatives to prevent childhood obesity. The most influential and supportive stakeholders were high school and primary school directors and parent groups., Conclusion: These findings help elucidate the actions of the Latvian government in November 2006 when it moved to ban certain foods and drinks from schools based on a concern for the adverse impact of additives on child health. The rapidity with which this poorly evidenced decision took place may have been supported by the unique context of an unstable government, nutrition leadership in dissolution, relatively weak industry influence and a surprisingly strong movement of teachers and parents.

Objectives: To investigate the prevalence of bullying among adolescents in Latvia and Lithuania and to study its association with self-rated health, health complaints, and life satisfaction., Methods: A total of 3417 students in Latvia and 5626 in Lithuania were surveyed using the Health Behaviour Study among School-aged Children 2001/2002 (HBSC) questionnaire and research protocol., Results: Being a victim, bully, or bully/victim was reported by 30.1% adolescents in Latvia and 52.3% in Lithuania with the highest proportion reporting being a victim. Bullying was associated with poor subjective health and low life satisfaction., Conclusions: The factors explaining the difference of bullying prevalence between both countries should be studied to develop effective anti-bullying interventions relevant to local conditions.

Background: Despite the relatively low recorded alcohol consumption level, the Baltic countries (Estonia, Latvia and Lithuania) and neighbouring Finland suffer from similar harmful consequences related to the use of alcoholic beverages, including socio-economic inequalities in alcohol related mortality. Comparative evidence is needed to understand harmful drinking patterns and to implement preventive alcohol policies also in the Baltic countries. This study compared heavy and binge drinking by sex, age, education, urbanisation and marital status in the Baltic countries and Finland. The data were nationally representative postal surveys conducted in Estonia (n = 6271), Latvia (n = 6106), Lithuania (n = 7966) and Finland (n = 15764) during 1994-2002. The criterion for heavy drinking was at least 15 portions weekly among men, and at least five among women, and for binge drinking at least six portions per one occasion. Heavy drinking was more common among younger participants in all countries, and in Latvia among the less-educated. Among Finnish men, and among women from all countries except Latvia, the better-educated were more often heavy drinkers. In Latvia and Finland, urban men, and in all countries, urban women, were more often heavy drinkers. Heavy drinking was more common among non-married Lithuanian and Finnish men, and Finnish women. Binge drinking was more common among less-educated Estonian and Latvian men, and among younger and less-educated women in all countries. Our results support the continued power of traditional drinking habits in the North Eastern part of Europe. In the future the target groups for prevention of excessive drinking should also include young and less-educated women in all four countries studied.

Background: European citizens are increasingly being offered Internet health services. This study investigated patterns of health-related Internet use, its consequences, and citizens' expectations about their doctors' provision of e-health services., Methods: Representative samples were obtained from the general populations in Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia. The total sample consisted of 7934 respondents. Interviews were conducted by telephone., Results: 44 % of the total sample, 71 % of the Internet users, had used the Internet for health purposes. Factors that positively affected the use of Internet for health purposes were youth, higher education, white-collar or no paid job, visits to the GP during the past year, long-term illness or disabilities, and a subjective assessment of one's own health as good. Women were the most active health users among those who were online. One in four of the respondents used the Internet to prepare for or follow up doctors' appointments. Feeling reassured after using the Internet for health purposes was twice as common as experiencing anxieties. When choosing a new doctor, more than a third of the sample rated the provision of e-health services as important., Conclusion: The users of Internet health services differ from the general population when it comes to health and demographic variables. The most common way to use the Internet in health matters is to read information, second comes using the net to decide whether to see a doctor and to prepare for and follow up on doctors' appointments. Hence, health-related use of the Internet does affect patients' use of other health services, but it would appear to supplement rather than to replace other health services.

Background: Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland., Methods: The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11,634) and Finland (n=18,821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms., Results: The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women., Conclusions: The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.

Background: The Baltic countries--Estonia, Latvia, and Lithuania--are considered to be an example of regional homogeneity over the period of transition. The World Health Organization cross-national study on Health Behavior in School-aged Children (HBSC) allows a comparison and time trends analysis of behavioral patterns among adolescents in this region. The aim of this study was to estimate the prevalence and trends of alcohol consumption and drunkenness among adolescents of Estonia, Latvia, and Lithuania in 1993/94, 1997/98, and 2001/02., Methods: Representative samples of 5286 boys and 6485 girls aged 15 from Estonia, Latvia, and Lithuania were surveyed in 1993/94, 1997/98, and 2001/02 school-year within the framework of HBSC study. The standardized survey methods were applied. The research focused on the following outcome variables: i) frequency of drinking beer, wine, and spirits; and ii) frequency of drunkenness. The same wording of questions on the consumption of alcohol was retained in each survey., Results: Beer was the most frequently used alcoholic beverage across the Baltic countries among adolescents. The rate of weekly drinking of any alcoholic beverage increased considerably during the eight years of observation, especially among Estonian and Lithuanian students. In 2001/02, 25% of boys and 12.5% of girls have reported drinking alcohol at least weekly. The rate of regular alcohol drinking was two times higher in boys, while irregular drinking was more prevalent in girls. Two or more episodes of drunkenness in the lifespan were reported by 30% of boys and 15% of girls in 1993/94 and by 52% of boys and 36% of girls in 2001/02. The use of alcoholic beverages was related to the perceived family wealth: the students from the families perceived by them as wealthy were more likely to drink weekly as compared to the students from the families perceived by them as not wealthy., Conclusion: Over the period between 1993 and 2002 the prevalence of alcohol consumption among adolescents increased considerably across the Baltic countries. The efforts of dealing with this problem should employ a combination of measures, including the strategies relevant for the period of transition.

Background: Public health problems in the Baltic countries are typical of Eastern European transition economies. A common assumption is that the economic transition has been particularly difficult for previously disadvantaged groups, and comparative research on the health differences between sociodemographic groups in the Baltic countries is therefore needed. This study compared associations of health with gender, age, education, level of urbanization and marital status in three Baltic countries and Finland., Methods: The data were gathered from cross-sectional postal surveys conducted in 1994, 1996, 1998 and 2000 on adult populations (aged 20-64 years) in Estonia (n = 5052), Latvia (n = 4290), Lithuania (n = 7945) and Finland (n = 12796). Three self-reported health indicators were used: (i) perceived health, (ii) diagnosed diseases and (iii) symptoms., Results: The prevalence of less-than-good perceived health (average, rather poor or poor) was higher in the Baltic countries (men 66-56%, women 68-64%) than in Finland (men 35%, women 31%). The odds ratios (with 95% confidence intervals) of less-than-good perceived health among the low educated compared to the highly educated in Estonia, Latvia, Lithuania and Finland were 2.03 (1.49-2.77), 2.00 (1.45-2.76), 2.27 (1.78-2.89) and 1.89 (1.61-2.20) among men, and 3.32 (2.43-4.55), 2.77 (2.04-3.77), 2.07 (1.61-2.66) and 1.89 (1.63-2.20) among women, respectively. Diseases and symptoms were also more common among the lower educated men and women in all four countries. However, urbanization and marital status were not consistently related to the health indicators., Conclusions: The Baltic countries share a similar sociodemographic patterning of health with most European countries, i.e. the lower educated have worse health. The methodological considerations of this study point out, however, that further research is needed to support public health policies aimed at the most vulnerable population groups.

Background: The Finbalt Health Monitor is a collaborative system for monitoring the health-related behaviour, practices and lifestyles in Estonia, Finland, Latvia and Lithuania. This system is based on nationally representative samples and self-administered mailed questionnaires. In comparing the results of national surveys, the awareness of the direction and socioeconomic patterning of the response bias is essential., Methods: The data were gathered from the cross-sectional surveys conducted in 1998 from Estonia (n = 1362), Finland (n = 3504), Latvia (n = 2322) and Lithuania (n = 1874). An analysis was made of the prevalence of late response, completeness of information obtained from respondents and the magnitude of response bias on the prevalence estimates of health behaviour indicators., Results: The response rates were comparatively high: 68% in Estonia, 70% in Finland, 77% in Latvia and 62% in Lithuania. Late response was weakly related to age, education or place of residence. The total proportion of missing information was below 10% and the sociodemographic patterning for this missing information was similar in all countries. Thus, older and less-educated respondents had more missing information on their questionnaires. Response bias of the prevalence estimates was minimal when it was calculated by using information obtained from late respondents., Conclusions: The level of nonresponse and missing information was comparable in different countries, not information on health behaviour. Therefore special efforts are needed to design a questionnaire form which appears equally relevant to all respondent groups. The follow-up mailings were an effective way to increase the total response rate, but it was unlikely that they provided an effective way to reach the 'hard core' nonrespondents.

Background: Physical inactivity is a known risk factor for heart disease and obesity, two major health problems in the Baltic Republics. This study examined patterns of physical activity level in these countries, and correlates of leisure-time sedentary behavior., Methods: Data from three national surveys of adults conducted in Estonia, Latvia, and Lithuania in 1997 were used. Respondents who provided information on their activity level were included in this study (Estonia: n = 2,018; Latvia: n = 2,303; Lithuania: n = 2,140)., Results: One in three Estonians and one in five Latvians and Lithuanians had a low physical activity level at work. Half the respondents (Lithuania: 60%, Latvia: 52%, Estonia: 43%) participated only in sedentary activities during their leisure time. Leisure-time sedentarity was inversely related to education level in men and women and with income in men. It was also associated with smoking in men and with inadequate vegetable intake in men and women., Conclusions: Sedentary behavior during leisure time should be a public health issue in the Baltic Republics. Health promotion strategies aiming at increasing leisure-time physical activity level will need to target the general population, but particularly individuals from lower socioeconomic strata., (Copyright 2000 American Health Foundation and Academic Press.)