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Objectives To examine (1) the effect of new dock-less bicycle-sharing programmes on change in travel mode and (2) the correlates of change in travel mode. Design A retrospective natural experimental study. Setting 12 neighbourhoods in Shanghai. Participants 1265 respondents were recruited for a retrospective study in May 2017. Main outcome measures Prevalence of cycling before and after launch of dock-less bicycle-sharing programme. Results The proportion of participants cycling for transport increased from 33.3% prior to the launch of the bicycle-sharing programmes to 48.3% 1 year after the launch (p<0.001). Being in the age group of 30-49 years (OR 2.28; 95% CI 1.30 to 4.00), living within the inner ring of the city (OR 2.27; 95% CI 1.22 to 4.26), having dedicated bicycle lanes (OR 1.37, 95% CI 1.12 to 1.68) and perceiving riding shared bicycles as fashionable (OR 1.46, 95% CI 1.21 to 1.76) were positively associated with adopting cycling for transport. Access to a public transportation stop/station (OR 0.82, 95% CI 0.67 to 0.99) was inversely correlated with adopting cycling for transport. Conclusions Dock-less bicycle sharing may promote bicycle use in a metropolitan setting. Findings from this study also highlight the importance of cycling-friendly built environments and cultural norms as facilitators of adopting cycling. [ABSTRACT FROM AUTHOR]

To reverse the global epidemic of physical inactivity that is responsible for more than 5 million deaths per year, many groups recommend creating “activity-friendly environments.” Such environments may have other benefits, beyond facilitating physical activity, but these potential co-benefits have not been well described. The purpose of the present paper is to explore a wide range of literature and conduct an initial summary of evidence on co-benefits of activityfriendly environments. An extensive but non-systematic review of scientific and “gray” literature was conducted. Five physical activity settings were defined: parks/open space/trails, urban design, transportation, schools, and workplaces/ buildings. Several evidence-based activity-friendly features were identified for each setting. Six potential outcomes/ co-benefits were searched: physical health, mental health, social benefits, safety/injury prevention, environmental sustainability, and economics. A total of 418 higher-quality findings were summarized. The overall summary indicated 22 of 30 setting by outcome combinations showed “strong” evidence of co-benefits. Each setting had strong evidence of at least three co-benefits, with only one occurrence of a net negative effect. All settings showed the potential to contribute to environmental sustainability and economic benefits. Specific environmental features with the strongest evidence of multiple co-benefits were park proximity, mixed land use, trees/greenery, accessibility and street connectivity, building design, and workplace physical activity policies/programs. The exploration revealed substantial evidence that designing community environments that make physical activity attractive and convenient is likely to produce additional important benefits. The extent of the evidence justifies systematic reviews and additional research to fill gaps. [ABSTRACT FROM AUTHOR]

Background: Countries in the Middle East have some of the lowest rates of physical activity and some of the highest rates of obesity in the world. Policies can influence population levels of physical activity. However, there is a dearth of research on physical activity policies in the Gulf region. This qualitative study analyses cross-sectoral barriers and facilitators for the development, implementation and evaluation of physical activity policies in Saudi Arabia and Oman, two of the largest countries in the region. Methods: Semi-structured interviews were conducted with 19 senior policymakers from the Ministries of Health, Education, and Sport in Saudi Arabia and Oman, and were examined using thematic analysis. Results: We identified seven themes related to physical activity policies in Saudi Arabia and Oman: leadership; existing policies; physical activity programs related to policies; private sector policies; challenges; data/monitoring; and future opportunities. Both countries have a central document that guides policy-makers in promoting physical activity, and the available policies in both countries are implemented via multiple programs and initiatives to increase physical activity. Compared with Oman, in Saudi Arabia, programs from the non-profit sector, represented by community groups, play a more significant role in promoting physical activity outside the government framework. The private sector has contributed to promoting physical activity in both countries, but interviewees stated that more financial support is required. Policy limitations differ between Saudi Arabia and Oman: intersectoral collaboration in Oman is limited and mainly based on individuals' own initiative, while the health transformation in Saudi Arabia tends to slow down policy implementation in relevant areas. Physical education in Saudi Arabia and Oman is similar; however, increased support and collaboration between government agencies and the private sector for out-of-school sports academies are needed. Conclusions: This study addresses key gaps in analysing physical activity policies in Gulf Cooperation Council countries. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Our insights assist policy-makers, public health officials and stakeholders in shaping effective physical activity-promoting policies, programs and interventions to prevent non-communicable diseases. Challenges identified in Saudi Arabia and Oman's policies will inform their future development. [ABSTRACT FROM AUTHOR]

Objectives Despite media and public dialog portraying loneliness as a worsening problem, little is known about how the prevalence of loneliness has changed over time. Our study aims to identify (a) temporal trends in episodic and sustained loneliness (lonely in 1 wave vs consistently lonely in 3 consecutive waves); (b) trends across sociodemographic subgroups by sex, race/ethnicity, birth cohort, education, employment status, marital status, and living alone; and (c) longitudinal predictors of loneliness in middle-aged and older Americans (≥50 years). Methods Based on Waves 3 (1996) to 14 (2018) of the Health and Retirement Study (n = 18,841–23,227), we conducted a series of lagged mixed-effects Poisson regression models to assess trends of episodic and sustained loneliness in the overall and sociodemographic subgroup samples (by sex, race/ethnicity, birth cohort, education, employment, relationship, and living alone status). To examine the predictors of episodic and sustained loneliness, we used a multivariate mixed-effects Poisson regression model with all sociodemographic variables entered into the same model. Results Episodic loneliness prevalence decreased from 20.1% to 15.5% and sustained loneliness from 4.6% to 3.6%. Trends were similar across most subgroups. Males, Caucasians, those born in 1928–1945, with university education, working, married/partnered, and those not living alone reported lower episodic and sustained loneliness, although associations with sustained loneliness were stronger. Discussion Contrary to common perceptions, loneliness has decreased over 20 years of follow-up in middle-aged and older Americans. Several sociodemographic subgroups have been identified as having a higher risk of loneliness, prompting targeted public health attention. [ABSTRACT FROM AUTHOR]

Purpose: Likert scales are frequently used in public health research, but are subject to scale perception bias. This study sought to explore scale perception bias in quality-of-life (QoL) self-assessment and assess its relationships with commuting mode in the Sydney Travel and Health Study.Methods: Multilevel ordinal logistic regression analysis was used to analyse the association between two global QoL items about overall QoL and health satisfaction, with usual travel mode to work or study. Anchoring vignettes were applied using parametric and simpler nonparametric methods to detect and adjust for differences in reporting behaviour across age, sex, education, and income groups.Results: The anchoring vignettes exposed differences in scale responses across demographic groups. After adjusting for these biases, public transport users (OR = 0.37, 95 % CI 0.21-0.65), walkers (OR = 0.44, 95 % CI 0.24-0.82), and motor vehicle users (OR = 0.47, 95 % CI 0.25-0.86) were all found to have lower odds of reporting high QoL compared with bicycle commuters. Similarly, the odds of reporting high health satisfaction were found to be proportionally lower amongst all competing travel modes: motor vehicle users (OR = 0.31, 95 % CI 0.18-0.56), public transport users (OR = 0.34, 95 % CI 0.20-0.57), and walkers (OR = 0.35, 95 % CI 0.20-0.64) when compared with cyclists. Fewer differences were observed in the unadjusted models.Conclusion: Application of the vignettes by the two approaches removed scaling biases, thereby improving the accuracy of the analyses of the associations between travel mode and quality of life. The adjusted results revealed higher quality of life in bicycle commuters compared with all other travel mode users. [ABSTRACT FROM AUTHOR]

Background: The prevalence of childhood obesity has substantially increased in the Gulf Cooperation Council countries, including Saudi Arabia. The Rashaka initiative is a Saudi national school-based multicomponent intervention that was introduced in the school year 2016-2017 to address childhood overweight and obesity. This study aims to examine the effect of the Rashaka initiative on students' body mass index (BMI) for two academic years (2016-2017 and 2018-2019) and to analyse predictors of BMI change., Methods: Secondary data for this pre-post study was provided by the Ministry of Health for 38 026 students from 89 intermediate and secondary schools that implemented the initiative in Makkah City, Saudi Arabia. It was analysed using non-parametric tests and multiple regressions at a 5% level of significance., Results: Over 2 y of implementation, BMI was reduced significantly across the schools (p < 0.001). Based on the regression modelling, school gender and education stage were found to be the only significant predictors of BMI change. Girls and intermediate schools had greater BMI reductions than boys and secondary schools (p < 0.001 and p = 0.031)., Conclusions: This study provides tentative evidence for the effectiveness of the Rashaka intervention in Makkah City. In addition, our study has identified that the Rashaka initiative may require modification to improve its effect on boys and students in secondary schools., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates (UAE), Kuwait, Bahrain, Oman, and Qatar). Weight-related interventions are urgently required in these countries to tackle childhood overweight and obesity and their-related consequences. To date, no systematic review has synthesised school-based weight-related interventions in the six GCC countries. This study aims to systematically review school-based, weight-related interventions conducted in the GCC countries, investigating the intervention characteristics, components, and outcomes., Methods: Medline, Scopus, and ProQuest databases were searched for peer-reviewed literature published in English without date restriction and Google Scholar for grey literature using combined Medical Subject Heading (MeSH) terms and keywords under five relevant concepts including population, setting, interventions, outcomes, and geographical location. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), records were identified, screened for eligibility, and included in this review. Using the Effective Public Health Practice Project tool, the methodological quality of the included studies was assessed independently by two authors., Results: Out of 1303 initially identified records, eight peer-reviewed articles and three doctoral theses were included in this review. The age of the students in the included studies ranged between 5 to 19 years, and the sample sizes between 28 and 3,967 students. The studies included between one and thirty public and private schools. Of the included studies, six were randomised controlled trials, four pre-post studies and one used a post-study design. Only four of the eleven studies were theory based. The included studies reported various improvements in the students' weight or weight-related lifestyle behaviours, such as healthier dietary choices, increased physical activity, and decreased sedentary behaviour., Conclusions: This review suggests the potential effectiveness of school-based interventions in the GCC countries. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies in this field should be theory-based and use more rigorous evaluation methods., Systematic Review Registration: PROSPERO registration number: CRD42020156535., (© 2024. The Author(s).)

Competing Interests: BG-C and MS were supported by National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship funding (grant numbers: 1107672 and 1136250); BG-C and HB were also supported by RMIT Vice-Chancellor's Fellowships; CH was supported through an NHMRC Centre for Research Excellence in Healthy Liveable Communities (grant number: 1061404) and The Australian Prevention Partnership Centre (grant number: 9100003); DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. EC's research was supported by the Australian Catholic University. APR was supported by the Centre for Health and Social Care Research of the University of Vic, Central University of Catalonia. The Barcelona Provincial Council and City Council of Vic provided funding for the Barcelona and Vic data collection. AAF was supported by a research fellowship from the Brazilian National Council for Scientific and Technological Development (grant number: 309301/2020-3). GB was supported by a grant from The Public Goods Projects. SL was supported by the experiential fellowships from College of Social Science and Humanities, Northeastern University. JFS was supported by Australian Catholic University. DS was supported by the Center for Diabetes Translation Research, Washington University in St Louis, MO, (grant number: P30DK092950 from National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] at the National Institutes of Health [NIH]) and by the Centers for Disease Control and Prevention (CDC) (grant number: U48DP006395). MAA was supported by the National Cancer Institute at the NIH (grant number: R01CA198915). GV was supported by Ayudas para contratos Juan de la Cierva-formación 2019 (grant number: FJC2019-041233-I), and the Centro de Excelencia Severo Ochoa 2019–23 Program (grant number: CEX2018-000806-S) from the Spanish Government. RFH was supported by the UK Research and Innovation—National Health and Medical Research Council (grant number: MR/T038934/1). All other authors declare no competing interests. The content of this article is solely the responsibility of the authors and does not represent the official views of any of the NIDDK/NIH, CDC, or of any of the funding agencies supporting this work. We thank Karel Frömel, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic; David Vale, Lisbon School of Architecture, University of Lisbon, Lisbon, Portugal; Andreia Pizarro, Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, and Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal; Javier Molina-García, Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, Valencia, Spain; Hannah Hook, College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Adetoyeje Y Oyeyemi, Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria; Belinda Nemec, Melbourne; Judy Boyce, Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries., Competing Interests: Declaration of interests BG-C reports Senior Principal Research Fellowship (GNT1107672) and grant (number 1061404) support from National Health and Medical Research Council during the conduct of the study. CH was also supported by National Health and Medical Research Council through the Centre for Research Excellence in Healthy Liveable Communities (grant number 1061404). GB reports grants from the Public Good Projects, during the conduct of the study. JFS reports personal fees from Sports, Play, and Active Recreation for Kids (SPARK) physical activity programmes of Gopher Sport, and travel support from Rails to Trails Conservancy, outside the submitted work. JFS also has a copyright on SPARK physical activity programmes with royalties paid by Gopher Sport. DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. SL was supported by the experiential fellowships from the College of Social Science and Humanities, Northeastern University, Boston, MA, USA. EC and JFS were supported by the Australian Catholic University, Melbourne, VIC, Australia. AAF is supported by a research fellowship from the Brazilian National Council for Scientific and Technological Development (CNPq) (#309301/2020-3). TB was supported by a Doctoral Scholarship from Auckland University of Technology, Auckland, New Zealand. AP-R was supported by the Centre for Health and Social Care Research at the University of Vic-Central University of Catalonia, Vic, Spain, and funding was provided by the Barcelona Provincial Council, Barcelona, Spain and City Council of Vic, Vic, Spain. CDGR is supported by the Portugal National Funds through Fundação para a Ciência e a Tecnologia, Instituto Público, Lisbon, Portugal, under the Research Fellowship (UI/BD/152231/2021). DS was supported by Washington University in St Louis, Center for Diabetes Translation Research, St Louis, MO, USA (P30DK092950 from National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health) and by the Cooperative Agreement Number U48DP006395 from the Centers for Disease Control and Prevention. RFH was supported by the UK Research and Innovation—National Health and Medical Research Council (project reference MR/T038934/1). The content of this article is solely the responsibility of the authors and does not represent the official views of any of the funding agencies supporting this work. Funding sources had no role in writing the manuscript or in the decision to submit for publication. All other authors report no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Regular physical activity is important for general health and reduces the risk for COVID-19 infections and for severe outcomes among infected people. However, measures to mitigate COVID-19 likely decrease population physical activity. This study aimed to examine 1) changes in exercise frequency in a representative sample of US adults during the pandemic (04/01/2020-07/21/2021), and 2) how sociodemographic characteristics, pre-COVID health-related behaviors and outcomes, and state-level stringency of COVID-19 containment measures predict exercise frequency. Self-reported exercise frequency and its individual-level predictors were determined based on 151,155 observations from 6,540 adult participants (aged ≥ 18 years) in all US states from the Understanding America Study. State-level stringency of COVID-19 control measures was examined from the Oxford COVID-19 Government Response Tracker. Exercise frequency varied significantly over 28 survey waves across 475 days of follow-up ( F 1,473  = 185.5, p  < 0.001, η 2  = 0.28, 95% CI = 0.23-1.00), where exercise frequency decreased between April 2020 and January 2021, and then increased from January 2021 to July 2021. Those who were younger, living alone, non-White, had no college degree, lower household income, low pre-pandemic physical activity levels, obesity, diabetes, kidney disease and hypertension had lower exercise frequency. State-level stringency of COVID-19 control measures was inversely associated with exercise frequency (B = 0.002, SE = 0.001, p  < 0.01) between April and December 2020 when the overall stringency level was relatively high; but the association was non-significant (B = 0.001, SE = 0.001, p  > 0.05) between January and July 2021, during which the stringency index sharply declined to a low level. This longitudinal probability survey of the US population revealed significant fluctuations in exercise during COVID-19. Low exercise levels are concerning and deserve public health attention. Health inequalities from physical inactivity are likely to exacerbate because of COVID-19. Physical activity promotion in safe environments is urgently warranted, especially in at-risk population subgroups., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier Inc.)

Our objective was to describe patterns and predictors of sedentary behavior (sitting time) over 10 years among a large Canadian cohort. Data are from the Canadian Multicentre Osteoporosis Study, a prospective study of women and men randomly selected from the general population. Respondents reported socio-demographics, lifestyle behaviors and health outcomes in interviewer-administered questionnaires; weight and height were measured. Baseline data were collected between 1995 and 1997 (n = 9418; participation rate = 42%), and at 5- (n = 7648) and 10-year follow-ups (n = 5567). Total sitting time was summed across domain-specific questions at three time points and dichotomized into "low" (≤ 7 h/day) and "high" (> 7 h/day), based on recent meta-analytic evidence on time sitting and all-cause mortality. Ten-year sitting patterns were classified as "consistently high", "consistently low", "increased", "decreased", and "mixed". Predictors of sedentary behavior patterns were explored using chi-square tests, ANOVA and logistic regression. At baseline (mean age = 62.1 years ± 13.4) average sitting was 6.9 h/day; it was 7.0 at 5- and 10-year follow-ups ( p for trend = 0.12). Overall 23% reported consistently high sitting time, 22% consistently low sitting, 14% decreased sitting, 17% increased sitting with 24% mixed patterns. Consistently high sitters were more likely to be men, university educated, full-time employed, obese, and to report consistently low physical activity levels. This is one of the first population-based studies to explore patterns of sedentary behavior (multi-domain sitting) within men and women over years. Risk classification of sitting among many adults changed during follow-up. Thus, studies of sitting and health would benefit from multiple measures of sitting over time.