Search

The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16–18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures. publishedVersion

ImportanceObservational studies have reported an association between the use of eye protection and reduced risk of infection with SARS-CoV-2 and other respiratory viruses, but, as with most infection control measures, no randomized clinical trials have been conducted.ObjectivesTo evaluate the effectiveness of wearing glasses in public as protection against being infected with SARS-CoV-2 and other respiratory viruses.Design, Setting, and ParticipantsA randomized clinical trial was conducted in Norway from February 2 to April 24, 2022; all adult members of the public who did not regularly wear glasses, had no symptoms of COVID-19, and did not have COVID-19 in the last 6 weeks were eligible.InterventionWearing glasses (eg, sunglasses) when close to others in public spaces for 2 weeks.Main Outcomes and MeasuresThe primary outcome was a positive COVID-19 test result reported to the Norwegian Surveillance System for Communicable Diseases. Secondary outcomes included a positive COVID-19 test result and respiratory infection based on self-report. All analyses adhered to the intention-to-treat principle.ResultsA total of 3717 adults (2439 women [65.6%]; mean [SD] age, 46.9 [15.1] years) were randomized. All were identified and followed up in the registries, and 3231 (86.9%) responded to the end of study questionnaire. The proportions with a reported positive COVID-19 test result in the national registry were 3.7% (68 of 1852) in the intervention group and 3.5% (65 of 1865) in the control group (absolute risk difference, 0.2%; 95% CI, −1.0% to 1.4%; relative risk, 1.10; 95% CI, 0.75-1.50). The proportions with a positive COVID-19 test result based on self-report were 9.6% (177 of 1852) in the intervention group and 11.5% (214 of 1865) in the control group (absolute risk difference, –1.9%; 95% CI, −3.9% to 0.1%; relative risk, 0.83; 95% CI, 0.69-1.00). The risk of respiratory infections based on self-reported symptoms was lower in the intervention group (30.8% [571 of 1852]) than in the control group (34.1% [636 of 1865]; absolute risk difference, –3.3%; 95% CI, −6.3% to −0.3%; relative risk, 0.90; 95% CI, 0.82-0.99).Conclusions and RelevanceIn this randomized clinical trial, wearing glasses in the community was not protective regarding the primary outcome of a reported positive COVID-19 test. However, results were limited by a small sample size and other issues. Glasses may be worth considering as one component in infection control, pending further studies.Trial RegistrationClinicalTrials.gov Identifier: NCT05217797

Ana Rito - Departamento de Alimentação e Nutrição, INSA. Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and wellbeing. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15–19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time. European Commission, Grant/Award Number: 774210; European Union info:eu-repo/semantics/publishedVersion

Background The World Cancer Research Fund International's (WCRF International) analysis of global research shows a strong link between diet, physical activity, and risk of cancer. To address this, WCRF International has developed a package of policy resources to promote healthy diets and physical activity to support reporting, categorising and monitoring of policy actions. The MOVING policy framework was developed as a complement to the well-established NOURISHING framework of diet-related policies-outlining a comprehensive set of areas in which governments should take action to promote physical activity. The new framework forms the basis for the MOVING database of implemented policy actions. Methods For the MOVING framework, literature reviews were undertaken, and the results were distilled into policy categories on which academics and policy experts provided feedback. The framework is the basis for a specific inclusion criteria and search strategy to determine how policy actions will be collected, reviewed and categorised for the MOVING database. A comprehensive scanning methodology was designed to identify all relevant policies across the MOVING policy areas. Relevant policies are then verified with in-country experts and uploaded to the database. This methodology was tested, refined and will be applied to 27 European countries. Results The MOVING policy framework comprises six policy areas within four policy domains and details the areas where governments should take action to promote physical activity. The framework forms the structure for a new database of global physical activity policies, which was launched in the summer of 2020. The MOVING database currently includes 234 policy actions from 12 countries. The MOVING database is a logical and practical tool, allowing users to search for policy actions categorised in the structure of the MOVING framework. Conclusion The MOVING physical activity framework and database are innovative tools that support reporting, categorising and monitoring of physical activity policy actions that will work alongside the NOURISHING framework and database. These physical activity policy tools allow stakeholders such as researchers, civil society organizations and policy makers to quickly identify both gaps and strengths in government action and therefore assess where there is scope for improvement within and across countries.

Background Global research shows a strong link between physical activity and risk of developing non-communicable diseases. To increase physical activity levels, governments must design and implement a comprehensive set of policy actions across a range of areas. To aid governments in this process, the MOVING benchmarking tool was developed to assess the strength of policies across three domains that make up a comprehensive approach to physical activity policy. Methods The MOVING benchmarking tool, which was developed using a consultative process that reviewed evidence on physical activity policy design and existing benchmarking tools, built on the policy areas of the MOVING framework. It values the strength of policy design, based on evidence-informed and aspirational attributes of effective policy-making that impacts health-related behaviours, with a focus on adolescents. The tool was applied to a set of physical activity policies from five countries: Netherlands, Norway, Poland, Portugal and UK. These countries were selected based on their participation in the EU-funded CO-CREATE project, which focuses on prevention of overweight and obesity among adolescents. Relevant physical activity policies in each participating country were identified based on a comprehensive scan, with a set methodology. Results The MOVING benchmarks assessed the strengths and weaknesses in the design of policies across the policy areas of the MOVING policy framework. They produced an overall assessment of policy environments for physical activity across the five countries, as well as an assessment of each individual policy area within the framework, such as walking and cycling infrastructure and active transport. Further, by allowing a fast assessment of many physical activity policies, the benchmarking tool enabled an analysis of the interplay of single policies and drawing conclusions about the overall policy environment in the five countries. Conclusion The MOVING benchmarking tools can identify gaps and assess the strength of actions taken by national governments to promote physical activity, and can be used by policymakers, researchers and civil society to inform advocacy for and design of policies. The scores generated by the benchmarking tool will be amalgamated into an overall policy index for 27 European countries.

Background Global research shows a strong link between physical activity and risk of developing non-communicable diseases. To increase physical activity levels, governments must design and implement a comprehensive set of policy actions across a range of areas. To aid governments in this process, the MOVING benchmarking tool was developed to assess the design and strength of countries' policies in promoting physical activity, as well as gaps in policy action. Methods The MOVING benchmarking tool was developed using a consultative process that reviewed evidence on physical activity policy design, existing benchmarking tools and built on the policy areas of the MOVING framework. The tool values the strength of policy design based on policy attributes that are evidence-based and aspirational - regardless of whether any countries have implemented them. The tool was applied to a set of physical activity policies from five countries participating in? CO-CREATE?, a European Commission-funded project: Netherlands, Norway, Poland, Portugal and UK. Physical activity policies that are currently implemented in these countries were identified based on a comprehensive country scan, with a set methodology. A set of policies from each country corresponding to benchmarks on access to quality public open space and green spaces and community and mass participation initiatives were analysed. The policies were assessed by applying the benchmark corresponding to the relevant policy area Results The benchmarking tools easily identified the strengths and weaknesses in the design of each policy. Thus, the benchmarking tool identified where there was scope for improvement in specific policy area for each country, such as walking and cycling infrastructure and active transport. It also allowed comparisons between countries for specific policy areas. Further, by allowing a fast assessment of many physical activity policies, the benchmarking tool enabled an analysis of the interplay of single policies and draw conclusions about the overall policy environment in the selected countries. Conclusion The MOVING benchmarking tool can inform the development and implementation of policies which promote physical activity. It can be used by government policy-makers, researchers and civil society organisations to identify areas of physical activity policy that require government action. The scores generated by the benchmarking tool will be amalgamated into an overall policy index for 27 European countries.

This document is an addition to the detailed research protocol for The effect of working at home versus at the office on risk of transmission of SARS-CoV-2 and other respiratory agents. The RCT has been registered in clinical trials (NCT05298488). This document was posted online before the analysis of the data and the unblinding took place.

BackgroundObservational studies have reported an association between use of eye protection and reduced risk of SARS-CoV-2 infection and other respiratory viruses, but as for most non-pharmaceutical interventions for infection control, no randomized trials have been conducted. We conducted a randomized trial to evaluate the effectiveness of recommending the use of glasses in public as protection against being infected with SARS-CoV-2 and other respiratory viruses.Methods and findingsThis was a pragmatic, randomized, trial in Norway from 2 February to 24 April 2022 where all adult members of the public who did not regularly wear glasses, had no symptoms of COVID-19 and no COVID-19 in the last 6 weeks, were eligible. Participants randomized to the intervention group were asked to wear glasses (e.g. sunglasses) for 2 weeks when close to others in public spaces. The primary outcome was positive COVID-19 test result notified to the Norwegian Surveillance System for Communicable Diseases (MSIS). Secondary outcomes included positive COVID-19 test result based on self-report and episode of respiratory infection based on self-report of symptoms. We randomized 3717 participants. All were identified and followed up in the registries and 87% responded to the end of study-questionnaire. The proportions with a notified positive COVID-19 test in the national registry were 3.7% in the intervention group (68/1852) and 3.5% (65/1865) in the control group (95% CI for risk difference -1.0% to 1.4%; relative risk 1.10, 95% CI 0.75 to 1.50). The proportions with a positive COVID-19 test based on self-report were 9.6% and 11.5% (95% CI for risk difference -3.9% to 0.1%; relative risk 0.83, 95% CI 0.69 to 1.00). The risk of respiratory infections based on self-reported symptoms was lower in the intervention group (31% vs. 34%; 95% CI for risk difference -3.3% to -0.3%; relative risk 0.90, 95% CI 0.82 to 0.99).ConclusionsOur results indicate that asking people to wear glasses may protect the public against respiratory infections, but the findings are not certain, and the study needs replication. Although the evidence is uncertain, and the effect probably modest at best, wearing glasses may be worth considering as one component in the infection control toolbox since it is a simple, low burden, and low-cost intervention, with few negative consequences.Trial registrationClinicalTrials.gov Identifier: NCT05217797FundingThe costs of running the trial were covered by the Centre for Epidemic Interventions Research (CEIR), Norwegian Institute of Public Health. The authors received no specific funding for this work

Background: Considering the large health burden of physical inactivity, effective physical activity promotion is a “best buy” for noncommunicable disease and obesity prevention. The MOVING policy framework was developed to promote and monitor government policy actions to increase physical activity as part of the EU Horizon 2020 project “Confronting Obesity: Co-creating policy with youth (CO-CREATE).” Method: A scanning exercise, documentary review of key international policy documents, and thematic analysis of main recommendations were conducted. Themes were reviewed as part of a consultation with physical activity experts. Results: There were 6 overarching policy framework areas: M—make opportunities and initiatives that promote physical activity in schools, the community, and sport and recreation; O—offer physical activity opportunities in the workplace and training in physical activity promotion across multiple professions; V—visualize and enact structures and surroundings that promote physical activity; I—implement transport infrastructure and opportunities that support active societies; N—normalize and increase physical activity through public communication that motivates and builds behavior change skills; and G—give physical activity training, assessment, and counseling in health care settings. Conclusions: The MOVING framework can identify policy actions needed, tailor options suitable for populations, and assess whether approaches are sufficiently comprehensive.

BackgroundA systematic review of observational studies indicated that eye protection may be an effective measure to prevent SARS-CoV-2 infections. Randomized trials are needed to assess whether the observed associations are caused by protection of the eye or confounding factors such as other systematic differences between users and non-users of eye protection, co-interventions, or changes in COVID-19 incidence when comparisons were done over time.MethodsPragmatic, virtual, parallel group, 1:1 randomized, superiority trial. We will recruit and randomize participants via an online portal. The trial will be fully remote and virtual without any personal interaction between investigators and participants. All members of the public are eligible who confirm that they are at least 18 years of age, do not regularly wear glasses, have not contracted COVID-19 since December 15th 2021, and are willing to be randomized to wear, or not wear glasses in public when close to other people, for a 2-week period. Persons who are dependent on visual aids but typically use contact lenses are eligible. The participants will be randomized (1:1) to wear glasses (sunglasses or other types of glasses) in public spaces when close to others (public transport, shopping centers etc.), or to the control group. The control group will be asked not to wear glasses in public spaces when close to others. The primary outcome is positive test for COVID-19. We aim to include about 25,000 participants to have a statistical power of 80% to detect a relative risk reduction of 25% for the primary outcome.DiscussionMany have easy access to sunglasses or other glasses. Wearing glasses may provide eye protection and repurposing sunglasses for infection control could be a simple, readily available, environmentally friendly, safe, and sustainable infection prevention measure.Trial registrationNCT05217797 (Clinicaltrials.gov)

The NOURISHING database is a repository of more than 1000 verified nutrition anddiet-related governmental policy actions currently in effect globally. The database isa unique and rich data source on governmental policy actions with a potential fordeveloping tools that capture the overall policy efforts in a country, identify policygaps, and enable cross-national comparisons. Policy actions from a sample of fiveEuropean countries have been benchmarked against aspirational standards using theNOURISHING benchmarking tool. This paper presents the results of the pilot testingfrom the benchmarking process for the construction of the NOURISHING policyindex. The development of the index was guided by existing tools for developingcomposite indicators. The findings from the pilot test indicate that the NOURISHINGpolicy index can identify both policy gaps and cross-national policy differences. Theseresults demonstrate that the policy index merits testing on a larger sample to identifypotential refinements. Pilot test of the NOURISHING policy index—Assessing governmental nutrition policies in five European countries

While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.

Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets. The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding from Albania: WHO through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia: Ministry of Health of the Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČ–VO EÚ 00023761; Denmark: Danish Ministry of Health; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of Kazakhstan and WHO Country Office; Kyrgyzstan: World Health Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO; Malta: Ministry of Health; Montenegro: WHO and Institute of Public Health of Montenegro; Norway: Ministry of Health and Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russian Federation: WHO; San Marino: Health Ministry, Educational Ministry; Serbia: This study was supported by the World Health Organization (Ref. File 2015-540940); Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: WHO Country Office in Tajikistan and Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank. The CO-CREATE project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 774210. info:eu-repo/semantics/publishedVersion

Background Global research shows a strong link between physical activity, nutrition and the risk of developing non-communicable diseases. To increase physical activity and healthy eating, governments must design and implement a comprehensive set of policy actions across a range of areas. The MOVING and NOURISHING benchmarking tools were developed to identify gaps and assess the strength of actions taken by national governments in these complex policy areas. Methods The benchmarking tools value the strength of policy design based on policy attributes that are evidence-informed and aspirational. Both tools were applied to five countries participating in CO-CREATE, a European Commission-funded project: Netherlands, Norway, Poland, Portugal and UK. Physical activity and nutrition policies in each of these countries were identified based on a comprehensive country scan, with a set methodology. Results The benchmarks assessed the strengths and weaknesses in the design of policies across the NOURISHING and MOVING policy areas. They identified where there was scope for improvement within a policy area. For example, the tools helped evaluate the design of health related-food taxes in Norway, Poland, Portugal, and UK and allowed a cross-country comparison of these policies. When comparing the overall policy environment across all countries, we found an overall lack of policies promoting access to open/green spaces and weaknesses in designing restrictions on marketing unhealthy foods to children. Conclusions The benchmarking tools can inform the development and implementation of policies which promote physical activity and healthy eating. They were developed for the European context but are also being tested on relevant policies in South Africa. They can be used by governments, policymakers, researchers and civil society to identify areas of physical activity and nutrition policy that are weak and require government action. Key messages Benchmarking nutrition and physical activity policy can identify gaps and assess the strength of actions taken by national governments in these complex policy areas. The NOURISHING and MOVING benchmarking tools can be used by governments, policymakers, researchers and civil society various to inform policy-making in nutrition and physical activity.

Whether university teaching on campus with infection control measures in place is associated with higher risk of COVID-19 than online instruction, is unknown. We will assess this by conducting repeated surveys among students at universities and university colleges in Norway, where some instruction is given in-person, and some is provided online (hybrid model). We will ask about the students’ COVID-19 status, and how much in-person and online instruction they are getting. We will estimate the association between in-person instruction and COVID-19-risk using multivariate regression, controlling for likely confounders. We will also assess whether type of instruction is associated with how satisfied the students are with the instruction, their quality of life, and learning outcomes.

Summary The aim of this overview of systematic reviews was to summarize evidence from up-to-date reviews of the effectiveness of interventions aimed at preventing overweight and obesity in adolescents aged 10 to 19 years. We searched nine databases for systematic reviews published between January 2008 and November 2019. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 to assess the quality of reviews, excluding those of critically low quality, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to grade the certainty of included evidence. We included 13 reviews. Three reviews focused on dietary behaviour, six on physical activity, and four on both types of behaviours. Individual-oriented and school-based interventions dominated. Results across reviews showed little or no effect on body mass index, or physical activity levels of adolescents, whereas results from a couple of reviews suggest possibly beneficial effects of public health interventions on dietary behaviours (i.e., consumption of sugar-sweetened beverages). The certainty of evidence was low to very low for all outcomes. Overall, the evidence base for the effect of primary interventions to prevent overweight and obesity in adolescents is weak. In particular, there is a lack of reviews assessing the impact of environmental interventions targeting adolescents, and reviews addressing social inequality are virtually absent from this body of literature.

Objective:To investigate family structure differences in adolescents’ consumption of fruit, vegetables, sweets and sugar-added soft drinks with adjustments for socio-demographic and socio-economic variables.Design:Cross-sectional data from the Health Behaviour in School-aged Children survey.Setting:Norwegian primary and secondary schools.Participants:Adolescents (n 4475) aged 11, 13, 15 and 16 years.Results:After adjusting for covariates, living in a single-mother family was associated with lower vegetable consumption (OR 0·76, 95 % CI 0·63, 0·91) and higher soft drink consumption (OR 1·29, 95 % CI 1·06, 1·57). Living in a mother and stepfather family was negatively associated with fruit (OR 0·71, 95 % CI 0·54, 0·95) and vegetable (OR 0·72, 95 % CI 0·54, 0·97) consumption. Living in a single-father family was associated with lower sweets consumption (OR 0·48, 95 % CI 0·32, 0·72). No significant interactions were demonstrated between family structure and socio-demographic or socio-economic covariates.Conclusions:The study suggests that an independent association between family structure and adolescents’ food habits exists.

In Norway, new national guidelines for school service emphasize the importance of establishing structured collaboration with schools. Nevertheless, few studies have explored the characteristics of such collaboration. The purpose of the present study is to explore how principals, teachers, and school nurses collaborate and to identify barriers and facilitators of structured collaboration. The study is based on 46 qualitative interviews conducted in five Norwegian municipalities in 2018 and 2019. The results reveal that school nurses are highly valued among the school staff but collaborations between teachers and school nurses varied both within and between schools, often for arbitrary reasons such as personal relations and office locations at schools. Personal relationships built over time as well as regular meetings, seemed to foster stronger collaboration, while discontinuity in personnel, recruitment difficulties, and sick and maternity leaves were frequently reported factors that seemed to have negative impacts on collaboration.

BackgroundAfter lock-down during the first wave of the COVID-19 pandemic, higher education institutions globally struggled to balance the need for infection control and educational requirements as they prepared to reopen. A particularly difficult choice was whether to offer for in-person or online teaching, since there was little or no empirical research to inform this decision. Norwegian universities and university colleges opted for a hybrid model when they reopened for the autumn semester, with some students offered more in-person teaching than others. This gave us an opportunity to study the association between different teaching modalities and COVID-19 risk, quality of life (subjective well-being), and teaching satisfaction.MethodsWe conducted a prospective, observational cohort study among students in higher education institutions in Norway. Participants were surveyed biweekly from September to December in 2020.Findings26 754 students from 14 higher education institutions provided data to our analyses. Our best estimate for the association between two weeks of in-person teaching and COVID-19 risk was −22% (95% CI −77% to 33%), compared to online teaching. Quality of life was positively associated with in-person teaching (3% relative risk difference; 95% CI 2% to 4%), as was teaching satisfaction (10%; 95% CI 8% to 11%).InterpretationThe association between COVID-19 infection and teaching modality was highly uncertain. Shifting from in-person to online teaching seems to have a negative impact on the well-being of students in higher education.FundingNone.

This protocol describes a randomized controlled trial where additional school nurse resources are assigned to work systemically with schools to improve the school environment and reduce bullying among and absence of 5th–7th grade students. Approximately 9000 students will have participated each year from 2018 to 2020 from 107 schools located in 12 Norwegian municipalities. Academic performance is studied as a secondary outcome.

Social inequalities in health in the Nordic countries persist and may even be growing. Our new report identifies a list of indicators that can be used to monitor and compare trends in health inequa ...

The protocol describes methods for how to monitor marketing of foods and beverages high in fat, salt and sugar towards children and young people at a given time as cross-sectional studies, as well as allowing for monitoring of trends. The data provided could also be used for evaluation purposes, for instance providing relevant data for evaluating regulation practices and schemes in the respective countries; to study advertising and marketing practices, contents and forms over time. In addition to being a tool for monitoring purposes within each country, the protocol will also enable comparisons between the Nordic countries by establishing a joint understanding on how each marketing channel should be monitored. The protocol has been developed as a Nordic project between representatives and experts from Iceland, Finland, Sweden, Denmark and Norway together with international experts.

The objective of the study was to describe self-reported health symptoms, the use of personal protective gear and clothing and poor safety procedures when applying pesticides among farm workers. A total of 128 adult farm workers were interviewed using a structured questionnaire during the farming season. The commonly used pesticides included profenofos, mancozeb, chlorpyrifos, cypermethrin, deltamethrin, permethrin, lambda-cyhalothrin, endosulfan and carbosulfan. The majority (>90%) of farm workers used no personal protective clothing while handling pesticides. More than one-third of farm workers ate and drank without washing their hands following pesticide handling, while a smaller number smoked or chewed gum. Wearing special boots during pesticide application was found to reduce the risk of skin rash (OR = 0.2, 95% CI: 0.06–0.66), whereas smoking when applying pesticides increased the risk of chest pain occurrence (OR = 4.0, 95% CI: 1.14–15.43), as well as forgetfulness (OR = 4.0, 95% CI: 1.30–14.02). Chewing gum and eating when applying pesticides was associated with diarrhoea (OR = 11.0, 95% CI: 1.80–6.84 and OR = 7.0, 95% CI: 1.27–3.67 respectively). The increased self-reported prevalence of post-exposure adverse health effects among farm workers was associated with poor use of personal protective clothing and poor safety practices during pesticide use and handling. These data indicate the need for improved availability and use of protective equipment, and training in crop and pest management practices to prevent risky behavioursand for safer and sustainable vegetable production.

The idea of having a Compare Forum focusing on the above title was first discussed with one of the Editors of Compare during a PhD defence in Oslo in 2011. The PhD dissertation itself was linked to...

This paper has the following aims: (i) to explore the extent to which students who received an intervention involving HIV/AIDS and sexuality perceived that their teacher cared for their health and well-being, (ii) to investigate the characteristics of students who reported to have caring teachers and (iii) to document the association between students' perceptions of care and reported onset of sexual activity. Data were obtained from the second follow-up survey of a prospective study carried out among high school students in South Africa (Cape Town and Mankweng). We analyzed data from 3483 students who met the inclusion criteria. Students from the intervention group perceived greater care from teachers than students in the control group. Female students and students from Cape Town perceived having received more care, and their perception of care was associated with the number of lessons received, how often students expressed their opinions in class and how often teachers talked about HIV/AIDS, condoms and abstinence. Students who perceived that their teacher cared for their health and well-being were less likely to initiate sexual intercourse. This is the first paper to demonstrate the salience of the concept of care in studies of school-based HIV/AIDS prevention programs in sub-Saharan Africa.

In this paper we explore the perceived desirable characteristics of South African Life Orientation teachers for teaching sexuality and HIV/AIDS. We also investigate the extent to which these characteristics can be understood as parts of a role script for teaching HIV/AIDS and sexuality. Data were collected from teachers who taught Grade Eight and Grade Nine students in South African public high schools. The teachers particularly emphasised the importance of personality and life experience as important characteristics for teaching sexuality and HIV/AIDS. In addition, they felt that it was challenging to create an open dialogue in the classroom and at the same time maintain classroom discipline. The teachers did not perceive that teaching about sexuality and HIV/AIDS was a role that a teacher could step in and out of. On the other hand, they were accustomed to playing different roles with respect to the students, such as parent, friend, counsellor and social worker.

A 14-item human immunodeficiency virus/acquired immunodeficiency syndrome knowledge scale was used among school students in 80 schools in 3 sites in Sub-Saharan Africa (Cape Town and Mankweng, South Africa, and Dar es Salaam, Tanzania). For each item, an incorrect or don't know response was coded as 0 and correct response as 1. Exploratory factor analyses based on polychoric correlations showed two separate factors for all sites. Two-parameter item response theory (IRT) analysis (bifactorial multiple indicators multiple causes confirmatory factor analysis models) consistently showed a general first factor and a second 'method' factor. One single global latent variable seemed to sufficiently well capture most of the systematic variation in knowledge. Some items did not discriminate well between levels of the underlying knowledge latent variable and information values were highest for low levels of knowledge. The scale might be improved by adding items, in particular items that are more difficult to answer. Some differential item functioning effects related to site and socioeconomic status were identified. Scores on the latent knowledge variable were particularly low among females in Dar es Salaam and Mankweng, and were negatively associated with socioeconomic status. This study illustrates advantages of using IRT analysis instead of more conventional approaches to examining psychometric properties of knowledge scales.

Aims: This article reports on the development and psychometric properties of an instrument to evaluate school-based HIV/ AIDS interventions aimed at adolescents in three African sites. Methods: The instrument was developed in a series of steps that involved a review of existing instruments; use of empirical data and secondary literature supporting an association between the variables of interest and sexual intercourse or condom use; operationalizing the constructs of the theoretical model employed; and using the objectives of the intervention. Test—retest reliability studies were conducted at each site. Results: The questionnaire demonstrated good internal consistency and adequate test—retest reliability. Cronbach's alpha was higher than 0.50 for all the 10 psychosocial scales, while Cohen's kappa showed poor to substantial test—retest reliability on the sexual behaviour items (κ = 0.14 to 0.69). Conclusions: We conclude that the instrument had sufficient test—retest reliability and internal consistency.

Aims: This study aimed to investigate how confident and comfortable teachers at Tanzanian and South African urban and rural schools are in teaching HIV/AIDS and sexuality. It also aimed at identifying factors associated with teacher confidence and investigated how reported confidence was associated with the implementation of educational programmes on HIV/AIDS and sexuality. Methods: A survey was conducted among South African grade 8 and 9 Life Orientation teachers, and among science teachers for grade 5 to 7 in public primary schools in Tanzania. Teachers' confidence levels were measured on a four-item scale (0—3). Results: A total number of 266 teachers participated in a survey in 86 schools in South Africa and Tanzania. Overall, teachers report to be rather confident in teaching HIV/AIDS and sexuality. Tanzanian teachers reported higher levels of confidence then did their South Africa colleagues (2.1 vs. 1.8; p < 0.01). Confidence in teaching was significantly associated with the numbers of years teaching HIV/AIDS and sexuality, formal training in these subjects, experience in discussing the topics with others, school policy and priority given to teaching HIV/AIDS and sexuality at school. Finally, confidence in teaching remained positively associated with self-reported successful implementation of school-based programmes after adjusting for gender, age, religion and numbers of years teaching HIV/AIDS and sexuality. Conclusions: Across urban and rural sites in South Africa and Tanzania teachers reported to be fairly confident in teaching HIV/AIDS and sexuality. Further strengthening of their confidence levels could, however, be an important measure for improving the implementation of such programmes.

This paper aims to explore South African Life Orientation teachers' perception and practice of teaching HIV/AIDS and sexuality in a cultural perspective. We aim to investigate how teachers respond to perceived cultural differences between the local community and the content of their teaching. Data were collected through interviews with teachers who taught students in grades 8 or 9 in public high schools. The teachers expressed differing viewpoints regarding the rationale for teaching about HIV/AIDS and sexuality. Many teachers saw teaching these topics as a response to declining moral standards, while others suggested that they were teaching issues that parents failed to address. The teachers were more concerned about young people's sexual behaviour than about preventing HIV/AIDS. They perceived that cultural contradictions between what was taught and local cultural values were an issue to which they needed to respond, although they differed in terms of how to respond. Some took an adaptive approach to try to avoid conflicts, while others claimed the moral neutrality of their teaching. Teaching about sexuality was perceived to be challenging in terms of language and communication norms. Teaching about HIV/AIDS was perceived as challenging because teachers often needed to convince students about the reality of AIDS.

Background Modelling and empirical evidence suggest that population differences in the practice of concurrent sexual partnership could be the most important explanation of the observed heterogeneity in HIV epidemic in sub-Saharan Africa. Biomedical and some behavioural evidence have not sufficiently explained the variation. This study aimed at comparing the rate of concurrent sexual partnerships among adolescents in Arusha, Tanzania and Polokwane, South Africa, two areas with contrasting level of HIV magnitude. Methods A baseline cross-sectional study involving junior secondary school adolescents in Arusha, Tanzania and Polokwane South Africa was conducted in 2010 as part of the school-based Health Intervention project (LASH). Adolescents from 12 randomly selected schools from each country were interviewed regarding their socio-demographic characteristics, sexual behaviours and substance use. Data were entered and analysed using SPSS statistical package. Results A total of 2408 adolescents from Arusha and 1649 from Polokwane participated in the study. Adolescent interviewed in Arusha were significantly older than their Polokwane counterpart (Mean age (SD) 19.3(0.5) and 15.5(0.7), respectively, p Conclusions High practice of multiple concurrent sexual partnerships among adolescent living in high HIV prevalent area as compared to those in low prevalence area indicate that concurrent partnership could be the most important explanation of the observed heterogenic HIV transmission in sub-Saharan Africa. Being sexually active and substance use predict practice of concurrent sexual partnerships among adolescents. Delaying sexual debut and addressing substance use among adolescents may have a significant impact on HIV epidemic.

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.