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PURPOSE: This study assessed the validity of the Dietary Quality Score (DQS) and investigated the association between the DQS and risk factors for cardiometabolic diseases.METHODS: The DQS was calculated based on an updated 23-item FFQ and validated against a 376-item FFQ. A sub-sample of 450 men and women aged 18-73 years, from the Danish Diet, Cancer and Health-Next generations (DCH-NG) cohort, completed the updated 23-item FFQ. We investigated the associations between the DQS and risk factors for cardiometabolic diseases (lipids, haemoglobin A1c (HbA1c), high-sensitive C-reactive protein (hs-CRP), blood pressure (BP), waist circumference (WC), visceral and total fat mass) using linear regression models.RESULTS: A high DQS, i.e. healthy dietary habits, was significantly associated with a higher intake of fruits, vegetables, fish, fibre, several vitamins and minerals and a lower intake of saturated fat. Moreover, a high DQS was significantly associated with lower levels of LDL cholesterol (P = 0.0133), Hs-CRP (P = 0.0449), WC (P = 0.0161), visceral fat (P = 0.0003), total fat mass (P = 0.0106) and total fat percentage (P = 0.0030) and significantly associated with a higher HDL cholesterol (P = 0.0379) level, when adjusting for education, smoking habits and physical activity. There was no association with total cholesterol, triglycerides, HbA1c, BP and BMI.CONCLUSION: The DQS, based on the updated 23-item FFQ, is a valid tool to classify individuals into groups with low, average and high dietary quality in the Danish population. Furthermore, a high DQS is significantly associated with lower levels of several risk factors for cardiometabolic diseases.

INTRODUCTION: The study aim was to identify predictors of motivation to reduce alcohol consumption and whether motivation predicts engagement in alcohol misuse treatment in alcohol-related liver disease (ALD). METHODS: Data from health surveys and health-care registries were combined. RESULTS: Of 674 patients with ALD, 65% consumed alcohol. Recent hospital admission and severe alcohol problems were associated with motivation to reduce alcohol consumption. Two-year probability for engagement in misuse treatment was 29% for patients with motivation to reduce alcohol consumption versus 6.5% for patients without motivation. DISCUSSION: ALD patients with recent hospital admission were more motivated to cut down alcohol consumption, and motivation predicted engagement in alcohol misuse treatment. This insight can help us target brief interventions.

BACKGROUND: The healthy donor effect (HDE) is a selection bias caused by the health criteria blood donors must meet. It obscures investigations of beneficial/adverse health effects of blood donation and complicates the generalizability of findings from blood donor cohorts. To further characterize the HDE we investigated how self-reported health and lifestyle are associated with becoming a blood donor, lapsing, and donation intensity. Furthermore, we examined differences in mortality based on donor status.STUDY DESIGN AND METHODS: The Danish National Health Survey was linked to the Scandinavian Donations and Transfusions (SCANDAT) database and Danish register data. Logistic- and normal regression was used to compare baseline characteristics and participation. Poisson regression was used to investigate future donation choices. Donation intensity was explored by the Anderson-Gill model and Poisson regression. Mortality was investigated using Poisson regression.RESULTS: Blood donors were more likely to participate in the surveys, OR = 2.45 95% confidence interval (2.40-2.49) than non-donors. Among survey participants, better self-reported health and healthier lifestyle were associated with being or becoming a blood donor, donor retention, and to some extent donation intensity, for example, current smoking conveyed lower likelihood of becoming a donor, OR = 0.70 (0.66-0.75). We observed lower mortality for donors and survey participants, respectively, compared with non-participating non-donors.CONCLUSION: We provide evidence that blood donation is associated with increased likelihood to participate in health surveys, possibly a manifestation of the HDE. Furthermore, becoming a blood donor, donor retention, and donation intensity was associated with better self-reported health and healthier lifestyles.

Background & Aims: The function and structure of social relationships influence mortality in individuals within the general population. We compared aspects of social relationships in individuals with cirrhosis and a matched comparison cohort and studied their association with health-related quality of life (HRQoL) and mortality in cirrhosis. Methods: Individuals with cirrhosis and comparators were identified among participants of the Danish National Health Surveys 2010–2017. The surveys included questions on functional (social support and loneliness) and structural (living alone/cohabitating and frequency of contacts with relatives and friends) aspects of social relationships and HRQoL (Short Form-12). We estimated associations of aspects of social relationships with HRQoL and all-cause mortality in individuals with cirrhosis through 2020. Results: Of 541 individuals with cirrhosis and 2,157 comparators, low social support (22% in cirrhosis vs. 13% in comparators), loneliness (35% vs. 20%), and living alone (48% vs. 22%) were more frequent in individuals with cirrhosis than comparators, whereas the frequency of contacts with relatives and friends was similar. Except for living alone, weak functional and structural social relationships were associated with lower mental HRQoL in those with cirrhosis. Physical HRQoL was only marginally associated with social relationships. During 2,795 person-years of follow-up, 269 individuals with cirrhosis died. Functional and not structural aspects of social relationships were associated with risk of mortality in cirrhosis. Specifically, the adjusted hazard ratio was 1.4 (95% CI 1.1–1.9), p = 0.011, for low vs. moderate-to-high social support (functional aspect), and 1.0 (95% CI 0.8–1.3), p = 0.85 for living alone vs. cohabitating (structural aspect). Conclusions: Individuals with cirrhosis have weaker functional and structural social relationships than matched comparators. Weak functional relationships are associated with lower mental HRQoL and increased risk of mortality in individuals with cirrhosis. Impact and implications: This study investigated the prevalence of weak social relationships in individuals with cirrhosis and their influence on health-related quality of life and risk of mortality. Individuals with cirrhosis were nearly twice as likely to report low social support, loneliness, and to live alone than a matched comparison cohort. Low social support and loneliness (functional measures of social relationships) were associated with lower mental health-related quality of life and increased risk of mortality risk in cirrhosis, when adjusting for known confounders. We hope that these results will make healthcare providers aware of the functional aspects of the social relationships of individuals with cirrhosis, in addition to the traditional clinical management, and motivate further research of interventions to strengthen the social support of individuals with cirrhosis.

BackgroundAgreement may be low when comparing self-reported diseases in health surveys with registry data. The aim of the present study was to examine the agreement between seven self-reported diseases among a representative sample of Danish adults aged ≥16 years and data from medical records. Moreover, possible associations with sociodemographic variables were examined.MethodsNationally representative data on self-reported current or previous diabetes, asthma, rheumatoid arthritis, osteoporosis, myocardial infarction, stroke and cancer, respectively, were derived from the Danish National Health Survey in 2017 (N=183 372). Individual-level data were linked to data on the same diseases from medical records in registries. Logistic regression models were used to explore potential associations between sociodemographic variables and total agreement.ResultsFor all included diseases, specificity was >92% and sensitivity varied between 66% (cancer) and 95% (diabetes). Negative predictive value (NPV) was >96% for all diseases and positive predictive value (PPV) varied between 13% (rheumatoid arthritis) and 90% (cancer). Total agreement varied between 91% (asthma) and 99% (diabetes), whereas the kappa value was lowest for rheumatoid arthritis (0.21) and highest for diabetes (0.88). Sociodemographic variables were demonstrated to be significantly associated with total agreement for all diseases, with sex, age and educational level exhibiting the strongest associations. However, the directions of the associations were inconsistent across diseases.ConclusionOverall, self-reported data were accurate in identifying individuals without the specific disease (ie, specificity and NPV). However, sensitivity, PPV and kappa varied greatly between diseases. These findings should be considered when interpreting similar results from surveys.

ObjectiveTo explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health.BackgroundPoor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache.MethodsThe Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification.ResultsThe response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache ( p ConclusionPoor social support and loneliness were prevalent among people with chronic headache. The combination of chronic headache and poor social support or loneliness showed higher odds ratios for stress, medication overuse, and poor self-rated health compared to those with good social support and low loneliness scores. The effect of loneliness in the relationship between chronic headache and medication overuse warrants further study.

BackgroundAn end date for smoking has been adopted in several countries and is now being discussed by governments all over the world. However, little is known about temporal changes in citizens’ support for a future smoking ban.AimTo examine temporal changes in support for a future smoking ban and for increasing taxes on tobacco in Denmark, and to explore whether these changes differ across sex, age, educational attainment, smoking status and between smokers with/without intention to quit.MethodThe study was based on two waves of ‘The Danish Capital Region Health Survey’ conducted in 2013 and 2017. The pooled study sample included 96 521 citizens aged ≥16 years old.ResultsPublic support for a future smoking ban increased from 30.6% in 2013 to 50.3% in 2017, whereas support for increasing tobacco taxes remained unchanged at 59%. Support for a future smoking ban increased significantly in almost all subgroups from 2013 to 2017: Support among daily smokers increased by 27% between 2013 and 2017. Support among never smokers was almost 2.63 times higher than among smokers in 2013 and increased further in 2017 (OR: 2013=2.63; 2017=5.13).ConclusionThis study indicates a readiness to support a future smoking ban and increasing tobacco taxes. Support for a future smoking ban has increased from 2013 to 2017 among both young people and adults. By 2017, about half of the population supported a future smoking ban and increasing tobacco taxes. Findings may help inform policy-making related to endgame strategies.

Aim: This article aims to describe the study design, including descriptive statistics on changes in response rates, characteristics associated with response and response mode distribution, in the Danish National Health Survey (DNHS) in 2010, 2013 and 2017. Methods: Each survey was based on five regional stratified random samples and one national random sample drawn from the Danish Civil Registration System. The subsamples were mutually exclusive. Around 300,000 individuals (aged ⩾16 years) were invited to participate in each survey using a mixed-mode approach (paper/web). A questionnaire with a minimum of 52 questions was used in all subsamples. In 2010 and 2013, invitations were sent via the regular postal service, whereas a secure electronical mail service was used to invite the majority (around 90%) in 2017. Weights accounted for survey design and non-response. Results: Participation decreased from 59.5% in 2010 to 54.0% in 2013 after which it increased to 58.7% in 2017. The proportion answering the web questionnaire increased from 31.0% to 77.4% between 2013 and 2017 and varied from 73.8% to 79.7% between the subsamples in 2017. Overall, the response rate was low among young men and old women and among individuals who were unmarried, had low sociodemographic status, were from ethnic minority backgrounds or were living in the eastern part of Denmark. Conclusions: The survey mode, response mode distribution as well as response rate have changed over time. Weights to handle non-response can be applied to accommodate possible problems in generalising the results. However, efforts should continuously be made to ensure that response is missing at random.

Aims: This study aimed to test the hypothesis that heavy alcohol consumption and problem drinking is associated with a higher risk of becoming unemployed and a lower chance of entering the job market across socioeconomic positions. Methods: A sample of 84,474 men and women aged 18–60 years from the Danish National Health Survey 2010 participated in the study. Information on alcohol consumption and problem drinking was obtained by questionnaire. The primary outcomes were becoming unemployed and entering the job market. The follow-up period was five years. Information on labour market transitions and socioeconomic position (educational level) was obtained through nationwide registers. Multiplicative analyses were performed. Results: Heavy alcohol consumption and problem drinking were associated with a higher risk of unemployment among low-educated (hazard ratio (HR)=1.5; 95% confidence interval (CI) 1.3–1.9) and medium-educated (HR=1.3; 95% CI 1.1–1.5) individuals in comparison to individuals with a similar educational level drinking one to seven drinks per week. Excessive alcohol consumption and problem drinking were associated with a lower chance of entering the job market for individuals with a medium or high level of education: medium-educated individuals drinking >28 drinks per week had a HR of 0.82 (95% CI 0.69–0.98) when compared to medium-educated individuals drinking one to seven drinks per week. The corresponding HR among high-educated individuals was 0.71 (95% CI 0.49–1.0). Conclusions: Heavy alcohol consumption and problem drinking are associated with a higher risk of unemployment in some social strata, whereas excessive alcohol consumption and problem drinking are associated with a lower chance of entering the job market in other social strata.

Background Low response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years. Methods Registry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents. Results Across all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%. Conclusions Applying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.

Purpose: Long-term cancer survivors may develop psychological late effects. The aim of the present study was to determine prevalence of high level of stress in testicular cancer survivors (TCS) compared with the general population and prevalence of high level of stress among TCS stratified by type of treatment (surveillance, bleomycin, etoposide and cisplatin (BEP), or abdominal radiotherapy (RT)). Methods: In this large, nationwide and population-based, cross-sectional study, a total of 2252 TCS filled in a questionnaire between 2014–2016 covering psychological stress (Perceived Stress Scale (PSS)), sociodemographic factors, and physical health variables. Results were compared with a reference population. The reference population consisted of 61,927 men without prior or present cancer and sampled at random from the central population. High level of stress was defined as a PSS score ≥ 16, equivalent to the highest scoring quintile in the reference population. Logistic regression models adjusted for relevant covariates were used to estimate prevalence ratios of high level of stress. Results: Distribution of TCS was: surveillance, n = 1134; BEP, n = 807; and RT, n = 311 (median time since diagnosis was 19 years). TCS were more likely to have high level of stress compared to the reference population with a prevalence ratio of 1.56 (95% CI, 1.40–1.73). Individually, surveillance, BEP and RT groups had higher level of stress compared to the reference population. Conclusions: TCS are more likely to have high level of stress. Screening programs for psychological stress should be considered as part of the follow-up program. Implications for cancer survivors: A higher level of stress is observed in TCS irrespective of treatment.

Background: Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help-seeking behavior in the healthcare system can identify possibilities for prevention and intervention. Method: The current study describes healthcare use, burden of disease, and prior morbidities over a 15-year period by current alcohol use behavior among Danish adults aged 60–70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014–2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12-month abstinent (n = 691), low-risk drinkers (n = 1978), moderate-risk drinkers (n = 602), and high-risk drinkers (n = 467)], and a group of treatment-seeking individuals with a 12-month DSM-5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses. Results: Low-, moderate-, and high-risk drinkers had similar rates of past healthcare utilization (low-risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25–8.45), outpatient care 0.80 (0.41–1.32) and inpatient care 0.13 (0.10–0.21)). Higher rates were observed for both the 12-month abstinent group (adjusted RR = 1.16–1.26) and the group with AUD (ARR = 1.40–1.60) compared to the group with low-risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve-month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10). Conclusions: Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol-related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention.

The aim was to examine the effects of replacing self-reported leisure-time sedentary behavior with sleep, light-to-moderate physical activity, or vigorous physical activity on incident diabetes among Danish adults using isotemporal substitution modeling. Participants >= 25 years from the Danish Capital Region Health Survey 2007 (N = 69 800, response rate 52.3%), 2010 (N = 95 150, response rate 52.3%), and 2013 (N = 95 150, response rate 43.5%) were included. Information on daily sleep duration, leisure-time sedentary behavior, and movement behaviors was collected by questionnaire. Information on incident diabetes was obtained from National registers. Analyses included Cox proportional hazards regression models and isotemporal substitution analyses, with time (in years) from baseline to incident diabetes or censoring December 31, 2017. Potential confounders, sex, age, BMI, ethnicity, education, smoking, inflammatory joint disease, perceived stress, physical and mental component scale and work status, were included. Out of N = 87 339 in the final study sample, n = 3007 had incident diabetes during a mean follow-up time of 7.4 years. Adults with incident diabetes included more men, higher mean age, and higher BMI, compared to respondents without incident diabetes. Theoretically substituting 30 minutes of leisure-time sedentary behavior with light-to-moderate PA (HR: 0.96; 95% CI: 0.94; 0.98) or with vigorous PA (HR: 0.82; 95% CI: 0.72; 0.94) decreased the risk of incident diabetes. We found no change in incident diabetes risk of substituting sedentary time with sleep (HR: 1.00; 95% CI: 0.97; 1.02). Substituting 30 minutes per day of leisure-time sedentary behavior with light-to-moderate or vigorous PA may significantly reduce the risk of incident diabetes among adults.

Highlights • A low level of physical activity and fitness were associated with higher stress. • The associations were strongest in the youngest age-groups. • Self-rated health largely explained the associations in the older age-groups. • Physical activity and fitness may be extra important for mental health in young age., Previous studies have indicated that both low physical activity and low physical fitness are associated with a higher level of stress but the influence of age and health status on the associations is unknown. This was examined in a cross-sectional study based on data from the Danish Capital Region Health Survey 2017. Among all adults ≥ 16 years residing in the largest of five regions in Denmark 1. January 2017 a random sample of 104,950 was invited to participate. Hereof, 55.185 responded (52,6%). Physical activity during leisure time, fitness, self-rated health and stress (Cohens Perceived Stress Scale) was self-reported by questionnaire. Logistic regression weighted for size of municipality and non-response was used. Age modified the associations. In all age-groups odds ratio (OR) for a high level of stress was increasingly higher the lower the level of physical activity. The association was strongest among the 16–24-year-olds and persisted after adjustment for self-rated health, that otherwise attenuated the associations to an increasing extent the older the age-group. Similar models investigating the modifying effect of age on the association between self-rated fitness and stress showed the same patterns and tendencies. This study showed that physical activity and self-rated fitness were both associated with stress. The OR for a high level of stress was increasingly higher the lower the level of physical activity or self-rated fitness. This was found in all age-groups, but most pronounced among the 16–24-year-olds. Furthermore, findings suggest that health condition explains the associations to an increasing extent with increasing age.

The aim of this study was to investigate the association of alcohol consumption and problem drinking on transitions between work, unemployment, sickness absence and social benefits. Participants were 86,417 men and women aged 18–60 years who participated in the Danish National Health Survey in 2010. Information on alcohol consumption (units per week) and problem drinking (CAGE-C score of 4–6) was obtained by questionnaire. The primary outcome was labour market attachment. Information on labour market attachment was obtained from the national administrative registers during a 5-year follow-up period. Using Cox proportional hazards models, we estimated hazard ratios (HR) for transitions between work, unemployment, sickness absence and social benefits. Analyses were adjusted for potential confounders associated with demography, health, and socio-economy. High alcohol consumption and problem drinking was associated with higher probability of unemployment, sickness absence and social benefits among participants employed at baseline compared with participants who consumed 1–6 drinks/week. High alcohol consumption and problem drinking was associated with lower probability of returning to work among participants receiving sickness absence at baseline compared with participants who consumed 1–6 drinks/week and with non-problem drinkers: HRs were 0.75 (0.58–0.98) for 35+ drinks per week and 0.81 (0.65–1.00) for problem drinking (CAGE-C score of 4–6). Similar trends for weekly alcohol consumption and problem drinking were observed among participants who were unemployed at baseline. In summary, problem drinking has adverse consequences for labour market participation and is associated with higher probability of losing a job and a lower chance of becoming employed again. Electronic supplementary material The online version of this article (10.1007/s10654-018-0476-7) contains supplementary material, which is available to authorized users.

Aims The objective of this paper was to examine 20-year trends of the socioeconomic status (SES) measures income and employment and their association with current alcohol use behaviors in Danish adults aged 60–70. Methods Data from The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2013–2016) were combined to form four groups from the general population with various drinking patterns, but with no recent treatment for alcohol use disorder (AUD), and one group seeking treatment: Abstinent (n = 691), low- (n = 1978), moderate- (n = 602), and high-risk (HR) drinkers (n = 467), and DSM-5 AUD seeking treatment (n = 262). For all groups, Danish national register data were linked at the individual level obtain find annual information on income and employment during the 20 years prior to interview. Mixed effects models were utilized to model trajectories of income and employment for the five groups. Results Lower income and employment status was observed from middle-aged adulthood when comparing 12-month abstinence or AUD to individuals with low or moderate alcohol consumption. At the end of the study period, moderate-risk drinkers experienced an increase, and HR drinkers a decrease, in income and rate of employment relative to the low-risk drinkers. Conclusions Alcohol use behaviors observed in older adults are related to distinct long-term trajectories regarding income and employment status, which are observable already in middle-aged adulthood.

Background: Previous studies have indicated that the alcohol consumption among older Danish individuals has increased during the last three decades of the 20th century. However, the research is limited and, hence, the aim of the present article is to describe the trends and peculiarities in the development of the present situation in older people’s drinking patterns in Denmark. Methods: Data were obtained from the Danish Health and Morbidity Survey (2005) and the Danish National Health Survey (2010, 2013, and 2017). Data used in this study were collected via self-administered questionnaires from random samples of the adult (≥ 16 years) Danish population. Response rates varied between 50.8% (2005) and 59.5% (2010). Drinking patterns are described using the following indicators: alcohol consumption during the past 12 months; alcohol consumption at least two days a week; mean number of standard drinks consumed in a typical week and heavy episodic drinking (at least monthly). Results are presented as percentages or means. Results: The prevalence of overall 12-month alcohol use in all individuals aged 60 years or older has slightly increased between 2010 (83.9%) and 2017 (85.2%). On the other hand, the prevalence of consuming alcohol at least twice a week has overall decreased slightly between 2010 (54.0%) and 2017 (52.0%) in the same age group. A decrease was also observed in the mean number of standard drinks consumed in a typical week, from 8.3 in 2010 to 7.0 in 2017. Additionally, the prevalence of consuming at least five standard drinks on one occasion at least monthly decreased markedly from 24.8% in 2005 to 14.8% in 2013 (the prevalence remained stable between 2013 and 2017). The trends in prevalence of various alcohol indicators varied by sex and age. Conclusions: The findings of this study suggest an overall decline in alcohol consumption among older Danes in the study period. The continuation of this trend will be the subject of future studies.

Highlights • Media attitude towards underpinning policy with evidence influences policy decision makers. • Individual skills, attitudes, values of policy makers impact the extent evidence use. • A solid research infrastructure is facilitating but not sufficient for evidence use. • Factors that impact evidence use in policy making differ by country and policy context. • Interventions connecting policy makers and researchers in the policy context seem most promising., The knowledge-practice gap in public health is widely known. The importance of using different types of evidence for the development of effective health promotion has also been emphasized. Nevertheless, in practice, intervention decisions are often based on perceived short-term opportunities, lacking the most effective approaches, thus limiting the impact of health promotion strategies. This article focuses on facilitators and barriers in the use of evidence in developing health enhancing physical activity policies. Data was collected in 2012 by interviewing 86 key stakeholders from six EU countries (FI, DK, UK, NL, IT, RO) using a common topic guide. Content analysis and concept mapping was used to construct a map of facilitators and barriers. Barriers and facilitators experienced by most stakeholders and policy context in each country are analysed. A lack of locally useful and concrete evidence, evidence on costs, and a lack of joint understanding were specific hindrances. Also users’ characteristics and the role media play were identified as factors of influence. Attention for individual and social factors within the policy context might provide the key to enhance more sustainable evidence use. Developing and evaluating tailored approaches impacting on networking, personal relationships, collaboration and evidence coproduction is recommended.

Background: Treatment for disseminated testicular cancer increases the risk of secondary malignancy and cardiovascular disease. The risk of developing these serious adverse effects may be positively affected by healthy living. The purpose of this study was to identify health behaviours with possible influence on late effects that could be targets for intervention. Material and methods: In this cross-sectional study, testicular cancer survivors diagnosed in the period 1984–2007 from the Danish Testicular Cancer database completed a questionnaire on health behaviours (2014–2016). We estimated prevalence of smoking, alcohol consumption, sedentary lifestyle and overweight. Prevalence ratios described with 95% confidence intervals of adverse health behaviours were stratified by treatment modalities and compared to a reference population by means of logistic regression with adjustment for sociodemographic confounders. Results: In total, 2395 testicular cancer survivors (surveillance, 1175; chemotherapy, 897; radiotherapy, 323), median time since diagnosis 19 years, and 65,289 noncancer males were included, questionnaire response rates were 60% and 54%, respectively. There were more current smokers (prevalence ratio; 1.14, 95% confidence interval (CI): 1.03–1.26) and patients with body mass index above 25 kg/m2 (prevalence ratio; 1.10, 95% CI: 1.01–1.20) among testicular cancer survivors than in the reference population. Testicular cancer survivors reported less sedentary lifestyle (prevalence ratio; 95% CI: 0.74, 0.64–0.85) and everyday drinkers were fewer (prevalence ratio; 0.79, 95% CI: 0.68–0.92) than in the reference population. Conclusion: We identified smoking cessation as primary target for intervention studies in testicular cancer survivors. The effect of smoking cessation interventions as part of treatment should be investigated. Whether drug-based intervention is effective in minimising the risk of exposure to conventional risk factors for cardiovascular disease is also of interest.

Aim:The present article summarises status and trends in the 21st century in older people’s (60–79 years) drinking behaviour in Denmark, Finland, Norway and Sweden and concludes this thematic issue. Each country provided a detailed report analysing four indicators of alcohol use: the prevalence of alcohol consumers, the prevalence of frequent use, typical amounts of use, and the prevalence of heavy episodic drinking (HED). The specific aim of this article is to compare the results of the country reports.Findings:Older people’s drinking became more common first in Denmark in the 1970s and then in the other countries by the 1980s. Since 2000 the picture is mixed. Denmark showed decreases in drinking frequency, typically consumed amounts and HED, while in Sweden upward trends were dominant regarding prevalence of consumers and frequency of drinking as well as HED. Finland and Norway displayed both stable indicators except for drinking frequency and proportion of women consumers where trends increased. In all four countries, the gender gap diminished with regard to prevalence and frequency of drinking, but remained stable in regard to consuming large amounts. In Norway the share of alcohol consumers among women aged 60–69 years exceeded the share among men. During the late 2010s, Denmark had the highest prevalence of alcohol consumers as well as the highest proportion drinking at a higher frequency. Next in ranking was Finland, followed by Sweden and Norway. This overall rank ordering was observed for both men and women.Conclusion:As the populations aged 60 years and older in the Nordic countries continue to grow, explanations for the drivers and consequences of changes in older people’s drinking will become an increasingly relevant topic for future research. Importantly, people aged 80 years and older should also be included as an integral part of that research.

Objectives To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. Background Chronic headache and MOH prevalence in Denmark were last estimated in 2010. Methods In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. Results Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3–3.2) and MOH prevalence was 2.0% (95% CI: 1.8–2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. Conclusions The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.

AIMS: To evaluate the association between education and living arrangements and the intake of fish, red meat and fruit and vegetables.METHODS: The study design was cross-sectional and conducted in Denmark in 2013. Participants filled in questionnaires about their educational level and living arrangements (living alone or with others) and dietary intake including fish, red meat, fruit and vegetables. Regression analyses were performed to assess the associations within 85,456 randomly sampled healthy men and women who were at least 25 years old.RESULTS: Length of education was statistically significant and positively associated with the intake of fruit and vegetables and negatively associated with the intake of red meat for both men and women. Men with a high level of education had a 187g/week (95% confidence interval: 199-175g/week) lower intake of red meat and a 109g/day (95% confidence interval: 102-117g/day) higher intake of fruit and vegetables than men with a low level of education. Women with a high level of education had a 175g/week (95% confidence interval: 186-164g/week) lower intake of red meat and a 106g/day (95% confidence interval: 97-114g/day) higher intake of fruit and vegetables than women with a low level of education. Living with others was statistically significant and positively associated with the intake of red meat, and fruit and vegetables. There were no clear associations between education, living arrangements and intake of fish.CONCLUSIONS: Men and women with a high educational level ate more fruit and vegetables but less red meat than men and women with a low educational level. Men and women living with others ate more red meat, fruit and vegetables than men and women living alone.

Aim Type 1 diabetes requires extensive self-management to avoid complications and may have negative effects on the everyday life of people with the disease. The aim of this study was to compare adults with type 1 diabetes to the general population in terms of health-related quality of life, occupational status (level of employment, working hours and sick leave) and education level. Methods 2415 adults (aged 18–98years) with type 1 diabetes were compared to 48,511 adults (aged 18–103years) from the general population. Data were obtained from two cross-sectional surveys conducted in 2010 and 2011 of adults living or treated in the Capital Region in Denmark. Differences between adults with type 1 diabetes and the general population were standardised for age and sex and analyzed using linear probability models and negative binomial regression. Differences were further analyzed in subgroups. Results Compared to the general population, adults with type 1 diabetes experienced lower health-related quality of life, were more frequently unemployed, had more sick leave per year and were slightly better educated. Differences in health-related quality of life and employment increased with age and were larger among women, as compared to men. No significant differences were found with regard to working hours. Conclusion Our findings suggest that type 1 diabetes is associated with lower health-related quality of life, higher unemployment and additional sick leave. The negative association with type 1 diabetes is more pronounced in women and older adults.

This article analyses the use of research evidence (RE) in three policy processes, at the local level, dealing with physical activity. We analysed an extensive number of policy documents and a total of 14 interviews with policymakers. Results show an unsystematic way of using RE, where demographic and statistical data as well as expert consultation were mostly used. Lack of transparency of RE use complicated the tracking of sources from introduction to actual policy impact. It can be concluded that the policymakers engaged in health issues have a wider use of RE than the policymakers working with more sports-oriented issues.

Background: Facilitating and enhancing interaction between stakeholders involved in the policymaking process to stimulate collaboration and use of evidence, is important to foster the development of effective Health Enhancing Physical Activity (HEPA) policies. Performing an analysis of real-world policymaking processes will help reveal the complexity of a network of stakeholders. Therefore, the main objectives were to unravel the stakeholder network in the policy process by conducting three systems analyses, and to increase insight into the similarities and differences in the policy processes of these European country cases.Methods: A systems analysis of the local HEPA policymaking process was performed in three European countries involved in the 'REsearch into POlicy to enhance Physical Activity' (REPOPA) project, resulting in three schematic models showing the main stakeholders and their relationships. The models were used to compare the systems, focusing on implications with respect to collaboration and use of evidence in local HEPA policymaking. Policy documents and relevant webpages were examined and main stakeholders were interviewed.Results: The systems analysis in each country identified the main stakeholders involved and their position and relations in the policymaking process. The Netherlands and Denmark were the most similar and both differed most from Romania, especially at the level of accountability of the local public authorities for local HEPA policymaking. The categories of driving forces underlying the relations between stakeholders were formal relations, informal interaction and knowledge exchange.Conclusions: A systems analysis providing detailed descriptions of positions and relations in the stakeholder network in local level HEPA policymaking is rather unique in this area. The analyses are useful when a need arises for increased interaction, collaboration and use of knowledge between stakeholders in the local HEPA network, as they provide an overview of the stakeholders involved and their mutual relations. This information can be an important starting point to enhance the uptake of evidence and build more effective public health policies.

Literature suggests that people living in areas with a wealth of unhealthy fast food options may show higher levels of fast food intake. Multilevel logistic regression analyses were applied to examine the association between GIS-located fast food outlets (FFOs) and self-reported fast food intake among adults (+ 16 years) in the Capital Region of Denmark (N = 48,305). Accessibility of FFOs was measured both as proximity (distance to nearest FFO) and density (number of FFOs within a 1 km network buffer around home). Odds of fast food intake ≥ 1/week increased significantly with increasing FFO density and decreased significantly with increasing distance to the nearest FFO for distances ≤ 4 km. For long distances (>4 km), odds increased with increasing distance, although this applied only for car owners. Results suggest that Danish health promotion strategies need to consider the contribution of the built environment to unhealthy eating.

Background The health benefits of active commuting are well established, but little is known about the temporal changes in active commuting across sociodemographic groups. Aim To examine temporal changes in active commuting in the Capital Region of Denmark from 2007 to 2017 and to examine whether these changes differed across gender, age, educational attainment, BMI, distance to work/educational institution, and place of residence. Method The study was based on four waves of “The Danish Capital Region Health Survey (DK-CRHS)” conducted in 2007, 2010, 2013 and 2017. The pooled study sample included 102.792 individuals aged 25–79 years old. Results From 2007-2017 the overall prevalence of active commuters increased from 71.8% to 76.4%. Also, the Odds Ratio (OR) of being an active commuter increased significantly among men, individuals aged 25–34 and 35–44 years of age, all educational attainment groups, all BMI groups except BMI 5 km, and in all groups by place of residence (urban, suburban and rural). Survey year modified the effect of gender, age, educational attainment, distance to work/education, and place of residence, but not the effect of BMI on the probability of being an active commuter. Conclusion Active commuting has become more prevalent among adults living in the Capital Region of Denmark, but temporal changes from 2007 to 2017 differed between sociodemographic groups. Findings may help inform future planning and policymaking to secure targeted interventions for continuous promotion of active commuting across all sociodemographic groups.

Background and aim A high intake of dairy has been linked to lower risk of type 2 diabetes (T2D). The relationship between dairy intake and glucose metabolism is still not well understood. The aim of this study was to investigate the relation between the intake of total dairy and dairy subgroups and T2D and measures of glucose metabolism. Methods and results A total of 5953 Danish men and women aged 30–60 years without baseline diabetes or cardiovascular diseases were included in this prospective analysis. The dairy intake at baseline was categorised into low-fat dairy, full-fat dairy, milk and milk products, cheese and fermented dairy. Fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), HbA 1c , insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B) were considered at 5-year follow-up. In the maximally-adjusted model (demographics, lifestyle factors, dietary factors and waist), cheese intake was inversely associated with 2hPG ( β = −0.048, 95% CI −0.095; −0.001). Fermented dairy intake was inversely associated with FPG ( β = −0.028, 95% CI −0.048; −0.008) and HbA 1c ( β = −0.016, 95% CI −0.030; −0.001). Total dairy intake and the dairy subgroups were not related to HOMA-IR and HOMA-B in the maximally-adjusted model. Furthermore, there was no significant association between intake of total dairy or any of the dairy subgroups and incidence of T2D. Conclusion Our data suggest a modest beneficial effect of cheese and fermented dairy on glucose regulation measures; however, this did not translate into a significant association with incident T2D.

Contestualizzazione degli indicatori di evidence-informed policy making sviluppati nell'ambito del progetto REPOPA in Italia e in Danimarca

We aimed to examine the effect of a large population-based multifactorial screening and lifestyle intervention programme on 10-year incidence of diabetes. In a randomised trial of the general Danish population initiated in 1999–2001 59,616 men and women aged 30–60 years were assigned to a five year screening and lifestyle counselling programme (n = 11,629) or control group (n = 47,987) and followed for ten years in nationwide registers. Intention to treat was applied and risk of diabetes was modeled by Cox regression and expressed as hazard ratios (HRs). We found that 1692 individuals had diabetes at baseline. Among 57,924 individuals without diabetes at baseline, 1267 emigrated, 2593 died and 3369 (Intervention group = 684, Control group = 2685) developed diabetes. We saw no significant difference in diabetes incidence between the groups after 10-year follow-up (Grey's test: p = 0.22). In the first year of follow-up, incidence of diabetes was significantly higher in the intervention group than the control group (HR = 1.68, 95%CI 1.29 to 2.29). We observed no difference in incidence of diabetes between the groups in the follow-up intervals from 1 to 6 years or after 6–10 years (HR = 0.94, 0.83 to 1.06; HR = 1.03, 0.91 to 1.17). Inviting the general population to participate in a repeated screening and lifestyle counselling programme over five years did not result in lower incidence of diabetes after 10 years of follow-up. As expected, significantly more individuals were diagnosed with diabetes in the intervention group during the first year, but this was not followed by a decrease in the following years. Trials registration: Clinical trials NCT00289237

Objective: To investigate whether sustained long-term changes in alcohol intake are predictive of cardiovascular risk. Methods: The study population was a subpopulation of the five-year intervention study, Inter99 study, (1999-2006), Copenhagen, Denmark (n = 2117; 30 - 60 years). Alcohol intake was assessed by questionnaires at baseline, one-, three- and five-year follow-up. The associations between sustained long-term changes in alcohol intake and cardiovascular risk factors (HDL and non-HDL cholesterol, systolic and diastolic blood pressure (BP); the absolute risk of ischemic heart disease (CRS)) at five-year follow-up were explored by linear regression models. The alcohol variables were tested for linear association with the response variable. Results: Sustained increased alcohol intake was significantly associated with increased CRS (β = 0.0028; P = 0.006) and a decreased HDL cholesterol (β = -0.0028; P = 0.005). Among participants with a moderate overall alcohol in-take at baseline increased alcohol intake was significantly associated with an increased plasma triglyceride (β = 0.0069; P = 0.04). No association with triglyceride was found for participants with a high alcohol intake. Change in wine intake was significantly negatively associated with changes in diastolic BP (β = 0.0015; P = 0.02). Conclusions: Sustained increase in the long-term intake of alcohol was a significant risk factor for an increased CRS, increased triglyceride level and decreased HDL cholesterol. Increased wine intake was associated with decreased diastolic BP.

Purpose: To investigate the effect of screening and five years of multi-factorial lifestyle intervention on changes in alcohol intake in a general population. Methods: The study was a pre-randomized intervention study on lifestyle, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n=6 091) had at baseline a medical health-examination and a face-to-face lifestyle counselling. Individuals at high risk of ischemic heart disease were repeatedly offered both individual and group-based counselling. The control group (n=3 324) was followed by questionnaires. Alcohol intake was measured by questionnaires. Changes were analyzed by multilevel analyses. Results: Binge drinking decreased both in men and women at three and five-year follow-up (men: five-year: net-change:-0.13; p=0.03; women: five-year: net-change:-0.08; p=0.04). Furthermore, in women the ratio between wine and total alcohol was increased compared with the control group at five-year follow-up (net-change: 0.04; P21 drinks pr week) the effect on total alcohol intake was maintained at five-year follow-up(net-change: -3.7; p=0.01). No significant effects were found in women on total alcohol intake. Conclusion: Multi-factorial lifestyle intervention, including low intensity alcohol intervention, improved long-term alcohol habits in a general population. Language: en

Objective To evaluate the effectiveness of a population-based multi-factorial lifestyle intervention on long-term changes in dietary habits compared to a non-intervention control group. Methods The study was a randomized controlled lifestyle intervention study, Inter99 (1999–2006), Copenhagen, Denmark, using a high-risk strategy. Participants in the intervention group ( n = 6 091) had at baseline a medical health-examination and a face-to-face lifestyle counselling. Individuals at high risk of ischemic heart disease were repeatedly offered both individual and group-based counselling. The control group ( n = 3 324) was followed by questionnaires. Dietary habits were measured by a validated 48-item food frequency questionnaire and changes were analyzed by multilevel analyses. Results At the 5-year follow-up the intervention group compared to the control group had significantly increased their intake of vegetables (men: net-change: 23 g/week; p = 0.04; women: net-change: 27 g/week; p = 0.005) and decreased the intake of highly saturated fats used on bread and for cooking (men: OR = 0.59 (0.41–0.86); women: OR = 0.42 (0.30–0.59)). Significant effects on fruit and fish intake were found at the 3-year follow-up but the effect attenuated at the 5-year follow-up. Conclusion A population-based multi-factorial lifestyle intervention promoted significant greater beneficial long-term dietary changes compared to the control group, especially the intake of vegetables and saturated fat was improved.

Background: It has been hypothesized that obesity and insulin resistance may play a role in the development of asthma and allergy. The aim of the study was to examine the association of obesity and insulin resistance with asthma and aeroallergen sensitization. Methods: Cross-sectional population-based study of 3609 Danish men and women aged 30–60 years. Aeroallergen sensitization was defined as positive levels of specific IgE against a panel of inhalant allergens. Asthma was defined as self-reported physician diagnosed asthma. Allergic asthma was defined as the presence of both asthma and aeroallergen sensitization. The homeostasis model assessment of insulin resistance was used to estimate the degree of insulin resistance. Body mass index, waist-to-hip ratio, and waist circumference were used as measures of obesity. Data were analyzed by multiple logistic regression analyses. Results: Obesity was associated with increased risk of aeroallergen sensitization as well as allergic and nonallergic asthma. Insulin resistance was asssociated with aeroallergen sensitization and allergic asthma, but not nonallergic asthma. The associations of obesity with aeroallegen sensitization and allergic asthma became nonsignificant after adjustment for insulin resistance, whereas the association of obesity with nonallergic asthma was unaffected. No sex-differences were observed. Conclusion: Obesity may be related to an increased risk of aeroallergen sensitization and allergic asthma through mechanisms also involved in the development of insulin resistance.

Background: The gaps observed between the use of research evidence and policy have been reported to be based on the different methods of using research evidence in policymaking by researchers and actual policymakers. Some policies and policymaking processes may therefore be particularly well informed by research evidence compared to others. The aims of the present article are to explore the use of research evidence in health-enhancing physical activity (HEPA) policies, identify when research evidence was used, and find what other types of evidence were employed in HEPA policymaking.Methods: Multidisciplinary teams from six EU member states analysed the use of research evidence and other kinds of evidence in 21 HEPA policies and interviewed 86 key policymakers involved in the policies. Qualitative content analysis was conducted on both policy documents and interview data.Results: Research evidence was mostly used to justify the creation of HEPA policies and, generally, implicitly without citation. The policies analysed used many types of evidence other than citable research. The evidence used in HEPA policies was found to fall into the following categories: societal framework, media, everyday knowledge and intuition, research evidence, and other types of evidence.Conclusions: Research evidence seems to be the only type of evidence used in policymaking. Competition between the use of other types of evidence and research evidence is constant due to the various sources of information on the Internet and elsewhere. However, researchers need to understand their role in translating research evidence into policymaking processes.

BackgroundA policy game is a structured simulated role-play dealing with highly complex decision-making in real life network settings. Its impact on health enhancing physical activity (HEPA) policy making is unexplored. We aim to explore if an internationally developed and pilot tested policy game change insight andattitude towards inter sectoral policy processes, such as the organization network, collaboration, and use of knowledge in HEPA policy making in three European countries. Methods The Netherlands (NL), Denmark (DK) and Romania (RO), partners in the REPOPA program, have carried out a policy game at local level, with 6 months intervals, including 18–19 policy makers in each game. Data was collected using a structured questionnaire one week after implementation of the games. Participants were asked if the game had changed their insight or attitude. Results: Response rate was 83%, 89% and 89% in NL, DK and RO respectively. Across countries the majority of participants, 60%, enhanced their nderstanding of the local HEPA policy process, the roles in the organization network, and howstakeholders can collaborate as result of the game. Most participants perceived change in insight of the collaboration process in NL (100%). The fraction of participants who enhanced their insight to leadership aspects of their networkvaried across aspects of leadership and across countries, from 14% in NL to 86% in RO. The fraction of participants being more positive towards use of knowledge varied across countries, 25% in NL to 75% in DK. Across countries the majority of participants, 67–70%, stressed’ importance of collaboration’ as the main learning experience. Conclusion: The policy game has potential to increase insight to HEPA policy process, including stakeholder roles, and attitude towards collaboration and use of knowledge. Differences between countries may be a result of diversity in potential for change in game participant groups and game processes.Key message: The policy game encountered changes at the domains‘organization network’, ‘collaboration’, ‘leadership’ and ‘use of knowledge’, with differences between countries.

Background A policy game is an intervention aimed at addressing complex issues of the policy development processes that require clarification of goals, roles, and relations within and between organizations. The aim of this presentation is to elaborate on the process of developing and conducting …

Background To explore whether the policy game In2Action changes insight and attitude towards inter sectoral policy processes, such as the organization network, collaboration, and use of knowledge in real life health enhancing physical activity (HEPA) policy making in three European countries. Methods The Netherlands (NL), Denmark (DK) and Romania (RO), have carried out a policy game in a real life …

Background The generic policy game In2action was developed to stimulate collaboration between identified stakeholders at local level in three cases in EU countries: The Netherlands, Denmark and Romania. Development and implementation of public health policy increasingly takes place at local level, involves many different stakeholders, each with own goals and interests, and evidence is hardly being used in inter …

To develop and assess the validity of the Dietary Quality Score (DQS) and investigate the association with cardiovascular risk factors. Cross-sectional population-based study. Copenhagen County, Glostrup, Denmark. A random sample of 12 934 men and women aged 30–60 years were invited to a health examination. A total of 6542 participants were included in the statistical analysis. The DQS was developed using eight questions from a 48-item food frequency questionnaire (FFQ) and validated using a 198-item FFQ. Associations between the DQS and fasting serum lipids, homocysteine, blood pressure and the absolute risk of ischaemic heart disease (IHD) were explored. A higher DQS was shown to be associated with higher dietary quality in general, including a low intake of fat, especially saturated fat; a high intake of fibre; various vitamins and minerals; and fruit, fish, vegetables and whole–grain products. A higher score according to the DQS was significantly negatively associated with total cholesterol (P=0.0031), triglyceride (P=0.0406), low-density lipoprotein-cholesterol (P=0.0071), homocysteine (P

OBJECTIVE—To examine the relationship between daily glycemic index, daily glycemic load, simple sugars, dietary fiber, and the prevalence of a measure of insulin resistance in 30- to 60-year-old nondiabetic Danish men and women. RESEARCH DESIGN AND METHODS—The Inter99 study is a nonpharmacological intervention study. We used baseline data and examined cross-sectional associations between carbohydrate-related dietary factors and an estimate of insulin resistance in 5,675 subjects at 30–60 years. The dietary intake was estimated from a self-administered food frequency questionnaire, and insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). Multiple regressions were performed with HOMA-IR as the dependent variable and carbohydrate-related factors as explanatory variables. All models were adjusted for age, sex, smoking, physical activity, total energy intake, BMI, and waist circumference. RESULTS—Intake of lactose was positively associated with HOMA-IR (P < 0.0001), whereas daily glycemic load and intake of glucose, fructose, dietary fiber, total carbohydrate, fruit, and vegetables were inversely associated with HOMA-IR (P < 0.05). Intake of dietary fiber explained the associations with daily glycemic load and total carbohydrate and attenuated the association with fruit and vegetables. No significant associations were observed for daily glycemic index or sucrose. CONCLUSIONS—Habitual intake of diets with a high glycemic index and high glycemic load or diets with a high content of total carbohydrate including simple sugars was not associated with the probability of having insulin resistance. Furthermore, intake of dietary fiber was inversely associated with the probability of having insulin resistance.

Evidence shows that regular physical activity is enhanced by supporting environment. Studies are needed to integrate research evidence into health enhancing, cross-sector physical activity (HEPA) policy making. This article presents the rationale, study design, measurement procedures and the initial results of the first phase of six European countries in a five-year research project (2011-2016), REsearch into POlicy to enhance Physical Activity (REPOPA). REPOPA is programmatic research; it consists of linked studies; the first phase studied the use of evidence in 21 policies in implementation to learn more in depth from the policy making process and carried out 86 qualitative stakeholder interviews. The second, ongoing phase builds on the central findings of the first phase in each country; it consists of two sets of interventions: game simulations to study cross-sector collaboration and organizational change processes in the use of evidence and locally tailored interventions to increase knowledge integration. The results of the first two study phases will be tested and validated among policy makers and other stakeholders in the third phase using a Delphi process. Initial results from the first project phase showed the lack of explicit evidence use in HEPA policy making. Facilitators and barriers of the evidence use were the availability of institutional resources and support but also networking between researchers and policy makers. REPOPA will increase understanding use of research evidence in different contexts; develop guidance and tools and establish sustainable structures such as networks and platforms between academics and policy makers across relevant sectors. Language: en