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Background: Despite its significant usefulness in adolescent health studies, the single-item “body size perception” question, developed within the Health Behaviour in School-aged Children (HBSC) survey, has yet to undergo multidimensional validation. Objectives: To assess the convergent, divergent and concurrent validity of the HBSC body size perception question among adolescents. Methods: The single-item HBSC body size perception question is as follows: “Do you think your body is…?,” with answers ranging from “much too thin” to “much too fat.” Fifteen-year-old participants included in the analysis were 72,086 from 45 HBSC countries in 2017/18 (concurrent validity), and 595, 127, and 615 in 2021/22 in French-speaking Belgium, Ireland, and Poland, respectively. The convergent, divergent, and concurrent validity was assessed with body dissatisfaction, social desirability, and selfesteem, respectively. The concurrent validity was also examined with body mass index (BMI) from the 2017/18 HBSC data. All analyses were sex-stratified. Results: Cohen’s Kappa values were 0.67 [confidence interval (CI): 95%: 0.62, 0.72] and 0.64 (0.59, 0.69) for boys and girls, respectively, in all 3 countries together. Body size perception was associated with social desirability, selfesteem, and BMI, with a stronger association in girls than that in boys. For instance, girls with higher social desirability were less likely to perceive themselves as “too thin” [Relative Risk Ratio (RRR) = 0.78 (0.69, 0.89)] rather than as the “right size.” Boys with higher selfesteem were less likely to perceive themselves as “too fat” [0.93 (0.90, 0.97)] rather than the “right size.” Girls with underweight were less likely to perceive themselves as “too fat” [0.38 (0.34, 043)] rather than “right size” and girls with overweight/obesity were more likely to perceive themselves as such [8.19 (7.49, 8.95)]. Conclusions: The single-item HBSC body size perception question demonstrated good convergent, divergent, and concurrent validity. It reflects adolescents’ own perception of body size, possibly influenced by societal norms and ideals.

Abstract We have built a quantitative systems toxicology modeling framework focused on the early prediction of oncotherapeutic‐induced clinical intestinal adverse effects. The model describes stem and progenitor cell dynamics in the small intestinal epithelium and integrates heterogeneous epithelial‐related processes, such as transcriptional profiles, citrulline kinetics, and probability of diarrhea. We fitted a mouse‐specific version of the model to quantify doxorubicin and 5‐fluorouracil (5‐FU)‐induced toxicity, which included pharmacokinetics and 5‐FU metabolism and assumed that both drugs led to cell cycle arrest and apoptosis in stem cells and proliferative progenitors. The model successfully recapitulated observations in mice regarding dose‐dependent disruption of proliferation which could lead to villus shortening, decrease of circulating citrulline, increased diarrhea risk, and transcriptional induction of the p53 pathway. Using a human‐specific epithelial model, we translated the cytotoxic activity of doxorubicin and 5‐FU quantified in mice into human intestinal injury and predicted with accuracy clinical diarrhea incidence. However, for gefitinib, a specific‐molecularly targeted therapy, the mice failed to reproduce epithelial toxicity at exposures much higher than those associated with clinical diarrhea. This indicates that, regardless of the translational modeling approach, preclinical experimental settings have to be suitable to quantify drug‐induced clinical toxicity with precision at the structural scale of the model. Our work demonstrates the usefulness of translational models at early stages of the drug development pipeline to predict clinical toxicity and highlights the importance of understanding cross‐settings differences in toxicity when building these approaches.

Abstract Background Studies assessing the nutritional quality of food provided to the homeless population show deficiencies in micronutrients and excess fat, sugar, and salt. The availability of cheap, energy-dense and nutrient-poor food has changed the profile of people living with homelessness from primarily underweight to obese in western countries. Many factors influence the nutritional quality of food provided to the homeless population such as budget and time constraints, food donations and limited equipment. Nutrient intakes in this population are unlikely to be met outside of charitable meal programmes, making the nutritional quality of these meals crucial. This review will synthesise mixed methods literature with the overarching aim of understanding the determinants of the nutritional quality of food provided to the homeless population. Methods This mixed methods systematic review will include English language empirical research studies from Europe, North America and Oceania. The following electronic databases have been chosen for this review: SCOPUS, EMBASE, PsycINFO, EBSCOHost SocIndex and CINAHL. The grey literature databases OpenGrey and ProQuest will also be searched. Quality appraisal will be conducted using the Mixed-Methods Appraisal Tool. Two independent reviewers will be included in study selection, data extraction and quality appraisal. A third reviewer will resolve conflicts. Thematic synthesis will be employed. Discussion Results will be organised based on a determinants of health model, to highlight areas where change may be effective, thereby making it more likely to be useful to practitioners and researchers. The iterative steps in the systematic review process will be the focus of this article. Findings from this review will be used to develop best-practice guidelines for stakeholders such as policy makers and service providers to improve the nutritional quality of food provided in the homeless sector. Systematic review registration This mixed methods systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42021289063.

Abstract Objective: The aim of this study was to investigate the social and environmental factors involved in the food decision-making processes of families living on lower incomes on the Island of Ireland. Design: A qualitative design was employed for this study, using photovoice and creative mapping methods. Parents were requested to take photos and draw maps of their food environments. Interviews were then conducted with parents, using the materials produced by parents as a cue to discuss their food environments, influences and decision-making processes around food choices. Setting: The participants were interviewed online via Microsoft Teams. Participants: The participants were parents or guardians of children between the ages of 2 and 18 who self-defined as ‘living on a tight budget’. Results: Twenty-eight participants were recruited and interviewed for this study, including twelve parents in Northern Ireland and sixteen in the Republic of Ireland. The findings were mapped on to Bronfenbrenner’s Ecological Systems Theory and showed that multiple, overlapping and intersecting factors at the individual, micro-, meso-, exo-, macro- and chrono-system were implicated in family food choices. Upstream factors in particular, including structural, policy and commercial determinants, appear to be significant drivers of behaviour. Conclusions: While the findings suggest that a complex range of factors are involved in family food choices, it is clear that policy measures and regulations are needed to stave off the impacts of rising social inequality and food poverty. Health promoters should strive to find non-stigmatising interventions to bridge the nutritional divide experienced by lower-income families.

Abstract Objective: To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001–2002 and 2017–2018 and in neighbouring comparison countries (without a tax). Design: Repeated cross-sectional surveys. Setting: Health Behaviour in School-aged Children study, spanning five survey years (school years 2001–2002 to 2017–2018). Participants: Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls). Results: Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (P interaction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (P interaction < 0·001). Prevalence of occasional soda consumption (

Abstract Fieldwork, including work done at sea, is a key component of many geoscientists' careers. Recent studies have highlighted the pervasive harassment faced by women and LGBTQ+ people during fieldwork. However, transgender and gender diverse (TGD) scientists face obstacles which have not yet been thoroughly examined. We fill this gap by sharing our experiences as TGD people. We have experienced sexual harassment, misconduct, privacy issues, and legal and medical struggles as we conduct seagoing work. In this work, we provide recommendations for individuals, cruise leaders, and institutions for making seagoing work safer for our communities.

Abstract Background The food environment within and surrounding homes influences family dietary habits with socio-economic areas at a nutritional disadvantage. Families’ perception of the food environment and how it influences their food decisions is less clear. This rapid review aimed to synthesise qualitative evidence of parental perspectives of the food environment and their influence on food decisions among disadvantaged families. Method Qualitative and mixed-methods peer-reviewed journal articles published after 2000, that explored the perspectives of low-income parents in relation to their food environment and how this impacted food decisions for families with children aged 2-17 years, were included in this review. Embase, Scopus and PsycINFO were the databases chosen for this review. Search strategies included seven concepts related to family, food, perceptions, influences, environment, socio-economic status and study type. Two independent reviewers screened sixty-four studies. Thematic synthesis was employed. Results Two thousand one hundred and forty five results were identified through database searching and 1,650 were screened. Fourteen articles that originated from the US, Australia and the UK were included in this review. No articles were excluded following quality appraisal. Child preferences, financial and time constraints, and location and access to food outlets were barriers to accessing healthy food. Parental nutrition education and feeding approaches varied but positive outcomes from interventions to address these behaviours will be short-lived if inequities in health caused by poverty and access to affordable and healthy food are not addressed. The reliance on social support from families or government sources played an important role for families but are likely to be short-term solutions to health and nutritional inequities. Conclusions This qualitative evidence synthesis provides an insight into the perceptions of low-income parents on the factors influencing food decisions. Findings have implications for public health and the development of effective strategies to improve the dietary habits of children of disadvantaged families. Sustainable changes to dietary habits for families on low-income requires policy responses to low income, food access and to the high cost of healthy foods.

Abstract Background The first UK-wide lockdown to prevent the spread of COVID-19 had a serious financial impact on low-income households, a population already in higher risk of food insecurity and poor dietary choices. Qualitative data on the impact of COVID-19 lockdown on food decisions of UK families are scarce. This study aimed to explore how the measures to control the spread of COVID-19 influenced the food-related decisions of socioeconomically deprived families in Northern Ireland. Methods A qualitative study captured data from online individual interviews. Participation was open for parents of children 2–17 years old living on a tight budget in urban and rural areas of Northern Ireland. A sampling matrix enabled equal representation of single- and two-parent households, as well as parents of younger children (

Background: Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity. Methods: The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years. Results: Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12). Conclusion: The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences.

Abstract Objective Marginalised populations are less likely to take part in health research, and are sometimes considered ‘easy to ignore’. We aimed to describe our approach and results of recruiting parents who experience disadvantage, for focus groups exploring infant feeding on the island of Ireland. Upon receiving ethical approval, we implemented recruitment strategies that included building rapport with community organisations through existing networks, targeting specific organisations with information about our aims, and utilising social media groups for parents. Results We approached 74 organisations of which 17 helped with recruitment. We recruited 86 parents/carers (one male) for 19 focus groups (15 urban/4 rural). Seventy two percent met at the eligibility criteria. Most participants were recruited through organisations (91%), and the remainder on social media (9%). Recruitment barriers included multiple steps, research fatigue, or uncertainty around expectations. Factors such as building rapport, simplifying the recruitment process and being flexible with procedures were facilitators. Despite comprehensive, multi-pronged approaches, the most marginalised parents may not have been reached. Further alternative recruitment strategies are required for recruiting fathers, rural populations, or those without the capacity or opportunity to engage with local services.

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents’ socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes.

Abstract Background Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. Methods Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the ‘best fit’ framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). Results Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs ‘Consumer Needs & Resources’ (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and ‘Compatibility’ with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs ‘Relative Advantage’ of menu labelling (e.g. improved business image/reputation) and ‘Consumer Needs & Resources’ (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. Conclusion This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration Systematic review registration: PROSPERO CRD42017083306 .

Abstract Fussy/picky eating behaviours are common across childhood. Recent reviews of the fussy eating literature focus on quantitative research and do not adequately account for families’ subjective experiences, perceptions and practices. This review aims to synthesise the increasing volume of qualitative work on fussy eating. A systematic search of relevant databases was carried out. Studies were included if they were qualitative, published since 2008, with a primary focus on families’ experiences, perceptions and practices regarding fussy eating, food neophobia, or food refusal in children (aged one to young adult). Studies with clinical samples, or relating to children under one year were excluded. Ten studies were eligible for this review and were synthesised using meta-ethnography (developed by Noblit and Hare). This review provides a comprehensive description and definition of fussy eating behaviours. A conceptual model of the family experience of fussy eating was developed, illustrating relationships between child characteristics (including fussy eating behaviours), parent feeding beliefs, parent feeding practices, mealtime emotions and parent awareness of food preference development. Our synthesis identified two ways in which fussy eating relates to mealtime emotions (directly and via parent feeding practices) and three distinct categories of parent beliefs that relate to fussy eating (self-efficacy, attributions and beliefs about hunger regulation). The model proposes pathways which could be explored further in future qualitative and quantitative studies, and suggests that parent beliefs, emotions, and awareness should be targeted alongside parent feeding practices to increase effectiveness of interventions. The majority of studies included in this review focus on pre-school children and all report the parent perspective. Further research is required to understand the child’s perspective, and experiences of fussy eating in later childhood. PROSPERO Registration: CRD42017055943

Background: Labelling menus with nutrition information has increasingly become an important obesity policy option. While much research to-date has focused on determining its effectiveness, few studies report the extent to which menu labelling is implemented as designed. The aim of this study was to explore factors influencing fidelity to a calorie posting policy in Irish acute public hospitals.Methods: A mixed methods sequential explanatory study design was employed, with a nested case study for the qualitative component. Quantitative data on implementation fidelity at hospitals were analysed first and informed case sampling in the follow-on qualitative phase. Maximum variation sampling was used to select four hospitals with high and low levels of implementation and variation in terms of geographic location, hospital size, complexity of care provided and hospital type. Data were collected using structured observations, unstructured non-participant observations and in-depth semi-structured interviews. The Consolidated Framework for Implementation Research guided qualitative data collection and analysis. Using framework analysis, factors influencing implementation were identified. A triangulation protocol was used to integrate fidelity findings from multiple sources. Data on influencing factors and fidelity were then combined using joint displays for within and cross-case analysis.Results: Quantitative fidelity data showed seven hospitals were categorised as low implementers and 28 hospitals were high implementers of the policy. Across the four hospitals selected as cases, qualitative analysis revealed factors influencing implementation and fidelity were multiple, and operated independently and in combination. Factors were related to the internal hospital environment (e.g., leadership support, access to knowledge and information, perceived importance of calorie posting implementation), external hospital environment (e.g., national policy, monitoring), features of the calorie posting policy (e.g., availability of supporting materials), and the implementation process (e.g., engaging relevant stakeholders). Integrated analysis of fidelity indicated a pattern of partial adherence to the calorie posting policy across the four hospitals. Across all hospitals, there was a consistent pattern of low adherence to calorie posting across all menu items on sale, low adherence to calorie information displayed per standard portion or per meal, low adherence to standardised recipes/portions, and inaccurate calorie information.Conclusion: Efforts to maximise fidelity require multi-level, multi-component strategies in order to reduce or mitigate barriers and to leverage facilitators. Future research should examine the relative importance of calorie posting determinants and the association between implementation strategies and shifts in fidelity to intervention core components.

Background: The importance of nutrition during childhood and the high prevalence of child and adolescent obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet, there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed-methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence the implementation of school food standards. Methods: This mixed-methods systematic review will use qualitative, quantitative and mixed-methods evidence from peer-reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full-text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adoption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904

Objectives: We explored whether modes of transport (cycling, walking, public transport or private vehicle) between home and school are associated with mental well-being in children aged 10–17 years, participating in the Irish Health Behaviour in School-aged Children (HBSC) study.Methods: Scores on the World Health Organization Well-being Index and the Mental Health Inventory five-item versions, self-reported life satisfaction, happiness with self, body satisfaction, excellent self-rated health, and multiple health complaints of 9,077 schoolchildren (mean age: 13.99 ± 1.91 years, percentage girls: 52.2%) were compared across modes of transport, unadjusted and adjusted for gender, age, family affluence and area of residence.Results: Those who reported using public transport reported poorer mental well-being than those using other means of transport, but adjusting for sociodemographic variables obscured these differences. The only exception was excellent health, where children who cycled outperformed the other three groups, even after adjustment for sociodemographic variables.Conclusions: Cycling can improve well-being in children. However, in promotion of cycling, social and environmental determinants and inequalities which influence adolescents’ and their parents’ decisions on modes of transport, need to be considered.

Background: The importance of nutrition during childhood and the high prevalence of child and adolescence obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence implementation of school food standards. Methods: This mixed methods systematic review will use qualitative, quantitative and mixed methods evidence from peer reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, Medline, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adaption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904

Background: The importance of nutrition during childhood and the high prevalence of child and adolescence obesity has resulted in several countries implementing nutritional standards for school food as a way of providing healthy school food environments. Yet there has been less focus on the barriers and facilitators influencing the process of implementing school food standards. This mixed methods systematic review aims to address this evidence gap by synthesising the empirical evidence on the factors that may influence implementation of school food standards. Methods: This mixed methods systematic review will use qualitative, quantitative and mixed methods evidence from peer reviewed publications retrieved from the following databases; PubMed, CINAHL, Scopus, EMBASE, PsycINFO and Web of Science. Grey literature will be accessed through Google Scholar, Open Access Theses and Dissertations, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, and public health organisation websites will also be accessed. Screening reference lists and citation chaining of all included studies will also be undertaken. No restrictions on publication date or language will be applied, however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. Study titles and abstracts will be screened to decide whether the full text manuscript should be retrieved. For screening reliability, a second review author will assess a random sample of 20%. Kappa statistics will be used to assess inter-rater reliability, with values of 0.75 and higher representing high agreement. Two authors will independently extract data and factors reported to influence implementation. This will be synthesized using the Theoretical Domains Framework. Discussion: A comprehensive understanding of these factors can provide guidance to relevant stakeholders to enhance the adaption, implementation and sustainability of nutrition standards for school meals. Systematic review registration: PROSPERO CRD42019117904

Abstract Background Menu labelling is continuing to gather public and legislative support as one of the potential environmental strategies for addressing the obesity pandemic. However, issues relating to implementation have been reported in countries where menu labelling has been introduced on a voluntary or mandatory basis. The aim of this mixed methods systematic review is to synthesise the empirical evidence on the barriers and facilitators to implementation of menu labelling interventions to support healthy food choices. Methods This review will use the ‘best fit’ framework synthesis approach to synthesise qualitative, quantitative and mixed methods evidence. Peer-reviewed publications will be accessed through PubMed, EMBASE, CINAHL, PsycINFO, Web of Science and Scopus. Grey literature will be accessed through Google Scholar, OpenGrey, RIAN, EThOS, ProQuest, WorldCat, Networked Digital Library of Theses and Dissertations, Open Access Theses and Dissertations, and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies will be undertaken. There will be no restriction on menu labelling scheme or format, publication year or language; however, only primary research studies relevant to supply-side stakeholders will be eligible for inclusion. Study quality will be assessed using the Mixed Methods Appraisal Tool. At least two independent reviewers will perform study selection, data extraction and quality appraisal; if consensus is required, another independent reviewer will be consulted. A combination of deductive coding, using the Consolidated Framework for Implementation Research as the a priori framework, and inductive analysis, using secondary thematic analysis, will be used. The overall process will assist in the construction of a new evidence-based conceptual model regarding the implementation of menu labelling interventions. The new model will be assessed for bias and a sensitivity analysis performed. Discussion Given the growing consensus that a systemic, sustained portfolio of obesity prevention strategies, delivered at scale, is needed to address the obesity epidemic, greater understanding of the practical issues relating to implementation of such strategies is required. Findings from this review will be used to develop a set of best-practice guidelines to enhance the adoption, implementation and sustainability of menu labelling interventions across countries worldwide. Systematic review registration PROSPERO CRD42017083306

Abstract Background Childhood obesity is a significant public health challenge that affects approximately one in five children worldwide. Infant feeding practices are implicated in the aetiology of childhood obesity. Infant feeding interventions for childhood obesity are increasingly popular but outcome reporting is inconsistent across trials. Lack of standardisation limits examination of intervention effects and mechanisms of change. The aim of the current project is to develop a core set of infant feeding outcomes for children ≤ 1 year old, to be evaluated in childhood obesity intervention trials. Methods This project will use similar methodology to previous core outcome development research. An infant feeding core outcome set (COS) will be developed in four stages: (1) a systematic review of the literature, (2) discussion and clarification of outcomes in a meeting involving multiple stakeholder perspectives, (3) prioritisation of outcomes using the Delphi technique with an expert panel of stakeholders, and (4) achieving consensus on the COS using the nominal group technique (NGT) consensus meeting. An online Delphi survey will be conducted following the NGT meeting to prioritise outcomes identified in the systematic review. An NGT meeting will be conducted with groups of health professionals, non-clinician researchers, and parents of infants ≤ 1 year old, to achieve final consensus on the infant feeding COS. Discussion This study aims to develop a core outcome set of infant feeding outcomes for randomised infant feeding studies to prevent childhood obesity. This research will improve examination and syntheses of the outcomes of such studies to prevent and reduce childhood obesity.

Background: Promotion of good nutrition is essential for reducing the risk of chronic disease and premature death. Evidence shows menu labeling interventions should be implemented in workplaces as part of a comprehensive approach to improve employees’ dietary habits; however, implementation challenges have arisen. This article describes a protocol for a multiple case study to explore the factors that impact on implementation of a calorie menu labeling policy in Irish public hospitals. Methods: Using a multiple case study design, comprising four Irish acute public hospitals, this study will draw on multiple perspectives and sources of evidence (observations followed by interviews, focus groups, and documentary analysis) to allow for a comprehensive depth and breadth of inquiry. Data collection and analysis will be guided by the Consolidated Framework for Implementation Research, bringing together constructs from implementation theories to understand the complexity of implementing policies. Hospitals will be categorized into high and low implementers of the policy based on quantitative data obtained from structured observations. Using framework analysis, within- and cross-case analyses will be performed to identify factors influencing policy implementation and to identify distinguishing patterns across high and low implementers and across hospital direct and indirect stakeholders. Strategies will be employed to ensure rigorous case study research, for example, triangulation, audit trail, reflexivity, and thick descriptions. An integrated knowledge translation approach, where researchers work with stakeholders throughout the research process, will be adopted to facilitate the translation of research into policy and practice. Discussion: This protocol highlights methodological insights in utilizing case study research to gain a greater understanding of the menu labeling implementation process. Study findings will be relevant to policy makers and other stakeholders involved in the rollout of such interventions and will provide a foundation to select and tailor implementation strategies to assist with scale-up of calorie menu labeling across the health service.

Introduction Childhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysis This protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and dissemination This study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.

We are a group of researchers and academics with decades of experience in the protection and promotion of public health. We are writing to raise our concerns about how conflicts of interest are reported in public health nutrition research. We highlight examples of why it is important to accurately declare such conflicts, as well as providing examples of situations in which conflicts of interest have been inadequately reported. We call on researchers, and others, to be transparent about conflicts of interest in research. Journal editors in particular have an important responsibility in fully understanding how conflicts of interest can impact on research findings and interpretations. They need to agree and adopt clear guidelines on conflicts of interest and ensure that authors abide by these to facilitate trust in the scientific process and the credibility of published articles.

We are a group of researchers and academics with decades of experience in the protection and promotion of public health. We are writing to raise our concerns about how conflicts of interest are reported in public health nutrition research. We highlight examples of why it is important to accurately declare such conflicts, as well as providing examples of situations in which conflicts of interest have been inadequately reported. We call on researchers, and others, to be transparent about conflicts of interest in research. Journal editors in particular have an important responsibility in fully understanding how conflicts of interest can impact on research findings. They need to agree and adopt clear guidelines on conflicts of interest and ensure that authors abide by these to facilitate trust in the scientific process and the credibility of published articles.

Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent’s perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with ‘deli’ counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents’ perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.

Background: Weaning marks the transition from a milk-only diet to the consumption of solid foods. It is a time period where nutrition holds an undeniable importance and taste experiences have a long-lasting effect on food preferences. The factors and conditions that form parental feeding practices are yet to be fully understood; doing so can help target problematic behaviours and develop interventions aiming to modify them. Objective: This study used a qualitative methodology to gain a better understanding of parental experiences of weaning a child. Particular emphasis was placed on exploring the factors and conditions that favour the establishment of a healthy relationship with food in infancy and those that impede it. Methods: Thirty-seven mothers of healthy infants 3–14 months with no previous history of allergies or food-related disorders were recruited. Eight semi-structured focus group discussions were conducted, transcribed and analysed thematically. Results: Discussions revealed a number of opportunities to establish healthy eating habits during weaning, as well as relevant challenges. Important opportunities included: acting as a role model for healthy foods; giving multiple opportunities to try a food; food variety “so you don’t have a fussy eater”; and without food variety “things aren’t going to work properly”. Additionally, some of the challenges identified were: misconceptions about the definition of food variety; and distractions occurring during feeding. Conclusions: Mothers were mindful of the need to provide their children with appropriate nutritional stimuli during weaning. They were aware of their role in influencing their infants’ likes and used strategies such as modelling and repeated food exposure. The importance of a diverse diet in infancy was acknowledged, although knowledge gaps exist in relation to its definition. Distractions were tactfully employed by mothers to assist feeding. Findings of this study have applications in developing interventions for nutritional education in the complementary feeding period.

Breakfast is often considered the most important meal of the day and children and adolescents can benefit from breakfast consumption in several ways. The purpose of the present study was to describe trends in daily breakfast consumption (DBC) among adolescents across 31 countries participating in the HBSC survey between 2002 to 2010 and to identify socio-demographic (gender, family affluence and family structure) correlates of DBC. Cross-sectional surveys including nationally representative samples of 11-15 year olds (n = 455,391). Multilevel logistic regression analyses modeled DBC over time after adjusting for family affluence, family structure and year of survey. In all countries, children in two-parent families were more likely to report DBC compared to single parent families. In most countries (n = 19), DBC was associated with family affluence. Six countries showed an increase in DBC (Canada, Netherland, Macedonia, Scotland, Wales, England) from 2002. A significant decrease in DBC from 2002 was found in 11 countries (Belgium Fr, France, Germany, Croatia, Spain, Poland, Russian Federation, Ukraine, Latvia, Lithuania and Norway), while in 5 countries (Portugal, Denmark, Finland, Ireland, Sweden) no significant changes were seen. Frequency of DBC among adolescents in European countries and North America showed a more uniform pattern in 2010 as compared to patterns in 2002. DBC increased significantly in only six out of 19 countries from 2002 to 2010. There is need for continued education and campaigns to motivate adolescents to consume DBC. Comparing patterns across HBSC countries can make an important contribution to understanding regional /global trends and to monitoring strategies and development of health promotion programs.