Food choice in transition: adolescent autonomy, agency, and the food environment.

Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.

The interplay between social and food environments on UK adolescents' food choices: implications for policy.

Factors from social and food environments can influence the food choices of adolescents in ways not experienced during childhood. Evidence suggests these two environments influence adolescents' food choices independently, but there is limited knowledge of how the interplay between these environments influence adolescents' diets. An enhanced understanding of this interplay surrounding adolescent food choice could aid the development of more nuanced interventions and policies. This qualitative study involved 13 online focus groups with adolescents (n = 45) aged 11-18 years, attending secondary school or college in England, UK. Data were analysed using thematic analysis. Social experiences which accompanied eating were perceived as more important than the food itself, and fast-food outlets were described as uniquely suited to facilitating these interactions. Young people wanted to spend their money on foods they considered worthwhile, but this did not always relate to the most affordable foods. Adolescents wanted to put little effort into making food decisions and appreciated factors that helped them make quick decisions such as prominent placement and eye-catching promotions on foods they wanted to buy. Chain food outlets were valued as they offered familiar and frequently advertised foods, which minimized the effort needed for food decisions. Adolescents' sense of autonomy underpinned all themes. Participants described having limited opportunities to make their own food choices and they did not want to waste these buying unappealing 'healthy' foods. Interventions and government policies should align with adolescents' experiences and values relating to food choice to ensure that they are effective with this important age group.

Young people's experiences of COVID-19 messaging at the start of the UK lockdown: lessons for positive engagement and information sharing.

BACKGROUND: To reduce COVID-19 infection rates during the initial stages of the pandemic, the UK Government mandated a strict period of restriction on freedom of movement or 'lockdown'. For young people, closure of schools and higher education institutions and social distancing rules may have been particularly challenging, coming at a critical time in their lives for social and emotional development. This study explored young people's experiences of the UK Government's initial response to the pandemic and related government messaging. METHODS: This qualitative study combines data from research groups at the University of Southampton, University of Edinburgh and University College London. Thirty-six online focus group discussions (FGDs) were conducted with 150 young people (Southampton: n = 69; FGD = 7; Edinburgh: n = 41; FGD = 5; UCL: n = 40; FGD = 24). Thematic analysis was conducted to explore how young people viewed the government's response and messaging and to develop recommendations for how to best involve young people in addressing similar crises in the future. RESULTS: The abrupt onset of lockdown left young people shocked, confused and feeling ignored by government and media messaging. Despite this, they were motivated to adhere to government advice by the hope that life might soon return to normal. They felt a responsibility to help with the pandemic response, and wanted to be productive with their time, but saw few opportunities to volunteer. CONCLUSIONS: Young people want to be listened to and feel they have a part to play in responding to a national crisis such as the COVID-19 epidemic. To reduce the likelihood of disenfranchising the next generation, Government and the media should focus on developing messaging that reflects young people's values and concerns and to provide opportunities for young people to become involved in responses to future crises.

Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey.

BACKGROUND: UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors. METHODS: Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one. RESULTS: The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores. CONCLUSIONS: The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.

Exploring the diet and physical activity behaviours of adolescents living in India and sub-Saharan Africa: a qualitative evidence synthesis.

OBJECTIVE: To carry out a qualitative evidence synthesis to explore what influences the diet and physical activity of adolescents living in five countries that constitute the Transforming Adolescent Lives through Nutrition (TALENT) consortium (Cote D'Ivoire, Ethiopia, India, South Africa and The Gambia). DESIGN: A search of electronic databases was conducted for qualitative articles published between 2000 and 2019. PARTICIPANTS: Studies that explore influences on the diets and physical activity habits of adolescents aged 10-19 years. RESULTS: Of the twelve included studies, none were identified from The Gambia or Cote D'Ivoire. The existing qualitative literature focussed on three major areas in relation to adolescents' diet and physical activity: (1) the influence of body image and self-esteem; (2) social and environmental influences and (3) poverty. The limited existing literature focusses heavily on girls' experiences particularly in relation to body image and dysfunctional eating practices. CONCLUSIONS: In-depth research exploring adolescents' perceptions of diet and physical activity is needed to better understand how both boys and girls, at different stages of adolescence, perceive health, diet and physical activity. More research with young people is required especially in countries where little exists to cover a wider range of issues that play a role in diet and physical activity.

Parental perspectives on negotiations over diet and physical activity: how do we involve parents in adolescent health interventions?

OBJECTIVE: To identify the ways in which parental involvement can be incorporated into interventions to support adolescent health behaviour change. DESIGN: Data from semi-structured interviews were analysed using inductive thematic analysis. SETTING: Southampton, Hampshire, UK. PARTICIPANTS: A convenience sample of twenty-four parents of adolescents. RESULTS: Parents consider themselves to play an important role in supporting their adolescents to make healthy choices. Parents saw themselves as gatekeepers of the household and as role models to their adolescents but recognised this could be both positive and negative in terms of health behaviours. Parents described the changing dynamics of the relationships they have with their adolescents because of increased adolescent autonomy. Parents stated that these changes altered their level of influence over adolescents' health behaviours. Parents considered it important to promote independence in their adolescents; however, many described this as challenging because they believed their adolescents were likely to make unhealthy decisions if not given guidance. Parents reported difficulty in supporting adolescents in a way that was not viewed as forceful or pressuring. CONCLUSIONS: When designing adolescent health interventions that include parental components, researchers need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents. Parental involvement in adolescent interventions could be helpful but needs to be done in a manner that is acceptable to both adolescents and parents. The findings of this study may be useful to inform interventions which need to consider the transitions and negotiations which are common in homes containing adolescents.

'I should be disease free, healthy and be happy in whatever I do': a cross-country analysis of drivers of adolescent diet and physical activity in different low- and middle-income contexts.

OBJECTIVE: To explore perceptions of how context shapes adolescent diet and physical activity in eight low- and middle-income (LMIC) sites at different stages of societal and economic transition. DESIGN: Novel qualitative secondary analysis of eight data sets generated as part of the international Transforming Adolescent Lives through Nutrition (TALENT) collaboration. SETTING: Diverse sites in India and Sub-Saharan Africa. PARTICIPANTS: Fifty-two focus group discussions with 491 participants (303 adolescents aged 10-17 years; 188 caregivers). RESULTS: Analysis of pooled qualitative data identified three themes: (1) transitions in generational nutrition education and knowledge; (2) transition in caregiver-adolescent power balance and (3) the implications of societal and economic transition for diet and physical activity. Adolescents in urban and peri-urban areas could readily access 'junk' food. Diets in rural settings were determined by tradition, seasonality and affordability. Physical activity was inhibited by site-specific factors including lack of space and crime in urban settings, and the prioritisation of academic performance. Gender influenced physical activity across all sites, with girls afforded fewer opportunities. CONCLUSIONS: Interventions to improve adolescent diet and physical activity in LMIC need to be complex, context-specific and responsive to transitions at the individual, economic and societal levels. Moreover, solutions need to acknowledge gender inequalities in different contexts, as well as structural and cultural influences on diet and physical activity in resource-limited settings. Programmes need to be effective in engaging and reconciling adolescents' and caregivers' perspectives. Consequently, there is a need for action at both the community-household level and also through policy.

Wow! They really like celeriac! Kindergarten teachers' experiences of an intervention to increase 1-year-olds' acceptance of vegetables.

Exposure to varied foods in early life is important for short- and long-term health and development. Strategically introducing toddlers to new vegetables is not a common practice in Norwegian kindergartens. Therefore, we developed, conducted, and evaluated a web-based cluster randomised kindergarten intervention, Pre-schoolers' Food Courage 2.0. The purpose of the current qualitative study was to explore kindergarten teachers' experience of implementing this intervention and what they thought facilitated the positive impact of the intervention reported in the quantitative evaluation. Ten individual telephonic interviews with kindergarten teachers who took part in the intervention study were conducted using a semi-structured interview guide. Data were transcribed verbatim and subjected to thematic analysis. Five main themes were identified: 1) One-year-olds love food and renewal of the menus was inspiring; 2) One-year-olds are surprisingly willing to try and accept novel foods; 3) Novel food at meals stimulate social interaction; and 4) The Sapere method is a fun and explorative activity for 1-year-olds. These four themes were the features perceived as the effective elements of the intervention by the kindergarten teachers. The fifth main theme was: 5) Sustained impact on kindergarten teachers' practices and beliefs. The kindergarten teachers found the intervention easy to implement, and they were surprised by the foods 1-year-olds like and how the intervention increased their food acceptance. This age window of opportunity seems to be underused in kindergartens. By using the strategies described in the intervention, kindergarten staff effectively took advantage of this opportunity and consequently, child and kindergarten staff behaviour in relation to food was enhanced. Interventions targeting healthy feeding practices may potentially have a long-term public health impact by increasing food variety and vegetable intake in toddlers. TRIAL REGISTRATION: ISRCTN98064772.

How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health?

Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face-to-face interviews with participants, a focus group with the HCS-trained midwives/nurses, case reports of participants receiving HCS and audio-recordings of mid-pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well-being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.

"It is really just brilliant to get credits for something that is so important to you!" Skills for Life: University students' perceptions of a planned dietary life skills course.

OBJECTIVE: Universities have a role in educating and empowering students to become healthy and literate citizens of the 21st century society. The aim of this study was to explore university students' perceptions regarding the relevance and utility of a planned dietary life skills course. DESIGN: Qualitative design including focus group discussions. SETTING: A Norwegian university with participating undergraduate students from seven different disciplines. METHOD: Data collection included 13 semi-structured focus group discussions involving 57 university students (35 women and 22 men aged 18-38 years). The focus group discussions were recorded and transcribed verbatim. To ensure in-depth knowledge of the research participants' thoughts and reflections, thematic analysis strategy was undertaken by a team of researchers. RESULTS: When presented to the idea of a dietary life skills course as a university course, the students were mostly positive regarding its relevance and utility, however both motivators and barriers for attending were put forward. Some mentioned potential academic course benefits, such as enhanced CV, and a few mentioned potential societal benefits such as a healthy population and sustainable food consumption. Several motivators for attending the course were launched, such as increased knowledge and cooking skills, having dinner and expanded network. The students wanted to learn about food, nutrients and health, and how to cook simple, affordable, healthy and sustainable meals. Potential barriers for attending were mostly related to practicalities, such as potential lack of alignment with ordinary study programme or too demanding lectures. CONCLUSION: Most students acknowledged the value of a dietary life skills course and thought that such a course could benefit their personal life. This encourages the offering of such courses at university level, tailored to consider both motivators and barriers for attending.

"It's More Than Just Exercise": Tailored Exercise at a Community-Based Activity Center as a Liminal Space along the Road to Mental Health Recovery and Citizenship.

Mental health care policies call for health-promoting and recovery-oriented interventions, as well as community-based programs supporting healthier habits. The purpose of this study was to explore how individuals facing mental health challenges experienced participating in tailored exercise at a community-based activity center, and what role tailored exercise could play in supporting an individual's process of recovery. Data were collected through in-depth interviews with nine adults experiencing poor mental health who engaged in exercise at the activity center. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation. Participants spoke about the community-based program being a safe space where they could "come as they are" (Theme 1). Taking part in the program was "more than just exercise" and allowed them to connect with others (Theme 2). The experiences they gained from exercise also helped with other areas in life and provided them with a safe space to build their confidence towards the "transition back to the outside" (Theme 3). We summarized the findings into one overall theme: "inside vs. outside". In conclusion, a community-based activity center acted as a liminal space that aided mental health recovery by allowing participants to feel safe, accepted and supported, as well as experience citizenship. The findings highlight the need to treat mental health challenges as a contextual phenomenon and creating arenas for community and citizenship in society.

Young women's and midwives' perspectives on improving nutritional support in pregnancy: The babies, eating, and LifestyLe in adolescence (BELLA) study.

RATIONALE: Teenage pregnancy has a high risk of poor outcomes for both mother and baby. Teenage girls have the poorest diets of any population group in the UK, which compounds the risk of poor pregnancy outcomes. Pregnant teenagers trust advice from their midwives, but midwives feel they do not have time, confidence, or knowledge to discuss nutrition. OBJECTIVE: This study examined how the relationship between pregnant teenagers and their midwives could be utilised to deliver support to improve diet quality. METHOD: Qualitative interviews were conducted across three urban sites in the UK: Manchester, Doncaster, and Southampton with adolescent mothers and their midwives regarding diet and lifestyle, and what form of support would be helpful. In total, 106 young women and 20 midwives were interviewed. Most of the young mothers were 19 or younger (67%). Half had had their first child in the past year (52%) and 21% were pregnant during the study. Thematic analysis was used to identify ways to better support young mothers to eat well. RESULTS: Young women found it difficult to prioritise healthy eating; they often felt isolated and not in control of their own lives and wanted support from their midwife. Midwives felt that it was their role to support young mothers with diet in pregnancy but were anxious about initiating conversations and felt they lacked clear guidance. CONCLUSIONS: Pregnant teenagers and their midwives lack reliable resources and strategies for healthy eating support. An effective intervention to improve pregnant teenagers' diet quality must empower, inform, and motivate young mothers and their midwives, and enable connections between young mothers.

How do we harness adolescent values in designing health behaviour change interventions? A qualitative study.

OBJECTIVES: Adolescent health behaviours do not support optimal development. Adolescents are reportedly difficult to engage in health behaviour improvement initiatives. Little is known about what adolescents value in relation to diet and physical activity or how best to target these in health interventions. This study explored adolescents' values in relation to diet and physical activity and how these values can inform health intervention design. DESIGN: Qualitative semi-structured interviews explored adolescents' lives, what they thought about diet and physical activity and what might support them to improve their health behaviours. METHODS: A total of 13 group interviews were conducted with 54 adolescents aged 13-14 years, of whom 49% were girls and 95% identified as White British. Participants were recruited from a non-selective secondary school in a large southern UK city. Inductive thematic analysis was used to identify key adolescent values. RESULTS: Adolescents valued being with their friends, doing what they enjoyed and were good at; being healthy was important to them but only if achievable without compromising other things that are important to them. The need to be healthy was not aligned with adolescents' basic psychological needs, nor their strongly held priorities and values. CONCLUSIONS: Health is not a motivating factor for adolescents; therefore, interventions designed solely to improve health are unlikely to engage them. Instead, interventions that align with the values and priorities specified by adolescents are more likely to be effective in supporting them to eat well and be more active.

The impact of diet during adolescence on the neonatal health of offspring: evidence on the importance of preconception diet. The HUNT study.

Emerging evidence suggests that parents' nutritional status before and at the time of conception influences the lifelong physical and mental health of their child. Yet little is known about the relationship between diet in adolescence and the health of the next generation at birth. This study examined data from Norwegian cohorts to assess the relationship between dietary patterns in adolescence and neonatal outcomes. Data from adolescents who participated in the Nord-Trøndelag Health Study (Young-HUNT) were merged with birth data for their offspring through the Medical Birth Registry of Norway. Young-HUNT1 collected data from 8980 adolescents between 1995 and 1997. Linear regression was used to assess associations between adolescents' diet and later neonatal outcomes of their offspring adjusting for sociodemographic factors. Analyses were replicated with data from the Young-HUNT3 cohort (dietary data collected from 2006 to 2008) and combined with Young-HUNT1 for pooled analyses. In Young-HUNT1, there was evidence of associations between dietary choices, meal patterns, and neonatal outcomes, these were similar in the pooled analyses but were attenuated to the point of nonsignificance in the smaller Young-HUNT3 cohort. Overall, energy-dense food products were associated with a small detrimental impact on some neonatal outcomes, whereas healthier food choices appeared protective. Our study suggests that there are causal links between consumption of healthy and unhealthy food and meal patterns in adolescence with neonatal outcomes for offspring some years later. The effects seen are small and will require even larger studies with more state-of-the-art dietary assessment to estimate these robustly.

Behaviour change interventions: getting in touch with individual differences, values and emotions.

Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people's logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.Drawing on our team's experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.

Engaging adolescents in changing behaviour (EACH-B): a study protocol for a cluster randomised controlled trial to improve dietary quality and physical activity.

BACKGROUND: Poor diet and lack of physical activity are strongly linked to non-communicable disease risk, but modifying them is challenging. There is increasing recognition that adolescence is an important time to intervene; habits formed during this period tend to last, and physical and psychological changes during adolescence make it an important time to help individuals form healthier habits. Improving adolescents' health behaviours is important not only for their own health now and in adulthood, but also for the health of any future children. Building on LifeLab-an existing, purpose-built educational facility at the University of Southampton-we have developed a multi-component intervention for secondary school students called Engaging Adolescents in Changing Behaviour (EACH-B) that aims to motivate and support adolescents to eat better and be more physically active. METHODS: A cluster randomised controlled trial is being conducted to evaluate the effectiveness of the EACH-B intervention. The primary outcomes of the intervention are self-reported dietary quality and objectively measured physical activity (PA) levels, both assessed at baseline and at 12-month follow-up. The EACH-B intervention consists of three linked elements: professional development for teachers including training in communication skills to support health behaviour change; the LifeLab educational module comprising in-school teaching of nine science lessons linked to the English National Curriculum and a practical day visit to the LifeLab facility; and a personalised digital intervention that involves social support and game features that promote eating better and being more active. Both the taught module and the LifeLab day are designed with a focus on the science behind the messages about positive health behaviours, such as diet and PA, for the adolescents now, in adulthood and their future offspring, with the aim of promoting personal plans for change. The EACH-B research trial aims to recruit approximately 2300 secondary school students aged 12-13 years from 50 schools (the clusters) from Hampshire and neighbouring counties. Participating schools will be randomised to either the control or intervention arm. The intervention will be run during two academic years, with continual recruitment of schools throughout the school year until the sample size is reached. The schools allocated to the control arm will receive normal schooling but will be offered the intervention after data collection for the trial is complete. An economic model will be developed to assess the cost-effectiveness of the EACH-B intervention compared with usual schooling. DISCUSSION: Adolescents' health needs are often ignored and they can be difficult to engage in behaviour change. Building a cheap, sustainable way of engaging them in making healthier choices will benefit their long-term health and that of their future children. TRIAL REGISTRATION: ISRCTN 74109264 . Registered on 30 August 2019. EACH-B is a cluster randomised controlled trial, funded by the National Institute for Health Research (RP-PG-0216-20004).

Improving recruitment to clinical trials during pregnancy: A mixed methods investigation.

OBJECTIVE: To identify reasons underlying women's refusal to participate in a pregnancy trial and to identify ways of increasing recruitment. DESIGN: Mixed methods study using a questionnaire and qualitative interviews. SAMPLE: A questionnaire asking them to indicate reasons for their decision was completed by 296 pregnant women who declined to participate in one of two trials of nutritional supplementation in a large teaching hospital in southern England. Qualitative interview data were collected from two samples of pregnant women: 1) 30 women who declined to participate in a trial but completed the questionnaire; and 2) 44 women who participated in a trial. RESULTS: Questionnaire data from pregnant women who declined to participate suggested the major barriers to participation were study requirements, including taking study medication, having a bone scan or blood tests, or being too busy. Thematic analysis of interview data identified differences in self-efficacy and levels of trust in medical research between participants and decliners. Participants believed that the research would cause no harm, while decliners felt they or their unborn child would be at risk. When faced with potential obstacles, participants found ways around them while decliners felt they were insurmountable. CONCLUSIONS: Recruitment methods for pregnancy trials should focus on building women's trust in the trial, and on enhancing women's self-efficacy so they feel able to meet trial requirements. Suggestions for building trust include investing time in open, honest discussion of the risks and benefits of participation, improving visibility of the research team, testimonials from previous participants and advertising study safety and ethical conduct. Self-efficacy can be enhanced by training research staff in empowering styles of communication enabling women to feel heard and supported to problem-solve. These strategies could be implemented relatively easily into pregnancy trial protocols, and their effectiveness tested through their impact on recruitment rates.

How well do national and local policies in England relevant to maternal and child health meet the international standard for non-communicable disease prevention? A policy analysis.

OBJECTIVES: (1) To identify national policies for England and local policies for Southampton City that are relevant to maternal and child health. (2) To quantify the extent to which these policies meet the international standards for nutrition and physical activity initiatives set out in the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases (WHO Action Plan). DESIGN: The policy appraisal process involved three steps: (1) identifying policy documents relevant to maternal and infant health, (2) developing a policy appraisal framework from the WHO Action Plan, and (3) analysing the policies using the framework. SETTING: England and Southampton City. PARTICIPANTS: 57 national and 10 local policies. RESULTS: Across both national and local policies, priority areas supporting public health processes, such as evidence-based practice, were adopted more frequently than the action-oriented areas targeting maternal and child dietary and physical activity behaviours. However, the policy option managing conflicts of interest was rarely considered in the national policies (12%), particularly in white papers or evidence-based guidelines. For the action-oriented priority areas, maternal health policy options were more frequently considered than those related to child health or strengthening health systems. Complementary feeding guidance (9%) and workforce training in empowerment skills (14%) were the least frequent action-oriented policy options adopted among the national policies. The maternal nutrition-focused and workforce development policy options were least frequent among local policies adopted in 10% or fewer. Macroenvironmental policy options tended to have a lower priority than organisational or individual options among national policies (p=0.1) but had higher priority among local policies (p=0.02). CONCLUSIONS: Further action is needed to manage conflicts of interest and adopt policy options that promote a system-wide approach to address non-communicable diseases caused by poor diet and physical inactivity.

A Systematic Review of Digital Interventions for Improving the Diet and Physical Activity Behaviors of Adolescents.

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data.

Translating Developmental Origins: Improving the Health of Women and Their Children Using a Sustainable Approach to Behaviour Change.

Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers. Since women from more disadvantaged backgrounds have poorer quality diets and the worst pregnancy outcomes, they need to be a particular focus. The behavioural sciences have made a substantial contribution to the development of interventions to support dietary changes in disadvantaged women. Translation of such interventions into routine practice is an ideal that is rarely achieved, however. This paper illustrates how re-orientating health and social care services towards an empowerment approach to behaviour change might underpin a new developmental focus to improving long-term health, using learning from a community-based intervention to improve the diets and lifestyles of disadvantaged women. The Southampton Initiative for Health aimed to improve the diets and lifestyles of women of child-bearing age through training health and social care practitioners in skills to support behaviour change. Analysis illustrates the necessary steps in mounting such an intervention: building trust; matching agendas and changing culture. The Southampton Initiative for Health demonstrates that developing sustainable; workable interventions and effective community partnerships; requires commitment beginning long before intervention delivery but is key to the translation of developmental origins research into improvements in human health.