Characteristics of built food environments associated with alternative protein food choices: a systematic review.

BACKGROUND: This systematic review contributes to the understanding of the characteristics of built food environments that may be associated with choices of alternative protein foods (APF). Using the built food environment typology proposed by Downs et al., we investigated various environmental structures (e.g., supermarkets, other retailers, farmers' markets, restaurants, schools, and online vendors) and the characteristics that may facilitate or hinder consumers' choices. For example, facilitators and barriers may refer to the physical characteristics of environmental structures, food presentation practices, the organizational strategies or policies operating in the setting, or the actions that retailers or consumers engage in while selling, serving, choosing, trying, or purchasing APF in these environmental structures. METHODS: A systematic review (PROSPERO database preregistration; no. CRD42023388700) was conducted by searching 13 databases for peer-reviewed journals focusing on the fields of economics and business, agriculture, medical sciences, and social sciences. Data searches, coding, and quality evaluations were conducted by at least 2 researchers. A total of 31 papers (36 original studies) were included. The risk of bias was evaluated with the Joanna Briggs Institute quality evaluation tool, with 24 publications presenting low risk of bias. RESULTS: The findings indicate that perceived and actual availability facilitate consumers' APF choices across a built food environment. Several barriers/facilitators were associated with APF choices in specific types of built food environments: the way food is presented in produce sections (supermarkets), consumer habits in terms of green and specialty shopping (grocery stores), and mismatches among retailer actions in regard to making APF available in one type of food environment structure (e-commerce) and consumers' preferences for APF being available in other food environment structures (supermarkets, grocery stores). The effect of a barrier/facilitator may depend on the APF type; for example, social norms regarding masculinity were a barrier affecting plant-based APF choices in restaurants, but these norms were not a barrier affecting the choice of insect-based APF in restaurants. CONCLUSIONS: Addressing barriers/facilitators identified in this review will help in developing environment-matching interventions that aim to make alternative proteins mainstream. TRIAL REGISTRATION: PROSPERO database registration: #CRD42023388700.

The Dyadic Interplay Between Relationship Satisfaction, Perceived Positive and Negative Social Control, and a Reduction of Sedentary Behavior Time.

BACKGROUND: Both the close relationship processes and health model and the dyadic health influence model posit that beliefs about the relationship (e.g., relationship satisfaction) and influence strategies (e.g., social control) serve as mediators of health behavior change. The evidence for such mediation is limited. PURPOSE: This study investigated two competing hypotheses that arise from these models: (1) perceived use of positive and negative social control (attempts to influence the partner's behaviors) predict sedentary behavior (SB) indirectly, via relationship satisfaction; or (2) relationship satisfaction predicts SB indirectly, via positive and negative social control. METHODS: Data from 320 dyads (target persons and their partners, aged 18-90 years), were analyzed using mediation models. SB time was measured with GT3X-BT accelerometers at Time 1 (T1; baseline) and Time 3 (T3; 8 months following baseline). Relationship satisfaction and social control were assessed at T1 and Time 2 (T2; 2 months following baseline). RESULTS: Higher T1 relationship satisfaction among target persons predicted target persons' reporting of higher T2 negative control from partners, which in turn predicted lower T3 SB time among target persons. Lower T1 relationship satisfaction among partners predicted target persons' reporting of higher T2 perceived negative control from partners, which predicted lower T3 SB time among target persons. On average, both members of the dyad reported moderate-to-high relationship satisfaction and low-to-moderate negative control. CONCLUSIONS: In contrast to very low levels of negative control, its low-to-moderate levels may be related to beneficial behavioral effects (lower SB time) among target persons reporting moderate-to-high relationship satisfaction.

Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour.

Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.

Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review.

BACKGROUND: Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors. METHODS: A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed. RESULTS: Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture). CONCLUSIONS: The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs. REGISTRATION: PROSPERO, #CRD42019133251.

Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity.

BACKGROUND: This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. METHODS: Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. RESULTS: Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). CONCLUSIONS: These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies.

Applying a systems perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme.

BACKGROUND: For the past two decades, the percentage of European children who consume fruit daily has remained at around 40%, despite numerous school-based policy efforts and interventions. This study aimed to apply a systems approach to provide an integrated perspective of the mechanisms of the European School Fruit and Vegetable Scheme (the Scheme) to understand better how to increase its long-term impact on children's fruit and vegetable consumption. METHODS: We developed a causal loop diagram by synthesizing peer-reviewed articles and national government documents related to the Scheme, following the conceptualization steps of system dynamics. The initial causal loop diagrams were then validated in three stages by consulting with experts (two individuals and a group) in school-based fruit and vegetable programmes, children's fruit and vegetable consumption and the Scheme, using disconfirmatory interview guidelines. RESULTS: The findings suggest that a central self-reinforcing mechanism through which children socialize during fruit and vegetable consumption is critical in the habituation process. Additionally, the initial increase in children's fruit and vegetable consumption following the Scheme implementation is due to growth in three self-reinforcing loops related to motivation and capability mechanisms; however, this trend gradually slows and stops due to four balancing feedback loops with alternative goals related to opportunity mechanisms that reach their limits. CONCLUSIONS: The scheme's design should incorporate activities that align the objectives of the implementers and recipients of the Scheme at all levels. This alignment should provide children with ongoing opportunities to consume fruits and vegetables and strengthen the motivation and capability mechanisms.

Cultivation and Enabling Effects of Social Support and Self-Efficacy in Parent-Child Dyads.

BACKGROUND: There are two alternative mechanisms, elucidating the reciprocal relationship between self-efficacy and social support when explaining health outcomes: self-efficacy beliefs may operate as the establisher of social support (the cultivation model) or social support may enable the formation of self-efficacy beliefs (the enabling model). PURPOSE: In line with the cultivation hypothesis, it was tested if self-efficacy (measured in parents and children) would indirectly predict parental and child moderate-to-vigorous physical activity (MVPA), via the mediator, social support (parent-provided, child-received). In line with the enabling hypothesis, it was tested if social support would predict MVPA indirectly, via the mediator, self-efficacy. METHODS: A total of 879 parent-child dyads (1758 individuals; 52.4% girls, aged 5-11 years old, 83.2% mothers) provided self-reports at the baseline (T1) and the 7- to 8-month follow-up (T2). Body weight and height were measured objectively. Manifest path analyses were performed, controlling for the baseline levels of the mediator and dependent variables. RESULTS: A similar number of significant simple indirect effects was found for the cultivation and the enabling model. Across the models, the indirect effects followed similar patterns: (a) within-individual indirect effects in children; (b) across-individual indirect effects, with the independent variable measured in children and the mediator/dependent variables measured in parents (e.g., child self-efficacy predicted parental support provision and, indirectly, parental MVPA); (c) across-individual indirect effects, accounting for self-efficacy and MVPA measured in children, combined with parental reports of social support. CONCLUSIONS: The findings provide support for both cultivation and enabling models in the context of MVPA among parent-child dyads.

Identifying the views of adolescents in five European countries on the drivers of obesity using group model building.

BACKGROUND: To make effective progress towards a global reduction in obesity prevalence, there needs to be a focus on broader structural factors, beyond individual-level drivers of diet and physical activity. This article describes the use of a systems framework to develop obesity prevention policies with adolescents. The aim of this research was to use the group model building (GMB) method to identify young people's perceptions of the drivers of adolescent obesity in five European countries, as part of the EU-funded Co-Create project. METHODS: We used GMB with four groups of 16-18-year-olds in schools in each of the five European countries (The Netherlands, Norway, Poland, Portugal and the UK) to create causal loop diagrams (CLDs) representing their perceptions of the drivers of adolescent obesity. The maps were then merged into one, using a new protocol. RESULTS: Two hundred and fifty-seven participants, aged 16-18 years, engaged in 20 separate system mapping groups, each of which generated 1 CLD. The findings were largely congruent between the countries. Three feedback loops in the merged diagram particularly stand out: commercial drivers of unhealthy diets; mental health and unhealthy diets; social media use, body image and motivation to exercise. CONCLUSIONS: GMB provides a novel way of eliciting from young people the system-based drivers of obesity that are relevant to them. Mental health issues, social media use and commercial practices were considered by the young people to be key drivers of adolescent obesity, subjects that have thus far had little or no coverage in research and policy.

Chemokine alterations in bipolar disorder: A systematic review and meta-analysis.

We aimed to perform a systematic review and meta-analysis of studies examining the levels of chemokines in peripheral blood of patients with bipolar disorder (BD) and healthy controls. Meta-analysis was based on random-effects models with Hedges' g as the effect size estimate. We included 13 eligible studies (1221 BD patients and 663 controls). The following chemokines were analysed: interleukin-8 (IL-8), monocyte-chemoattractant protein-1 (MCP-1), eotaxin-1, eotaxin-2 and interferon-γ-induced protein 10 (IP-10). The levels of IL-8 (N = 8, g = 0.26, 95%CI: 0.11-0.41, p < 0.001), MCP-1 (N = 8, g = 0.40, 95%CI: 0.18-0.63), eotaxin-1 (N = 3, g = 0.55, 95%CI: 0.21-0.89, p = 0.001) and IP-10 (N = 4, g = 0.95, 95%CI: 0.67-1.22, p < 0.001) were significantly higher in BD patients as compared with controls. Subgroup analyses revealed that elevated levels of IL-8 (N = 5, g = 0.75, 95%CI: 0.42-1.07, p < 0.001) and MCP-1 (N = 4, g = 0.57, 95%CI: 0.28-0.86, p < 0.001) appeared only in BD patients during their depressive phase. Illness duration was associated with significantly lower levels of IL-8 in meta-regression analysis. In turn, elevated levels of IP-10 were present during euthymia (N = 2, g = 0.76, 95%CI: 0.43-1.10, p < 0.001) but not depression (N = 2, g = 1.81, 95%CI: -0.16 to 3.77, p = 0.072). The analysis of eotaxin-1 levels was mainly based on studies of euthymic BD patients (N = 3). Our results suggest that chemokine alterations in BD might be related to mood state. Elevated levels of IL-8 and MCP-1 might be specific to depression. Available evidence indicates that increased levels of eotaxin-1 and IP-10 appear in euthymia; however, more studies are needed to address these alterations in other mood states.

Sedentary behaviors and anxiety among children, adolescents and adults: a systematic review and meta-analysis.

BACKGROUND: Although the number of studies examining the relationships between sedentary behaviors (SB) and anxiety is growing, an overarching evidence, taking into account children, adolescents, and adults as well as different types of SB and different categories of anxiety outcomes, is still missing. Thus, this systematic review and meta-analysis aimed at obtaining a comprehensive overview of existing evidence. METHODS: A search in the following databases: PsycINFO, PsycARTICLES, Academic Search Complete, ERIC, HealthSource: Nursing/Academic Edition and MEDLINE, resulted in k = 31 original studies included in the systematic review (total N = 99,192) and k = 17 (total N = 27,443) included in the meta-analysis. Main inclusion criteria referred to testing the SB--anxiety relationship, the quality score (above the threshold of 65%), and the language of publications (English). The study was following the PRISMA statement and was registered at PROSPERO (CRD42017068517). RESULTS: Both the systematic review and meta-analysis indicated that overall average effects were small: higher levels of symptoms of anxiety were associated with higher levels of SB (weighted r = .093, 95% CI [.055, .130], p < .001). Moderator analyses indicated that trends for stronger effects were observed among adults, compared to children/adolescents (p = .085). CONCLUSIONS: Further longitudinal studies are necessary to elucidate the predictive direction of the anxiety-SB relationship and to clarify whether the effects depend on the type of anxiety indicators.

Enabling, Not Cultivating: Received Social Support and Self-Efficacy Explain Quality of Life After Lung Cancer Surgery.

BACKGROUND: Although the effects of self-efficacy and social support on health outcomes are well established, it is crucial to find out if these predictors are chained in a specific way, with either self-efficacy prompting support receipt or with support receipt prompting self-efficacy. PURPOSE: In the context of adaptation after lung cancer surgery, this study investigated (1) the cultivation hypothesis, assuming that the relationship between self-efficacy and quality-of-life indices would be mediated by social support received from medical personnel, family, and friends, and (2) the enabling hypothesis, assuming that the association between received social support and quality-of-life indices would be mediated by self-efficacy. METHOD: Patients with the first onset of non-small-cell lung cancer (N = 102) filled in questionnaires at 3-4 days after segmentectomy or lobectomy (time 1), at 1-month follow-up (time 2), and at 4-month follow-up (time 3). RESULTS: Mediation analyses accounting for the effects of age, gender, marital status (all measured at time 1), and the mediator (measured at time 1 and time 2) yielded no support for the cultivation hypothesis. Indirect effects were observed for 0 out of 14 quality-of-life indices, measured at time 3. In contrast, the enabling hypothesis was confirmed for 11 out of 14 quality-of-life indices (physical, functional, cognitive, social, and emotional aspects; measured at time 3). CONCLUSIONS: Interventions for patients with lung cancer may focus on enhancing social support receipt within the first week after surgery, followed by a self-efficacy prompt 3 weeks later.

Women with family cancer history are at risk for poorer physical quality of life and lower self-efficacy: a longitudinal study among men and women with non-small cell lung cancer.

BACKGROUND: We investigated the determinants of trajectories of physical symptoms related to lung cancer (a quality of life [QOL] aspect) and self-efficacy among patients with non-small cell lung cancer (NSCLC). It was hypothesized that gender and family cancer history in first-degree relatives would have synergistic effects on QOL-lung cancer specific symptoms and self-efficacy. Women with family cancer history were expected to be at risk of poorer adjustment. METHODS: Quantitative, longitudinal design was applied. Participants provided their responses at 3-4 days after surgery, 1-month follow-up, and 4-month follow-up. We recruited 102 in-patients (men: 51%) with NSCLC who underwent surgery aimed at removing a lung tumor. Self-report data were collected with QLQ-LC13 and a scale for self-efficacy for managing illness. RESULTS: Mixed-models analysis indicated that trajectories of physical quality of life (symptoms of lung cancer) as well as self-efficacy were unfavorable among women with family cancer history. CONCLUSIONS: Among NSCLC patients, gender and family cancer history may be considered basic screening criteria for identifying groups of patients at risk for poorer physical QOL (higher level of physical symptoms related to lung cancer) and lower incline of self-efficacy after cancer surgery.

Effects of physical activity planning interventions on reducing sedentary behavior in parent-child dyads: A randomized controlled trial.

Effects of parent-child dyad interventions on behavior remain unclear. This randomized controlled trial investigated if, compared with a control condition, three types of physical activity (PA) planning interventions (individual "I-for-me," dyadic "we-for-me," and collaborative "we-for-us") would reduce sedentary behavior (SB) time in parents and their children. The study involved 247 dyads comprising parents (aged 29-66) and their children (aged 9-15), randomized into one of the three types of PA planning-intervention arms or the control condition. Mixed models were applied to analyze data from a preregistered trial (NCT02713438) with the outcome of accelerometer-measured SB time, assessed at 1-week and 36-week follow-ups. Although children's SB remained unaffected by the planning interventions, a small reduction of SB time was found among parents in the collaborative (p = .048) and individual (p = .042) planning conditions. The effects were observed at the 1-week follow-up only. While short-term reductions in parents' SB were achieved, these were not sustained long-term. PA planning interventions delivered to parent-child dyads did not substantially reduce children's SB, which may be due to young people's needs of increased independence from their parents.

Physical activity planning interventions, body fat and energy-dense food intake in dyads: ripple, spillover, or compensatory effects?

OBJECTIVES: It is unclear if planning to change one behavior may prompt changes in other health behaviors or health outcomes. This study tested if physical activity (PA) planning interventions may result in (i) a body fat reduction in target persons and their dyadic partners (a ripple effect), (ii) a decrease in energy-dense food intake (a spillover effect), or an increase in energy-dense food intake (a compensatory effect). METHOD: N = 320 adult-adult dyads were assigned to an individual ('I-for-me'), dyadic ('we-for-me'), or collaborative ('we-for-us') PA planning intervention or a control condition. Body fat and energy-dense food intake were measured at baseline and at the 36-week follow-up. RESULTS: No Time x Condition effects were found for target persons' body fat. There was a reduction in body fat among partners participating in any PA planning intervention, compared to the control condition. Across conditions, target persons and partners reduced energy-dense food intake over time. The reduction was smaller among target persons assigned to the individual PA planning condition compared to the control condition. CONCLUSIONS: PA planning interventions delivered to dyads may result in a ripple effect involving body fat reduction among partners. Among target persons, the individual PA planning may activate compensatory changes in energy-dense food intake.

Assessing adolescents' readiness for action and attitudes toward obesity prevention: Instrument development and psychometric properties.

Engaging adolescents in obesity prevention is a main objective of the CO-CREATE project. This paper presents the development of a questionnaire to assess readiness for action and attitudes toward obesity prevention among adolescents. The questionnaire was developed based on literature searches and internal discussions with experts in the CO-CREATE consortium. The questionnaire was translated, back translated, and pretested for time and comprehensiveness by adolescents from five countries (the Netherlands, Norway, Poland, Portugal, and the United Kingdom). Exploratory factor analysis was performed, and internal reliability of the resulting factors was determined using baseline data from Poland and Norway. Furthermore, test-retest reliability was assessed in a sample of Norwegian adolescents. The exploratory factor analysis on readiness for action identified four factors. Analysis on attitudes toward obesity prevention identified four factors on responsibility and five factors on drivers of behavior. Six of the factors had a Cronbach's alpha value above 0.70, five factors had a value between 0.60-0.70, whereas the remaining two factors were below 0.60. The test-retest correlation ranged from 0.46 to 0.87. The exploratory factor analyzes on readiness for action identified the same factors as hypothesized in the development of the questionnaire, whereas attitudes toward obesity prevention identified more factors than initially assumed. The questionnaire is considered reliable as a tool for measuring adolescents' readiness for action and attitudes toward obesity prevention.

Dyadic reciprocal associations between self-efficacy and planning predict sedentary behaviour.

OBJECTIVES: There are two alternative hypotheses regarding bidirectional associations between self-efficacy and planning in predicting health behaviour change: self-efficacy may establish planning (cultivation hypothesis) or planning may enable the formation of self-efficacy (enabling hypothesis). This study investigates the order in which these two social cognitions are linked in adult-adult dyads in the context of sedentary behaviours (SB). DESIGN: A longitudinal study with 4 measurement points, spanning 8 months. METHODS: A total of 320 dyads (age: 18-90 years) were enrolled. Dyads included a focus person (who received the recommendation to reduce SB and intended to change their SB), and their partners, who were willing to support the focus persons and intended to reduce their own SB as well. Data were collected at Time 1 (T1), Time 2 (1 week later, T2), Time 3 (T3, 2 months after T1) and Time 4 (T4, 8 months after T1). SB was measured with accelerometers at (T1 and T4). Mediation models with individual and dyadic reciprocal effects were tested with path analyses. RESULTS: Only one indirect effect was found: A higher level of partners' SB reduction-specific self-efficacy at T2 was related to the focus person's more frequent planning to reduce SB at T3, which, in turn, predicted lower SB time among partners at T4. CONCLUSIONS: The findings provide partial support for the cultivation model (self-efficacy prompting planning) and for dyadic reciprocal associations in the context of SB time reduction among adult dyads.

Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research-A cross-sectional study.

Background: Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated barriers and facilitators to the adoption of physical activity policies in elementary schools in Baden-Wuerttemberg, Germany, from the perspective of school principals. Methods: A cross-sectional study was conducted between May and June 2021. School principals from elementary and special needs schools (n = 2,838) were invited to participate in the study. The online questionnaire used was developed based on the CFIR and included questions on school characteristics and constructs of the CFIR domains inner setting, characteristics of individuals, and process. Logistic regression analyses were performed to examine associations between policy adoption and school characteristics as well as CFIR determinants. Results: In total, 121 schools (4%) participated in the survey, of which 49 (40.5%) reported having adopted a policy to promote physical activity. Positive associations with policy adoption were found for general willingness among teaching staff [odds ratio (OR): 5.37, 95% confidence interval (CI): 1.92-15.05], available resources (OR: 2.15, 95% CI: 1.18-3.91), access to knowledge and information (OR: 2.11, 95% CI: 1.09-4.09), and stakeholder engagement (OR: 3.47, 95% CI: 1.24-9.75). Conclusions: This study provides a first insight into potential barriers and facilitators at the organizational level of schools that may be relevant to the adoption of physical activity policies, from the perspective of school principals. However, due to a low response rate, the results must be interpreted with caution. A strength of this study includes theoretical foundation through the use of the CFIR. The CFIR could be well-adapted to the school setting and provided valuable support for developing the questionnaire and interpreting the study results.

Adolescents' capacity to take action on obesity: A concurrent controlled before-and-after study of the European CO-CREATE project.

This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n = 132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.

What policies are there and what policies are missing? A Photovoice study of adolescents' perspectives on obesity-prevention policies in their local environment.

The aim of this study was to investigate adolescents' critical awareness of whether obesity prevention policies targeting physical activity (PA) and nutrition were operating in their local community. Participants were 41 adolescents (aged 16-18, 90% women) recruited from three communities in Poland. Prior to this study, they were involved in obesity-prevention participatory initiatives (conducted within the CO-CREATE project), where obesity-related public policy limitations were analyzed in a youth-led discussion. A Photovoice exercise was designed to capture obesity-related public policies that were either present or absent in young people's local environments. The photographs (N = 213) were coded and mapped according to the policy themes they illustrated, using the MOVING and NOURISHING frameworks. The public policies represented in the photographs are most frequently related to: healthy retail or food service environments; food advertising or promotion; structures and surroundings that promote PA; and infrastructure and opportunities that support public or active transport. Adolescents are critically aware of the presence and lack of specific public policies operating in their local environment, particularly policies affecting structural aspects of food and PA environments. Policy-oriented photovoice exercises may prompt critical awareness among adolescents and empower them to contribute to obesity prevention policy processes.

The Healthy Food Environment Policy Index in Poland: Implementation Gaps and Actions for Improvement.

BACKGROUND: Poland is facing the growing problem of overweight and obesity in the population, which makes it necessary to conduct a thorough assessment of the existing food environment policies. The aims of the study were: (1) to depict the strength of healthy food environment policies in Poland and identify implementation policies and infrastructure support gaps; (2) to identify and prioritise improvement policies, taking into account their importance, achievability and equity. METHODS: We used the Healthy Food Environment Policy Index (Food-EPI). An experts' panel rated Polish policies and infrastructure compared to international best practices and developed a list of recommended improvement actions addressing both components. RESULTS: eight of the twenty-two policy and four of the twenty-two infrastructure indicators achieved the "no/very weak policy" result. Another four policy and five infrastructure indicators were considered "weak". Another seven and eight indicators, respectively, were assessed as "moderate". Among the identified actions, the highest priority was given to a food labelling system and training for persons involved in nutrition in schools. CONCLUSIONS: The Polish healthy food environment has been assessed as very weak or weak in most aspects. The infrastructure was assessed as slightly better compared to the policies domain, with more indicators receiving the "moderate" score.