International Journal of Behavioral Nutrition and Physical Activity

IntroductionPhysical activity is an important global health issue, yet surveillance and measurement methods vary considerably across countries and programs. This paper examines the use of the single-item physical activity (SIPA) measure through a comparative analysis of three representative national surveys and evaluates how well the SIPA reflects national estimates of meeting cutpoints for physical activity guidelines. Finally, we assess the application of the SIPA in the evaluation of four large community-based physical activity programs. MethodsWe describe the SIPA distribution using national data from the Active New Zealand Survey, the Australian National Health Survey and the Irish Sport Monitor. We explore the relationship between the SIPA and existing physical activity measures of guideline attainment using Receiver Operating Characteristic (ROC) analysis, with Area Under the Curve (AUC) as the measure of fit. For the four community programs, we compare pre- to post-program changes, including effect sizes (Cohens {delta}). ResultsAcross the three national datasets, mean SIPA values ranged from 2.68 to 3.31 days/week, with a bimodal distribution--people reported either zero or seven days of physical activity/week. A cutpoint at a threshold of [≥]3 days/week provided optimal classification of guideline attainment (AUC >0.8 in all countries). Across the four large community programs, SIPA values increased by a typical 0.5-1.0 days/week, with 10-30% more participants meeting physical activity guidelines post-program. ConclusionSIPA offers a feasible, low-cost option for both population surveillance and community program evaluation. This is particularly relevant in low-income countries and settings, and complements growing interest in device-based measurement (e.g., accelerometry). Testing of SIPA in low- and middle-income countries is urgently needed. Despite the need for future research, SIPA holds immediate promise as a standardised physical activity measure for policymakers, researchers and community program evaluators. Key MessagesThere are many measures used for physical activity population surveillance and for large program evaluation, but the single item physical activity (SIPA) offers new potential for coordination and standardisation of measures used by asking adults about the number of days/week they were active. Limited research has described population use of the SIPA. This study describes population physical activity levels in national surveys in Australia, New Zealand and Ireland, and also describes the use of the SIPA in the evaluation of physical activity change in four large community physical activity programs. The SIPA provides a validated, comparable, and easy to administer measure for use in physical activity surveillance systems and for policymakers and practitioners evaluating community programs.

Abstract Background: Previous physical activity simulation studies only account for the effects of cardiovascular diseases, diabetes, dementia, and some cancers, which neglects many of its costs and benefits. We estimate the health and economic impacts of increased physical activity in Australia, including those on mental health, increased injury rate, and conditions mediated by other risk factors, commencing 2021, over 20 years. Methods: We used a Proportional Multistate Lifetable Model specified with disease rate and risk factor forecasts, and causal associations, derived from the Global Burden of Disease study and other sources. Findings: If all Australians shifted to the maximum physical activity level of 4200+ MET-min/week, there would be: 653,000 (230,000 - 1,210,000) or 0.16% more HALYs lived; 9,720 (7,400 to 12,700) or 1.33% fewer deaths before age 75; increased working age income of AUD$16.8 billion ($12.8 - $22.2 billion); and decreased health expenditure of $748 million (-$4.46 billion - $6.98 billion) or 0.02%. Net health gains diminish for each additional 600 MET-min/week increase in physical activity, and above 4,200 MET-min/week the health costs from injuries outweigh the reduction in health costs from avoided disease. Because of injuries, increasing physical activity in the lowest activity group to meet the physical activity guidelines reduces health expenditure more ($1.86 billion; 896 million - 3.13 billion) than shifting to maximum activity levels. Interpretation: Increasing physical activity levels in Australia would improve population health (even allowing for injuries due to participation), reduce health spending, and increase income. Funding: Australian Sports Commission. TB is funded by NHMRC Investigator Grant (2023) #2026992

Introduction High consumption of ultra-processed foods (UPF) is associated with adverse health outcomes and weight gain. Despite increasing calls for behavioural strategies to reduce UPF intake, no theory-informed intervention targeting UPF reduction has been evaluated in UK adults in alignment with national dietary guidance. We assessed the feasibility, acceptability, and preliminary behavioural and clinical outcomes of a multi-component intervention designed to reduce UPF consumption (and increase physical activity (PA)/minimally processed food (MPF) intake). Methods In this exploratory single-arm pre-post study, adults (N=45) living with overweight or obesity and habitual UPF intake [&ge;]50% of total energy were offered a 6-month behavioural intervention following a controlled feeding phase (UPDATE trial, stage 1). The intervention was developed using the Behaviour Change Wheel and Capability, Opportunity, Motivation-Behaviour (COM-B) model and included one-to-one sessions with a behavioural scientist, tailored print and digital materials, peer-support meetings, and a moderated group chat. Feasibility outcomes included uptake, retention, and intervention fidelity. Secondary outcomes included COM-B constructs, dietary intake, PA, clinical and self-reported outcomes, and qualitative feedback. Results Uptake was 91% (41/45). Retention at 6 months was 68% (28/41), with 83% (34/41) providing follow-up data (intention-to-treat). Median attendance at one-to-one sessions was 86% (interquartile range (IQR): 57-100) with 56% (23/41) attending all sessions (per-protocol). Fidelity to core behaviour change techniques was high. At 6 months, COM-B scores improved for healthy eating (+7%, standard deviation (SD): 8; p<0.001) and physical activity (+5%, SD: 9; p=0.013). UPF intake decreased by 25% of total energy (95% confidence interval (95%CI): -32, -17), with a corresponding increase in minimally processed foods (+23%; 95%CI: 17, 29). Vigorous physical activity increased (+60 min/week, IQR: 0-180), weekday sitting time decreased (-61 min/day, SD: 110), and weight reduced by 3.8 kg (IQR: -8.5-1.0; p=0.001). Findings were similar in per-protocol analyses. Qualitative data indicated perceived improvements in wellbeing and habit formation. Conclusion This theory-informed intervention demonstrated good feasibility and acceptability and was associated with improvements in targeted behavioural mechanisms and health-related outcomes. A randomised controlled pilot trial is warranted to evaluate effectiveness and refine implementation.

Background: This prospective cohort analysis investigated how age, sex, and body morphology modify associations of physical activity (PA) intensity, duration, and volume with cardiovascular disease (CVD) mortality. Methods: We analysed wrist-worn accelerometer data from 8,661 adults (51.9% women) in the National Health and Nutrition Examination Survey. The outcome was CVD mortality. PA intensity and volume were quantified using the intensity gradient and average acceleration, respectively. Survey-weighted Cox proportional hazards models were used to estimate associations, including interaction terms with age, sex, or body morphology (waist-to-height ratio as indicator of adiposity). Results: Median (interquartile range) follow-up was 81 (69, 94) months. All hazard ratios (HR) compare 50th with 25th percentile. Beneficial associations between CVD mortality and PA were stronger in younger than older adults for intensity (e.g., 45-year-olds: HR=0.47, 95%CI:0.29-0.75 vs 75-year-olds: HR=0.75, 95%CI:0.54-1.06), and volume (e.g., HR=0.18, 95%CI:0.07-0.71 vs 0.29, 95%CI:0.16-0.51). In women, intensity-related association were stronger than in men (HR=0.45, 95%CI:0.31-0.65 vs HR=0.79, 95%CI:0.50-1.24). Volume-related associations were stronger in men (HR=0.37, 95%CI:0.22-0.60 vs HR=0.24, 95%CI:0.11-0.51), though with earlier plateauing and greater uncertainty. Associations were observed across waist-to-height ratio levels but attenuated at higher values (intensity: waist-to-height ratio 0.5, HR=0.45, 95%CI:0.29-0.69 vs 0.6, HR=0.69, 95%CI:0.49-0.97; volume: 0.5, HR=0.07, 95%CI:0.03-0.17 vs 0.6, HR=0.28, 95%CI:0.17-0.45). Conclusion: Older adults and men may benefit more from increasing PA volume than intensity, whereas younger adults and women may benefit more from higher-intensity PA. Although benefits were observed across adiposity levels, associations were attenuated as adiposity increased, suggesting stronger benefits in individuals with low-to-moderate adiposity.

BackgroundHigher levels of sedentary behaviour, such as leisure screen time (LST), and lower levels of physical activity are associated with diseases across multiple body systems which contribute to a large global health burden. Whether these associations are causal is unclear. The primary aim of this study is to investigate the causal effects of higher LST (given greater power) and, secondarily, lower moderate-to-vigorous intensity physical activity (MVPA), on a wide range of diseases in a hypothesis-free approach. MethodsA two-sample Mendelian randomisation phenome-wide association study was conducted for the main analyses. Genetic single nucleotide polymorphisms (SNPs) were first selected as exposure genetic instruments for LST (hours of television watched per day; 117 SNPs) and MVPA (higher vs. lower; 18 SNPs) based on the genome-wide significant threshold (p < 5x10-8) from the largest relevant genome-wide association study (GWAS). For disease outcomes, we used summary results from FinnGen GWAS, including 1,719 diseases defined by hospital discharge International Classification of Diseases (ICD) codes in 453,733 European participants. For the main analyses, we used the inverse-variance weighting method with a Bonferroni corrected p-value of p [&le;] 3.47x10-4. Sensitivity analyses included Steiger filtering, MR-Egger and weighted median analyses, and data from UK Biobank were used to explore replication. FindingsGenetically predicted higher LST was associated with increased risk of 87 (5.1% of the 1,719) diseases. Most of these diseases were in musculoskeletal and connective tissue (n=37), genitourinary (n=12) and respiratory (n=8) systems. Genetic liability to lower MVPA was associated with six diseases: three in musculoskeletal and connective tissue and genitourinary systems (with greater risk of these diseases also identified with higher LST), and three in respiratory and genitourinary systems. Sensitivity analyses largely supported the main analyses. Results replicated in UK Biobank, where data available. ConclusionsHigher levels of sedentary behaviour, and lower levels of physical activity, causally increase the risk of diseases across multiple body systems, making them promising targets for reducing multimorbidity.

Background Physical activity (PA) is essential for childrens physical, cognitive, and psychosocial development; however, many children do not meet recommended PA levels, particularly in low- and middle-income settings. Parents play a critical role in shaping childrens PA behaviours, yet limited empirical evidence exists regarding parental perceptions of PA participation, satisfaction, barriers, and improvement strategies within the Nigerian context. Methods A qualitative study was conducted in Enugu City, Nigeria, using in-depth semi-structured interviews with 20 parents of children enrolled in nursery, primary, and secondary schools. Participants were recruited purposively from community settings. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following Braun and Clarkes framework. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Five themes were identified: (1) parents perceptions of childrens PA participation as context-dependent and variable; (2) satisfaction with PA opportunities existing along a continuum from high satisfaction to dissatisfaction; (3) perceived enablers, including accessible spaces, social support, parental involvement, and safety; (4) perceived barriers, notably time constraints, academic prioritisation, limited facilities, safety concerns, and parental availability; and (5) strategies for improvement, emphasising school-based reforms, parental engagement, community collaboration, and policy-level support. Conclusions Parental satisfaction with childrens PA opportunities was mixed and frequently conditional, with many participants expressing dissatisfaction related to academic prioritisation, limited time for physical education, and inadequate recreational facilities. The findings suggest that improving both satisfaction and participation may require strengthened school-based physical activity provision, greater parental engagement, and enhanced community infrastructure to support balanced child development.

Background: Companies in the Health and Life Insurance space are increasingly turning to digital tools to promote healthier behaviours among their user base and reduce future health risks. This approach shifts insurers' role from passive underwriters to partners in health management. These tools, often smartphone or wearable-tracker-based, enable real-time monitoring of behaviours (such as physical activity or meditation), providing fruitful targets for behavioural change interventions. Gamification, a Behavioural Change Technique with rich theoretical backing, is increasingly used in this context; however, despite its theoretical promise, current evidence remains mixed, and makes it hard to disambiguate its effect compared to more isolated financial incentives, the extent to which initial effects may be sustained over time, and how such changes in behaviour potentially translate to downstream health risk reductions. Objective: This 9-month parallel-group, open-label Randomised Controlled Trial was designed to assess the causal impact of gamification in promoting health behaviours, independent of financial incentivisation. This was conducted in a real-world workplace setting, involving a cohort of participants using the YuLife Health and Wellbeing app, provided within an employer-sponsored group cover setting. Methods: For the purposes of the RCT, the app was adapted such that gamification features could be turned on or off in a controlled manner, and in-app rewards in the form of "YuCoin" were adjusted between treatment groups to account for the effect of financial incentives. Following a baseline phase involving acquisition of baseline step estimates and questionnaire data, 1,288 participants -- recruited from a number of companies partnered with YuLife, spanning various sectors -- were randomised to gamified versus non-gamified versions of the app using stratified block-randomisation, and evaluated at specific milestones over a 9-month period, to enable comparison of short-term to long-term outcomes. The primary outcomes assessed were absolute differences in mean daily step count and engagement with the YuLife app. The data were analysed using Linear Mixed-Effects Models (LMMs). Additionally, a Cox Proportional Hazards model fitted to UK Biobank data was used to map step differences directly onto downstream health risks, and reductions were evaluated using an LMM. Further secondary outcomes (such as smoking and alcohol consumption) were also evaluated using non-parametric statistics. Results: Compared with control, the gamified intervention was associated with greater mean daily steps throughout the study, with month / intervention interaction effects reaching one-sided 5% significance at months 3 ({beta}=473.84, p=0.027), 5 ({beta}=626.54, p=0.006), and 9 ({beta}=480.91, p=0.033). Additionally, strong seasonal effects were identified, with fewer steps in Autumn ({beta}{approx}-943.50, p<0.001) and Winter ({beta}{approx}-1,145.45, p<0.001) versus Summer; higher baseline activity was a strong predictor of later activity ({beta}{approx}0.85, p<0.001) and higher BMI was negatively associated with steps ({beta}{approx}-60.84 per unit, p<0.001). For app engagement, month / intervention interactions were positive and significant from Month 3 onwards (Month 3 {beta}=0.205, Month 5 {beta}=0.182, Month 7 {beta}=0.170, Month 9 {beta}=0.175, all p<0.001), effectively showing sustained engagement while main milestone terms indicated declines in the control arm. Sensitivity analyses demonstrated the potential for baseline step inflation due to novelty effects, motivating repeating the step count analyses under an alternative baseline definition; this showed similar results, but with interaction effects achieving one-sided significance over all study milestones. Predicted partial-hazard analyses showed progressively larger month / intervention reductions in hazard, reaching one-sided significance at months 5 (coef=-0.018, p=0.016) and 9 (coef=-0.026, p=0.002). No significant intervention effects were observed for other secondary outcomes (e.g. smoking, alcohol) following Bonferroni-Holm correction. Conclusions: Gamification elements can be an effective component in the context of digital interventions aiming to promote positive health behaviours, leading to improved engagement with the intervention and positive behavioural outcomes. Through progressive risk-reduction, even small but sustained improvements can be shown to meaningfully improve long-term health outcomes. Gamification is likely to add value to workplace health promotion initiatives, particularly for targeted short- to medium-term behavioural change interventions operating within a larger risk-management framework. Trial Pre-registration: https://osf.io/926pd

BackgroundLarge Language Model (LLM) chatbots are increasingly used for exercise and fitness topics, yet users experience with these tools remains understudied. MethodsThis study is a national survey of U.S. adults who have used an LLM chatbot for exercise-related topics in the past month. Participants answered questions about the exercise-related topics for which they used LLM chatbots, their perceptions of these chatbots value for exercise-related questions, and how chatbot use had changed their exercise behaviors and use of other exercise-related resources. ResultsParticipants (n=258) were majority male (n=138, 53.5%) and white (n=146, 56.6%) with a mean age of 41.7 (SD=14.9) years. The most endorsed topics for LLM chatbot use were making an exercise plan (n=137, 53.1%), nutrition related to exercise (n=132, 51.2%), advice on amount of exercise (n=122, 47.3%), specific exercises to try (n=120, 46.5%), and motivation or emotional support for exercise (n=112, 43.4%). On average, participants endorsed high trust (M=4.0, SD=0.7; on 1-5 scale) and a moderate emotional bond (M=3.0, SD=1.3) with LLM chatbots. Most participants (n=140, 54.3%) reported that they increased their exercise due to LLM chatbot use (M=55.6 minutes increase). Some participants reported increases in use of other resources; e.g., gyms (26.4%), wearable technology (23.3%), and exercise questions to their healthcare providers (25.6%). Those who increased exercise with LLM chatbot use reported significantly higher trust (M=4.1 vs M=3.9) and emotional bond (M=3.2 vs M=2.6) with chatbots and more use for motivation/emotional support (70.5% vs 29.5%) compared to those who did not. Many participants also used LLM chatbots for nutrition and weight-related questions. DiscussionLLM chatbots may meaningfully impact exercise-related behavior and resource use, warranting more rigorous causal research.

ObjectiveTo investigate in the National School Feeding Program (PNAE) the local-level drivers and barriers to the implementation of four guidelines: the banning of sugary drinks; restrictions on the procurement of processed and ultra-processed foods; the mandatory increase in weekly servings of fruits and vegetables offered to students; and mandatory direct procurement from family farmers. DesignQualitative study that used semi-structured interviews. Street-level bureaucracy theory informed the theoretical framework and thematic analysis. SettingBrazilian municipalities, across the countrys five geographic regions (North, Northeast, Southeast, South, and Midwest). ParticipantsStakeholders (e.g. nutritionists, school cooks, and food procurement managers) involved in the local implementation of the PNAE program across the country. ResultsNinety stakeholders were interviewed. Stakeholders reported having autonomy to perform their activities, collaboration and support from other members within the local government and food providers, adequate infrastructure such as a well-equipped kitchens, the availability of trained personnel, and political commitment as drivers for optimum program implementation. Reported barriers included lack of support and resistance to change among cooks, teachers and parents; insufficient physical and human resources; and limited political commitment. When barriers outweighed drivers, interviewees reported adapting their practices, often in restrictive ways that could compromise the implementation of the program. ConclusionsDrivers and barriers to local PNAE implementation were generally similar across studied municipalities, although their magnitude varied. In contexts of greater economic vulnerability and fiscal constraint, additional support and targeted actions from the federal government may be required to strengthen local implementation.

Abstract Background: Schools are widely recognised as key settings for promoting childrens health behaviours. However, many schools struggle with the implementation and especially sustainment of health promotion programmes e.g. due to limited resources. Strengthening schools capacity for health promotion has therefore been identified as a central strategy for achieving better implementation and ultimately behaviour change outcomes among children. The fit4future Kids programme was developed as a large-scale, multi-component initiative in Germany that aims to promote childrens physical activity, nutrition, mental health, and responsible digital media use while simultaneously supporting schools in building structures for sustainable health promotion. Methods: This paper describes the intervention and evaluation protocol of the nationwide fit4future Kids programme implemented in several cohorts of German primary schools from Sept. 2022 to Sept. 2027. The intervention is based on the Health Promoting Schools framework and integrates established implementation and behaviour change frameworks, including the Consolidated Framework for Implementation Research, the COM-B model, and Behaviour Change Techniques. The programme combines curricular materials, environmental components, and structured implementation support to facilitate the integration of health promotion into everyday school practice. The evaluation follows a mixed-methods design involving multiple stakeholder groups, including school staff, parents, and children. Quantitative and qualitative data are collected to assess implementation processes, contextual factors, and programme outcomes. The large and diverse sample of 1,153 participating primary schools allows for the exploration of different implementation trajectories and the investigation of potential equity-related effects. Discussion: By combining evidence-based health promotion strategies with implementation science approaches, fit4future Kids provides a large-scale real-world example of how schools can be supported in implementing sustainable health promotion. The evaluation is expected to generate important insights into the implementation and potential effectiveness of multi-component school-based interventions and to inform future initiatives aiming to strengthen health-promoting school environments.

BackgroundEvidence on the long-term impact of urban green and blue spaces (UGBS) interventions remains limited. This study is a 15-year evaluation of an urban greenway development in Belfast (United Kingdom), assessing the potential effects of this UGBS intervention on physical activity (PA), mental wellbeing and co-benefits. MethodsUsing quasi-experimental design, a repeated cross-sectional survey was conducted in 2010 (baseline), 2017 (post-opening) and 2023 (long-term follow-up) with about 1,200 adults participated each wave. Outcomes included PA, mental wellbeing, general health, quality of life, social capital and environmental perception. Multilevel mixed-effect regressions were performed to examine within-group changes at long-term follow-up. Difference-in-differences analysis investigated the between-group changes that might be attributed to the greenway. Additional comparative analyses included distance-decay analysis and comparison with population trends in Northern Ireland. ResultsAt six years after completion, the greenway intervention appears to buffer a decline in duration of PA - mainly from moderate-intensity activity (decline lower by 118.6 min/week, 95%CI: 3.9-232.2) but with no significant impact on the proportion of the population meeting the recommended PA level. The intervention is associated with a smaller decline in self-rated health (4.98 units; 95%CI: 0.62-9.34) relative to control group. Intervention association with mental wellbeing was positive but not significant (p=0.30). The greenway also showed positive effects on social capital and environmental perceptions, with impacts most evident in improving safety and trust in the local area. ConclusionThis study provides evidence to support the public health impact of UGBS and its long-term health and social benefits.

Background Physical inactivity and sedentary behaviour are major contributors to non-communicable diseases (NCDs) and are unevenly distributed across populations, disproportionately affecting migrants and ethnic minority groups. Somali communities in the UK experience multiple structural and socio-economic disadvantages; however, evidence on physical activity and associated inequities remains limited. This study examined physical activity, sedentary behaviour, and related barriers and facilitators among Somali residents in Sheffield, United Kingdom. Methods A cross-sectional mixed-methods study was conducted among Somali adults (n = 238). Quantitative data were collected using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and analysed using descriptive statistics and ordinal logistic regression. Qualitative data were obtained from two focus group discussions (n = 14) and analysed using inductive thematic analysis to explore socio-cultural, environmental, and structural determinants of physical activity. Results No statistically significant predictors of physical activity were identified in the adjusted analysis; however, consistent trends indicated lower activity levels among older adults and those in employment. Qualitative findings revealed multiple, intersecting barriers rooted in structural inequities, including migration-related lifestyle changes, reduced incidental activity, sedentary occupations, limited health literacy, language barriers, financial constraints, and gendered responsibilities. Cultural norms and environmental conditions further shaped behaviour. Facilitators included community-based, culturally tailored interventions, peer support, gender-sensitive programmes, and adaptation of traditional practices. Conclusion Somali residents in Sheffield face overlapping structural and socio-cultural barriers to physical activity that are not fully captured by quantitative measures alone. Equity-oriented, culturally competent, and community-led interventions addressing both systemic and behavioural determinants are essential to improve access to physical activity and reduce health inequalities and NCD risk.

Abstract Background: Insufficient physical activity, excessive sedentary time, and suboptimal sleep are linked to premature mortality and chronic disease and may contribute to social inequalities in health, but most evidence is self-reported. Device-measured, nationally representative data capturing the full 24-hour movement spectrum remain scarce, particularly among older adults. This study examined social, economic, and environmental disparities in 24-hour movement behaviours in the 2021-23 English Longitudinal Study of Ageing (ELSA) accelerometry sub-study. Methods: A subset of 5,382 ELSA participants (71.9%) was invited to wear an Axivity AX3 wrist accelerometer for eight days, with 4,354 (80.9%) agreeing. Raw data were processed using machine learning to derive step count, sleep duration, moderate-to-vigorous and light physical activity, sedentary time, and time in bed. Cross-sectional associations with sex, age, education, marital status, wealth, and urbanicity were examined using linear regression. Findings: Data from 3,648 participants (mean age 68.5 {+/-} 9.3 years; 44.3% men) were included in wear time analyses (median 6.6 days, IQR 6.0-6.9), with 3,161 (86.7%) having sufficient wear time for movement behaviour analyses. Older, unmarried, or lower education/wealth participants were less active, more sedentary, and slept less. Rural participants were more active than urban participants. Women accumulated fewer steps and less moderate-to-vigorous physical activity and sedentary time, but more light activity and longer sleep than men. Interpretation: Social, economic, and environmental disparities exist across the full 24-hour movement spectrum, highlighting population groups for targeted interventions. Follow-up data will clarify how 24-hour movement behaviours influence healthy ageing and contribute to social inequalities in health.

HighlightsO_LIHealth inequalities have widened over 15 years, favouring high-income groups C_LIO_LIInequality in physical activity & mental health widened the most pre-intervention C_LIO_LIPost-intervention, inequalities persisted but stayed relatively unchanged. C_LIO_LILong-term illness and unemployment were key drivers of inequality C_LIO_LIThe greenway may have slowed down the inequality widening but the impact is limited C_LI BackgroundEvidence concerning health inequalities following urban green and blue space UGBS) interventions is limited. This study examined the changes in health inequalities after a major urban regeneration project, the Connswater Community Greenway (CCG), in Belfast, UK. MethodCross-sectional household surveys were conducted in 2010/11 (baseline), 2017/18 (immediately after completion), and 2023/24 (long-term follow-up) with a sample of approximately 1,000 adults each wave. Using concentration indices (CI), income-related health inequalities for three outcomes (physical activity, mental wellbeing and quality of life) were measured. A regression-based decomposition of concentration index examined the contribution of sociodemographic factors to the observed inequalities underpinning each outcome over time. ResultsAcross three waves, there was widening of inequalities over the 15-year period across all three health outcomes, with those from high-income groups reported higher levels of physical activity (CI=0.33, SE=0.026), better mental wellbeing (CI=0.03, SE=0.003), and better quality of life (CI=0.09, SE=0.008). The widening inequalities mainly occurred during the construction phase of CCG (2010-2017) and remained stable post-intervention (2017-2023). Decomposition analysis revealed that the pro-poor concentration of long-term illness and unemployment was the key driver that together explained approximately 51%-76% of the inequalities. ConclusionThe CCG was limited in reducing health inequalities which were mainly driven by long-term illness and unemployment - factors beyond the direct scope of the UGBS intervention - resulting in low-income groups likely to fall further behind the wealthier groups. The widening of inequality is consistent with findings from other public interventions that did not have a primary equity focus.

BackgroundAdherence to UK dietary guidelines is poor, yet no evidence exists regarding population-level knowledge of these guidelines, or the barriers and facilitators to adherence. This study aimed to characterise knowledge of UK dietary guidelines and perceived barriers and facilitators to adherence in a nationally representative UK sample. MethodsA cross-sectional survey was administered to 1003 adults recruited via Prolific, matched to the UK population by age, sex, and ethnicity. A 22-item knowledge questionnaire assessed awareness of the Eatwell Guide and broader Dietary Reference Values (DRVs), with both strict and liberal scoring applied. Perceived barriers and facilitators to adherence were assessed using custom questionnaire items informed by the COM-B model and TDF framework. ResultsKnowledge of Eatwell Guide recommendations was moderate under strict scoring (53.3%) and improved under liberal scoring (72.5%), despite nearly half of participants reporting no familiarity with the Eatwell Guide. Knowledge of broader DRVs was poor using strict scoring (17.9%) but moderate with liberal scoring (58.9%). The most commonly reported barriers were social (e.g. celebrations), environmental (e.g. access to unhealthy foods), and psychological (e.g., mood). The most strongly endorsed facilitators were economic (e.g. cheaper healthy foods) and health-related (e.g. motivated by weight and mental health). ConclusionsThese findings suggest that whilst knowledge of UK dietary guidelines is reasonable, individualised behaviour change approaches alone are unlikely to be sufficient. Meaningful population-level improvements will require complementary structural changes to the food environment.

Time compositions of physical behaviours are associated with premature mortality, but the moderating role of sleep remains unclear. Using data from the UK Biobank accelerometry subsample, we examined associations of time reallocations between five device-measured physical behaviours (sleep, sedentary behaviour (SB), standing, light-intensity (LPA) and moderate-to-vigorous physical activity (MVPA)) with all-cause, cardiovascular disease (CVD) and physical activity-related cancer mortality, and the potential effect modification by sleep duration and regularity. Compositional Cox regression was used to examine associations of behavioural reallocations with mortality. In 58,149 adults, 2,209 deaths occurred over a mean follow-up of 8.0 years. Among participants who meet sleep duration guidelines, reallocating 30 minutes from sleep to standing, LPA or MVPA was favourably associated with all-cause mortality with HRs of 0.86 (95%CI 0.79, 0.93), 0.87 (0.80, 0.95), and 0.80 (0.73, 0.87), respectively. Reallocating 30 minutes from sleep to SB, standing, or LPA was adversely associated with CVD risk (HRs 1.08 (1.02, 1.15), 1.10 (1.01, 1.20), and 1.11 (1.03, 1.20)) among those not meeting guidelines. Beneficial associations of reallocating SB to sleep were evident only amongst short (<7h/day) or regular (SRI>87.8) sleepers across mortality outcomes. Our findings support incorporating sleep characteristics into future personalised behavioural interventions design and behavioural targets.

Background Physical activity (PA) and body mass index (BMI) shape cardiovascular risk, particularly in women. Yet, little research exists examining intersectional social axes shaping PA and BMI inequities among women living in the United States (US). Methods Data included women sampled in the 2015-2020 National Health and Nutrition Examination Survey. We used Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) via linear models to examine PA (n=,4591) and BMI (n=4,596) inequities across intersectional strata defined by race/ethnicity, age, education, nativity, and work status. We further quantified the contribution of these strata to the observed inequities and estimated additive fixed effects. Results In the null model, intersectional strata explained 4.6% and 13.8% of the variance in PA and BMI inequities, respectively, with 99.2% for PA and 97.5% for BMI explained by age, race/ethnicity, education, nativity, and occupation status. On average, Asian and Black women, those aged 35-49 years, those born outside the US, and those with less than a high school diploma had the lowest predicted mean PA. For BMI, Black and Hispanic/Latino women and those younger than 64 years had the highest mean BMI. Conclusion PA and BMI inequities are mostly explained by race/ethnicity, age, education, nativity, and work status. Our findings offer insights into universal and potential policy-informed health promotion strategies that may be tailored to women with these social identities and lived experiences that have shaped physical activity and body mass index inequities.

Background: Hospital canteens provide an effective setting for improving the dietary habits of users. The study evaluates the food choices of users after an educational and environmental intervention, considering nutritional composition and environmental impact, and to compare the results with pre-intervention choices. Methods: A cross-sectional study was conducted in three hospital canteens (C1, C2, C3) in northeastern Italy, during two index weeks in September 2022 (T0) and 2023 (T1). An intervention was introduced between T0 and T1, consisting of posters on healthy eating, descriptive norm messages, and environmental changes regarding fruit and vegetables. Photos of lunch trays were collected, and choices were analyzed for nutritional composition and sustainability. Results: 2,851 trays were analyzed: 1,227 at T0 (798 in C1, 228 in C2 and 201 in C3) and 1,624 at T1 (1,005 in C1, 348 in C2, 271 in C3). In C1 and C3, there was an increase in median energy (+30 kcal; +135 kcal) compared to pre-intervention meals, while in C2 there was a decrease (-118 kcal). Despite a slight improvement in macronutrient composition, at T1 meals in all canteens were still high in lipids (30%E; 39%E; 35%E) and low in carbohydrates (44%E; 39%E; 41%E). The fibre value fell within the recommended range only in C1 and C3. The median carbon (CF) and water (WF) footprints of meals in all canteens remained high: at T1 CF ranged from 966 gCO2eq. to 1,227 gCO2eq. and WF from 1,025 L H2O to 1,207 L H2O. Conclusion: The intervention has led to partial improvements in food choices. To achieve more significant results, it may be necessary to implement a parallel intervention on food offer.

BackgroundCollege-attending young adults frequently experience declines in diet quality, physical activity, and psychological well-being during the transition to independent living, contributing to weight gain during the first year of college. Although multicomponent lifestyle interventions have been developed to address these behaviors, the responsiveness to such programs could differ across demographic factors associated with health behaviors, such as sex, race, and ethnicity. Hence, this secondary analysis of large-scale college health trials evaluated whether the effectiveness of such interventions differed by these demographic factors. MethodsData were combined from two multi-site randomized controlled trials: Young Adults Eating and Active for Health (YEAH) trial and the Get FRUVED trial. Both interventions used theory-based approaches to promote healthy weight management through improvements in diet quality, physical activity, and stress management. Baseline-adjusted linear regression models evaluated the effects of group (intervention, control) and its interactions with sex, race (White, Black, Other), or Hispanic ethnicity. Models were adjusted for baseline outcome values, baseline BMI, study (YEAH vs. FRUVED), and state of data collection. ResultsIntervention participants reported higher fruit and vegetable intake, lower processed meat intake, and longer sleep duration compared with controls. However, there was significant heterogeneity in these dietary outcomes by ethnicity, race, and sex. Non-Hispanic participants in the intervention group had higher fruit and vegetable intake compared to controls (p < 0.05). And, within the intervention group, Hispanic females had lower bacon/sausage intake than Hispanic males and non-Hispanic females (p < 0.05). With respect to race, Black participants reported higher total processed meat intake than White and Other race participants in the intervention group (p <0.05). These demographic factors did not moderate the interventions impact on physical activity, sleep duration, and perceived stress. Overall, the intervention appeared to be the least effective for Hispanic males who exhibited higher body weight and waist circumference compared with Hispanic females and non-Hispanic males (p < 0.05). ConclusionsMulticomponent lifestyle interventions can improve selected dietary outcomes among college students, but effectiveness may differ across demographic subgroups. Culturally and sex-tailored strategies that consider the intersecting influences of sex, race, and ethnicity may enhance intervention effectiveness during the transition to college.

IntroductionIncreasing global prevalence of overweight and obesity underscores the need for context-specific evidence to guide preventive policy implementation. Previous modelling showed that promoting healthy indigenous foods, implementing a 20% tax on sugar-sweetened beverages (SSBs), and introducing mandatory kilojoule menu labelling in formal-sector restaurants in Kenya were health-promoting, cost-saving, and cost-effective. Cost-effectiveness evidence is strengthened when considered alongside broader policy implementation considerations. We engaged stakeholders to assess additional implementation considerations relevant to decision-makers and to evaluate the stakeholder engagement process used in the modelling study. MethodsUsing the Assessing Cost-Effectiveness approach, we conducted a stakeholder-engaged study with national-level Kenya stakeholders recruited through purposive and snowball sampling. Through deliberative dialogue at a hybrid workshop, stakeholders assessed implementation considerations such as equity, feasibility and sustainability using a colour-coded scoring tool. We evaluated the engagement process using an anonymous survey covering seven stakeholder-engaged research domains. We analysed responses thematically. ResultsAcross the three interventions, most implementation considerations for feasibility, reach and impact, affordability, acceptability, and sustainability were assessed as medium or high. Industry acceptability of kilojoule labelling and SSB tax and affordability of kilojoule labelling to industry were rated low. Equity scores varied. Stakeholders proposed complementary measures that could raise low ratings to favorable scores. Clarity on stakeholder roles was identified as a key strength of the engagement process, while competing time commitments limited participation. ConclusionStakeholder insights contextualise prior cost-effectiveness evidence within policy-relevant implementation considerations and inform current fiscal and regulatory debates. Evaluation of the stakeholder engagement process underscores its contribution to strengthening public health research.