Professor Maria Maynard

There is limited evidence on diet and physical activity (PA) interventions to prevent childhood over- and under-nutrition in Nigeria, particularly those with parental involvement. The aim of this qualitative cross-sectional study was to explore parents’, children’s, and other stakeholders’ views on what might enable or hinder participation in diet and PA interventions with parental involvement, and potential intervention components likely to be feasible and acceptable. The study took place in Lagos State, Nigeria. Sixteen boys and girls aged 8–11 years in four participating schools were involved in the study. In addition, women (n = 19) and men (n = 13) aged 18–60 years took part. These included parents, teachers, school heads, community leaders, health professionals, and health or education civil servants, recruited via the participating schools, community and professional links. Data were collected in schools, homes, and places of work via one-to-one interviews and focus groups, audio-recorded with participants’ consent. Topics included knowledge about a balanced diet and active living; frequency of exercise and barriers and facilitators of participation; and ideas for fostering good diet and physical activity habits. Socio-demographic data were collected orally at the start of each discussion. Thematic analysis of verbatim transcripts of the recordings was conducted. Three overarching themes were identified: (1) Active community collaboration; (2) strategies for involving families; and (3) schools as key settings for interventions. The main barriers to participation in potential interventions included poor access to clean water, safe outdoor play space, and menstrual hygiene products. Suggested solutions included increased security, infrastructure improvements using recycled materials, school gardening, and health campaigns funded by local dignitaries. Health literacy education for parents, tailored to local dialects, was considered an important potential intervention component that would engage families. The feasibility and acceptability of grassroots suggestions for intervention components and parental involvement could usefully be explored in future pilot studies.

BACKGROUND: To evaluate the association between weight misperception and psychological symptoms in the Determinants of young Adults Social well-being and Health (DASH) longitudinal study. METHODS: A longitudinal sample of 3227 adolescents, in 49 secondary schools in London, aged 11-16 years participated in 2002/2003 and were followed up in 2005/2006. A sub-sample (N = 595) was followed up again at ages 21-23 years in 2012/2013. An index of weight misperception was derived from weight perception and measured weight. Psychological well- being was measured using the Strengths and Difficulties Questionnaire at 11-16 years and the General Health Questionnaire at 21-23 years. Associations with weight misperception was assessed using regression models, adjusted for socio-economic and lifestyle factors. RESULTS: White British males and females were more likely than ethnic minority peers to report accurate perceptions of measured weight. At 11-13y, 46% females and 38% males did not have an accurate perception of their measured weight. The comparable figures at 14-16y were 42 and 40%. Compared with male adolescents, more females perceived themselves as overweight or were unsure of their weight but measured normal weight, and this was more pronounced among Indians, Pakistanis and Bangladeshis. At 14-16y, more males perceived themselves as underweight but measured normal weight, and this was more pronounced among Indians. Compared with those who had an accurate perception of their normal weight, a higher likelihood of probable clinically-relevant psychological symptoms was observed among those who measured normal weight but perceived themselves to be underweight (females Odds Ratio (OR) = 1.87 95% CI 1.03-3.40; males OR = 2.34 95% CI 1.47-3.71), overweight (females only OR = 2.06 95% CI 1.10-3.87), or unsure of their weight (males only OR = 1.61 95% CI 1.04-2.49). Among females, the association was driven by internalising rather than externalising symptoms. An accurate perception of overweight was associated with higher psychological symptoms in adolescence and early 20s. Ethnic specific effects were not evident. CONCLUSION: Weight misperception may be an important determinant of psychological symptoms in young people, with an accurate perception of normal weight status being protective. Culturally targeted interventions should be considered to promote healthy perceptions of body image.

Background & aims When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice. Methods Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180). Results UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (H p) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (H p (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was −0.6 (−2.4, +1.2); Asian women, (H p = 3.26 UL + 77.62), mean difference +0.5 (−1.4, 2.4) cm. For Black men, H p = 3.14 UL + 85.80, −0.4 (−2.4, 1.7); Black women, H p = 3.14 UL + 79.55, −0.8 (−2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height. Conclusions The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations.

Abstract

Unfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21–23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21–23 years were higher among those who regularly skipped breakfast at 11–13 years (BMI 1·41 (95 % CI 0·57, 2·26), P=0·001; cholesterol 0·15 (95 % CI –0·01, 0·31), P=0·063) and at 21–23 years (BMI 1·05 (95 % CI 0·22, 1·89), P=0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P=0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups.

Background Evidence on the relationship between fruit and vegetable consumption (FV) and mental health in adolescence is sparse and inconsistent. Social determinants of FV include ethnicity, family environments and economic disadvantage. We investigated the relationship between FV and mental health in the British multi-ethnic Determinants of Adolescents (now young Adult) Social well-being and Health (DASH) longitudinal study. Methods A longitudinal study of 4683 adolescents living in London at age 11–13 years and followed up at 14–16 years. FV was measured using validated questions on the number of portions consumed daily. Mental health was measured by the Strengths and Difficulties Questionnaire as mean Total Difficulties Score (TDS) and by classification as a ‘probable clinical case’ (TDS > 17). Social measures included ethnicity, parenting and socioeconomic circumstances. Multilevel modelling was used to investigate the association between FV and mental health throughout adolescence. Results Low FV was common among adolescents, with approximately 60–70% of adolescents reporting < 5 portions/day and 20–30% reporting < 1 portion/day. In late adolescence, most ethnic minority groups reported lower FV than their White peers. In fully adjusted models, < 1 portion/day remained a significant correlate with mean TDS (Coef: 0.55, 0.29–0.81, P < 0.001) and TDS > 17 (Odds Ratio: 1.43, 1.11–1.85, P = 0.007). Gender- or ethnic-specific effects were not observed. Low parental care partly attenuated the association between FV and mental health. Conclusions Low FV is a longitudinal correlate of poor mental health across adolescence. A focus on FV in parenting interventions could yield interrelated benefits across developmental outcomes given its importance to both physical and socioemotional health.

Childhood obesity is a common concern across global cities and threatens sustainable urban development. Initiatives to improve nutrition and encourage physical exercise are promising but are yet to exert significant influence on prevention. Childhood obesity in London is associated with distinct ethnic and socio-economic patterns. Ethnic inequalities in health-related behaviour endure, underpinned by inequalities in employment, housing, access to welfare services, and discrimination. Addressing these growing concerns requires a clearer understanding of the socio-cultural, environmental and economic contexts of urban living that promote obesity. We explore opportunities for prevention using asset based-approaches to nutritional health and well-being, with a particular focus on adolescents from diverse ethnic backgrounds living in London. We focus on the important role that community engagement and multi-sectoral partnership play in improving the nutritional outcomes of London's children. London's children and adolescents grow up in the rich cultural mix of a global city where local streets are characterised by diversity in ethnicities, languages, religions, foods, and customs, creating complex and fluid identities. Growing up with such everyday diversity we argue can enhance the quality of life for London's children and strengthen their social capital. The Determinants of young Adult Social well-being and Health longitudinal study of about 6500 of London's young people demonstrated the positive impact of cultural diversity. Born to parents from over a hundred countries and exposed to multi-lingual households and religious practices, they demonstrated strong psychological resilience and sense of pride from cultural straddling, despite material disadvantage and discrimination. Supporting the potential contribution of such socio-cultural assets is in keeping with the values of social justice and equitable and sustainable development. Our work signals the importance of community engagement and multisectoral partnerships, involving, for example, schools and faith-based organisations, to improve the nutrition of London's children.

Background: In the UK, Black African-Caribbean adults are three times more likely to develop type 2 diabetes mellitus (T2DM) compared to the majority population (1). Sixty-nine percent of Black African-Caribbean adults identified as Christian in the 2011 Census (2). Various perspectives are required to address inequity in diabetes prevalence, including people’s own views on the relationship between their faith and health (3); however, there is a lack of UK studies. The aim of this qualitative study was therefore to explore views on Christian faith beliefs in relation to the prevention and management of T2DM among Black African-Caribbean adults living in Birmingham, UK. Methods: A purposive, convenience sample of Black AfricanCaribbean adults of Christian faith was recruited. Snowball sampling via a gatekeeper with Caribbean community links aided the recruitment process. Seven participants (six women and one man) took part in two focus groups (n = 3, all female; and n = 4). Focus groups were facilitated by one researcher (ES) and conducted in January and February 2017. A semi-structured topic guide of open-ended questions and prompts on lifestyle, nutrition and T2DM knowledge were used to facilitate dialogue, developed with input from a church leader and specialist diabetes nurse. Focus groups took place in the gatekeeper’s home and were digitally recorded, with permission. Recordings were transcribed verbatim, transcripts manually coded and thematic analysis conducted. Participants also completed a short questionnaire confirming ethnic and faith identity and reporting diabetes status. Ethical approval was granted by the School of Clinical and Applied Sciences, Leeds Beckett University. Results: Participants were aged 30–75 years and four reported being diagnosed with T2DM or pre-diabetes. Emergent themes suggested that participants felt the prevention and management of T2DM should be addressed with the use of both medical interventions and faith because “God gave man knowledge to create medicine to alleviate our suffering” [Focus Group 1], and that according to the bible there was personal responsibility to take ownership of health. There was reported interest in the use of herbal remedies for a range of conditions, but not in relation to diabetes. Participants related that they could “pray to God for the knowledge, the wisdom and the understanding” [Focus Group 2] with which to make diabetes-related lifestyle changes. However, participants described high intake of Western convenience foods and takeaways, and little inclusion of traditional Caribbean foods in their diets due to their cost and low availability of good quality produce. Compared with the Caribbean setting, it was felt that lifestyles in the UK were less physically active and that these changes were contributing factors in the prevalence of T2DM among their ethnic group. Discussion: The findings are consistent with research among African Americans, which showed faith belief could coincide with acceptability of diabetes-related advice (3). The interaction of beliefs with other cultural and social factors, such as dietary acculturation, could have important implications for tackling T2DM among Black-African Caribbeans. Depth of data was achieved, however the small sample size, and therefore potentially narrow range of voices, may impact on the theoretical generalisability of the findings. Conclusion: Faith can support conventional approaches to addressing T2DM among UK Black-African Caribbeans with Christian beliefs, in the context of other social and cultural factors. References 1. Public Health England (2014). Adult obesity and type 2 diabetes. https://www.gov.uk/government/uploads/system/up loads/attachment_data/file/338934/Adult_obesity_and_type_ 2_diabetes_.pdf (accessed 14/7/17). 2. Office for National Statistics (2012). Religion in England and Wales 2011. https://www.ons.gov.uk/peoplepopulationa ndcommunity/culturalidentity/religion/articles/religionineng landandwales2011/2012-12-11 (accessed 14/7/17). 3. Polzer R & Miles MS. Spirituality and self-management of diabetes in African Americans. Journal of Holistic Nursing. 2005;23:230–250.

Objective: To explore views on food, place and risk of type 2 diabetes among Black Caribbeans in the United Kingdom (UK). Design and Methods: The food, diabetes and ethnicity (FOODEY) study included 61 men and women (80% Black Caribbean; aged 24–90 years) in focus groups and interviews. Thematic analysis of transcripts was conducted to identify emergent themes. Results: Rich descriptions of food habits highlighted some continuity of ‘traditional’ Caribbean food culture. Alongside food habits common to the general population, participants’ diets regularly included dishes such as rice and peas with fried chicken, or for post-retirement participants’ individual foods such as plantain. Although the prevalence of Type 2 diabetes in the Caribbean is similar to that among UK Black Caribbeans, the contention of lower prevalence in the Caribbean was strongly held. While family history was considered a key risk-factor, “West Indian” food habits were viewed as detrimental in the British setting and that “bad genes load the gun, but lifestyle pull the trigger”. Cold weather, stress due to racism and lack of physical activity in the UK were felt to contribute to increased risk. The Caribbean as “not the same environment” was deemed a suitable setting for consuming traditional foods and high sugar intakes, for example, due to active living, consumption of organic vegetables and the hot climate. Conclusions: Lay explanatory models for the role of food, place and risk of diabetes, which included both accurate knowledge and misconceptions, have implications for addressing Type 2 diabetes among UK Black Caribbeans

Ethnic inequalities in cardiometabolic disease(1,2) may be explained by differences in diet and lifestyle. Poor dietary habits, such as skipping breakfast and consumption of fizzy drinks and fast foods are more common amongst ethnic minority children and adolescents(3,4) . The long-term effects of these childhood behaviours on adult cardiometabolic risk factors have not yet been investigated in an ethnically diverse population. We aimed to assess ethnic patterns in adolescent and young adult breakfast skipping and its influence on cardiometabolic risk in young adulthood amongst a diverse UK cohort. The DASH cohort was recruited in 2002/03 and consisted of 6643 11–13 year olds, sampled to represent the main ethnic groups of the UK population. The ‘DASH 10 years on’ study is a longitudinal follow-up of a subset of the cohort who are now young adults (21–23 years). Participants had anthropometric measures (weight, BMI, waist circumference), blood pressure, total and HDL-cholesterol and HbA1c assessed and completed a short dietary behaviours questionnaire indicating how frequently they consume breakfast (daily, 3–4 days a week, 1–2 days a week, never/hardly ever). The cohort consisted of 311 males (age 22·8 (95 % CI 22·7, 22·9) years; BMI 24·7 (95 % CI 24·3, 25·2) kg/m2 ) and 316 females (age 22·7 (95 % CI 22·6, 22·8) years; BMI 24·9 (95 % CI 24·3, 25·5) kg/m2 ). A total of 107 White British, 102 Black Caribbean, 132 Black African, 99 Indian, 111 Bangladeshi or Pakistani and 115 Other (mainly mixed) were included in the follow-up. In young adulthood regular breakfast skipping was reported by 56 % of participants; Black African participants were more likely to skip breakfast than White British (OR: 1·81, 1·04 to 3·17, p = 0·004). The highest proportion of breakfast skipping occurred amongst the Black Caribbean (66 %) and Black African (64 %) groups and the lowest amongst Indian participants (46 %). The impact of skipping breakfast during both adolescence and young adulthood on cardiometabolic risk factors during young adulthood were investigated using multivariate regression modelling. Skipping breakfast at 11–13 years was a significant determinant of BMI at 21–23 years (1·45 (95 % CI 0·61, 2·29), p = 0·001) as was skipping breakfast at 21–23 years, although the effect was slightly attenuated in this age group (0·92 (95 % CI 0·1, 1·73), p = 0·027). Skipping breakfast at both 11–13 years and 21–23 years were also important determinants of total cholesterol levels (11–13 years: 0·17 (95 % CI 0·01, 0·33), p = 0·041; 21–23 years: 0·23 (95 % CI 0·07, 0·38), p = 0·003). This is the first longitudinal assessment of breakfast skipping and its impact on cardiometabolic risk factors amongst an ethnically diverse cohort of young adults in the UK. In this work we have recognised the detrimental impact of childhood breakfast skipping on cardiometabolic risk factors, such as BMI and cholesterol concentrations, in young adulthood. Furthermore we have identified distinct ethnic patterns in breakfast skipping, such that skipping breakfast is most prevalent amongst Black African and Caribbean groups and less common amongst Indians. Our findings provide a useful insight into dietary behaviours that health promotion campaigns could target in aiming to improve the diets of young people, and highlights the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific groups of young adults in the population. 1. Becker E et al. (2006) National Centre for Social Research. 2. Zhang Q et al. (2009) Ethnicity & Health 14(5): 439–57. 3. Harding S et al. (2008) Int J Epi 37(1): 162–72. 4. Nicklas TA et al. (1998) J Am Diet Assoc 98(12): 1432–8.

Background In The Gambia, existing research to understand and address malnutrition among adolescent girls is limited. Prior to the conduct of large-scale studies, formative research is needed. The aim of this mixed methods, cross-sectional study was to explore cultural contexts relevant to nutritional status, feasibility and appropriateness of recruitment and data collection methods (questionnaires and anthropometric measures), and plausibility of data collected. Methods The study took place in May–June 2021 in an urban conurbation in Brikama local government area (LGA) and two rural villages in Mansakonko LGA, The Gambia. The purposive sampling frame of the all-female sample included residence in the selected urban or rural settings and being aged 10–14 or 15–19 years. Thirty-two girls aged 10 to 19 years, with equal numbers in urban and rural settings were recruited. Four focus groups discussions (FGDs), with eight participants in each, were held to understand perspectives on cultural practices; concepts of under- and overweight, and research recruitment methods. The same participants completed questionnaires on socioeconomic circumstances, health, access to community resources, nutrition knowledge, sleep, and physical activity, and had anthropometric measures taken. FGDs were then reconvened to discuss the feasibility and acceptability of the questionnaires and anthropometric measures, and views on providing biological samples in the future. FGD data were analysed using thematic analysis. Body mass index (BMI)-for-age and height-for-age z-scores, mid-upper arm circumference, and waist: hip ratios were assessed and descriptive statistics used to explore the data obtained. Results Five themes were identified in the focus group discussions: 1. Cultural norms: harmful vs. beneficial to nutrition-related health; 2. Concepts of healthy diet and weight; 3. Approaches to tackling under- and overnutrition; 4. Study recruitment: barriers and facilitators; 5. Study questionnaires and proposed measures are mostly feasible and acceptable. Questionnaire data highlighted limited access to resources (e.g. food markets and electricity) as important individual, household and community factors influencing malnutrition in rural settings. The anthropometric measures reflected the double burden of malnutrition in The Gambia, with the presence of stunting (41%), underweight (31%), and living with overweight or obesity (10%). A higher proportion of participants were underweight in rural compared to urban settings (50% vs 12.5% respectively, p = 0.03). Over 70% of those classified as underweight perceived their weight as normal. Conclusion This exploratory study provides novel data to inform larger-scale research to understand and address malnutrition among adolescent females in The Gambia. Urban–rural variance in the double burden of malnutrition, factors influencing malnutrition, and in the barriers to and facilitators of adolescents taking part in research, are key considerations.

Introduction The wealth of free food-based resources available to UK consumers on healthy eating and nutrition provides very limited illustrations of ethnic foods including African-Caribbean cuisines. This inequality in available resources limits the ability of African-Caribbean communities to effectively manage their health and reduces the cultural competence of health professionals. Objective The aim was to co-design healthier versions of several traditional African-Caribbean recipe resources by working in partnership with academics, a community-based Third Sector organisation, and their service-users. Methods Nutritional analysis software was used to theoretically modify the nutritional composition of popular traditional African-Caribbean recipes using recently produced analytical food composition data. Twelve recipes were theoretically modified to reduce the content of key nutrients and ingredients of concern (i.e., salt/sodium, free sugars), or increase those nutrients known to be at risk of lower than adequate intakes (i.e., iron, folate) within the UK African-Caribbean communities. Recipes were then prepared by community service-users (n = 12) of African-Caribbean ethnicity living in Leeds (UK) in the community service setting. The feasibility and acceptability of the recipes were evaluated by obtaining verbal feedback from service-users, following which recipes were further refined as appropriate. Results Modification resulted in a reduction in the overall energy (in the range of 23–188 kcal), fat (in the range of 0.1–13.7 g), saturated fatty acid (in the range of 0.1–2.9 g) and sugar (in the range of 0.2–8.3 g), provided by 100 g of the standard recipes. Similarly, modification resulted in the reduction in salt from about 63 to 0.01 g per 100 g edible portion of the standard recipe. Conclusion It is feasible to modify African-Caribbean recipes to be healthier and acceptable to consumers. Combined with improving access to food environments that make available healthy foods, the recipes are intended to support healthier eating with African-Caribbean foods.

PURPOSE: No known UK empirical research has investigated prospective associations between ambient air pollutants and conduct problems in adolescence. Ethnic minority children are disproportionately exposed to structural factors that could moderate any observed relationships. This prospective study examined whether exposure to PM2.5 and NO2 concentrations is associated with conduct problems in adolescence, and whether racism or ethnicity moderate such associations. METHODS: Longitudinal associations between annual mean estimated PM2.5 and NO2 concentrations at the residential address and trajectories of conduct problems, and the potential influence of racism and ethnicity were examined school-based sample of 4775 participants (2002-2003 to 2005-2006) in London, using growth curve models. RESULTS: Overall, in the fully adjusted model, exposure to lower concentrations of PM2.5 and NO2 was associated with a decrease in conduct problems during adolescence, while exposure to higher concentrations was associated with a flattened trajectory of conduct symptoms. Racism amplified the effect of PM2.5 (β = 0.05 (95% CI 0.01 to 0.10, p < 0.01)) on adolescent trajectories of conduct problems over time. At higher concentrations of PM2.5, there was a divergence of trajectories of adolescent conduct problems between ethnic minority groups, with White British and Black Caribbean adolescents experiencing an increase in conduct problems over time. CONCLUSION: These findings suggest that the intersections between air pollution, ethnicity, and racism are important influences on the development of conduct problems in adolescence.

Background Ethnic health disparities continue to widen in the UK. For example, UK black men have double the risk of prostate cancer compared with white men, and deprivation has a greater negative impact on men's health outcomes than on women's. Few culturally tailored health programmes have engaged minority men in the UK. Boyz2men (B2M) aimed to obtain a snapshot of self-reported health of ethnic minority boys and men and explore the feasibility and acceptability of health intervention activities among this population. Methods B2M was cross-sectional, mixed-methods study, which was conducted in Leeds, West Yorkshire, UK, in 2017–18. All male individuals aged 16 years or older who had responded to community flyers, word-of-mouth invitations, social media, and other media, and who self-defined as being from a minority ethnic group, were included in the study. Self-reported questionnaire data (sociodemographic factors; GP attendance, health-related behaviours; and physical and mental conditions, such as cardiovascular diseases and depression) were supplemented by two focus groups. 26 healthy-eating, physical activity, and health empowerment sessions were planned. Six Black or Asian community health champions (CHCs) delivered and led evaluation of the sessions. Leeds Beckett University approved the study (ref:44443/51896) and all participants gave written informed consent. Findings We included 126 participants, of whom 42 were Black African, 38 were Black Caribbean, 40 were South Asian, and six were North African. Mean age of participants was 47 years (SD 17); 82 (65%) of the sample lived in neighbourhoods with the highest levels of deprivation, and 54 (43%) of the 126 men were unemployed. Black Caribbeans (17 [46%] of 37 participants, data were missing for one participant) and North Africans (four [67%] of six participants) were more likely to smoke than other groups (6–31%; p=0·006); Sikh men were more likely to drink alcohol (12 [71%] of 17 participants) than other groups (17–61%; p=0·001). Lunch was often skipped, and a third of the total sample exercised regularly. Two or more physical conditions were reported by 45 (36%) and at least one mental health problem by 15 (12%). Narratives around cutting down on smoking, concern about alcohol consumption, and time or pain as barriers to exercise emerged from the focus groups. Half of the planned sessions were not delivered because of issues such as difficulty securing venues. However, due to popularity, 12 further exercise sessions were provided in addition to the six planned, achieving 25 sessions in total. Barbershops and places of worship had potential for engaging men, but activities were not practical in all venues, and study personnel experienced challenges in building trust when working cross-culturally with respect to ethnicity or religion. Interpretation Peer-led health education in social spaces shows promise for health promotion among ethnic minority boys and men. Further surveys and intervention might contribute to policy and practice that responds to intersections between gender, ethnicity, and deprivation. Funding NHS Leeds North CCG Third Sector Health Grants 3.

Background: Portion size estimation is one of the largest sources of error in dietary assessment and relies on individuals’ perception, memory and conceptual skills(1). Varying methods adopted by researchers and practitioners have led to conflicting conclusions on accuracy of current dietary assessment methods including food photography and household measure estimations. There is also an absence of research focusing on young adults in this area. This study aimed to assess the accuracy of portion size estimations using household measures and food photographs compared to actual weights, among young adults. Methods: In a cross-sectional study design, 35 (18 female, 17 male; aged 18–26 years) participants were recruited by posters distributed around a North England university campus. Participants volunteered by arriving at a designated location indicated on the posters. A short demographic questionnaire was completed before participants self- served a meal consisting of three items with either a definite shape (jacket potato) or amorphous foods of no defined shape (baked beans and grated cheese). Serving dishes were weighed before and after serving, providing the actual weight of foods served. Fifteen minutes after eating, a questionnaire was used to collect dietary information. Participants described portions using household measures e.g. number of spoonfuls or ‘small’, ‘medium’ or ‘large’. These were quantified using a portion size reference guide(2). A food photograph atlas(3) was used for selection of a photograph representing each item and the associated weight recorded. In total each participant provided three weights per component (i.e. actual weight, household measure estimate, food photograph estimate) providing 315 weights overall. Results: For the overall meal, household measure estimations were the most accurate with an average 4% underestimation compared to actual weight. Food photographs overestimated portion weight by 14% on average. For individual meal components food photographs were more accurate in estimating the size of jacket potatoes with no significant difference between estimates and actual weights (P = 0.34). Cheese was significantly overestimated by food photographs (P = 0.029) and underestimated by household description (P = 0.005) compared to actual weights. Baked beans were overestimated by both methods. Females overestimated more frequently, however differences in estimation between males and females were not statistically significant. Discussion: Estimated portion weights of all three food components differed significantly to actual weight for at least one of the methods. It would therefore be inappropriate to suggest that either method can assess the dietary intake of young adults without error. Household measure descriptions were closer to actual weight than estimations based on food photographs. Amorphous foods may be particularly prone to overestimation regardless of method. Consideration should be given to the likely overestimation in portion size associated with food photographs and underestimation with household measures. Both under- and over-estimation can be associated with household measure descriptions according to the type of food being assessed. Food photographs and household methods are useful portion size assessment tools for use among young adults only when inherent errors in both methods are acknowledged.

Purpose: The Determinants of young Adult Social well-being and Health longitudinal study draws on life-course models to understand ethnic differences in health. A key hypothesis relates to the role of psychosocial factors in nurturing the health and well-being of ethnic minorities growing up in the UK. We report the effects of culturally patterned exposures in childhood. Methods: In 2002/2003, 6643 11–13 year olds in London, ~80 % ethnic minorities, participated in the baseline survey. In 2005/2006, 4782 were followed-up. In 2012–2014, 665 took part in a pilot follow-up aged 21–23 years, including 42 qualitative interviews. Measures of socioeconomic and psychosocial factors and health were collected. Results: Ethnic minority adolescents reported better mental health than White British, despite more adversity (e.g. economic disadvantage, racism). It is unclear what explains this resilience but findings support a role for cultural factors. Racism was an adverse influence on mental health, while family care and connectedness, religious involvement and ethnic diversity of friendships were protective. While mental health resilience was a feature throughout adolescence, a less positive picture emerged for cardio-respiratory health. Both, mental health and cultural factors played a role. These patterns largely endured in early 20s with family support reducing stressful transitions to adulthood. Education levels, however, signal potential for socio-economic parity across ethnic groups.

BACKGROUND: Warm, caring parenting with appropriate supervision and control is considered to contribute to the best mental health outcomes for young people. The extent to which this view on 'optimal' parenting and health applies across ethnicities, warrants further attention. We examined associations between perceived parental care and parental control and psychological well-being among ethnically diverse UK adolescents. METHODS: In 2003 a sample of 4349 pupils aged 11-13 years completed eight self-reported parenting items. These items were used to derive the parental care and control scores. Higher score represents greater care and control, respectively. Psychological well-being was based on total psychological difficulties score from Goodman's Strengths and Difficulties Questionnaire, increasing score corresponding to increasing difficulties. RESULTS: All minority pupils had lower mean care and higher mean control scores compared with Whites. In models stratified by ethnicity, increasing parental care was associated with lower psychological difficulties score (better mental health) and increasing parental control with higher psychological difficulties score within each ethnic group, compared with reference categories. The difference in psychological difficulties between the highest and lowest tertiles of parental care, adjusted for age, sex, family type and socio-economic circumstances, was: White UK =-2.92 (95% confidence interval -3.72, -2.12); Black Caribbean =-2.08 (-2.94, -1.22); Nigerian/Ghanaian =-2.60 (-3.58, -1.62); Other African =-3.12 (-4.24, -2.01); Indian =-2.77 (-4.09, -1.45); Pakistani/ Bangladeshi =-3.15 (-4.27, -2.03). Between ethnic groups (i.e. in models including ethnicity), relatively better mental health of minority groups compared with Whites was apparent even in categories of low care and low autonomy. Adjusting for parenting scores, however, did not fully account for the protective effect of minority ethnicity. CONCLUSIONS: Perceived quality of parenting is a correlate of psychological difficulties score for all ethnic groups despite differences in reporting. It is therefore likely that programmes supporting parenting will be effective regardless of ethnicity.

Background This paper examines (1) the accuracy of self-reported height, leg length and weight in a group of subjects aged 56–78; (2) whether recent measurement of height and weight influences the accuracy of self-reporting and (3) associations between childhood and adult height, leg length and BMI measured in old age. Methods All 3182 surviving members of the Boyd Orr cohort were sent postal questionnaires in 1997–1998 and a sub-sample (294) was also clinically examined. Results Self-reported height was overestimated and body mass index (BMI), based on reported height and weight, underestimated. The mean difference between self-report and measured values were for height: 2.1 cm in males and 1.7 cm in females; for BMI the difference was –1.3 kg/m2 in males and –1.2 kg/m2 in females. Shorter individuals and older subjects tended to over-report their height more than others. The overweight under-reported their weight to a greater extent. Recent measurement appeared to decrease over-reporting of height but not weight. Correlations between self-report and measured height and BMI were generally over 0.90, but weaker for leg length (r = 0.70 in males and 0.71 in females). Adult height and leg length were quite closely related to their relative values in childhood (correlation coefficients ranged from 0.66 to 0.84), but associations between adult and childhood BMI were weak (r = 0.19 in males and 0.21 in females). Conclusions Self-reported measures of height and weight may be used in studies of the elderly although systematic reporting errors may bias effect estimates. As overweight individuals tend to under-report and the short and underweight tend to over-report, studies investigating associations of disease with height and weight using self-reported measures will underestimate effects. The weak associations between childhood and adult BMI indicate that associations between childhood adiposity and adult cardiovascular disease found in this cohort may reflect the specific effect of childhood overweight, rather than its persistence into adulthood. This suggests that avoidance of adiposity may be as important in childhood as in adulthood.

BACKGROUND: The assessment of the impact of data quality issues, such as omitting to answer questions on a food frequency questionnaire (FFQ), is important in all study populations, including those in early old age. Assumptions about the limited nature of diets of older participants may influence the treatment and interpretation of their dietary data. SUBJECTS/METHODS: The Boyd Orr cohort is a long-term study based on 4999 UK men and women whose families took part in a survey of diet and health during 1937-1939. In 1997-1998, all 3182 traced, surviving study members, then aged 60 years and over, were sent a health and lifestyle questionnaire, including a 113-item FFQ, primarily to examine relationships between childhood and adult fruit, vegetable and antioxidant intakes. In-depth interviews were conducted with a purposively sampled subset of 31 respondents. RESULTS: Of the 1475 subjects who returned the questionnaire, 11% (n=161) had missing data on their FFQ. Those who omitted answers to more than 10 questions (n=127; 8.6%) were more likely to be aged over 70, to be female, but no more likely to report being overweight than those with 10 or fewer missing answers. Follow-up by telephone or post to reassess missing FFQ data was successful for 102 of the subjects with more than 10 omitted answers. Mean intakes of energy, fruit and vegetables, and selected nutrients were significantly increased after reassessment. The use of 'cross-check' questions to weigh fruit and vegetable intake (n=1383) showed potentially systematic errors in the reporting of these foods, vitamin C and carotene. Analysis of interview data among a subset of participants partially challenged stereotypical views of the diets of older people with, for example, increased freedom in food choice associated with life transitions. CONCLUSIONS: Food frequency questionnaires for those in early old age, as for others, need to meet competing demands of being comprehensive for those with varied diets, while not being so onerous that they deter completion. Reviewing questionnaires with participants remains important in this group, as omitting to answer questions on the FFQ does not necessarily equate to non-consumption. Qualitative interviews may aid in the interpretation of the quantitative data obtained.

Objectives To describe the selection and modification of an appropriate diet score to assess diet quality in early old age. Design and setting Cross-sectional analyses of the Boyd Orr cohort – a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy. Subjects In total, 1475 traced, surviving cohort members aged 60 years and over. Results Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r = 0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r = −0.57), red meat (r = −0.46), dietary fibre (r = 0.58), fruit and vegetables (r = 0.54) and percentage energy from carbohydrates (r = 0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items. Conclusions The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.

Background: The aim of this study is to identify the socio-economic and health-related factors in childhood and later life associated with healthy eating in early old age. Methods: The study is based on surviving members of the Boyd Orr cohort aged 61–80 years. Data are available on household diet and socio-economic position in childhood and on health and social circumstances in later life. A 12-item Healthy Diet Score (HDS) for each subject was constructed from food frequency questionnaire responses. Complete data on all exposures examined were available for 1234 cohort members. Results: Over 50% of study members had inadequacies in at least half of the 12 markers of diet quality. In multivariable models having a childhood diet which was rich in vegetables was associated with a healthy diet in early old age. The HDS for those in the upper quartile of childhood vegetable intake was 0.30 (95% confidence interval –0.01 to 0.61) higher than those with the lowest intake levels (P-trend across quartiles = 0.04). The adult factors that were most strongly associated with a healthy diet were not smoking, being an owner–occupier, and taking anti-hypertensive medication. Conclusion: Our analysis indicates that diet in early old age is influenced by childhood vegetable consumption, current socio-economic position, and smoking. Interventions for improving the diet of older people could usefully focus on both encouragement of healthy diet choices from an early age and higher levels of income or nutritional support for older people.

BACKGROUND: Ethnicity is a consistent correlate of obesity; however, little is known about the perceptions and beliefs that may influence engagement with obesity prevention programmes among ethnic minority children. Barriers to (and facilitators of) healthy lifestyles were examined in the qualitative arm of the London (UK) DiEt and Active Living (DEAL) study. METHODS: Children aged 8-13 years and their parents, from diverse ethnic groups, were recruited through schools and through places of worship. Thirteen focus group sessions were held with 70 children (n = 39 girls) and eight focus groups and five interviews with 43 parents (n = 34 mothers). RESULTS: Across ethnic groups, dislike of school meals, lack of knowledge of physical activity guidelines for children and negativity towards physical education at school among girls, potentially hindered healthy living. Issues relating to families' wider neighbourhoods (e.g. fast food outlets; lack of safety) illustrated child and parental concerns that environments could thwart intentions for healthy eating and activity. By contrast, there was general awareness of key dietary messages and an emphasis on dietary variety and balance. For ethnic minorities, places of worship were key focal points for social support. Discourse around the retention of traditional practices, family roles and responsibilities, and religion highlighted both potential facilitators (e.g. the importance of family meals) and barriers (reliance on convenience stores for traditional foods). Socio-economic circumstances intersected with key themes, within and between ethnic groups. CONCLUSIONS: Several barriers to (and facilitators of) healthy lifestyles were common across ethnic groups. Diversity of cultural frameworks not only were more nuanced, but also shaped lifestyles for minority children.

Recent studies suggest that stress can amplify the harm of air pollution. We examined whether experience of racism and exposure to particulate matter with an aerodynamic diameter of less than 2.5 µm and 10 µm (PM2.5 and PM10) had a synergistic influence on ethnic differences in asthma and lung function across adolescence. Analyses using multilevel models showed lower forced expiratory volume (FEV1), forced vital capacity (FVC) and lower rates of asthma among some ethnic minorities compared to Whites, but higher exposure to PM2.5, PM10 and racism. Racism appeared to amplify the relationship between asthma and air pollution for all ethnic groups, but did not explain ethnic differences in respiratory health.

OBJECTIVE: The DASH longitudinal study found better mental health for ethnic minorities compared to White British adolescents in the UK, despite more disadvantage. This paper investigates the impact of parenting style and attendance at a place of worship on mental well-being from adolescence to young adulthood. DESIGN AND METHODS: In 2002/03, 6643 11-13 year olds in London, 80% ethnic minorities, participated in the baseline survey. In 2005/06 4,782 were followed-up. In 2012-14 665 took part in a pilot follow-up aged 21-23y, including 42 qualitative interviews. Measures of socio- economic and psychosocial factors and health were collected. RESULTS: In adolescence, ethnic minorities generally experienced more adversity but reported better mental health. Regardless of ethnicity, low parental care vs. high parental care (e.g. males coefficient: 1.32, 95% confidence interval 0.94-1.70), high parental control vs. low parental control (males: 1.37, 1.00-1.74), and attendance to a place of worship vs. no attendance were independently associated with mental health. At 21-23y, the ethnic patterning of mental health appeared to track, with increasing parental care, but not religious involvement, continuing to have a protective effect on mental health. Education levels signalled potential for socio-economic parity across ethnic groups, and family support appeared to reduce stress of transitions to adulthood. CONCLUSIONS: DASH provides evidence for a protective effect from parenting styles and religious involvement for young people growing up in ethnically diverse and deprived urban contexts. This suggests the value of cultural and social resources for psychological well- being.

Objective. To investigate the effect of racism, own-group ethnic density, diversity and deprivation on adolescent trajectories in psychological well-being. Design. Multilevel models were used in longitudinal analysis of psychological well-being (total difficulties score (TDS) from Goodman's Strengths and Difficulties Questionnaire, higher scores correspond to greater difficulties) for 4782 adolescents aged 11-16 years in 51 London (UK) schools. Individual level variables included ethnicity, racism, gender, age, migrant generation, socio-economic circumstances, family type and indicators of family interactions (shared activities, perceived parenting). Contextual variables were per cent eligible for free school-meals, neighbourhood deprivation, per cent own-group ethnic density, and ethnic diversity. Results. Ethnic minorities were more likely to report racism than Whites. Ethnic minority boys (except Indian boys) and Indian girls reported better psychological well-being throughout adolescence compared to their White peers. Notably, lowest mean TDS scores were observed for Nigerian/Ghanaian boys, among whom the reporting of racism increased with age. Adjusted for individual characteristics, psychological well-being improved with age across all ethnic groups. Racism was associated with poorer psychological well-being trajectories for all ethnic groups (p<0.001), reducing with age. For example, mean difference in TDS (95% confidence interval) between boys who experienced racism and those who did not at age 12 years=1.88 (+1.75 to+2.01); at 16 years=+1.19 (+1.07 to+1.31). Less racism was generally reported in schools and neighbourhoods with high than low own-group density. Own ethnic density and diversity were not consistently associated with TDS for any ethnic group. Living in more deprived neighbourhoods was associated with poorer psychological well-being for Whites and Black Caribbeans (p<0.05). Conclusion. Racism, but not ethnic density and deprivation in schools or neighbourhoods, was an important influence on psychological well-being. However, exposure to racism did not explain the advantage in psychological well-being of ethnic minority groups over Whites. © 2012 Copyright Taylor and Francis Group, LLC.

BACKGROUND: In the United Kingdom, there has been an increase in cigarette smoking in ethnic minority adults since the 1970s; in some groups levels are now similar to that of White British people. We aimed to examine the determinants of exposure to secondhand smoke in ethnic minority children. We hypothesised that exposure to secondhand smoke in children will vary across ethnic groups, but that the correlates of exposure would be similar to that of Whites. METHODS: The Determinants of Adolescent Social well-being and Health sample comprises 3468 White United Kingdom and ethnic minority (Black Caribbean, Black African, Indian, Pakistani, Bangladeshi) pupils aged 11-13 yrs. Outcome was saliva cotinine concentration. Explanatory variables collected by self-complete questionnaire included ethnicity, child reported household smoking and socio-economic circumstances. Data were analysed using linear regression models with a random intercept function. RESULTS: Ethnic minority children had lower saliva cotinine than Whites, partly explained by less smoking among parents. White and Black Caribbean children had higher cotinine levels if they lived in a household with a maternal smoker only, than with a paternal smoker only. Living in a lone compared to a dual parent household was associated with increased cotinine concentration of 45% (95%CI 5, 99%) in Whites, 27% (95%CI 5,53%) in Black Caribbeans and 21% (95%CI 1, 45%) in Black Africans after adjusting for household smoking status. Material disadvantage was a significant correlate only for White children (40% (95%CI 1, 94%) increase in cotinine in least compared to most advantaged group). CONCLUSIONS: Ethnic minority children were less exposed to secondhand smoke than Whites, but the variations within groups were similarly patterned. These findings suggest that it is important not to be complacent about low smoking prevalence in some minority groups.

The cause of ethnic differences in cardiovascular disease remains a scientific challenge. Blood pressure tracks from late childhood to adulthood. We examined ethnic differences in changes in blood pressure between early and late adolescence in the United Kingdom. Longitudinal measures of blood pressure, height, weight, leg length, smoking, and socioeconomic circumstances were obtained from London, United Kingdom, schoolchildren of White British (n=692), Black Caribbean (n=670), Black African (n=772), Indian (n=384), and Pakistani and Bangladeshi (n=402) ethnicity at 11 to 13 years and 14 to 16 years. Predicted age- and ethnic-specific means of blood pressure, adjusted for anthropometry and social exposures, were derived using mixed models. Among boys, systolic blood pressure did not differ by ethnicity at 12 years, but the greater increase among Black Africans than Whites led to higher systolic blood pressure at 16 years (+2.9 mm Hg). Among girls, ethnic differences in mean systolic blood pressure were not significant at any age, but while systolic blood pressure hardly changed with age among White girls, it increased among Black Caribbeans and Black Africans. Ethnic differences in diastolic blood pressure were more marked than those for systolic blood pressure. Body mass index, height, and leg length were independent predictors of blood pressure, with few ethnic-specific effects. Socioeconomic disadvantage had a disproportionate effect on blood pressure for girls in minority groups. The findings suggest that ethnic divergences in blood pressure begin in adolescence and are particularly striking for boys. They signal the need for early prevention of adverse cardiovascular disease risks in later life.

BACKGROUND: In Britain and elsewhere there is ethnic variation in mental health in adulthood but less is known about adolescence. Few studies examining the role of family life in adolescent mental well-being have been based on a multi-ethnic UK sample. We explored whether family activities explain ethnic differences in mental health among adolescents in London, UK. METHOD: These analyses are based on 4,349 Black Caribbean, Black African, Indian, Pakistani and Bangladeshi and White UK boys and girls aged 11-13, in 51 schools. Psychological well-being was measured as the total difficulties score from Goodman's strengths and difficulties questionnaire (increasing score represents increasing difficulties). RESULTS: Participation in family activities varied by ethnicity. Compared with the White UK group, all minority groups were more likely to visit friends and relatives and go other places as a family. Black Caribbeans and Nigerian/Ghanaians were less likely and South Asian groups more likely to eat a meal together as a family. In multivariate analyses all minority groups had better well-being scores compared to Whites, independent of family type and socio-economic status (SES). Although adjusting for family activities slightly attenuated the association for South Asians, the minority ethnic advantage in psychological well-being remained [regression coefficients for Black Caribbeans = -0.66 (95% CI = -1.13, -0.20); Nigerian/Ghanaians = -1.27 (-1.81, -0.74); Other Africans = -1.43 (-2.00, -0.86); Indians = -1.15 (-1.73, -0.58); Pakistani/Bangladeshis = -0.66 (-1.20, -0.12)]. In analyses based on the whole group, all activity variables were independent correlates of psychological well-being. Multivariate models, stratified by ethnicity, showed that

Background: It is not known if adolescents from diverse groups of Black African origin experience similar or different psychological well-being. Aims: To examine adolescent self-report of psychological well-being among Black African and White UK origin groups and to assess the extent to which family type and social deprivation influence any ethnic differences. Method: The 25-item Strengths and Difficulties Questionnaire (SDQ) was used to assess psychological well-being in a study of 6,632 11-13 year-olds in 51 schools in London. Results: Overall, family type (but not material deprivation) was an important independent correlate of psychological well-being. Nigerian/ Ghanaian boys reported the lowest mean Total Difficulties Score (TDS) compared to White boys (regression coefficient (95% CI) 2.09 (2.83, 1.35) p < 0.001). They also had significantly higher mean pro-social behaviour score, and were at reduced risk of a high (i.e., likely psychological distress) TDS score. TDS was also significantly lower than Whites for Other African boys and girls. Other African and Mixed ethnicities were protective factors against risk of psychological distress for girls. Conclusions: Black African boys and Other African boys and girls reported the most favourable psychological well-being scores. The influence of family type on mental health may operate differently for girls compared to boys and for Africans compared to other ethnic groups. © Springer-Verlag 2007.

Background Ethnicity is a consistent correlate of excess weight in youth. We examine the influence of lifestyles on ethnic differences in excess weight in early adolescence in the UK. Method Data were collected from 6599 pupils, aged 11–13 years in 51 schools, on dietary practices and physical activity, parental smoking and overweight, and on overweight and obesity (using International Obesity Task Force criteria). Results Skipping breakfast [girls odds ratio (OR) 1.74, 95% confidence interval (CI) 1.30–2.34; boys OR 2.06; CI 1.57–2.70], maternal smoking (girls OR 2.04, CI 1.49–2.79; boys OR 1.63, CI 1.21–2.21) and maternal overweight (girls OR 2.01, CI 1.29–3.13; boys OR 2.47, CI 1.63–3.73) were associated with obesity. Skipping breakfast, more common among girls, was associated with other poor dietary practices. Compared with White UK peers, Black Caribbeans (girls OR 1.62, CI 1.24–2.12; boys OR 1.49, CI 1.15–1.95) and Black Africans (girls OR 1.96, CI 1.52–2.53; boys OR 2.50, CI 1.92–3.27) were more likely to skip breakfast and engage in other poor dietary practices, and Indians were least likely. White Other boys reported more maternal smoking (OR 1.37, CI 1.03–1.82). All these reports were more common among those born in the UK than those born elsewhere. Black Caribbean girls were more likely to be overweight (OR 1.38, CI 1.02–1.87) and obese (OR 1.65, CI 1.05–2.58), Black African girls to be overweight (OR 1.35, CI 1.02–1.79) and White Other boys to be overweight (OR 1.37, CI 1.00–1.88) and obese (OR 1.86, CI 1.15–3.00). Adverse dietary habits and being born in the UK contributed to these patterns. Conclusion These findings signal a potential exacerbating effect on ethnic differences in obesity if adverse dietary habits persist. Combined adolescent and parent-focused interventions should be considered.

Purpose of review: To critique the scope and value of recent studies with a focus on obesity-related health promotion in faith organizations. Recent findings: Electronic database searches, scanning of the reference lists of identified articles, and hand searching of journals for articles written in English and published in 2013-16, revealed 16 studies. Half of the studies involved African-Americans, in churches and with predominantly female participants. Research among other ethnic groups was more likely to be exploratory. All of the 11 studies reporting the impact of programs on weight-related measures showed favourable outcomes. However due to study limitations (small sample size; short duration; attrition), significant unbiased effects cannot yet be concluded for most of the interventions reviewed. Study strengths included application of theory in community engagement, and detailed description of cultural tailoring. Summary: Faith organizations show promise as settings for obesity prevention among high-risk groups, particularly African-Americans. Support for progressing formative work to adequately powered, randomized controlled trials is vital. Wider involvement of diverse faith settings, and targeting obesity in men and childhood, would be valuable developments.

Small-scale, detailed exploration of the recruitment, assessment, and evaluation processes of obesity intervention among minority ethnic children. The study took place in schools and places of worship during 2008-2010 in London, UK. Measures included 3-day food diaries, 24 hour dietary recalls, the Youth Physical Activity Questionnaire, accelerometry, and diet and physical activity self-efficacy questionnaires. Potential intervention components were evaluated via observation, questionnaires, and focus group discussions. Schools and places of worship that reflected the ethnic and religious diversity of inner city London populations (Hindus, Muslims and Christians) were targeted. Telephone invitations to 12 schools achieved recruitment of five schools (42% response); 181 invitations to 94 places of worship, recruited eight organisations (9%). Multi-strategy approaches were required to build relationships with faith organisations. Sixty-five children aged 8-13 years participated in the testing of measures. High completion rates were achieved for 24 hour recalls, diet and PA self-efficacy questionnaires (ranging from 89% to 100%), with more consistent quality in schools. Dietary assessment highlighted inadequacies in composition data for minority ethnic foods. Intervention sessions were tested among 155 children in all five schools, and 33 children in a church, temple and mosque. Evaluation coverage was more consistent in these places of worship than in schools. Schools may logistically be more straightforward settings for delivery of interventions but, despite complex issues (engagement strategies; cultural foodways), places of worship provide opportunities for effective reach of children, families and communities. We suggest community based participatory research between researchers, schools and community organisations to harness culturally-specific support.

Background: The latest available data for England show that childhood obesity continues to be a major public health concern with 9.3% of 4–5 years old and 18.9% of 10–11 years old children found to be obese (1). The aim of the study was to explore attitudes towards a community based childhood obesity prevention project among parents participating in the programme. Methods: The ‘Fit Together’ programme was provided in socio-economically deprived areas of Leeds which, at the time of the research study, was in its final year of running. The programme was delivered for 2 hours each week over a six week period by community health educators, and involved health education and cooking sessions. A convenience sample of parents who had attended at least one session of the Fit Together programme, delivered between November-December 2014, were recruited from a children’s centre (where families access health advice and related activities with their children aged 0– 5yr) and a primary school. Semi-structured interviews were conducted using a topic schedule with prompts, and were digitally recorded. A short screening questionnaire was completed to obtain demographic information. Three parents were present in each of the two Fit Together sessions allocated for recruitment. These six parents were recruited to the study and were interviewed. Interviews were transcribed verbatim, transcripts manually coded and thematic analysis conducted using a framework approach. Ethical approval for the study was obtained from the Faculty of Health & Social Sciences Local Research Ethics Coordinator, Leeds Beckett University. Results: Participants were all mothers with 1–3 children, and mean age was 27 years. Four participants self-defined their ethnicity as White British and the remaining two as Pakistani. Themes emerging from the interview data suggested that participants’ appraisal of the programme was positive and they reported benefits in behaviour change relevant to addressing childhood obesity. Parents felt the programme was logistically suitable, and had appropriate content and leaders. All participants would recommend the programme and highlighted the development of their cooking skills, which related to an increase in home cooking and in fruit and vegetable consumption. The opportunity to involve their children and spend time with them learning skills was a strongly held view among respondents. Parents felt the programme had also increased their awareness of nutrition content and children’s dietary habits. However, the view that an extended programme and subsequent follow-up were needed was commonly held. Additional benefits beyond behaviour change were also expressed. For example, the importance of social interaction was clear, with respondents reporting the alleviation of boredom and isolation while attending the programme, as this participant states: “Something to do ain’t it? Gets you out. There’s nothing else to go to” (White British, 23yr, 2 children). Participants also reported exchanging cultural beliefs and learning new styles of cooking from people from different backgrounds. Discussion: The findings of this first exploration of parents’ attitudes to Fit Together supports existing literature on the value of community educators in delivering health interventions (2). Beneficial behaviour change such as increased homecooking was consistent with previous programmes (3). Conclusion: Attitudes towards Fit Together were positive, with mothers viewing the programme as acceptable and bene- ficial. References 1. Stevens. L., & Nelson, M. The contribution of school meals and packed lunch to food consumption and nutrient intakes in UK primary school children from a low income population. Journal of Human Nutrition and Dietetics, 24; 223–232. 2011. 2. Evans, C., & Harper, C. A History and Review of school meals standards in the UK. Journal of Human Nutrition and Dietetics, 89–99. 2009. 3. Lop ez Nomdedeu, C. Agencia Espanola de Seguridad Alimentaria y Nutricion. Ministerio de Sanidad y Consum. La alimentacion de tus ni nos. Nutrici ~ on Saludable de la Infan- cia a la Adolescencia. Madrid: Fiselgraf, S.L. 2002.

The contemporary increase in life expectancy is opening up a new stage in the life course - early old age. Diet during early old age makes an important contribution to disease prevention, the management of established disease and postponing the onset of physical dependency. Despite its importance, few specifically medical, dietary interventions have been designed for this age group. The presently reported study aims to supply background information for such an endeavour. Qualitative interviews have been conducted with people in early old age, sampled purposively from members of a longitudinal study cohort. A number of background influences on the dietary choices of the interviewees have been identified. Some of these influences are specific to the present generation of people in early old age, such as eating in NAAFI canteens during National Service. However, the more general categories of which they are a part will have enduring usefulness. The findings are discussed in relation to: future dietary advice; the potential for interventions in primary care; enhancing the policy of free school fruit and research on the next age cohort to enter early old age.

Study objective: To examine associations between food and nutrient intake, measured in childhood, and adult cancer in a cohort with over 60 years follow up. Design and setting: The study is based on the Boyd Orr cohort. Intake of fruit and vegetables, energy, vitamins C and E, carotene, and retinol was assessed from seven day household food inventories carried out during a study of family diet and health in 16 rural and urban areas of England and Scotland in 1937–39. Participants: 4999 men and women, from largely working class backgrounds, who had been children in the households participating in the pre-war survey. Analyses are based on 3878 traced subjects with full data on diet and social circumstances. Main results: Over the follow up period there were 483 incident malignant neoplasms. Increased childhood fruit intake was associated with reduced risk of incident cancer. In fully adjusted logistic regression models, odds ratios (95% confidence intervals) with increasing quartiles of fruit consumption were 1.0 (reference), 0.66 (0.48 to 0.90), 0.70 (0.51 to 0.97), 0.62 (0.43 to 0.90); p value for linear trend=0.02. The association was weaker for cancer mortality. There was no clear pattern of association between the other dietary factors and total cancer risk. Conclusions: Childhood fruit consumption may have a long term protective effect on cancer risk in adults. Further prospective studies, with individual measures of diet are required to further elucidate these relations.

Longitudinal evidence on the association between air pollution and blood pressure (BP) in adolescence is scarce. We explored this association in an ethnically diverse cohort of schoolchildren. Sex-stratified, linear random-effects modelling was used to examine how modelled residential exposure to annual average nitrogen dioxide (NO2), particulate matter (PM2.5, PM10) and ozone (O3), measures in μg/m3, associated with blood pressure. Estimates were based on 3,284 adolescents; 80% from ethnic minority groups, recruited from 51 schools, and followed up from 11-13 to 14-16 years old. Ethnic minorities were exposed to higher modelled annual average concentrations of pollution at residential postcode level than their White UK peers. A two-pollutant model (NO2 & PM2.5), adjusted for ethnicity, age, anthropometry, and pubertal status, highlighted associations with systolic, but not diastolic BP. A μg/m3 increase in NO2 was associated with a 0.30 mmHg (95% CI 0.18 to 0.40) decrease in systolic BP for girls and 0.19 mmHg (95% CI 0.07 to 0.31) decrease in systolic BP for boys. In contrast, a 1 μg/m3 increase in PM2.5 was associated with 1.34 mmHg (95% CI 0.85 to 1.82) increase in systolic BP for girls and 0.57 mmHg (95% CI 0.04 to 1.03) increase in systolic BP for boys. Associations did not vary by ethnicity, body size or socio-economic advantage. Associations were robust to adjustments for noise levels and lung function at 11-13 years. In summary, higher ambient levels of NO2 were associated with lower and PM2.5 with higher systolic BP across adolescence, with stronger associations for girls.

Objectives: To examine the impact of overweight on mean, high normal and high blood pressure in early adolescence, and how this relates to ethnicity and socio-economic status. Design: Cross-sectional study with anthropometric and blood pressure measurements. Setting: A total of 51 secondary schools in London. Sample: A total of 6407 subjects, 11–13 years of age, including 1204 White UK, 698 Other Whites, 911 Black Caribbeans, 1065 black Africans, 477 Indians and 611 Pakistanis/Bangladeshis. Main outcome measures: Mean, high normal (gender, age and height-percentile-specific 90–94th percentile) and high (95th percentile) blood pressure. Results: Based on the International Obesity Task Force age-specific thresholds, 19% of boys and 23% of girls were overweight, and 8% of each were obese. Overweight and obesity were associated with large increases in the prevalence of high normal and high blood pressures compared with those not overweight. The increases in the prevalence of high systolic pressure associated with overweight were as follows: boys, odds ratio 2.50 (95% confidence intervals 1.73–3.60) and girls 3.39 (2.36–4.85). Corresponding figures for obesity were: boys 4.31 (2.82–6.61) and girls 5.68 (3.61–8.95). Compared with their White British peers, obesity was associated with larger effects on blood pressure measures only among Indians, despite more overweight and obesity among black Caribbean girls and overweight among Black African girls. The effect of socio-economic status was inconsistent. Conclusions: The tendency to high blood pressure among adult Black African origin populations was not evident at these ages. These results suggest that the rise in obesity in adolescence portends a rise in early onset of cardiovascular disease across ethnic groups, with Indians appearing to be more vulnerable.

Objectives: To quantify measurement error in the estimation of family diet intakes using 7-day household food inventories and to investigate the effect of measurement-error adjustment on diet–disease associations.

Design and setting: Historical cohort study in 16 districts in England and Scotland, between 1937 and 1939.

Subjects: 4999 children from 1352 families in the Carnegie Survey of Diet and Health. 86.6% of these children were traced as adults and form the Boyd Orr cohort. The reproducibility analysis was based on 195 families with two assessments of family diet recorded 3–15 months apart.

Methods: Intraclass correlation coefficients (ICCs) were calculated for a variety of nutrients and food groups. Diet–cancer associations reported previously in the Boyd Orr cohort were reassessed using two methods: (a) the ICC and (b) the regression calibration.

Main results: The ICCs for the dietary intakes ranged from 0.44 (β carotene) to 0.85 (milk and milk products). The crude fully adjusted hazard ratio (HR) for cancer mortality per 1 MJ/day increase in energy intake was 1.15 (95% CI 1.06 to 1.24). After adjustment using the ICC for energy (0.80) the HR (95% CI) increased to 1.19 (1.08 to 1.31), and the estimate from regression calibration was 1.14 (0.98 to 1.32). The crude fully adjusted odds ratio (OR) for cancer incidence per 40 g/day increase in fruit intake was 0.84 (95% CI 0.73 to 0.97). After adjustment using the fruit ICC (0.78) it became 0.81 (0.67 to 0.96) and the OR derived from regression calibration was 0.81 (0.59 to 1.10).

Conclusions: The diet–disease relationships for the dietary intakes with low measurement error were robust to adjustment for measurement error.

BACKGROUND: The aim of this study is to identify the socio-economic and health-related factors in childhood and later life associated with healthy eating in early old age. METHODS: The study is based on surviving members of the Boyd Orr cohort aged 61-80 years. Data are available on household diet and socio-economic position in childhood and on health and social circumstances in later life. A 12-item Healthy Diet Score (HDS) for each subject was constructed from food frequency questionnaire responses. Complete data on all exposures examined were available for 1234 cohort members. RESULTS: Over 50% of study members had inadequacies in at least half of the 12 markers of diet quality. In multivariable models having a childhood diet which was rich in vegetables was associated with a healthy diet in early old age. The HDS for those in the upper quartile of childhood vegetable intake was 0.30 (95% confidence interval -0.01 to 0.61) higher than those with the lowest intake levels (P-trend across quartiles = 0.04). The adult factors that were most strongly associated with a healthy diet were not smoking, being an owner-occupier, and taking anti-hypertensive medication. CONCLUSION: Our analysis indicates that diet in early old age is influenced by childhood vegetable consumption, current socio-economic position, and smoking. Interventions for improving the diet of older people could usefully focus on both encouragement of healthy diet choices from an early age and higher levels of income or nutritional support for older people.

Objective: To examine the association between childhood diet and cardiovascular mortality.

Design: Historical cohort study.

Setting: 16 centres in England and Scotland.

Participants: 4028 people (from 1234 families) who took part in Boyd Orr’s survey of family diet and health in Britain between 1937 and 1939 followed up through the National Health Service central register.

Exposures studied: Childhood intake of fruit, vegetables, fish, oily fish, total fat, saturated fat, carotene, vitamin C, and vitamin E estimated from household dietary intake.

Main outcome measures: Deaths from all causes and deaths attributed to coronary heart disease and stroke.

Results: Higher childhood intake of vegetables was associated with lower risk of stroke. After controlling for age, sex, energy intake, and a range of socioeconomic and other confounders the rate ratio between the highest and lowest quartiles of intake was 0.40 (95% confidence interval 0.19 to 0.83, p for trend 0.01). Higher intake of fish was associated with higher risk of stroke. The fully adjusted rate ratio between the highest and lowest quartile of fish intake was 2.01 (95% confidence interval 1.09 to 3.69, p for trend 0.01). Intake of any of the foods and constituents considered was not associated with coronary mortality.

Conclusions: Aspects of childhood diet, but not antioxidant intake, may affect adult cardiovascular risk.

Objective: To examine the relation between energy intake in childhood and adult mortality from cancer. Study design: Cohort study. Setting: 16 rural and urban centres in England and Scotland. Subjects: 3834 people who took part in Lord Boyd Orr's Carnegie survey of family diet and health in prewar Britain between 1937 and 1939 who were followed up with the NHS central register. Standardised methods were used to measure household dietary intake during a one week period. Main outcome measures: Cancer mortality. Results: Significant associations between childhood energy intake and cancer mortality were seen when the confounding effects of social variables were taken into account in proportional hazards models (relative hazard for all cancer mortality 1.15 (95% confidence interval 1.06 to 1.24), P = 0.001, for every MJ increase in adult equivalent daily intake in fully adjusted models). This effect was essentially limited to cancers not related to smoking (relative hazard 1.20; 1.07 to 1.34; P = 0.001), with similar effects seen in men and women. Conclusion: This positive association between childhood energy intake and later cancer is consistent with animal evidence linking energy restriction with reduced incidence of cancer and the association between height and human cancer, implying that higher levels of energy intake in childhood increase the risk of later development of cancer. This evidence for long term effects of early diet confirm the importance of optimal nutrition in childhood and suggest that the unfavourable trends seen in the incidence of some cancers may have their origins in early life.

The overall prevalence of childhood obesity is levelling off in the UK but this is not evident among socio-economically disadvantaged children and ethnic differences are apparent. Few UK intervention studies involve ethnic minority groups. This study aimed to conduct developmental research in areas of ethnic diversity in both schools and places of worship to identify culturally acceptable child- and family-based interventions. Awareness of some healthy eating messages (e.g. five-a-day fruit and vegetables) was widespread across ethnic groups but there were gaps in knowledge, such as a lack of awareness of physical activity recommendations for children. For ethnic minority groups, a key facilitator of healthy lifestyles included regular family meals. Concern was expressed about fast food outlets near homes and schools, the perceived danger of outdoor spaces and, for Black Caribbean and Black African parents, lack of traditional ingredients in large supermarkets. Interactive intervention sessions to address gaps in knowledge and promote skills and habits yielded the most favourable results. Participation rates were also high for all dietary and physical activity assessment measures. There is, however, a need to augment food composition databases with ethnic-specific foods to improve cultural appropriateness. Feedback from teachers, parents and key contacts in places of worship signaled approval of the intervention. The feasibility of delivering intervention sessions may be better in schools but raises the question of the extent of compliance and sustainability of behaviour change in the long-term, without the culturally-focused support for families from their communities.

Background: Childhood obesity is a major public health concern with serious implications for the sustainability of healthcare systems. Studies in the US and UK have shown that ethnicity is consistently associated with childhood obesity, with Black African origin girls in particular being more vulnerable to overweight and obesity than their White peers. Little is known, however, about what promotes or hinders engagement with prevention programmes among ethnic minority children. Methods/Design: This paper describes the background and design of an exploratory study conducted in London, UK. The aim of the study was to assess the feasibility, efficacy and cultural acceptability of child- and family-based interventions to reduce risk factors for childhood and adolescent obesity among ethnic minorities. It investigated the use of a population approach (in schools) and a targeted approach (in places of worship). We used a mixture of focus group discussions, in-depth interviews and structured questionnaires to explore what children, parents, grandparents, teachers and religious leaders think hinder and promote engagement with healthy eating and active living choices. We assessed the cultural appropriateness of validated measures of physical activity, dietary behaviour and self efficacy, and of potential elements of interventions informed by the data collected. We are also currently assessing the potential for wider community support (local councils, community networks, faith forums etc) of the intervention. Discussion: Analysis of the data is ongoing but the emergent findings suggest that while the school setting may be better for the main implementation of healthy lifestyle interventions, places of worship provide valuable opportunities for family and culturally specific support for implementation. Tackling the rise in childhood and adolescent obesity is a policy priority, as reflected in a range of government initiatives. The study will enhance such policy by developing the evidence base about culturally acceptable interventions to reduce the risk of obesity in children.

OBJECTIVES: In this first large-scale study of ethnic differences in blood pressure (BP) among British adolescents, we examine the differences in BP levels in adolescence and the extent to which age, sex, body size and stage of maturation affect any observed differences. METHOD: A total of 6365 11-13 year olds (including 1189 white, 907 black Caribbeans and 1056 black Africans, 473 Indians, 605 Pakistanis and Bangladeshis, and 548 of mixed ethnicity) had systolic blood pressure (SBP) and diastolic blood pressure (DBP), anthropometry and pubertal stage measured in 2003. RESULTS: Compared with their white UK counterparts, black Caribbean and African boys were taller, and black Caribbean and African girls were taller, larger and matured earlier. Except for DBP among Indian girls, BP in minority groups was generally lower than in white UK children. Adjusted for age, height and body mass index, mean SBP was 109.1 mmHg (95% confidence interval 108.4, 109.8) and DBP 65.7 mmHg (65.2, 66.3) among white UK boys. Black Caribbean boys had lower SBP (-2.0; -3.2, -0.9 mmHg) and DBP (-1.5; -2.3, -0.6), and black African (-2.3; -3.4, -1.2) and mixed ethnicity (-1.6; -2.9, -0.3) boys had lower SBP. Adjusted SBP was 108.5 (107.8, 109.3) and DBP was 67.5 mmHg (66.9, 68.1) among white UK girls. Pakistani (-1.8; -3.2, -0.4) and black African (-1.1; -1.9, -0.3) girls had lower SBP and Indian girls (1.2; 0.1, 2.4) had higher DBP. Unlike African American girls, late puberty was not associated with higher BP in minority groups. CONCLUSION: At these ages, the ethnic-specific patterns in BP in adulthood were not observed. Apart from higher DBP for Indian girls, BP in minority groups was generally lower than their white UK counterparts. Targeting intervention in adolescence may be a critical opportunity for preventing ethnic differences in BP in later life.

We examined the association of diet with insulin-like growth factors (IGF) in 344 disease-free men. Raised levels of IGF-I and/or its molar ratio with IGFBP-3 were associated with higher intakes of milk, dairy products, calcium, carbohydrate and polyunsaturated fat; lower levels with high vegetable consumption, particularly tomatoes. These patterns support the possibility that IGFs may mediate some diet-cancer associations.

Background: Childhood obesity is a major public health concern with serious implications for the sustainability of healthcare systems. Studies in the US and UK have shown that ethnicity is consistently associated with childhood obesity, with Black African origin girls in particular being more vulnerable to overweight and obesity than their White peers. However, little is known about what promotes or hinders engagement with prevention programmes among ethnic minority children. Methods: The aim of DEAL was to assess the feasibility, efficacy and cultural acceptability of child- and family-based interventions to reduce risk factors for childhood and adolescent obesity among ethnic minorities. It investigated the use of a population approach (schools) and a targeted approach (places of worship). We used a mixture of focus group discussions, in-depth interviews and structured questionnaires to explore what children, parents, grandparents, teachers and religious leaders think hinder and promote engagement with healthy eating and active living choices. We assessed the cultural appropriateness of validated measures of physical activity, dietary behaviour and self efficacy, and of potential elements of interventions informed by the data collected. Results: Analysis of the data is ongoing but the emergent findings suggest that while the school setting may be better for the main implementation of healthy lifestyle interventions, places of worship provide valuable opportunities for family and culturally specific support for implementation. Conclusion: The study will enhance such policy on a range of government initiatives by developing the evidence base about culturally acceptable interventions to reduce the risk of obesity in children. Conflict of interest: None disclosed. Funding: Research relating to this abstract was funded by the Public Health Research Consortium, UK.

OBJECTIVE: Trends in suicide death rates among migrants to England and Wales 1979-2003 were examined. METHODS: Age-standardised rates derived for eight country of birth groups. RESULTS: For men born in Jamaica, suicide death rates increased in 1999-2003. There were declines in rates for men and women from India and from Scotland, men from East Africa and Northern Ireland and women from the Republic of Ireland. For both men and women born in Scotland or the Irish Republic, despite declines for some, rates remained higher than for England and Wales born. Rates among men from Pakistan were consistently lower than men born in England and Wales. CONCLUSION: These analyses indicate declining trends for most migrant groups and for England and Wales-born women, but adverse trends in death rates for some country of birth groups

BACKGROUND: A mental health advantage has been observed among adolescents in urban areas. This prospective study tests whether cultural integration measured by cross-cultural friendships explains a mental health advantage for adolescents. METHODS: A prospective cohort of adolescents was recruited from 51 secondary schools in 10 London boroughs. Cultural identity was assessed by friendship choices within and across ethnic groups. Cultural integration is one of four categories of cultural identity. Using gender-specific linear-mixed models we tested whether cultural integration explained a mental health advantage, and whether gender and age were influential. Demographic and other relevant factors, such as ethnic group, socio-economic status, family structure, parenting styles and perceived racism were also measured and entered into the models. Mental health was measured by the Strengths and Difficulties Questionnaire as a 'total difficulties score' and by classification as a 'probable clinical case'. RESULTS: A total of 6643 pupils in first and second years of secondary school (ages 11-13 years) took part in the baseline survey (2003/04) and 4785 took part in the follow-up survey in 2005-06. Overall mental health improved with age, more so in male rather than female students. Cultural integration (friendships with own and other ethnic groups) was associated with the lowest levels of mental health problems especially among male students. This effect was sustained irrespective of age, ethnicity and other potential explanatory variables. There was a mental health advantage among specific ethnic groups: Black Caribbean and Black African male students (Nigerian/Ghanaian origin) and female Indian students. This was not fully explained by cultural integration, although cultural integration was independently associated with better mental health. CONCLUSIONS: Cultural integration was associated with better mental health, independent of the mental health advantage found among specific ethnic groups: Black Caribbean and some Black African male students and female Indian students.

Background: There is little longitudinal evidence on how longer-term air pollution affects blood pressure (BP) development across adolescence. Methods: Linear random effects modeling using 60 multiply imputed datasets was applied to multi-pollutant exposures and confounding variables (including change in weight, height, or waist, parental background, pubertal status, psychological measures, and activity) to explore how longer-term exposure to annual nitrogen dioxide (NO2) and particulate matter (PM2.5) based on adolescents’ residential addresses, affected systolic/diastolic. Estimates are based on data from 3323 adolescents recruited in 5 ethnic groups from 51 schools in 10 London boroughs and followed up in the Determinants of Young Adult Social and Health “DASH” study between ages 11–13 and 14–16 years. Results: During the 3-year follow up, mean ± SD air NO2 was 41 ± 4, range 26.7–75.5, µg/m3, while similar PM2.5 values were 17.7 ± 1.8, 14.4–22.9, µg/m3. A 1-SD increase in NO2 levels led to a SBP fall of 1.26 (95% CI 0.80–1.71) mmHg for girls and of 0.80 (0.33–1.28) mmHg for boys. A 1-SD PM2.5 increase led to a 0.97 (0.10–1.86) mmHg increase in SBP for boys and a larger 2.37 (1.51–3.23) mmHg) increase for girls. DBP effects were trivial. Ethnic specific effects were not evident. Conclusion: From this first known British study of air pollution and adolescent BP, higher air NO2 decreases BP, especially in girls particularly while greater PM2.5 exposure increases BP. Whether these effects are due to time indoors, cooking gas exposure (1), and PM2.5 from wood-smoke fires remains unclear. Further longitudinal studies should clarify these contrasting effects in different socio-economic settings.

There is limited evidence on diet and physical activity (PA) interventions to prevent childhood over- and under-nutrition in Nigeria, and none focused on parental involvement. Knowledge of socio-cultural and environmental contexts, prioritising views of target populations, is needed to inform intervention strategies. The aim of this study was to explore parents, children and other stakeholders’ views on the factors that might enable or hinder participation in diet and PA interventions and parental involvement, and potential intervention components likely to be feasible and acceptable. A grounded theory, qualitative cross-sectional study was conducted in culturally diverse local government areas of Lagos State, Nigeria. Participants were identified through purposive and theoretical sampling, and data collected over three iterative phases. Eleven boys and girls aged 8–11 years; 19 women and 14 men aged 19–60 years who were parents, teachers/school heads, community leaders, health workers, and health or education civil servants, took part in 25 semi-structured one-to-one interviews and three focus groups. Discussions were digitally recorded and transcribed verbatim. Manual thematic analysis and independent coding of the transcripts generated key themes and reduced bias in the analysis. Three overarching themes were identified: 1. Active community collaboration 2. Strategies for involving families; and 3. Schools as key settings for interventions. Adult participants voiced active partnership between communities and schools as essential to addressing barriers to diet and physical activity interventions, such as inconsistent funding and lack of safe outdoor space for PA. Children reported concerns about school meal quality and poor access to clean water and menstrual hygiene products impacting PA participation. Suggested solutions achieved by community partnerships included security for outside play areas, and infrastructure improvements using recycled/locally sourced materials, and health campaigns funded by local dignitaries. Suggested activities for engaging families in interventions included health literacy teaching for parents, using learning aids tailored to literacy levels and local dialects, and involving religious leaders. This study highlighted the challenges for consideration in childhood diet and PA intervention development in Nigeria. The feasibility and acceptability of grassroots suggestions for intervention components and parental involvement could usefully be explored in future pilot studies.

Abstract

There is global recognition of the impact of malnutrition among adolescent girls on current health, adult health, and the health of subsequent generations. However, there is a dearth of evidence in this area in The Gambia with which to inform effective solutions to this public health issue. The aim of this programme of research was to investigate nutritional status and the individual and wider level determinants among adolescent girls in The Gambia. Three interrelated studies were conducted to address the overall aims. A systematic review (study 1) examined prevalence and determinants of nutritional status among female adolescents in low- and middle-income countries (LMICs). Study 1 revealed multiple determinants (including age, nutrition knowledge, unfavourable eating habits, parental occupation, and setting) of a triple burden of malnutrition (undernutrition, overnutrition and micronutrient deficiencies) among girls in LMICs. The review confirmed the need to conduct primary research among female adolescents in urban and rural Gambia. A pilot study (study 2) involving 32 adolescent girls was conducted. Four focus groups discussions were held to understand views on cultural contexts relevant to nutritional status, optimal recruitment methods, and feasibility and acceptability data collection methods. Questionnaires were administered and physical measures conducted to assess the quality and plausibility of the data obtained (health, diet, physical activity, and nutritional status outcomes, and potential individual and wider-level influences on nutritional status). Findings suggested the main study (Study 3) would be feasible but required mitigation of challenges such as potential refusal to participate linked to fear of injections and distrust of research. Study 3 assessed individual and wider-level influences on nutritional status (including anaemia, weight status, and stunting) defined from anthropometric indices and biomarker measures among 208 adolescent girls. The prevalence of anaemia, underweight, and stunting were 36%, 33%, and 31% respectively, and 26% of participants experienced overweight. Determinants of undernutrition at the individual level included younger age, lack of parasitic worm treatment, and low nutrition awareness. For example, in fully adjusted logistic regression models, the odds of undernutrition (95% confidence intervals) among younger (10-14 years) compared to older (15-19 years) adolescents was 2.44 (1.137 to 5.242); p=0.022. Wider determinants of malnutrition include the availability of electricity, and rural or urban settings. This programme of research identified various individual, household, community, and national level determinants contributing to the triple burden of malnutrition in LMICs, including The Gambia. Adolescence is a critical developmental stage requiring more attention, including targeted nutrition related programmes and policies.

Introduction Interventions addressing malnutrition (under- and overnutrition) among adolescents have not been developed in The Gambia. We aim to coproduce the first phase of ‘The Health-Secure Partnership’ (HSP) – an innovative multicomponent intervention for adolescents in rural areas of The Gambia. Inference drawn from existing evidence and public contribution suggest that the future intervention would ideally involve nutrition-specific components coupled with changes to wider school and community contexts, delivered in partnerships between schools and local communities. Methods The design of HSP is underpinned by health promoting school and community centred approaches, informed by a systems-thinking lens. The project activities will be conducted in three linked stages. Stage 1: Current nutrition-related activities and environments will be observed in four rural Gambian schools, their local village communities, and one additional village which does not have a school. Around 50 key stakeholders (such as teachers, parents, community members, and wider systems stakeholders) will complete questionnaires on their views on the current nutrition-related context and systems, cultural norms, and actions needed to address adolescent malnutrition. Focus groups and interviews will then be conducted with approximately 70 adolescent girls and boys to understand their experiences and opinions about their intervention needs. Stage 2: Potential intervention components, session content and mode/s of delivery will be explored in meetings and workshops with the consortium and stakeholders (including adolescents) to achieve consensus on the intervention format. Examples of session content, and intervention resources will be made, and a community event held to see what the public think of the ideas and materials. Stage 3: A description of the intervention and a codesigned evaluation plan will be documented. Dissemination will include publications, presentations, song and drama to suit a range of audiences (adolescents and their communities, other stakeholders, academics, and policy makers). Discussion This study protocol presents our plans for the HSP intervention development project, addressing a critical gap in the evidence base. Findings will inform subsequent research phases exploring the feasibility and acceptability of the intervention among adolescents.

BACKGROUND: A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. METHODS: A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. RESULTS: The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. CONCLUSION: Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.

Reliable data on the diet and nutritional status of African and Caribbean adults in the UK is essential for the implementation of targeted interventions to prevent diseases, and to ensure health equity. This review provides an overview of diet and nutritional status, and research and intervention priorities for West African and Caribbean adults in the UK. Cross-sectional studies that compared the two groups with their counterparts in their country of origin and/or in Europe were identified from PubMed, SCOPUS, Cochrane and CINAHL electronic databases and manual searches of bibliographies. Six eligible studies were reviewed. Reported nutrient composition focused predominantly on energy, and macronutrients, with limited information on micronutrients. Carbohydrates and fats were the main sources of energy. Low quantities of non-starch polysaccharides fibre and protein were reported. Participants from rural areas in Ghana had lower average BMI and smaller waist circumference compared to their counterparts in urban Ghana and Europe. Ghanaians in Europe consumed more alcohol and were less physically active than those in the home country. The studies measured limited nutrient composition and health-related outcomes. Studies that measure a wide range of anthropometric and clinical outcomes and key micronutrients, and use objective measures of health-related risk behaviours are needed.

Background It is suspected that the prevalence of Neuropathic pain (NeP) is higher in the countries normally categorized as belonging to the global South, i.e. developing countries, because of the high prevalence of NeP generating diseases including HIV, diabetes mellitus and cancer. However, few articles have estimated the prevalence of NeP in these limited resource countries. By contrast, the prevalence of NeP worldwide has been evaluated in two systematic reviews to range between 3.3% in Austria to 8.2% in the UK (Smith and Torrance, 2012, Hecke et al., 2014) with an outlier of prevalence at 17% in Canada. Aims The aim of this systematic review was to screen the literature for the prevalence of NeP in the general population of the global South and to compare this prevalence with the prevalence in the global North using a meta-analytic approach. Methods Pubmed; Siencedirect; EMBASE; AMED and PsycINFO databases were searched on July 2016 to capture peer reviewed articles that contain data on NeP prevalence either in adult general populations or among chronic pain patients. Two reviewers applied the inclusion criteria and extracted information from all eligible studies including study period, country, study design, sample size, tools to diagnose NeP, outcome and overall prevalence and judged the outcome for each study by scrutinising the methods and result section. Guidelines for reporting Meta-Analysis of Observational Studies in Epidemiology (MOOSE) (Stroup, 2000) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher, 2009) were followed. Random effects modelling was applied on extracted data to produce the overall prevalence in the two study areas. Effect size and confidence intervals of overall prevalences was calculated by producing Forest plots in the Comprehensive Meta-analysis software. Risk of publication bias and heterogeneity between studies were also estimated. Results Out of the 624 studies identified in the search 14 studies were finally selected (total sample size of 78421 patients, 8137 from developing countries (global south) and 70284 from developed countries (global north). The average quality score of all studies was 6.7 out of a maximum of 8. There was a high level of heterogeneity between the studies (I2>90) possibly because of differences in the target populations, sample sizes, study design and data collection methods. However, there was no publication bias as the Egger’s test value was not significant (p=0.053). The prevalence of NeP worldwide was 4.8 % (95%CI, 4.7%-5.0%). Only four studies were conducted in the global South; 2 in Libya, 1 in Morocco and 1 in Brazil. The prevalence of NeP in the global South was 8.3% (7.7%-9.0%). The overall prevalence in the global North was 4.9% (4.7%-6.0%). Conclusion There were few studies on the prevalence of NeP in the global South suggesting that there is less awareness of the significance of NeP in the developing countries. Differences exist between the studies in each region in the estimate of the prevalence of NeP and this is mainly because of differences in data collection methods. Clinical examination tends to produce more variable estimates than telephone, postal and internet based questionnaires using NeP screening tools such as DN4 and S-LANSS. This meta-analysis tentatively suggests that the prevalence of NeP is significantly higher in the global South compared to global North.

Background: Rapid changes to dietary and lifestyle patterns have transformed the home and food environment with an increased trend towards convenience in home food preparation and ready-meal availability [1]. Despite the widespread use of convenience foods, there is a lack of research into the nutritional quality of convenience foods for young children. This study examined the nutritional content of ready-meals for children aged 12 months to 3 years. The objectives of this study were to (i) investigate the nutritional quality of ready-meals, on sale in the UK market for children aged 12 months to 3 years, comparing their nutrition labelling information to dietary standards, (ii) identify the nutrition claims on the packaging of ready-meals for this age group and (iii) determine whether the nutrition claims identified met European Union legislation. Methods: A sample of main course ready-meals (n=38) marketed to children aged 12 months to 3 years from five brands, available in the UK was assessed. One ready-meal represents only a proportion of energy and nutrients consumed per day, therefore dietary standards were obtained taking 30% of age-appropriate dietary reference values (DRVs). The energy, protein and sodium content of these ready-meals were compared to the calculated dietary standards using one sample t-tests. Descriptive analysis was performed on all nutritional information (energy, carbohydrate, sugars, protein, fat, saturated fat, fibre, sodium and iron) collected. Nutrition claims were validated against legislative requirements [2,3,4]. Results: All ready-meals examined were significantly lower in energy (p=0.000) and higher in protein (p=0.000) compared to the dietary standards. Sodium was significantly higher than the dietary standard in three brands; brand 1 (p=0.000), 3 (p=0.004) and 5 (p=0.03), with brand 5 containing only 65mg less than the DRV (500mg) for total daily allowance. Four of the nutrition claims made across the brands were assessed - “no added salt”, “no added sugar”, “low salt” and “source of iron”. Only brand 1 and 5 did not meet legislation for “no added salt” as the ready-meals contained more than the amount of sodium per 100g permitted. All other nutrition claims conformed to legislative requirements; however the majority of ready-meals from brand 1 did contain ingredients with added salt and/or sugar e.g. mustard or sun-dried tomato, despite claims of “no added salt/sugar” and this could misinform consumers. Discussion: The ready-meals investigated did not meet calculated dietary standards and although the majority of nutrition claims displayed on the packaging did meet legislation, some claims did not and there were claims that could mislead consumers. There is paucity in research into the nutritional quality of convenience foods for young children and therefore comparisons between this study and other work cannot be drawn. Furthermore, since comprehensive dietary standards are unavailable for this age group, it is difficult to fully assess the nutritional adequacy of these ready-meals. Conclusion: The development of nutritional standards and transparent nutrition claim legislation would enable practitioners to fully assess the adequacy of children’s diets and enable consumers to make healthier food choices. Keywords : Children’s ready-meals; convenience foods; nutrition labelling.

The clinical benefit of low carbohydrate (LC) diets compared with low fat (LF) diets for people with type 2 diabetes (T2D) remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare their efficacy and safety in people with T2D. RCTs comparing both diets in participants with T2D were identified from MEDLINE, Embase, Cochrane Library, and manual search of bibliographies. Mean differences and relative risks with 95% CIs were pooled for measures of glycaemia, cardiometabolic parameters, and adverse events using the following time points: short-term (3 months), intermediate term (6 and 12 months) and long-term (24 months). Twenty-two RCTs comprising 1391 mostly obese participants with T2D were included. At 3 months, a LC vs. LF diet significantly reduced HbA1c levels, mean difference (95% CI) of −0.41% (−0.62, −0.20). LC diet significantly reduced body weight, BMI, fasting insulin and triglycerides and increased total cholesterol and HDL-C levels at the short-to-intermediate term, with a decrease in the requirement for antiglycaemic medications at intermediate-to-long term. There were no significant differences in other parameters and adverse events. Except for reducing HbA1c levels and adiposity parameters at short-to-intermediate terms, a LC diet appears to be equally effective as a LF diet in terms of control of cardiometabolic markers and the risk of adverse events in obese patients with T2D.

Childhood malnutrition is a major public health concern with serious implications. This thesis comprising of three studies (i) A mixed methods systematic-type review on studies in developing countries focused on parental influences on optimal diet, physical activity, and body mass index of children. (Study 1). (ii) Exploring views of children, parents, and other stakeholders on the influences on potential diet and physical activity interventions among children in Nigeria (Study 2). (iii) Evaluating potential intervention components and outcome measures for promoting a healthy diet, physical activity and improved water, sanitation, and hygiene practices (WASH) among children in Nigeria (Study 3).  Study 1 findings showed increasing parental associations of income, educational level, and socioeconomic status was associated with less favourable BMI status among children. Peer influence facilitated and parental perceptions of weight, household level, and a limited income were barriers to optimal diet, physical activity, and BMI in children. The review also indicated a lack of intervention and qualitative studies conducted in Nigeria, and a need to address this integrating a focus on undernutrition and WASH.  Studies 2 and 3 took place in a suburban multi-ethnic community in Lagos, Nigeria from 2018- 2020. Study 2 involved parents, school children, teachers, school heads, community leaders, health workers, and civil servants in the health and education sector recruited using purposive and theoretical sampling strategies. Three phases of qualitative semi structured interviews and focus group discussions were conducted with 32 adults and 16 children. Participants voiced active partnership between communities and schools as essential to addressing barriers to diet and physical activity interventions. Activities for engaging families in interventions such as health literacy teaching for parents in local dialects were suggested. Mixed methods were used in Study 3.  Acceptability and feasibility of 12 school and community intervention sessions and the Global School‐based Student Health Survey (diet, PA, hygiene knowledge/practices questionnaire and body mass index (BMI) measures) were evaluated. Participants included 130 children aged 8-15 yrs. Three children and their parents took part in qualitative interviews. All 12 planned intervention sessions were delivered with 100% participation, and approval by parents and children. Timing of sessions, integration of activities into school curriculum were potential barriers to sustainability. Researcher capacity and school timing impacted on the completion of the survey and measurements (n=59; 45% response rate); however, there were no missing questionnaire data.

INTRODUCTION: A limited number of diet, physical activity and weight management programmes suitable for UK black and Asian populations have been evaluated. We aim to coproduce 'Health Connections'-an ambitious new intervention to support dietary and physical activity choices, and maintaining a healthier weight, tailored to the needs of black Caribbean, black African and South Asian adults. Our existing research and public engagement work suggests that the intervention should be designed to be embedded in communities and delivered by peer educators supported by health professionals. METHODS AND ANALYSIS: The project is underpinned by a systems perspective that posits collective efficacy within communities, behaviour change theory and coproduction. Project activities will be conducted in three stages. Stage 1: semistructured interviews will be conducted with adults from diverse South Asian ethnic groups to understand their experiences, perspectives and intervention needs, adding to our existing data from black ethnic groups. We will synthesise the data, literature, available intervention resources and local practice, and develop the theoretical framework to codevelop intervention goals, programme theory and a draft logic model of change. Stage 2: a theorised list of potential intervention components, session content and mode/s of delivery will be explored in a modified Delphi exercise and workshop to achieve consensus on the intervention format. We will also develop prototype materials and a formal implementation plan. Stage 3: a description of the intervention will be documented. ETHICS AND DISSEMINATION: The study has received ethical approval from the School of Health Research Ethics Committee, Leeds Beckett University. Information on the project aims and voluntary participation is provided in the study participation information sheet. Consent will be certified by the completion and signing of a consent form prior to data collection. Dissemination for a range of stakeholders and audiences will include publications, presentations, short films and an infographic.

BACKGROUND: Existing literature examines barriers to the provision of ethnically diverse dietary advice, however, is not specific to total diet replacement (TDR). There is a lack of literature from the UK, limiting the potential applicability of existing findings and themes to the UK context. This study addresses this gap in research by interviewing participants of South Asian ethnicity who have undertaken the National Health Service (NHS) low-calorie diet programme (LCD) for people with type 2 diabetes living with overweight or obesity. This study explores factors that may affect the uptake and acceptability of its TDR, food reintroduction and weight maintenance stages. This aims to provide rich data that can inform effective tailoring of future programmes with South Asian participants. OBJECTIVE: To explore the perspectives of individuals of South Asian ethnicity on an NHS programme using TDR approaches for the management of type 2 diabetes (T2D). DESIGN: Qualitative study. SETTING: Individuals in the community undertaking the NHS LCD programme. PARTICIPANTS: Twelve one-to-one interviews were conducted with individuals from a South Asian ethnicity participating in the NHS LCD. MAIN OUTCOME MEASURES: Qualitative semistructured interviews conducted through different stages of the programme. Reflexive thematic analysis was used to analyse the transcripts. RESULTS: Key themes highlighted positive and negative experiences of the programme: (1) more work is needed in the programme for person centeredness; (2) it is not the same taste; (3) needing motivation to make changes and feel better; (4) a mixed relationship with the coach; (5) social experiences; (6) culture-related experiences. CONCLUSION: This study provides important experience-based evidence of the need for culturally tailored T2D programmes. Action to address these findings and improve the tailoring of the NHS LCD may improve experience, retention and outcomes on the programme for people of South Asian ethnicity and thereby reduce inequalities.

Background The management of type 2 diabetes (T2D) within diverse ethnic populations requires a culturally tailored approach. However, little is known about the experiences of coaches delivering interventions for T2D, such as the National Health Service (NHS) Low Calorie Diet (LCD) programme, to people from diverse ethnic backgrounds. Objective To explore the experiences of coaches delivering an NHS programme using total diet replacement approaches to individuals from diverse ethnic backgrounds, to inform the effective tailoring and equitable delivery of future interventions. Design Qualitative study. Setting Individuals delivering the NHS LCD programme. Participants One-to-one semistructured interviews were conducted with seven health coaches delivering the NHS LCD programme. Inclusion criteria included participants delivering the NHS LCD programme either from a minoritised ethnic background or delivering the programme to those from ethnic minority and white British backgrounds. Main outcome measures Qualitative semistructured interviews conducted through different stages of the programme. Reflexive thematic analysis was used to analyse the transcripts. Results Key themes highlighted the following experiences of delivering the LCD programme: (1) training and support needs; (2) needing to understand culture and ethnicity; (3) the impact of language; (4) the use of resources in providing dietary advice and (5) experiences of cultural tailoring. The themes highlight the need to prioritise person-centred care, to integrate culturally tailored approaches and for provision of education and training to those delivering health programmes. Conclusion These findings describe the experiences of health coaches in tailoring delivery and emphasise the role of cultural competence in ensuring equitable and effective healthcare interventions for diverse populations. This learning can inform future programmes and policies aimed at promoting inclusive healthcare practices.

(1) Background: Traditional foods are important in the diets of Black Africans and Caribbeans and, more widely, influence UK food culture. However, little is known about the nutritional status of these ethnic groups and the nutrient composition of their traditional foods. The aim was to identify and analyse African and Caribbean dishes, snacks and beverages popularly consumed in the UK for energy, macronutrients and micronutrients. (2) Methods: Various approaches including focus group discussions and 24-h dietary recalls were used to identify traditional dishes, snacks, and beverages. Defined criteria were used to prioritise and prepare 33 composite samples for nutrient analysis in a UK accredited laboratory. Quality assurance procedures and data verification were undertaken to ensure inclusion in the UK nutrient database. (3) Results: Energy content ranged from 60 kcal in Malta drink to 619 kcal in the shito sauce. Sucrose levels did not exceed the UK recommendation for adults and children. Most of the dishes contained negligible levels of trans fatty acid. The most abundant minerals were Na, K, Ca, Cu, Mn and Se whereas Mg, P, Fe and Zn were present in small amounts. (4) Conclusion: There was wide variation in the energy, macro- and micronutrients composition of the foods analysed.

© 2017 European Pain Federation - EFIC®.Literature suggests that pain perception diminishes in old age. The most recent review used search strategies conducted over a decade ago and concluded that study findings were equivocal. The aim of this systematic review, with meta-analysis, was to determine age-related changes in pain sensitivity in healthy pain-free adults, children and adolescents. A search of PubMed, Science Direct, and PsycINFO identified studies that compared pain sensitivity response to noxious stimuli at different time points in the lifespan of healthy individuals. Selected studies were assessed for methodological quality and data pooled and meta-analysed. Publication bias was tested using Funnel plots. Twelve studies were included in the review (study sample sizes 30-244 participants). Seven of nine studies found statistically significant differences in pain sensitivity response between old (mean ± SD 62.2 ± 3.4 to 79 ± 4 years) and younger adults (22 ± 1.5 to 39.1 ± 8.8 years), but the direction of change was inconsistent. Meta-analysis found that pressure pain threshold was lower in old adults compared with younger adults (p = 0.018, I2 = 60.970%). There were no differences in contact heat pain thresholds between old and younger adults (p = 0.0001, I2 = 90.23%). Three studies found that younger children (6-8.12 years) were more sensitive to noxious stimuli than older children (9-14 years). Methodological quality of studies was high, with a low risk of publication bias. There was substantial statistical and methodological heterogeneity. There is tentative evidence that pressure pain threshold was lower in old adults compared with younger adults, with no differences in heat pain thresholds. Further studies are needed. Significance: There is tentative evidence that old adults may be more sensitive to mechanically-evoked pain but not heat-evoked pain than young adults. There is a need for further studies on age-related changes in pain perception.

The marketing of unhealthy foods has been implicated in poor diet and rising levels of obesity. Rapid developments in the digital food marketing ecosystem and associated research mean that contemporary review of the evidence is warranted. This preregistered (CRD420212337091)1 systematic review and meta-analysis aimed to provide an updated synthesis of the evidence for behavioural and health impacts of food marketing on both children and adults, using the 4Ps framework (Promotion, Product, Price, Place). Ten databases were searched from 2014 to 2021 for primary data articles of quantitative or mixed design, reporting on one or more outcome of interest following food marketing exposure compared with a relevant control. Reviews, abstracts, letters/editorials and qualitative studies were excluded. Eighty-two studies were included in the narrative review and twenty-three in the meta-analyses. Study quality (RoB2/Newcastle–Ottawa scale) was mixed. Studies examined ‘promotion’ (n 55), ‘product’ (n 17), ‘price’ (n 15) and ‘place’ (n 2) (some > 1 category). There is evidence of impacts of food marketing in multiple media and settings on outcomes, including increased purchase intention, purchase requests, purchase, preference, choice, and consumption in children and adults. Meta-analysis demonstrated a significant impact of food marketing on increased choice of unhealthy foods (OR = 2·45 (95 % CI 1·41, 4·27), Z = 3·18, P = 0·002, I2 = 93·1 %) and increased food consumption (standardised mean difference = 0·311 (95 % CI 0·185, 0·437), Z = 4·83, P < 0·001, I2 = 53·0 %). Evidence gaps were identified for the impact of brand-only and outdoor streetscape food marketing, and for data on the extent to which food marketing may contribute to health inequalities which, if available, would support UK and international public health policy development.

Background: Obesity and type 2 diabetes can both profoundly impact health and wellbeing, and their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England, aims to support people to achieve type 2 diabetes remission, while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the ten localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: Covid-19 and primary care capacity and engagement, methods of communication, approaches to training, approaches to incentivisation, approaches to Referrals, barriers to referrals and the importance of collaboration. Covid-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across ten geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention generated inequalities.

Background: Development of effective, culturally-tailored interventions to address excess risk of type 2 diabetes among Black Caribbeans in the United Kingdom (UK) requires understanding of the views and experiences of the target population. We explored the social context of views on risk, prevention and management of type 2 diabetes among this ethnic group. Methods: The Food, Diabetes and Ethnicity (FOODEY) study included 56 Black Caribbean men and women aged 24-90 years (21 (38%) diagnosed with diabetes or pre-diabetes). Nine focus groups were conducted in community hubs in Leeds, Bradford, Birmingham, and Huddersfield, UK. Inductive themes were identified through thematic analysis of transcripts. Results: While family history was considered a key risk factor, there was a clearly articulated view of the interaction between “bad genes” and unfavourable dietary and physical activity (PA) habits. Rich descriptions of food habits and food related negotiations among family and friends included cost and low availability as barriers to maintaining traditional foodways, and high intake of convenience foods. The perception that diabetes risk was greater in the UK than in home countries was widely held, and it was felt that this was due to the lack of PA, cold weather and stress due to racism experienced in the UK. The Caribbean was deemed a suitable setting for consuming traditional foods and high sugar intake as this was mitigated by active living, organic vegetable consumption, and the hot climate. Trust in health professionals’ diabetes advice was evident, however behaviour change was preferred to medication, and the need for choice regarding healthcare decisions was emphasised. Faith beliefs coincided with acceptability of health-related advice and underpinned views on personal responsibility for health. Conclusions: Complex explanatory models of risk, encompassing lifestyle, economic, cultural, religious and psychosocial contexts, have implications for developing interventions to address type 2 diabetes among UK Black Caribbeans.

Summary Background Prevalence of both obesity and type 2 diabetes can be higher in patients from certain ethnic groups, yet uptake and adherence to current support within these groups is lower, leading to widening health inequalities in high‐income countries. Objectives The main objective of this study is to understand the views, perceptions, and experiences of and barriers and facilitators in relation to the uptake and adherence to weight management and type 2 diabetes programs in minoritized ethnic groups in high‐income countries. Methods CINAHL, MEDLINE, PsycINFO, Scopus, Academic Search Complete, and PubMed were searched for English language studies undertaken in community‐dwelling adults residing in high‐income countries, who are from a minoritized ethnic group within the country of study. Results Seventeen studies were synthesized using the JBI System for the Unified Management of the Assessment and Review of Information. From these studies, 115 findings were retrieved, and seven key themes were identified: (1) family health status and program education, (2) social support, (3) challenges, (4) cultural beliefs, (5) increased awareness and dietary changes, (6) impact of psychological evaluations, and (7) considerations for future. Conclusions Nutritional considerations for type 2 diabetes mellitus and weight management programs in high‐income countries should include social, habitual, economic, and conceptual components, which should include consideration of local ethnic and cultural norms and building community relationships while creating culturally tailored programs.

Minority ethnic groups in UK disproportionately suffer from nutrition related diseases compared to the mainstream population, contributing to widening health inequalities. However, reliable nutrient composition data of the traditional foods of these ethnic groups, which play an important part in their diets, is lacking. This makes it impossible to provide adequate and culturally acceptable nutrition interventions to reduce prevalent metabolic disorders. This study aimed to identify and analyse popularly consumed African and Caribbean foods in the UK for macro and micronutrients. Various approaches including focus group discussions, individual interviews and 24 hr dietary recalls were used to identify traditional foods. Defined criteria were used to prioritise and prepare 33 composite samples (26 dishes, 4 snacks and 3 beverages) for nutrient analyses in a UK accredited laboratory. This study methodology is novel because it uses various approaches to generate new data of commonly consumed ethnic foods and traditional recipes. In addition, the approach used in preparation of the food samples enhanced their authenticity and representativeness compared to previously published work. This paper describes the procedures undertaken and analytical methods used to develop a multi ethnic nutrient data for inclusion in UK food composition tables.

Background National Health Service England piloted a low-calorie diet programme, delivered through total diet replacement and behaviour change support via 1 : 1, group or digital delivery, to improve type 2 diabetes in adults with excess weight. Aim To coproduce a qualitative and economic evaluation of the National Health Service low-calorie diet pilot, integrated with National Health Service data to provide an enhanced understanding of the long-term cost-effectiveness, implementation, equity and transferability across broad and diverse populations. Research questions What are the theoretical principles, behaviour change components, content and mode of delivery of the programme, and is it delivered with fidelity to National Health Service specifications? What are the service provider, user and National Health Service staff experiences of the programme? Do sociodemographics influence programme access, uptake, compliance and success? What aspects of the service work and what do not work, for whom, in what context and why? Can the programme be improved to enhance patient experience and address inequities? What are the programme delivery costs, and policy implications for wide-spread adoption? Methods A mixed-methods study underpinned by a realist-informed approach was delivered across five work packages, involving: semistructured interviews with service users (n = 67), National Health Service staff (n = 55), service providers (n = 9); 13 service provider focus groups; and service user surveys (n = 719). Findings were triangulated with clinical data from the National Health Service England’s first cohort analysis (n = 7540). Results Fifty-five per cent of service users who started total diet replacement completed the programme and lost an average of 10.3 kg; 32% of those with data available to measure remission achieved it. Examination of programme mobilisation identified barriers around referral equality and the impact of COVID-19, while effective cross-stakeholder working and communication were key facilitators. Service delivery and fidelity assessments identified a drift in implementation fidelity, alongside variation in the behaviour change content across providers. Perceived barriers to programme uptake and engagement aligned across service providers and users, resulting in key learning on: the importance of person-centred care, service user support needs, improvements to total diet replacement and the social and cultural impact of the programme. Early National Health Service quantitative analyses suggest some socioeconomic variation in programme uptake, completion and outcomes. Insights from the evaluation and National Health Service data were combined to develop the programme theory and underpinning context, mechanisms and outcomes. These were used to develop a list of recommendations to improve the cultural competency of programme delivery, total diet replacement delivery, peer support and address psychological support needs. Cost-effectiveness analyses using short-term follow-up data indicated there is potential for the programme to be cost-effective, but not cost saving. Conclusions The National Health Service low-calorie diet can provide a clinically effective and potentially cost-effective programme to support weight loss and glycaemic control in adults with type 2 diabetes. However, this evaluation identified areas for improvement in referral equity, uptake and completion, and fidelity of delivery, which have informed the development of the programme, which has now been rolled out nationally. Ongoing programme monitoring and long-term follow-up are now required. Future work and limitations The real-world setting limited some data collection and analysis. Future work will focus on the analysis of long-term clinical and cost-effectiveness, and addressing inequalities. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132075.