title: Proximity of supermarkets is positively associated with diet quality index for pregnancy. Worksite Opportunities for Wellness (WOW): effects on cardiovascular disease risk factors after 1 year. A randomised controlled trial for overweight and obese parents to prevent childhood obesity - Early STOPP (STockholm Obesity Prevention Program) Effects of socialization in the household on youth susceptibility to smoking: a secondary analysis of the 2004/05 Canadian Youth Smoking Survey. Promotion and Provision of Drinking Water in Schools for Overweight Prevention: Randomized, Controlled Cluster Trial Influence of placement of a nutrition logo on cafeteria menu items on lunchtime food Choices at Dutch work sites. The Effect of Worksite Physical Activity Intervention on Physical Capacity, Health, and Productivity: A 1-Year Randomized Controlled Trial Declines in Acute Myocardial Infarction After Smoke-Free Laws and Individual Risk Attributable to Secondhand Smoke Does the provision of cooled filtered water in secondary school cafeterias increase water drinking and decrease the purchase of soft drinks? Density of tobacco retailers near schools: effects on tobacco use among students. A 4-year, cluster-randomized, controlled childhood obesity prevention study: STOPP The Impact of School Tobacco Policies on Student Smoking in Washington State, United States and Victoria, Australia Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study. Impact of different food label formats on healthiness evaluation and food choice of consumers: a randomized-controlled study Active commuting to school: Associations with environment and parental concerns. Nutrition labels decrease energy intake in adults consuming lunch in the laboratory. A group-randomized controlled trial for health promotion in Girl Scouts: Healthier Troops in a SNAP (Scouting Nutrition & Activity Program) Modifying middle school physical education: piloting strategies to increase physical activity. Dissociation between hospital performance of the smoking cessation counseling quality metric and cessation outcomes after myocardial infarction. A smoking ban in public places increases the efficacy of bupropion and counseling on cessation outcomes at 1 year. Pilot evaluation of a walking school bus program in a low-income, urban community Promoting healthy eating and physical activity short-term effects of a mass media campaign. Modest effects of a controlled worksite environmental intervention on cardiovascular risk in office workers. Price changes alone are not adequate to produce long-term dietary change. Residential self-selection bias in the estimation of built environment effects on physical activity between adolescence and young adulthood Reduced incidence of acute myocardial infarction in the first year after implementation of a public smoking ban in Graubuenden, Switzerland. Are Perceptions about Worksite Neighborhoods and Policies Associated with Walking? A randomized, controlled trial of financial incentives for smoking cessation. A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Impact of worksite wellness intervention on cardiac risk factors and one-year health care costs. Effects of a smoker's hotline: results of a 10-county self-help trial. Smoke-free legislation and hospitalizations for acute coronary syndrome. Purchasing behavior and calorie information at fast-food chains in New York City, 2007. Large scale food retailing as an intervention for diet and health: quasi-experimental evaluation of a natural experiment A prospective study of household smoking bans and subsequent cessation related behaviour: the role of stage of change The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children Prevention through Activity in Kindergarten Trial (PAKT): A cluster randomised controlled trial to assess the effects of an activity intervention in preschool children A controlled trial of a school-based environmental intervention to improve physical activity in Dutch children: JUMP-in, kids in motion. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse Increasing the Availability and Consumption of Drinking Water in Middle Schools: A Pilot Study Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial A Policy-Based School Intervention to Prevent Overweight and Obesity Using the mass-media to target obesity: an analysis of the characteristics and reported behaviour change of participants in the BBC's 'Fighting Fat, Fighting Fit' campaign. Short-term impact of a university based smoke free campaign. The impact of school smoking policies and student perceptions of enforcement on school smoking prevalence and location of smoking. Effects of a classroom-based program on physical activity and on-task behavior. Longitudinal trends in gasoline price and physical activity: the CARDIA study. Urban trails and physical activity: a natural experiment. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Industry sponsored anti-smoking ads and adolescent reactance: test of a boomerang effect Longitudinal associations between neighborhood-level street network with walking, bicycling, and jogging: the CARDIA study. Fruit and vegetable intake among urban community gardeners. The association of cigarette smoking with self-reported disease before middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Implications of a public smoking ban. Secondhand smoke exposure in the workplace. Brief supportive telephone outreach as a recruitment and intervention strategy for smoking cessation. Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well Joint analysis of three U.S. community intervention trials for reduction of cardiovascular disease risk. Community education for cardiovascular disease prevention. Morbidity and mortality results from the Minnesota Heart Health Program. Telephone counseling for smoking cessation: effects of single-session and multiple-session interventions. A Study of the Importance of Education and Cost Incentives on Individual Food Choices at the Harvard School of Public Health Cafeteria Innovative newsletter interventions improve fruit and vegetable consumption in healthy adults. Obesity and the Built Environment: Does the Density of Neighborhood Fast-Food Outlets Matter? Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Fall in total cholesterol concentration over five years in association with changes in fatty acid composition of cooking oil in Mauritius: cross sectional survey Walking towards health in a university community: a feasibility study. Gender differences among smokers and quitters in the Working Well Trial. The effects of a 3-year obesity intervention in schoolchildren in Beijing. Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia An intervention study targeting energy and nutrient intake in worksite cafeterias. Effects of promotional materials on vending sales of low-fat items in teachers' lounges. Body mass index in elementary school children, metropolitan area food prices and food outlet density. Effectiveness of a primary school-based intervention to reduce overweight. Use of food nutrition labels is associated with lower fat intake. Socioeconomic inequalities in food purchasing: the contribution of respondent-perceived and actual (objectively measured) price and availability of foods. Adolescent smoking: effect of school and community characteristics. 1% or less: a community-based nutrition campaign. Neighborhood food environments and Body Mass Index: the importance of in-store contents. Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment. A Pilot Study Testing the Effect of Different Levels of Financial Incentives on Weight Loss Among Overweight Employees Work-site smoking policies: their population impact in Washington State. Predictors of self-initiated, healthful dietary change. Are perceptions of the physical and social environment associated with mothers' walking for leisure and for transport? A longitudinal study. Cholesterol Control Beyond the Clinic: New York City's Trans Fat Restriction Weight status and restaurant availability a multilevel analysis. Adolescents' Responses to Anti-tobacco Advertising: Exploring the Role of Adolescents' Smoking Status and Advertisement Theme
abstract: OBJECTIVES To investigate the association between distance to the closest supermarket and a composite measure of diet , the diet quality index for pregnancy ( DQI-P ) was constructed . METHODS Data from the Pregnancy , Infection and Nutrition ( PIN ) cohort , a prospect i ve study of determinants of preterm birth , were analyzed . Food frequency question naires were used to construct DQI-P which includes : servings of grains , vegetables , fruits , folate , iron and calcium intake , percentage of calories from fat , and meal pattern score . Street address of residence , supermarkets , grocery and convenience stores were geocoded . Participants with complete food frequency and address data were included ( n = 918 ) .  Multinomial logistic regression was used to estimate the conditional association of food outlets on diet quality , controlling for confounders and using a robust variance estimator to account for clustering of neighborhood characteristics . RESULTS Women living greater than 4 miles from a supermarket were more than twice the odds ( adjusted odds ratio = 2.16 ; 95 % confidence interval = 1.2 , 4.0 ) of falling into the lowest compared to highest DQI-P tertile compared to women living within 2 miles of a supermarket , after controlling for individual characteristics , other food retail outlets . CONCLUSION These findings suggest that proximity of food retail outlets influences the diet quality of pregnant women OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention Background Overweight and obesity have a dramatic negative impact on children 's health not only during the childhood but also throughout the adult life . Preventing the development of obesity in children is therefore a world-wide health priority . There is an obvious urge for sustainable and evidence d-based interventions that are suitable for families with young children , especially for families with overweight or obese parents . We have developed a prevention program , Early STOPP , combating multiple obesity-promoting behaviors such unbalanced diet , physical inactivity and disturbed sleeping patterns . We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents . This protocol outlines methods for the recruitment phase of the study . Design and methods This r and omized controlled trial ( RCT ) targets overweight and /or obese parents with infants , recruited from the Child Health Care Centers ( CHCC ) within the Stockholm area . The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach ( dietitian , physiotherapist or a nurse ) . The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC , which include advices on healthy food choices and eating patterns , increasing physical activity/reducing sedentary behavior  and regulating  sleeping patterns . Discussion The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population , defining a feasible , theory-based intervention and assessing multiple measurements to vali date and interpret the program effectiveness . The early years hold promise as a time in which obesity prevention may be most effective . To our knowledge , this longitudinal RCT is the first attempt to demonstrate whether an early , long-term , targeted health promotion program focusing on  healthy eating , physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective . If proven so , Early STOPP may protect children from the development of overweight and obesity . Trial registration The protocol for this study is registered with the clinical trials registry clinical trials.gov , ID : ES-2010 OBJECTIVE To determine associations between younger youths ' susceptibility to smoking and four household variables related to tobacco socialization : parental and sibling smoking , restrictions on smoking in the home and exposure to smoking in vehicles . METHODS A secondary analysis of the 2004/05 Canadian Youth Smoking Survey used logistic regression to investigate the relationships between youth susceptibility to smoking , gender , and four household variables related to tobacco socialization . Susceptibility to smoking was operationalized by three levels of smoking experience and intention : non-susceptible non-smoker , susceptible non-smoker and experimenter/smoker . The national survey included 29 243 grade 5 to 9 students from r and omly sample d public and private schools in ten provinces . RESULTS For non-smokers , the odds of being susceptible to smoking increased with having a sibling who smokes , a lack of a total household smoking ban and riding in a vehicle with a smoker in the previous week , when adjusting for all other variables in the model . These variables also increased the odds of being an experimenter/smoker versus a susceptible non-smoker . Parent smoking status  was not significant in these models . CONCLUSION Denormalization messages , through enforced home and vehicle smoking bans , appear to support youth in maintaining a resolve to not smoke , regardless of parental smoking status OBJECTIVE . The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school . METHODS . The participants in this r and omized , controlled cluster trial were second- and third- grade rs from 32 elementary schools in socially deprived areas of 2 German cities .  Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools ( N = 17 ) to promote water consumption .  Control group schools ( N = 15 ) did not receive any intervention . The prevalence of overweight ( defined according to the International Obesity Task Force criteria ) , BMI SD scores , and beverage consumption ( in glasses per day ; 1 glass was defined as 200 mL ) self-reported in 24-hour recall question naires , were determined before ( baseline ) and after the intervention . In addition , the water flow of the fountains was measured during the intervention period of 1 school year ( August 2006 to June 2007 ) . RESULTS . Data on 2950 children ( intervention group : N = 1641 ; control group : N = 1309 ; age , mean ± SD : 8.3 ± 0.7 years ) were analyzed . After the intervention , the risk of overweight was reduced by 31 % in the intervention group , compared with the control group , with adjustment for baseline prevalence of overweight and clustering according to school . Changes in BMI SD scores did not differ between the intervention group and the control group . Water consumption after the intervention was 1.1 glasses per day greater in the intervention group . No intervention effect on juice and soft drink consumption was found . Daily water flow of the fountains indicated lasting use during the entire intervention period , but to varying extent . CONCLUSION . Our environmental and educational , school-based intervention proved to be effective in the prevention of  overweight among children in elementary school , even in a population from socially deprived areas This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherl and s. A cluster r and omized controlled trial was conducted .  Intervention cafeterias ( n=13 ) , where the Choices logo was used to promote healthier eating for a 3-week period , were compared with control cafeterias ( n=12 ) , which offered the same menu without the logo .  Sales data were collected daily for 9 weeks , from March to May 2009 . In addition , employees from one intervention and one control company completed an online question naire at baseline and after the intervention ( n=368 ) in which the behavioral determinants of food choice ( ie , attitude , self-efficacy , and intention ) and logo use were measured . Generalized estimating equation analyses , χ² tests , t tests and linear regression analyses were performed . No nutritionally meaningful intervention effects were found in the sales of s and wiches , soups , snacks , fruit , and salads . Also , no significant differences in behavioral determinants were found . " Intention to eat healthier " and " paying attention to product information " were positively associated with self-reported consumption of foods with the Choices logo at lunch . The intervention did not have a significant effect on employees ' lunchtime food choices . Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change . Further research should focus on the possible health benefits of menu reformulation in the catering sector Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity Background — The estimated effects of recent pubic and workplace smoking restriction laws suggest that they produce significant declines in community rates of heart attack . The consistency of these declines with existing estimates of the relative risk of heart attack in individuals attributable to passive smoking exposure is poorly understood . The objective is to determine the consistency of estimates of reductions in community rates of heart attacks result ing from smoking restriction laws with estimates of the relative risk of heart disease in individuals exposed to passive smoking . Methods and Results — Meta-analyses of existing estimates of declines in community rates were compared with a mathematical model of the relationship between individual risk and community rates . The outcome measure is the ratio of community rates of acute myocardial infa rct ion ( after divided by before implementation of a smoking restriction law ) . There is a significant drop in the rate of acute myocardial infa rct ion hospital admissions associated with the implementation of strong smoke-free legislation . The primary reason for heterogeneity in results of different studies is the duration of follow-up after adoption of the law . The pooled r and om-effects estimate of the rate of acute myocardial infa rct ion hospitalization 12 months after implementation of the law is 0.83 ( 95 % confidence interval , 0.80 to 0.87 ) , and this benefit grows with time . This drop in admissions is consistent with a range of plausible individual risk and exposure scenarios . Conclusion — Passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced acute myocardial infa rct ions , and these benefits grow with time BACKGROUND Secondary school students often do not drink sufficient quantities of water during the school day to prevent dehydration , promote learning and good health . The study aim ed to measure the effect of health promotion and the free provision of cooled filtered water on the consumption of water and soft drinks . It also aim ed to explore students ' views of drinking water provision . METHODS A study was conducted with three secondary schools in North Tyneside . Over a 3 month period one school was given cooled filtered water and active promotion ( W + P ) , another had water only ( W ) . The control school ( C ) took part in post-intervention focus group work . RESULTS The average volume of water drunk by students , in school ' W + P ' was greater ( P = 0.05 ) than that drunk in school ' W ' and control school ' C ' . The volume of soft drinks purchased by students in all three schools before and during the intervention remained static . Focus group data revealed that students viewed their existing water provision as poor and wanted sufficient supplies of cooled filtered water in school . CONCLUSIONS This pilot study indicates that active promotion of water drinking increased consumption of water by secondary school students . Further developments of the project are suggested OBJECTIVES We examined the relationship between students ' tobacco use  and the density and proximity of tobacco retailers near their schools . METHODS We used data from the 2003 - 2004 California Student Tobacco Survey and California retail licensing data . Measures included students ' self-reported tobacco use and geocoded state-reported locations of tobacco retailers . We used r and om-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors . RESULTS Density of retailers was associated with experimental smoking ( odds ratio [ OR ] = 1.11 ; 95 % confidence interval [ CI ] = 1.02 , 1.21 ) but not established smoking ( OR = 1.06 ; 95 % CI = 0.94 , 1.20 ) . The effects on experimental smoking were confined to high school students ( OR = 1.17 ; 95 % CI = 1.06 , 1.29 ) in urban areas ( OR = 1.11 ; 95 % CI = 1.01 , 1.21 ) ; no effects were observed among middle school students or in rural schools . High school students were more likely to obtain cigarettes from a retailer ; middle school students relied more heavily on social sources . CONCLUSIONS Our results support the plausibility of reducing rates of students ' experimental smoking , but not established smoking , by restricting their access to commercial sources of tobacco in urban areas Objective : To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children . Design : Cluster-r and omized , controlled study .Subjects : A total of 3135 boys and girls in grade s 1–4 were included in the study . Methods : Ten schools were selected in Stockholm county area and r and omized to intervention ( n=5 ) and control ( n=5 ) schools .  Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools .  Physical activity ( PA )  was aim ed to increase by 30 min day−1 during school time and sedentary behaviour restricted during after school care time . PA was measured by accelerometry .  Eating habits at home were assessed by parental report . Eating disorders were evaluated by self-report . Results : The prevalence of overweight and obesity decreased by 3.2 % ( from 20.3 to 17.1 ) in intervention schools compared with an increase of 2.8 % ( from 16.1 to 18.9 ) in control schools ( P<0.05 ) . The results showed no difference between intervention and controls , after cluster adjustment , in the longitudinal analysis of BMI sds changes . However , a larger proportion of the children who were initially overweight reached normal weight in the intervention group ( 14 % ) compared with the control group ( 7.5 % ) , P=0.017 . PA  did not differ between intervention and control schools after cluster adjustment . Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention . There was no difference between children in intervention and control schools in self-reported eating disorders . Conclusions : A school-based intervention can reduce the prevalence of overweight and obesity in 6 to 10-year-old children and may affect eating habits at home . The effect of the intervention was possibly due to its effect on healthy eating habits at school and at home rather than on increased levels of PA This paper measures tobacco polices in statewide representative sample s of secondary and mixed schools in Victoria , Australia and Washington , US ( N = 3,466 students from 285 schools ) and tests their association with student smoking . Results from confounder-adjusted r and om effects ( multi-level ) regression models revealed that the odds of student perception of peer smoking on school grounds are decreased in schools that have strict enforcement of policy ( odds ratio ( OR ) = 0.45 ; 95 % CI : 0.25 to 0.82 ; p = 0.009 ) . There was no clear evidence in this study that a comprehensive smoking ban , harsh penalties , remedial penalties , harm minimization policy or abstinence policy impact on any of the smoking outcomes OBJECTIVES This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines . METHODS  Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites . Four pricing levels ( equal price , 10 % reduction , 25 % reduction , 50 % reduction ) and 3 promotional conditions ( none , low-fat label , low-fat label plus promotional sign ) were crossed in a Latin square design . Sales of low-fat vending snacks were measured continuously for the 12-month intervention . RESULTS Price reductions of 10 % , 25 % , and 50 % on low-fat snacks were associated with significant increases in low-fat snack sales ; percentages of low-fat snack sales increased by 9 % , 39 % , and 93 % , respectively . Promotional signage was independently but weakly associated with increases in low-fat snack sales . Average profits per machine were not affected by the vending interventions . CONCLUSIONS Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent population Background Front of pack food labels or signpost labels are currently widely discussed as means to help consumers to make informed food choices . It is hoped that more informed food choices will result in an overall healthier diet . There is only limited evidence , as to which format of a food label is best understood by consumers , helps them best to differentiate between more or less healthy food and whether these changes in perceived healthiness result in changes of food choice . Methods In a r and omised experimental study in Hamburg/Germany 420 adult subjects were exposed to one of five experimental conditions : ( 1 ) a simple " healthy choice " tick , ( 2 ) a multiple traffic light label , ( 3 ) a monochrome Guideline Daily Amount ( GDA ) label , ( 4 ) a coloured GDA label and ( 5 ) a " no label " condition . In the first task they had to identify the healthier food items in 28 pair-wise comparisons of foods from different food groups . In the second task they were asked to select food portions from a range of foods to compose a one-day 's consumption . Differences between means were analysed using ANOVAs . Results Task I : Experimental conditions differed significantly in the number of correct decisions ( p < 0.001 ) . In the condition " no label " subjects had least correct decisions ( 20.2 ± 3.2 ) , in the traffic light condition most correct decisions were made ( 24.8 ± 2.4 ) . Task II : Envisaged daily food consumption did not differ significantly between the experimental conditions . Conclusion Different food label formats differ in the underst and ing of consumers . The current study shows , that German adults profit most from the multiple traffic light labels . Perceived healthiness of foods is influenced by this label format most often . Nevertheless , such changes in perceived healthiness are unlikely to influence food choice and consumption . Attempts to establish the informed consumer with the hope that informed choices will be healthier choices are unlikely to change consumer behaviour and will not result in the desired contribution to the prevention of obesity and diet related diseases PURPOSE This study examined the association of objective and perceived neighborhood environmental characteristics and parent concerns with  active commuting to school  , investigated whether parental concerns varied by environmental characteristics , and compared the association of the perceived environment , parental concerns , and objective environment on the outcome active commuting to school . METHODS R and omly selected parents of children ( aged 5 - 18 yr ) , in neighborhoods chosen for their variability in objective ly measured walkability and income , completed question naires about their neighborhood environment , concerns about children walking to school , and children 's behavior ( N = 259 ) . Objective measures of the environment were available for each participant and each neighborhood . Logistic regression analyses were used to investigate the relationships among environment , parental concerns , and walking or biking to or from school  at least once a week . RESULTS A parental concerns scale was most strongly associated with child active commuting ( odds ratio : 5.2 , 95 % CI : 2.71 - 9.96 ) . In high-income neighborhoods , more children actively commuted in high-walkable ( 34 % ) than in low-walkable neighborhoods ( 23 % ) ( odds ratio : 2.1 , 95 % CI : 1.12 - 3.97 ) , but no differences were noted in low-income neighborhoods . Parent concerns and neighborhood aesthetics were independently associated with active commuting . Perceived access to local stores and biking or walking facilities accounted for some of the effect of walkability on active commuting . CONCLUSION Both parent concerns and the built environment were associated with children 's  active commuting to school . To increase active commuting to school , interventions that include both environmental change and education campaigns may be needed Increased visibility of food labels is a potential method to reduce the rate of obesity . However , few empirical studies have investigated the impact of nutrition labeling on food selection or energy intake . This study tested the hypothesis that nutrition labeling in combination with nutrition label education would promote reductions in energy intake using a laboratory-based paradigm . Forty-seven male ( n=24 ) and female ( n=23 ) participants visited the Nutrition and Health Research Laboratory for a single lunch session during the months of May through August 2009 . Participants were r and omly assigned to one of two video groups ( Nutrition Labeling Education or Organic Food Movement ) and one of two labeling conditions ( Nutrition Labels or No Labels ) . Participants watched a short educational video and then consumed a buffet lunch . Data were analyzed using a three-way analysis of covariance with sex , video condition , and labeling group as the between-subject factors and age and race as covariates . There were main effects of sex and nutrition label condition on lunch energy intake with females consuming less than males and people with nutrition labels consuming less energy than those without , regardless of sex or video condition . Examination of energy intake from low-energy-density and high-energy-density foods showed that the nutrition labeling group consumed less energy from both low-energy-density and high-energy-density food sources . These data support the use of nutrition labels as a way to reduce energy intake Background  Girl Scouting may offer a viable channel for health promotion and obesity prevention programs . This study evaluated the effectiveness of an intervention program delivered through Girl Scout Junior troops that was design ed to foster healthful troop meeting environments and increase obesity prevention behaviors at home . Methods Seven Girl Scout troops were r and omized to intervention ( n = 3 , with 34 girls ) or st and ard-care control ( n = 4 , with 42 girls ) conditions . Girls ranged in age from 9 to 13 years ( mean 10.5 years ) . Intervention troop leaders were trained to implement policies promoting physical activity ( PA ) and healthful eating opportunities at troop meetings , and to implement a curriculum promoting obesity-prevention behaviors at home . The primary outcome variable was child body mass index ( BMI ) z-score . Secondary outcomes included accelerometer-assessed PA levels in troop meetings , direct observations of snack offerings , time spent in physically active meeting content , and leader encouragement of PA and healthful eating . Results The intervention was delivered with good fidelity , and intervention troops provided greater opportunities for healthful eating and PA ( x2 = 210.8 , p < .001 ) , relative to control troops . In troop meetings , intervention troop leaders promoted  PA  ( x2 = 23.46 , p < .001 ) and healthful eating ( x2 = 18.14 , p < .001 ) more frequently , and discouraged healthful eating and PA less frequently ( x2 = 9.63 , p = .002 ) compared to control troop leaders . Most effects of the intervention on individual-level variables of girls and parents were not significantly different from the control condition , including the primary outcome of child BMI z-score ( F1 , 5 = 0.42 , p = .544 ) , parent BMI ( F1 , 5 = 1.58 , p = .264 ) , and related behavioral variables . The notable exception was for objective ly assessed troop PA , wherein girls in intervention troops accumulated significantly less sedentary ( x2 = 6.3 , p = .011 ) , significantly more moderate ( x2 = 8.2 , p = .004 ) , and more moderate-to-vigorous physical activity , ( x2 = 18.4 , p < .001 ) , than girls in control troops . Conclusions Implementing a health promotion curriculum and supporting policies to provide more healthful environments in Girl Scout troop meetings appears feasible on a broader scale . Additional work is needed to bridge health promotion from such setting s to other environments if lasting individual-level behavior change and obesity prevention remain targeted outcomes . Trial registration number : Two pilot studies were conducted to examine whether 6th grade students can achieve moderate to vigorous physical activity ( MVPA ) from 1 ) activity-based physical education ( AB-PE ) with 585 participants and 2 ) a curricular-based ( CB-PE ) program with 1,544 participants and r and omly sample d heart rates during lessons . AB-PE participants spent between 54 - 66 % with a heart rate > 140 bpm .  CB-PE participants spent between 49 - 58 % with a heart rate > 140 bpm . Girls ' mean heart rate was 3.7 bpm lower than the boys . PE can be readily modified so that students spend more than 50 % of time in MVPA BACKGROUND Recognizing the importance of smoking cessation after acute myocardial infa rct ion ( AMI ) , the Centers for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations currently uses documentation of smoking cessation counseling ( SCC ) as a metric of hospitals ' quality of AMI care . Yet , the association between hospitals ' performance of this quality measure and subsequent tobacco cessation rates has not been established . METHODS We analyzed 889 consecutive smokers treated for AMI at 19 hospitals in PREMIER ( Prospect i ve Registry Evaluating Myocardial Infa rct ion : Events and Recovery ) between January 1 , 2003 , and June 28 , 2004 . Patients were followed up for 1 year after hospitalization . Multivariate regression modeling was performed to determine the association between hospital-level documented SCC rates and tobacco cessation rates after discharge . RESULTS On a hospital level , the median medical record-documented SCC rate was 72.0 % ( interquartile range , 59.6%-90.1 % ) . At 1 year , the median smoking cessation rate was 55.6 % ( interquartile range , 37.5%-61.9 % ) . Although patients with documented SCC were more likely to recall receiving SCC at 1 month ( 86.1 % vs 70.8 % , P < .001 ) , their rate of quitting at 1 year was lower than that of patients without documented SCC ( 50.1 % vs 60.7 % , P = .02 ; relative risk , 0.76 ; 95 % confidence interval , 0.61 - 0.94 ) . At the hospital level , there was no correlation between SCC documentation and successful quitting at 6 months ( r = -0.19 , P = .11 ) or 1 year ( r = -0.13 , P = .45 ) . CONCLUSIONS The performance metric for SCC , as it is currently structured , does not correlate with actual smoking cessation at 6 months or 1 year . Revision of this performance measure should be considered to more effectively reflect the goal of promoting smoking cessation INTRODUCTION Legal restrictions have contributed to the decline in smoking prevalence in several European countries . We investigated the impact of the Italian 2005 indoor smoking ban on the efficacy of counseling alone or in combination with bupropion for smoking cessation . METHODS Before and after the introduction of the ban ( 2001 - 2006 ) , 550 smokers were enrolled in the smoking cessation program in Rome and were asked to choose between a 6-week group counseling therapy ( GCT ) given alone or in combination with 7 weeks of daily bupropion . Follow-up was completed 12 , 26 , and 52 weeks after the quit day . Due to the observational nature of the study , we used propensity scores to match 138 and 290 subjects ( pre-/postban ) in the bupropion- and GCT-only groups , respectively . RESULTS Covariate balance in the two matched sample s was adequate for all variables except " coffee consumption " in the GCT-only group . The regression adjusted odds ratios indicated that the introduction of the ban result ed in 52 % reduced odds of continued smoking at 12 months among the GCT + bupropion group and 41 % reduced odds in the GCT-only group . We observed that the ban was associated with both increased 12-month abstinence rates and motivation to quit . In a mediation analysis , we determined that the total effect of the smoking ban on the abstinence rate was reduced after controlling for motivation , which confirmed that motivation was a partial mediator . DISCUSSION The introduction of an indoor smoking ban improved the efficacy of smoking cessation treatments by possibly providing a setting that increased the level of motivation to stop smoking Background To evaluate the impact of a walking school bus ( WSB ) program on student transport in a low-income , urban neighborhood . Methods The design was a controlled , quasi-experimental trial with consecutive cross-sectional assessment s. The setting was three urban , socioeconomically disadvantaged , public elementary schools ( 1 intervention vs. 2 controls ) in Seattle , Washington , USA . Participants were ethnically diverse students in kindergarten-5th grade ( aged 5–11 years ) . The intervention was a WSB program consisting of a part-time WSB coordinator and parent volunteers . Students ' method of transportation to school was assessed by a classroom survey at baseline and one-year follow-up . The Pearson Chi-squared test compared students transported to school at the intervention versus control schools at each time point . Due to multiple testing , we calculated adjusted p-values using the Ryan-Holm stepdown Bonferroni procedure . McNemar 's test was used to examine the change from baseline to 12-month follow-up for walking versus all other forms of school transport at the intervention or control schools . Results At baseline , the proportions of students ( n = 653 ) walking to the intervention ( 20 % + /- 2 % ) or control schools ( 15 % + /- 2 % ) did not differ ( p = 0.39 ) . At 12-month follow up , higher proportions of students ( n = 643 , p = 0.001 ) ) walked to the intervention ( 25 % + /- 2 % ) versus the control schools ( 7 % + /- 1 % ) . No significant changes were noted in the proportion of students riding in a car or taking the school bus at baseline or 12-month follow up ( all p > 0.05 ) . Comparing baseline to 12-month follow up , the numbers of students who walked to the intervention school increased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . In contrast , the numbers of students who walked to the control schools decreased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . Conclusion A WSB program is a promising intervention among urban , low-income elementary school students that may promote favorable changes toward active transport to school . Trial Registration Clinical Trials.gov BACKGROUND Soaring obesity levels present a severe health risk in the United States , especially in low-income minority population s. INTERVENTION High-frequency paid television and radio advertising , as well as bus and streetcar signage . SETTING / PARTICIPANTS A mass media campaign in New Orleans to promote walking and fruit and vegetable consumption in a low-income , predominantly African-American urban population . Messages tailored with consideration of the African-American majority . DESIGN R and om-digit-dial telephone surveys using cross-sectional representative sample s at baseline in 2004 and following the onset of the campaign in 2005 . MEASURES Survey items on campaign message recall ; attitudes toward walking , snack food avoidance , and fruit and vegetable consumption ; and behaviors related to fruit and vegetable consumption , snack food consumption , and utilitarian and leisure walking . RESULTS From baseline , there were significant increases in message recall measures , positive attitudes toward fruit and vegetable consumption , and positive attitudes toward walking . Behaviors did not change significantly . In 2005 , message recall measures were associated with positive levels of each of the outcome variables . CONCLUSIONS Over 5 months , the media campaign appeared to have stimulated improvements in attitudes toward healthy diet and walking behaviors addressed by the campaign . These findings encourage the continuation of the media campaign , with future evaluation to consider whether the behavioral measures change OBJECTIVE To present the effects of a relatively modest environmental intervention on biological cardiovascular risk indicators . METHOD A controlled trial , including two worksites . Measurements ( i.e. , body composition , blood pressure and serum cholesterol ) took place at baseline and at 3- and 12-month follow-up . The 12-month environmental intervention ( The Hague , The Netherl and s , 2004 ) consisted of : a ' Food'-part : to stimulate healthier food choices by means of product information in the canteen , and a ' Steps'-part : focused on stimulating stair use by means of motivational prompts in staircases and on elevator doors . RESULTS Significant differences in change between groups ( n=540 ) in favor of the intervention group were found on : [ 1 ] total cholesterol for women ( -0.35 mmol/l ) ; [ 2 ] HDL for men at 3 months ( 0.05 mmol/l ) and 12 months ( 0.10 mmol/l ) ; and [ 3 ] the total-HDL ratio for the total intervention group at 3 and 12 months ( -0.45 mmol/l ) . Both groups showed a decrease in all body composition values at both follow-ups . A significant difference in change in systolic BP was found in favor of the control group ( approximately 4 mm Hg ) , due to an increase in the intervention group at both follow-ups . CONCLUSIONS Based on the contrasting results , this modest environmental intervention was ineffective in reducing cardiovascular risk in a population of office workers Taxation has been proposed as a means to reduce consumption of unhealthy food items . However , it is unknown if taxation without regulations or other activities known to shift eating behaviors lead to long-term dietary change . This unexplored issue is examined using data from the Russia Longitudinal Monitoring Survey . Data were from adults aged 25 - 55 y who participated in the nationally representative Russian Longitudinal Monitoring Survey . Twenty-four-hour dietary recalls , detailed food expenditure data , and community-level food prices collected over 1994 - 2005 were used for these analyses . Longitudinal r and om effects models were used to test the relation of time on the structure of diet while controlling for total household expenditures . The proportion of total energy consumed from fat was higher in all other years combined compared with 1998 ( P < 0.001 ) . The proportion of dietary fat from high-fat meat and high-fat dairy items were lowest in 1998 and increased over subsequent years despite increasing costs . Percent fat from fats and oils continued to decline with rising costs . Price changes led to substantial shifts in the structure of food consumption . However , except for the most expensive items , consumption of items returned to levels consumed in the former Soviet Union following price stabilization Background Built environment research is dominated by cross-sectional design s , which are particularly vulnerable to residential self- selection bias result ing from health-related attitudes , neighborhood preferences , or other unmeasured characteristics related to both neighborhood choice and health-related outcomes . Methods We used cohort data from the National Longitudinal Study of Adolescent Health ( United States ; Wave I , 1994 - 95 ; Wave III , 2001 - 02 ; n = 12,701 ) and a time-varying geographic information system . Longitudinal relationships between moderate to vigorous physical activity ( MVPA ) bouts and built and socioeconomic environment measures ( l and cover diversity , pay and public physical activity facilities per 10,000 population , street connectivity , median household income , and crime rate ) from adolescence to young adulthood were estimated using r and om effects models ( biased by unmeasured confounders ) and fixed effects models ( within-person estimator , which adjusts for unmeasured confounders that are stable over time ) . Results R and om effects models yielded null associations except for negative crime-MVPA associations [ coefficient ( 95 % CI ) : -0.056 ( -0.083 , -0.029 ) in males , -0.061 ( -0.090 , -0.033 ) in females ] . After controlling for measured and time invariant unmeasured characteristics using within-person estimators , MVPA was higher with greater physical activity pay facilities in males [ coefficient ( 95 % CI ) : 0.024 ( 0.006 , 0.042 ) ] , and lower with higher crime rates in males [ coefficient ( 95 % CI ) : -0.107 ( -0.140 , -0.075 ) ] and females [ coefficient ( 95 % CI ) : -0.046 ( -0.083 , -0.009 ) ] . Other associations were null or in the counter-intuitive direction . Conclusions Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self- selection can bias associations toward the null , as opposed to its typical characterization as a positive confounder . Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias . The authors discuss complexities of adjusting for residential self- selection and residential relocation , particularly during the adolescent to young adult transition OBJECTIVE On March 1st , 2008 a smoking ban in public buildings became effective in the Canton of Graubuenden , Switzerl and . The aim of our study was to investigate , whether implementation of this new regulation was followed by a decrease in the incidence of acute myocardial infa rct ion ( AMI ) . PATIENTS AND METHODS The Kantonsspital Graubuenden serves as a tertiary care hospital , possessing the only cardiac catheterization laboratory in the Canton of Graubuenden . Based on an excellent functioning network including all hospitals in the Canton of Graubuenden , virtually all patients experiencing an AMI in the Canton of Graubuenden are transferred to our hospital for either acute or early coronary angiography . Data of all patients with AMI undergoing coronary angiography at our hospital between March 1st , 2008 and February 28th , 2009 were collected prospect ively . The data were then compared with those of the two corresponding 12-month periods preceding implementation of the public smoking ban . RESULTS In the two years before adoption of smoke-free legislation , the number of patients with AMI was 229 and 242 , respectively ( p = ns ) . In the 12 months after implementation of the public smoking ban , the number of AMI patients dropped to 183 ( p < 0.05 vs. each of the previous 12-month periods ) , representing an overall 22 % reduction in the AMI incidence within the first year after enactment of the new regulation . This reduction was driven by a significant decrease in the AMI incidence in men , nonsmokers , and individuals with established coronary artery disease , including those with prior AMI or prior percutaneous coronary intervention . CONCLUSIONS Similar to other countries in Europe and various regions of the USA and Canada , implementation of a public smoking ban was followed by a significant early decline in the incidence of AMI in the Canton of Graubuenden , Switzerl and Purpose . To examine associations of the built environment surrounding worksites and of work policies with walking behaviors . Design . Cross-sectional convenience sample survey . Setting . Workplace . Subjects . Employed adults residing in Montgomery County , Maryl and . Measures . Four different step measures taken at or near work as recorded using an accelerometer and a fifth measure indicated self-reported walking from work . Participants reported on eight built environment characteristics surrounding the worksite ( e.g. , the presence of sidewalks , crosswalks , and pedestrian signals ) and on four worksite policies ( e.g. , the presence of exercise facilities and exercise programs ) . Analysis . Cross-sectional associations of self-reported built environment characteristics surrounding worksites and worksite policies with walking behavior were examined . Results . Although participants reported worksites exhibiting built environment characteristics that were supportive of walking ( seven of eight characteristics were reported by > 50 % of participants ) , no built environment characteristic was associated with walking more than the median number of average weekday steps ( p > .05 ) . All four worksite policies were associated with walking more than the median number of average weekday steps ( p < .05 ) . In addition , a perception of few cul-de-sacs and of the presence of litter , sidewalks , crosswalks , and pedestrian signals surrounding the worksites was associated with a higher proportion of participants taking at least one walking trip from work in the past month ( p < .05 ) . Conclusions . Locating worksites in walkable environments and implementing worksite policies may favorably influence  employee walking .  Future studies should consider a prospect i ve design and examine a larger , more diverse employee population and worksite environment to examine these associations BACKGROUND Smoking is the leading preventable cause of premature death in the United States . Previous studies of financial incentives for smoking cessation in work setting s have not shown that such incentives have significant effects on cessation rates , but these studies have had limited power , and the incentives used may have been insufficient . METHODS We r and omly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs ( 442 employees ) or to receive information about programs plus financial incentives ( 436 employees ) . The financial incentives were $ 100 for completion of a smoking-cessation program , $ 250 for cessation of smoking within 6 months after study enrollment , as confirmed by a biochemical test , and $ 400 for abstinence for an additional 6 months after the initial cessation , as confirmed by a biochemical test . Individual participants were stratified according to work site , heavy or nonheavy smoking , and income . The primary end point was smoking cessation 9 or 12 months after enrollment , depending on whether initial cessation was reported at 3 or 6 months . Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs . RESULTS The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment ( 14.7 % vs. 5.0 % , P<0.001 ) and 15 or 18 months after enrollment ( 9.4 % vs. 3.6 % , P<0.001 ) . Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program ( 15.4 % vs. 5.4 % , P<0.001 ) , completion of a smoking-cessation program ( 10.8 % vs. 2.5 % , P<0.001 ) , and smoking cessation within the first 6 months after enrollment ( 20.9 % vs. 11.8 % , P<0.001 ) . CONCLUSIONS In this study of employees of one large company , financial incentives for smoking cessation significantly increased the rates of smoking cessation . ( Clinical Trials.gov number , NCT00128375 . OBJECTIVE The objective was to test the hypothesis that a community-based environmental change intervention could prevent weight gain  in young children ( 7.6 + /- 1.0 years ) . RESEARCH METHODS AND PROCEDURES A non-r and omized controlled trial was conducted in three culturally diverse urban cities in Massachusetts . Somerville was the intervention community ; two socio-demographically-matched cities were  control communities . Children ( n = 1178 ) in grade s 1 to 3 attending public elementary schools participated in an intervention design ed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before- , during- , after-school , home , and community environments . Many groups and individuals within the community ( including children , parents , teachers , school food service providers , city departments , policy makers , healthcare providers , before- and after-school programs , restaurants , and the media ) were engaged in the intervention . The main outcome measure was change in BMI z-score . RESULTS At baseline , 44 % ( n = 385 ) , 36 % ( n = 561 ) , and 43 % ( n = 232 ) of children were above the 85th percentile for BMI z-score in the intervention and the two control communities , respectively . In the intervention community , BMI z-score decreased by -0.1005 ( p = 0.001 , 95 % confidence interval , -0.1151 to -0.0859 ) compared with children in the control communities after controlling for baseline covariates . DISCUSSION A community-based environmental change intervention decreased BMI z-score  in children at high risk for obesity . These results are significant given the obesigenic environmental backdrop against which the intervention occurred . This model demonstrates promise for communities throughout the country confronted with escalating childhood obesity rates Cardiac rehabilitation and exercise training ( CRET ) provides health risk intervention in cardiac patients over a relatively short time frame . Worksite health programs offer a unique opportunity for health intervention , but these programs remain underused due to concerns over recouping the costs . We evaluated the clinical efficacy and cost-effectiveness of a 6-month worksite health intervention using staff from CRET .  Employees ( n = 308 ) and spouses ( n = 31 ) of a single employer were r and omized to active intervention ( n = 185 ) consisting of worksite health education , nutritional counseling , smoking cessation counseling , physical activity promotion , selected physician referral , and other health counseling versus usual care  ( n = 154 ) . Health risk status was assessed at baseline and after the 6-month intervention program , and total medical cl aim costs were obtained in all participants during the year before and the year after intervention . Significant improvements were demonstrated in quality -of-life scores ( + 10 % , p = 0.001 ) , behavioral symptoms ( depression -33 % , anxiety -32 % , somatization -33 % , and hostility -47 % , all p values < 0.001 ) , body fat ( -9 % , p = 0.001 ) , high-density lipoprotein cholesterol ( + 13 % , p = 0.0001 ) , diastolic blood pressure ( -2 % , p = 0.01 ) , health habits ( -60 % , p = 0.0001 ) , and total health risk ( -25 % , p = 0.0001 ) . Of employees categorized as high risk at baseline , 57 % were converted to low-risk status . Average employee annual cl aim costs decreased 48 % ( p = 0.002 ) for the 12 months after the intervention , whereas control employees ' costs remained unchanged ( -16 % , p = NS ) , thus creating a sixfold return on investment . In conclusion , worksite health intervention using CRET staff decreased total health risk and markedly decreased medical cl aim costs within 12 months The effect of a  smokers ' hotline  as an adjunct to self-help manuals was examined . Subjects were 1,813 smokers recruited from a 10-county rural and small urban area . Counties were matched on demographic characteristics and assigned to a manual only or manual plus hotline condition . Subjects were followed over an 18-month period . Hotline services included taped messages and access to paraprofessional counselors . Results show a consistent , significant hotline effect across outcome measures and follow-up periods . This effect emerged either as a main effect for the hotline or as an interaction with enrollment method such that a significant hotline effect emerged for subjects who enrolled through face-to-face methods . These findings indicate the effectiveness of the hotline in enhancing self-help quit rates BACKGROUND Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places . However , it is unknown whether the reduction in admissions involved nonsmokers , smokers , or both . METHODS Since the end of March 2006 , smoking has been prohibited by law in all enclosed public places throughout Scotl and . We collected information prospect ively on smoking status and exposure to  secondh and smoke based on question naires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year . These hospitals accounted for 64 % of admissions for acute coronary syndrome in Scotl and , which has a population of 5.1 million . RESULTS Overall , the number of admissions for acute coronary syndrome decreased from 3235 to 2684 - -a 17 % reduction ( 95 % confidence interval , 16 to 18)--as compared with a 4 % reduction in Engl and ( which has no such legislation ) during the same period and a mean annual decrease of 3 % ( maximum decrease , 9 % ) in Scotl and during the decade preceding the study . The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital ; this latter number decreased by 6 % . There was a 14 % reduction in the number of admissions for acute coronary syndrome among smokers , a 19 % reduction among former smokers , and a 21 % reduction among persons who had never smoked . Persons who had never smoked reported a decrease in the weekly duration of exposure to secondh and smoke ( P<0.001 by the chi-square test for trend ) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter ( P<0.001 by the t-test ) . CONCLUSIONS The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation . A total of 67 % of the decrease involved nonsmokers . However , fewer admissions among smokers also contributed to the overall reduction We surveyed 7318 customers from 275 r and omly selected restaurants of 11 fast food chains . Participants purchased a mean of 827 calories , with 34 % purchasing 1000 calories or more . Unlike other chains , Subway posted calorie information at point of purchase and its patrons more often reported seeing calorie information than patrons of other chains ( 32 % vs 4 % ; P<.001 ) ; Subway patrons who saw calorie information purchased 52 fewer calories than did other Subway patrons ( P<.01 ) . Fast-food chains should display calorie information prominently at point of purchase , where it can be seen and used to inform purchases Objectives : To assess the effect on fruit and vegetable consumption , self reported , and psychological health of a “ natural experiment”—the introduction of large scale food retailing in a deprived Scottish community . Design : Prospect i ve quasi-experimental design comparing baseline and follow up data in an “ intervention ” community with a matched “ comparison ” community in Glasgow , UK . Participants : 412 men and women aged 16 or over for whom follow up data on fruit and vegetable consumption and GHQ-12 were available . Main outcome measures : Fruit and vegetable consumption in portions per day , poor self reported health , and poor psychological health ( GHQ-12 ) . Main results : Adjusting for age , sex , educational attainment , and employment status there was no population impact on daily fruit and vegetable consumption , self reported , and psychological health . There was some evidence for a net reduction in the prevalence of poor psychological health for residents who directly engaged with the intervention . Conclusions : Government policy has advocated using large scale food retailing as a social intervention to improve diet and health in poor communities . In contrast with a previous uncontrolled study this study did not find evidence for a net intervention effect on fruit and vegetable consumption , although there was evidence for an improvement in psychological health for those who directly engaged with the intervention . Although definitive conclusions about the effect of large scale retailing on diet and health in deprived communities can not be drawn from non-r and omised controlled study design s , evaluations of the impacts of natural experiments may offer the best opportunity to generate evidence about the health impacts of retail interventions in poor communities Objective : To assess the degree to which smokers living with a full household ban on smoking change their cessation related behaviour . Design , setting , and participants : Prospect i ve cohort study ; follow up of a population based cohort of 1133 smokers , identified from a 1997 telephone survey of adult Oregonians . After a median of 21 months , 565 were located and reinterviewed . Main outcome measures : Quit attempts , time until relapse , and smoking cessation , defined as seven day and 90 day sustained abstinence at follow up . Results : A full ban at baseline was associated with a doubling of the odds of a subsequent quit attempt ( odds ratio ( OR ) = 2.0 , 95 % confidence interval ( CI ) , 1.0 to 3.9 ) . Among respondents in the preparation stage at baseline ( intention to quit in the next month with a quit attempt in the previous year ) , a full ban was associated with a lower relapse rate ( hazard ratio = 0.5 ( 95 % CI , 0.2 to 0.9 ) ) , while for those in precontemplation/contemplation ( no intention to quit or intention to quit within the next six months , respectively ) , there was no significant association between full ban and relapse rate . For respondents in preparation , those with a full ban had over four times the odds of being in cessation for seven or more days before the follow up call ( OR = 4.4 ( 1.1 to 18.7 ) ) , but for those in precontemplation/contemplation , full bans were unrelated to cessation . Conclusions : Full household bans may facilitate cessation among smokers who are preparing to quit by increasing quit attempts . They may also prolong time to relapse among those smokers Objective : To model the health benefits and cost-effectiveness of  banning television ( TV ) advertisements in Australia for energy-dense , nutrient-poor food and beverages during children 's peak viewing times . Methods : Benefits were modelled as changes in body mass index ( BMI ) and disability-adjusted life years ( DALYs ) saved . Intervention costs ( AUD$ ) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions . Changes in BMI were assumed to be maintained through to adulthood . The comparator was current practice , the reference year was 2001 , and the discount rate for costs and benefits was 3 % . The impact of the withdrawal of non-core food and beverage advertisements on children 's actual food consumption was drawn from the best available evidence ( a r and omized controlled trial of advertisement exposure and food consumption ) . Supporting evidence was found in ecological relationships between TV advertising and childhood obesity , and from the effects of marketing bans on other products . A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of ‘ strength of evidence ’ , ‘ equity ’ , ‘ acceptability to stakeholders ’ , ‘ feasibility of implementation ’ , ‘ sustainability ’ and ‘ side-effects ’ . Results : The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 ( 95 % uncertainty interval ( UI ) $ 2.40 , $ 7.70 ) per DALY . Total DALYs saved were 37 000 ( 95 % UI 16 000 , 59 000 ) . When the present value of potential savings in future health-care costs was considered ( AUD$ 300 m ( 95 % UI $ 130 m , $ 480 m ) , the intervention was ‘ dominant ’ , because it result ed in both a health gain and a cost offset compared with current practice . Conclusions : Although recognizing the limitations of the available evidence , restricting TV food advertising to children would be one of the most cost-effective population -based interventions available to governments today . Despite its economic credentials from a public health perspective , the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government Background Physical activity and motor skills acquisition are of high importance for health-related prevention and a normal development in childhood . However , few intervention studies exist in preschool children focussing on an increase in physical activity and motor skills  . Proof of positive effects is available but not consistent . Methods / Design The design , curriculum , and evaluation strategy of a cluster r and omised intervention study in preschool children are described in this manuscript . In the Prevention through Activity in Kindergarten Trial ( PAKT ) , 41 of 131 kindergartens of Wuerzburg and Kitzingen , Germany , were r and omised into an intervention and a control group by a r and om number table stratified for the location of the kindergarten in an urban ( more than 20.000 inhabitants ) or rural area . The aims of the intervention were to increase physical activity and motor skills in the participating children , and to reduce health risk factors as well as media use . The intervention was design ed to involve children , parents and teachers , and lasted one academic year . It contained daily 30-min sessions of physical education in kindergarten based on a holistic pedagogic approach termed the " early psychomotor education " . The sessions were instructed by kindergarten teachers under regular supervision by the research team . Parents were actively involved by physical activity homework cards . The kindergarten teachers were trained in workshops and during the supervision . Assessment s were performed at baseline , 3 - 5 months into the intervention , at the end of the intervention and 2 - 4 months after the intervention . The primary outcomes of the study are increases in physical activity ( accelerometry ) and in motor skills performance ( composite score of obstacle course , st and ing long jump , balancing on one foot , jumping sidewise to and fro ) between baseline and the two assessment s during the intervention . Secondary outcomes include decreases in body adiposity ( BMI , skin folds ) , media use ( question naire ) , blood pressure , number of accidents and infections ( question naire ) , increases in specific motor skills ( throwing , balancing , complex motor performance , jumping ) and in flexibility . Discussion If this trial proofs the effectiveness of the multilevel kindergarten based physical activity intervention on preschooler 's activity levels and motor skills , the programme will be distributed nationwide in Germany . Trial Registration Clinical Trials.gov Identifier : Interventions to promote physical activity are important in preventing children from becoming overweight . Many projects have been developed but only a few showed ( moderate ) effects . JUMP-in is a systematic ally developed primary -school-based intervention that focuses on the use of theory , environmental changes , parental influences and cooperation with multi-level parties in intervention development . The effects of JUMP-in were evaluated with a quasi-experimental pre-test/post-test research design . In total , 510 children from Grade s 4 , 5 and 6 of four intervention schools and two control schools in Amsterdam were followed for an intervention period of one school year . Changes in physical activity as well as in the social cognitive determinants were assessed using self-reports . In addition , a process evaluation has been executed . The results show that JUMP-in was effective in influencing physical activity , especially among children from Grade 6 . Children in the control group decreased their level of physical activity considerably , while activity levels in intervention children from Grade 6 remained stable . The intervention effects could not be explained by changes in the measured social cognitive determinants . In contrast , process information illuminated differences in intervention effects between the participating schools . The results from the JUMP-in study show the importance of intervention design s that focus on a theory-based mix of relevant environmental and social cognitive factors BACKGROUND AND OBJECTIVES To examine the long term impact of workplace smoking bans on  employee smoking cessation and relapse .  Over three years we studied a total of 1033 current or former smokers ( intervention group ) employed in smoke-free hospitals and 816 current or former smokers ( comparison group ) employed in non-smoke-free workplaces . The design of this natural experiment is a prospect i ve cohort study . We r and omly selected both hospitals and employees from 12 strata based on hospital size and state tobacco regulations , and sample d employees in the same communities . Main outcome measures were post-ban quit ratio and relapse rate . RESEARCH DESIGN Between groups comparisons were conducted using the Cochran-Mantel-Haenszel statistic for general association , stratified Cox proportional hazards models , and the CMH analysis of variance statistic based on ranks . McNemar 's test and the sign test were used to test for changes over time within each group . RESULTS Differences in the post-ban quit ratio were observed between intervention and comparison groups ( p ⩽ 0.02 ) . For employees whose bans were implemented at least seven years before survey , the post-ban quit ratio was estimated at 0.256 , compared with 0.142 for employees in non-smoke-free workplaces ( p = 0.02 ) . After controlling for a variety of factors , time to quit smoking was shorter for the hospital employees ( p < 0.001 ) , with an overall relative risk of quitting of 2.3 . Contrary to expectations , relapse rates were similar between the groups . CONCLUSION Employees in workplaces with smoking bans have higher rates of smoking cessation than employees where smoking is permitted , but relapse is similar between these two groups of employees . The results of this investigation have international applicability for policy makers , clinicians , employers , and employees . Countries should review smoking policies in workplaces in light of their own smoking patterns and efforts to deal with environmental tobacco smoke Introduction Although several studies suggest that drinking water may help prevent obesity , no US studies have examined the effect of school drinking water provision and promotion on student beverage intake . We assessed the acceptability , feasibility , and outcomes of a school-based intervention to improve drinking water consumption among adolescents . Methods The 5-week program , conducted in a Los Angeles middle school in 2008 , consisted of providing cold , filtered drinking water in cafeterias ; distributing reusable water bottles to students and staff ; conducting school promotional activities ; and providing education .  Self-reported consumption of water , nondiet soda , sports drinks , and 100 % fruit juice was assessed by conducting surveys among students ( n = 876 ) , preintervention and at 1 week and 2 months postintervention , from the intervention school and the comparison school . Daily water ( in gallons ) distributed in the cafeteria during the intervention was recorded . Results After adjusting for sociodemographic characteristics and baseline intake of water at school , the odds of drinking water at school were higher for students at the intervention school than students at the comparison school . Students from the intervention school had higher adjusted odds of drinking water from fountains and from reusable water bottles at school than students from the comparison school . Intervention effects for other beverages were not significant . Conclusion Provision of filtered , chilled drinking water in school cafeterias coupled with promotion and education is associated with increased consumption of drinking water at school . A r and omized controlled trial is necessary to assess the intervention 's influence on students '  consumption of water and sugar-sweetened beverages , as well as obesity-related outcomes Objective To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren . Design Cluster r and omised controlled trial . Setting 28 classes from 15 elementary schools in Switzerl and r and omly selected and assigned in a 4:3 ratio to an intervention ( n=16 ) or control arm ( n=12 ) after stratification for grade ( first and fifth grade ) , from August 2005 to June 2006 . Participants 540 children , of whom 502 consented and presented at baseline . Intervention Children in the intervention arm ( n=297 ) received a multi-component physical activity programme that included structuring the three existing physical education lessons each week and adding two additional lessons a week , daily short activity breaks , and physical activity homework . Children ( n=205 ) and parents in the control group were not informed of an intervention group . For most outcome measures , the assessors were blinded . Main outcome measures Primary outcome measures included body fat ( sum of four skinfolds ) , aerobic fitness ( shuttle run test ) , physical activity ( accelerometry ) , and quality of life ( question naires ) . Secondary outcome measures included body mass index and cardiovascular risk score ( average z score of waist circumference , mean blood pressure , blood glucose , inverted high density lipoprotein cholesterol , and triglycerides ) . Results 498 children completed the baseline and follow-up assessment s ( mean age 6.9 ( SD 0.3 ) years for first grade , 11.1 ( 0.5 ) years for fifth grade ) . After adjustment for grade , sex , baseline values , and clustering within classes , children in the intervention arm compared with controls showed more negative changes in the z score of the sum of four skinfolds ( −0.12 , 95 % confidence interval −0.21 to −0.03 ; P=0.009 ) . Likewise , their z scores for aerobic fitness increased more favourably ( 0.17 , 0.01 to 0.32 ; P=0.04 ) , as did those for moderate-vigorous physical activity in school ( 1.19 , 0.78 to 1.60 ; P<0.001 ) , all day moderate-vigorous physical activity ( 0.44 , 0.05 to 0.82 ; P=0.03 ) , and total physical activity in school ( 0.92 , 0.35 to 1.50 ; P=0.003 ) . Z scores for overall daily physical activity ( 0.21 , −0.21 to 0.63 ) and physical quality of life ( 0.42 , −1.23 to 2.06 ) as well as psychological quality of life ( 0.59 , −0.85 to 2.03 ) did not change significantly . Conclusions A school based multi-component physical activity intervention including compulsory elements improved physical activity and fitness and reduced adiposity in children . Trial registration Current Controlled Trials IS RCT N15360785 BACKGROUND . The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic setting s. Schools are ideal setting s for population -based interventions to address obesity . OBJECTIVE . The purpose of this work was to examine the effects of a multicomponent , School Nutrition Policy Initiative on the prevention of overweight ( 85.0th to 94.9th percentile ) and obesity ( > 95.0th percentile ) among children in grade s 4 through 6 over a 2-year period . METHODS . Participants were 1349 students in grade s 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50 % of students eligible for free or reduced-price meals .  Schools were matched on school size and type of food service and r and omly assigned to intervention or control . Students were assessed at baseline and again after 2 years . The School Nutrition Policy Initiative included the following components : school self- assessment , nutrition education , nutrition policy , social marketing , and parent outreach . RESULTS . The incidences of overweight and obesity after 2 years were primary outcomes . The prevalence and remission of overweight and obesity , BMI z score , total energy and fat intake , fruit and vegetable consumption , body dissatisfaction , and hours of activity and inactivity were secondary outcomes . The intervention result ed in a 50 % reduction in the incidence of overweight . Significantly fewer children in the intervention schools ( 7.5 % ) than in the control schools ( 14.9 % ) became overweight after 2 years . The prevalence of overweight was lower in the intervention schools . No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years . CONCLUSION . A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grade s 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals The study aim ed to assess the characteristics and reported behaviour change of participants in the BBC 's ' Fighting Fat , Fighting Fit ' ( FFFF ) campaign .  A postal question naire survey was sent to a r and om sample of 6000 adults registering with the FFFF campaign at the start of the campaign and 5 months later .  Demographic characteristics , weight , eating behaviour and activity patterns were assessed . In total , 3661 respondents completed the baseline question naire and 2112 ( 58 % ) of these completed a follow-up evaluation question naire 5 months later . The majority of evaluation participants were women and classified as ' overweight ' or ' obese ' . Participants reported significant reductions in weight , and in fat and snack intake , and significant increases in exercise levels , and in fruit , vegetable and starch intake during the 6 months of the campaign . These effects remained significant if non-responders were assumed to have made no change . These results show that mass-media campaigns might make a contribution to weight control at the population level , but particular subgroups such as men and people under 25 may require specifically targeted campaigns . In addition , whilst such campaigns may initially attract obese people , they may be more likely to drop out of the campaign than overweight and normal weight individuals STUDY OBJECTIVE : The aim of this study was to evaluate the impact of a smoke free programme implemented at the University of Geneva , Switzerl and , in 1996 . This programme included a prohibition to smoke in university buildings everywhere except in limited areas , and a smoking cessation counselling service . METHODS : Surveys were conducted before and four months after the programme was implemented , in representative sample s of programme participants ( n = 833 ) and university members not exposed to the programme ( n = 1023 ) . RESULTS : In retrospective assessment s , participants reported being less bothered by environmental tobacco smoke after programme implementation , but no between group difference was detected in prospect i ve assessment s. Relationships between smokers and non-smokers improved moderately in the intervention group and remained unchanged in the comparison group ( between group p = 0.001 ) . Proportions of smokers who attempted to quit smoking in the past four months increased from 2.0 % to 3.8 % in the intervention group and remained unchanged at 3.5 % in the comparison group ( between group difference : p = 0.048 ) . No impact on smoking prevalence ( 25 % ) was detected . The programme was appreciated by university members , although some of its modalities were criticised . CONCLUSION : A regulation prohibiting smoking everywhere but in limited areas of university buildings was acceptable and reduced the perception of bother by environmental tobacco smoke . It did not , however , influence smoking habits or attitudes toward smoking The purpose of this study was to comprehensively assess the impact of school  tobacco policy intention , implementation and students ' perceptions of policy enforcement on smoking rates and location of tobacco use during the school day . Data were obtained from all students in Grade s 10 - 11 ( n = 22,318 ) in 81 r and omly selected schools from five Canadian provinces . Policy intention was assessed by coding written school tobacco policies . School administrators most familiar with the tobacco policy completed a survey to assess policy implementation . Results revealed policy intention and implementation subscales did not significantly predict school smoking prevalence but result ed in moderate prediction of tobacco use on school property ( R(2 ) = 0.21 - 0.27 ) . Students ' perceptions of  policy enforcement significantly predicted school smoking prevalence ( R(2 ) = 0.36 ) and location of tobacco use ( R(2 ) = 0.23 - 0.63 ) . The research findings emphasize : ( i ) the need to consider both written policy intention and actual policy implementation and ( ii ) the existence of a policy is not effective in controlling tobacco use unless the policy is implemented and is perceived to be strongly enforced PURPOSE This study evaluated the effects of a classroom-based physical activity program on  children 's in-school physical activity levels  and on-task behavior during academic instruction . METHODS Physical activity of 243 students was assessed during school hours . Intervention-group students ( N = 135 ) received a classroom-based program ( i.e. , Energizers ) . The control group ( N = 108 ) did not receive Energizers .  On-task behavior during academic instruction time was observed for 62 third- grade ( N = 37 ) and fourth- grade students ( N = 25 ) before and after Energizers activities . An independent groups t-test compared in-school physical activity levels between intervention and control classes . A multiple-baseline across-classrooms design was used to evaluate the effectiveness of the Energizers on on-task behavior . Additionally , a two-way ( time [ pre- vs postobservation ] x period [ baseline vs intervention ] ) repeated- measures analysis of variance compared on-task behavior between observation periods . Magnitudes of mean differences were evaluated with Cohen 's delta ( ES ) . RESULTS Students in the intervention group took significantly ( P < 0.05 ) more in-school steps ( 5587 + /- 1633 ) than control-group students ( 4805 + /- 1543 ) , and the size of this difference was moderate ( ES = 0.49 ) . The intervention was effective in improving on-task behavior ; after the Energizers were systematic ally implemented , on-task behavior systematic ally improved . The improvement in on-task behavior of 8 % between the pre-Energizers and post-Energizers observations was statistically significant ( P < 0.017 ) , and the difference was moderate ( ES = 0.60 ) . Likewise , the least on-task students improved on-task behavior by 20 % after Energizers activities . This improvement was statistically significant ( P < 0.001 ) and meaningful ( ES = 2.20 ) . CONCLUSION A classroom-based physical activity program was effective for increasing daily in-school physical activity and improving on-task behavior during academic instruction OBJECTIVE To investigate longitudinal associations between community-level gasoline price and physical activity ( PA ) . METHOD In the Coronary Artery Risk Development in Young Adults study , 5115 black and white participants aged 18 - 30 at baseline 1985 - 86 were recruited from four U.S. cities ( Birmingham , Chicago , Minneapolis and Oakl and ) and followed over time . We used data from 3 follow-up exams : 1992 - 93 , 1995 - 96 , and 2000 - 01 , when the participants were located across 48 states . From question naire data , a total PA score was summarized in exercise units ( EU ) based on intensity and frequency of 13 PA categories . Using Geographic Information Systems , participants ' residential locations were linked to county-level inflation-adjusted gasoline price data collected by the Council for Community & Economic Research . We used a r and om-effect longitudinal regression model to examine associations between time-varying gasoline price and time-varying PA , controlling for age , race , gender , baseline study center , and time-varying education , marital status , household income , county cost of living , county bus fare , census block-group poverty , and urbanicity . RESULTS Holding all control variables constant , a 25-cent increase in inflation-adjusted gasoline price was significantly associated with an increase of 9.9 EU in total PA ( 95 % CI : 0.8 - 19.1 ) . CONCLUSION Rising prices of gasoline may be associated with an unintended increase in leisure PA BACKGROUND The built environment in which a person lives and works is thought to have a strong influence on his or her level of physical activity . However , this belief is largely based on cross-sectional studies underlining the need for prospect i ve studies using natural experiments . DESIGN This study adopted a quasi-experimental research design with multiple control neighborhoods and was conducted between 2005 and 2007 . Data were analyzed in 2008 . SETTING / PARTICIPANTS The subjects were children , adolescents , and adults in free-living conditions within one experimental and two control neighborhoods . INTERVENTION An urban greenway/trail was retrofitted in a neighborhood that lacked connectivity of the residential pedestrian infrastructure to nonresidential destinations . MAIN OUTCOME MEASURES The main outcomes were 2-hour counts of directly observed physical activity in the general neighborhood and , at the school level , active transport to school . RESULTS At the neighborhood level , the 2-hour counts of physical activity significantly increased between 2005 and 2007 ( p=0.000 ) in the intervention neighborhood , with a median increase of 8.0 counts . The control neighborhoods had a significant decrease in counts ( p=0.000 ) . The pre- and post-intervention changes between experimental and control neighborhoods were significantly different for total physical activity ( p=0.001 ) ; walking ( p=0.001 ) ; and cycling ( p=0.038 ) . There was no noted change over time for active transport to school in either the intervention or control neighborhoods . CONCLUSIONS Changes to the pedestrian connectivity of the built environment infrastructure may lead to greater levels of physical activity . However , this positive effect was limited to physical activity at the neighborhood level and not to active transport to school BACKGROUND Physical Activity Across the Curriculum ( PAAC ) was a three-year cluster r and omized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children . METHODS Twenty-four elementary schools were cluster r and omized to the Physical Activity Across the Curriculum intervention or served as control .  All children in grade s two and three were followed to grade s four and five .  Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers . Body Mass Index was the primary outcome , daily Physical activity and academic achievement were secondary outcomes . RESULTS The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9 , respectively ( NS ) . However , change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum . Schools with > or = 75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had < 75 min of Physical Activity Across the Curriculum ( 1.8+/-1.8 vs. 2.4+/-2.0 , p=0.02 ) . Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores . CONCLUSIONS The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children . Additionally , 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index Objective : To examine whether adolescents ’ exposure to youth smoking prevention ads  sponsored by tobacco companies promotes intentions to smoke , curiosity about smoking , and positive attitudes toward the tobacco industry . Design : A r and omised controlled experiment compared adolescents ’ responses to five smoking prevention ads sponsored by a tobacco company ( Philip Morris or Lorillard ) , or to five smoking prevention ads sponsored by a non-profit organisation ( the American Legacy Foundation ) , or to five ads about preventing drunk driving . Setting : A large public high school in California ’s central valley . Subjects : A convenience sample of 9th and 10th grade rs ( n = 832 ) ages 14–17 years . Main outcome measures : Perceptions of ad effectiveness , intention to smoke , and attitudes toward tobacco companies measured immediately after exposure . Results : As predicted , adolescents rated Philip Morris and Lorillard ads less favourably than the other youth smoking prevention ads . Adolescents ’ intention to smoke did not differ as a function of ad exposure . However , exposure to Philip Morris and Lorillard ads engendered more favourable attitudes toward tobacco companies . Conclusions : This study demonstrates that industry sponsored anti-smoking ads do more to promote corporate image than to prevent youth smoking . By cultivating public opinion that is more sympathetic toward tobacco companies , the effect of such advertising is likely to be more harmful than helpful to youth OBJECTIVE To investigate the differential association between neighborhood-level street network with walking , bicycling , and jogging by urbanicity and gender . METHODS We used prospect i ve data from 4 repeated exams on 5115 young adults recruited in 1985 - 1986 , followed through 2000 - 2001 , with self-reported walking , bicycling , and jogging .  Using a Geographic Information System , we spatially and temporally linked time-varying residential locations to street network data within a 1 km Euclidean buffer . Two-part marginal effect modeling assessed longitudinal associations between neighborhood-level street network with walking , bicycling , and jogging , by urbanicity and gender , controlling for time-varying individual- and census-level covariates . RESULTS Neighborhood street density was positively associated with walking , bicycling , and jogging in low urbanicity areas , but in middle and high urbanicity areas , these associations became null ( men ) or inverse ( women ) . CONCLUSION Characteristics of neighborhood streets may influence adult residents ' walking , bicycling , and jogging , particularly in less urban areas . This research may inform policy efforts to encourage physical activity OBJECTIVE To determine the association between household participation in a community garden and fruit and vegetable consumption  among urban adults . DESIGN Data were analyzed from a cross-sectional r and om phone survey conducted in 2003 . A quota sampling strategy was used to ensure that all census tracts within the city were represented . SETTING Flint , Michigan . PARTICIPANTS 766 adults . VARIABLES MEASURED Fruit and vegetable intake was measured using question naire items from the Behavioral Risk Factor Surveillance System . Household participation in a community garden  was assessed by asking the respondent if he or she , or any member of the household , had participated in a community garden project in the last year . ANALYSIS Generalized linear models and logistic regression models assessed the association between household participation in a community garden and fruit and vegetable intake , controlling for demographic , neighborhood participation , and health variables . RESULTS Adults with a household member who participated in a community garden  consumed fruits and vegetables 1.4 more times per day than those who did not participate , and they were 3.5 times more likely to consume fruits and vegetables at least 5 times daily . CONCLUSIONS AND IMPLICATION S Household participation in a community garden may improve fruit and vegetable intake among urban adults BACKGROUND Evidence that demonstrates the harmful effect of cigarette smoking during young adulthood is limited . Therefore , we assessed associations between cigarette smoking and several self-reported illnesses in a prospect i ve cohort study in healthy young adults . METHODS Data were derived from 4472 adults aged 18 to 30 years at baseline participants in the Coronary Artery Risk Development in Young Adults ( CARDIA ) study and reexamined at least once after 7 , 10 , or 15 years . RESULTS Cigarette smoking in 1985 - 86 was related to self-reported smoking-related cancers , circulatory disease , and peptic ulcer . Incidence of these diseases was 9.3/1000 person years among current smokers vs. 4.5/1000 person years among never smokers with no exposure to passive smoke , relative risk ( adjusted for race , sex , education , and center ) 1.96 ( 1.42 - 2.70 ) . Assuming causal relationships , 32 % of these premature incidents were attributable to smoking . The relative risks of liver disease , migraine headache , depression , being ill the day before the examination , and chronic cough and phlegm production were also higher in smokers . CONCLUSIONS Smokers aged 18 - 30 followed for 7 to 15 years reported an excess of both major and minor ailments related to earlier and current smoking . Thus , prevention , cessation , and avoiding passive smoking should remain strong goals among young people OBJECTIVES Legislation to ban smoking in public places is currently a major area of interest across Canada . The main objectives of the study were to 1 ) determine the effect of the smoking ban on incidence of acute myocardial infa rct ion , 2 ) determine if the new legislation altered population -based smoking prevalence , and 3 ) measure public support for the public smoking ban . METHODS The city of Saskatoon initiated a public smoking ban on July 1 , 2004 . We retrospectively review ed all hospital discharges for acute MI from July 2000 to June 2005 . We review ed CCHS survey information on smoking prevalence for Saskatoon , Saskatchewan and Canada from 2003 to 2005 . We prospect ively contacted 1,255 Saskatoon residents by telephone to determine support for the public smoking ban . RESULTS The age-st and ardized incidence rate of acute MI fell from 176.1 ( 95 % CI 165.3 - 186.8 ) cases per 100,000 population ( July 1 , 2000 to June 30 , 2004 ) to 152.4 ( 95 % CI 135.3 - 169.3 ) cases per 100,000 population ( July 1 , 2004 to June 30 , 2005 ) . Smoking prevalence in Saskatoon fell from 24.1 % in 2003 ( 95 % CI 20.4 - 27.7 ) to 18.2 % in 2005 ( 95 % CI 15.7 - 20.9 ) while smoking prevalence in Saskatchewan remained unchanged at 23.8 % ( 95 % CI 22.6 - 25.3 ) and Canada reduced from 22.9 % ( 95 % CI 22.5 - 23.3 ) to 21.3 % ( 95 % CI 20.8 - 21.8 ) . Seventy-nine percent of Saskatoon residents believed the smoking ban was a good idea . INTERPRETATION The public smoking ban in Saskatoon , Canada , is associated with reduced incidence rates of acute MI , lower smoking prevalence and high levels of public support BACKGROUND Currently , there is little underst and ing of the relationship between the strength of workplace smoking policies and the likelihood and duration , not just the likelihood , of exposure to secondh and smoke at work . METHODS This study assessed self-reported exposure to secondh and smoke at work in hours per week among a cross-sectional sample of 3650 Massachusetts adults who were employed primarily at a single worksite outside the home that was not mainly outdoors . The sample data were from a larger longitudinal study design ed to examine the effect of community-based tobacco control interventions on adult and youth smoking behavior . Participants were identified through a r and om-digit-dialing  telephone survey . Multiple logistic regression and zero-inflated negative binomial regression models were used to estimate the independent effect of workplace smoking policies on the likelihood and duration of exposure to secondh and smoke . RESULTS Compared to employees whose workplace banned smoking completely , those whose workplace provided design ated smoking areas had 2.9 times the odds of being exposed to secondh and smoke and 1.74 times the duration of exposure , while those with no restrictions had 10.27 times the odds of being exposed and 6.34 times the duration of exposure . CONCLUSIONS Workplace smoking policies substantially reduce the likelihood of self-reported secondh and smoke exposure among employees in the workplace and also greatly affect the duration of exposure BACKGROUND Formal efforts to recruit smokers into cessation programs have failed to reach large segments of the smoking population . Telephone intervention may represent a viable strategy to promote smoking cessation . An even more promising approach may be a combination of brief telephone support and outreach to identified smokers . METHODS Telephone support for smoking cessation  was provided to four identified smoker population s in Bloomington , Minn , one of three Minnesota Heart Health Program education communities . Smokers were r and omly assigned to an intervention consisting of two 15-minute telephone calls approximately 1 to 3 weeks apart or to a nonintervention control . RESULTS At the 6-month follow-up , a significant overall effect was found in favor of the intervention condition for both self-reported and cotinine-vali date d quitting . Differences between intervention and control conditions were no longer significant at 18 months . CONCLUSIONS Smokers '  receptivity to telephone intervention was at least moderately encouraging . The cost of intervention could be relatively low if trained volunteers initiated telephone calls . However , more intensive telephone intervention and support may be needed to produce lasting changes in smoking prevalence Background : Be Active Eat Well ( BAEW ) was a multifaceted community capacity-building program promoting healthy eating and physical activity for children ( aged 4–12 years ) in the Australian town of Colac . Objective : To evaluate the effects of BAEW on reducing  children 's unhealthy weight gain . Methods : BAEW had a quasi-experimental , longitudinal design with anthropometric and demographic data collected on Colac children in four preschools and six primary schools at baseline ( 2003 , n=1001 , response rate : 58 % ) and follow-up ( 2006 , n=839 , follow-up rate : 84 % ) . The comparison sample was a stratified r and om selection of preschools ( n=4 ) and primary schools ( n=12 ) from the rest of the Barwon South Western region of Victoria , with baseline assessment in 2003–2004 ( n=1183 , response rate : 44 % ) and follow-up in 2006 ( n=979 , follow-up rate : 83 % ) . Results : Colac children had significantly lower increases in body weight ( mean : −0.92 kg , 95 % CI : −1.74 to −0.11 ) , waist ( −3.14 cm , −5.07 to −1.22 ) , waist/height ( −0.02 , −0.03 to −0.004 ) , and body mass index z-score ( −0.11 , −0.21 to −0.01 ) than comparison children , adjusted for baseline variable , age , height , gender , duration between measurements and clustering by school . In Colac , the anthropometric changes were not related to four indicators of socioeconomic status ( SES ) , whereas in the comparison group 19/20 such analyses showed significantly greater gains in anthropometry in children from lower SES families . Changes in underweight and attempted weight loss were no different between the groups . Conclusions : Building community capacity to promote healthy eating and physical activity appears to be a safe and effective way to reduce unhealthy weight gain in children without increasing health inequalities During the 1980s three comprehensive community-based heart disease prevention trials were conducted in the United States . The Stanford Five-City Project , Minnesota Heart Health Program , and Pawtucket Heart Health Program involved 12 cities ; six received a 5 - 8 year multifactorial risk reduction program .  This analysis pools data from the three studies to delineate the common intervention effects with greater sample size and power than could be attained by the single studies . Time trends were estimated for cigarette smoking , blood pressure , total cholesterol , body mass index , and coronary heart disease mortality risk in women and men aged 25 - 64 years . The joint estimates of intervention effect were in the expected direction in nine of 12 gender-specific comparisons ; however , these were not statistically significant . The results illustrate the analytic challenges of evaluating community-based prevention trials and point to the smaller than expected net differences , rather than small sample size , as the reason for few statistically significant effects in the three U.S. prevention trials The Minnesota Heart Health Program was a community trial of cardiovascular disease prevention methods that was conducted from 1980 to 1990 in three Upper Midwestern communities with three matched comparison communities . A 5- to 6-year intervention program used community-wide and individual health education in an attempt to decrease population risk . A major hypothesis was that the incidence of vali date d fatal and nonfatal coronary heart disease and stroke in 30- to 74-year-old men and women would decline differentially in the education communities after the health promotion program was introduced . This hypothesis was investigated using mixed-model regression . The intervention effect was modeled as a series of annual departures from a linear secular trend after a 2-year lag from the start of the intervention program . In the education communities , 2,394 cases of coronary heart disease and 818 cases of stroke occurred , with 2,526 and 739 cases , respectively , being seen in the comparison communities . The overall decline in coronary heart disease incidence was 1.8 percent per year in men ( p = 0.03 ) and 3.6 percent per year in women ( p = 0.007 ) . For stroke , there were no significant secular trends . The authors recently published findings showing minimal effects of sustained intervention on risk factor levels . In the current report , there was no evidence of a significant intervention effect on morbidity or mortality , either for coronary heart disease or for stroke Smokers ( N = 3,030 ) were r and omized to receive 1 of 3 interventions : ( a ) a self-help quit kit , ( b ) a quit kit plus 1 telephone counseling session , or ( c ) a quit kit plus up to 6 telephone counseling sessions , scheduled according to relapse probability . Both counseling groups achieved significantly higher abstinence rates than the self-help group . The rates for having quit for at least 12 months by intention to treat were 5.4 % for self-help , 7.5 % for single counseling , and 9.9 % for multiple counseling . The 12-month continuous abstinence rates for those who made a quit attempt were 14.7 % for self-help , 19.8 % for single counseling , and 26.7 % for multiple counseling . A dose-response relation was observed , as multiple sessions produced significantly higher abstinence rates than a single session . The first week after quitting seems to be the critical period for intervention Objectives : To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria . Design : A non-r and omized intervention study . Setting : A medium size cafeteria in the Harvard School of Public Health . Participants : Customers of the cafeteria mainly consisting of public health students , faculty , and school staff and workers from the medical campus . Intervention : The purchase of healthy foods and dishes was subsidized and their prices reduced by 20 % . This promotion was accompanied by the distribution of educational material . Main Outcome Measures : Change in consumption of healthy and less healthy foods . Analysis : The geometric mean was used to calculate the change in consumption . Results : During the intervention , we observed a 6 % increase in the consumption of healthy foods ( 95 % confidence interval [ CI ] ; 5 % to 8 % ) , and a 2 % decline in the consumption of less-healthy foods ( 95 % CI ; −1 % to −4 % ) . After the prices returned to their original levels , the consumption of healthy foods increased further to 17 % ( 95 % CI ; 13 % to 20 % ) and a 2 % decline in the consumption of less-healthy foods ( 95 % CI ; % 1 to −5 % ) persisted . Conclusions : Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion OBJECTIVE To evaluate the effectiveness of computer-tailored newsletter interventions in improving the number and variety of fruits and vegetables eaten by adults . DESIGN The 4-group r and omized trial with pre- and postintervention measures consisted of a control group and 3 intervention groups receiving nontailored newsletters , computer-tailored newsletters , or tailored newsletters with tailored goal - setting information . Intervention groups received 1 newsletter each month for 4 months . SUBJECTS Baseline surveys were completed by 710 health maintenance organization clients . Postintervention surveys administered 6 months after baseline were completed by 573 participants ( 80.8 % ) . INTERVENTION All newsletters contained strategies for improving fruit and vegetable consumption . Tailored newsletters used computer algorithms to match a person 's baseline survey information with the most relevant newsletter messages for promoting dietary change . MAIN OUTCOME MEASURES Daily intake and weekly variety of fruits and vegetables were measured using a food frequency question naire . STATISTICAL ANALYSES PERFORMED Analysis of covariance and Tukey 's honestly significant difference test were used to assess differences in the number and variety of fruits and vegetables consumed among intervention groups . RESULTS For persons completing postintervention surveys ( n = 573 ) , all 3 newsletter groups had significantly higher daily intake and variety scores compared with the control group . Although there was a trend of improved intake and variety with each added newsletter element , there were no significant differences at follow-up among the newsletter groups . CONCLUSIONS Newsletters can be effective in improving the fruit and vegetable consumption of adults . In this study , a computer-tailoring system did not significantly enhance the effect of the nutrition newsletters on fruit and vegetable intake Purpose . Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents ' behavioral , psychosocial , and sociodemographic characteristics . Design . Cross-sectional and multilevel design . Setting . Census block groups , used as a proxy for neighborhoods , within the metropolitan region 's Urban Growth Boundary in Portl and , Oregon . Subjects . A total of 1221 residents ( mean age , 65 years ) recruited r and omly from 120 neighborhoods ( 48 % response rate ) . Measures . A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created . Residents within the sample d neighborhoods were assessed with respect to their body mass indices ( BMI ) , frequency of visits to local fast food restaurants , fried food consumption , levels of physical activity , self-efficacy of eating fruits and vegetables , household income , and race/ethnicity . Analyses . Multilevel logistic regression analyses . Results . Significant associations were found between resident-level individual characteristics and the likelihood of being obese ( BMI ≥ 30 ) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density : odds ratios for obesity , 95 % confidence intervals ( CI ) , were 1.878 ( CI , 1.006–3.496 ) for weekly visits to local fast food restaurants ; 1.792 ( CI , 1.006–3.190 ) for not meeting physical activity recommendations ; 1.212 ( CI , 1.057–1.391 ) for low confidence in eating healthy food ; and 8.057 ( CI , 1.705–38.086 ) for non-Hispanic black residents . Conclusion . Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles , poorer psychosocial profiles , and increased risk of obesity among older adults OBJECTIVE To examine the quantity ( density ) and location ( proximity ) of  tobacco outlets and retail cigarette advertising  in high school neighborhoods and their association with school smoking prevalence . METHODS Data from the 135 high schools that participated in the 2005 - 2006 California Student Tobacco Survey were combined with retailer licensing data about the location of tobacco outlets within walking distance ( 1/2 mi or 805 m ) of the schools and with observations about the quantity of cigarette advertising in a r and om sample of those stores ( n=384 ) . Multiple regressions , adjusting for school and neighborhood demographics , tested the associations of high school smoking prevalence with the density of tobacco outlets and retail cigarette advertising and with the proximity of tobacco outlets to schools . RESULTS The prevalence of current smoking was 3.2 percentage points higher at schools in neighborhoods with the highest tobacco outlet density ( > 5 outlets ) than in neighborhoods without any tobacco outlets . The density of retail cigarette advertising  in school neighborhoods was similarly associated with high school smoking prevalence . However , neither the presence of a tobacco outlet within 1000 ft of a high school nor the distance to the nearest tobacco outlet from school was associated with smoking prevalence . CONCLUSIONS Policy efforts to reduce  adolescent smoking  should aim to reduce the density of tobacco outlets and retail cigarette advertising  in school neighborhoods . This may be achieved through local zoning ordinances , including limiting the proximity of tobacco outlets to schools Abstract Objective : To determine the extent to which reducing the saturated fatty acid composition of a ubiquitously used cooking oil influenced changes in  cholesterol concentration in the population during a five year intervention  programme in Mauritius . Design : Cross sectional surveys in 1987 and 1992 determined mean total cholesterol concentrations in the population . A r and om sample of respondents in the 1992 survey completed a nutrition question naire that included questions on diet in the previous 24 hours . Setting : Mauritius . Intervention : In 1987 the  government of Mauritius changed the composition of the commonly used cooking oil from being mostly palm oil ( high in saturated fatty acids ) to being wholly soya bean oil ( high in unsaturated fatty acids ) . Subjects : 5080 and 5162 subjects in 1987 and 1992 cross sectional surveys . 2059 subjects aged 30–64 years were r and omly selected from the respondents of the 1992 survey to take part in the nutrition survey Main outcome measures : Fatty acid composition of phospholipids in pooled serum sample s from men and women from the two surveys ; measured and predicted change in serum cholesterol concentration . Results : From 1987 to 1992 total cholesterol concentrations fell significantly by 0.79 mmol/l ( P<0.001 ) in men and 0.82 mmol/l ( P<0.001 ) in women . The estimated intake of saturated fatty acids decreased by 3.5 % of energy intake in men and by 3.6 % in women , and the intake of polyunsaturated fatty acids increased by 5.5 % and 5.6 % of energy intake , respectively . These changes were reflected in changes in the fatty acid composition of serum phospholipids , and according to Keys ' formula these changes explained much of the decrease in serum cholesterol concentrations ( predicted decrease of 0.38 mmol/l in men and by 0.40 mmol/l in women ) . Conclusion : Dietary changes that entailed a reduction in the saturated fat content of a ubiquitous cooking oil explained most of the observed decrease in serum cholesterol concentration over five years in the population of Mauritius . Key messages The saturated fatty acid intake of Mauritians was reduced by modifying the composition of the widely used cooking oil Mean serum cholesterol concentration decreased by 15 % after the cooking oil intervention was introduced nationwide Effective , low cost prevention programmes for chronic disease are needed in less industrialised countries . Simple action in dietary policy could be one such OBJECTIVE Using a r and omised control trial design , this study assessed the impact of two walking interventions , on the work day step counts and health of UK academic and administrative , university employees . METHOD A convenience sample of 58 women ( age 42+/-10 years ) and 6 men ( age 40+/-11 years ) completed baseline and intervention measures for step counts , % body fat , waist circumference and systolic/diastolic blood pressure , during a ten-week period ( October to December , 2005 ) . Before intervention , baseline step counts ( five working days ) were used to r and omly allocate participants to a control ( maintain normal behaviour , n=22 ) and two treatment groups ( " walking routes " , n=21 ; " walking in tasks " , n=21 ) . Intervention effects were evaluated by calculating differences between pre-intervention and intervention data . A one-way ANOVA analysed significant differences between groups . RESULTS A significant intervention effect ( p<0.002 ) was found for step counts , with mean differences indicating a decrease in steps for the control group ( -767 steps/day ) and increases in the " walking routes " ( + 926 steps/day ) and " walking in tasks " ( + 997 steps/day ) groups . Small , non-significant changes were found in % body fat , waist circumference and blood pressure . CONCLUSIONS Findings have implication s for work-based physical activity promotion and the development of walking interventions within the completion of work-based tasks BACKGROUND Gender differences in smoking and smoking cessation among participants in the Working Well Trial are characterized . METHODS A prospect i ve r and omized matched-pair evaluation was conducted among 90 predominantly blue-collar worksites .  Cross-sectional surveys of employees ' tobacco use behaviors were conducted at baseline and after a 2.5-year smoking cessation intervention .  Respondents included 5,523 females and 12,313 males at baseline and 4,663 females and 10,919 males at follow-up . The main outcome measures included self-reported continuous smoking abstinence rates for 7 days and for 6 months . RESULTS Smoking prevalence was significantly higher for women than for men at baseline , but not at follow-up . Variables believed to influence smoking cessation were compared at baseline . Significant gender differences were found for number of cigarettes smoked/day , number of previous quit attempts , job strain , stage of change , and behavioral processes of change . At follow-up , no gender differences in quit rates were observed ; however , women in the intervention condition were more likely to quit than women in the control condition , whereas no differences were seen among men by treatment condition . CONCLUSIONS Gender is not a strong predictor of smoking cessation in this population ; however , women were more likely to quit with an intervention than without one BACKGROUND Childhood obesity has become a health problem in urban areas in China . Intervention to reduce childhood obesity should be of high priority . School-based intervention programmes are needed to deal with the growing prevalence of childhood obesity in China . METHODS Five primary schools were selected r and omly for this study in the Beijing urban area in China ; two were allocated to the intervention group and three to the control group . A total of 2425 children ( 1029 children in intervention schools and 1396 children in control schools ) took part in the study for 3 years . In the intervention group , children and their parents were involved in a programme of nutrition education and physical activity . Control school students followed their usual health and physical education curriculum with no extra intervention . RESULTS After the 3-year intervention , the prevalence of overweight and obesity were significantly lower in the intervention schools than in the control schools ( overweight : 9.8 % vs. 14.4 % , P < 0.01 ; obesity : 7.9 % vs. 13.3 % , P < 0.01 ) . The prevalence of overweight and obesity decreased by 26.3 % and 32.5 % in intervention schools respectively after intervention . The prevalence of overweight and obesity increased in control schools . There was also significant difference in body mass index between intervention and control schools ( 18.2 + /- 2.6 vs. 20.3 + /- 3.4 , P < 0.01 ) after intervention . More non-obese children became obese in the control schools ( 7.0 % ) than in the intervention schools ( 2.4 % ) at end line ( P < 0.01 ) . Among the children who were obese at baseline , 49.2 % remained obese at end line in intervention schools while 61.9 % remained obese in control schools ( P < 0.01 ) . CONCLUSIONS Our study showed that an intervention programme could be feasible in schools in Beijing , China . The prevalence of overweight and obesity was reduced in schoolchildren in Beijing through an intervention focused on nutrition education and physical activity . Overweight and obesity children as well as normal weight children and their parents should be involved in such an intervention programme OBJECTIVES : To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity .  DESIGN : Crossroads Undiagnosed Disease Study : a cross-sectional study undertaken between June 2001 and March 2003 . SETTING : A regional centre and six shire capitals of variables size in rural Victoria , Australia . PARTICIPANTS : In total , 1454 residents of r and omly selected households . MEASUREMENTS : Obesity ( by body mass index ( BMI ) or waist circumference ) , weekly recreational activity , self-reported frequency of takeaway consumption , number of local takeaway and restaurant food outlets in the area . RESULTS : The prevalence of obesity ranged from 25.5–30.8 % and was higher than the general Australian population among both men and women . Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150 min or more ( 39.7 vs 48.4 % , 46.0 % respectively , P=0.023 ) and yet reported better access to facilities and amenities for physical activity . Recreational activity of ≥150 min/week was associated with 0.75 ( 0.58–0.97 ) fold less risk of obesity . BMI was unrelated to takeaway consumption . Waist circumference was significantly lower among those eating no takeaways , but similar whether takeaways were consumed < 1/month or ≥1/week . Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products . Availability of takeaway outlets and restaurants was unrelated to obesity . CONCLUSION : The obesity epidemic exists among those without significant consumption of or availability to takeaway foods . In a setting of easy availability of food , the obesity epidemic relates strongly to reduced physical activity , but not to consumption of takeaway food Modifying the food environment is a promising strategy for promoting healthier eating behavior . This study aim ed to evaluate nutritional and weight changes in a program that used worksite cafeterias to reduce employees ' calorie content of purchased foods and improve their macronutrient intake . Participants were r and omly assigned to one of two conditions : 1 ) only environmental change ( i.e. , the introduction of 10 new low-energy-density ( ED ) foods and provision of labels for all foods sold at lunch , which listed ED , calories , and macronutrient content ) or 2 ) the environmental change plus pricing incentives for purchasing low-ED foods and education about low-ED eating delivered in four , 1-hour group sessions . Participant lunch choices were monitored electronically at the point of purchase for 3 months before the intervention was instituted ( i.e. , the baseline period ) and for 3 months afterward ( i.e. , intervention period ) . Participants were adults ( n=96 , BMI = 29.7+/-6.0 kg/m(2 ) ) who regularly ate lunch at their workplace cafeteria . There was no difference between groups in total energy intake over the study period . Across groups , energy and percent of energy from fat decreased and percent of energy from carbohydrate increased from baseline to the intervention period ( all p<.01 ) . Follow-up analyses , conducted by averaging Baseline Months 1 and 2 and comparing them to Intervention Month 3 as a conservative estimate of overall impact of the intervention , indicated that change in energy , carbohydrate , and fat intake remained significant ( p<.001 ) . Providing nutrition labels and reducing the ED of selected foods was associated with improved dietary intake This study examined the impact of an environmental intervention in the form of promotional material s and increased availability of  low-fat items  on vending machine sales . Ten vending machines were selected and r and omly assigned to one of three conditions : control , or one of two experimental conditions . Vending machines in the two intervention conditions received three additional low-fat selection s. Low-fat items were promoted at two levels : labels ( intervention I ) , and labels plus signs ( intervention II ) . The number of individual items sold and the total revenue generated was recorded weekly for each machine for 4 weeks . Use of promotional material s result ed in a small , but not significant , increase in the number of low-fat items sold , although machine sales were not significantly impacted by the change in product selection . Results of this study , although not statistically significant , suggest that environmental change may be a realistic means of positively influencing consumer behavior OBJECTIVE The aim of this study was to examine the association between food prices and food outlet density and changes in the body mass index ( BMI ) among elementary school children in the USA . METHODS The Early Childhood Longitudinal Study followed a nationally representative sample of kindergarten children over 4 years . We merged  individual-level data to ( a ) metropolitan data on food prices and ( b ) per capita number of restaurants , grocery stores and convenience stores in the child 's home and school zip code . The dependent variables were BMI changes over 1 and 3 years . We analysed mean changes with least-squares regression , and median changes and 85th percentile changes with quantile regression . We controlled for baseline BMI , age , real family income and sociodemographic characteristics . RESULTS Lower real prices for vegetables and fruits were found to predict a significantly lower gain in BMI between kindergarten and third grade ; half of that effect was found between kindergarten and first grade . Lower meat prices had the opposite effect , although this effect was generally smaller in magnitude and was insignificant for BMI gain over 3 years . Differences across subgroups were not statistically significant due to smaller sample sizes in subgroup analyses , but the estimated effects were meaningfully larger for children in poverty , children already at risk for overweight or overweight in kindergarten , and Asian and Hispanic children . There were no significant effects for dairy or fast-food prices , nor for outlet density , once we had controlled for individual characteristics and r and om intercepts to adjust st and ard errors for the sampling design . DISCUSSION The geographic variation in fruit and vegetable prices is large enough to explain a meaningful amount of the differential gain in BMI among elementary school children across metropolitan areas . However , as consumption information was not available , we can not confirm that this is the actual pathway . We found no effects of food outlet density at the neighbourhood level , possibly because availability is not an issue in metropolitan areas OBJECTIVES The purpose of this study was to evaluate the effect of a school-based intervention program to reduce overweight and improve fitness in primary school children . METHODS A cluster r and omized controlled design was used over one school year with schools as unit of r and omization . In total 20 schools and 2,622 children aged 6 - 12 years ( grade s 3 - 8 ) from multi-ethnic , low income inner-city neighbourhoods in Rotterdam , Netherl and s , participated . The intervention , named Lekker Fit ! ( Enjoy being fit ! ) was a multi-component intervention based on behavioural and ecological models . Main components of the intervention are the implementation of three physical education ( PE ) sessions a week by a professional PE teacher , additional sport and play activities outside school hours and an educational program . Main primary outcome measures were weight status , body mass index ( BMI ) , waist circumference and fitness ( 20 m shuttle run ) . RESULTS Significant positive intervention effects were found for percentage overweight children ( OR 0.53 ; 95 % CI 0.36 - 0.78 ) , waist circumference ( -1.29 cm ; 95 % CI -2.16 to -0.42 cm ) and 20 m shuttle run ( 0.57 laps ; 95 % CI 0.13 - 1.01 laps ) among pupils of grade s 3 - 5 ( 6 - 9-year olds ) . The prevalence of overweight in grade s 3 - 5 increased by 4.3 % in the control group and by 1.3 % in the intervention group . No significant effects were found for BMI or for grade s 6 - 8 ( 9 - 12-year olds ) . CONCLUSIONS Our results provide evidence for the effectiveness of the multi-component intervention Lekker Fit ! among pupils of grade s 3 - 5 and adds to the growing body of evidence that school-based programs with a focus on PA are most effective in reducing childhood obesity . [ IS RCT N84383524 ] OBJECTIVE The Nutrition Labeling and Education Act of 1990 m and ated that st and ardized nutrition information appear on almost all packaged foods manufactured after May 1994 . This study describes the demographic and diet-related psychosocial correlates of nutrition label use , and examines the relationship between label use and diet . DESIGN /SUBJECTS Data are from a r and om-digit-dial telephone survey of 1,450 adult residents of Washington State . The question naire assessed nutrition label use , fat-related diet habits , fruit and vegetable consumption , diet-related psychosocial factors , health behavior , and demographic characteristics . STATISTICAL ANALYSES Analyses examined associations of demographic characteristics with nutrition label use ; diet-related psychosocial factors and health behavior with nutrition label use , controlled for demographic characteristics ; and nutrition label use with fat and fruit and vegetable intake , controlled for demographic characteristics and psychosocial factors . RESULTS  Nutrition label use was significantly higher among women , residents younger than 35 years , and residents with more than a high school education . When controlled for demographic characteristics , the strongest predictors of label use were believing in the importance of eating a low-fat diet , believing in an association between diet and cancer , and being in the maintenance stage of change for adopting a low-fat diet . Label use was significantly associated with lower fat intake and , after controlling for all demographic , psychosocial , and behavioral variables , explained 6 % of the variance in fat intake ( P < .001 ) . Label use was not associated with fruit and vegetable consumption . APPLICATIONS/ CONCLUSION Persons successfully limiting their fat intake use nutrition labels , suggesting that the new nutrition labels are helpful . Dietetics professionals can use the results of this study to emphasize to their clients the importance of reading nutrition labels in maintaining a low-fat diet BACKGROUND Research has shown that lower socioeconomic groups purchase foods that are less consistent with dietary recommendations . The price and availability of foods are thought to be important mediating factors between socioeconomic position and food purchasing . OBJECTIVES We examined the relative contribution of the perceived and objective ly measured price and availability of recommended foods to household income differences in food purchasing . METHODS Using a face-to-face interview , a r and om sample of Brisbane residents ( n=812 ) were asked about their food purchasing choices in 2000 . They were also asked about their perceptions of the price and availability of ' recommended ' foods ( i.e. choices lower in fat , saturated fat , sugar , salt or higher in fibre ) in the supermarkets where they usually shopped . Audits measuring the actual availability and price of identical foods were conducted in the same supermarkets . RESULTS Lower socioeconomic groups were less likely to make food purchasing choices consistent with dietary guideline recommendations . Objective availability and price differences were not associated with purchasing choices , nor did they contribute to socioeconomic inequalities in food purchasing choices . Perceived availability and price differences were associated with the purchase of recommended foods . Perceived availability made a small contribution to inequalities in food purchasing , however perceived price differences did not . CONCLUSION Socioeconomic inequalities in food purchasing are not mediated by differential availability of recommended foods and differences in price between recommended and regular foods in supermarkets , or by perceptions of their relative price . However , differential perceptions of the availability of recommended foods may play a small role in food purchasing inequalities BACKGROUND A substantial challenge in addressing adolescent tobacco use is that smoking behaviors occur in complex environments that involve the school setting and larger community context . PURPOSE This study provides an integrated description of factors from the school and community environment that affect youth smoking and explains variation in individual smoking behaviors both within and across schools/communities . METHODS Data were collected from 82 r and omly sample d secondary schools in five Canadian provinces ( British Columbia , Manitoba , Ontario , Quebec , Newfoundl and , and Labrador ) during the 2003 - 2004 school year . Cross-sectional data were obtained from students ; school administrators ( school-based tobacco control policies and programs ) ; and from observations in the community . In 2009 , hierarchic logistic regression was used to model the role of individual , school , and community variables in predicting student smoking outcomes . RESULTS Students who attended a school with a focus on tobacco prevention ( OR=0.87 , 95 % CI=0.81 , 0.94 ) and stronger policies prohibiting tobacco use ( OR=0.92 , 95 % CI=0.88 , 0.97 ) were less likely to smoke than students who attended a school without these characteristics . A student was more likely to smoke if a greater number of students smoked on the school periphery ( OR=1.25 , 95 % CI=1.07 , 1.47 ) . Within the community , price per cigarette ( OR=0.91 , 95 % CI=0.84 , 0.99 ) and immigrants ( OR=0.99 , 95 % CI=0.98 , 0.99 ) were inversely related to students ' smoking status . CONCLUSIONS The results suggest that school and community characteristics account for variation in smoking levels across schools . Based on the current findings , the ideal school setting that supports low student smoking levels is located in a neighborhood where the cost of cigarettes is high , provides tobacco prevention education , and has a policy prohibiting smoking OBJECTIVE The authors evaluated the effectiveness of a community education campaign to encourage a switch from high-fat ( whole and 2 % ) milk to low-fat ( 1 % , 1/2 % , and skim ) milk as a way to reduce consumption of saturated fat . METHODS Milk sales data were collected from supermarkets in the intervention and comparison communities for three one-month time periods : at baseline , immediately following the campaign , and six months after the campaign . In addition , trained volunteers conducted pre- and post-intervention telephone surveys . RESULTS Overall milk sales increased by 16 % in the intervention cities following the campaign and remained high at follow-up . Low-fat milk 's market share increased from 18 % of overall milk sales at baseline to 41 % of overall milk sales in the month following the end of the campaign , an increase in market share that was sustained at the six-month follow-up . In the post-intervention telephone survey , 38.2 % of those respondents who reported drinking high-fat milk at baseline reported having switched to low-fat milk . CONCLUSION A focused message communicated through paid advertising , public relations activities , and community-based education programs increased low-fat and overall milk consumption in one community BACKGROUND Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement , yet marketing research has long documented the influence of in-store shelf-space on consumer behavior . PURPOSE This paper combines these two str and s of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMI s of its residents . METHODS Fielded from October 2004 to August 2005 , this study combines mapping of retail food outlets , in-store surveys , and telephone interviews of residents from 103 r and omly sample d urban census tracts in southeastern Louisiana . Linear shelf-space of fruits , vegetables , and energy-dense snack foods was measured in 307 food stores in the study tracts . Residential addresses , demographic information , and heights and weights were obtained from 1243 respondents through telephone interviews .  Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area . RESULTS After controlling for sociodemographic variables , income , and car ownership , regression analysis , conducted in 2008 , showed that cumulative shelf-space availability of energy-dense snack foods was positively , although modestly , associated with BMI . A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent 's household was associated with an additional 0.1 BMI points . Fruit and vegetable shelf-space was not significantly related to BMI . CONCLUSIONS Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods , because the results suggest that the availability of energy-dense snack foods plays a role in weight status OBJECTIVE Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets , quantified by geographic distance or store concentration measures . However , in-store food availability may also be an important determinant , particularly for urban neighbourhoods with a greater concentration of small food stores . This study synthesis es both types of information - store access and in-store availability - to determine their potential relationship to fruit and vegetable consumption . DESIGN Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake . Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques . In-store fruit and vegetable availability was measured by linear shelf space . Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption . SETTING Four contiguous census tracts in central -city New Orleans . SUBJECTS A r and om sample of 102 households . RESULTS Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake ; each additional metre of shelf space was associated with 0.35 servings per day of increased intake . Fresh fruit availability was not associated with intake , although having a small food store within this same distance was a marginal predictor of fruit consumption . CONCLUSIONS The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake Objective : To test the ability of two levels of modest financial incentives to encourage weight loss among overweight employees . Methods : This study used a r and omized design with measurements at baseline , 3 , and 6 months and two levels of financial incentives ( $ 7 and $ 14 per percentage point of weight lost ) . Payments were structured so that all participants had equal ability to obtain the incentives during the study period . Results : At 3 months , participants with no financial incentive lost 2 pounds , those in the $ 7 group lost approximately 3 pounds , and those in the $ 14 group lost 4.7 pounds . Between baseline and 6 months , when the financial gains were equalized , weight losses were similar across groups . Conclusion : This study revealed that modest financial incentives can be effective in motivating overweight employees to lose weight This article presents data from a population -based , r and om-digit dialing telephone survey of 1228 employed adults in Washington State , conducted 1989 through 1990 . Eighty-one percent of men and 91 % of women reported work-site smoking restrictions . Employees in work sites with no-smoking policies were less likely to be current smokers ;  men in work sites with policies restricting smoking smoked fewer cigarettes on both workdays and nonworkdays . Forty-eight percent of male and 53 % of female smokers reported reduced smoking as a result of work-site policy . Work-site smoking policies , intended to protect against smoke exposure , may also reduce employee smoking OBJECTIVE To examine demographic and psychosocial factors that predict healthful dietary change . DESIGN A cohort study , examining how factors assessed at baseline predicted change in fat-related dietary habits and fruit and vegetable intakes 2 years later . PARTICIPANTS Participants were recruited in 1995 and 1996 by r and om-digit dialing ( response rate 0.63 ) , and followed-up in 1997 and 1998 ( follow-up rate 0.82 ) . The final sample included 336 men and 502 women . MAIN OUTCOME MEASURES Fruit and vegetable intake and fat-related dietary patterns , measured by telephone-administered surveys . STATISTICAL ANALYSES Chi2 tests and linear regression were used to test associations of baseline characteristics with dietary change . RESULTS Fat intake ( energy from fat ) decreased by approximately 2 percentage points and fruits and vegetables intake increased by 0.17 servings per day ( both P<.001 ) . Changes were significantly larger among women and persons who were well educated . Persons in the maintenance stage of change and persons who believed there was a strong relationship between diet and cancer made the largest dietary changes . Use of food labels was strongly associated with fat reduction , but not with increases in fruits and vegetables . APPLICATIONS These results suggest that food labels are useful for helping people reduce fat intake , that interventions should target persons at all stages of dietary change , and that new efforts are needed to reach men and persons who are less well educated OBJECTIVE The role local neighbourhood environments play in influencing purpose -specific walking behaviors has not been well-explored in prospect i ve studies . This study aim ed to cross-sectionally and prospect ively examine whether local physical and social environments were associated with mothers ' walking for leisure and for transport . METHODS In 2004 , 357 mothers from Melbourne , Australia , provided information on their local physical and social neighbourhood environments , and in 2004 and 2006 reported weekly time spent walking for leisure and for transport .  Environmental predictors of high levels of walking and increases in walking were examined using log binomial regression . RESULTS Public transport accessibility and trusting many people in the neighbourhood were predictive of increases in walking for leisure , while connectivity , pedestrian crossings , a local traffic speed were predictive of increases in transport-related walking . Satisfaction with local facilities was associated with increasing both types of walking , and the social environment was important for maintaining high levels of both leisure- and transport-related walking . CONCLUSION The findings provide evidence of a longitudinal relationship between physical and social environments and walking behaviors amongst mothers . Enhancing satisfaction with local facilities and giving consideration to '  walkability ' , safety and public transport accessibility during environment planning processes may help mothers to increase walking Although blood cholesterol levels in the United States have decreased slightly since the late 1980s ( 1 ) , consumption of saturated and trans fats remains above recommended maximum levels ( 2 , 3 ) , and only one quarter of U.S. adults with high cholesterol have it under control ( 4 ) . Some 24 million U.S. adults report taking cholesterol-lowering medications ( 5 ) . Changing a person 's nutrition-related behavior to improve cholesterol control is challenging ( 6 ) and a source of frustration for clinicians ( 7 ) . Public health action can complement health care provider efforts . The New York City Department of Health and Mental Hygiene adopted such a strategy when it restricted the use of artificial trans fat in restaurant food . We describe the rationale and process that led to this New York City Health Code amendment and the Department 's experience implementing the rule . Artificial trans fat is an unnecessary ingredient that poses a substantial risk to heart health . Although no r and omized , controlled trials have assessed the effect of trans fat consumption on cardiovascular events , evidence from experimental studies , dietary trials , and prospect i ve observational studies ( 3 , 8) demonstrates that consumption of trans fatty acids provides no apparent nutritional benefit and has considerable potential for harm . The Institute of Medicine ( 3 ) concluded that a positive linear trend exists between  trans fatty acid intake and low-density lipoprotein cholesterol level , which increases the risk for coronary heart disease . Unlike saturated fat , trans fat also decreases high-density lipoprotein cholesterol levels ( 3 , 8 , 9 ) . Trans fat intake has a large effect on cardiovascular health : A mere 2 % increase in energy intake from trans fat may increase the risk for a coronary event by up to 23 % ( 8) . Other potential adverse effects have been noted , such as affecting insulin sensitivity and increasing systemic inflammation , which raises additional public health concerns ( 8 , 10 ) . Each year , 6 % to 19 % of coronary heart disease events and 30000 or more premature deaths are estimated to occur in the United States because of trans fat consumption ( 8 , 11 ) . The Institute of Medicine , the American Heart Association , the U.S. Department of Agriculture , and other leading health organizations recommend minimizing trans fat intake ( 3 , 1215 ) . To achieve this , health care providers are asked to counsel patients ( 12 ) . However , such advice is unlikely to be broadly effectivemillions of Americans would need to routinely study package labels on groceries and actively seek information on trans fat in restaurant foods , where a growing proportion of calories are now consumed . Health would be better served by making the use of safer fats the default in food preparation . The Emergence of Artificial Trans Fat and Recognition of Its Risks Trans fats occur naturally in small amounts in some meat and dairy products ( 3 ) ; however , these sources make up only 21 % of total trans fat intake ( 16 ) . The remaining trans fat in the U.S. diet is artificial , produced by partial hydrogenation of vegetable oils and found mostly in processed foodsespecially baked and fried goods and spreads . Partial hydrogenation was patented in 1903 . Eight years later , Crisco ( J.M. Smucker , Orrville , Ohio ) became the first such product widely marketed in the United States ( 17 ) . These chemically modified oils , like several food ingredients in the 20th century , entered the food supply without a full evaluation of human health effects and were generally recognized as safe on the basis of experience ( 18 ) . Industrial advantages , such as extended product shelf life and fry oil stability , led to increased use in the 1950s . In the 1970s , margarine made from partially hydrogenated oil was promoted as a healthier alternative to butter ( 19 ) . However , by the 1990s , studies began to identify trans fat as a health hazard ( 9 ) . In 2003 , the U.S. Food and Drug Administration ( FDA ) required that all packaged goods display information on trans fat content by 2006 ( 20 ) . The regulation allows products that contain less than 0.5 grams of trans fat per serving to be labeled zero grams trans fat . This prompted a widespread industry response of reformulating products to declare zero grams trans fat on front-of-package labeling ( 2123 ) , although such products may still contain trans fat in small amounts , which can add up . The nutrition facts labeling allowed attentive consumers to avoid trans fat in packaged foods ; however , restaurantswhich provide one third of daily caloric intake (24)generally do not disclose nutritional information , leaving consumers no practical way to avoid trans fat . At the time of the FDA action , only Denmark limited trans fat in its entire food supply ( 25 ) . Although local health departments do not commonly regulate packaged goods , inspecting , licensing , and regulating restaurants and retail food outlets are core local public health functions ( 26 ) . Building on its food safety infrastructure , the Department trained restaurant inspectors in May 2005 to assess the presence of artificial trans fat in products used for frying , baking , or cooking or in spreads by means of food label inspection . Because inspection visits are scheduled each year on the basis of original restaurant licensing date and compliance records , a survey fielded during regularly scheduled inspections approximates a r and om sample of these establishments . In May and June 2005 , inspectors assessed the use of trans fat in oils , shortenings , and spreads used for frying , baking , or cooking or in spreads in 529 restaurants . Of the 478 restaurants that used fats for any of these purpose s and for which complete data were collected , trans fat presence could not be determined in one third . Where it could be assessed , 50 % of restaurants used artificial trans fat to prepare food . Educational Campaign In August 2005 , the Department launched an educational campaign to reduce restaurant artificial trans fat use . Information was sent to the 30000 licensed food outlets in the city , 15000 suppliers and supermarkets , and hundreds of thous and s of consumers . Mailings urged restaurants to remove artificial trans fat from food , suppliers to promote 0-grams trans fat products , and patrons to inquire about oils used . Press coverage was extensive ( 2729 ) . More than 7800 restaurant operators received training on the issue during the m and atory food protection course . Nearly a year later , inspectors surveyed 1021 restaurants in April and May 2006 by following the same methodology as the previous year . Despite the educational campaign , prevalence of artificial trans fat use remained virtually unchanged at 51 % in places where it could be assessed . Given survey findings of a wide range of restaurants that cooked without artificial trans fat , successful reformulation of packaged foods , and the Danish experience , the Department concluded that food choice and quality would be unaffected by replacing artificial trans fat and proposed using its regulatory authority to reduce artificial trans fat use ( 26 ) . Crafting Regulation Department clinical staff , food safety experts , and lawyers considered a range of regulatory options , from disclosure-only requirements to content restrictions . Labeling trans fat would benefit only consumers who were aware of and would act on the dangers of trans fat and would be difficult to enforce . A restriction , however , would benefit all New Yorkers , regardless of language , literacy , level of health awareness , or age . Protecting children , who consume French fries and other quick-service foods that are common sources of artificial trans fat ( 30 ) , was particularly important . Because artificial trans fat is both harmful and fully replaceable , allowing continued use , even with disclosure , could not be justified . Similarly , restricting trans fat in cooking oils and spreads onlyalthough easier to achievewould be insufficient because baked goods are the largest dietary source of trans fat ( 16 ) . Given that an estimated one third of calories comes from away-from-home sources , removing most trans fat from restaurants could be expected to reduce trans fatassociated deaths proportionately . The Department drafted a broad proposal to restrict artificial trans fat use in fry oils ; spreads ; and all other ingredients and products , including baked goods . For the regulation to be clear and enforceable , the Department adopted the FDA threshold used for labeling of up to 0.5 grams of trans fat per serving for products containing any trans fat ( 20 ) . The regulation would apply to all licensed food establishments , including restaurants , school cafeterias , caterers , senior centers , and street-food vendors . It intentionally did not affect products that contained only natural trans fat . The Department design ed enforcement to rely on existing infrastructure . Inspectors check product labels , which restaurants now must maintain , during their regular annual inspections . The rule included a 6-month phase-out period for artificial trans fat in fry oils and spreads and 18 months for all other items , to give restaurants time to identify alternatives and reformulate ( 31 ) . Fines for violations range from $ 200 to $ 2000 . From Concept to Action The regulation was proposed as an amendment to the city 's Health Code , approvable by the Board of Health . Nearly 2300 public comments were received , with supporters outnumbering opponents 31 to 1 . Local , regional , and national organizations and professional medical associations made statements of support . Opposition came primarily from industry associations , including the National Restaurant Association and its state affiliate and the Grocery Manufacturers Association ( 32 ) . The restaurant industry , which often opposes regulation on principle , alleged that the elimination of artificial trans fat would result in more expensive and less flavorful food and also cl aim ed that the supply of alternative oils was insufficient and the regulatory timeline BACKGROUND Empiric studies find that context ual factors affect individual weight status over and above individual socioeconomic characteristics . Given increasing levels of obesity , research ers are examining how the food environment contributes to unhealthy weight status . An important change to this environment is the increasing availability of away-from-home eating establishments such as restaurants . METHODS This study analyzed the relationship between the  restaurant environment and weight status across counties in the United States . Individual data from the 2002 - 2006 Behavioral Risk Factor Surveillance System ( N=714,054 ) were linked with  restaurant data from the 2002 U.S. Economic Census . Fast-food and full-service restaurant density , along with restaurant mix ( the ratio of fast-food to full-service restaurants ) , were assessed . RESULTS Fast-food restaurant density and a higher ratio of fast-food to full-service restaurants were associated with higher individual-level weight status ( BMI and the risk of being obese ) . In contrast , a higher density of full-service restaurants was associated with lower weight status . CONCLUSIONS Area-level restaurant mix emerged as an important correlate of weight status , with components of the restaurant environment exhibiting differential associations . Hence , it is the availability of fast-food relative to other away-from-home choices that appears salient for unhealthy weight outcomes . Areas with a high density of full-service restaurants were indicative of a more healthful eating environment , suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants . Future prospect i ve studies are required to delineate causal pathways Anti-smoking media directed at adolescents use many different message themes , but little evidence exists as to which is most effective . Additionally , little is known about how teens who smoke respond to anti-tobacco ads . This study examined smoking and nonsmoking adolescents ' responses to three popular thematic approaches : ( 1 ) endangering others , ( 2 ) negative life circumstances , and ( 3 ) industry manipulation .  Sixteen groups of high school students ( total N = 488 ) were r and omly assigned in a balanced fashion to one of three anti-tobacco ad conditions or a control condition . Outcome variables included adolescents ' immediate emotional and cognitive responses , and intentions to smoke . Adolescents exposed to negative life circumstances ads reported lower intentions to smoke than those exposed to control and industry manipulation ads . Additionally , adolescents ' responses differed based on smoking status . Smokers liked the ads less and had fewer positive and more negative thoughts . Findings suggest a media campaign focusing on negative life circumstances can be an effective component of a tobacco control program aim ed at adolescents . Mechanisms through which the negative life circumstances ads influence adolescents ' intentions to smoke are discussed . Findings also suggest that smokers respond differently to anti-tobacco ads , and their responses need to be considered when developing effective anti-tobacco advertising campaigns
target: Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified , providing a set of specific evidence -based strategies that deserve close attention and prioritization for wider implementation .
  Effective interventions included specific approaches in all 6 domains evaluated for improving diet , increasing activity , and reducing tobacco use .
  The writing group also identified several specific interventions in each of these domains for which current evidence was less robust , as well as other inconsistencies and evidence gaps , informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies .
  This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
background: BACKGROUND Poor lifestyle behaviors , including suboptimal diet , physical inactivity , and tobacco use , are leading causes of preventable diseases globally .
  Although even modest population shifts in risk substantially alter health outcomes , the optimal population -level approaches to improve lifestyle are not well established .