Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation represent systematic disparities consistent with the disproportionality literature.

A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.

Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low implementation scores had a greater percentage of students who identified as African American/Black and nurses with less experience.

Findings highlight current disparities in the implementation of concussion management policies and support adoption of a disproportionality lens in this sphere.

Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents.

Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding.

One private secondary school and two after-school clubs.

Convenience sample of 105 Uruguayan adolescents aged 11–17 years.

Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products.

This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.

To characterize the association between the protracted biopsychosocial coronavirus disease 2019 (COVID-19) pandemic exposures and incident suicide attempt rates.

Data were from a nationally representative cohort based on electronic health records from January 2013 to February 2021 (N = 852 233), with an interrupted time series study design. For the primary analysis, the effect of COVID-19 pandemic on incident suicide attempts warranting in-patient hospital treatment was quantified by fitting a Poisson regression and modeling the relative risk (RR) and the corresponding 95% confidence intervals (CIs). Scenarios were forecast to predict attempted suicide rates at 10 months after social mitigation strategies. Fourteen sensitivity analyses were performed to test the robustness of the results.

Despite the increasing trend in the unexposed interval, the interval exposed to the COVID-19 pandemic was statistically significant (p < 0.001) associated with a reduced RR of incident attempted suicide (RR = 0.63, 95% CI 0.52–0.78). Consistent with the primary analysis, sensitivity analysis of sociodemographic groups and methodological factors were statistically significant (p < 0.05). No effect modification was identified for COVID-19 lockdown intervals or COVID-19 illness status. All three forecast scenarios at 10 months projected a suicide attempt rate increase from 12.49 (7.42–21.01) to 21.38 (12.71–35.99).

The interval exposed to the protracted mass social trauma of the COVID-19 pandemic was associated with a lower suicide attempt rate compared to the unexposed interval. However, this trend is likely to reverse 10 months after lifting social mitigation policies, underscoring the need for enhanced implementation of public health policy for suicide prevention.

The aim of this study was to explore and analyse the actions implemented by civil society to contribute to food security in the context of the COVID-19 outbreak in Uruguay, a high-income country in South America.

An exploratory systematic approach was used to identify the contributions of civil society to food security through reports in news websites and Facebook posts. Data were analysed based on content analysis following a deductive–inductive approach.

Uruguay, Latin America.

A total of 1220 civil society organisations were identified, which developed two main actions to increase access to food among the Uruguayan population: food baskets and ‘community pots’ (also known as ‘common pots’). Most of the initiatives targeted citizens under socioeconomic vulnerability in the face of COVID-19, without specifying any specific requirement or population segment. Actions were mainly led by spontaneously organised community groups, and, to a lesser extent, by consolidated organisations. Interactions between organisations were identified. The foods provided by the organisations were mostly aligned with national dietary guidelines. Social media posts evidenced that the main challenge faced by organisations was related to the lack of funds or supplies.

Results from this work suggest that the lack of funds or supplies poses challenges to the medium- and long-term contributions of civil society to food security and stresses the need for comprehensive governmental measures to guarantee food security amongst Uruguayan citizens.

In 2015, beverages were removed from display at a self-service café within a major health service, resulting in fewer purchases of unhealthy beverages. This initiative was continued following initial evaluation of the results. The current study aimed to determine customer acceptability of the initiative, and whether healthier purchases had continued, at 18 months following implementation.

Drinks were categorised as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit), based on the state government nutrient profiling system, for intervention and analysis purposes. In 2015, unhealthy ‘red’ drinks were removed from display. In 2017, weekly beverage sales were counted, through stock-taking, for 6 weeks, and customer surveys were conducted over 2 days.

A café located within a major Victorian health service.

Café customers (hospital staff, patients and visitors).

Eighteen months after the implementation of the initiative, the proportion of ‘red’ beverages sold was 7 % of total drink sales (compared with 33 % before the removal of unhealthy beverages from display in 2015 (P < 0·001), and 10 % immediately following the removal of unhealthy beverages from display). Customer surveys revealed high levels of acceptability for the initiative and low levels of awareness of the initiative.

The removal of unhealthy beverages from display can result in customers making healthier purchases, and this appears to continue over the long-term. Such interventions have the potential to contribute to the sustained shift in population purchases and consumption needed to make meaningful improvements to population health.

To assess the consumption of sugar-sweetened beverages (SSB) and other energy-dense nutrient-poor (EDNP) foods in two Southern low-income communities targeted by the Balance Calories Initiative, a campaign by the top-three American beverage companies intended to reduce the consumption of sugary beverages by 20 % over 10 years.

We conducted self-administered intercept surveys in front of food retail outlets between August and November 2016. We recruited adults with children <18 years living at home and adolescents aged 10–17 years with parental consent.

Retail food outlets in Mississippi and Alabama, USA.

Adults (n 11 311) and adolescents (n 3460).

The percentage of high SSB consumers (≥4 servings/d) was 40·9 % among adult males, 32·3 % among adult females, 43·0 % among adolescent males and 34·4 % among adolescent females (male – female difference, P < 0·0001). In aggregate, respondents also reported consuming a mean of 3 servings of salty snacks, cookies and/or candy in the past 24 h, with adolescent males reporting 4 servings.

SSB should be a primary target of future interventions to improve dietary intake, but EDNP foods likely contribute as many daily kilojoules as SSB among this population. Future campaigns should aim to limit the consumption of all EDNP foods.

In politically contested health debates, stakeholders on both sides present arguments and evidence to influence public opinion and the political agenda. The present study aimed to examine whether stakeholders in the Soft Drinks Industry Levy (SDIL) debate sought to establish or undermine the acceptability of this policy through the news media and how this compared with similar policy debates in relation to tobacco and alcohol industries.

Quantitative and qualitative content analysis of newspaper articles discussing sugar-sweetened beverage (SSB) taxation published in eleven UK newspapers between 1 April 2015 and 30 November 2016, identified through the Nexis database. Direct stakeholder citations were entered in NVivo to allow inductive thematic analysis and comparison with an established typology of industry stakeholder arguments used by the alcohol and tobacco industries.

UK newspapers.

Proponents and opponents of SSB tax/SDIL cited in UK newspapers.

Four hundred and ninety-one newspaper articles cited stakeholders’ (n 287) arguments in relation to SSB taxation (n 1761: 65 % supportive and 35 % opposing). Stakeholders’ positions broadly reflected their vested interests. Inconsistencies arose from: changes in ideological position; insufficient clarity on the nature of the problem to be solved; policy priorities; and consistency with academic rigour. Both opposing and supportive themes were comparable with the alcohol and tobacco industry typology.

Public health advocates were particularly prominent in the UK newspaper debate surrounding the SDIL. Advocates in future policy debates might benefit from seeking a similar level of prominence and avoiding inconsistencies by being clearer about the policy objective and mechanisms.

Latin American countries are taking important steps to expand and strengthen universal health coverage, and health technology assessment (HTA) has an increasingly prominent role in this process. Participation of all relevant stakeholders has become a priority in this effort. Key issues in this area were discussed during the 2017 Latin American Health Technology Assessment International (HTAi) Policy Forum.

The Forum included forty-one participants from Latin American HTA agencies; public, social security, and private insurance sectors; and the pharmaceutical and medical device industry. A background paper and presentations by invited experts and Forum members supported discussions. This study presents a summary of these discussions.

Stakeholder involvement in HTA remains inconsistently implemented in the region and few countries have established formal processes. Participants agreed that stakeholder involvement is key to improve the HTA process, but the form and timing of such improvements must be adapted to local contexts. The legitimization of both HTA and decision-making processes was identified as one of the main reasons to promote stakeholder involvement; but to be successful, the entire system of assessment and decision making must be properly staffed and organized, and certain basic conditions must be met, including transparency in the HTA process and a clear link between HTA and decision making.

Participants suggested a need for establishing clear rules of participation in HTA that would protect HTA producers and decision makers from potentially distorting external influences. Such rules and mechanisms could help foster trust and credibility among stakeholders, supporting actual involvement in HTA processes.

The aim of this study was to identify good practice principles for health technology assessment (HTA) that are the most relevant and of highest priority for application in Latin America and to identify potential barriers to their implementation in the region.

HTA good practice principles proposed at the international level were identified and then explored during a deliberative process in a forum of assessors, funders, and product manufacturers.

Forty-two representatives from ten Latin American countries participated. Good practice principles proposed at the international level were considered valid and potentially relevant to Latin America. Five principles were identified as priority and with the greatest potential to be strengthened at this time: transparency in the production of HTA, involvement of relevant stakeholders in the HTA process, mechanisms to appeal decisions, clear priority-setting processes in HTA, and a clear link between HTA and decision making. The main challenge identified was to find a balance between the application of these principles and the available resources in a way that would not detract from the production of reports and adaptation to the needs of decision makers.

The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.

The present study assessed the impact of the retailer-led removal of unhealthy beverages from display at a self-service café within a major health service. While unhealthy beverages remained available from behind the counter upon request, this was not communicated directly to customers.

Drinks were categorised based on the state government nutrient profiling system, classifying drinks as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit). Total drink sales (as number of items sold per week) in the café were measured for five weeks. All unhealthy ‘red’ beverages were removed from display (but were still available for purchase) and the sales of all beverages were measured for another six weeks.

We found that, in response to this strategy, the proportion of ‘red’ drinks sold decreased from 33 % to 10 % of total drink sales. As ‘amber’ and ‘green’ drink sales increased in response to this strategy, total retailer sales remained steady. Most consumers appeared to switch to purchasing ‘amber’ drinks rather than the healthiest option, ‘green’ drinks.

The removal of unhealthy beverages from display can result in consumers making healthier purchases, while not significantly affecting retailers’ sales.

To compare the energy, nutrient and food group compositions of three sources of school-day lunches among students in five secondary schools in the Republic of Ireland (ROI).

Cross-sectional study conducted between October 2012 and March 2013. Students completed self-report food diaries over two school days. The energy, nutrient, nutrient density and food group composition of school-day lunches from home, school and ‘out’ in local food outlets were compared using ANCOVA and Tukey’s Honest Significant Difference post hoc analysis.

Five secondary schools in the ROI.

Male and female students aged 15–17 years (n 305).

Six hundred and fifteen lunches (376 home lunches, 115 school lunches and 124 lunches sourced ‘out’ in the local environment) were analysed. School and ‘out’ purchased lunches were significantly higher than packed lunches from home in energy (2047 kJ (489 kcal), 2664 kJ (627 kcal), 1671 kJ (399 kcal), respectively), total fat (23·5 g, 30·1 g, 16·6 g, respectively) and free (added) sugars (12·6 g, 19·3 g, 7·4 g, respectively). More home lunches contained more fruit, wholemeal breads, cheese and red meat than lunches from school or ‘out’. Meat products, chips and high-calorie beverages were sourced more frequently at school or ‘out’ than home. Fibre and micronutrient contents of lunches from all sources were low.

Home-sourced lunches had the healthiest nutritional profile in terms of energy and macronutrients. Foods high in energy, fat and free sugars associated with school and local food outlets are of concern given the public health focus to reduce their consumption. While school food should be improved, all sources of lunches need to be considered when addressing the dietary behaviours of secondary-school students.