Purpose: Across numerous contexts, many adults accumulate considerable time in screen-based behaviours, which has been associated with negative physical and psychological health outcomes. Currently, there is a lack of evidence on patterns of contemporary screen-based behaviours and trends in usage over time. Using up-to-date industry data, the purpose of this research was to characterise contemporary patterns of screen-based behaviours and describe temporal trends in these behaviours by global region, age, sex and education.

Methods: Data were from GWI (previously known as Global Web Index), a digital technology market research company, and were collected annually between 2012 and 2019. Temporal trends in PC, laptop and tablet use, mobile phone use, traditional TV viewing, online TV viewing and games console use were described using data from over 2 million participants from 46 countries. Total screen time was calculated as the sum of all behaviours listed above. Means and standard deviations (SD) were calculated for each time point for the full sample and stratified by global region, age, sex and education.

Results/Findings: Globally, daily mean duration of screen time increased from approximately 9 hours in 2012 to 11 hours in 2019. Latin America exhibited the largest increase in screen-time during this period (2012 (mean(SD): 10:38(10:55); 2019: 13:43(12:59)). Globally, between 2012 and 2019, time spent watching traditional TV decreased by approximately 15 minutes whilst the duration of time spent on a mobile phone increased by approximately 2 hours. The results also demonstrated that duration of time spent on different types of screens varied by socio-demographic factors. Daily mean duration of time spent on a mobile phone demonstrated noticeable differences between age groups with usage being much higher in younger age groups.

Conclusions: The findings indicate that screen-based behaviours such as mobile phones and online TV have become more prevalent over the last 8 years. However, these behaviours are rarely included in public health surveillance and little is known about their links to physical and mental health. Surveillance and research tools should be reviewed and updated to include contemporary types of screen-based behaviours.

 

Purpose: Mothers play a crucial role in shaping children's early experiences with foods. This study was conducted to explore the association between maternal feeding practices and toddlers’ fruit and vegetable intakes in Ireland. Relevant studies have focused on pre-school and school-age children. This study was novel in investigating into toddlerhood, the critical period for the development of eating habits.

 

 

 

Methods: The DIT-Coombe Hospital birth cohort was conducted in Dublin to assess maternal breastfeeding and weaning practices from birth to six months of infants’ life. The present study was a follow up study two years upon the completion of the cohort. Mothers in the cohort were contacted via telephone and invited to participate in the present study. A questionnaire assessing maternal feeding behaviour and the child's 3-day food diary were sent to mothers who agreed to take part in the present study by mail, together with a self-addressed stamped envelope. Logistic regression analyses were performed to examine the association between maternal infant and toddler feeding practices and toddlers’ fruit and vegetable consumption, after controlling for potential confounders.

 

 

 

Results: There were 193 mother-children pairs included in this study, including 106 (54.9%) boys and 87 (45.1%) girls. The mean age of children was 2.4±0.7 years. Toddlers’ mean daily intake of vegetable was 149.6±73.7g, and the median daily intake of fruit was 169 (IQR: 101, 289) g. The contribution of fruit and vegetable to total dietary intake was 24.3%. Maternal practices of letting the child eat with other family members (OR=3.894, 95% CI: 1.155-13.127) and not being too worried about child’s food refusal (OR=2.858, 95% CI=1.295-6.307) were positively associated with toddlers’ vegetable intake. Breastfeeding for more than four weeks (OR=2.508, 95% CI: 1.167-5.394) and the use of coaxing strategy (OR=2.234, 95%CI=1.024-4.912) was positively associated with toddlers’ fruit intake.

 

 

 

Conclusions: To promote toddler’s fruit and vegetable intake, and develop good eating habits, mothers should eat with their children, be patient and not put much pressure on their children when feeding.

Purpose: Adolescents from families of lower socioeconomic position (SEP) tend to be less physically active than their counterparts from higher SEP families. Research on adolescents, socioeconomic inequalities, and physical activity needs to look beyond only the individual level to understand how environmental factors interact and influence social inequalities in physical activity. The present qualitative study takes an ecological view exploring how adolescents and their parents from higher and lower SEP neighbourhoods in Oslo, Norway, perceive the social, organisational and physical environment to influence adolescents’ physical activity behaviours.

Methods: We conducted six semi-structured focus groups with 35 13–14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower SEP neighbourhoods in Oslo, Norway. Theme-based inductive coding was used for analysis.

Results: The results indicate that the barriers and facilitators for physical activity varied between the SEP neighbourhoods. Factors like social norms in a neighbourhood could shape adolescents’ physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher SEP neighbourhood. Higher availability and high parental engagement did also seem to facilitate higher physical activity in this neighbourhood. In the lower SEP neighbourhoods, the availability of local organised physical activity and volunteer participation and engagement from parents varied. Programmes from the municipality and volunteers seemed to influence and be essential for adolescents’ physical activity behaviour in these neighbourhoods.

Conclusions: The results indicate that the perceived barriers and facilitators for physical activity varied between the SEP neighbourhoods and that several factors could affect adolescents’ physical activity levels. The results illustrate a limitation in explaining the phenomenon if the focus is primarily at the individual level in an ecological model and not at several levels at the same time. An extra focus towards the lower SEP neighbourhoods and opportunities for organised physical activity for all adolescents could facilitate physical activity behaviour. The results could inspire interventions and policy actions aiming to promote and facilitate physical activity behaviour in adolescents’ local neighbourhoods.

Purpose: Obesity prevention often has an insufficient quality of planning, which can influence the intervention's success. The systematic and theory-based development of interventions is complex and requires time as well as personnel resources. With WEPI we aim to develop a web-based planning tool for municipalities and schools, that follows the evidence-based intervention mapping approach (IMA) but also supports the planning process of obesity prevention time saving and user-oriented. The project is supported by the Federal Ministry of Health, Germany.

Methods: To meet the requirements of the IMA, two systematic literature reviews (SLR) were conducted in the databases Pubmed, LIVIVO and Cochrane on evidence-based determinants of obesity development and on proven obesity intervention methods. Because of Covid‑19 the first version of WEPI was virtually tested with selected municipalities and schools in October 2020. In addition, the second version was reflected and discussed in a virtual meeting with experts from health promotion. The prototype as a third version was tested by three municipalities and two schools in February 2021. Feedback was collected through questionnaires and telephone interviews.

Results: The first SLR revealed 806 hits. Evidence-based determinants for the development of obesity were identified in 8 guidelines and 37 reviews. They were adopted for WEPI in form of 15 problem areas. Based on these problem areas, the WEPI user can conduct an evidence-based problem analysis. The result of the second SLR are 25 obesity prevention interventions that were developed using the IMA. Evaluated methods of these interventions were integrated into the planning tool and recommended as good practice. In the first trial the expert feedback revealed aspects of content and user-friendliness as well as technical aspects that should be optimized in the WEPI planning tool. The feedback of the municipalities and schools underlines, that scientific findings need to be translated into practical logic.

Conclusions: Using WEPI, prevention planning becomes more evidence-based and user-oriented. The intervention's standardization and quality assurance are guaranteed as the planning process is transparent and supported by scientific content. In the next step, WEPI will be tested and evaluated with municipalities and schools from March to December 2021.

Purpose: Most adults fail to meet physical activity (PA) guidelines. A broader understanding of barriers, reinforcements, and motivators of PA is important for community-based program development. 

Methods: Four years of baseline, data from a community-based walking program were analyzed (n=1491).  Barriers to PA were assessed with seven dichotomous items assessing weather, health, and time-related barriers.  Reinforcements to PA were assessed with four dichotomous items assessing weather and health related reinforcements.  Participants were also asked to provide open-ended responses to barriers and reinforcements to PA. Self-reported physical activity and walking was assessed using the International Physical Activity Questionnaire Short-Form.

Descriptive statistics summarized participant characteristics, barriers, reinforcements, and PA. Open-ended responses were analyzed using thematic analysis. Chi-square and two-sample t-tests were used to assess differences between the reported barriers, reinforcements, and motivators and PA-level.

Results: On average, participants were white (96%), middle age (52±13 years old) females (92%) with 30% of participants classified as low PA, 35% as moderate PA, and 35% as high PA.

Participants classified as moderate or high PA were more likely to be motivated by health reasons including weight maintenance. Inactive participants were more likely to report weather and time related barriers. Inactive participants were also more likely to be overweight or obese. There was no significant difference between PA category and other demographics. 

Open-ended responses (n=141) identified additional barriers (listed in frequency) of lack of motivation (n=37), joint issues (n=29), being tired (n=24), safety or lack of environmental supports (n=17), family or work demands (n=15), would rather do something else (n=10), or do not have a walking partner (n=9). Additional motivators (n=282) were identified of stress relief and mental health (n=82), social time (n=70), dog care (n=41), other health benefits (n=38), connect with nature (n=19), enjoyment (14), occupation (n=11), environmental and community supports (n=6)

Conclusions: Findings highlight the importance of understanding participant barriers and motivators for PA before starting a program.  Future research will examine how reported barriers and motivators are related to program completion and adherence. Tailoring community-based programs to address specific barriers and motivators may enable more participants to effectively change and maintain PA.

 

Purpose: In the U.S., Black adolescent girls living in low-income communities experience high rates of obesity, low diet quality and physical activity, and short sleep duration. In a sample of Black adolescent girls, we aimed to identify longitudinal reciprocal associations between unique sleep patterns and cardiometabolic factors. 

Methods: We used longitudinal data from a multilevel school-based randomized controlled trial aimed at improving diet and physical activity behaviors among adolescent girls. Nocturnal sleep data (total sleep time, sleep quality) were extracted from omnidirectional accelerometers worn > 7 days at T1 (enrollment, n = 556), T2 (6-month follow-up, n = 419), and T3 (18-month follow-up, n = 329) using a validated algorithm. We measured height and weight at Time 1-3 (calculated z-scores for body mass index, zBMI) and systolic and diastolic blood pressure (SDBP) at T1 and T3 using a digital oscillometric monitor (values normalized for U.S. adolescents). We used longitudinal latent profile analysis on sleep minutes/efficiency to derive mutually exclusive sleep profiles with discrete change over time. We used poisson models with robust variance to examine whether T1 zBMI and SDBP predicted sleep profiles, and linear regression models to examine if sleep profiles predicted T3 cardiometabolic factors (BMIZ, SDBP), controlled for age, race, and Tanner score. 

Results: At enrollment, girls were mean 12.2 years old (+ 0.72), 48.6% had overweight or obesity, systolic and diastolic at the 59^th and 39^th percentiles, respectively. At T1, girls had valid sleep data for 4.8 nights, mean nighttime sleep of 7.9 hours. Girls followed two sleep profiles: regular (86%) or irregular (13%), with no demographic or cardiometabolic differences between the profiles. T1 BP predicted sleep profile; girls had a lower likelihood of following a regular sleep trajectory for each additional point in systolic percentile at T1 (Prevalence Risk Ratio = 0.99; 95% CI: 0.98, 0.99). 

Conclusions: Girls with higher-than-average systolic BP were more likely to have an irregular sleep trajectory. Determining the sources of vulnerability in health behaviors experienced within each of these groups, such as short sleep duration and poor sleep quality, provides opportunities to intervene to disrupt chronic disease risk and address disparities

Purpose: Summer is a time of reduced physical activity (PA) for children; however, summer care programs (SCPs) can provide opportunities for children to be active and foster friendships. In the US, 14.3 million youth attend summer programs each summer. Children from low-income families were more likely than others to attend these summer programs providing an access point to potentially lessen health disparities seen in these populations. Because child PA is greatly impacted by their social network, this presentation uses social network analysis to investigate associations between PA and friendship formation among children at SCPs. 

Methods: Children (ages 8-12 years old) from two SCPs reported demographics, PA, and skill competency, at the beginning (time 1) and end of summer (time 2). Children indicated up to five people they interacted with the most while at the program. Exponential random graph modeling determined significant factors associated with the presence of friendship ties at each time point and separable temporal exponential random graph modeling determined significant changes between time points. 

Results: Children (n=166) who reported more PA were more likely to receive connections (PE=-0.24, SE=0.12), but less likely to send connections (PE=0.59, SE=0.16) at time one.  At site one, children were significantly more likely to form connections with those who reported similar levels of PA (PE-0.16, SE=0.08). However, children at site two were significantly more likely to form connections with those who differed from themselves in reported PA (PE=0.26, SE=0.12) and maintain connections with those who reported similar levels of PA (PE=-0.78, SE=0.39). Additionally, children at site two were significantly more likely to maintain outgoing connections if they reported more perceived skill (PE=0.71, SE=0.35), and incoming connections if they reported more PA (PE=0.89, SE=0.40). 

Conclusions: Overall, self-reported PA was a significant factor associated with the social connections reported at these programs, which aligns with literature on social connections in schools and after-school programs. A further understanding of the social dynamics underscoring the maintenance of PA behaviors during summer may improve the odds children engage in the recommended amounts of PA during this crucial time. 

 

Purpose: There is abundant evidence that community gardening has the potential to improve populations’ health and well-being by providing opportunities for physical activity (PA), healthy and nutritious eating, stress management and coherent communities. The benefits of community gardening can be of particular value for immigrants/refugees whose health has been observed to decline over years in the destination country, which is known as the “years since immigration effect”. We aim to investigate the impact of community gardening participation on immigrants’ PA levels, dietary practices, food security and mental well-being in the Western world. This will inform the development of effective community gardening interventions that promote immigrants’ health and well-being and reduce health disparities in immigrants-receiving countries.

Methods: A systematic scoping review of 95 studies was conducted across five electronic databases (Embase, PubMed, Medline, PsycINFO and Anthropology Plus) to locate relevant articles from Europe, Canada, the US, Australia and New Zealand, while adhering to PRISMA guidelines. Both quantitative and qualitative study designs were eligible, and no limits were made on immigrants/refugees’ age, gender or country of origin.

Results: Community gardening participation was associated with improved PA levels among immigrants who often lacked familiarity with gym exercise modalities. Community gardens enhanced immigrants’ healthy eating by improving their access to nutritious, culturally acceptable produce and reducing their consumption of poor-nutrient, energy-dense foods. Community garden interventions were significantly associated with improved food security levels among immigrants by reducing worry about food running out, tackling food shortage and combating hunger and malnutrition. In addition to improved PA and healthy eating, community gardening enhanced immigrants’ social cohesiveness and strengthened their ethnic identity, improving community resilience and mental health and well-being.  

Conclusions: Community gardening appears to be an effective health promotion and disease prevention measure that can improve immigrants’ health and well-being through multiple pathways. Mixed-method, community-engaged research is needed to thoroughly explore immigrants’ perceptions about community gardening and co-identify the elements that constitute effective community gardening interventions. This will help inform the co-development of evidence-based, tailored community gardening interventions that encourage the adoption of healthy behaviours and lifestyle choices, promoting immigrants’ health and well-being.

Purpose: Workplace interventions to increase physical activity and reduce sedentary behavior among employees have been evaluated in various reviews. However, most published reviews focus on specific interventions types, behaviors and/or populations making it difficult to draw a conclusive picture of the evidence. The purpose of this umbrella review is to identify and synthesise all systematic reviews and primary studies on physical activity and sedentary behavior workplace interventions (PROSPERO registration number CRD42020171774).

Methods: We conducted a systematic search in six scientific databases to identify systematic reviews published as peer-reviewed articles and doctoral dissertations from 2000 to 2020. Backward citation tracking and searches of relevant websites complemented the search. Reviews with or without meta-analysis and in any language were included if they evaluated the effects of workplace interventions on physical activity and/or sedentary behaviors in adult employees. Two independent reviewers screened titles, abstracts and full-texts for inclusion. Data extraction, and risk of bias appraisals using the AMSTAR 2 tool were also conducted in duplicate. To analyse the data, we extracted primary studies included in the reviews and grouped them based on intervention level (individual, social, environmental, organisational, multi-component) and type (e.g., self-monitoring intervention within individual level interventions). In our analyses we report the effects of interventions on physical activity and sedentary behavior according to intervention level and type. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to rate the quality of evidence for each of these outcomes, at each level and for each intervention type.

Results: The data base search revealed 6444 items, of which 31 were included in our umbrella review. Additional search strategies identified 10 more reviews bringing the total to 41 reviews being included. More than 120 primary studies were identified. Analysis is in its final stages and will be completed by March 2021.

Conclusion: Our umbrella review will provide guidance to those planning to implement strategies addressing sedentary behaviour or physical activity at workplace. We will also indicate research gaps and make recommendations for advancing workplace sedentary behaviour and physical activity research.

 

Purpose: Many research studies have adopted accelerometry as a measure for movement behaviors. Traditionally, the site in which the devices are attached to the body must be determined prior to deployment as it affects the choice of data extraction method and cut points, and it cannot be determined retrospectively. The ability to detect the device wear-site after collection could allow greater flexibility for deployment and less reliance on adhering instructed protocols. Thus, in this study, we developed and examined the efficiency of a machine learning-driven wear-site detection algorithm based on raw accelerometer data.

Methods: 60 participants (30 adults, 18-65 years; 30 youths, 9-17 years) wore tri-axial ActiGraph accelerometers at three sites (waist, wrist, and chest) and conducted a series of lab-based physical activities. Raw accelerations, at 100Hz, of activity segments were extracted and used for analyses. The Long Short-Term Memory approach was used for the development of the classification algorithm. 80% of the data was used for model training and the remaining 20% was used for validation.

Results/findings: Models for classification between three (waist, wrist, and chest) and two (waist and wrist only) were developed and evaluated separately. Both models resulted in high accuracies in wear-site detection: 0.94 and 0.98 for three and two wear-sites, respectively. The performances of the algorithm were similar for adults and youths.

Conclusions: The developed algorithm demonstrated promising accuracies in terms of detecting the wear-site of accelerometers. This implies that researchers can determine wear sites retrospectively and then apply appropriate cut-points for activity classification. Furthermore, wear-site neutral algorithms can be developed, which would allow researchers to measure movement behaviors of participants more accurately.

Purpose: Positive ageing represents a multidimensional and holistic approach to viewing older age. Many older adults desire to ‘age in place’ and remain physically active and mobile within their local environments. As the mobility radius of older adults decreases with age and frailty, the importance of supportive and accessible built environment features is intensified. Yet, the vast positive ageing literature has rarely explored the contribution of the built environment, place, and physical mobility. Guided by Arksey and O’Malley’s scoping review framework, we bring together heterogenous terminology and understandings to explore positive ageing among community-dwelling older adults in relation to built environment, place, and mobility.

Methods: This research builds on an earlier review which developed a multidimensional understanding of positive ageing. We conducted systematic searches of six electronic databases (CINAHL, Embase, Web of Science Core Collection, Medline, Scopus, PsycINFO) and manual searches of studies included in seven relevant reviews, yielding 6,340 results. Studies meeting general (Study type: English language, peer-reviewed primary study; Participants/Context: community-dwelling older adults (≥65 years), Concept: positive ageing) and specific criteria (exploring built environment, place, and/or physical mobility) were eligible for inclusion. No publication period limits were applied. Methodological quality was assessed using the Mixed Methods Appraisal Tool (five methodological criteria assessed across five study types). Study characteristics and findings were extracted. Data will be analysed following the six-step reflexive thematic analysis approach of Braun and Clark (2006).

Results: Full text screening was completed with 896 articles. Ten articles (seven qualitative; three quantitative) met inclusion criteria and explored built environment (n=4), place (n=5), and/or physical mobility (n=6). Various cultural perspectives were considered across nine countries in Europe (5/10 articles), North America (3/10), Oceania, and Asia. Methodological quality ranged from moderate to high. Common themes highlighting how built environment, place, and physical mobility have been considered in positive ageing literature and their contribution to positive ageing will be discussed.    

Conclusions: Findings will offer insight into how older adults interact with their local environments in relation to positive ageing. This knowledge can inform initiatives to create enriching environments to support positive ageing in place.

Purpose: Coronavirus Disease 2019 (COVID-19) has spread worldwide. Attention has been paid to pregnant women and their newborns, as they are vulnerable groups. However, the safety of breastfeeding and breastfeeding methods have not yet reached consolidate agreement around the world. The present study aims at summarizing the current scientific evidence including the safety of breast milk and wellbeing of breastfed infants of the infected mothers, and summarizing the current recommendations during the COVID-19 pandemic.

Methods: A comprehensive literature search on the relationship between COVID-19 and breastfeeding to date was conducted. The scope of the literature search included journal article databases (including PubMed, Web of Science, and CNKI) and official websites of health organizations worldwide.

Results: The majority of studies to date focused on whether breast milk from infected mothers contains SARS-CoV-2 virus, and mainly demonstrated negative results. However, evidence on antibodies, ingredients of antiviral drugs in breast milk and follow-up outcomes among breastfed infants born to the infected mothers was limited. Besides, among studies that have detected SARS-CoV-2 in breast milk, only a few studied the activity of the virus. Breastfed infants were not likely to develop viral infections; while contamination of the milk containers appeared to be a threat. The Holder pasteurization process could inactivate SARS-CoV-2 in breast milk. According to the current recommendations, direct breastfeeding with precautions is generally suggested as the first choice. For very sick mothers, it is recommended to express breast milk with precautions and feed the infants by a healthy caregiver.

Conclusions: Although currently the effects of breastfeeding on SARS-CoV-2 infection are unclear, breastfed infants are less likely to develop other viral infections. Our review also suggests a need to further evaluate the safety of breastfeeding, with specific focuses on viral test of breast milk samples collected at multiple time points, specific antibodies and drugs for COVID-19 treatment in breast milk, and follow-up health assessments of infants who were directly breastfed by their infected mothers.

Purpose: Early intervention is required to increase physical activity (PA) levels and motor competence (MC) in pre-school children. Nature-based early childhood education (ECE) may enhance children’s PA and MC. The purpose of this study was to systematically review and synthesise global evidence on associations between nature-based ECE and children’s PA and MC.

Methods: A literature search including nine databases and grey literature was concluded in August 2020 to capture published and unpublished evidence. Studies were eligible if a) children were aged 2-7 years old and attending centre-based ECE, b) ECE settings integrated nature, and c) they assessed physical outcomes at a child level. Two reviewers independently screened full-text articles and assessed study quality. Data extraction was completed by one reviewer and checked by another. Synthesis was conducted using effect direction (quantitative) and thematic analysis (qualitative), and the certainty of evidence was assessed using GRADE.

Results: After duplicate removal, 31,098 records remained, of which 1,370 full-text articles were screened and 33 unique (25 quantitative; 8 qualitative) studies were eligible. Of the quantitative studies, 20 studies assessed PA, (4,961 children) and 6 assessed MC (523 children). Studies were of controlled (n=5) and uncontrolled (n=2) before/after design, and cross-sectional design (n=18). Findings indicated inconsistent associations between nature-based ECE and children’s sedentary time, moderate-to-vigorous physical activity (MVPA) and object control skills (n=2 studies each). A positive association was found for balance whereas there was a negative association on speed and agility (n=3 studies each). Positive associations were also found between specific natural elements (e.g. vegetation) and lower sedentary time (n=3), and higher MVPA (n=6) and total PA (n=4). The quality of 23/25 studies was weak. From the qualitative analysis (248 children), most studies indicated that nature-based ECE affords higher intensity PA and risky play, however, some also suggested that PA and risk were similar irrespective of playground type.

Conclusions: Nature-based ECE may benefit some PA and MC outcomes but drawing firm conclusions is difficult because the evidence is limited. More high-quality studies are needed to understand the impact of nature-based ECE on children’s PA levels and MC.

 

Purpose: Gestational diabetes (GDM) affects up to 18% of pregnancies and also increases both the woman’s and child’s risk of developing non-communicable diseases such as type 2 diabetes. The IMPACT DIABETES B2B project has been designed to demonstrate the real-world implementation of an evidence-based, effective system of care for prevention of diabetes, overweight, and obesity across antenatal settings. Bump2Baby and Me is the multicentre randomised controlled trial central to the project that aims to investigate a mHealth coaching program for women who are at high risk of developing GDM.

Methods: 800 women will be recruited in early pregnancy from 4 clinical sites within Ireland, UK, Spain, and Australia. Women will be screened for eligibility using the validated Monash GDM screening tool. Participants will be enrolled at approximately 12 weeks’ gestation and randomised on a 1:1 basis into the intervention or usual care arm. The intervention group will receive mHealth coaching via a smartphone application, which will use a mixture of synchronous and asynchronous video and text messaging and allow for personalised support and goal setting with a health coach. The usual care arm of the study will receive standard information as part of usual antenatal care. 

Results: The Bump2Baby and Me study will assess the effectiveness and cost-efficiency of the low-cost health coaching lifestyle behaviour change app on weight and health outcomes for both mother and child through pregnancy and the first year following birth. The primary outcome will be change in maternal weight at 12 months postpartum. Secondary maternal and infant health outcomes will include development of GDM, weight management in pregnancy, diet, physical activity, sleep, and infant health and growth patterns.

Conclusion: The Bump2Baby and Me intervention proposes to bridge the health service gap using a low-resource, precision medicine, evidence-based intervention, which will take a concurrent mixed-methods implementation research approach. It is anticipated that this study will contribute to early prevention of maternal and child diabetes, overweight, obesity, and other non-communicable diseases.

Purpose: Lifestyle interventions during pregnancy have proven success in limiting excess gestational weight gain and reducing the risk of non-communicable diseases such as gestational diabetes, type 2 diabetes, and obesity. However, existing successful interventions have not moved beyond the research phase to consider implementation into routine service. The IMPACT DIABETES B2B project (IDB2B) is an EU funded multi-centre project that has been designed to demonstrate the real-world implementation of an evidence-based, effective system of care for prevention of diabetes, overweight, and obesity when delivered ‘at scale’ across antenatal settings.

Methods: The Exploration, Preparation, Implementation, Sustainment (EPIS) model frames the IDB2B project design. The intervention consists of a validated gestational diabetes risk screening tool that will be incorporated into usual care. Women at risk of gestational diabetes will be randomised to receive support and information on healthy eating and physical activity either via usual care or mHealth app with personalised health coaching over 18 months. The RE-AIM framework will be used for IDB2B evaluation. Efficacy, fidelity, penetration, and cost effectiveness will be examined across 4 clinical sites within Ireland, UK, Spain, and Australia.

Results: Implementation science and behaviour change theory provide a framework to ensure IDB2B can be suitably evaluated for its  scalability and roll out in other settings.

 

Conclusions: A large research translation gap exists around delivering implementable interventions with adequate population penetration and participation. IDB2B aims to bridge the healthcare gap between pregnancy and the post-natal time period to improve health outcomes for high risk mothers and babies in a cost-effective manner. 

Purpose: Increased longevity is one of the greatest success stories in public health. However, ageing is accompanied by cognitive decline which affects people’s daily functioning and, if it develops to dementia, their ability to live independently. The aim of the PASOCA study is to precisely examine how physical activity (PA) and sleep, both modifiable lifestyle factors, are related to cognition and which role they can play in optimal cognitive ageing.

Methods: This is an observational longitudinal study spanning over three years. Objective and subjective data of healthy, community dwelling adults aged 55 years and above (n=220) will be collected once a year. Participants will wear ActiGraph’s wGT3X-BT on the wrist of their non-dominant hand for 7 consecutive days and nights in order to objectively capture PA, sedentary behaviour and sleep. In addition, the International PA Questionnaire Short Form, a muscle-strengthening exercise survey and the Pittsburgh Sleep Quality Index will be administered to gather subjective input on PA and sleep. Cognition (executive function and memory) will be tested with the CANTAB test battery. Data will be analysed using multiple linear regressions with cognitive function as dependent variable and PA and sleep as independent variables, controlled for potential covariates such as socio-demographic factors, health behaviours and depressive symptoms. Furthermore, associations between combinations of 24-hour activity and sleep data with cognitive function will be examined with Compositional Data Analysis.

Results: This study will meet the current need for longitudinal studies with objective PA and sleep data, as well as provide, for the first time, in-depth information on associations of type of PA (aerobic vs muscle strengthening), characteristics of sleep (quality vs quantity) with specific cognitive domains (executive function and memory). Moreover, we will consider these behaviours within the 24-hour day.

Conclusions: The resulting deeper understanding of the precise relationship between PA, sleep and cognitive function will contribute to the development of preventive interventions for maintaining cognitive health at older age.

Purpose: We examined the accuracy (bias and precision) of self-reported physical activity for predicting body weight changes following exercise training by quantifying physical activity energy expenditure (PAEE) in sedentary individuals who participated in a 15-week prescribed exercise intervention. 

Methods: Using data from the Training Intervention and Genetics of Exercise Response (TIGER) study (2003–2015), physical activity (PA) rating, activity logs, rating of perceived exertion (RPE), and the Block food frequency questionnaire were used to predict changes in body weight after 15 weeks of aerobic exercise training. Body weight was estimated using the equations from the NIDDK Body Weight Planner program. PAEE was estimated using five different methods, four entirely self-reported and one including measured heart rate (HR), during the exercise intervention sessions. Weights were measured at baseline, at two interim timepoints during the intervention, and after the intervention. The average difference between the predicted and observed body weight changes represented bias (systematic error) of the predicted value, and the standard deviation of the differences represented its precision (random error).

Results/findings: A total of 1,565 TIGER participants were included in the analyses. Average pre-post measured weight change was -0.23 kg (SD=2.55). Using the objectively measured HR with self-reported RPE produced the lowest bias (2.54 kg) in predicting weight change. Using the self-reported activity logs with RPE was the best combination of low bias (3.20 kg) and good precision (±8.57 kg) among the entirely self-reported methods.

Conclusions: Our results suggest that more accurate prediction of body weight change can be assessed by more refined self-reported measures including duration, activity, and intensity as well as training and instructing participants for accurate reports. 

Purpose: Although obesity has a multifactorial etiology, a concomitant rise in maternal employment has been suggested as an important factor in the prevalence of childhood obesity. This study investigated the association of maternal employment with children’s weight status and weight-related behaviors in a sample of racially/ethnically diverse parent-child dyads. 

Methods: Cross-sectional study conducted among 136 mothers (aged 34±6.8 yrs) of children (aged 6.4±0.8 yrs; 48% girls) from six racial/ethnic groups (18% African American, 18% American Indian, 17% Hispanic/Latinx, 15% Hmong, 17% Somali, 15% White). Mothers answered survey questions about their employment status and completed three 24-h dietary recalls using the Nutrition Data System for Research (NDSR) to report child dietary intake. Children wore a hip-mounted accelerometer for eight days to measure sedentary time and moderate-vigorous physical activity (MVPA). Adjusted logistic regression models evaluated the association between maternal employment and child weight status (overweight [BMI percentile ≥85 and <95], obese [BMI percentile ≥95]). Adjusted linear regressions evaluated the association between maternal employment and child sedentary time, MVPA, and aspects of dietary intake. 

Results: Four categories of maternal employment status were identified: stay-at-home caregiver (17%), working part-time (23%), working full-time (41%), and unemployed/out of the labor force (19%). The average predicted probability that children were overweight or obese if mothers were unemployed was 73% and 40%, respectively. The probability that children were overweight or obese if mothers were stay-at-home caregivers was 44% and 28%, whereas if mothers were employed, it was between 42%-48% and 28%-29%, respectively. Consistent with these findings, higher mean intake of total calories, solid and saturated fats, and added sugars were observed for children whose mothers were unemployed relative to children in other categories of maternal employment. Similar sedentary time and MVPA, sodium intake, and overall diet quality across categories of maternal employment were observed. 

Conclusions: In contrast to previous studies, we found that children of employed mothers had similar weight status and weight-related behaviors to stay-at-home mothers. However, these findings highlight that dietary interventions for the children of unemployed/out of the labor force mothers may be important.

Purpose: Stay-at-home orders designed to curb the coronavirus disease 2019 (COVID-19) pandemic have created unprecedented circumstances for families. In particular, mothers might be at increased risk for lower engagement in health behaviors due to caregiving demands, which may in turn result in poor mental health outcomes. The purpose of this study is to evaluate the associations of perceived changes in moderate-vigorous physical activity (MVPA) and sedentary behavior (SB) with psychological outcomes (stress, affect, and anxiety) among mothers during stay-at-home orders.

Methods: Between May-August 2020, 309 mothers (aged 37.6±1.5 years; 75% White) with children (aged 0-20 years) at home, who were enrolled in the Lifetime Experiences And Pregnancy (LEAP) study -a subset of the longitudinal Project EAT cohort-, completed an online survey of perceived changes in MVPA and SB. This survey also included validated measures of stress (Perceived Stress Scale [PSS]), affect (Positive and Negative Affect Schedule [PANAS]), and anxiety (Generalized Anxiety Disorder Assessment [GAD-7]). Adjusted linear regressions evaluated the associations of perceived change in MVPA and SB with stress, affect, and anxiety.

Results: For MVPA, 39% of women reported becoming less active, 38% maintaining similar activity levels, and 23% becoming more active during stay-at-home orders. For SB, 63% reported engaging in more sedentary activities, 27% maintaining a similar sedentary lifestyle, and 11% becoming less sedentary. Adjusted regression results revealed that women engaged in less MVPA during the stay-at-home orders reported higher perceived stress, negative affect, and anxiety and lower positive affect relative to those who reported engaging in similar or higher levels of MVPA. Results also revealed that women who engaged in more sedentary activities reported higher stress and negative affect and lower positive affect than those who reported engaging in a similar sedentary lifestyle.

Conclusions: During stay-at-home orders, larger proportions of women reported being less physically active and more engaged in SB, which were associated with poorer mental health indicators. Given the ongoing challenges with the COVID-19 pandemic, researchers and clinicians play a pivotal role in finding new ways to facilitate women’s engagement in health-promoting behaviors while reducing the risks of COVID-19.

Purpose: The rising number of people in the United Kingdom (UK) living with overweight and obesity has highlighted a need for continued preventive strategies, such as increasing physical activity and reducing sedentary behaviour. However, the COVID-19 pandemic has limited community fitness opportunities, reduced daily energy expenditure and increased energy intake, contributing to the increase in people living with excess weight. This increases the risk of COVID-19 resulting in adverse outcomes including hospitalisation, advanced levels of treatment and death. The first UK lockdown period from March 2020 resulted in an increase in the number of social media influencers and self-proclaimed fitness gurus promoting and delivering home-based exercise sessions. However, this is not a sustainable, evidence-based solution, tailored to specific population groups with morbidities.

This rapid review conceptualises home-based exercise programmes for individuals with excess weight, to encourage the production of efficacious and effective, home-based exercise programmes.

Methods: MEDLINE, SPORTDiscus, CINAHL and AMED databases will be searched, using search terms and Boolean operators including ‘home based exercise’ AND ‘overweight’ OR ‘obesity’. Studies must have been published within the last ten years. Participants must be adults ≥19 years, with a Body Mass Index of ≥25 kg/m², that had undertaken a home-based exercise programme, which may be multi-modal. Publications not available in English, programmes intended for rehabilitative purposes, multi component programmes e.g. with a diet intervention, along with those undertaken in the community will be excluded. Extracted data will be recorded and analysed to allow for comparisons between programmes and control. Results will be ready for presentation at the Xchange, focussing on participant demographics, programme details, health and fitness outcomes, adherence and directions for future research.

Conclusions: Individuals with overweight and obesity are at a higher risk of contracting COVID-19 and experiencing less favourable outcomes. This rapid review will conceptualise home-based exercise programmes, providing much needed direction for developing guidelines and content to construct and implement efficacious, effective, evidence-based exercise programmes at scale. 

Purpose: Associations between low levels of physical activity (PA) and adverse health outcomes have been reported in preschool-age children (preschoolers). Utilizing previous PA guidelines, studies have shown that most children do not meet PA guidelines. Preschoolers (61%) spend a significant portion of their day at childcare centers. These centers play a role in getting preschoolers to meet PA guidelines. No study has currently examined preschoolers’ PA prevalence during the preschool-day using the recently released Department of Health and Human Services (DHHS) PA guidelines. Therefore, the purpose of this cross-sectional study was to examine the prevalence of preschoolers meeting the 2018 DHHS PA guidelines during the preschool-day and the association between sex and meeting PA guidelines.

Methods: Data utilized for this study was from the Preschoolers Actively Learning (PAL) Study (n=47). PA was assessed using Actigraph accelerometers. PA prevalence during the preschool-day was defined as at least 105 minutes of total [light, moderate, and vigorous] PA during the 7-hour waking period of the preschool-day. Sex was obtained from parent questionnaires. Multivariate logistic regression analysis modeled the odds of meeting guidelines on sex.

Results: In our sample, 26% of the preschoolers met the DHHS PA guidelines and participated in 85±10.7 minutes of total PA during the preschool-day. Being younger was significantly (p<0.05) associated with meeting PA guidelines as compared to older age. In age-adjusted analyses, we found that boys had an increased odds of meeting the PA guidelines (OR=4.67; 95% CI: 0.95–22.87, p>0.05) but this was not statistically significant.

Conclusion: This study contributes to our understanding of PA prevalence in preschoolers during the preschool-day and sex differences associated with meeting PA guidelines. Findings highlight the need to target the preschool-day as a time frame to support preschoolers in meeting PA guidelines.

Introduction: Unstructured, self-directed, free play is essential to children’s health as it contributes to their physical, cognitive, and social-emotional development. Unfortunately, there has been a significant decline in children’s outdoor play; time spent outdoors is now spent indoors which is concerning given the health benefits of playing outside. One way to enhance children’s outdoor play experiences and increase the time spent outdoors is through the integration of loose parts (LP) in the outdoor play space. LP are materials that can be manipulated and combined in various ways (e.g. wooden planks, crates, tubes). The open-endedness of LP play allows children to move their body in different ways encouraging gross motor development, balance, and coordination, all which affords children the opportunity to develop physical literacy (PL): the motivation, confidence, physical competence, knowledge and understanding to be active for life.

 

Purpose: The purpose of this project is to explore how the outdoor play space affords aspects of PL development in children attending before and after school programs in Nova Scotia, Canada.

 

Methods: Using a quasi-experimental, multi methods design, LP materials will be integrated in an intervention site with a control site set as a comparison. Children’s PL will be captured through the process of behavioural mapping. Behavioural mapping is a research tool used to observe and record behaviours occurring in a particular setting at a particular time. Using this technique, children’s fundamental movement skills and physical activity behaviour will be observed and recorded, comparing the observations pre-post the implementation of the LP intervention, and to the control site. At the end of the intervention, go-along interviews will be conducted with children at the intervention site to capture the affective components of PL. 

 

Anticipated results: Preliminary findings from our previous work (PLEY project) demonstrates that outdoor LP play diversifies children’s movements. Similar findings are expected for this project.

 

Conclusions: To date, aspects of PL in the context of outdoor LP play have not been explored using behavioral mapping. This project will be a critical step to understanding how we can support quality outdoor play experiences for children while optimizing their overall health and wellness.  

Purpose: Many children watch television during mealtimes which has been cross sectionally associated with poor diets. The aim of this study was to assess the prospective association between baseline mealtime television use and subsequent 2-year intakes of discretionary food, fruit and vegetables in young children. Additionally, to assess whether the associations differ by socioeconomic position (SEP).

Methods: This prospective study, conducted in 2014 and followed up two years later, surveyed parents of young Australian children, aged 6 months to 6 years. Parents reported their children’s weekly mealtime television frequency during breakfast, lunch, dinner and snack time, children’s discretionary food intakes over the past month, and usual daily consumption of fruit and vegetables. Responding parent education level (university-education vs non-university educated) was used as a proxy for SEP. Multivariable linear and logistic regression analyses with adjustment for baseline intakes, child gender, child age, family meal frequency and meal location were performed to assess the association between baseline mealtime television use and intakes of discretionary foods, fruit and vegetables at the follow up. Stratified analyses were conducted to assess if the association differed by SEP.

Results: Analyses included 352 children. Overall mealtime television use (occasions/week) was associated with 2 years’ subsequent higher daily intake frequency of discretionary food (β 0.02, 95%CI 0.01-0.04). For individual mealtimes, television use during breakfast and dinner 1-2 days/week, compared to never, predicted higher daily intake frequency of discretionary food, β 0.18 (95%CI 0.02-0.37) and β 0.19 (95%CI 0.00-0.39), respectively. Similarly, 3-7 days/week of television during breakfast and lunch predicted higher daily intake frequency of discretionary food, β 0.18 (95%CI 0.02-0.37) and β 0.31 (95%CI 0.07-0.55), respectively. No significant associations were seen between mealtime television use and prospective vegetable or fruit intakes. There were few socioeconomic associations between mealtime television use and intakes.

Conclusions: Developing strategies to limit television during mealtimes may be a useful component of interventions for addressing the high consumption of discretionary foods in young children. Such strategies are likely to be applicable across the socioeconomic spectrum, though particularly relevant to low SEP populations with greater frequency of television viewing during mealtimes.

Purpose: Both physical inactivity and poor sleep are deleteriously associated with all-cause and cause-specific mortality, but beyond their independent health effects, the joint effects of these two key behaviors remain largely unknown.

Methods: This is a prospective cohort study based on 380,055 participants (55.9±8.1 years, 55% female) from the UK Biobank with 11.1±1.2 years of follow-up. Baseline physical activity (PA) levels were categorized as high (≥ 1200 metabolic equivalents (MET) minutes per week), medium (600 to < 1200), low (< 600), and no moderate-to-vigorous PA (MVPA). We used an established sleep score based on five healthy characteristics (morning chronotype, adequate sleep duration (7-8 hr/d), never or rarely insomnia, no snoring, and infrequent daytime sleepiness). The sleep score was categorized as healthy (≥ 4 sleep score), intermediate (2-3), and poor (≤ 1). We derived twelve PA–sleep combinations, accordingly. Mortality risks were ascertained to May 2020 for all-cause and cancers (all-type and lung cancer). The association of the two behaviors with mortality was examined with Cox proportional hazard models.

Results/findings: There was a dose-response increase toward poor sleep in all-cause mortality risk with adjustment for selected confounders and PA. Compared to healthy sleepers, the hazard ratio (HR) was 1.05 (95% CI: 1.02 to 1.09) for intermediate sleepers and 1.23 (1.13 to 1.34) for poor sleepers. Compared to those in the referent (optimal) high PA-healthy sleep group, participants with no MVPA-poor sleep combination had the highest mortality risks for all-cause (HR: 1.39 (1.20 to 1.61)), total cancers (HR: 1.30 (1.06 to 1.59)), as well as lung cancer (HR: 1.59 (1.08 to 2.34)). The deleterious associations of poor sleep and all the outcomes were amplified with decreasing PA levels (P_interaction < .0001).

Conclusions: Low PA deteriorates the adverse effect of poor sleep with both all-cause and cancer-specific mortality risks. Lifestyle behaviors may have synergistic effects on health. The present results support the need to integrate lifestyle behavior interventions in research and clinical practice.

Purpose: Previous research from high-income countries has shown adolescents' and young adults’ efforts to lose or maintain weight are associated with dietary quality. This research has found that youth that engages in more healthful strategies, such as reducing intake of unhealthy food, have higher diet quality whereas youth that engages in unhealthy behaviors, such as fasting or skipping meals, have lower diet quality. Little is known about how behaviors to control weight are associated with diet quality among youth from low- and middle-income countries. The aim of this study was to examine associations between efforts to control weight (ECW) and diet quality among Brazilian adolescents and young adults.

Methods: Data from 731 participants (19.6±SE 0.3years, 51.1% female) of the 2015 Health Survey of São Paulo were used for this cross-sectional study. Dietary intake was assessed using a 24h dietary recall and diet quality was calculated using the Brazilian Healthy Eating Index - Revised (BHEI-R). Participants reported their ECW, weight satisfaction, and socio-demographics. Descriptive statistics and linear regressions were calculated to investigate associations between ECW and diet quality.

Results: BHEI-R mean score was 54.8 (SE ±0.43) classifying participants as “needs improvement”. From all respondents, 47.7% were dissatisfied with their current weight, and 41.0% reported ECW. Reported strategies to control weight included increased physical activity, controlling what they ate, and dieting (8.2%, 3.1%, and 2.5%, respectively). After adjusting for covariates (age, sex, race/ethnicity, and BMI), participants reporting at least one reported ECW (ß= 0.08; 95%CI 0.02, 0.13), controlling what they ate (ß= 0.15; 95%CI 0.08, 0.22), practicing regular physical activity (ß= 0.04; 95%CI 0.00, 0.07) and satisfied with their weight (ß= 0.08; 95%CI 0.02, 0.13) were associated with a higher overall BHEI-R mean score.

Conclusion:  Engaging in behaviors to control weight, i.e., increased physical activity, controlling what they ate, and dieting, was associated with higher diet quality among a sample of Brazilian youth. Future research should further explore the weight control behaviors that Brazilian youth are engaging in, including disordered eating behaviors, and the associations between these behaviors and diet quality among Brazilian youth.

Purpose: Schools play a fundamental role in the prevention of childhood overweight and obesity by providing nutrition education. Teachers currently struggle to effectively implement nutrition education in their classrooms due to an overcrowded curriculum and perceived lack of time. Integration of nutrition content into core school subjects has been suggested to reduce this time barrier, thereby enhancing implementation. However, it is unclear how integrative approaches have been used in interventions and whether this approach is effective. This scoping review aimed to explore the use and effectiveness of integrative teaching in primary school-based nutrition programs.

Methods: Six databases (i.e., Medline, CINAHL Complete, Embase, Scopus, EBSCO Megafile Ultimate and Eric) were searched, for primary school-based interventions that focused on nutrition education. Only papers reporting on the integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened in duplicate using Covidence™ software to determine eligibility for inclusion. Data were extracted and findings were collated and summarised to describe the interventions characteristics, subject integration and effectiveness of the included programs.

Results/findings: Of 3328 possible database entries identified, data describing the integration of nutrition into the primary school curriculum was extracted from 39 eligible papers. Nutrition education programs frequently involved lessons about food groups and were commonly integrated with educational standards for mathematics, science or literacy. Although articles reported on the integration of nutrition, this was not commonly defined and detailed description was usually lacking. Furthermore, nutrition programs are mostly implemented through professional development of classroom teachers. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects.

Conclusions: Firm conclusions about the effectiveness of school‐based nutrition intervention that embed integrative teaching cannot be drawn currently because of the lack of program description and methodological limitations. However, this review provides evidence in support of further evaluation of integrative nutrition education programs in primary schools. Current review findings should guide future trials and classroom practices. Prospective studies that include a detailed explanation of the integrative approach and evaluation of effectiveness are needed.

Purpose   The implementation nutrition and physical activity guidelines within Australian early childhood education and care (ECEC) is integral for the health of children and is dependent on collaboration. The quality assessment of services within the Australian National Quality System is undertaken by the Department of Education assessors in line with legislation. Assessors have a unique perspective on monitoring and assessment due to visiting multiple services in their region and collaborating with assessors from other regions.    This study sought to capture the under-explored experiences of assessors for ECEC services in Queensland, to give insight into the implementation of infant and young child nutrition and physical activity within the National Quality Framework.    Methods Five multi-region teleconferences using professional conversations with Assessors (n=10) who assess metropolitan, regional and remote areas were conducted in Queensland, Australia to inform qualitative analysis of data guided by the Framework method and Social Cognitive Theory.   Results Four identified themes emerged using inductive and deductive analysis, guided by Social Cognitive Theory impacting the implementation of nutrition and physical activity guidelines: (1) Supportive Equitable Environments; (2) Efficacy; (3) Working with Parents; and (4) Regulatory Compliance. Important findings included increasing visibility of infants and young children in policies; focussing educator training to build efficacy in infant and young child feeding and physical activity, working with parents and increasing educator efficacy for the assessment process to increase collective agency.   Conclusions This study presents the results of the first Australian study investigating the experiences of assessors who help to implement NQF legislation and uphold quality through assessment and ratings of services. Inclusion of assessors in future studies as key stakeholders will increase best-practice for educators and short- and long-term health outcomes for infants and young children in ECEC settings.

Purpose: Physical activity (PA) is recommended as a non-pharmacologic chronic disease self-management strategy. Many interventions achieve short-term PA changes but not long-term PA maintenance. Given the possible usefulness of theory-based interventions, this systematic review examines potential theoretical mediators in PA maintenance among adults with chronic disease.

Methods: Systematic literature searches were conducted in PubMed, Embase, Web of Science, CINAHL, PsycINFO, and SPORTDiscus. Inclusion criteria consisted of 1) randomized controlled trial; 2) adults with arthritis, cancer, diabetes, or heart disease; 3) reported PA outcomes ≥6 months post-intervention; and 4) reported intervention effects on a theoretical construct OR effects of a theoretical construct on PA maintenance OR mediation effects of a theoretical construct between the intervention and PA maintenance. Study quality was assessed using the Cochrane Risk of Bias Tool.

Results: Thirteen studies focused on populations with arthritis (n=2), cancer (n=3), diabetes (n=4), and heart disease (n=4). Studies were medium-low quality. Sample sizes ranged from 45-543 and intervention effects on PA were maintained in 8 studies. Eight studies examined only the effects of the intervention on theoretical constructs, four examined the effects of theoretical constructs on PA maintenance, and three tested for mediation. Of the studies that achieved PA maintenance, positive intervention effects were also reported on a) self-efficacy toward PA maintenance (arthritis); b) general PA self-efficacy, self-efficacy toward PA barriers, coping with relapse (diabetes); and c) use of a PA planning strategy and PA-related goal attainment (heart disease). The use of a PA planning strategy was effective in promoting PA maintenance (heart disease). And among studies that tested mediation, the following mediated intervention effects on PA maintenance: a) self-efficacy toward PA barriers, coping with relapse, and social support, modeling, and injunctive norms from family (diabetes); and b) use of a PA planning strategy (heart disease). Among the studies where intervention effects on PA were not maintained: a) the intervention positively changed PA self-efficacy and motivational readiness (cancer) and b) PA self-efficacy and perceived barriers promoted PA maintenance (cancer).

Conclusions: We found evidence of theoretical constructs (e.g., self-efficacy, planning) that may be effective in promoting PA maintenance among individuals with chronic diseases.

Purpose

In this population-based cohort study, we investigated the associations between combinations of modifiable lifestyle risk factors and infectious disease mortality, including COVID-19.

Methods

Participants were 468,569 men and women (aged 40 to 69) from the UK Biobank study. Lifestyle indexes were based on traditional and emerging lifestyle risk factors using health guidelines and best practice recommendations that included: physical activity, sedentary behaviour, sleep quality, diet quality, alcohol consumption, and smoking status. The main outcome was mortality from infectious diseases, including pneumonia, and coronavirus disease 2019 (COVID-19). Multivariable proportional hazards regression and binomial regression models were adjusted for age, sex, sociodemographics, body mass index, ethnicity, and comorbidities that included: cancer, cardiovascular disease, diabetes, chronic respiratory illness, and immune disorders.

Results/findings

During 5,166,793 person-years of follow-up (mean age = 56.5 (8.1), 54.6% female), 4,563 deaths occurred. Meeting public health guidelines or best practice recommendations among any combination of lifestyle behaviours was inversely associated with mortality. Hazard ratios ranged from 0.29 (0.26 to 0.33) to 0.66 (95% CI: 0.59 to 0.75) for infectious disease, and 0.26 (0.23 to 0.30) to 0.69 (0.60 to 0.79) for pneumonia. Among participants with pre-existing cardiovascular disease or cancer, hazard ratios ranged between 0.30 (0.25-0.34) to 0.73 (0.60-0.89). COVID-19 mortality risk ranged between 0.42 (0.28-0.63) to 0.75 (0.49-1.13). The preventable fraction was 34.8% for infectious disease, 35.6% for pneumonia, and 29.6% for COVID-19. There was limited evidence of relative excess risk due to interactions between pairs of healthy lifestyle behaviours.  

Conclusion

We found a clear protective dose-response with higher lifestyle indexes against infectious disease mortality. The protective benefits conferred by different behaviours seem to be additive. Public health efforts that include improvements in lifestyle risk factors could be used as an ancillary measure to prevent infectious disease mortality.

Purpose: Childhood obesity and physical inactivity are major public health issues.  Almost every second household in Australia has a dog. Dog ownership leads to greater physical activity in adults and school-aged children. We examined if dog ownership and dog-facilitated physical activity was associated with higher physical activity in young pre-school aged children.

Methods: A secondary data analysis of the ‘Play Spaces & Environments for Children’s Physical Activity’ (PLAYCE) study cohort (2015-2018) was undertaken. Data was collected for 1490 children 2-5 years from 122 long day-care centres in Perth, Western Australia. Parent-report surveys measured socio-demographic factors, dog ownership, child-dog play and dog walking, structured and unstructured physical activity and sedentary screen time.

Results/findings: Compared with non-dog owners, dog-owning pre-schoolers did 8 times/week more unstructured physical activity, but 5 minutes/day less park play (all p<0.01). Within the dog-owning sub-sample, pre-schoolers who played with their dog 3 or more times/week did 12 times/week more unstructured physical activity, 0.5 times/week more structured physical activity, 31 minutes/day more home yard play and 8 minutes/day more park play (all p<0.05). Pre-schoolers who walked their dog three or more times/week did 10 times/week more unstructured physical activity, 0.5 times/week more structured physical activity, 10 minutes/day more home yard play and 21 minutes/day more park play (all p<0.05). Pre-schoolers walking with their dog three or more times/week had 17 mins/week less sedentary screen time (p=0.003).

Conclusions: Family dog ownership is associated with more unstructured physical activity but less park play in preschoolers. Dog-owning preschoolers who play and walk with their dog regularly, have higher levels of outdoor play (at home, in the park and overall), unstructured and structured physical activity, and lower levels of screen time, compared with dog-owning preschoolers who engage in little dog play and walking. Dog play and dog walking may be viable strategies for increasing pre-schoolers’ physical activity levels and should be considered in future multi-level interventions to improve children’s physical activity.

This study investigated the effect of acute continuous and intermittent physical activity (PA) on children's executive function (EF). Twenty-nine participants (16 boys M=9.34± 0.48 years), using a within-subjects design, performed a continuous (The Daily Mile™) and an intermittent PA running bout (Shuttle Runs: ≥85%HRmax; 12 bouts 30 active/45s rest), both lasting 15min. The Stroop task, Digit Span and Corsi Blocks tests were administered before, 1 min post and 30 min post. Comparing both conditions (Repeated Measures ANOVA), The Daily Mile™ (TDM) group has not significantly changed compared to the control condition (all p>0.05). Whereas the Shuttle Runs condition improved for 1 min post (congruent stimuli) (mean diff=119ms ± 37; p=0.004, respectively) compared to control. No effects on visual or verbal memory were observed (all p>0.05). The results demonstrated that an intermittent PA bout might be a time-efficient approach for enhancing EF, with the shuttle runs condition having a better inhibitory performance following PA, suggesting that this protocol might be more appropriate for implementation in school settings than the TDM to promote improvements in EF.

Keywords: Physical Activity, Cognitive Performance, Inhibition, Working Memory

Purpose: Despite parent-child bedtime interactions are crucial to children’ sleep quality, few validated tools exist to capture sleep parenting among parents with infants. This study developed a Sleep Parenting Scale for Infants (SPS-I) and aimed to (1) explore and validate its factorial structure, (2) examine its measurement invariance across mothers and fathers, and (3) investigate its reliability and concurrent validity.

Methods: SPS-I was developed via a combination of items modified from existing scales and the development of novel items. 340 mothers and 152 fathers (152 dyads from the same household and 188 independent mothers) (51.8% white, mean age=34.6) from the Rise and SHINE (Sleep Health in INfancy and Early childhood) cohort study completed a 14-item SPS-I for their 12-month old infant. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore and validate SPS-I’s underlying structure. Multi-group CFA was then used to examine measurement invariance across mothers and fathers. Reliability was examined using Cronbach’s alpha. Concurrent validity was examined using linear regressions exploring associations between SPS-I factors and parent-reported infants nighttime sleep duration. Data were collected between 2017 and 2019, and were analyzed in 2020.

Results: EFA and CFA confirmed a 3-factor, 12-item model: sleep routine, sleep autonomy, and media use at bedtime. SPS-I was invariant across mothers and fathers and was reliable. All three factors were associated with infants nighttime sleep duration.

Conclusions: SPS-I has good psychometric properties, supporting its use for characterizing sleep routine, sleep autonomy, and media use at bedtime by mothers and fathers. 

Purpose: The Active Women over 50 (AWo50) trial evaluated a low-dose information/support intervention to enhance physical activity in employed women aged 50+. This qualitative study explores participants’ perspectives on factors to consider when designing physical activity interventions appropriate for women aged 50+.

Methods: Semi-structured interviews were conducted with participants who had completed the AWo50 program. Interviews were audio-recorded and transcribed verbatim. Data were managed in NVivo12. One researcher used an inductive analytic approach to generate recurrent themes on program and contextual factors which hindered and promoted physical activity. Themes were checked against the data by two other researchers early in the analysis, interpretations were refined, and final themes were derived in consultation with the research team.

Findings: The female participants (n=20) had an average age of 56.4 years (SD4.5) and worked 35.6 hours (SD10.1) on average per week. Four participants worked in a health-related field, nine had carer responsibilities, and nine had previously participated in structured physical activity. The analysis generated four themes describing what attracted participants to the AWo50 program and their experience of the program. These were: (1) Age matters, (2) Physical activity is social, (3) Structure for physical activity, and (4) Self-responsibility. Participants noted a range of personal and contextual factors particular to their age which affect their physical activity generally but also shaped their affinity for AWo50. There was a complex interaction between these factors and a strong sense of self-responsibility to become more active. The program’s unstructured approach (participants chose the amount and type of physical activity) was helpful for some who valued autonomy in physical activity, while others would have preferred greater structure (such as social support, program accountability, and tailored feedback) to sustain involvement in the face of competing demands from family and work.

Conclusion: Interventions aimed at an individual level are operationalised within broader systems and need to consider the complex interplay between personal, environmental, and behavioural influences. Future iterations of the program could draw on the sense of agency conferred by the self-responsibility narrative but bolster maintenance by integrating social support and flexibility in program features to address contextual threats.

Purpose: This study compared habitual (current, unhealthy) diet costs across Australian socioeconomic groups (SEGs), utilising modifications of the Healthy Diets Australian Standardised Affordability and Pricing (HD-ASAP) protocol. Surprisingly, detailed quantitative evidence regarding food group intakes and dietary costs of low SEGs compared to higher SEGs has been lacking.

Method: The Confidential Unit Record Files (CURFs) of the Australian Health Survey National Nutrition and Physical Activity Survey were analysed to describe the reported dietary intake of three reference households in each SEG quintile (defined by household income). Household A included two adults and two children; Household B included one adult and two children; and Household C included two older, retired adults. The habitual diet pricing tool of the HD-ASAP protocol was modified to align with these dietary intakes. Food pricing data from food outlets in one location were collected and analysed to determine the cost of habitual diets for each reference household across SEG quintiles.

Results: Low SEGs reported habitual diets of significantly lower cost than higher SEGs for Households A and C. No significant difference was found across SEG quintiles for Household B. When the diets were divided into healthy and discretionary (not needed for health and high in saturated fat, added sugar, salt and/or alcohol) components, the cost of reported intakes of healthy foods tended to increase from the lowest to highest SEG quintile for all reference households, but costs of discretionary food intakes were similar across quintiles. Analysis of more granular food group costs shows additional differences between SEGs.

Conclusions: The lower healthy food and total dietary costs in low SEGs compared to higher SEGs, reflecting lower intakes, helps explain the higher rates of diet-related disease experienced in low SEGs. The findings can inform potential policy action to improve food environments and affordability of healthy foods, and drive healthier diets among low SEGs.

Purpose: This review of reviews aims to (1) identify components of primary school-based nutrition education programs and (2) synthesize component effects on fruit and vegetable (FV) consumption and nutrition knowledge in children.

Methods: Systematic reviews and/or meta-analysis were eligible for inclusion if they focussed on school-based interventions in children aged 4-12 years old that reported FV consumption and/or nutrition knowledge in children. Six databases were searched for relevant entries published between 2010 to August 2020 in English language. Two reviewers independently assessed all potential articles. Data extraction included characteristics of included reviews and methodological quality was appraised using the JBI Critical Appraisal Instrument for Systematic Reviews and Research Syntheses. Conflicts were resolved through discussion between the reviewers. Data synthesis involved categorizing the interventions based on their used component and outcomes. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess quality of evidence and if possible, a meta-analysis will be performed to determine the effect on FV intake.

Results/findings: From 547 records that were identified for title and abstract screening, 63 full texts were retrieved for assessment, with 11 reviews included (six systematic reviews, four systematic reviews and meta-analysis and one meta-analysis) that were published between 2011 and 2020. FV intake was reported by most of the reviews (n=8), both FV intake and nutrition knowledge were reported by two reviews and one review reported nutrition knowledge only. The following 10 components were identified for analysis: (1) FV provision (availability and accessibility of FV at school), (2) computer-based, (3) educational/curriculum, (4) environmental change, (5) marketing campaigns, (6) school food policies, (7) family/caregiver involvement, (8) garden-based nutrition education, (9) behavioural change techniques and (10) point-of-purchase labelling.

Conclusions: This umbrella review will provide an overview of all components included in school-based nutrition education programs and its effect on FV intake and nutrition knowledge in children aged 4-12 years old. We expect the findings will contribute to the development of future successful programs and evaluations, and consequently promotes healthy eating behaviour among children.

Purpose: Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders’ acceptability of interventions.

Methods: A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers’ behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools.

Results: Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants’ perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals.

Conclusion: There is limited reporting of stakeholders’ experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants’ acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up.

Purpose: Fundamental motor skills are the platform for movement competency. Object control (OC) skills and socio-economic status (SES) can influence a child’s participation in physical activity. There is a lack of research, especially in South Africa, regarding OC skills and SES and the influence it has on physical activity levels and patterns of boys. This study aimed to determine if there is a relationship between object control skills, SES and physical activity levels and patterns in boys aged nine- to 10 years in the North West Province of South Africa.

 

Method: This is a cross-sectional study that made use of the secondary data that was gathered in 2013, from the original study, the NW-CHILD study (Child-Health-Integrated and Development). A total of 455 boys with the mean age of 9.9 years (±0.41) participated in the study, out of the 455 boys, 179 was from high SES and 277 from low SES. The Test of Gross Motor Development Test was used to assess the boys’ gross movement skills. The Children’s Leisure Activities Study Survey questionnaire was used to determine the physical activity levels and patterns that the boys participated in. STATISTICA software was used to analyse the data by means of two-way tables, Spearman rang order correlations and independent t-testing.  

 

Results/findings: Boys from low SES performed statistically (p≤0.05) and practically (d≥0.3) better regarding the kicking skills. However, boys from high SES performed statistically (p≤0.05) and practically (d≥0.3) better regarding the overhand throw, underarm roll and the OC standard score. Boys from high SES participated significantly (p≤0.00; d=0.83; d=0.5) more in moderate- and high-intensity activities. Lastly, positive correlations with a small effect (r≥0.1) was reported with riding a bicycle, hockey and basketball, while negative correlations with a small effect (r≥0.1) effect was found with gymnastics, walking the dog, playing on playground equipment and doing house hold chores.

 

Conclusion: The results determine the influence that well- and under-developed object control skills have on a child’s physical activity levels and patterns. Furthermore, children from low SES tend not to be as physical active as their peers.

Purpose: Physical activity practice is positively associated with levels of physical fitness in youth. Prior cross-sectional research revealed positive associations between physical fitness components (i.e., cardiorespiratory fitness, muscular strength, and speed-agility) and health-related quality of life (HRQoL) in adolescents (1,2) . However, only one longitudinal study investigated the association of cardiorespiratory fitness with HRQoL in adolescents (3), whereas the longitudinal association between muscular strength, and speed-agility physical fitness components and HRQoL during adolescence has not been previously investigated. The purpose of this study was to investigate the association of cardiorespiratory fitness, muscular strength, and speed-agility at baseline with HRQoL at 24-month follow-up in a sample of adolescents.

Methods: This is a longitudinal analysis with 199 adolescents (13.9 ± 0.3 years at baseline) from DADOS (Deporte, ADOlescencia y Salud) study. Cardiorespiratory fitness was assessed using the 20m Shuttle Run Test.  Muscular strength was assessed using the standing broad jump test. Speed-agility was assessed using the 4×10m shuttle-run test. HRQoL was evaluated using the KIDSCREEN-10 questionnaire. Linear regression analyses, controlling for sex, pubertal status, socioeconomic status, waist circumference, and baseline HRQoL were performed in order to analyze longitudinal association between fitness components and HRQoL. A p-value of p<0.05 was set as statistically significant.

Results: Cardiorespiratory fitness and muscular strength at baseline were significantly associated with HRQoL at 24-month follow-up (β=0.183, 95% CI=0.008;0.086, p=0.019 and β=0.175, 95% CI=0.008;0.075, p=0.014, respectively). No significant association between speed-agility and HRQoL was found.

Conclusions: Our results revealed that the levels of cardiorespiratory fitness and muscular strength at baseline were positively associated with HRQoL at 24-month follow-up in adolescents. Current results are in line with the cardiorespiratory fitness results found in previous studies (3) . These findings underline the key role of improving both cardiorespiratory fitness and muscle strength through physical activity promotion in order to increase HRQoL during adolescence.

1. Evaristo S, et al. Journal of Exercise Science and Fitness. 2019; 55–61.
   


2. Evaristo OS, et al. Eur J Public Health. 2018 Aug; 28(4):631–5.
   


3. Evaristo OS, et al. Am J Hum Biol. 2019 Nov; 31(6):e23304.

Purpose: Health-related quality of life (HRQoL) is a person’s self-perceived functioning and well-being in physical, social, and mental domains of health. Children’s HRQoL may be enhanced through development of components of physical fitness but the relationships between fitness and HRQoL have seldom been investigated. The purpose of this study was to investigate the cross-sectional and longitudinal associations between English primary school children’s cardiorespiratory fitness (CRF) and HRQoL.

Methods: This study involved 383 children (age 10.0 ± 0.5 years) recruited from 20 primary schools situated in northwest England. Data were collected on two occasions 12 weeks apart. On each occasion the children completed the 20m Shuttle Run Test (20mSRT) with the number of laps completed used as a proxy indicator of cardiorespiratory fitness (CRF). HRQoL was assessed using the KIDSCREEN-10 questionnaire and the children self-reported their physical activity using the English version of the Youth Activity Profile. Anthropometric assessments of height, weight, and waist circumference were taken and home postcodes were used to generate neighbourhood-level measures of socioeconomic status (SES). Linear mixed models with random intercepts (schools) assessed associations between CRF and HRQoL cross-sectionally, and longitudinally with HRQoL at 12 weeks as the outcome.

Results: After adjustment for sex, time of year, maturation, SES, waist-to-height ratio (WHtR) and physical activity, CRF was significantly associated with HRQoL (β=0.09 (95% CI=0.02, 0.16), p=0.015) in the cross-sectional analysis. In the longitudinal analysis CRF at baseline was significantly associated with HRQoL at 12 weeks after additionally controlling for baseline HRQoL (β=0.08 (95% CI=0.002, 0.15), p=0.045).

Conclusions: HRQoL in primary school children was cross-sectionally associated with CRF. This association remained significant over a 12-week period of time although the magnitude of the association diminished. Twelve weeks corresponds to the duration of a typical English school term, during which time schools can provide multiple opportunities to enhance children’s fitness status through structured and unstructured physical activity. These findings support the promotion of fitness through school physical activity programmes to enhance children's well-being.

Purpose: The social environment is a key determinant of our food intake. In adolescence, friends are particularly important socializing agents within this environment. This study aims to assess whether similarities exist in (un)healthy food intake in adolescent best friend dyads. Innovatively, we will examine if adolescents initiate friendships with friends who report similar food intake (selection) and/or if adolescents are influenced by their friend’s food intake (socialization). Additionally, we will examine if zBMI moderates friend socialization involving food intake.

Methods: We analyze two waves of data from Dutch secondary school students participating in the “G(F)OOD together!” research project, which were collected six months apart in the same school year. We identify pairs of adolescents who nominated each other as best friends – a “reciprocated friendship dyad” – either at both waves (enduring friendship dyad) or at the second wave only (new friendship dyad). We use both dyad member’s self-reports on healthy (fruit and vegetables) and unhealthy (SSBs, sweet snacks, savory snacks) food intake as measured by food frequency questionnaires. Both dyad members are also distinguished based on their zBMI (based on objective height and weight). To adequately handle dependencies in the data, we employ longitudinal Actor-Partner Interdependence Models (APIMs).

Results/findings: We are currently pre-registering our analysis plan on the Open Science Framework. We plan to estimate APIMs using Structural Equation Modeling in R (lavaan), separately for each dyad type (new and enduring) and type of food intake. To identify selection effects, we will examine similarity in the levels of food intake at wave 1 between dyad members in new friendship dyads. Moreover, to detect socialization effects, we focus on enduring friendship dyads, and test if the effect of one dyad member’s food intake at wave 1 predicts the other member’s food intake at wave 2 (partner effect). Lastly, to examine the moderating role of zBMI in friend socialization involving food intake, we will test whether the magnitude of partner effects differs between the lower and the higher zBMI friend in enduring dyads.

Conclusions: This study will improve our understanding of the dyadic patterns of food intake in adolescent best friends.

Purpose: There is a great lack of data examining associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy. The aim of this study was therefore to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy.



Methods: This cross-sectional study utilized baseline data (n=303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-minute walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR) and metabolic syndrome score (MetS score) per SD increase in body composition and fitness variables.



Results/Findings: Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72-2.14, P < 0.001), HOMA-IR (ORs: 3.01-3.80, P < 0.001), blood pressure (ORs: 1.82-2.05, P < 0.001) and MetS score (ORs: 3.29-3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26-1.82, P = 0.001-0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88-1.54, P = 0.039-0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57-0.63, P ≤ 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P ≥ 0.61).



Conclusions: Accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.

Purpose: Individuals with a migrant background are still severely underrepresented in health research, and research on individual factors or mechanisms associated with integration and well-being in migrant populations is scarce. Following social identity and acculturation theory, we address this research gap by examining the relation of cultural identity (integrated, assimilated, separated, and marginalized), an indicator of emotional integration, with health behaviors and health outcomes.

Methods: Data from N = 7,449 adolescents with migrant background from the CILS4EU study, a multinational panel, were analyzed using multivariate analysis of variance (MANCOVAs). Follow-up ANCOVAs and post-hoc tests were used to investigate differences in health behaviors (physical activity, having breakfast, having a hot meal, hours of sleep, consumption of alcohol, cigarettes, and drugs) and health outcomes (life satisfaction, internal and external mental health problems, self-esteem, academic self-efficacy, and general health) for the different identity types.

Results/findings: The MANCOVAs showed significant differences between the types of identity on the combined health behaviors (V = .03, F(3, 13401) = 6.4, p < .001) and health outcomes (V = .03, F(3, 13335) = 7.2, p < .001). For health behaviors, the types of cultural identity showed significant differences in physical activity, the frequency of having breakfast, and alcohol consumption (Fs > 9.8, ps < .001). No differences were found for the frequency of having a hot meal, smoking, and consuming drugs. Except for general health, cultural identity types showed significant differences in all health outcomes (Fs > 9.0, ps < .001). Post-hoc tests showed that for the frequency of having breakfast, alcohol consumption, self-esteem, and self-efficacy, the integrated identity showed better outcomes than the assimilated identity (Fs > 7.1, ps < .01).

Conclusions: Cultural identity is not only a key determinant of integration but also linked to various health outcomes and behaviors. The results support selective acculturation theory and question whether national affiliation alone is the most beneficial health strategy. As health behavior change interventions seem not to reach migrants, innovative interventions incorporating and enhancing cultural identity formation could improve health behavior, resiliency, and health on a global level.

Purpose: Development of poor diet and physical inactivity in adolescence, increases the risk of obesity and its related comorbidities in adulthood. Adolescents account for 16% of the global population yet are seldom involved in decision-making regarding research designed to support them to reduce risk factors and to prevent obesity. Traditionally adolescent participation in research has been tokenistic in nature, however, engaging adolescents in meaningful decision-making enhances research translation. The aim of this review was to analyse the current mode of adolescent participation in obesity-related research.

Method: A systematic scoping review was conducted using the Arksey and O’Malley’s 6-stage framework for scoping reviews. Six major databases were searched for peer-review primary research studies with adolescent (10-24 years) participation related to physical activity, diet, overweight and obesity or obesity-related chronic disease prevention. Studies published in all languages and countries were considered. Studies published prior to 1995 were excluded. The mode of adolescent participation in the research cycle was classified into consultative, collaborative, or adolescent-led using the Lansdown-UNICEF Conceptual Framework. The NHMRC consumer engagement framework defined the degree of involvement in the research cycle.

Results: The selection process identified 127 papers describing 71 unique studies. Of these 69% took place in the USA and 73.2% were conducted in minority or underserved communities. Gender differences observed between studies included under-representation of males in 50.7% of studies in contrast to females under-represented in 10% of studies. The mode of adolescent participation varied between studies, in 86% (61/71) of studies participation was either consultative or collaborative, while only 8.5% (6/71) involved an adolescent-led approach, giving adolescents autonomy and control over research processes and outcomes. Furthermore, 87% (62/71) of studies incorporated adolescent participation in one or more of the formative phases of the research cycle, such as relationship building, needs assessment, research idea development and project design. Only 11% (8/71) of studies involved adolescents in all stages of the research cycle.

Conclusion: Meaningful and inclusive adolescent participation in the obesity prevention research cycle is limited. Empowering and mobilising equal partnership with adolescents should be at the forefront of all adolescent-related obesity prevention research.

Purpose: Physical activity (PA) is important for maintaining health and wellbeing for people with long-term conditions (LTCs). However, people with LTCs are often less active than the general population. Digital tools offer potential to support a more physically active lifestyle. They are often successful in increasing PA in the short-term but there is little evidence of their effect on longer-term behaviour change. This scoping review aimed to identify the range of existing digital tools, their theoretical foundations and components to support the maintenance of PA in people with LTCs.

Methods: The review was conducted in accordance with PRISMA-ScR guidance (1). Searches of the CINAHL, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholarand clinical trial databases were conducted. Initial screening of titles was undertaken by two reviewers to exclude irrelevant results. Titles/abstracts were reviewed by two independent assessors against the eligibility criteria (2), with conflicts resolved by a verifier, using the Covidence software. The review of full-texts followed the same procedure. Data extraction was undertaken by four groups of two reviewers using a charting form (modified through piloting), with discrepancies discussed. 

Results: In total, 38 journal articles from 34 studies were included. The most commonly identified LTCs were cardiovascular disease, type 2 diabetes mellitus and obesity, with most studies also reporting comorbidities (n=20). Digital tools were predominantly web-based +/- wearables/activity trackers/pedometers. A wide range of maintenance periods were identified (3 – 12 months). Full descriptive results will be ready for presentation at ISBNPA 2021.

Conclusion: This scoping review will collate and present the available literature in this area for the first time across a range of LTCs. The findings will help to identify gaps in the literature for future research and to optimise intervention components to support the maintenance of PA in people with LTCs.

1. Tricco AC, Lillie E, Zarin W, et al. (2018b) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 169(7):467-473. 

2. Clarkson P, McDonough S, Adams J, et al. (2020). (Protocol) Maintaining physical activity through the use of digital tools for people with a long-term condition/s (LTCs): a scoping review. Protocols.io. DOI:10.17504/protocols.io.bf7gjrjw

 

Purpose: Well-developed object control (OC) skills provide boys with the self-confidence to participate in sports and are associated with higher health-related fitness (HRF) levels. Consequently, boys with inadequate OC skills will withdraw from participation in sports requiring these skills. There appears to be limited research regarding the relationship between OC skills and boys' HRF in South Africa. The study aimed to determine if there is a possible relationship between OC skills and HRF in boys aged nine- to 10 years in the North West Province of South Africa.

Methods: This study is part of the longitudinal NW-Child study (Child-Health-Integrated and Development), conducted over seven years (2010-2016). A cross-sectional study that made use of secondary data gathered in 2013 was used for this study. A total of 456 boys with an average age of 9.94±0.41 years participated in the study. The Test of Gross Motor Development was used to assess the boys' OC skills. The Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) was used to determine the boys' strength and the PACER test of the FITNESSGRAM was used to determine their cardiovascular endurance. Lastly, the body fat percentage was determined using the Body Mass Index (BMI) and skinfolds.

Results/findings: Various OC skills indicated small and statistically significant relationships (≤0.05, r≈0.1) with various HRF skills. The striking a ball- and dribble skills respectively showed correlations with, standing long jump (r=0.10; r=0.16) and V-ups (r=0.13; r=0.10). Furthermore, the dribble, catch and underhand roll showed correlations with push-ups (r=0.17; r=0.12; r=0.12) and sit-ups (r=0.25; r=0.11; r=0.17). The overhand throw only showed correlations with sit-ups (r=0.15). No correlations were found between the kicking skill and any of the strength sub-items. The dribble, catch, kick and underhand roll found correlations with cardiovascular endurance (r=0.11; r=0.12; r=0.14; r=0.16), whereas the overhand throw only showed a correlation with BMI (r=0.10). No correlations were found between the various OC skills and body fat percentage.

Conclusion: The results observed that OC skills could influence most of the HRF activities. Therefore, more attention to boys' OC skills and HRF is required to prevent possible sport participation backlogs.

Purpose: Older adults in nursing home are at risk for mal- and undernutrition. A human rights perspective could contribute to better nutritional care for older adults at nursing home, but few studies investigate how to introduce human rights in nursing education. The aim of this study was to investigate how to introduce food as a human rights perspective for nursing students combining education at campus and in clinical placement at nursing home.

Methods: The study took place from 2017-2018. Based on educational design research, two iterative cycles were conducted. In the 1st cycle, qualitative method with multistage focus group interviews with 18 nursing students was used to get knowledge and understanding about nursing students’ definitions and experiences of the right to food. In the 2nd cycle, qualitative methods with focus group interviews with 26 nursing students and their written assignments was used to get knowledge and understanding about the nursing students learning about the right to food.                                                                                                                                                                     

Findings: The study showed that definitions and experiences about human rights were highly influenced by the placement in nursing home. The study showed the importance of clinical practice for students to understand human rights, and the importance of interhuman relations for learning about and promoting human rights. A human rights perspective contributed to development of a language about human rights and brought in a more holistic approach to the phenomenon of food through the right to food. Awareness of human rights seemed to make the students take autonomous decisions regarding nutritional care following values related to social justice and dignity, and gave them a perspective of structural challenges related to the right to food.

Conclusion: Introducing a human rights perspective can enable recognizing situations where the right to food is violated. In the learning process practical placement is of key importance. Combining human rights perspective with nursing ethics perspective can improve nursing students capacity to deal with challenging food related situations thus improving the nutrition situation at nursing homes.

Purpose: Previous studies have shown that multicomponent interventions could improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at nine-month follow-up.

Methods: The study included first-year students attending high school in Denmark. Participating schools were randomized to the HHS intervention (N=15) or control group (business as usual) (N=15). The HHS intervention included a curriculum, structural and organizational initiatives, a workshop, and a smartphone application, designed to promote well-being by focusing on in example meal frequency and eating habits. Self-administered online questionnaires were filled out by students at the beginning of the schoolyear and nine months later. To account for the clustering of data, multilevel logistic regression analyses was used to estimate odds ratios (OR). We used an intention-to-treat approach with multiple imputation of missing data.

Results: At baseline 4,577 of 5,201 students answered the questionnaire and 4,512 at follow-up. Breakfast frequency decreased notably from baseline to follow-up, lunch frequency decreased only a few percentages. Daily water intake, intake of fresh fruit and intake of vegetables did not change noteworthy from baseline to follow up. We did not find evidence of an effect of the intervention on any of the outcomes: breakfast: OR=0.88 (95% CI: 0.68;1.17), lunch: OR=0.99 (95% CI: 0.78;1.25), water intake: OR=1.16 (95% CI: 0.95;1.41), intake of fresh fruit: (OR=1.09, 95% CI: 0.85;1.39), vegetables: (OR=1.01, 95% CI: 0.78;1.32).

Conclusion: No evidence of an effect of the HHS intervention was found for any of the outcomes. Process evaluation have shown signs of positive changes in food environment at the intervention schools and appreciation of the canteen intervention; however, our outcome measures might not be sensitive enough to show these changes. Furthermore, other intervention elements might have had low implementation and therefore low impact on student behavior. Lastly, the lack of an effect of the intervention, could be due to the lack of involvement of systems outside the school-setting.

Purpose: Many school-based interventions are poorly implemented and sustained which challenge intervention effectiveness.  Knowledge of schools’ opportunities and barriers for implementation prior to implementation may guide the selection of appropriate implementation support strategies. We explored schools’ opportunities and barriers for implementing universal school-based interventions aimed at promoting healthy weight among 6-15-year-olds in the municipalities of the region of Southern Denmark.

Methods: In nine municipalities, we conducted individual telephone interviews with central school managers (N=9). In three municipalities we conducted a focus group (N=15) consisting of 1) five local school managers from different schools, (2) the central and local school manager, the health nurse, a member of the school board, and the manager of the after-school-program. All interviews were recorded and transcribed verbatim. We conducted thematic analysis, following 6 steps: 1) Familiarization with data, 2) generating of initial codes, 3) searching for themes, 4) reviewing themes, 5) defining and naming themes, 6) producing the final report. The analysis draws on concepts inspired by Sccacia et al.’s (2015) aspects of organizational readiness e.g. the daily operation of the organization, knowledge and skills needed for a specific intervention and the motivation for the intervention.

Findings: Facilitators for implementation included good internal cooperation, cooperation with local sports clubs, a high political priority of aspects of healthy weight development, especially movement during the school day, and relevant knowledge, and skills. Moreover, the informants appreciated opportunities for local adaptation, a plan for sustainability, networking, capacity-building, and involvement of teachers, students, and parents in intervention development. Barriers included poor or lack of cooperation between different professional groups e.g. school staff, and consultants of both the school and health area, limited resources, and project fatigue.

Conclusions: Schools have different opportunities for implementing interventions and therefore different support needs. Schools’ adoption of school-based interventions aiming at promoting healthy weight among children may be motivated by involvement of different stakeholders in intervention development, establishment of cross-functional networks, and that the intervention can be adapted locally and integrated into the existing school practice.

Purpose: Smartphone apps have become popular for tracking food intake in daily life. However, the wide range of available apps differ substantially in the implemented tracking features such as photo-based recording, food databases, and recording of serving sizes, and thus the required input. The present study investigated whether differences in the required input are related to acceptability, induced food-related cognitions and behavior.

Methods: In an online study, 30 participants were randomly assigned to viewing one of two app mock-ups, consisting of screenshots and a verbal description: (1) “simple” app requiring to take one photo of their meal; (2) “complex” app requiring to take a meal photo, identifying the meal components in a database or by free-text input, and providing the serving size. Subsequently participants were asked to rate the app’s acceptability for tracking food intake in daily life and potential consequences of tracking on food-related cognitions, intentions, and behavior.

Results: The simple app was perceived to be more feasible (t(28) = -3.81, p = .001, Cohen’s d = 1.38) and to induce fewer food-related cognitions (t(28) = -3.72, p = .001, Cohen’s d = 1.38) compared to the complex app. No significant differences were found regarding intentions or eating behavior (t(28) = -0.68, p = .504).

Conclusions: Complex food tracking apps provide a higher level of detail, but recording is more cumbersome and induces more food-related cognitions that may impact behavior. Depending on the goal of the study, careful considerations have to made regarding the choice of the tracking app.

Purpose: Physical Activity (PA) is an integral component of prevention and treatment programmes for overweight/obese youth. While the PA guidelines recommend ‘activity to develop movement skills, muscular fitness and bone strength’, there has been limited research to date on health-related outcomes of resistance training (RT). The aim of this study was to explore the impact of a RT intervention on strength and weight status of overweight/obese and/or inactive youth.

Methods: Following ethics approval, 12 participants were assigned to an experimental (EG; males = 3, females = 3, age 8.7±1 years, BMI z-score = 2.54±0.61) or control group (CG; males = 4, females = 2, age 9.2±1 years, BMI z-score = 1.50±0.93). Data presented as mean±SD.  Pre and post intervention assessments for strength (isometric mid-thigh pull) and weight status (stature, mass, four skinfold sites, and girth measurements) were completed and BMI z-scores calculated. The EG participated in a 10-week RT programme, with 45 min sessions 2x a week.

Results/Findings: Attendance at the RT programme was 93%. There were no statistically significant differences between the EG and CG in changes in any outcomes. There was a large effect size for relative strength (Hedges’ g = 0.825, P = 0.140). There was a medium positive effect on upper arm circumference (Hedges’ g = 0.500, P = 0.357) with a decrease in the EG, but an increase in the CG.

Conclusions: There was high attendance at the intervention suggesting RT may be a feasible intervention for overweight/inactive youth.  The increase in relative strength is key, as for an overweight population, strength level may be insufficient to perform activities of daily living due to a high body mass. The decrease in upper arm circumference could be explained by increases in overall energy expenditure from taking part in an active intervention. However, this is difficult to interpret due to no change in skinfolds, although it would be unlikely that this change would be due to a decrease in muscle mass as the intervention involved RT. While there is some evidence to support a positive effect of RT, a larger scale study of longer duration is recommended.

Purpose: As the literature about this topic in typically developing children is scarce, the aim of this study was to determine the relationship between executive functioning and motor coordination skills in typically developing Grade 7 learners, and if any gender- and socio-economic differences will occur regarding these skills.

Methods: This cross-sectional study formed part of a longitudinal NW-CHILD study. A Total of 271 learners (boys n=148; girls n=123), with a mean age of 12.95 (SD = 0.40) years, were tested. The BOT-2 was used to assess the children’s motor coordination skills, while the TOLDX-2 was used to evaluate their executive functioning.

Results: There were no practical significance between executive functioning and motor coordination skills in the total group. However the boys and girls respectively had small correlations (d=0.1) between their executive functioning and motor coordination skills. This study also found gender differences (p≤0.05) between the boys and the girls, where the relationship between executive functioning and motor coordination skills were more evident in girls than in boys. The results of this study also suggested that the boys outperformed the girls in most of the BOT-2 and TOLDX-2 variables. Researchers found that the relationship between executive functioning and motor coordination skills are closely linked, even though the results of this study might indicate a slight difference with regards to this statement. This paper also aimed to determine if socio-economic status (SES) could have an impact and found that no significant correlations were found between motor coordination and executive functioning in high socio-economic groups, however bilateral coordination and the total correct score of the TOLDX-2 indicated a significant small correlation in the low SES group.

Conclusion: Due to limited research done on the relationship between executive functioning and motor coordination skills in typically developing children in South-Africa, this could be a great platform to inspire further research done on this issue. Multidisciplinary teams, such as Kinderkineticists, teachers, and other therapists, just to name a few, can benefit from interpreting these results in order to understand the close relationship between executive functioning and motor coordination skills and how they impact academic related skills.

Background: Excessive gestational weight gain (GWG) is a major public health concern associated with negative health outcomes for mother and child. Digital interventions have the potential to reach many women and promote healthy GWG. Most previous digital intervention studies have been pilot studies and/or have not included women from all BMI-categories. We examined the effectiveness of a smartphone application (app) in 305 pregnant women covering all BMI-categories.

Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG (primary outcome), body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia and insulin resistance (secondary outcomes) in comparison to standard maternity care.

Methods: A 2-arm parallel randomized controlled trial was conducted. Women were recruited at maternity clinics in Östergötland, Sweden. Women were randomized (1:1 ratio) after completion of baseline measures (intervention, n=152; control, n= 153). The control group received standard maternity care while the intervention group also received the HealthyMoms smartphone app for 6 months. Outcome measures were assessed at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). 

Results: Overall, we found no statistically significant effect on GWG; however, the data indicate that the intervention effect differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group compared to the control group in the imputed analyses (-1.33 kg [95% CI -2.92; 0.26, P=.10]) and completers only analyses (-1.67 kg [95% CI -3.26; -0.09, P=.031]). Bayesian analyses showed a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was > 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27 [95% CI, 0.05 to 0.50], P=.017). No statistically significant differences were observed in the other secondary outcomes.

Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain in pregnancy in women with overweight and obesity.

Purpose: To determine whether pediatric healthcare providers are meeting American Academy of Pediatrics (AAP) guidelines regarding infant feeding and sleep recommendations.

Methods: A 10-minute online survey assessed infant feeding and sleep recommendations providers discuss with caregivers. The survey was sent to the AAP Rhode Island Chapter and Rhode Island State Nurses Association. Responses were coded as “meeting vs. not meeting” guidelines.

Results: A total of 28 medical doctors (MDs) and 31 physician assistants (PAs), registered nurses (RNs), and nurse practitioners (NPs) completed the survey. Most were non-Hispanic white (95.7%), and a third were between 31-40 years of age (29.8%). Almost all MDs discussed the importance of exclusive breastfeeding for 6 months (100%), how to identify developmental readiness for solid foods (100%), the importance of introducing a variety of foods (100%), the importance of responsive feeding practices (96.4%), vitamin D supplementation for exclusively breastfed (EBF) infants (96.4%), and discouraging bed-sharing (96.3%). The majority of MDs also discussed the importance of continued breastfeeding for 12 months (74.1%), the importance of introducing different types of textures (85.7%), and the importance of self-feeding (85.7%). Less than half did not discuss introducing solids between 6-7 months (21.4%), transitioning to cup drinking at six months (45.8%), and avoiding introducing juices and sugar-sweetened beverages before 12 months (32.1%).

PAs and nursing staff reported similar compliance for discussing the importance of exclusive breastfeeding for six months (96.8%) and the importance of responsive feeding practices (96.7%). Although a greater percentage of PAs and nurses discussed the importance of continued breastfeeding for 12 months (96.8%), fewer met the guidelines for how to identify developmental readiness for solid foods (51.6%), the importance of introducing a variety of foods (41.9%), vitamin D supplementation for EBF infants (29.0%), the importance of introducing different types of textures (40.0%), and the importance of self-feeding (35.5%).

Conclusions: Most pediatric healthcare providers meet AAP guidelines for discussing breastfeeding and responsive feeding practices, but there is room for improvement regarding other relevant feeding and sleeping recommendations. Future interventions to support provider awareness of and communication about these practices may be warranted to improve infant health outcomes.

Purpose: Evidence suggests nutrition education can improve staff nutrition knowledge and centre compliance with nutrition guidelines, within the early childhood education and care setting. Despite the potential impact of such nutrition education, the uptake of such opportunities within the setting is poor. Nudge strategies are an attractive approach to influence behaviour, as they are low-cost and have been shown to be effective in improving participation in population-level public health programs. This study aimed to assess the impact of incorporating nudge strategies in the design of a nutrition education workshop invitation on workshop registration among early childhood education and care centres. Secondary aims were to assess invitation recall and invitation acceptability.

Methods: A parallel-group randomized controlled trial was conducted with 88 centre-based childcare centres in Hunter New England, New South Wales, Australia. Centres randomised to the intervention received nudge strategies (messenger, incentive, norms, salience, priming, commitment and ego) embedded within an enhanced invitation to attend a nutrition education workshop. Centres randomised to the control group received a generic invitation. Childcare centre workshop registration, invitation recall and invitation acceptability were measured post-intervention only via online registration records and a computer assisted telephone interview. Logistic and linear regression models were used to compare differences between the two arms.

Results: No statistically significant differences in workshop registration (25% vs 20%; P = 0.61), invitation recall (69% vs 62%; P = 0.58) or invitation acceptability (mean: 8.38 vs 8.06; P = 0.50) were found between the intervention and control arms, respectively. The advertisement of accredited professional development contribution was reported as the most appealing feature within the enhanced invitation.

Conclusions: Low-intensity behavioural strategies embedded in the design of an invitation were insufficient to significantly increase workshop registration. Investigation and application of alternate evidence-based nudge strategies to encourage staff participation in nutrition education in the early childhood education and care setting is recommended.

Background: Low attendance and engagement in behavioural weight management trials are common. Research suggests that mental health may play an important role, however previous research exploring this association is limited with inconsistent findings. We aimed to investigate whether participant mental health (including anxiety, depression, quality of life, satisfaction with life) was associated with attendance and engagement in a trial of behavioural weight management programmes.

Methods: This is a secondary data analysis of the WRAP trial, which randomised 1267 adults with overweight or obesity to a brief intervention, WW (formerly Weight Watchers) for 12-weeks, or WW for 52-weeks.  We used regression analyses to assess the association of baseline mental health with programme/trial attendance and engagement.

Results: Every one unit of baseline depression score was associated with a 1% relative reduction in rate of session attendance (IRR 0.99; 95% CI 0.98, 0.999; n=625). An increase in anxiety was associated with 4% reduction in odds to report high engagement with WW digital tools (OR 0.96 ; 95% CI 0.94, 0.99). Every one unit of global quality of life was associated with 69% lower odds of reporting high engagement with the WW mobile app (OR 0.31; 95% CI 0.15, 0.64). Increases in depression and anxiety were associated with decreased odds of attending study visits ([3-months: anxiety - OR 0.95; 95% CI 0.92, 0.98; depression - OR 0.93; 95% CI 0.89, 0.97]; [12-months: anxiety - OR 0.94; 95% CI 0.91, 0.97; depression - OR 0.94; 95% CI 0.91, 0.98]; [24-months: anxiety - OR 0.94; 95% CI 0.91, 0.97; depression - OR 0.95; 95% CI 0.91, 0.997]; [60-months: anxiety - OR 0.95; 95% CI 0.92, 0.98; depression - OR 0.94; 95% CI 0.91, 0.97]).

Conclusions: Participants are less likely to attend programme sessions, engage with resources, and attend study assessments when reporting poor baseline mental health. Differences in attendance and engagement were small, however changes may still have a meaningful effect on programme and trial effectiveness. Future research should investigate targeted strategies to maximise attendance and engagement in those reporting poorer mental health.

Purpose: Social support is a primary facilitator of participant engagement in public health interventions, such as exercise referral schemes (ERSs). ERSs are internationally widespread physical activity interventions for insufficiently active adults with one or more health conditions. The provision and receipt of effective social support is underpinned by a subjective sense of social identification. Therefore, greater understanding of how to promote social identity can improve participant engagement among ERSs and wider public health settings. This study documents the application of a peer volunteer social identity approach to a UK-based ERS.

Methods: Three sets of semi-structured interviews were conducted with ERS participants (n = 38), providers (n = 5) and peer volunteers (n = 4) from an ERS in northwest England between 2018 and 2020. Interviews investigated (1) the feasibility of implementing a social identity approach, (2) the prospective acceptability of a peer-based approach in relation to desirable demographic and personal characteristics of ERS peers and valued peer roles, and (3) the retrospective acceptability of the peer intervention post implementation. All data were analysed thematically. 

Results: The interviews generated three main themes, as follows: (1)The ERS presented a challenging context in which to implement a social identity approach due to a non-group-based delivery format and vast participant heterogeneity in relation to age, sex, and health status. The structured introduction of peer volunteers was selected to improve social support opportunities for participants, with peers acting as representatives and propagators of an ERS-specific social identity. (2) ERS participants de-emphasised the importance of demographic similarity between themselves and prospective peers in relation to age or sex, though peers must have previously completed the ERS and had experience of managing a personal health-related condition. Desired peers were individuals who could exude positivity and empathy whilst providing practical, informational, motivational, and emotional support. (3) Peers who performed these roles made participants feel more comfortable and socially supported during ERS, reducing burden on ERS providers.

Conclusions: These findings provide a methodological framework to inform the adoption of a social identity approach among ERSs and wider physical activity interventions using peer volunteers.  

Purpose: Disparities exist in childhood physical activity, and ongoing research suggests that intergenerational trauma affects child health behaviors. The purpose of this study is to identify the association between parental adverse childhood experiences (ACEs) and child physical activity (PA) and sedentary behaviors (SB) in a racially and ethnically diverse sample. 

 

Methods: Cross-sectional survey conducted with 1,295 parents of children (aged 6.9±1.5 yrs; 49% girls; 21% African American, 18% white, 17% Hmong, 17% Hispanic/Latinx, 16% Native American, 10% Somali) in Minneapolis/St. Paul, MN. Parent-reported ACEs were assessed through a 10-item survey; affirmative answers were summed. Parents also reported their child’s usual weekly hours of light PA (LPA), moderate PA (MPA), and vigorous PA (VPA) and SB.Adjusted linear regressions evaluated the association between parental ACEs (high ACEs [>5] vs. low ACEs [<5]) and child’s LPA, MPA, VPA and SB.

 

Results: Ten percent of the sample had a high ACEs score (>5). On average, children of a parent with high ACEs engaged in more hours of weekly LPA (0.54; 95% CI 0.13, 0.95), MPA (0.71; 95% CI 0.3, 1.11) and VPA (0.3; 95% CI -0.11, 0.72) relative to children of a parent with a low ACEs score. Results showed similar levels of weekly hours of SB between children of parents with high or low ACEs. Relative to children of parents with a negative answer for individual ACEs items, children of a parent who had divorced parents (0.84; 95% CI 0.01, 1.67), had a family member in prison (1.37; 95% CI 0.16, 2.57), experienced food insecurity (1.25; 95% CI 0.07, 2.44), was physically abused (1.28; 95% CI 0.03, 2.53), and was sexually abused by a parent (3.66; 95% CI 1.6, 5.72) participated in more hours of weekday sedentary behaviors. 

 

Conclusion: High parental ACEs were associated with more weekly hours per week of LPA and MPA, and individual ACE items were associated increased hours of weekday sedentary behaviors. The results of this study provide additional insight into how childhood trauma affects health behaviors in future generations.

Purpose: A child’s food choice and exposure will be influenced by their environment. The extent to which maternal socio-economic status (SES), maternal education and childcare exposure are associated with childhood eating behaviours has not yet been fully established. We sought to determine what associations exist between these environmental factors with both food approach and food avoidant eating behaviours.

Methods: Data was collected as part of the ROLO (randomised control trial of low glycemic index diet) longitudinal birth cohort study. At the 5 year follow up, eating behaviours were measured using the Children’s Eating Behavior Questionnaire (CEBQ). SES was determined using maternal education level and neighborhood deprivation score. Lifestyle questionnaires were used to measure childcare exposure. Multiple linear regression analysis was used to determine associations between maternal SES, maternal education level, childcare exposure and children’s eating behaviours.

Results: In the current analysis, 401 mother and child pairs were included. Of these, 23% of the children had a BMI in the overweight or obese range. 51% of mothers were considered in the highest SES group. A significant difference was observed between the highest SES group and the lowest SES group for maternal BMI and maternal age at delivery (p=0.003, and p=<0.001 respectively). Children from the lowest maternal SES category had significantly lower mean ‘Food fussiness’ scores compared to those in the highest category (B=-5.52, 95% CI=-5.00, -0.03). Of the food approach eating styles, children from the lower SES group had higher mean scores for ‘Desire to drink’ than those from the highest SES group. Childcare was availed of by 89% of children, with median childcare exposure of 4.1 years. Increased childcare exposure was positively associated with food responsiveness (B=0.451, 95%CI 0.032,0.870) and emotional overeating (B=0.272, 95%CI=0.061,0.482).

Conclusions: Childhood eating behaviours were associated with maternal SES, with this more evident in food avoidant rather than food approach eating styles. Additionally, we found that longer exposure to childcare was associated with food approach eating behaviours thus indicating the importance of instilling healthy eating behaviours both in the home and outside the home settings, particularly the longer the child is exposed to childcare.

Adolescence is an important life stage that bridges childhood and adulthood. During this critical phase of growth and development, youth lifestyle choices can be health protecting or health risk behaviours. In high-income countries, the influence of family wanes while the influence of peers becomes more salient, Yet, little is known about the role of social media and online ‘influencers’ of physical activity (PA) behaviour. School closure due to the COVID-19 pandemic catapulted adolescents into online schooling. The purpose of this study was to examine who the key influencers of PA behaviour across school-age adolescents were during the first COVID-19 lockdown.

In the Autumn term of 2020, seven second-level schools, as part of the Active School Flag feasibility study completed a whole-school survey. Items were framed to the period of the lockdown in March-April 2020. Pilot and cognitive testing were conducted for reliability and construct validity of the items. Adolescents reported how much they agreed (1-strongly disagree, 5-strongly agree) with the use of online PA information given by; i) family member, ii) friends, iii) sport coach, iv) teacher, v) TV or YouTube celebrity, vii) bloggers. One way ANOVA (REGWQ post-hoc tests) were used to emphasis changes in the scores as adolescents get older, stratified by gender.

The items were understood as intended, as evidence from cognitive test results. Adolescents aged between 12-17y old (n=3204, 62.5% females) reported teachers as the lowest influencer (mean=2.07, SD=.83) and sport coaches as the highest (mean=2.52, SD=0.77). Influence of friends remained stable across the ages, but sport coaches (p<.001, eta2=.011), family (p<.001, eta2=0.031) and teachers (p<.001, eta2=0.024) declined for both males and females with age. Despite the decline with age, sport coaches remained the most influential among the oldest adolescents. Among females, celebrities (p<.001, eta2=0.028) and bloggers (p<.001, eta2=0.019) influence increased with age.

Sport coaches need access to all adolescents to provide information. Although, change in other influencers during lockdown as adolescents got older would suggest the need to tailor programs for different age groups across second-level education. The role of online celebrities or bloggers increases with age among female adolescents.

Purpose: Active commuting to/from school (ACS) has been associated with an increase in levels of physical activity (PA) and other health-related benefits. However, there is no consensus on the best objective methodology to assess ACS PA (ACS-PA). This study aimed to show the preliminary results of the systematic review (PROSPERO: CRD42020162004) through two objectives: (1) to identify existing studies that assess ACS-PA through objective measures and (2) to propose an appropriate methodology and practical considerations to assess ACS-PA.

 

Methods: A systematic search was carried out to 2020 in five different electronic databases (PubMed, Web of Science, SPORTdiscuss, Cochrane Library, and National Transportation Library) following the PRISMA and PICO(S) strategies. The inclusion criteria were (1) studies with young people who ACS in free-living conditions, (2) the language of the studies had to be English or Spanish, (3) studies had to assess ACS-PA through objective measures, and (4) ACS-PA had to be reported. Furthermore, the risk of bias and quality assessment were evaluated.

 

Results: Although in the initial search, 3.224 references were identified, only 26 studies met the inclusion criteria. The preliminary results of this systematic review suggested that 92% of the identified studies assessed ACS-PA through accelerometers, and only 8% of the studies used pedometers. Furthermore, 72% of the studies have used an interval time (ranged from 1 to 4 hours) to assess ACS-PA, and only 18% of the studies combined accelerometer and Global Positioning System to assess ACS-PA. Regarding the data collection of accelerometers, most of the studies placed the device in the right hip, used cut-off points proposed by Evenson for moderate to vigorous PA and Troiano for non-wear time definitions, and the registration period protocol was set in 7 days. However, other data collection such as epoch, valid day, valid week, and frequency (hertz) presented a greater heterogeneity of criteria among the different studies.

 

Conclusion: This systematic review will provide an overview of the most used objective measures in the scientific literature, and practical applications of the most suitable processes to data collection for objectively assess ACS-PA.

Purpose: Culinary medicine (CM) or culinary nutrition (CN) education provided to professionals with the capacity to support health behaviour change in others is an emerging strategy to promote diet quality and reduce diet-related chronic disease burden. The aim of this scoping review is to synthesise the literature describing CM/CN provided to, and by health, education and culinary professionals, or students of these disciplines.

 Methods: This review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Eleven electronic databases were searched. Eligible studies included: (i)nutrition, health or lifestyle programs with a CM/CN component, (ii)study participants working or training in health, community and/or adult education or culinary roles, or programs facilitated by people working or training in health, community and/or adult education or culinary roles where facilitator training was described, (iii)published in English from 2003. Title, abstract, full text screening and data charting was completed by two reviewers.

 Results/findings: Thirty-three studies were included. Most studies(n=22) delivered programs to general population groups facilitated by CM/CN trained health professionals and/or university students from health disciplines, while other studies(n=11) delivered CM/CN training to university students or health professionals. Of these studies, seven were programs provided to medical students, two to nutrition and/or dietetic students, one to nutrition and medical students together and one to qualified physicians and healthcare professionals. Twenty-five studies were based in the USA and one study in Australia, Netherlands, Brazil, Iran, Israel, China, Singapore and Kenya. The evidence indicates that CM/CN programs provided to health professionals or students of health disciplines can improve competency in nutrition counselling and culinary practice; and improve dietary patterns of the health professional or student, and their patients or clients. 

 Conclusions: Further research is needed to provide evidence for effectiveness of CM/CN programs in improving culinary skill and diet-related health practices, and to optimise content, format and timing of CM/CN programs. Research evaluating the impact of CM/CN training to education and culinary professionals, who potentially have the capacity to influence healthy cooking behaviour is needed.

Purpose: Programs to better equip health professionals with the knowledge and skills to provide culinary nutrition education and behaviour change support to their patients and clients, as well as improving their own diet-related health practices are emerging. Programs are commonly limited to health and medical trainees. However, culinary and nutrition education professionals could also provide culinary nutrition education and behaviour change support to their students. This research aimed to examine the facilitators and barriers encountered by health and education professionals in providing culinary nutrition education and health behavior support in usual practice; and to identify their continuing professional development (CPD) needs in this domain.

Methods: An Australia wide online survey of health, community nutrition, adult nutrition or culinary education professionals was conducted. The survey included items on socio-demographic characteristics, nutrition knowledge, cooking and food skills confidence, fruit and vegetable intake and CPD needs. Descriptive statistics were used to summarise results.

Results: There were 279 (81% health, 10% adult education 9% community education) responses. Highest cooking skills confidence scores reported were chopping, mixing and stirring food (5.6 (SD=1.6)) while lowest cooking skills confidence scores reported were making sauces and gravy from scratch (4.7 (SD=1.9)). Highest food skills confidence scores reported were reading best before date on food (5.5 (SD=1.6)) while lowest food skills confidence scores reported were using vegetables as snacks (4.6 (SD=1.9)). Highest fruit and vegetable intake and variety scores were recorded in adult education professionals. Highest nutrition knowledge scores were recorded in health and community education professionals. Gaps in knowledge were noted as the greatest modifiable barrier to providing nutrition education; food preparation and cooking education; food skills education; and behaviour change support. Of participants likely/somewhat likely to participate in a culinary nutrition CPD program (65%) the most commonly requested nutrition topics were understanding differences between special diets and ‘fad’ diets (n= 92, 17%) followed by goal setting for healthy eating (n=94, 17%).

Conclusions: The current survey identified that health and education professionals are interested in CPD to enhance their knowledge of culinary nutrition education and behaviour change support, and highlighted specific areas where education could be targeted.

Purpose: The Coaching and Exercise for Better Walking (ComeBACK) trial is a hybrid effectiveness-implementation (type 1) three-arm pragmatic randomised controlled trial (n=600). It is investigating the effectiveness of two interventions (a physiotherapy-led telephone health coaching intervention and a prescheduled unilateral text message intervention) compared to a waitlist control group to enhance physical activity in adults living in the community with self-reported walking difficulties. The main aim of this study is to report on the dosage of text messages received in the Texting to ComeBACK and Texting to ComeBACK Later groups, as well as report on the participant acceptability of the intervention.

 

Methods: Data on the dosage of text messages received by participants in the ComeBACK program is retrieved from the web-based SMS delivery service and reported descriptively. The acceptability of the texting intervention is being assessed through a study-specific questionnaire completed at the end of the intervention period and reported descriptively.

 

Results: To date, there have been 240 participants randomised in the ComeBACK trial, 161 of these into the Texting to ComeBACK and Texting to ComeBACK Later groups. Of the participants currently receiving text messages or who have completed the program, 72% have maintained the frequency of text messages at 5 times a week, 18% have reduced to 3 times a week and 7% have increased to daily messages. 11% of participants have, at some stage, paused the sequence primarily due to illness. A small number of participants (4%) have requested to opt out of the messages. Of the 75 participants who have completed the texting interventions, the average rating of benefit of the program was 6/10. Fifty-two percent of participants (52%) reported the program met their expectations and 57% would recommend it to others.

 

Conclusions: A web-based SMS service can be set up to deliver physical activity health coaching text messages as intended. Text message interventions may be an acceptable intervention to enhance physical activity for adults living in the community with a walking difficulty.

Purpose: There is a burgeoning amount of evidence on the presence of conflicting health and nutrition information, and a general consensus that the perception of conflicting health information can have adverse effects which may go beyond the current issue and carry over to other topics, perceptions, beliefs and behaviours. However, despite this awareness, very little theoretical knowledge exists on the underlying causes and effects, and the factors that determine the process. The aim is to develop a framework that assists in understanding how consumers handle and process conflicting health information.

Methods: We derive the framework through a literature review and integration of concepts from various disciplines. Insights from fields such as multiple document processing, consumer decision making and the public understanding of science are interpreted, integrated and applied to the health and nutrition context. In the present paper, a model is described that adds to the literature and extends other frameworks by bringing together theoretical conceptions about processing pathways and strategies, in addition to seeking to identify and categorise the determinants that influence the processing of conflicting health information.

Findings: An integrated framework is proposed that identifies stages, paths, strategies and determinants related to processing conflicting information and aims to improve its conceptual understanding. A useable structured presentation of the determinants is proposed. We identify modifiable characteristics of the reader and propose the importance of the reader’s beliefs about knowledge, how knowledge is constructed, and why and how experts may disagree with one another and conflicting information may arise. Lastly, we describe the implications of our framework and how this may inform further research and practice.

Conclusion: A framework is proposed to facilitate an understanding of the underlying mechanisms of the processing of conflicting health information. The framework may support future research and practice, e.g. in nutrition literacy.

Purpose: People living with cardiovascular disease (CVD) require flexible self-management support for health behaviour change for CVD secondary prevention. Digital health interventions can assist with these complex self-management activities. Many stakeholder groups can be involved in digital health design, including people living with CVD (users), researchers, healthcare professionals and technology developers. However, decision-making and aligning views can be difficult to negotiate within interdisciplinary teams, so the use of appropriate methodological strategies is vital. The aim of this study was to co-design and develop the Salvio digital platform.

Methods: A triangulation of research methods was used for this iterative development process. Participatory design (PD) approaches included guided group discussions, activity-based workshops, and think-aloud tasks. Data collection was supported by self-efficacy theory to encourage user contributions. Over a 12-month period, participants met at various time points to collectively design and develop Salvio. Workshops were 2-3 hours in length and were facilitated in small groups of 4-6 participants per session. All sessions were audio-recorded, central parts of workshop conversations were transcribed, and qualitative content analysis of data was undertaken.

Results: Users (n=8) worked collaboratively with researchers (n=5) and technology developers (n=5). Findings indicated that it was critical to include an interdisciplinary team with a wide range of expertise, to build a meaningful and flexible digital platform. Effective methodological strategies were essential for genuine participation and continuous conflict resolution. Our research highlighted key elements that added to the success of this co-design process including i) the creation of a collaborative space where all voices were acknowledged and considered and ii) the effective translation of information during decision-making stages.

 Conclusions: Future research is needed to expand and evaluate PD tools and techniques which challenge the power relations between users and other stakeholders. By exploring methods that create space for mutual learning and resolving conflict through systematic decision-making, complex digital platforms for health behaviour change can be successfully developed with diverse groups. It is clear that flexible digital platforms may be valuable to users, but further research will also be required for the successful implementation and knowledge translation of these contemporary developments.

 

Introduction: In Mexico, 35.6% of school-age children are overweight or obese. Likewise, 29.0% of the Mexican population does not meet the World Health Organization (WHO) physical activity (PA) recommendations. Increasing the quantity and improving the quality of physical activity among children has gained relevance. Thus, the physical education (PE) class component becomes an essential and low-cost tool for successful interventions on PA. It is thus imperative to study PE classes to better understand its relationship with PA.

Methods: The System for Observing Fitness Instruction Time (SOFIT) was used to objectively assess the quality and quantity of the PE lessons. One hundred and thirty-nine observations were conducted in six Mexican rural elementary schools. Grades were stratified into three groups, according to the Mexican national education curriculum.

Results: The average PE class length and minutes of MVPA were 39.7±10.6 and 21.3±7.1, respectively, with significant differences found between groups. MVPA in PE lessons met international recommendations, with an average minute ratio of 0.51±0.12, 50.5 % of the total lesson length. Regression models found 'knowledge' lesson context categories to have a significant negative impact on PE MVPA (β= -0.46, P< 0.001; β= -0.35, P<0.01; β= -0.73, P< 0.001). Teacher behaviour categories (promotion and demonstration fitness) had a significant positive relationship on PE MVPA for second and third groups (β= 0.42, P<0.001; and β= 0.42, P<0.001; respectively).

Conclusions: Students did not achieve the national PE lesson length standards. However, the international MVPA minutes from PE lessons standards were achieved. Nevertheless, those minutes were not enough to meet the WHO PA standards (150 MVPA minutes a week). Schools will require at least four weekly PE lessons to meet the WHO PE lessons recommendations. Quality of PE lessons needs to be improved with more teacher involvement to avoid sedentary and low PA to MVPA lesson contexts.

Purpose: To inform implementation and future research, this scoping review assessed reviews of the evidence for physical activity (PA) interventions among adults aged 60+ years. Our research questions are: (1) what is the evidence for interventions designed to increase total PA in adults aged 60+ years, in accordance with three of the four strategic objectives of GAPPA (active societies; active environments; active people)?; (2) what is the current evidence regarding effectiveness of tailored PA programmes and services for older adults?; (3) what are evidence gaps requiring further research?

Methods: We searched PEDro, MEDLINE, CINAHL and Cochrane from 1 January 2010 to 1 November 2020 for systematic reviews of PA interventions in older adults aged 60+ years. We identified interventions designed to: (1) increase PA and (2) deliver PA programmes and services in home, community or outpatient settings. We extracted and coded data from eligible reviews according to our proposed framework informed by TIDieR, Prevention of Falls Network Europe (PROFANE), and WHO’s International Classification of Functioning, Disability and Health (ICF). We classified the overall effects as positive, negative or inconclusive.

Results: We identified 39 reviews of interventions aiming at PA and 342 reviews of PA programmes/services for older adults. Most of the reviews (290/342, 85%) reported positive overall findings for physical and cognitive/emotional function outcomes. Interventions were predominantly structured exercise programs, including balance strength/resistance training, and physical recreation (e.g., yoga and tai chi). There were few reviews of health promotion/coaching and health professional education/referral, and none of sport, workplace, sociocultural or environmental interventions. Fewer reported outcomes of overall PA, social participation and quality of life/well-being. We noted limited evidence for diverse and disadvantaged older adults and from low-middle income countries. 

Conclusion: There is modest but growing evidence for interventions to increase PA in older adults, although more population-based health promotion and environmental interventions are needed. There is abundant evidence for specific PA programmes and services, but coverage of sport, workplace and diverse samples is lacking. A comprehensive review of evidence from individual studies is now needed as well as research targeting neglected outcomes, populations and settings.

Purpose: The COVID-19 pandemic has imposed additional barriers for physical activity (PA) in cancer survivors. Adaptations to PA programs are needed during the pandemic. Therefore, the purpose of this study was to evaluate the: 1) PA preferences of cancer survivors during the pandemic; and 2) the available resources to engage in PA during the pandemic. 

Methods: Using a cross-sectional study design, cancer survivors were recruited globally through convenience sampling using Prolific (www.prolific.co; an online survey distribution tool). Cancer survivors were 18 years of age or older, have been diagnosed with cancer, and were able to complete the study in English. Cancer survivors completed a self-reported online survey addressing the COVID-19 guidelines where they live, their PA preferences, and available PA resources during the pandemic. Questions were Likert scale, closed, and open-ended questions addressing the study objectives. Descriptive statistics, including frequencies and percentages of responses, were used to determine trends in PA preferences and resources.  

Results: Cancer survivors (N=511) were mainly female (n=356, 69.7%), with a mean age of 48.4±15.6 years, diagnosed with breast (n=148, 29.0%), gynecologic (n=60, 11.7%), and hematologic cancer (n=60, 11.7%), with a mean of 86.3 ± 81.8 months since diagnosis. Since the start of the pandemic, cancer survivors were primarily walking (n=419, 82.0%), preferred performing PA at home (n=238, 46.6%) or outdoors/around their neighbourhood (n=244, 47.7%), and alone (n=319, 62.4%). The majority of cancer survivors had available space to perform PA at home in their living room (n=337, 65.9%), and in their neighbourhood on sidewalks (n=320, 62.6%) and walking paths (n=275, 53.8%). The most common equipment available to survivors in their homes were free weights (n=205, 40.1%) and exercise mats (n=207, 40.5%). Few survivors were made aware of at-home PA resources (n=98, 19.2%), and approximately half of cancer survivors indicated wanting to receive at-home PA resources (n=254, 49.7%). 

Conclusions: Understanding cancer survivors’ preferences for PA during the pandemic and the resources they have available is critical to designing effective home-based interventions. This may lead to increased PA behaviour for better quality of life and health outcomes among cancer survivors.

Purpose: The aim of this systematic review and meta-analysis was to investigate the effectiveness of behaviour change interventions for changes in physical activity and anthropometrics (body mass, body mass index and waist circumference) in ambulatory hospital populations.

Methods: A systematic literature search was conducted using five bibliographic databases (MEDLINE, Embase, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO) to identify randomised controlled trials of ambulatory hospital initiated behaviour change interventions. Two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies. Meta-analyses were conducted using change scores from baseline to determine mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (95% CI). The quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach.

Results: Twenty nine studies met the eligibility criteria, and 21 studies were included in meta-analyses. Ambulatory hospital initiated behaviour change interventions significantly increased physical activity (SMD: 1.30; 95% CI: 0.53 to 2.07, p < 0.01), and resulted in significant reductions in body mass (MD: -2.74; 95% CI: − 4.42 to − 1.07, p < 0.01), body mass index (MD: -0.99; 95% CI: − 1.48 to − 0.50, p < 0.01) and waist circumference (MD: -2.21; 95% CI: − 4.01 to − 0.42, p = 0.02). Due to the heterogeneity in study populations, reported outcomes, and intervention components, the GRADE assessment indicated that the evidence is very uncertain about the effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital patients.

Conclusions: Behaviour change interventions initiated in the ambulatory hospital setting resulted in a significant increase in physical activity and significantly reduced body mass, body mass index and waist circumference. The results support the implementation of behaviour change interventions in ambulatory secondary care clinics for the mitigation of chronic disease risk factors. The explicit reporting of behaviour change interventions definitions, theories and techniques in published studies is strongly recommended.

Purpose: Internationally, up to 70% of pregnant women gain weight outside of their gestational weight gain recommendations. The assessment and management of gestational weight gain as part of routine antenatal care is recommended in many countries to improve pregnancy and birth outcomes, and maternal and child chronic disease risk. Little is known about the conduct and acceptability of such practices in antenatal care. This study reports the: i) proportion of pregnant women assessed and offered support to manage gestational weight gain in line with the Australian Pregnancy Care guidelines, ii) characteristics of pregnant women and antenatal services associated with care receipt, and iii) women’s acceptability of recommended care.

Methods: Cross sectional telephone surveys with postpartum women who had recently attended public antenatal services were undertaken in one health district in Australia. The surveys were reviewed to ensure Aboriginal cultural safety and inclusion. Women self-reported demographic characteristics, gestational weight gain during pregnancy, and receipt and acceptability of guideline recommended care of care were examined. Characteristics associated with receipt of recommended care were analysed using multiple logistic regression.

Results/findings: A total of 514 women completed the survey. Seventy percent of women gained weight below or above the gestational weight gain guidelines. Only 7% of women received recommended gestational weight gain care. Women who were in their first pregnancy, identified as Aboriginal, had a higher pre-pregnancy body mass index, and not residing in an advantaged area were more likely to receive recommended care. Most Aboriginal and non-Aboriginal women agreed that recommended care for gestational weight gain (92% and 93%) should be provided as routine antenatal care.

Conclusions: Most women did not receive antenatal care for gestational weight gain as recommended by the Australian Pregnancy Care Guidelines, despite high acceptability of receiving such care. There is a need for service-wide practice change to increase care to address gestational weight gain in pregnancy.

Background: There is increasing concern about the time people spend in sedentary behaviour, including screen time, leisure and occupational sitting. The number of both primary research studies (published trials) and reviews has been growing rapidly in this research area. A summary of the highest level of evidence that provides a broader quantitative synthesis of diverse types of interventions is needed.  This research is to articulate the evidence of the efficacy of sedentary behaviour interventions to inform interventions to reduce sitting time. The umbrella review, therefore, synthesised systematic reviews that conducted meta-analyses of interventions aiming at reducing sedentary behaviour outcomes across all age group and settings.

Method: A systematic search was conducted on six databases (MEDLINE Complete, PsycINFO, CINAHL, Global Health via EBSCOhost platform, EMBASE, and Cochrane Central Register of Systematic Reviews). Included articles were systematic reviews with meta-analysis of interventions aiming at reducing sedentary behaviour (screen time, sitting time or sedentary time) in the general population across all age group.

Results: Seventeen reviews met the inclusion criteria (7 in children and adolescent, 10 in adults). All reviews of sedentary behaviour interventions in children and adolescents investigated intervention effectiveness in reducing screen time. Six out of 11 meta-analyses (reported in 7 reviews) showed small but significant changes in viewing time. All reviews of sedentary behaviour interventions in office workplaces indicated a substantial reduction in occupational sitting time (range: 39.6 to 100 min per 8-hour workday). Sub-group analyses reported a trend favouring environmental change components such as sit-stand desks, active permissive workstations etc. Meta-analyses indicated that sedentary behaviour interventions were superior to physical activity alone interventions or combined physical activity and sedentary behaviour interventions in reducing sitting time.

Conclusion: The current systematic reviews and meta-analyses supported sedentary behaviour interventions for reducing occupational sitting time in particular, with small changes seen in screen time in children and adolescents. Future research should explore approaches to maintaining behaviour change beyond the intervention period and investigate the potential of sedentary behaviour reduction interventions in older age groups in non-occupational settings.

Purpose: This study aimed to explore the barriers and facilitators to dietary intake in adults with type 2 diabetes in Kenya. It is estimated that 2.2% of the adult population in Kenya have diabetes and nearly two-thirds of the adults have undiagnosed diabetes. Diabetes is associated with all-cause mortality, cardiovascular diseases and causes heavy economic burdens. Various components of dietary behavior and the food environment are probable facilitators and barriers to type 2 diabetes. However, there is little information on the specific drivers of the disease in Kenya.

Methods: Adult participants aged 20 to 65 years old, with type 2 diabetes mellitus were purposively selected from six hospitals based on their ability openly elucidate on the theme of dietary intake. A semi-structured questionnaire developed though a theoretical framework was administered through telephone interviews conducted in Swahili or English. Telephone interviews were selected as a safe approach during the COVID 19 crisis. After transcription and translation, NVivo 12 Software was used to code the responses from each question. Inductive thematic analysis was used to identify the highest ranking facilitators and barriers to dietary intake.  

Results/findings: Thirty interviews were conducted, each lasting between 27-47 minutes. The four highest ranking facilitators to healthy dietary intake were knowledge on the benefits of various foods, owning kitchen gardens or farms, family support, and nutrition education provided by healthcare workers. Three highest ranking barriers included lack of reliable sources of information on healthy food choices and practices, unsupportive families and socio-economic factors.

Conclusions: Access to knowledge on food and dietary practices, which is a components of food literacy was identified as a leading and modifiable facilitator and barrier to healthy dietary intake. Innovative and context-specific interventions to facilitate food literacy have the potential to sustainably improve treatment outcomes for adults with type 2 diabetes in Kenya. 

Purpose: Dietary factors play a major role in the development of cancers, however little is known regarding the impact of nutrition on bone sarcomas in children and adolescents. This study aimed at evaluating the relative validity of a Food Frequency Questionnaire (FFQ) to measure the consumption of foods in comparison with a 3-days diet diary in a healthy student population aged between 12 and 17 years in Italy.

Methods: An extended version (including food groups for children) of the semi-quantitative FFQ used in the European Prospective Investigation into Cancer and Nutrition (EPIC) was administered. The validity of the FFQ was assessed by comparing the intakes from the FFQ against the 3-day diary method (non-consecutive days), collected in 2019. In total, 254 subjects were included in the analyses: 128 females and 126 males, 116 from High School, 138 from Middle School. Spearman correlations adjusted for within-person variability were calculated.

Results/findings: Mean and median intakes are overall higher in the FFQs than in the food diaries. Correlations were highest for legumes, vegetables and coffee/tea (>0.5), followed by potatoes, meat, fruits, breakfast cereals, biscuits and candies and milk/yoghurts (>0.4). Moderate correlations were found for Alcoholic drinks, Soft drinks, juices, and grains (including pizza) (>0.3). For some food groups, such as fish, potatoes and bread, these moderate correlations tend to become higher when stratifying the analyses for age group. During a focus group meeting with the researchers involved in the fieldwork, it was specified that students had more difficulties in completing the 3-day diaries than in completing the FFQ, what may have impacted the relative validity results.

Conclusions: Correlations between the FFQs and food diaries were acceptable for frequently consumed foods and for most infrequently consumed foods after adjustment of the variance ratio of the three day diaries. This demonstrates that the adapted EPIC COS FFQ which has originally been developed and validated for use in Italian adults is also appropriate and well understood by Italian children and adolescents. This FFQ will be used in individuals at least 12 years old who are included in a case control study among bone sarcoma patients.

Purpose: Our overall goal is to evaluate the impact of promoting diet and lifestyle recommendations at colorectal cancer (CRC) screening among individuals at higher risk of developing CRC. We aim at evaluating the impact of the intervention on changes in their adherence to these cancer prevention recommendations. In addition, aim to evaluate changes in patients’ risk perception and knowledge about lifestyle behaviours that may prevent CRC, as well as changes in their automaticity of target behaviours over the trial period. Finally, this study also aims to evaluate the impact of the intervention on physical fitness, body size, metabolic health and biomarkers of CRC development.

Methods: This study is a parallel, two-arm, cluster, randomised controlled trial (RCT) in individuals at higher risk of CRC, comparing an evidence-based diet and lifestyle advice intervention with ‘usual care’. The lifestyle recommendations provided are developed based on the latest evidence-based diet and lifestyle recommendations and will be delivered using multiple materials (e.g. leaflets, posters and digital information) by health professionals in hospitals based in the Rhone region, France. Information on how to transform these recommended behaviours into habits, and therefore render them easier to maintain over time, is also provided, as well as concrete examples and tips for healthy lifestyle behaviours (e.g. healthy recipes, examples of convenient exercises for the target group, etc.). Individuals receive the intervention material during their hospital visit before colonoscopy, with a refreshment intervention during their medical visit after their colonoscopy and a further follow-up for 12 months.

Results/findings: The proposed study is expected to promote a greater improvement in diet and lifestyle behaviours, as well as improvement in quality of life, biomarkers for cancer risk, physical fitness and body weight among individuals at higher risk of developing CRC. 

Conclusions: Providing lifestyle advice for cancer prevention at screening programs is a new field in public health that has the potential to be cost-effective, convenient, appealing and wide-reaching. It may also help to reach individuals at higher risk at a time-window when they are more receptive to advice on healthy lifestyles and more likely to make the required behavioural changes.

Purpose: Benefits of mindfulness and aerobic exercises on predominately Caucasian children’s physical and mental health have been documented (e.g., Biddle et al., 2019; Garcia et al., 2019). However, scarce research in this area has involved minority children. Thus, this study aimed to test the efficacy of a 12-week mindful-aerobic exercise program in increasing moderate-to-vigorous physical activity and reducing anxiety and emotional eating among Latinx and African American youth.

Methods: 148 Latinx and African American early adolescents (M_age = 10.1 years, SD_age = 1.3; 52% girls) were randomized into an experimental or comparison group. In the experimental group, participants attended two weekly 60-minute exercise group sessions of fitness yoga and kickboxing/spinning for 12 weeks. They also practiced mindful meditation and breathing exercises. The comparison group participated in a weekly 60-minute recreational play session during the same period. All participants completed pre- and post-intervention surveys, e.g., demographics, the Physical Activity/Preference Questionnaire (Kowalski et al., 2004), the Multidimensional Anxiety Scale for Children (March & Parker, 2004), and the McKnight Risk Factor Survey-IV emotional eating subscale (McKnight Investigators, 2003). To measure physical activity objectively, participants wore an accelerometer for seven days pre-and post-intervention. Participants’ height, weight, and waist circumference data were taken at pre- and post-intervention. Repeated measures analysis of covariance (covariates included gender, age, and adiposity) was conducted to assess the effectiveness of the intervention in primary outcomes.

Results: According to CDC’s obesity status classification, 52% fell within overweight/obese range at baseline. Participants had an average of 27.6% body fat (SD = 10.5%). Except for ethnicity, no significant differences were found at pre-test in demographics or variables of interest between the experimental and the control group. Results indicated that experimental group showed a significantly greater decrease in anxiety [F(1,118) = 5.09, p = .03, partial η² = .04], and emotional eating [F(1,121) = 5.41, p = .02, partial η² = .04] after intervention. However, pre-post intervention changes in physical activity were not significantly different between two groups.

Conclusion: These findings suggest a positive impact of a mindful-aerobic exercise intervention on anxiety, and emotional eating among Latinx and African American youth.

Purpose: Physical activity (PA) tracking app interventions can increase PA among users although engagement remains a challenge. This study examined the effects of an in-app PA challenge intended to increase app usage and PA among users of the ParticipACTION app, a freely available and nationally promoted PA app.

Methods: From 1-31 October 2020, the Great Big Move Challenge (GBM) encouraged PA by allowing users to virtually travel across Canada and track PA minutes on the ParticipACTION app. App users participated in the challenge in teams of up to 8. Engagement metrics were extracted from internal app analytics and moderate-to-vigorous PA (MVPA) data were extracted from the app database, using an 8-week (21 September-14 November 2020) quasi-experimental design assessing MVPA two weeks before and after the 4-week challenge. Weekly MVPA was monitored through wearable fitness trackers and health apps synced to the ParticipACTION app. Repeated measures ANOVAs with simple main effects were used to determine changes over time (pre/post; mean+SE) and differences between groups (Participants/Non-participants).    

Results: The GBM attracted 30,932 new registered users to the ParticipACTION app and increased monthly active users by 185% from 20,434 users in September to 58,134 in October. A total of 6,414 users had data for all 8 weeks of the evaluation, 3,025 participants (app users on a team) and 3,389 non-participants (app users not on a team). Non-participants (214.5±5.0 min) recorded less MVPA at Week 1 compared to participants (248.5±5.3 min, p<0.001). Non-participants steadily declined in MVPA over the 8 weeks (Week 1: 214.5±5.0 min vs Week 8: 158.2±4.1 min, p<0.001), while participants demonstrated an increase in MVPA that peaked at Week 3 and then declined (Week 1: 248.5+5.3 min, Week 3: 290.2+5.1 min, p<0.001; Week 6: 258.2+4.6 min, p=0.050; Week 8: 196.1+4.5, p<0.001).  App usage declined after the challenge, 28,077 users had some PA data during Week 3 compared to 14,203 users by Week 8.

Conclusions: In-app challenges appear to be a viable approach to drive app engagement and increase MVPA short-term. Significant declines in MVPA occurred following the challenge which may reflect disengagement with the app. Long-term app engagement remains a challenge.

Purpose: Physical activity promotes health and wellbeing in older age. Implementation of effective physical activity interventions needs to consider value for money. This scoping review aimed to assess the evidence of economic evaluations of physical activity interventions for people aged 60+. The specific questions were: 1) what is the volume of systematic review evidence regarding economic evaluations of physical activity interventions for older people? (review of reviews); 2) what is the volume of cost utility analysis (CUA) of physical activity interventions for older people? (review of CUA studies); 3) what are the literature gaps requiring future research?

 

 Methods: Review of reviews: a search for systematic reviews of economic evaluations of physical activity interventions for people aged 60+ was conducted in PEDro, MEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews (January-2010 to November-2020).

Review of CUA studies: we searched the Tufts Cost-Effectiveness Analysis Registry to identify individual studies investigating cost-utility of physical activity interventions for older people. Two independent reviewers performed screening and data extraction of included studies.

 

 Results/findings: Review of reviews: we found 10 potential reviews, but none fully met our inclusion criteria, as they were not focused on physical activity interventions, economic evaluations, or older people. For these reviews, we only extracted information from the individual studies that met our criteria (n=29). All studies included in the reviews investigated the cost-effectiveness of structured exercise and most revealed that the intervention was more costly but also more effective compared to no intervention.

Review of CUA studies: we included CUA from 18 individual studies, and all investigated structured exercise programmes. Most studies (n=15) found that the intervention was more costly and also more effective, and two interventions were cost-saving.

 

 Conclusions: Very few systematic reviews investigated the cost-effectiveness of physical activity interventions for older people and none were conducted investigating only physical activity interventions. All included studies investigated structured exercise programmes and, in general, the interventions were more efficient and also more costly when compared to no intervention. A review of individual studies is needed to summarise the evidence on value for money of physical activity interventions for older people.

Purpose: Accelerometer-assessed physical activity outcomes are traditionally based on cutpoints and expressed as time spent in absolute activity intensities. In recent years alternative metrics derived directly from raw accelerations and that are not subject to the limitations of cutpoints have been introduced. However, little is known about these metrics in boys and girls across a wide age range. We aimed to assess average acceleration (activity volume), intensity gradient (intensity profile), and M60 (minimum acceleration for the most active 60-minutes) metrics in primary and secondary school boys and girls. 

 

Methods: This is a pooled secondary analysis of data collected in northwest England between 2015-2019. Two-hundred-and-fifty-eight lower primary school children (LPS; age 6.0 years, 144 girls), 788 upper primary school children (UPS; age 10.1 years, 405 girls), and 450 secondary school adolescents (SS; age 13.6 years, 328 girls) participated. Wrist accelerometers were worn for 7 days. Average acceleration, intensity gradient, and M60 metrics were calculated based on a 16-hour waking hours day. Adjusted mixed linear models investigated differences between sex and age groups.

 

Results: Boys were significantly more active than girls for each metric in all age groups (p<.001). SS boys and girls were significantly less active than UPS boys and girls for all metrics (p<.001). There were no differences in average acceleration or M60 between LPS and UPS boys or girls (p>.05). The intensity gradient of UPS children was though significantly greater than for LPS children, with the largest difference seen in girls (p<.001). M60 values equivalent to brisk walking (~290 mg) were observed in <20% of LPS boys and in no LPS girls. The most active 60% and 30% of UPS and SS boys respectively, had M60 values equivalent to brisk walking (~220 mg), while 40% of UPS girls and no SS girls had M60 values this high.

 

Conclusions: Boys were more active than girls irrespective of metric or age group. UPS children’s intensity profiles suggested that they spent more time in higher intensity activities than LPS and SS peers. Directly measured accelerometer metrics can effectively describe the physical activity volume and intensity of children and adolescents.

Purpose: School-based physical education (PE) provides a unique setting to deliver physical activities that promote muscular fitness (MF). However, such delivery may be impaired by a lack of PE teacher expertise and confidence in school-based MF activity. An understanding of teachers’ thoughts and perceptions regarding the delivery of MF may help to develop teaching quality in these activities and inform intervention design to engage students in MF-promoting activities through PE.

Methods: An online survey to investigate perceived benefits, challenges and experiences of delivering MFin UK secondary school was distributed to PE teachers via Twitter. Survey responses were collected from across England, Wales, Northern Ireland and Scotland. Data were reported descriptively and differences between teaching experience and gender were analysed using log-linear regression.

Results: Completed surveys were returned by 194 teachers. Seventy-nine percent of teachers perceived MF activity as an important element of PE compared to 21% who did not (β=0.86, CI 0.04, 1.69, p=0.04). Assessments of MF were more likely to be conducted by teachers with 5-14 years of teaching experience (β=-1.60, CI -2.91, -0.29, p=0.01) and 15+ years of teaching experience (β=-1.39, CI -2.71, -0.07, p=0.04) compared to teachers with <4 years of experience. Only 27% teachers used MF assessments to inform programming decisions regarding future provision of MF activity (β=-1.48, CI -2.45, -0.51, p<0.01). Seventy-six percent of teachers suggested their knowledge of MF needed development compared to 9% who did not believe professional development was required (β=2.08, CI 1.04, 3.12, p<0.01,). Eighty-eight percent of teachers suggested that further professional development in the teaching and assessment of MF activities would be useful (β=-2.56, CI -3.74, -1.39, p<0.01,).

Conclusion: Teachers delivering PE from across the UK believe their knowledge of school-based MF activity requires development. A lack of knowledge in the teaching and assessment of school-based MF was demonstrated by a high number of MF assessments conducted with no subsequent informed decision-making that is required to safely and effectively teach MF activity. Provision of continued professional development is warranted to deliver successful MF interventions through PE.

Purpose: The aim of this study was to examine differences in active commuting to school (ACS) between different and consecutive educational levels,  educational stages and school grades, separately. Methods: Data were obtained from 28 cross-sectional studies conducted across Spain in 2010-2017. The analytical sample comprised 42,074 participants; namely, 5,327 children aged 3-5.99 years old (48% girls), 18,329 children aged 6-11.99 years old (50.4% girls) and 18,438 adolescents aged 12-18 years old (49.3% girls). Individual data included participant´s age, gender, and mode of commuting to school. The ACS was self-reported in the 28 studies using different questions; a final categorization was conducted into “active” (i.e., by walk/cycling and/or non-motorised scooter) and “passive” (i.e., by school bus/public bus/train/metro/taxi/moto and/or car). Participants were classified into educational levels, educational stages and school grades, aligning with the Spanish educational system based on age. Logistic regressions models were performed to analyze the associations between ACS and educational levels, ACS and consecutive educational stages from different educational levels, and ACS and consecutive school grades from different educational stages. Results: Each educational level and stage was associated with  the previous educational level and stage showing a higher odds  (all, p<0.001) respectively, except one case (i.e., adolescents in the first cycle of compulsory secondary education had lower odds of ACS than those in the third cycle of primary education; p<.05). There were no changes between consecutive school grades, except adolescents of first grade in the secondary education level who had lower odds of ACS than their counterparts of the last grade of primary education level (p<.05). Conclusions: Overall, ACS increased in students from higher educational levels and stages, but ACS did not increase within consecutive school grades. Future interventions should focus on pre-primary education level that showed lower rates of ACS in order to acquire active habits in the early childhood.

Purpose: To examine the effect of a multicomponent intervention program designed according to current paediatric guidelines for childhood obesity and including a family-based lifestyle and psychoeducation program plus a supervised exercise intervention on visceral adipose tissue (VAT) in children with overweight/obesity.

Methods: In this two-arm, non-randomized, parallel design clinical trial (Clinical Trial registration: NCT02258126), participated 101 children with overweight/obesity aged 8-12 years. Children were allocated to either a 22-week lifestyle and psychoeducation program (control group, n = 52) or to the same program plus a supervised exercise intervention (intensive group, n = 49). The control group received two monthly sessions of a family-based lifestyle and psychoeducational program. The intensive group received the same intervention than the control group plus three weekly sessions of supervised exercise including both cardiovascular endurance and strength training at moderate-to-vigorous intensity. The primary outcome was the change in VAT (measured by magnetic resonance imaging) between baseline and post-intervention period. Further, we additionally explore whether cardiorespiratory fitness (measured by maximal treadmill test) mediates the changes in VAT.   

Results/findings: Both groups significantly reduced VAT at the end of the intervention (all p < 0.002), yet the reduction was significantly greater in the intensive group compared to the control group (percentage of change = - 18.1% vs. -8.5%, p < 0.001, mean difference - 4.2 cm², p = 0.010; d-Cohen = 0.51). Indeed, the percentage of children with a clinically significant VAT reduction from baseline to post-intervention (i.e., d-Cohen ≥ 0.2) was two times higher in the intensive group compared to the control group (73.5% vs. 36.5%, p < 0.001). The change in cardiorespiratory fitness has a mediation role on the effect of the intervention on VAT (indirect effect: β = -0.057, 95% confidence interval = -0.139, -0.004).

Conclusions: A multicomponent intervention program that includes lifestyle and psychoeducation plus supervised exercise reduces VAT content in children with overweight/obesity, which might be mediated by changes in cardiorespiratory fitness. Therefore, intervention programs aiming to target paediatric obesity should focus not only on reducing fatness but also on improving fitness.  

 

Purpose: Green exercise is associated with numerous health benefits among children. The adults in the same household have an impact on children’s green exercise as adult’s nature visit frequency is associated with children´s nature visit frequency. Sociodemographic factors may act as predictors of family´s green exercise participation. Therefore, the aim of this study is to explore the associations of sociodemographic factors and adult-child nature visits.

Methods: This study included data from three questionnaires: the cross-sectional DAGIS study collected in 2015–2016 (n=864), the DAGIS intervention study collected in 2017–2018 (n=728) and the Naturkraft (Empowered by Nature) survey collected in 2019 (n=1463). The data from the DAGIS studies were combined in the analyses. Parents of children aged 2 to 7 were the respondents of the questionnaires. The variable “adult-child nature visit frequency” was dichotomized into 1) at least once a week and 2) less than once a week. Binary logistic regression analyses were conducted and adjusted for the origin of the data and questionnaire´s filler (mother/father) except for the Naturkraft-data.

Results: Adult-child nature visits decreased as the child grew older. This was observed both in the whole data sample (OR= 0.91, 95 % CI 0.86–0.97), as well as in the Naturkraft-data sample alone (OR= 0.91, 95 % CI 0.84–0.99). In the Naturkraft-data the number of children aged 7 to 17 also decreased the odds (OR= 0.84, 95 % CI 0.72–0.95) while high perceived financial situation (OR= 1.93, 95 % CI 1.35–2.75) and lower educational level of mothers (OR= 1.47, 95 % CI 1.06–2.03) increased the odds of weekly nature visits. In the combined DAGIS-data mothers outside working life increased the odds of adult-child nature visits (OR= 1.42, 95 % CI 1.02–2.00).

Conclusions: Children´s age, number of children, perceived financial situation, mother´s education and employment status were associated with adult-child nature visit frequency. The results partly corroborate previous studies. These results indicate that sociodemographic factors should be taken into consideration when planning activities to promote green exercise.

Purpose: The aim of this study was to examine the relationship between the cumulative number of undefined complaints and the lifestyle habits of female university students, whose daily activities were restricted and were forced to receive online classes due to the COVID-19 pandemic.

Methods: Three hundred and forty-nine female university students voluntarily participated in this study, which was a baseline assessment of an interventional study of a project for exercise videos distributed online. The subjects filled out a web questionnaire which asked about status of breakfast intake, sleep time on days with and without classes, sitting time per day, exercise frequency per week in the past month, as well as 21 complaints. Subjects were divided into tertiles based on a distribution of the cumulative number of symptoms. Following a trend test to extract variables which associated the number of symptoms, odds ratios of each lifestyle behavior in each tertile were calculated using a logistic regression model.

Results: Significant trends were observed between the number of complaints and the sleep and physical activity-related variables. Also, odds ratios in the sleep time on the days with classes and the frequency of exercise were significantly lower in the middle tertile compared with the bottom tertile. Further, in the top tertile, a significantly lower odds ratio was found in the sleep time on the days with classes, on the other hand, the odds ratio was significantly higher in the sleep time on the days without classes. Similarly, the odds ratio for the sitting time was also significantly higher in the top tertile.

Conclusions: Our findings suggested that the higher the cumulative number of self-reported complaints, the stronger the tendency for lack of sleep on class days and excessive sleep on non-class days, as well as a more serious physical inactivity. It is a well-known fact that the undefined complaints in females are affected by female hormones; however, we concluded that lifestyle problems, especially in sleep and physical activity, might be also able to explain the cumulative number of complaints in female university students, who were under the self-quarantine due to the spread of COVID-19. 

Background: Television (TV) time is associated with health issues such as obesity and cardiometabolic disease, especially in women, but there is a lack of prospective studies on multiple determinants of TV time. Higher TV viewing is linked with low socioeconomic position but the role of education in moderating associations between determinants and TV viewing is unknown. Therefore, among women living in socioeconomically disadvantaged neighbourhoods and using a social-ecological framework, this study aimed to 1) investigate baseline intrapersonal, social, and physical environmental factors associated with TV viewing over five years, and 2) examine whether any associations between intrapersonal, social, and physical environmental factors and TV time is moderated by education. 

Methods: Data were collected three times over five years from women living in socioeconomically disadvantaged neighbourhoods of Victoria, Australia. Women self-reported weekly TV time using reliable measures. Exposure variables were intrapersonal (self-efficacy, enjoyment, outcome expectancies, behavioural skills for physical activity [PA]), social (childcare, dog ownership, sports/recreational club membership, interpersonal trust) and physical environmental (neighbourhoods aesthetics, neighbourhoods safety, neighbourhoods walking environment, neighbourhoods cohesion, number of TVs at home) factors. Multilevel-mixed modelling (negative binomial) determined baseline correlates and predictors of TV time, adjusting for covariates. Three-way interactions examined the moderating effect of education.

Results: Cross-sectionally at baseline, those reporting medium or high PA self-efficacy, PA enjoyment, outcome expectancies, behavioural skills and interpersonal trust watched less TV time. Similarly, those from neighbourhoods with medium aesthetics reported less TV time. Those with ≥2 TVs at home watched more TV. No longitudinal predictors of TV time were found. Education did not moderate the association between intrapersonal, social, and physical environmental factors and TV time.

Conclusion: Among women from disadvantaged neighbourhoods, cross-sectional intrapersonal, social, and physical environmental correlates of TV viewing time were identified supporting previous research, but no longitudinal predictors of TV time over five years were found. The relationship between social-ecological factors and TV time was not moderated by education status. Reasons for the lack of longitudinal associations require further in-depth investigation but could focus on exploring other TV behaviour-specific socioecological factors, and other potential individual-level socioeconomic moderators (e.g., employment status) of TV time.

Purpose: Prehabilitation aims to optimise patients’ ‘readiness’ for surgery by improving pre-operative health and fitness status, with a view to reducing complications and improving post-operative recovery. To evaluate the health benefits of prehabilitation, it   is   important   to   use   patient-appropriate,   valid   and   reliable measurements. However, current prehabilitation interventions are heterogeneous in design and different measurement tools have been used to evaluate efficacy and adherence. This issue of heterogeneity in outcome measurement and reporting could be reduced with the development and application of an agreed standardised set of outcomes, also known as a core outcome set (COS). The overarching aim of this project is to develop a COS for studies evaluating prehabilitation interventions in intra-abdominal cancer patients.

Methods: The protocol of this COS development study was designed by an International collaborative group of experts within the field. It adheres to the Core Outcome Set-STAndardised Protocol statement and is registered on the COMET database and the Open Science Framework. Stage 1 of this project is a systematic review to identify all relevant outcomes used in prehabilitation interventions in intra-abdominal cancer patients. In stage 2 a list of outcomes will be created (based on the results of the review) and categorized into specific domains (e.g. physical/psychosocial outcomes) which will be converted into an online survey. Stage 3 consists of a two-round Delphi-study (using the outcomes survey developed in stage 2), in which the outcomes will be evaluated and prioritized. Experts will have the opportunity to add additional relevant outcomes during the Delphi-study. Stage 4 of this project is a consensus meeting with all relevant stakeholders to agree on the final COS.

Results/findings: The systematic review is currently ongoing and preliminary results will be presented during the ISBNPA conference in June 2021.

Conclusions: Standardization of outcome measures will be an important step forward for clinical research studies aimed at evaluating and understanding the health benefits of single and multi-modality prehabilitation in different cancer care settings. This project will add value to the field of prehabilitation and help to define its role in cancer care.

Purpose: Text-based interventions are considered as an effective and relatively simple technology for health promotion purposes. The E-Supporter is a text-based (SMS and e-mail) lifestyle coaching intervention to encourage physical activity and healthy nutrition in people with Type 2 Diabetes Mellitus (T2DM). This study aimed to develop and qualitatively evaluate the first E-Supporter version tailored to the Stages of Change and self-efficacy levels.

Methods: The development of the E-Supporter was based on scientific evidence, theory and experts input. Furthermore, 13 diabetes experts participated in two focus groups to evaluate the E-Supporter on readability, relevance and correctness of the provided information. Lastly, the E-Supporter was evaluated in a field test of 9 weeks by 20 people with T2DM. Participants wore a Fitbit for measuring physical activity and kept a food diary for assessing eating behavior. Besides, participants received two text messages per day and one email weekly. At the end of the nine-weeks, telephone interviews were conducted to assess the E-Supporter on perceived effectiveness, ease of use and content quality. The interview transcripts were inductively coded, clustered and sorted into general themes.

Findings: A total of 279 SMS messages and 9 email formats were discussed in the focus groups of which 208 SMS messages were approved immediately, 56 messages were adapted before approval, 15 messages were excluded and minor textual adjustments were made to all email formats. The final version of the E-Supporter consisted of 264 informational and motivational SMS-messages (103 targeting physical activity and 161 targeting nutrition) tailored to the Stages of Change and 9 email formats containing feedback on behavior based on Fitbit and food diary data tailored to self-efficacy levels. Participants were predominantly positive about E-Supporter; they thought that the E-supporter can support them in achieving a better lifestyle and experienced high ease of use. Both the content of messages and e-mails were appreciated, even though most participants preferred the e-mails because these were perceived as more personal.

Conclusions: Based on the first positive evaluation results, we expect the E-Supporter to be a useful intervention to promote physical activity and healthy nutrition in people with T2DM.

Purpose: Living in urban areas is associated with health risks (e.g. inactivity and social isolation). Preliminary studies show that urban structures expose residents to varying risks in this respect, leading to recommendations on health enhancing urban design. However, former findings revealed inconsistencies regarding the association between walkability, active mobility, and health. Furthermore, the influence of social and physical environmental factors on momentary affect in everyday life are almost unexplored. To address this gap, we developed an innovative triggered EMA to capture real-time data on psychological as well as social and physical environmental factors whenever an individual is walking outside home. In a first step we explored feasibility of this walking-trigger.

Methods: The walking-trigger combines movement acceleration and positioning by mobile phone positioning services (GPS and transmission tower) to identify active mobility. The trigger started an e-diary whenever movement acceleration exceeds a certain threshold and participant’s locations were identified as outside the home. Participants received e-diaries for ten consecutive days (6am to 10pm) on three different occasions: 1) every morning, 2) randomly during four time-blocks throughout the day, and 3) whenever the trigger identified active mobility. Activity data are integrated into a mapping software to add information on origins and destinations as well as additional information on facilities and amenities along the pathway.

Results: Data of 79 individuals (48% female, M_age = 40.67, SD_age = 14.56) could be analyzed. Two datasets were missing due to technical problems or non-compliance. Participants received on average 13 EMA prompts per day, of which they completed 64%. Validation analyses showed that in 71% of all triggered assessments individuals were walking outside their home at the time. Furthermore, triggered EMA revealed substantial variability in social and physical environment.

Conclusion: This triggered EMA has been successful to collect data in everyday life situations in different social and physical environments. The high compliance rate supports the robustness of a method that helps to analyze the moderating effects of movement through social and physical environments on mental health. Such a design could help to learn more about health effects of specific locational context factors during everyday life.

 

Schools are considered as a key setting for childhood obesity prevention and appropriate to reach children for programs aiming to change energy-balance related behaviors. However, effectiveness of school-based programs is low, regarding behavior and BMI changes. An explanation could be that parents and family environment are rarely included. In addition, strategies to enhance the engagement of parents are lacking and knowledge regarding barriers and beneficial factors is incomplete. This study examines how families can be reached, applying a qualitative approach.

In a first step one-on-one semi-structured telephone interviews are conducted with family experts, such as social and community workers, teachers and principals, staff of family-centers and nurseries. Participants shared their experience regarding: problems to reach the families, needs and barriers of families in the communication with schools and reaching especially those families that are hard to reach. In a second step semi-structured interviews will be conducted with families to gather information on their experiences and perceived barriers to participate in health promotion programs and what might be a reason why they do not attend. All interviews will be recorded and transcribed verbatim. To date five interviews with family experts and eight interviews with principals of participating schools were conducted and transcribed. The interviews lasted on average 30 minutes. The recruitment of participants will be guided by the principle of theoretical saturation. Transcripts will be systematically analyzed using MAXQDA, following content analysis principles with a combination of inductive and deductive analysis. Theoretical considerations will provide a first set of categories according to which statements will be coded. New categories formed by the content will also be included.

The study aims to shed light on the problem to involve parents into school-based obesity prevention programs. Gaining knowledge regarding psycho-social, socio-cultural, environmental, and program related barriers as well as beneficial factors of involving parents is crucial to enhance the effectiveness of school-based obesity prevention programs. Based on the identification of those barriers and beneficial factors, innovative strategies to enhance the reach and involvement of parents could be developed and integrated into school-based obesity prevention programs.

Purpose: The ActWELL trial demonstrated that an intervention programme focussed on reducing breast cancer risk factors  initiated within breast cancer screening and delivered by volunteer lifestyle coaches achieved a significant reduction in body weight at 12 months in women with a BMI >25kg/m². There is further interest in expanding volunteer support to increase community capacity for weight management but little is known about the experience of delivering lifestyle interventions on the health behaviours of those delivering the intervention.

 Methods: Volunteer coaches for the intervention delivery were recruited and managed by the charity Breast Cancer Now. The charity recruited volunteers who had relevant experience with assisting people undertake life changes (e.g. nurses, teachers, church work) and they underwent a 2-day bespoke training programme focussing on physical activity, food choices and behaviour change techniques).    Ongoing support (e.g. frequently asked questions, face to face sessions),   was provided by the charity. In total, 39 coaches provided 623 face to face coaching sessions. At the end of study, coaches were asked to complete an anonymous eight item questionnaire with closed questions offering YES/NO/NOT RELEVANT responses and to provide further details. The items asked about personal lifestyle changes arising from being a coach and changes in personal lifestyle habits, body weight, health information seeking and communications on health with friends and family during the coaching period.

 

Results In total, 29 (74%) of coaches responded to the questionnaire and 82% of respondents provided detailed comments. Around a third (35%) reported that coaching had made them feel uncomfortable about their own health behaviours. Most (70%) reported (positive) changes to physical activity, with 43% highlighting changes in weight management practices and 37% reducing alcohol intake. Many (45%) reported seeking cancer prevention information using internet and media sources and specifically mentioning cancer charity sites. Most coaches also reported increased conversation with friends and family on weight management (71%), Physical activity (79%) and alcohol (52%).

 

Conclusion Volunteer coaching is associated with reported changes in health-related behaviours  and advocating for changes in cancer related lifestyles by the coaches themselves.

 

Introduction:  Adolescent underweight, overweight, and obesity are linked to mental health. However, little is known about whether body mass index (BMI) operates through the pathway of one’s weight perception in order to influence mental wellbeing. This study aims to explore associations between young people’s weight status, body image, and mental wellbeing in an international sample, which is of interest for policymakers and others working in the field of public health.

Methods: The study was based on cross-sectional data from 15-year-old adolescents from 46 countries (n = 76998), participating in the 2017/2018 Health Behaviour in School-aged Children survey. Mixed regression models were used to assess associations between weight status and mental wellbeing. The mediating effect of body image was tested in a second model. Country and school class were considered as random variables in models 1 and 2. The relationship between gender, socioeconomic status, country, and mental wellbeing, as well as their interactions with weight status, were also included in the analysis.

Results: Living with normal BMI was associated with higher life satisfaction and lower levels of subjective health complaints, than did living with underweight, overweight, and obesity. Positive body image (perceiving own body as “about the right size”) was associated with higher levels of mental wellbeing almost regardless of weight status. Around one-third of the adolescents classified with normal BMI, reported negative body image (perceiving own body as “too thin” or “too fat”). Country, SES, and gender influenced both, weight status and mental wellbeing. Further, country and gender differences in the association between weight status and mental wellbeing can be linked to body image.

Conclusion: While both weight status and body image were related to adolescents’ life satisfaction and subjective health complaints, body image was more strongly associated with these indicators of mental wellbeing. The findings should be considered when informing policies and public health programs addressing adolescents, as promoting positive body image could potentially increase adolescents’ mental wellbeing. Cross-national variation as well as gender differences in the influence of body image should be viewed in light of socio-cultural differences related to body norms.

Purpose: Cooking education is an increasingly popular component of lifestyle interventions, but the relationship between cooking, diet, and weight loss is unclear. This study examined home cooking practices among participants in a digital weight loss intervention and how they relate to demographic factors, dietary behaviors, and weight loss. 

Methods: Two hundred and eighty-eight overweight/obese individuals participated in the Vibrant Lives digital nutrition and physical activity program over 2 waves (mean age = 42.5, 39% Hispanic, 88% female). Self-reported demographics, anthropometrics, and dietary behaviors were collected pre and post intervention. Cooking practices, as assessed by the Healthy Cooking Index (HCI), were assessed post intervention in wave 1, and pre and post intervention in wave 2. HCI scores were examined in relation to demographics, diet, and weight loss. Using data from wave 2, we evaluated the relationship between change in HCI and weight loss.

Results: Of the 288 participants, 86.4% reported cooking at home within last 2 days. The mean HCI score post intervention was 2.69 (possible range -9 to +10). HCI scores were higher (indicating healthier cooking) among participants that reported low consumption of red meat (t(247)=3.24, p=0.001) or fast food (t(247)=3.98, p<0.001), and those that reported eating more than 2 cups of fruit (t(247)=2.08, p=.038) or vegetables (t(247)=2.09, p=0.037) per day. Higher HCI scores post intervention were associated with weight loss (β= –1.49, t(245)= -3.91, p < 0.001). This relationship persisted after adjusting for diet variables(β= –1.17, t(245)= -2.89, p=0.004). In wave 2, HCI scores improved over the course of the intervention (t(65)= 2.24, p =0.029). Increases in HCI score from pre to post intervention were not significantly associated with weight loss (β= –1.53, t(64)= -1.85, p = 0.069). 

Conclusions: Cooking skills may help individuals integrate nutritional recommendations and intervention lessons more effectively into the home food environment. Our preliminary results suggest cooking quality is associated with weight loss and healthy eating behaviors in the context of a digital DPP intervention, but more research is needed. 

Purpose: Adolescent obesity increases risk of weight-related health challenges and stigma (Greydanus et al., 2018). The prevalence is rising in sub-Saharan Africa and linked to dietary practices (Sedibe et al., 2018). There is insufficient data to assess its driving factors in South Africa (SA). The purpose of this paper is to compare gender specific trends in overweight and obesity as well as eating habits between adolescents in SA and Europe over two decades.

Methods: Study data were extracted from SA Demographic and Health Surveys (1998 and 2016) and SA National Health and Nutrition Examination Survey (2012) for survey participants within 15 and 19 years old. Participants’ measures extracted from the surveys are Body Mass index Z-score, sex, daily fruit, vegetable, and sugar-sweetened beverage (SSB) consumption. Chi-square test (X²) analyses were performed to assess significance of change in overweight/obesity proportion through three time points and compared within sex. Changes in daily fruit, vegetables and SSB consumption at two time points were also assessed. All significance is at p<0.05. Results were compared with Health Behaviour in School-aged Children (HSBC) European 2018 data (Inchley et al., 2020).

Results: Adolescents’ overweight/obesity proportion peaked at 23.50% in 2012 similar with HSBC report that showed 21% overweight/obesity in European adolescents by 2018. Girls showed trend of greater overweight/obesity proportions (1998 - 27%, 2012 - 34%, 2016 - 34%) than boys (10%, 10%, 9%) in contrast with Europe where proportion was lower in girls (14%) compared to boys (22%). Decrease in daily fruit (2012 - 57%, 2016 - 48%) and vegetable (55%, 50%) consumption were not significant but SSB consumption significantly increased (X² = 22.5, p<0.001) compared to HBSC data where 48% did not consume fruit daily and 16% consumed SSB.

Conclusions: Preliminary data show nearly similar proportion of adolescents with abnormal weight, yet sex differences exist as girls are at greater risk in SA in contrast with Europe where boys face greater risk. Furthermore, daily poor nutritional choices especially with SSB consumption in SA is evident. Further analyses will show if these choices affect obesity prevalence in this cohort.

Purpose: Physical activity (PA) disparities focus on moderate-vigorous (MV) PA across racial/ethnic groups. Little is known regarding disparities in 24-hr compositional data within single minority groups, despite the potential to influence health outcomes. Research questions:  How do sleep, sedentary and PA behaviors vary in a 24hr-day among African-American (AA) girls? What are the effects of family, socioeconomic, and environmental factors?

Methods: Butterfly Girls is a randomized trial promoting healthy diet and PA among 8-10 year old AA girls in Houston TX (n=390). Seven days PA data (accelerometry) were used (criteria: >1000 min wear time, >600 min awake per day (d)). Baseline outcomes (sleep, sedentary, light, MVPA min/d) were converted to percent of 24-hrs. Factors at the level of family (number of children/adults in home, times family eats together, child eats at restaurants/fast food), sociodemographics (parental education, income, free/reduced lunch), and environment (transportation to school, TV in child’s bedroom, hrs/d media use, PA parenting practices (PAPP)) were examined using Kruskal-Wallis test or correlations. Multivariate regression (MANOVA) controlling for wear time explored which factor concurrently influences all PA outcomes.

Results: Daily wear time was 23.6±0.5 hrs. Average days worn was 6.9±0.3. On average, 2.1% of 24-hr was spent in MVPA, 28.7% sleep, 29.8% sedentary, and 30.1% light PA. Cronbach’s-alpha for PAPPs ranged from 0.52-0.88 for discouraging practices and 0.83-0.88 for encouraging practices. Correlations of PA with media use and PAPPs were low. PA differences (P<0.05) were observed by income (light PA: <$21,000 29.5%, $21-$61,000 30.8%, >$61,000 29.5%; MVPA: 1.8%, 2.1%, 2.3%); free/reduced lunch (MVPA: free 1.9%, reduced 2.3%, full 2.4%), education (light PA: < high school (HS) 25%, HS 31%, college 31%, > college 29%; similar trend for MVPA (P=0.06)). MANOVA indicated that number of days child eats at restaurants/fast food (P<0.05), education (P<0.1) influence all PA outcomes.

Conclusions: Disparities were identified by income, education, free/reduced lunch, and restaurant/fast food use. Methods examining PA behaviors concurrently reveal different associations. This research addresses PA and sleep behaviors considering 24-hrs among AA girls who experience greater risk for obesity, and provides support for targeted within-group interventions promoting equity in PA behaviors.

Purpose: Cluster analysis can be used to group people who are similar in terms of engagement in lifestyle behaviours into non-overlapping groups (i.e., clusters). The Nicotine Dependence In Teens (NDIT) study provides a rich opportunity to investigate clusters of lifestyle behaviours during late adolescence and young adulthood and identify sociodemographic characteristics associated with cluster membership. The NDIT study included up to 20 self-report assessments of five lifestyle behaviours (alcohol consumption, tobacco use, screen time, physical activity, fruit and vegetable consumption) throughout adolescence and 3 assessments in adulthood. It thus provides a unique opportunity to identify clusters of lifestyle behaviours in late adolescence and young adulthood (aim 1), identify sociodemographic characteristics associated with cluster membership at both life stages (aim 2), and examine changes in lifestyle clusters across life stages (aim 3).

Methods: We analyzed lifestyle behaviours and sociodemographic characteristics self-reported during late adolescence (n=804; Mage=16.8) and young adulthood (n=724; Mage=20.4) using the TwoStep cluster analysis procedure, cross-tabulation, and analysis of variance (ANOVA).

Results/Findings: Three behavioural clusters were identified in late adolescence, which differed significantly by levels of physical activity, screen time, alcohol consumption, and tobacco use based on ANOVAs. Three behavioural clusters were also identified in young adulthood, which differed significantly by levels of alcohol consumption and tobacco use based on ANOVAs. At both life stages, significant differences were observed across clusters by sex, maternal education, place of birth (participant, parent) and ethnicity based on ANOVAs. Cross-tabulation of the proportion of participants in each cluster in young adulthood based on cluster membership in late adolescence indicates that 50.4% of adolescents moved to a cluster with higher alcohol consumption and tobacco use; 33.9% remained in a cluster with similar alcohol consumption and tobacco use; 15.5% moved to a cluster with lower alcohol consumption and tobacco use.

Conclusions: Many studies focus on a single lifestyle behaviour. Our results suggest there are distinct clusters of lifestyle behaviours. Moreover, most adolescents increase alcohol consumption and tobacco use in young adulthood regardless of behaviours in adolescence. Investigation into explanatory factors underlying clustering is necessary to increase the likelihood of interventions effectively targeting lifestyle behaviours.

Purpose: Fathers have a positive influence on their children’s physical activity, yet are underrepresented in family-based physical activity interventions. To address this gap, we will pilot test Active Dads, a physical activity promotion program delivered through Parks and Recreation (P&R) for fathers/father figures and children ages 2-5 years.

Methods: The 8-week Active Dads program was developed by our team and a local P&R organization using the Integrated Model of Physical Activity Parenting, Social Cognitive Theory and the programmatic expertise of the P&R partners. Each session will include a brief education session for fathers and organized activities for fathers and children to promote co-participation in activity. Families will also receive personalized feedback on their activity before and after the program and a home toolbox with educational materials and play equipment. To align with the mission and seasonal structure of P&R, we have developed and will test three adaptations of Active Dads: fitness (Spring), fitness + positive parenting (Summer), and activity + outdoor education (Fall), using non-randomized, quasi-experimental single and between cohort designs. Father-child dyads (n=45; 15 per program) will be recruited using social media and community postings. The primary outcome is feasibility, defined by five criteria: meeting recruitment goals, maintaining 70% attendance, child engagement in activity during programming, fathers’ satisfaction with the program, and obtaining 90% of measures. Feasibility will be assessed using a combination of process measures, observations, surveys, and semi-structured interviews. Secondary outcomes include changes in accelerometer measured father and child physical activity and fathers’ self-reported involvement and activity parenting. Descriptive statistics will be used to summarize feasibility outcomes and linear mixed models will be used to evaluate changes in secondary outcomes.

Results/findings: Recruitment and program delivery will begin in March 2021, with preliminary data available by June 2021 and completion of the study in December 2021.

Conclusions: Findings from this novel pilot study will provide evidence for the feasibility of engaging fathers in young children’s physical activity. Additionally, partnering with P&R represents an innovative, sustainable, and scalable model for the delivery of family-based physical activity promotion focused on fathers and their young children.

Purpose: Parental practices influence early adolescents’ eating behaviors, and therefore play a key role in obesity prevention. During adolescence, children gain more independence. Thus, adolescents’ eating behaviors, specifically making food choices without their parents’ supervision, can impact their overall diet quality and health. However, there is no published evidence identifying the influence of parental practices on adolescents’ food choices during independent eating occasions (iEOs) in Hawaiʻi. Examining whether parental practices are different for low-income households defined as below the 185% U.S. federal poverty guidelines, compared to middle- to high-income households is needed for developing tailored interventions for each population. Therefore, this study examined potential differences in parental practices as they relate to adolescents’ iEOs by comparing children from different household income groups in Hawaiʻi.

Methods: Early adolescents (mean [SD] age, 11.40 [1.03] years; n=45) and their parents/caregivers (n=46) were recruited in Oʻahu, Hawaiʻi, and one-on-one interviews were separately conducted for parents and children in each income group. The interview data were analyzed using the Sort and Sift, Think and Shift method.

Results: Four of the same core themes emerged from parent and child interviews: 1) Rules and Expectations, 2) Environment, 3) Teaching about Healthy Eating Behavior, and 4) Child Control, including several subthemes under each core theme. Regarding the core themes and subthemes, there was no difference in parental practices between the income groups. However, when considering one of the subthemes, “restriction” under “child control,” some parents in low-income households indicated that the challenges parents face can impede positive parental practices. For instance, parents did not want their child to eat instant noodles but had difficulty restricting their child from eating it due to their busy schedules. This phenomenon was not seen among middle- to high-income households. 

Conclusions: Further studies are needed to elucidate factors that may interfere with positive parental practices, as well as differences in parental characteristics such as race/ethnicity, in addition to household income. The findings may inform the development of effective interventions for promoting healthy eating behaviors in adolescents in the target population and thus address the problem of adolescents’ unhealthy eating behaviors in Hawaiʻi.

Purpose: Although the health benefits of nature are well-recognised, it is still unclear which nature aspects can counteract stress and whether nature also influences eating behavior.

Methods1: Before (5min) and after (8min) the Trier Social Stress Test, 81 participants (82% women, 19-30y) saw one of the four slideshows with nature or urban environments in green or black-white shades. Group differences were tested on Perceived Restorativeness Scale, five repeated measures of heart rate variability (HRV), salivary cortisol and mood, food wanting and snack buffet consumption.

Methods2: The separate online questionnaire was completed by 130 participants (40±18y, 66% women).

Results1: Reported restorative power was higher in the nature pictures than urban pictures with an even better attentional/happiness restoration capacity for green versus black-white nature (13.8±0.6 vs 11.8±06 on 20). Nature overall was somewhat beneficial compared to urban pictures by lower HRV and negative emotions reactivity; and the green nature group had the best happiness recovery. In food intake or wanting, no differences existed.

Results2: Indoor plants had the same stress-protective scores as indoor flowers, nature sounds and nature smell but were stronger than wooden interior or nature pictures, while green interior accents/objects and fake plants were scored lowest. Still, pictures with green objects scored better than grey objects. For eating behaviour, forest smell and indoor plants were scored highest. A perceived effect of nature on stress was mentioned via fascination, green colour and ‘feeling at home’. The majority did not expect an effect of nature on diet, but mechanisms via stress-reduction and nudging towards healthy lifestyle were mentioned.

Conclusion: For stress prevention, the environmental content (=nature) as such seems most important, although a green color can also help. A focus group study, a lab study on green nature indoor and nature sounds, a diary study and cohort analyses are ongoing in preparation towards an intervention.

Purpose: Promoting physical activity to improve the health of the young people, is a main priority among school-based interventions. Nevertheless, there is little information about the implementation of games and/or gamification to promote physical activity within the school. Recently, our research group have published a systematic review protocol that has been registered in the International prospective register of systematic reviews (ID: CRD42019123521). Therefore, the aim of this study is to describe the preliminary results of the systematic review of school-based interventions for promoting physical activity in pre-schoolers, children, and adolescent students using games and/or gamification.

Methods: A systematic search was carried out up to August 2020 in several scientific databases (i.e., PubMed, Web of Science, SportDiscus, Cochrane Library, ERIC, and PsycINFO). A standardized procedure was conducted following the PRISMA-P and the PICO(S) strategies. The inclusion criteria were (a) to report physical activity as a primary or secondary outcome; (b) to implement a game and/or gamification intervention within the school; (c) intervention studies where a game and/or gamification were included with the learning objective; (d) to target pre-schoolers, children, and/or adolescent students (non-university students); and (e) to be written in English or Spanish.  Detailed information from each study was extracted, and additional quantitative and qualitative assessments were performed.

Results: The preliminary results identified a total of 2.105 manuscripts, and only 38 studies of these met the inclusion criteria. The total sample of these studies were 8.921 participants with less than 30% pre-schoolers, more than 60% children and less than 10% adolescents. The instruments to assess physical activity were around 30% accelerometers, more than 25% questionnaires, less than 15% pedometers, and less frequently direct observation tools or mobile applications or others. Most of the identified studies were rated as low quality interventions because they were not RCTs, the effect size was not calculated, they did not include control group or they considered short intervention periods. However, some interventions were rated as good quality studies.

Conclusion. The data provided from this systematic review will allow to set the main elements for designing effective interventions to promote physical activity through games and/or gamification.

Purpose: Health Related Quality of Life (HRQoL) refers to the subjective perception of well-being of the individual in different physical, mental and social dimensions of health. An important factor contributing to a good perception of HRQoL is the physical fitness (PF) implies various benefits. Among the possible other factors that could influence the HRQoL of young people, the daily physical activity (PA) levels could have a significant impact. For instance, active commuting to/from school (ACS) has been considered a potential alternative for accumulating daily PA in youth. There is little information in the literature about the relationship between HRQoL and ACS. The aims of this study were (1) to analyse the associations between HRQoL, PF (i.e., cardiorespiratory fitness, muscular strength, and speed-agility) in Spanish children, and separately by gender, and (2) to analyse the difference in cardiorespiratory fitness level by mode of commuting to and from school by gender.  

Methods: The data of this study were obtained as part of the PREVIENE Project (Promoting Healthy Lifestyles for the School Environment). We conducted a cross-sectional analysis including 415 children aged 8.47 ± 0.36 years old from 14 public schools in Granada, Spain. The HRQoL was assessed using the valid and reliable KINDL-R questionnaire distributed into 6 dimensions (physical wellbeing, emotional wellbeing, self-esteem, family, friends, and school), and children’s physical fitness was assessed by the ALPHA fitness test battery (Cardiorespiratory fitness, muscular strength, and speed-agility). Commuting to/from school was assessed using the valid, reliable and feasible “Mode and Frequency of Commuting To and From School Questionnaire”.

Results: Cardiorespiratory fitness was positively correlated with all dimensions of HRQoL in boys, whereas higher muscular strength (standing long jump test) was positively correlated with the emotional well-being dimension only in girls (all p=<0.005). 

Conclusions: HRQoL was positively correlated with cardiorespiratory fitness in boys (all dimensions), while muscular strength (standing long jump) was positively correlated with the emotional well-being dimension only in girls. The boys who actively commute to school were related to emotional wellbeing, family and total score of the KINDL-R. Improving cardiorespiratory fitness might be especially useful to improve HRQoL in children.

Purpose: Many primary school-based interventions to increase physical activity (PA) and cardiorespiratory fitness (CRF), or to reduce sedentary behaviour (SB) have been undertaken in the past decade. The Health Promoting School (HPS) framework postulates a whole-school approach, encompassing the individual, environmental and structural level. Our aim was to characterize interventions from the last decade by features of the HPS framework and to provide an explorative overview of their effectiveness. We hypothesized that addressing more HPS features would increase effectiveness.

Methods: A systematic electronic search of six databases was combined with a hand search of reference lists to retrieve studies published between 2010 and 2019. Arksey and O'Malley's scoping review methodology framework guided the conduct of this review. Data extraction included information on study and intervention characteristics, statements of effectiveness on PA, SB and CRF outcomes from study authors, and HPS features addressed.

Results: 178 interventions were included. 47% (n=84) addressed only one feature of the HPS framework. ‘Health skills and education’ (n=104, 58%) was the most frequent feature followed by ‘Links with parents or community’ (n=95, 53%); both were also most often combined (n=25, 14%). The features ‘Healthy school policies’ and ‘Access to (school) health services’ were rarely addressed (n=13, 7% and n=4, 2%, respectively). None of the interventions encompassed all six features. Theory-based interventions, compared to interventions without a stated theoretical basis, were deemed more often effective (e.g. for CRF: 68% vs. 26% success rate). Interventions that addressed more than one feature of the HPS framework did not seem to be more effective.

Conclusions: Most interventions targeting PA, CRF and SB in primary school children were single feature interventions. For certain feature combinations, the number of studies was limited, however, no specific feature combination seemed to be associated with superior effectiveness. Theory-based interventions seem to have a higher potential to be effective. Based on our findings, we recommend a) utilizing theory-based interventions, b) further exploring combinations of HPS features, c) exploring the potential of features that have not been addressed extensively, and d) recognizing that interventions addressing multiple features are not necessarily more effective than single feature interventions.

 

Aim: In the last week of February 2020, just as the first Covid-19 cases were being reported in Ireland, Sport Ireland commissioned Ipsos MRBI to undertake a survey of respondents aged 15+ with the aim of providing insights into Sports Participation and Recreational Walking trends in Ireland through the pandemic. The self reported seven day recall questions used on this survey were identical to the ones used in the Irish Sports Monitor (ISM) allowing for comparison with 2019 and now 2021 data.

Methods: The 2020 telephone survey was undertaken over 7 waves between February and September 2020 using random digit dialling. Wave 1 pre-dated most of the limitations on movement. The second wave happened mostly under the “Delay” phase of the pandemic (March). Waves 3 to 5 took place during the “Stay at Home” lockdown phase (April-May) and waves 6 and 7 were aligned with the first two phases of the Roadmap for Reopening Society and Business (May-September). Approximately 1,000 respondents took part in each wave.

Results: As the Covid-19 pandemic in Ireland progressed in 2020, physical inactivity consistently declined. At the peak of the pandemic restrictions in Ireland in May, approximately 255,000 people or 7% of the population, who were previously inactive, started walking or taking part in sport. 

Personal exercise, cycling and running were the most popular sports during the reopening phase, bringing sports participation levels nearly in line with 2019 levels to 45%.  A large majority of respondents identified that physical activity was more important during these times with roughly one in five adults having taking up a new activity.

However, as the pandemic has progressed, early data from ISM 2021 suggests that while recreational walking levels have held strong, participation in Sport is on a decline. This data suggests that a large take up in recreational walking among the younger cohort (16-24) has driven participation rates in walking. The challenge emerging is the potential detrimental effect on fitness and confidence levels of individuals, potentially affecting their likelihood of returning to sport in the future.

Conclusion: Two key areas for consideration have emerged- 1. sustaining the positive trends seen particularly with recreational walking and building on that to move people back into Sport 2. recovering losses incurred in facility and team based sport.

Purpose:  Diet and physical activity programs are effective at reducing one’s risk of developing type 2 diabetes (T2D); however, it is not known what specific techniques lead to optimal outcomes. When developing and implementing diabetes prevention programs in the community, it is imperative that intervention components are thoroughly and consistently reported to understand program effectiveness and help with scaling up. Small Steps for Big Changes (SSBC) is an evidence-based diabetes prevention program that consists of six one-on-one sessions with a coach. Coaches deliver diet and physical activity content to clients using behaviour change techniques (BCTs) and motivational interviewing (MI). BCTs are the specific active intervention components, and MI techniques describe the relational aspects of how intervention components are delivered. By reporting BCTs and MI techniques, future researchers can better replicate the components and the delivery style of an intervention. The purpose of this study was to comprehensively identify the BCTs and MI techniques within SSBC.

Methods:  BCTs and MI techniques were coded within each of the six SSBC session protocols using the BCT Taxonomy v1 and the Table of MI Techniques. To ensure reliable coding, two coders completed the BCT coding and two coders completed the MI techniques coding. Interrater reliability was assessed.

Results/findings: Forty-three BCTs (interrater reliability [kappa]=0.77) and 20 MI techniques (kappa=0.63) were identified within the SSBC protocols (mean BCTs/session=30; mean MI techniques/session=16). SSBC sessions specifically focussed on the BCT categories of “Goals and Planning”, “Feedback and Monitoring”, and “Repetition and Substitution”, and the MI technique processes of “Engaging” and “Evoking”.

Conclusions: Detailed reporting of intervention components are necessary for future reviews to accurately test which intervention components are effective in eliciting change in desired outcomes. This study revealed the use of a greater number of BCTs in the SSBC program compared to the numbers of BCTs reported in a number of T2D programs. In general, more thorough reporting of BCTs used in interventions will progress the field of health behaviour change. Further, the detailed reporting of the specific techniques within SSBC can be used to inform development of future diabetes prevention programs.

Wearable activity trackers (wearables) may offer an affordable and accessible way of increasing child and adolescent physical activity (PA). Wearables have been shown to successfully increase adult PA, however, less is known about their impact on child and adolescent PA. The aim of this systematic review was to examine the acceptability, feasibility and effectiveness of wearables, and their potential mechanisms of action, for increasing PA, in 5- to 19-year olds.A systematic search was conducted of 7 databases (start date of each database to December 2019). The following eligibility criteria were used: (a) published in English; (b) participants aged 5- to 19-years; (c) examined the use of a wearable within an intervention, acceptability or feasibility study; and (d) measured PA and/or experiences of using a wearable. The presence or absence of behaviour change techniques (BCTs), were coded, using the behaviour change technique taxonomy v1. A narrative review (effectiveness findings), and thematic synthesis (acceptability and feasibility findings) were conducted. Study heterogeneity did not permit a meta-analysis. Thirty-three studies were included. There was some evidence that wearables increase steps, and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. Some evidence suggested that multi-component interventions may be more effective than using a wearable alone. On average, 7.8 BCTs (range:2-12) were present in studies exploring the effectiveness of wearables. From the thematic synthesis, four analytical themes (14 subthemes) were identified: (1) perceived facilitators and barriers of using a wearable may impact device use, (2) affective attitude: feelings towards using wearables, (3) wearables ease of use, understanding of PA outputs, and perceived impact on PA varies between devices and individuals, and (4) perceived mechanisms of action underlying wearables impact on PA. Children and adolescents reported wearables increased their PA, via wearable features that promote self-monitoring, goal setting, feedback, and competition. However, barriers of wearable use (technical difficulties, novelty effect) were present. Thus, there is some evidence that wearables are an acceptable, feasible and effective way of increasing PA, in 5- to 19-year olds. Future interventions may benefit from incorporating multiple intervention components and more BCTs, and aiming to overcome barriers of wearable use.

 

Purpose: One of the underlying reasons for the rise in (visceral) obesity is thought to be stress. Previous studies have found that both chronic and acute stress were weakly associated with weight gain. This weak association might be explained by a variance in behavioral and psychological responses that individuals express when exposed to stress. Therefore, the potential moderating factors in the complex association between stress and adiposity need to be explored further. We aimed to assess associations between chronic stress and visceral obesity over a seven-year period in the general population and assess moderation by weight change.

Methods: Two population-based cohorts were combined: the Hoorn Study (1989-1998) and the New Hoorn Study (2006-2015), with a total of 2535 participants. Stressful life events were self-reported and total baseline and follow-up scores were summed to create a ten-year stressful life event score which were grouped in quartiles. BMI (kg/m²) and waist circumference (cm) were measured at baseline and follow-up. Linear regression analyses were performed to assess associations between stressful life events and BMI/waist circumference for both the total sample and the stratified sample based on three weight-change groups, “gained weight” (≥ 2 kg), “lost weight” (≤ 2kg), and “maintained weight” (weight change less than 2 kg). Analyses were adjusted for age, sex, education, follow-up duration, baseline weight status, smoking, physical activity, and comorbidities.

Results: In the fully adjusted models, stressful life events were associated with an increase of waist circumference for the highest versus the lowest quartile (0.98 (95%CI: 0.2;1.8)), but not with change in BMI (0.13 (95%CI: -0.1;0.4)). The moderation analyses showed that in those who gained weight, a higher stress quartile had a significant increase in waist circumference (1.60 (95% CI: 0.5;2.7)) as well as an increase in BMI (0.33 (95%CI: 0.04;0.6)), compared to the participants in the lowest stressful life event quartile. No associations were found for the groups who lost or maintained weight with BMI or waist circumference.

 

Conclusions: Chronic stress amplifies changes in (visceral) obesity among those who gained weight over time, but     not among those who lost weight in the general population.

Research suggests that breaking up sedentary behavior (SB), can positively influence executive functions (EF) and creativity (CREA), as several brain mechanisms are stimulated by light physical activity such as standing. Two out of five adolescents in the Netherlands are enrolled in vocational education and training (VET) education. In general, the SB levels are high in adolescents in VET students. As stimulating EF and CREA is important for their academic performances, our aim is to investigate the effect of breaking up sitting time by standing during class on EF and CREA in VET students.

Two randomized controlled cross-over studies were conducted with respectively 165 (EF study; mean age 18.8 years, SD = 7.9) and 192 VET students (CREA study; mean age 18.2 years, SD = 1.7), allocated to either a sitting or standing condition. The students were taught for 15 minutes after which they performed in the EF study the Letter Memory Test and the Color Shape Test, to measure updating, shifting and inhibition, respectively. In the CREA study, the students performed the Guilford’s Alternate Uses Test for divergent thinking and the Remote Associates Test for convergent thinking. Subsequently, the conditions were switched and the procedure was repeated after one week in the EF study and immediately in the CREA study.

Mixed model analyses showed no effect of standing on updating (B = .50, SEb = .50, 95% CI = -.49; 1.50), shifting (B = -10.48, SEb = 14.61, 95% CI = -39.41; 18.46), or inhibition scores (B = 2.31, SEb = 10.64, 95% CI = -18.77; 23.39). Neither effects of standing on divergent thinking (B = -0.06, SEb = 0.22, 95%CI = -0.49; 0.38), or convergent thinking (B = -0.20, SEb = 0.15, 95%CI = -0.56; 0.03) were found.

It can be concluded that short-time standing during class has no acute beneficial effect on the EF of VET students, nor on their CREA. Future research should investigate the effect of a more prolonged duration of standing on EF and CREA in VET students.

Purpose: Breast cancer is the second leading cause of cancer deaths among U.S. women. In 2014-2018 44% of the women that died from breast cancer were between the ages of 65-84. Sedentary behavior is related to mortality among women with and without breast cancer. The context and patterns in which women with breast cancer accrue their sedentary time is unknown.

Methods: Overall, 5,141 women (mean age= 78.4 ±6.7) from the Objective Physical Activity and Cardiovascular Health (OPACH) Study, an ancillary study to the Women’s Health Initiative (WHI), were classified into three groups: those with breast cancer (n=350), with any other cancer (n=528), and those without cancer (n=4,263). Participants self-reported time spent sitting in common sedentary behaviors. G3TX+ triaxial accelerometers measured sitting time and patterns of sitting for 7 days. Self-reported and accelerometer-measured sitting measures were summarized, with results displayed in radar plots. Pairwise comparisons tested differences between groups.

Results: Mean (SD) self-reported hours/day were: watching television=3.1 (1.5); reading or doing crafts=1.7 (1.2); on the computer=1.0 (1.1); in transportation=0.9 (0.7); working without a computer=0.8 (0.8); and talking on the phone=0.7 (0.7). The only significant difference was for television watching (p=0.02), women with breast cancer watched 11.8 minutes/day more than women with no cancer, adjusting for age and race-ethnicity. Women with breast cancer had 15 more minutes/day of sedentary time (634 vs. 619, respectively; p-value < 0.001), and had longer sitting patterns (13.2 vs. 12.4 minutes/day; p-value < 0.001) than women without cancer.

Conclusions: Women with breast cancer have more prolonged sedentary behavior patterns than women without cancer. Findings can inform tailored interventions to raise awareness among women with breast cancer with high levels of sitting, particularly while watching television, and can be used to encourage less sitting in shorter bouts to reduce sitting patterns Future studies should examine the extent to which reduced sitting patterns enhance the health and well-being of women with breast cancer.

Purpose: Emerging evidence highlights impacts of the COVID-19 pandemic on U.S. families, including lifestyle changes (employment, school), increased stress, and changes in eating behavior. Prior to COVID-19, parental stress has been linked with child eating behavior, including frequent fast-food consumption, which is associated with poorer diet quality. Aims of the present study were to examine whether parent stress and at home vs. out-of-home childcare/school predicted families’ restaurant-related behaviors during COVID-19. 

 

Methods: An online survey was administered to a nationally representative sample of U.S. parents with a 4-to-8-year-old child in October 2020 (n=1000). Linear and logistic regression were used to examine whether parent stress (from the validated 4-item Perceived Stress Scale) and at home vs. out-of-home childcare/school predicted: 1) the frequency the child consumed restaurant meals (take-out, delivery, dine-in), 2) who chose the child’s restaurant meal, and 3) parent-reported reasons for the child’s meal choice. Income, education, employment, race/ethnicity and regional COVID-19-related restrictions were tested as covariates, with sampling weights incorporated in all analyses.

 

Results: Parents who reported that their children were receiving care or attending school at home rated nutrition as more important when rank ordering reasons for selecting the child’s restaurant meal compared to those with children attending school or childcare outside of the home (for delivery p=0.006; for dine-in p=0.022). Parents with higher stress rated children’s liking as a less important reason for child restaurant meal selection (for take-out p=0.001; for delivery p=0.018) compared to parents with lower stress. Generally, sociodemographics predicted more variability in restaurant-related behaviors than childcare/school status or stress (e.g., higher-income and employed parents reported higher frequency of children dining at restaurants). Parents reporting more COVID-19 restrictions rated child liking as more important (p=0.017) and habit as less important (p=0.019) reasons for child meal selection.

 

Conclusions: It is important to understand factors predicting variability in health-related behaviors as the COVID-19 pandemic continues. We observed sociodemographic differences in families’ restaurant-related behaviors, and reasons behind the selection of children’s restaurant meals also varied by parent stress, child schooling/care location, and COVID-19 restrictions. Continued research in these areas could inform the focus of healthy eating interventions during COVID-19. 

Purpose: A classic paper examining the summer weight gain phenomenon in children (6-11 yrs.) utilized the Early Childhood Longitudinal Study Kindergarten Class of 2010-2011 (ECLS-K:2011) to estimate accelerated summer body mass index (BMI) gain. height and weight measurements were collected from October-November each Fall and February-March each Spring. This is problematic because estimating school and summer BMI change requires measures be taken as close to the beginning and end of the school year as possible. To account for this, complex analytical methods were used to predict August and May BMI of students that were not measured during those months. The use of BMI z-score (zBMI) is generally considered a better measure of body composition in children. The current study aimed to replicate the findings of past work using BMI and zBMI change in children whose height and weight measurements were collected during August/September and April/May.

Methods: Height and weight were measured in the Fall and spring of each school year (2010-2013). Mixed-effect regression analyses estimated differences in monthly change in BMI and zBMI between the summer and school year. Models also examined differences in the magnitude of BMI and zBMI change between the summer and school year by race/ethnicity, income, and locality.

Results: A total of 3,926 children (48% female, 55% non-white) were included. Monthly change in BMI and zBMI during the school year was 0.024 (SD=0.136) and 0.003 (SD=0.082), respectively. Monthly change in BMI and zBMI during Summer was 0.041 (SD=0.191) and 0.002 (SD=0.098), respectively.  Children who were low-income, Hispanic, and lived-in suburban areas experienced accelerations in BMI change of 0.193 (95%CI=0.024,0.363), 0.149 (95%CI=0.001,0.297), and 0.223 (95%CI=0.097,0.350), respectively during the Summer compared to the school year. No accelerations in zBMI were observed during the Summer for any subgroups.  

Conclusions: Findings were consistent with past studies that examined accelerated summer BMI gain. However, while BMI gain accelerated during summer, zBMI change did not accelerate. Studies explicitly designed to measure changes in body composition over the summer are needed. These studies should incorporate appropriate measures of BMI, and alternative measures of body composition (e.g., bioelectrical impedance).

Purpose. Theories and models describing development of sport participation suggest that multi-sport participation is associated with long-term health benefits, whereas single-sport participation is not. While there is well-developed literature on elite athletes, evidence on adherence to sport participation in the general population is lacking. Further, whether individuals in the general population have trajectories similar to those of athletes is unknown. The objectives of this analysis were: (i) to identify naturally occurring sport participation trajectories during adolescence, (ii) assess similarity with those described in sport participation models among athletes, and (iii) examine longitudinal associations between trajectories identified and health outcomes in young adults in the general population.

Methods. We used data from 655 participants in the Nicotine Dependence in Teens study (51% of the 1294 recruited). Participants self-reported sport involvement four times per year from age 12 to 17 years. At age 24, level of physical activity was assessed using the IPAQ and height, weight, waist circumference, skinfold thickness and blood pressure were measured objectively. We used group-based trajectory modeling to identify trajectories of the number of sports youth take part in, as a function of age. Associations between adolescent sport participation trajectories and physical activity, anthropometric and blood pressure outcomes in early adulthood were estimated in multivariable linear regression models.

Results. We identified four distinct sport participation trajectories during adolescence: non-participants (n=149, 22%), dropouts (n=133, 21%), single sport participants (n=247, 37%), and multi-sport participants (n=126, 20%). Single- and multi-sport participation during adolescence were associated with higher levels of physical activity in young adulthood (β (95 % confidence interval) = 0.21 (0.01-0.42); 0.30 (0.04-0.55), respectively). There was no association between sport participation trajectories during adolescence and anthropometry or blood pressure in early adulthood.

Conclusions. In contrast to theories and models describing the development of sport participation suggesting that early multi-sport participation is associated with higher physical activity levels in adulthood, we found that both single- and multi-sport participation trajectories are associated with physical activity levels in young adulthood. However, sport participation trajectories in adolescence did not appear to translate into better anthropometric or blood pressure measures.

 

Purpose: Long periods of uninterrupted sitting (i.e., sedentary bouts) and their relationship with adverse health outcomes have moved into focus of public health recommendations. However, evidence on associations between indicators of obesity and sedentary bouts is scarce. The aim of this study was to investigate associations of waist circumference (WC) and body mass index (BMI) with the daily number of sedentary bouts.

Methods: In this cross-sectional study, data were collected from three studies among adults from the general population that took place in the area of Greifswald, Northern Germany, between 2012 and 2018. Four hundred sixty 40–75-year-old adults wore tri-axial accelerometers on the hip for seven consecutive days. A wear time of ≥10 hours on ≥4 days was required for analyses. WC (cm) and BMI (kg m^-2) were measured in a standardized way. Separate multiple linear regression analyses were used to investigate associations of sedentary bouts (10-to-30 min and >30 min) with WC and BMI including the covariates sex, age, school education, employment, smoking, season, original study, moderate-to-vigorous physical activity, light physical activity, and accelerometer wear time.

Results: Participants (66% females) were on average 57.1 (SD 8.5) years old and 36% had school education >10 years. Mean WC was 91.1 cm (SD 12.3) and mean BMI was 26.9 kg m^-2 (SD 3.8). The mean number of sedentary bouts per day was 16.5 (SD 4.1) for 10-to-30 min bouts and 3.2 (SD 1.8) for >30 min bouts. The number of >30 min bouts per day was positively associated with WC (b = 0.776; p = 0.038), but not with BMI (b = 0.243; p = 0.074). Associations of sedentary 10-to-30 min bouts with WC and BMI were not significant (p = 0.732 and p = 0.960, respectively).

Conclusions: The findings provide evidence on the deleterious association of sedentary bouts that last longer than 30 min with waist circumference. Sedentary periods between 10 and 30 min were not related to any of the obesity markers. Our findings may contribute to a growing body of literature that is needed to develop public health recommendations on interruptions of prolonged sedentary time.

Purpose:  To describe the prevalence, patterns and barriers of active commuting by bicycle in university students in Santiago, Chile. Methods:  We conducted a cross-sectional study that included a non-probabilistic sample of 534 university students in Chile (171 men, 363 women), with an average age of 26.5±7.7 years. Participants completed a questionnaire about barriers to active commuting by bicycle. Means, standard deviations, and percentages were used for the descriptive analysis of commuting mode and perceived barriers for using the bicycle. Data were compared by sex using Chi-square or Student t-tests as required. Results: In total, only 2.3% reported using the bicycle as the primary means of transport to go (4.1% men vs. 1.4% women, p=0.053) and 2.5% (5.3% men vs. 1.1% women, p=0.006) from the university. Approximately 50% of participants reported using the public bus to commute to (51.8%) and from university (50.9%). Transportation by public bus was more common in women than men when going to (57.5% vs. 38.9%, p <0.001) and from the university (55.9% vs. 40.4%, p <0.001). Men and women reported different barriers to cycling. The most common barrier for cycling in men was “It requires too much physical effort” (60.4%), while in women, it was “I need a car or motorcycle to work” (63.5%). Some barriers differed by sex such as “I need a car or motorcycle to work” (50% men vs 63.5% women, p = 0.005), “There are no places to leave the bicycle” (58.4% men vs 46.2% women, p = 0.003) and “It requires physical effort” (60.4% men vs 51.5% women, p = 0.047).

Conclusions: Active commuting by bicycle in university students in Santiago, Chile is low compared with national data. The barriers for cycling to and from the university differed by sex, suggesting that strategies for promoting active commuting should include these perspectives into their actions.

Children’s energy-balance related behaviors (EBRBs) are embedded in different social environments, most importantly family and school. Therefore, effective obesity prevention need to address both environments simultaneously. Although schools are appropriate to reach children and implement obesity prevention programs, school-based programs often fail to include families. The Family⁺ project (funded by Federal Ministry of Health, Germany) focuses on the link between school and family environment as part of a school-based intervention. The aims are twofold: a) develop school-and-family intervention practices and implementation strategies, and b) implement and evaluate the intervention practices and implementation strategies in three model regions.

An uncontrolled effectiveness-implementation hybrid trial will be conducted in a real-world context. We apply a mixed-methods approach and include stakeholders, teachers, and families in a reflective participatory process of modifying and adapting intervention practices and implementation strategies. The project comprises four phases: 1) development of intervention practices and implementation strategies (guided by intervention and implementation mapping protocol), 2) pilot study and participatory adaptation of interventions and implementation (guided by COM-B), 3) implementation and evaluation of effectiveness and implementation (evaluation framework of Proctor et al.) applying a pre-post design, 4) dissemination of the results by translating the findings in a reflective participatory process into an e-learning module.

Nine primary schools from three model regions in Germany participate in the project. Phase 1 will be finished in April 2021. To date, we conducted network analyses and qualitative interviews with family experts, and school principals. In the next step, focus group interviews will be conducted with local stakeholders. All interviews will be transcribed verbatim. Transcripts will be analyzed following content analysis principles aiming to identify categories of needs of the implementing schools as well as perceived barriers of implementation from the perspective of different stakeholders.

Family⁺ provides evidence for improving the school-family partnership with regard to obesity prevention and changing EBRBs. The project combines a theory and evidence based approach with a reflective process of translation and implementation in a real-world setting including stakeholders and participants. The results will inform the development of effective school-based interventions involving parents and the implementation in research and real-world settings.

 

Purpose: The study aimed to evaluate the effectiveness of the German Nutrition Societyˈs Guidelines on Quality Standards for Canteens in the Workplace (DGE-GQS; health promoting food option). The DGE-GQS was implemented in a university canteen. Possible changes of food consumption and nutrient intake of canteen users (substudy A) at least ten weeks after the implementation of the DGE-GQS, the perception of the health promoting food option by the canteen users (substudy B.1), and possible changes of their satisfaction regarding the canteen (substudy B.2) were examined.

Methods: Substudy A used a controlled pretest-posttest-design (paired sample). The participating university students were classified as intervention group (IG, canteen visits ≥ once/wk) or control group (CG, canteen visits < once/wk). In substudy B.1 a cross-sectional design was used, in substudy B.2 a pretest-posttest-design (paired sample). Substudy B included students, if they visited the canteen ≥ once/wk.

 Results/findings: Food consumption and nutrient intake did not change (p > 0.05) in the IG (n = 27, 92.6 % female, 21.5 ± 2.7 years) compared to the CG (n = 39, 94.9 % female, 22.8 ± 3.4 years) (substudy A). In substudy B.1 canteen users (n = 90, 77.8 % female, 23.5 ± 4.3 years) were aware of the health promoting food option and highly appreciated it. They were satisfied with the health promoting food option and bought the health promoting lunch offer 0.8 ± 0.9 times/wk or every third (34.3 ± 34.1 %) canteen visit. In substudy B.2 the canteen users (n = 30, 86.7 % female, 23.5 ± 6.3 years) were at posttest more satisfied with the service and the health value of the lunches offered (both: p < 0.05).

Conclusions: Although the health promoting food option was known and highly appreciated, no effects on the daily food consumption and nutrient intake were observed. The proportion of the health promoting lunch option should be increased.

Purpose: To improve population health effective interventions must be scaled up and sustained. Choose to Move (CTM) is an effective, choice-based health promotion program for older adults. We are currently scaling up CTM in 4 phases (2016-2021) across British Columbia, Canada. We describe our systematic adaptation of CTM to context and delivery partner needs and resources, elsewhere. In Phase 4 we aim to optimize reach and maintain impact (retain fidelity to core functions) -- while reducing implementation costs. Our specific objectives are to: 1) describe the systematic optimization process we undertook for Phase 4 scale-up and 2) share the resulting adapted CTM model.

Methods: Using a 6-stage approach we adapted CTM implementation strategies and content for Phase 4 scale-up. When the COVID-19 pandemic struck, we made additional adaptations to comply with public health restrictions. Stage 1: reviewed existing data (feedback from CTM participants and delivery partners). Stage 2: conducted focus groups (intervention providers) and interviews (previous CTM participants). Stage 3: developed a new CTM prototype. Stage 4: validated the prototype with delivery partners. Stage 5: created a final, adapted model. Stage 6: pilot tested the model. We describe adaptations within FRAME, the updated Stirman et. al (2019) coding framework.

Results: We adapted CTM phase 4 content (added/removed/reordered elements (e.g. more group interaction; shortened program from 6 to 3 months)), context (delivery format changed), and evaluation (added/removed indicators). When COVID-19 struck we adapted the setting (virtual delivery), training and evaluation (e.g., online; added/removed indicators) and implementation strategies (e.g., virtual recruitment). We piloted the CTM phase 4 model with CTM alumni during the acute COVID-19 stage [April - August 2020]. We are currently conducting impact, implementation and economic evaluations of CTM Phase 4.

Conclusions: We share our approach to optimizing CTM as one example of a data-driven method to reduce intervention cost while striving to maintain impact. If the reduced-cost model proves effective, it may increase the reach and longevity of program delivery by enhancing sustainability.

 

 

 

Purpose: A collateral consequence of the novel coronavirus (COVID-19) pandemic has been the alarming increase in sedentary behaviours, especially among children. As many countries begin to alleviate social/physical distancing regulations and proceed towards normalcy, children's traditional physical activity (PA) opportunities will be offered. A predicted barrier to returning to PA in public settings is the stigma and fear associated with contracting COVID-19. The objective of this exploratory study was to investigate current societal perspectives related to engaging children in traditional PA opportunities.

Methods: A cross-sectional survey was administered online in Canada throughout January 2021. Canadian residents, ≥18 years of age, who could understand English or French were eligible to participate. Survey items required participants to indicate their level of agreement with statements that were designed to understand their attitude towards parents engaging their children in physical activities (playgrounds, individual or group sports, community programs). There were five scale items developed by referring to the Theory of Reasoned Action. Scale items were assessed prior to dissemination using cognitive interviewing techniques. As a part of demographics, participants indicated if they were parents or not. Data were evaluated descriptively. A Chi-Square analysis was performed to compare the selection of responses between parents and non-parents.

Results: 459 participants completed the survey, of which 160 were parents, 270 were non-parents and 29 chose not to specify parental status. Most participants indicated responses that were neutral or accepting engagement in traditional individual sports (75.7%) and for using playground or community equipment (74.0%). However, half of participants disagreed with encouraging the participation of group sports (51.3%) or sporting competitions (59.0%). When comparing responses between parents and non-parents, more parents expressed strong disagreement with preventing playground use (22.5%) than non-parents (11.8%, p=0.04). 

Conclusions: Overall, participants appear to be comfortable returning children to individual structured sporting activities; however, there is public hesitation for group-based activities. Parents disagree more with restricting playground use compared to non-parents. Public health authorities should plan effective safety strategies to increase community comfort levels when resuming the use of free playgrounds and group sports.

Purpose: The behavioral strategies that impact changes in physical activity (PA) for high-risk youth remain unclear. This study examines self-efficacy and parental support for PA as key factors associated with changes in child PA observed during a 6-week pilot PA intervention for high-risk middle school youth

Methods: Participants (9-14 years) from five public schools were enrolled in the 6-week pilot program, delivered remotely at home, during the summer of 2020. Based in social cognitive theory, the program included daily text-messages for parents and youth from a health coach, access to a private YouTube channel with sport and exercise videos, and three home deliveries of sport equipment. Parents and children completed baseline and follow-up surveys including child PA self-efficacy and self-reported PA, as well as parental support for PA. Data were analyzed using repeated measures multivariate analyses of covariance (RM-MANCOVA).

Results/findings: 34 parent-youth dyads completed baseline and follow-up surveys (mean age 12.1 [SD= 1.27] years, 67.6% male, 85.3% Black/African American).

The RM-MANCOVA results indicate changes in both self-reported PA (F(1, 33)= 9.64; p= .004) and PA self-efficacy (F(1, 33)= 5.471; p= .026) were statistically significant. Pairwise comparisons indicate self-reported PA (ΔM= 4.21, SE= 1.21) and PA self-efficacy (ΔM= .385, SE= .17) increased from baseline to follow-up. When parental support for PA was included as a covariate, only change in self-reported PA was statistically significant (F(1,33)= 15.77; p< .001). Multivariate tests indicate parental support for PA had a positive main effect (F(2,31)= 9.28; p= .001) and negative interaction effect (F(2,31)= 4.60; p= .018) on self-reported PA, indicating parental support for PA was positively associated with self-reported PA and that youth with lower parental support for PA at baseline actually experienced greater increases in self-reported PA.

Conclusion: Camp From Home participants reported increased PA self-efficacy and self-reported PA at the end of the 6-week pilot study. The increase in PA self-efficacy was explained by parental support for PA. Participants with lower perceived parental support experienced greater increases in self-reported PA suggesting that a remote home-based PA program might be more efficacious for high-risk youth with less parental support for PA.

Purpose: The COVID-19 pandemic caused drastic changes in U.S. families’ daily lives, with evidence of short-term impacts on food acquisition and eating behavior. More recent behaviors are less understood and may reflect a “new normal” following relaxation of protection measures in many regions. A survey was administered in October 2020 to assess reported impacts of the pandemic and current family food-related behaviors in a nationally representative sample of U.S. parents.

 Methods: An online survey was administered to U.S. parents with at least one 4-to-8-year-old child (n=1000). Questions included parent-reported impacts of COVID-19 on daily life and food acquisition, as well as current food security and restaurant use. Frequencies, means, and standard errors were calculated, incorporating sampling weights based on sociodemographics.

 Results: Parents reported increased working from home, decreased work hours, and increased child care and instruction due to COVID-19, with a majority of children attending school virtually or being homeschooled. About two-thirds of parents reported preparing food at home more often, 44% reported using take-out/delivery less often, and 33% reported using restaurant take-out/delivery more often than before. About half of parents reported that their child dined at restaurants, 62% reported getting take-out, and 57% reported delivery from restaurants at least 2-3 times per month during the past two months. Parents reported convenience and taste as the most important reasons for ordering take-out/delivery. About half believed it was very or somewhat safe to dine at restaurants, and take-out and delivery were believed to be safe by 74% and 77% respectively. Approximately two-thirds of parents reported food insecurity in the previous two months.

 Conclusions: Results illustrate some possible longer-lasting shifts in family life, including children spending more time at home, high food insecurity, and increased home cooking. Many families are using restaurants at this point in the pandemic, with some variability in their use and perceived safety. Continued surveillance can aid in understanding the extent to which the COVID-19 pandemic may have catalyzed changes in energy-balance-related behaviors that can have lasting impacts on health and well-being. Sociodemographic differences and implications for future research and policy will be discussed.

Purpose: Farm to school (FTS) program prevalence with respect to various school and student level factors was analyzed, including race/ethnicity, proportion of children on free or reduced-price meals (FRPM), and school level (elementary vs middle/high school). It was hypothesized that there will be a higher prevalence of FTS programs in elementary than middle/high schools, for non-white ethnic groups, and in schools with a lower proportion of students eligible for FRPM. There is a gap in research on the prevalence of FTS in higher grade levels as well as with respect to socioeconomic factors.

Methods: A secondary analysis on cross-sectional data from the New Jersey Child Health Study (NJCHS) on FTS prevalence was conducted from a sample of schools (n=497) located in four cities from 2010 to 2017. T-tests and chi square analyses were used among bivariate data before and after the enactment of the Healthy Hunger-Free Kids Act (HHFKA) as well as for each individual year to compare FTS prevalence with various factors. A robust linear regression was also conducted with respect to both pre vs post-HHFKA and individual in order to model multivariate associations between school-level factors. 

Results/Findings: FTS prevalence significantly increased after the implementation of the HHFKA for both elementary (p=0.001) and middle/high school (p=0.049), with elementary schools having a higher FTS prevalence both before (p=0.043) and after (p=0.001) the HHKFA. There was no statistical difference in the prevalence of FTS with respect to race or proportion of students on FRPM. Additionally, there was a statistical increase in FTS prevalence for years 2016 (p=0.008) and 2017 (p=0.003) using the linear regression model accounting for school-level factors, although a large confidence interval was noted.

Conclusions: FTS programs fluctuate over time due to a variety of factors, including schools not maintaining these programs or not having proper champions advocating for these policies. In addition, this study reflects the need for more FTS advocacy in middle and high schools due to their low FTS program prevalence compared to elementary schools. More research must be done to determine how FTS prevalence impacts pediatric health outcomes, especially with respect to socioeconomic factors.

Purpose: Walking is a more common mode of transport to school than cycling in many countries worldwide. Adolescents' have different perceptions of walking versus cycling to school, and therefore, these two modes need to be examined separately. Most previous studies investigated the associations between the built environment and active transport to school in home neighborhoods, while only a few studies focused on school neighborhoods. This study compared adolescent girls' perceptions of the school neighborhood environment for walking versus cycling to school.

Methods: Adolescent girls (n=68; age: 14.6±1.54) from two secondary schools in Dunedin, New Zealand, participated in the BEATS Natural Experiment study in 2020. Participants completed an online survey about the perceptions of school neighborhood environment for walking and cycling to school.

Results: In this sample, 33.8% of adolescent girls walked to school, and only 1.5% cycled. For walking to school, most adolescents reported enough footpaths in their school neighborhoods (79.4%), dangerous intersections (54.4%), the presence of crosswalks/signals (76.5%), diverse destinations within walking distance (75.0%), interesting scenery (58.8%), the presence of hills (66.2%), good lighting along the routes (80.9%), and a lot of noise along the routes (58.8%). For cycling, most adolescents reported high traffic volume (61.8%), dangerous intersections (54.5%), the presence of crosswalks/signals (64.7%), diverse destinations within cycling distance (61.8%), slippery routes (51.5%), the presence of hills (66.2%), good lighting along the routes (77.9%), and a lot of noise along the routes (54.4%). Fewer adolescents reported enough cycle paths versus footpaths (47.1% vs 79.4%; p<0.001), crossings and signals for cyclists versus pedestrians (64.7% vs 76.5%; p=0.008), and destinations with easy cycling versus walking distance (61.8% vs 75.0%; p=0.002) in their school neighbourhoods. In contrast, a greater proportion of adolescents reported too much traffic along with cycling versus walking routes (61.8% vs. 45.6%; p=0.028) in their school neighborhoods.

Conclusions: Adolescent girls from Dunedin, New Zealand, perceived the built environment of their school neighborhoods to be more supportive of walking versus cycling to school. Future built environment interventions in school neighborhoods to increase active transport to school need to be tailored to address walking- and/or cycling-specific barriers in a local context. 

 

Purpose: High consumption of ultra-processed food (UPF) increases the risks of non-communicable diseases, obesity, depression and all-cause mortality in adulthood, and the risk of caries in early childhood . Limited evidence about factors influencing children’s consumption of UPF existed. This study was conducted to evaluate the association between caregivers’ emotional feeding, children’s emotional eating and the consumption of UPF among children under three years of age.

Methods: A cross-sectional self-administered survey was conducted in rural areas of China among 409 caregivers whose children were 6-36 months. Parents’ Feeding Practices Scale for Infant and Young Child and Children’s Eating Behavior Questionnaire were used to assess caregivers’ emotional feeding and children’s emotional eating, respectively. Children’s consumption of UPF was assessed by a Food Frequency Questionnaire. Logistic regression analyses were performed to evaluate the associations between caregiver’s emotional feeding, children’s emotional eating and their consumption of UPF, after controlling for potential confounders.

Results: In total, 98% children consumed UPF. The highest prevalence of UPF consumed was pastries (63.5%), followed by solid or semi solid dairy products (58.8%), infant formula (56.7%), reconstituted meat products (56.4%), and then confectionery (38.2%), sweet or savory packaged snacks (35.8%), sugar-sweetened beverage (20.0%), infant rice flour (15.6%). There existed differences in the consumption of UPF among children aged 6-11 months, 12-24 months, and 25-36 months. Logistic regression showed that among children aged 12-24 months, caregivers’ emotional feeding was associated with higher odds of children’s consumption of reconstituted meat products (OR 5.453, 95%CI 2.081, 14.292) and sweet/savory packaged snacks (OR 5.532, 95%CI 1.615, 18.948). Children’s emotional overeating was marginally associated with higher odds of consumption of sweet/savory packaged snacks (OR 2.404, 95%CI 0.994, 5.817) and pastries (OR 2.837, 95%CI 1.231, 6.539). Among children aged 25-36 months, children’s emotional undereating was associated with higher odds of reconstituted meat products consumption (OR 1.661, 95%CI 1.151, 2.398).

Conclusion: Caregivers’ emotional feeding, children’s overeating and undereating were associated with children’s consumption of unhealthy UPF, including reconstituted meat products, sweet/savory packaged snacks, and pastries. To improve children’s diet quality, caregivers’ feeding practices and cultivating children’s good eating habits should be educated.

Purpose: Intuitive eating (IE) which includes unconditional permission to eat (UPE), reliance on hunger and satiety cues (RHSC), eating for physical rather than emotional reasons (EPR), and body-food choice congruence (B-FCC) is an alternative paradigm to encourage healthful behaviors. IE has been associated with positive health benefits, yet the research investigating IE with diet intake is minimal, inconsistent, and may differ by sex and food security status. The purpose of this study is to identify relationships between IE and diet intake in adults living in the US and explore differences by sex and food insecurity status.

 

Methods: We recruited 308 adults 18 years and older living in the US to complete an online survey including demographic data, IE, a diet screener questionnaire, and food insecurity. We used structural equation modeling to analyze relationships between IE subscales, calcium, whole grains, added sugars, vegetables, and fruits. Then, we explored differences by sex and food insecurity status.

 

Results: Across all groups, UPE was consistently associated with a higher intake of added sugar. B-FCC was associated with a lower intake of added sugar and calcium, and a higher intake of vegetables and whole grains. EPR was associated with a higher intake of calcium and vegetables. In men, RHSC was associated with a lower intake of vegetables and B-FCC was associated with a lower intake of calcium. In women, EPR was associated with a lower intake of added sugar; B-FCC was associated with a higher intake of vegetables, whole grains and fruit. Among food secure adults, EPR and B-FCC were associated with a higher intake of vegetables, while RHSC was associated with a lower intake of vegetables. In food insecure adults, B-FCC was associated with a lower intake added sugar and higher intake of fruit.

 

Conclusions: While intuitive eating is not consistently related to the intake of more nutritious foods, EPR, RHSC, and B-FCC may promote diet quality. Therefore, in addition to the positive health benefits, IE may be an effective mechanism to promote diet quality. Differences by sex and food insecurity suggest tailoring IE interventions may be essential to increase effectiveness.

Background: Prolonged sitting in desk-based office workers is found to be associated with increased cardiometabolic risk and poor cognitive performance. Technology-based physical activity (PA) interventions using smartphone applications (SmPh app) to promote PA levels might be effective in reducing cardiometabolic risk among the sedentary population but the evidence remains inconclusive.

Objective: The objective is to investigate the effects of a technology-based PA intervention compared to PA education with a worksite manual or no intervention on PA levels, cardiometabolic risk, cognitive performance, and work productivity among desk-based employees.

Method: A three-arm clustered randomized trial will be conducted. The study will be conducted among various administrative offices of a multifaceted university in India. Desk-based employees aged between 30 and 50 years (n=159; 53 in each arm) will be recruited. Employees from various constituent institutions (clusters) of the university will be randomized into one of the three following groups - SMART: SmPh app-driven break reminders (visual exercise prompts) plus pedometer-based step intervention, TRADE: worksite PA education with a manual plus American College of Sports Medicine guided PA prescription, or CONTROL: usual workgroup. At baseline and after the 1st, 3rd and 6th month of the trial period, accelerometer-measured sitting time and PA levels, cardiometabolic risk (fasting blood glucose, triglycerides, insulin, blood pressure, heart rate variability, functional capacity, and subcutaneous fat), cognitive performance (executive function), sickness absenteeism and work limitations will be assessed by a blinded assessor. Therapist delivering interventions will not be blinded.

Conclusion: This trial will determine whether a combined SmPh-app and pedometer-based intervention is more effective than education or no intervention in altering PA levels, cardiometabolic risk and cognitive performance among desk-based employees in India. This study has the potential to foster institutional recommendations for using SmPh-based technology and pedometers to promote PA at work.

Background: Anecdotal evidence link occupational sedentary behaviour, low energy expenditure (EE) and cognitive dysfunction. Nevertheless, EE across different work postures including active workstations remains unclear and its influence on cognitive processing speed is yet to be established.

Objective: We aimed to investigate differences in EE across various work postures and influence on cognitive processing speed.
Methods: In our counterbalanced randomised trial, sixteen desk-based employees performed simulated work tasks (typing, reading and cognitive tasks) in three different work positions (sitting, standing, walking) in three different days. EE was measured for three days consecutively for 30-minutes in each simulated position using indirect calorimetry. Processing speed was assessed through computer-based choice reaction times during each work posture. The outcome variables of interests (EE, reaction times and accuracy) were compared between work positions using repeated measures ANOVA and Pearson correlation.

Results: Walking EE in walking was higher (5.57 ± 0.45 Kcal) than sitting (1.07 ± 0.12 Kcal) and standing (1.88 ± 0.42 Kcal). Total EE was significantly higher in walking than standing (35.17 ± 6.86 Kcal) and sitting postures (41.37 ± 8.46 Kcal). We did not find any significant differences in reaction times between different work postures except within standing work condition (60.22 ±13.97 ms). Accuracy was found to be reduced in walking compared to sitting (0.76 ± 0.83%) and standing (0.43 ± 0.09%) but not reached significance.

Conclusions: Though significant differences in EE were observed between work postures, walking or standing at work did not affect the cognitive processing speed.

Purpose: With an increasing number of children attending regular childcare services, this setting presents an opportunity to develop physical activity habits and movement skills of children. These health behaviours play an important role in the development and well-being of children. In 2017, a Director of Licensing Standard for Active Play (AP Standard) was introduced in British Columbia, Canada, to mandate practices related to physical activity, sedentary time, screen-time and provision of opportunities to develop movement skills in licensed childcare services. A capacity building initiative including training and on-line resources was released alongside these new guidelines to support educators in implementation. The purpose of this study was to qualitatively examine the barriers and facilitators early learning practitioners faced in implementing the AP standard, and explore the role of the capacity building training and resources.

Methods: Data were collected via semi-structured telephone interviews with educators (n=23), sampled across all five health authorities in British Columbia, Canada. Thematic analysis was used to code and theme the data informed by a theoretical framework of contributions to implementation.

Results: Data were sorted into three major themes with four subcategories of implementation influences in each theme and included: attributes of the standard and capacity-building training (enhanced awareness and knowledge, simplicity, compatibility, and prompting of intention and commitment); characteristics of providers (personal activity level, previous experience, personal philosophy, and role models); and characteristics of childcare settings (infrastructure, schedules, social support, and policies and practices). Educators discussed how each of these three themes directly influenced provision of physical activity opportunities. Educators were overwhelmingly supportive of one of the standards; minimal to zero screen time in childcare. Interestingly, educator responses did not highlight or discussed movement skills.

Conclusions: The guideline and capacity building training which included a strong focus on physical literacy appeared to support implementation of physical activity opportunities, but educators did not articulate specific benefits to movement skill development. Future training should work to engage educators who may not place a high value on movement skills to ensure that provision of physical activity is purposeful and involve development of locomotor, object control, and balancing skills.

Purpose: Health literacy (HL) entails people's knowledge, motivation, and competences to access, understand, appraise, and apply health information necessary to make appropriate health decisions during the life course. Food literacy (FL), a subset of HL, refers to people’s knowledge and competences to meet the complex demands of a healthy and sustainable diet.
HL was demonstrated to be limited among adults in Germany aged 65 and over (Hurrelmann et al., 2020). Furthermore, almost every second adult between the ages of 60 and 69 has limited FL (Kolpatzik & Zaunbrecher, 2020). Despite this, there is a conspicuous lack of studies that have examined the relationship between older people's FL, HL, and nutritional behavior in more detail. Here, we report on a study that aims to shed light on this relationship.

Methods:
The baseline data of 119 individuals from the “GUSTO” intervention study were used for this analysis. FL and HL were measured using a German version of the Self-Perceived FL Scale (Poelman et al., 2018) and a German version of the HLS-EU-Q16 questionnaire. The nutritional behavior was exemplified by the daily fruit and vegetable consumption as well as the daily drinking quantity. We examined anticipated associations between the FL score and the following characteristics: HL, gender, chronic diseases, educational level, daily fruit and vegetable consumption and daily drinking quantity.

Results/findings:
We observed the anticipated positive association between the FL scores of 97 participants (mean age: 72.2 ± 6.8 years, male: 27.8%) and the ascending ordered alternatives of their HL score (inadequate, problematic, sufficient, and excellent). In addition, we identified a significant difference in FL scores between their gender, chronic diseases and fruit and vegetable consumption. However, we could not find a significant difference in FL scores between their educational level, as evidenced in health literacy, and daily drinking quantity.

Conclusions: The FL score is associated with the HL score. Nevertheless, discrepancies regarding sociodemographic characteristics suggest that FL and HL cannot be considered analogously. This study is a first step towards closing the current gap in research on the relationship between FL, HL, and nutritional behavior. However, more research is needed in this field

Purpose: Improvements to diet and physical activity (PA) can reduce risk of developing type 2 diabetes (T2D); however, long-term adherence to diet and PA is poor. In order to influence T2D risk at a population level, scalable interventions are needed to facilitate behaviour change adherence. Text messaging interventions are a cost-effective way to improve long-term diet and PA changes; however, they often fail to report on theoretical underpinnings of message development. Study aims: describe the development of a bank of text messages to support diet and PA behaviour change adherence following a diabetes prevention program using the Behaviour Change Wheel (BCW). The BCW is a synthesis of 19 behaviour change frameworks which provides structure to intervention design and has been used extensively in health behaviour change interventions. 

Methods: The following stages of the BCW were followed: (I) target behaviours and barriers/facilitators to engaging in them; (II) intervention options and policy categories; and (III) relevant behaviour change techniques (BCTs) associated with selected intervention options. A library of text messages was then written to map onto identified BCTs and was coded for BCT fidelity by an independent reviewer trained in BCT identification. 

Results: Target behaviours included adherence to diet and PA recommendations. Sixteen barriers/facilitators and 28 associated BCTs were identified through previous qualitative work. One hundred and twenty-four messages were written based on selected BCTs and following the fidelity check, a total of 43 unique BCTs were included in the final bank of messages. 

Conclusion: While other research has utilized the BCW to develop text messaging interventions, this is first, to our knowledge, to have an independent coder assess BCT classification in the final message development as a form of fidelity check. This additional step proved imperative in developing a comprehensive picture of the active components within the current bank of messages. By reporting on the theoretical underpinnings and mechanisms of action within text messages, future research can understand not only if these messages are effective, but also why certain messages may be more or less effective, and what combination and dose of messages can optimally influence behaviour change.

Purpose: Physical activity (PA) may mitigate cancer-related cognitive impairment (CRCI), but COVID-19 pandemic restrictions have created challenges for PA. The purpose of this study was to: a) examine the associations between changes in PA and cognitive function in cancer survivors during the pandemic; and b) examine clinical subgroups that moderate this association.
Methods: An online, cross-sectional survey was administered globally to cancer survivors (≥18 years of age). Cancer survivors self-reported demographic and clinical variables, regional COVID-19 restrictions, PA prior to and during the pandemic using the modified Godin Leisure Time Exercise Questionnaire, and perceived cognitive function using the Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog). Change in PA during the pandemic was categorized into non-exercisers, inactive adopters (inactive before, active during), complete relapsers (active before, inactive during), partial relapsers (meeting combined aerobic and strength guidelines before, only a single guideline during), single guideline maintainers, and combined guideline maintainers. Analysis of covariance examined differences in FACT-Cog scores across the PA change categories in the total sample and across clinical subgroups.

Results: Cancer survivors (N=454; Mage=48.3±15.3 years) were primarily female (71.4%), diagnosed with mainly breast (31.7%), gynecologic (13.2%) and hematologic (12.1%) cancer, and had mean months since diagnosis of 87.0±83.1. No significant differences were found across the PA change categories on the FACT-Cog or its subscales. Subgroup analyses revealed that when <5 years of diagnosis, partial relapsers had significantly worse scores on the comments from others subscale compared to inactive adopters (-3.6 points; p=.01), complete relapsers (-3.1 points; p=.02), single (-3.1 points; p=.01) and combined guideline maintainers (-3.1 points; p=.02). For underweight/normal weight cancer survivors, combined guideline maintainers had less Perceived Cognitive Impairment (PCI) than non-exercisers (10.04 points; p=.047), and partial relapsers (17.8 points; p=.02), and higher cognitive functioning on the FACT-Cog than partial relapsers (28.7 points; p=.04). Underweight/normal weight partial relapsers had significantly higher PCI (-31.2 points; p=.04) and worse cognitive functioning (FACT-Cog;-18.6 points; p=.03) than complete relapsers.

Conclusions: PA promotion efforts during the COVID-19 pandemic should consider maintaining PA among cancer survivors closer to their date of diagnosis, as well as retaining a healthy weight to mitigate CRCI.

Purpose:  Numerous studies use mail methods to distribute and collect accelerometer devices to and from participants. In 2020 and the foreseeable future, there is a need for studies to pivot from in-person to non-contact protocols to distribute accelerometer devices via the mail. The purpose of this study is to overview mail methods for accelerometer-based data collection, highlight successful practices, offer guidance on data analysis, and provide best practices for managing mail methods protocols.

Methods: Studies, including research articles and protocol documents, describing mail-methods for distribution and/or return of accelerometers were systematically identified across 4 databases. Information regarding distribution of monitors and accompanying materials, frequency and type of contact with study participants, and rates of device loss were extracted. Studies that provided information about unique features of data processing, including determining “mail time” versus “wear time”, were also reviewed.

Results: A total of 10 articles in adult populations (average N= 8, 961, range 580 to 19,458) provided detailed information about mailing protocols (n=7) and/or data management protocols (n=3). Most of the studies that used mail protocols included (1) information for participants sent with the monitor(s), (2) frequent follow-up using phone, text, or email, (3) participant logs, and (4) trackable packages from the carrier. Challenges reported included battery life issues related to participants not wearing the device at the desired time, incomplete logs, and non-response for return after initial contact.  Common data management protocols included using participant logs to determine “wear” days from “mail” days as well as visual inspection of the data. The average rate of data loss due to non-return of equipment was ~5% (range 2-10%).

Conclusion: Based on the literature and experience during the pandemic, mailing accelerometers to participants is feasible and suitable, regardless of study size. Best practices include providing detailed information about wearing a monitor, logs/diaries to document wear, and frequent follow-up with participants to ensure appropriate wear and timely return of the devices. Data processing can be carried out using standard protocols, provided researchers screen for “wear” days using participant logs and visual inspection of the data prior to processing.

Purpose: Beginning in 2011, the University of New Mexico Prevention Research Center (UNM PRC)  began implementing Child Health Initiative for Lifelong Eating and Exercise (CHILE) Plus, as an evidence-based and multilevel obesity prevention program among American Indian and Hispanic children enrolled in Head Start (HS) programs across rural New Mexico. As the dissemination of the original CHILE intervention study funded by NIDDK, CHILE Plus aims to help young children eat more healthy food and participate in more physical activity (PA). The objective of this study is to report eight years (2011 to 2019) PA outcome (i.e., add at least 30 mins of structured PA to daily class activities) from this statewide initiative.

Methods: As one of six CHILE Plus intervention components, HS teachers are provided with well-designed PA curriculum, the necessary tools, equipment, and lessons needed to incorporate an additional 30 mins of PA per day into classroom time. Most activities are short in duration (5 to 10 mins), require little space, and use a minimum amount of equipment. Children’s PA (i.e., mins spent in structured PA) at school are reported by HS teachers daily. Descriptive statistics were calculated and presented as mean ± standard deviation.

Results: A total of 8150 children from 16 school districts have valid PA data. Overall, children spent 49.95±25.89 mins in daily structure PA at school. Specifically, children (n = 316) from two school districts had more than 70 mins PA (75.28±34.72); children (n = 5896) from seven school districts participated in PA between 50 and 60 mins (55.33±29.72); children (n =  1753) from six school districts spent 30-40 mins in PA (36.36±13.78); and children (n = 185) from one school district engaged less than intended 30 mins structured PA (20.69±15.26).

Conclusions: Overall, intended gains in additional 30 mins daily structured PA were made for most implementing agencies. The assessment of the implementation and maintenance showed the potential of the CHILE Plus program for high public health impact among New Mexico HS children. This initiative should continue to be applied across a wider range of school-based programs and populations.

 

Purpose: In recent years, the idea of a positive attitude towards eating is immerging to move away from pathology, restriction, and concern related to food and eating behavior. To further investigate to which extent this positive eating attitude could be beneficial for one’s health, the present study focuses on the associations between the Positive Eating Scale (PES), weight management, food intake, and body mass index with regards to sex differences within a non-clinical sample of the general Swiss population.

 

Methods: Data from the third (2019) and fourth (2020) waves of the Swiss Food Panel 2.0, a longitudinal paper-and-pencil survey which started in 2017, were analyzed. Participants (N₂₀₁₉ = 2795, N₂₀₂₀ = 2291) answered questions related to their positive eating attitude, food intake, eating behavior, and sociodemographic status. Correlations, logistic regressions, and linear regressions were performed.

 

Results: Cross-sectional results showed that variables related to food restriction and weight concern (e.g., restrained eating, weight regulation through calorie monitoring) were negatively correlated with the PES total score (r = -.08 – -.34, p < .001) and the subscale satisfaction with eating (r = -.09 – -.45, p < .001), while there were only small or no significant correlations with pleasure when eating for both sexes. Overall, diet quality was positively correlated with positive eating (total score and satisfaction with eating) for women (r = .10, p < .001). There was no such evidence found for men. Furthermore, body mass index was negatively correlated with the PES total score (men: r = -.19, p < .001; women: r = -.18, p < .001) and the subscale satisfaction with eating (men: r = -.29, p < .001; women: r = -.25, p < .001) for both sexes. On a longitudinal level, positive eating was not a significant predictor for change in diet quality. However, higher levels of positive eating significantly decreased the likelihood of being overweight after one year.

 

Conclusions: A positive attitude towards eating, and especially satisfaction with eating, seems to be primarily associated with a healthier food choice, better diet quality, and a lower likelihood of becoming overweight over time. Promoting a positive attitude towards food and eating might, thus, be beneficial for one’s health and needs to be further explored in intervention settings.

 

Purpose: The home environment and parents’ roles have received much attention in early childhood obesity prevention research. However, the possible reciprocal relationship between environment and the parent is seldom addressed. This is critical because parents with certain parenting styles, feeding practices, and weight status may need additional support creating home environments that facilitate children’s health behaviors. Therefore, this study aimed to describe parental qualities associated with healthy home food and activity environment of children.

Methods: This cross-sectional study utilized baseline data from a randomized control pilot study of a wellness program, which included a sample of 50 ethnically diverse parents (84% mothers, Mage = 31.7 years) and their toddler age child (12-36 months). Parental BMI was calculated via self-reported weight and height data. Parents completed the Comprehensive General Parenting Questionnaire (van der Horst and Sleddens 2017) and Structure and Control in Parent Feeding (Savage et al. 2017) questionnaire. Health behavior resources, barriers, social norms, and policies in the home were assessed using the Healthy Home Survey (Bryant et al. 2008), the Home Food Inventory (Fulkerson et al. 2008), the Sleep Environment Questionnaire (Wilson et al. 2014), and items developed for this study. To calculate one home environment composite score, scores on all home environment items were standardized and then summed. Items related to obesogenic behaviors were reverse scored; therefore, a higher score would represent a healthier home environment. Pearson's correlations tested associations between parental qualities and healthy home environment. 

Results: Most parents were Hispanic/Latino (38%), and African American (32%), and their mean BMI was 28.4 kg/m2. Parental BMI (r=-0.306; p=0.032) and coercive control (r=-0.333; p=0.022) were inversely correlated with healthy home environment. Parental use of structure in general parenting and in feeding practice were related to overall home environment (r=0.336; p=0.026) and home food environment scores (r=0.415; p=0.003), respectively. 

Conclusion: Preliminary evidence suggests that parents, who provide clear and consistent communication regarding expectations, set age-appropriate limits, avoid pressure to control their children’s behaviors, and have a lower weight status, live in a home environment that supports their children’s healthy eating, activity, and sleep behaviors development.

Background: Unhealthy lifestyle choices are a major problem in secondary vocational students. However, very few healthy lifestyle interventions have been developed to improve their health behaviours. This study examines the effectiveness of the peer-delivered, school-based intervention Healthy by Design (HbD). The main aim of the HbD intervention is to promote a positive change in the (determinants of) dietary and physical activity behaviours among secondary vocational students.

Methods: The HbD intervention was implemented at two locations of a secondary vocational school in a metropolitan area of the Netherlands. In the intervention implementation phase, senior secondary vocational students functioned as role-models to motivate fellow-students to eat healthy and be physically active. Data were collected in two cross-sectional surveys before and after invention implementation. In total 1,177 vocational students (before: 557, after: 620) participated in an online health behaviour survey. Multilevel logistic and multilevel linear models explored the effect of the intervention over time and the effect of the intervention dose received on (determinants of) dietary of physical activity behaviours. Intervention dose received was calculated using various survey questions asking about exposure to the intervention.

Results: A significant positive effect over time was found for moderate intensity physical activity and knowledge of the under 18 physical activity guidelines. A high intervention dose was positively associated with increased water, breakfast and fruit consumption and higher levels of moderate and vigorous physical activity compared to no intervention dose received. A moderate and high intervention dose was negatively associated with high calorie snacks consumption compared to no intervention dose received.

Conclusion: Effects of the HbD intervention on the investigated dietary and physical activity behaviours over time are limited and restricted to a positive change in (determinants of) physical activity behaviour. However, a higher intervention dose showed a strong relation with healthier dietary and physical activity behaviours. This suggests that low exposure to an intervention is not enough to promote behaviour change. Therefore, it is important to make sure that students come into contact with intervention components on a regular basis.

Purpose: The relationship between sedentary behaviour (SB) and subjective well-being (SWB) is currently unclear. Numerous cross-sectional studies demonstrate weak, negative correlations between high SB and poorer SWB outcomes. Recent research suggests that within-person changes in SB may be more strongly associated with outcomes of SWB than between-person differences, warranting experimental exploration. However, relatively little research has explored the relationships between SB and SWB outcomes experimentally, limiting current interpretations of the nature of these relationships. Hence, the primary purpose of this pilot study was to examine the preliminary effectiveness of an acute sedentary behaviour (SB) reducing intervention to enhance university students’ subjective well-being (SWB).

Methods: A three-week (i.e., baseline, intervention, follow-up) randomized controlled pilot trial was conducted. Thirty-two sedentary (i.e., ≥7 hours of device-measured SB) university students from the local institution were randomized to an acute behavioural counseling intervention (n = 17) or control group (n = 15). Behavioural counseling was aimed at reducing daily SB for 1 week and was grounded in the Health Action Process Approach theory. Device-measured SB outcomes (i.e., average daily steps, standing time, sitting time, and sit-to-stand transitions), self-reported SBs (i.e., self-compared, domain-specific), and SWB measures (i.e., affect, life satisfaction, subjective vitality, overall SWB) were assessed weekly.  A series of repeated-measures ANOVAs were conducted for outcomes of interest.

Results/findings: Repeated-measures ANOVAs revealed non-significant medium-to-large effects for self-reported SBs (i.e., 0.116 ≤ η_p² ≤ 0.253), device-measured standing time (i.e., η_p² = 0.161), and life satisfaction and overall SWB (i.e., 0.141 ≤ η_p² ≤ 0.178) favouring the treatment group over the control group.

Conclusions: Overall, this acute intervention was ineffective in reducing SB among university students. Comparatively to previous acute SB-inducing interventions, results suggest that SB-reducing interventions may require more robust treatment application than the current pilot study. Strategies such as prompts/cues, repeated intervention delivery, and longer intervention periods are recommended. .Strategies that promote larger non-convenient sampling (e.g., longer recruitment periods) also are recommended. Taken together, these strategies will increase treatment effects and statistical power of subsequent intervention trials.

Purpose: To improve opportunities for girls to be physically active by determining the enablers and barriers to girls’ engagement in male dominated action sports

Methods: Twenty-eight young (12-18 years) Australian mountain-biking, skateboarding or surfing participants or enthusiasts­ (n=17 boys; 11 girls) and 20 Australian adults (n=8 parents; 12 stakeholders - board/committee members, chief executive officers, coaches, officials, event coordinators in either action sport) shared their perspectives on the enablers and barriers to girls’ engagement in the aforementioned sports. Data were collected through telephone interviews with young people and focus groups with adults in a blended face-to-face/video conferencing format which were audio-recorded, transcribed verbatim and analysed thematically.

Results/findings: From a social-ecological perspective enablers and barriers discussed were at the individual, social and environmental level. Common barriers raised by adults and young people included: gender stereotypes, “…boys love bikes and girls love dolls…” or sexism (e.g. clothing/equipment primarily designed for boys, unequal prize money favouring males), friends/family not engaged in the sport and limited access to the requisite environments or equipment. Adults said the absence of skill development pathways for girls, no toilets/change-rooms, “…girls with periods need toilets” and a focus on competition over participation were other barriers. Parents and girls said lack of visibility of girls playing sport in the media and self-consciousness were reasons for lower participation by girls. Common enablers discussed included initiatives that promote inclusivity (e.g. non-competitive events, infrastructure for all skill levels, access to equipment), fostering social connections (e.g. engage friends/families), developing/expanding all girls events/programs/coaching/clubs/groups, skill development pathways enabling life-long engagement (including becoming coaches, equipment maintenance), school based programs/events for all skill levels. Normalising girls’ participation through improved promotion (e.g. through media) and growing and promoting female action sport role models were other common enablers.

Conclusions: Girls face barriers to participating in action sports not experienced by boys. Many barriers are social and can be remediated with minimal resource input. Removing barriers to girls’ engagement in action sports may provide untapped opportunity to correct lower levels of physical activity amongst girls compared with boys.

Purpose: Few prospective studies have examined the associations between diet patterns and the development of cardiometabolic risk factors over time in children and adolescents. The current study examined the longitudinal association between alternate Mediterranean Diet (aMedDiet) score and cardiometabolic risk factors in Mexican children and adolescents.

Methods: The analytic sample is composed of 686 participants (51.02 % female) in the Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT) birth cohort in Mexico City birth cohort study, who were followed at up to four-time points from 6 to 21 years.  At each visit, diet quality was assessed by deriving adherence to the Mediterranean diet (aMedDiet) score from a validated semi-quantitative food frequency questionnaire. To detect a dose-specific relationship, aMedDiet score was divided to quartiles, with the lowest quartile set as the reference group. At each study visit, six cardiovascular risk factor measures were collected: waist circumference, systolic and diastolic blood pressure, serum glucose, high-density lipoprotein cholesterol (HDL-C), and triglyceride. Linear mixed models with random intercepts were used to model the longitudinal association with repeated assessments between aMedDiet and each cardiometabolic risk measure. Models were adjusted for age at each visit, sex, maternal parity and education, delivery mode, sexual maturation, and other covariates.

Results: The mean age (years) at baseline was 8.20 (±2.08) and at the last follow-up visit was 16.43 (±2.14).  A positive longitudinal association was detected between aMedDiet score and serum HDL-C where participants in the highest vs. lowest quartile of aMedDiet score had higher serum HDL-C (β=1.08 mg/dL (1.03), p-value<0.01), and a linear trend was found (p-value<0.01) for serum HDL-C.  No relationship was detected with other cardiometabolic risk factors.

Conclusions: Our findings showed a positive longitudinal association between higher diet quality and serum HDL-C among Mexican children. These findings highlighted the importance of childhood diet and the development of cardiometabolic risk factors.

Funding Sources: NIH/NIEHS

Background: Depression, anxiety and their related symptoms are a leading cause of global disability and economic burden. Three quarters of all mental disorders occur by the age of 24 years making the identification of modifiable risk factors during these years imperative for prevention. This study examined associations between diet and psychological distress, depression and anxiety in a nationally representative sample of Australians during emerging adulthood. 

Methods: Cross-sectional data (N= 1,340) from the 2017-18 Australian National Health Survey were analysed including fruit, vegetable and sugar sweetened beverage consumption. The primary outcome was psychological distress measured by the Kesler Psychological Distress Scale. Self-reported depression and anxiety were secondary outcomes. Ordinal logistic regression analyses were fitted and adjusted for demographic and lifestyle factors.

Results: Adjusted odds of high psychological distress were 44% greater among participants not meeting daily fruit intake guidelines (OR 1.44; 95% CI 1.13–1.84). Failure to meet fruit intake guidelines was associated with 63% and 55% increased odds for depression (OR 1.63; 95% CI 1.00–2.70) and anxiety (OR 1.55; 95% CI 1.02–2.38), respectively. Trends for vegetable and sugar sweetened beverage consumption were in the expected direction; however, did not reach statistical significance in adjusted models. Adjustment for lifestyle factors rendered results statistically non-significant across all outcomes

Limitations: This study is limited by reliance on cross-sectional, self-reported data and use of rudimentary diet proxies.

Conclusions: These findings support an association between diet and mental health amongst emerging adults. Further longitudinal studies in this age group are warranted to investigate the directionality of this association. 

Keywords: Depression, anxiety, nutritional psychiatry, prevention, emerging adulthood, diet

 

Despite some decrease in Western countries, regular sugar-sweetened beverage consumption is at the top of the alarming dietary habits worldwide. The effectiveness of actions to reduce their consumption and the methods for evaluating them need to be improved. Furthermore, in a context of growing concern about sustainable food systems, little is known about sustainability-focused interventions. The objective of this cluster randomized controlled trial is to evaluate the long-term effectiveness of nutrition- and sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 4th-to-6th-grade children.

French-speaking Belgian primary schools will be randomized using a factorial plan: (i) control; (ii) nutrition-based intervention; (iii) sustainability-based intervention; and (iv) both. The estimated sample size needed is 48 schools (i.e. around 3.500 pupils followed-up over two years). Interventions (information meetings, water breaks, provision of posters, flyers, reusable cups and glass bottles…) will take place from September 2021 to June 2023. The distinction between intervention groups will be made through the nature of the information given. 

Children and schools will be evaluated in Spring 2021, 2022 and 2023. The main quantitative judgement criterion will be the change over time in mean sweetened beverage consumption. Daily mean beverage consumption will be estimated through a 4-day diary. An internal calibration study will be carried out to take into account the measurement error in beverage intake estimation (n=130). A large set of information on nutrition-related behaviors, perception of environmental risks and related behaviors, and other characteristics will be collected among children and their parents. Repeated audits will be performed in all schools to assess involvement of the staff in health promotion actions, feasibility of such actions… A qualitative assessment will specifically aim at identifying barriers and enablers in the transmission of health messages coming from the school towards the families. At last, the total cost of interventions will be monitored to anticipate the potential generalization. To note, the trial is funded by public Belgian stakeholders.

The originality of this three-year project lies in studying the potential interacting effectiveness of interventions including levers in both nutrition and sustainability domains.

Purpose: Co-occurrence of energy balance-related behaviours of preschool children in Asia and their correlates are poorly known and there are few comparative analyses between Asia and Europe. In cohort studies in Singapore (GUSTO) and France (EDEN), we characterized lifestyle patterns of children and investigated their associations with contextual factors.

Methods: Ten behavioural variables related to the child’s diet, outdoor play, walking, and screen time were ascertained using parental questionnaires at age 5-6 years. Sex-specific lifestyle patterns were derived independently for GUSTO and EDEN children using principal component analysis. We categorized contextual variables based on the socio-ecological model [demographic and socioeconomic (10 variables), parental health and lifestyle (7 variables), and parent-child interaction (8 variables)] and examined their associations with lifestyle patterns by three-stage hierarchical linear regression analyses.

Results: Of 630 GUSTO (n=330 boys) and 989 EDEN children (n=527 boys), three similar sex-specific lifestyle patterns were identified in both GUSTO and EDEN: “discretionary consumption and high screen time”, “fruit, vegetables, and low screen time” and “high outdoor playtime and walking”. The latter two patterns showed marginal differences between cohorts.
Focusing on the common pattern in both cohorts, higher scores on “ discretionary consumption and high screen time” were observed in children who often had the TV on while eating, snacked between meals, and whose mothers’ diet were less healthy during pregnancy. In GUSTO, scores for this pattern were higher in children of Malay and Indian ethnicity, with a high allowance of child control over his/her food intake, and those in partial centre-based childcare and had non-parents as primary caregivers. In EDEN, scores for this pattern were higher in children with later bedtime (only in girls) and whose mothers had lower educational attainment.

Conclusions: Three similar lifestyle patterns were observed among preschool children in Singapore and France. While some contextual factors were common across both cohorts, certain factors differed due to differences in physical environment, social and cultural settings. Findings will provide valuable information to each country on prioritizing areas for action and aid in intervention development and prevention strategies to improve the health and well-being of our children.

Purpose: Adolescence is a sensitive period regarding the development of long-lasting health-related attitudes and behaviors. Adolescent females are particularly sensitive to overweight and obesity, especially those from disadvantaged backgrounds. However, little research has examined the factors that influence their engagement in these behaviors using a qualitative approach. Therefore, the current study aimed to develop an understanding of the factors which influence health-related behaviors of disadvantaged adolescent girls in Ireland from a teachers’ perspective. 

Methods: Online semi-structured interviews were conducted with teachers (n=9) from post-primary disadvantaged schools in Dublin (Ireland). Data were recorded, transcribed verbatim and independently coded by two researchers. Themes were examined using an inductive thematic analytic approach and fitted to the Socio-Ecological Model (SEM).

Results/Findings: Nine themes were identified and mapped within the SEM levels: 1) individual: lack of interest and knowledge, lack of self-confidence, the dual role of modern technology; 2) interpersonal: behaviors of significant others, need for good role models; 3) school and community: availability of convenience foods, inadequate existing approaches and initiatives, lack of resources to promote a healthy lifestyle; and 4) societal: living difficulties at home and in the community.

Conclusions: Findings presented a range of factors that should be addressed to promote positive health-related change in disadvantaged adolescent girls, with opportunities for intervening at a range of different levels, from individual-level factors to community-level factors. Among these identified factors, a lack of interest among the girls makes it difficult to harness motivation to engage with health-related content and interventions.

Purpose: Vegetable intake among disadvantaged adolescents is particularly low. Findings on the determinants of vegetable intake in young populations remain inconsistent. To date, no review on this topic has particularly focused on disadvantaged adolescents. Therefore, this systematic review aimed to investigate the determinants of vegetable intake in disadvantaged adolescents.

Methods: Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO and ERIC) were searched from January 2013 to October 2020. The search strategy used the following set of descriptors: vegetable intake, adolescents, and determinants and correlates. Studies published in peer-reviewed journals were included if they comprised a sample of disadvantaged individuals aged 12-18 years, examined an association between vegetable intake as a separate outcome and at least one hypothesized determinant, and were conducted in urban settings of high-income countries.

Results/Findings: Thirteen studies meeting the inclusion criteria were included (10 cross-sectional, two longitudinal, one cross-sectional and one longitudinal). The main reasons for the exclusion of full texts (n=144) were not targeting disadvantaged samples or adolescents, and not investigating vegetable intake either separately or at all. Encouraging others to eat vegetables was consistently associated with higher own vegetable intake; however, these conclusions were drawn from two related samples and thus cannot be considered as independent findings. Nutrition knowledge was the only determinant consistently investigated in several independent samples and it was not associated with vegetable intake in disadvantaged adolescents. We failed to observe a consistent pattern of association between any of the remaining determinants and vegetable intake in this population group, probably due to the low number of papers that met the inclusion criteria.

Conclusions: Our results suggest that intervention studies aiming to promote vegetable intake by exclusively providing nutrition education may not be effective. Other strategies, such as involving teenagers to promote vegetable intake, may be more successful. More research is warranted to investigate determinants of vegetable intake in disadvantaged youth at different societal levels, preferably with longitudinal designs and involving large and representative samples. There is a need for further research on the determinants of vegetable intake to gather more evidence and guide the development of successful interventions in disadvantaged adolescents.

Purpose: Dietary guidelines generally reference the effect of individual macronutrients. However, macronutrients are not eaten in isolation and therefore the relevance of such an approach needs to be assessed, particularly regarding disease risk.

Methods: A prospective cohort of 120,963 individuals (57% women) from the UK Biobank, who completed ≥ two 24-hour diet recalls were included. The associations of energy intake and macronutrients (carbohydrate (total, sugar and fibre), protein (total) and fat (total, saturated and unsaturated)), as percentages of total energy intake, with death, cardiovascular disease (CVD) and dementia were investigated. Combinations of macronutrients were defined using k-means cluster analysis, and macronutrient combinations explored in association with outcomes. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for death and competing risk analyses, producing sub-distribution HRs (SHRs), were conducted for CVD and dementia. Sex differences were investigated.

Results: There was a higher risk of death with high carbohydrate intake (upper versus lowest third HR 1.12, (95% CI, 1.02, 1.22)), yet a lower risk with higher intakes of protein (upper versus lowest third 0.83, (0.77,0.90)). There was a lower risk of CVD with moderate intakes (middle versus lowest third) of energy and protein (SHR 0.87 (0.78, 0.96) and (0.87 (0.79, 0.96)) respectively). There was a lower risk of dementia with moderate energy intake (SHR 0.70, (0.52, 0.96)). Minimal sex differences were identified. The dietary cluster characterised by low carbohydrate, low fat and high protein was associated with a lower risk of death (HR 0.86, (0.78, 0.95) compared to the reference cluster (characterised by low polyunsaturated fat and low protein intake), and was associated with a lower risk of CVD for men (SHR 0.84 (0.72, 0.98)).

Conclusions: We found some evidence that energy, protein and carbohydrate intake were each associated with risks of death, CVD or dementia. However, combining nutrients may lead to more meaningful epidemiological analyses. We identified one dietary cluster, characterised by low carbohydrate, low fat and high protein intake which reduced the chance of premature death, and CVD for men. This suggests dietary guidelines and interventions could target this grouping to improve health outcomes.

Purpose: This study was conducted to explore the experiences of Chinese immigrant mothers who exclusively breastfed for four to six months in Ireland, and their suggestions on promoting breastfeeding in Ireland. This study was novel in providing solutions to specific barriers to exclusive breastfeeding among the Chinese immigrants.
Methods: Fourteen semi-structured in-depth interviews were conducted with Chinese mothers who were residing in and had breastfed exclusively for four to six months in Ireland. Interviews were recorded and transcribed into Chinese. Thematic content analysis was used to analyze the data.
Results: Two themes were determined for mothers’ successful experiences: 1) favourable factors for exclusive breastfeeding (including strong self-determination, appropriate physical conditions, awareness of the benefits of exclusive breastfeeding, free from time constraints, support from the people around them); 2) difficulties with exclusive breastfeeding (e.g. the difficulty of balancing breastfeeding and employment, language barriers, an inability to consume traditional Chinese postpartum diet and a lack of public breastfeeding facilities) and specific solutions (e.g. seeking family support and pumping breast milk when going outside). In addition, participants’ suggestions on promoting exclusive breastfeeding in Ireland were summarized, including 1) mothers should be strong mentally and getting support from family and friends; 2) employers should create a supportive workplace by setting up private rooms and breastmilk storage facilities; 3) healthcare professionals should advocate breastfeeding in the hospital and addressing cultural differences by recruiting multilingual staff; 4) the Irish government should promote breastfeeding by initiating societal and policy changes.
Conclusions: Our findings may help researchers understand the needs of Chinese immigrants in successful exclusive breastfeeding, and may have implications for interventions and policy changes that promote breastfeeding among immigrants in Ireland and other countries.

PURPOSE: In recent years, fitness armbands and smartwatches, namely wearable activity trackers (ATs), have become increasingly popular. Smartphones with in-built sensors also provide the capacity to monitor physical activity (PA), sedentary behavior (SB), and other health behaviors. There has been rapid growth in the use of wearable or smartphone-based ATs in research and clinical practice to promote PA. However, when designing an intervention based on a smartphone or wearable AT, there is still limited evidence on critical contextual factors contributing to behavior change or health outcomes. This systematic review investigates the effects of intervention using smartphone or wearable AT on PA, SB, or health outcomes in primary and secondary prevention settings. Specifically, we want to evaluate: 1) Are there differences in the effects of these interventions between the general population in primary prevention settings and the clinical patients in secondary prevention settings? 2) Are there differences in these interventions' effects due to the types of device and technology used for tracking? 3) What types of behavior change techniques (BCTs) are the most frequently used in these interventions? 4) Are these interventions more effective if they use BCTs compared to those without BCTs? 

METHODS: Studies will be identified by searching MEDLINE, PsycINFO, CINAHL, Scopus, Sports Medicine & Education Index, Cochrane Library, and scanning reference lists of relevant reviews. We will include published studies of controlled trial that conducts intervention based on smartphones or wearable devices, applying body/movement sensors or geolocation to monitor PA via biomechanical variables, aimed to improve PA, SB, or health outcomes in primary or secondary prevention settings. Where there are sufficient numbers of studies reporting similar outcome measures, we will calculate and report pooled risk ratios or standardized mean differences.

RESULTS: The preliminary search is completed and identified 22,562 records from the electronic databases.

CONCLUSIONS: This study will summarize the evidence-based AT interventions in different contextual settings, explicitly targeted population, device and technology, BCTs, and outcomes. This study will inform users, developers, health professions, and policymakers about the potential of turning this "digital fashion" into digital public health opportunities. (PROSPERO: CRD42020205400)

 

Background: Adequate calcium intake in childhood is essential in optimising peak bone mass. Dairy products are an important source of calcium, however, children’s milk consumption has reduced over the past decade in developed countries. As food preferences developed in early life can persist into adulthood, intervening before school age may be effective in improving milk consumption further into childhood and adolescence. There is a paucity of literature examining the factors determining milk consumption, specifically in preschool-aged children, and a lack of dietary interventions targeting milk consumption alone. 

Aim: To explore the factors influencing milk consumption among preschool-aged children.

Methods: Questionnaires were completed by parents of 2-5 year-old children as part of a pilot intervention aiming to increase milk consumption in 12 preschools. Chi-square and logistic regression were used to examine the association between children’s milk consumption and child and parent-related factors including socio-demographics, milk availability and attitudes.  The factors identified were retrospectively applied to components of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model).

Results: There was an 82% (n=330) response rate and questionnaire responses from 319 parents of 2-5 year-old children (50.5% male, 49.5% female) were analysed. Eighty percent of children and 57% of parents were daily milk consumers. Factors associated with milk consumption were mapped to the following COM-B components: Automatic motivation: Children were more likely to be daily milk consumers if they liked milk (OR=2.86; CI=1.05, 5.10). Social opportunity: Children were more likely to consume milk if their parents also consumed milk daily (OR=5.196; CI=2.33, 11.57). Psychological capability: Children’s milk consumption was negatively associated with parents’ belief that it is difficult to encourage their child to drink milk (OR = 0.245; CI=0.08, 0.68).  Additionally, fruit and vegetable consumption was identified as an associated healthy eating behaviour. Children were more likely to be daily consumers of milk if they were daily consumers of both fruit and vegetables (OR=2.31 CI=1.06, 5.01).

Conclusion: The factors identified are potential targets for future interventions promoting milk consumption among preschool children. Specifically, social opportunity in the form of parents’ influence should be a key consideration when designing preschool nutrition interventions.

Purpose: Over the past year, many Canadian children were unable to participate in recreational sports due to COVID-19 stay-at-home orders. Given the reduced programming to support physical activity (PA), and the increasingly important role of parents for encouraging movement, it is imperative to understand their knowledge of, and support for healthy movement behaviours. The purpose of this study was to investigate parents’ perceptions of their child’s movement behaviours and the resources they accessed to cope during the pandemic.

Methods: Parents (N = 364) from Ontario, Canada completed an online questionnaire detailing the health behaviours of their eldest child, aged 5 to 13, in summer 2020. Descriptive statistics were used to summarize parents’ perceived knowledge of the Canadian 24h Movement Guidelines, children’s activity levels, and resources accessed.

Results: Adequate understanding of the guidelines was reported by 48.1% of parents, with 35.2% reporting no knowledge of the guidelines. Most children met moderate-to-vigorous PA (MVPA) guidelines (86.3% on weekdays; 91.6% on weekends), but only one quarter met sedentary behaviour (SB) recommendations (25.7% on weekdays; 22.4% on weekends). Those with higher perceived knowledge of guidelines reported that their children engaged in more MVPA (rs= .139 - .143, ps < .05), more light PA (rs= .136 - .183, ps <0.05), and less SB (rs= -.110 - (-.163), ps <0.05) on both weekdays and weekends. However, parents reported significant increases in SB compared to pre-pandemic (t(332)= -9.58, p <0.001 on weekdays; t(338)= -12.05, p < .01 on weekends). Many parents (i.e., 72%) sought out one or more resources related to health behaviours. Of the 262 parents that used a resource, 57.6% accessed something PA-related (e.g., FitBit), and 69.1% accessed something leisure-related (e.g., Netflix).

Conclusions: Despite pandemic restrictions, parent reports suggest the majority children met PA recommendations. However, SB exceeded pre-pandemic levels with few children meeting the guidelines. While parents accessed various resources to support positive health behaviours, their reliance on leisure resources could be promoting SB. Since meeting PA guidelines may not protect against high SB, it is important to help parents understand how to limit SB in addition to promoting PA of all intensities.

Physical activity can improve academic performance; however, much less is known about the specific association between sport participation and academic performance and this evidence has not been synthesised. Our aim was to systematically review and combine via meta-analyses evidence of the association between sport participation and academic performance in children and adolescents. We conducted searches of five electronic databases using sport and academic performance related terms. We combined evidence from eligible studies using a structural equation modelling approach to multilevel meta-analysis.  From 115 eligible studies, most of which had a high risk of bias (k=87), we meta-analysed 298 effect sizes. Overall, sport participation had a small positive effect on academic performance (d=0.26, 95% CIs 0.09, 0.42). Moderator analyses indicated that sport participation was most beneficial for academic performance when it was at a moderate dose (i.e., 1–2 hours per week), compared to no sport or a high dose of sport (3+ hours per week). Sport participation during school hours was more beneficial for academic performance compared to sport participation outside of school hours. Based on mostly low-quality studies, we found some evidence that sport could positively impact academic performance in children and adolescents. It appears that sport participation of a moderate dose and at school could be used to promote academic performance. However, if this field were to inform policy, high-quality studies are needed that provide insight into the effect of dose and sport characteristics on academic performance.

Purpose: The COVID-19 pandemic and related restrictions can adversely impact antenatal maternal well-being and health behaviours, including physical activity, diet and sleep. To examine differences in health behaviours, as well antenatal stress and stress-reduction strategies, and social support between women pregnant before and during the pandemic in Ireland.

 

Methods: 210 pregnant women were recruited online and in the antenatal department of a tertiary maternity hospital before the pandemic, and 235 women recruited online during the pandemic in June and July 2020. Only women resident in Ireland were included in this study. Women completed self-report measures of health behaviours including physical activity, diet and sleep. Women also completed self-report measures of stress, and social support. Independent samples t-tests and Chi-squared tests were used to examine differences in outcomes were examined between women pregnant before and during the pandemic, and between Phase 2 and Phase 3 of the Irish Government COVID-19 restrictions. 

 

 Findings: There were no differences for healthy eating (p-.42) or sleep (p=0.17). Women pregnant during the pandemic reported less physical activity (p=0.06) health behaviours but women reported less physical activity during the pandemic. Women reported higher stress and lower social support during the pandemic, but this did not impact on self-reported physical activity. No differences were observed between phases of pandemic related restrictions for any outcome.

 

Conclusions: Our findings highlight negative impacts of the pandemic on physical activity, as well as social support and stress, which can have implications for maternal and child health. Lack of differences between restriction phases suggests on-going negative effects for antenatal well-being and behaviours irrespective of easing of pandemic-related restrictions. Greater attention to the impact of the pandemic of prenatal health behaviours such as physical activity is needed to mitigate adverse impacts for women and infants.

Purpose: This work presents a unique perspective on the concept of role merging within the healthcare setting by exploring the views, opinions and attitudes of dietitians and exercise professionals on an emerging role of the dietitian prescribing exercise advice to older adults, for the prevention and treatment of sarcopenia.

Methods: Following ethical approval, a qualitative methodology was employed to explore the perspectives from two professional groups. The research used in-depth interviews and focus groups using a purposive sample of participants from each profession. Data was analysed inductively using Braun and Clarke’s (2006) thematic analysis. Data was coded using latent and semantic coding, and then grouped into similar themes. Using triangulation, a narrative synthesis was conducted to compare the findings from the two professionals’ perspectives, to inform future practice.

Findings: Four overarching themes emerged: 1) patient related benefits of a two-pronged approach; 2) risk management, competencies and training requirements; 3) levels of exercise intervention; and 4) efficiency and effectiveness. An overall positive response from both professional groups acknowledged the need for a two-pronged approach of nutrition and physical activity interventions for sarcopenia. Therefore health care professionals must work together to achieve improved clinical outcomes and manage increased patient demand. Basic messages around increasing physical activity and reducing sedentary behaviour were deemed a duty of care for all professionals as part of the Making Every Contact Count initiative (HEE, 2020). However, prescribed exercise advice was perceived as higher risk for patients in the frail older adult population, therefore advanced training for dietitians was advised before they consider offering prescriptive advice.

Conclusion: This study suggests role diversification may lead to service efficiency and improved patient care in the management of sarcopenia, however appropriate training and an agreed competency framework is required to ensure safe and effective delivery of exercise advice by dietitians. With an ageing population there is a need to change the way practitioners manage patient care (NHS, 2019), in addition, a call for dietitians to take on leadership roles in relation to the prevention of disease, to enable more holistic patient care (AHPs into Action framework, 2017; Hickson et al, 2017). 

The use of social media has grown rapidly in the last decade, and emerging adults are particularly avid users. Fitness-based content is widely available on social media, especially image-based sites (i.e., TikTok, Instagram), and it may impact physical activity (PA). However, it is likely that this relationship depends on the extent to which an individual is interested in fitness and exercise.

PURPOSE: To examine whether social media use is associated with PA, exercising to lose/maintain weight, and exercising to improve muscle size/tone during emerging adulthood. To determine whether the association is moderated by desire to stay fit and exercise.  

METHODS: Using data from EAT 2010-2018 (Eating and Activity over Time), participants (N=1428, age=22±2 years) were dichotomized as care less (CL) or care very much (CVM) about staying fit and exercising. Stratified linear and logistic regression models were assessed to determine the association between social media use with PA, exercising to lose/maintain weight, and exercising to increase muscle tone/size.

RESULTS: Emerging adults in the CL group (n=1062) and CVM group (n=495) completed 6.6±5.7 and 8.9±6.4 hours/week of PA, respectively (p<.0001). Both CL and CVM groups reported the same amount of social media use (1.9±1.5 hours/day). Participants in the CVM group were more likely to report exercising to lose/maintain weight and to increase muscle size/tone relative to CL participants. No significant associations were reported between social media with PA, exercising to lose/maintain weight, or exercising to increase muscle size/tone among emerging adults in the CL or CVM groups.

CONCLUSIONS: Emerging adults’ social media use does not differ by their level of caring about fitness and exercise. Although evidence of associations between social media use with PA and exercise-related goals was not supported, this relationship must be explored further. Exposure to varying quality of fitness-based social media content with differing characteristics (e.g., body positivity) could influence this association and should be investigated to inform researchers aiming to use social media as an intervention modality. 

Purpose: Understanding the socioeconomic inequalities in physical (in)activity and sedentary behaviours is essential to address the socioeconomic gradient in obesity. The prevalence of obesity in Chile is high and associated with socioeconomic position (SEP). Therefore, we systematically reviewed, for the first time, SEP inequalities in physical activity (PA) and sedentary behaviour (SB) in Chile.

Methods: Peer-reviewed and grey literature were searched until 31st December 2019 in PubMed, Scopus, PsycINFO, Web of Sciences and LILACS. Observational studies included were in English and Spanish, and reported comparisons of physical activity or sedentary behaviour between at least two SEP groups in Chile. Two independent researchers conducted data searches, screening, extraction, and quality assessment using the Newcastle Ottawa Quality Assessment Scale.

Results/findings: Seventeen articles (from 16 separate study samples) met the inclusion criteria (14 cross-sectional; 2 cohort). Across them, quality was considered low, medium and high for 19, 69 and 13% respectively. There was consistent evidence for a lower leisure-time physical activity and sitting time, and higher physical inactivity among adults from the lower SEP groups. Associations between SEP and total PA, moderate-and-vigorous PA, low PA, and transport and work-related PA were inconsistent.

Conclusions: Lower SEP groups in Chile spent less time in leisure-time physical activities and are more likely to be physically inactive when compared to their higher SEP counterparts. These findings are in line with previous US and European studies. Further policies should aim at understanding and tackling the unequal distribution of factors affecting leisure-time PA and physical inactivity in lower SEP groups.

Purpose: Due to the myriad of benefits of children’s outdoor play and time, there is increasing concern over its decline. This systematic review synthesized evidence on the correlates of outdoor play and outdoor time among children aged 3-12 years.

Methods: A total of 12 electronic databases in five different languages (Chinese, English, Korean, Spanish, Portuguese) were searched between October 28, 2019 and July 27, 2020. Covidence software was used during screening and Microsoft Excel with a predesigned coding form was used during data extraction. Evidence was synthesized and correlates were categorized using the socioecological model framework.

Results/findings: Based on 107 studies representing 188,498 participants and 422 childcare centers from 29 countries, 85 studies examined potential correlates of outdoor play while 23 studies examined that of outdoor time (one examined both). The duration of outdoor play and outdoor time ranged between 60-165 min/d and 42-240 min/d, respectively. Out of 287 (outdoor play) and 61 (outdoor time) potential correlates examined, 111 correlates for outdoor play and 34 correlates for outdoor time were identified as significant correlates. Thirty-three variables were identified as key/common correlates of outdoor play/time, including eight correlates at the individual level (e.g., sex/gender, race/ethnicity, physical activity), 10 correlates at the parental level (e.g., parental attitude/support/behavior, parenting practice), nine at the microsystem level (e.g., proximal home/social environment such as residence type, peer influence), three at the macrosystem/community level (e.g., availability of space children can play), and three at the physical ecology/pressure for macrosystem change level (e.g., seasonality, rurality). No key correlates were found at the institutional level.

Conclusions: Individual, parental, and proximal physical (home) and social environments appear to play a role in children’s outdoor play and time. Ecological factors (i.e., season, rural) also appear to be related to outdoor play/time. Standardizing terminology and measures of outdoor play/time is warranted. Future work should investigate the interactions and processes of multiple variables and levels of socioecological modelling to better understand the mechanisms through which outdoor play/time opportunities can be optimized for children.

Purpose: Reducing sedentary behavior in the workplace has become an important public health priority; however, some employers have expressed concerns regarding the potential for reduced productivity if employees are not seated while at work. Therefore, the aim of this study was to determine the relationship between workplace sedentary behavior (sitting time) and work productivity among full-time office-based employees, and further to investigate other potential factors that may be associated with productivity.

Methods: An online 19-item self-report survey was developed using existing validated questionnaires and was completed by 2,068 government employees in Kansas. The survey assessed workplace sedentary behavior as a percentage of time spent sitting during an average workday in the past week, as well as work productivity, job satisfaction, and fatigue over the previous 7 days. A 3-step linear regression analysis (entry method) was used to determine the association between sitting time and productivity with statistical adjustment for potential confounding variables. Changes in R2 were determined at each step. Additional analyses were conducted to determine differences in productivity, job satisfaction and fatigue index by three levels (lowest, middle, and highest) of percentage of time spent sitting during a typical workday.

Results/Findings: Overall, office workers reported high levels of sedentary time (mean > 78%). The primary results indicated that sitting time was not significantly associated with productivity (β = 0.013, p = 0.519), but job satisfaction and fatigue were positively (β = 0.473, p < 0.001) and negatively (β = −0.047, p = 0.023) associated with productivity, respectively. Furthermore, participants with the highest level of sitting time (>91% of the time) reported lower job satisfaction and greater fatigue as compared with the lowest level of sitting time (<75% of the time).

Conclusions: The primary results of the current study indicated that there was not a significant association between workplace sedentary behavior and productivity among this sample of full-time government office workers when using self-report measures. However, taken together, these results offer promising support that less sitting time is associated with positive outcomes that do not seem to come at the expense of productivity.

Purpose: Parents are key players in sculpting the physical activity (PA)and dietary behaviours of their children. Research in western countries has shown thatparents’ knowledge, attitudes and beliefs towards PA and eatingdo influence these behaviours in their children. In Asian countries, research on the role of parents in influencing these behaviours is minimal. This qualitative study is the first to explore parents' perspectives of their children's PA and eating behaviours in Singapore, a multi-racial country in South-East Asia.

Methods: Sixteen semi-structured in-depth interviews were conducted with parents (n=10 female, mean age: 42.4 years)recruited by convenience sampling from two primary schools in Singapore. All sessions were audio-recorded and transcribed verbatim. Data analysis was carried out by one coder, with 10% being cross-coded by a second coder, using inductive thematic analysis. 

Findings: Our findings revealed that parents generally recognised the importance and benefits of PA and healthy eating for children but were unsure of local guidelines for PA and diets for children. Nevertheless, most parents felt that their children were not spending enough time on PA and have diets that are of poor nutritional quality (e.g., lacking in fruits and vegetables). To encourage healthy behaviours among their children, parents reported a variety of practices, such as providing logistical support for PA, being a positive role model, and controlling and monitoring their children’s food intake. Some barriers parents faced include difficulty in persuading their children to heed their advice, physical environment concerns (e.g., hot weather and easy access to fast foods), and parents’ conflicting priorities (e.g.,prioritising children’s academic studies over PA participation and preference for less healthy foods).While most parents perceived themselves to be primarily responsible for their children’s health behaviours, several parents felt that schools should share some responsibilities, particularly for PA. 

Conclusion: Our findings suggest that parents in Singapore are knowledgeable about the benefits of encouraging physical activity and healthy eating (as are parents in western countries) but are challenged by physical environmental influences and their personal priorities and preferences. These findings can help inform the development of future school-based interventions involving parents.

Purpose: The purpose of this qualitative study is to provide an understanding of a self-determination theory (SDT) guided intervention program aimed at increasing physical activity of both children and parents from the perception of facilitators. We examined how SDT-tenets were operationalized within teaching strategies employed, and how basic need satisfaction led to behavioural changes. 

 

Methods: Five semi-structured interviews with six facilitators (three females and three males) were conducted. Interviews were audio-recorded and conducted in Cantonese. Interviews were transcribed verbatim by trained research assistants. Both deductive (themes related to the SDT) and inductive (other aspects of the intervention and participants’ behavioural changes) approaches of thematic analyses were conducted. 

 

Results: Themes identified using deductive approach included (1) need-supportive teaching strategies and(2) participants behavioural changes. Inductive themes identified included (3) feasibility of the intervention and (4) implications and suggestions. Specifically, teaching strategies employed by facilitators provided support for participants’ autonomy (i.e., provide choices of grouping), competence (i.e., let participants choose difficulty levels and compare with themselves) and relatedness (i.e., being more supportive in providing interactions). These resulted in high levels of parent engagement, improved motor skills in children and parent-child-facilitator relationships. Programme design, including theory-driven intervention components, combined mode for parents and children, provision of modified equipment, and strong researcher-facilitator communication were deemed feasible and effective. Facilitators felt the intervention could be further improved by providing standard assessment criteria, having stronger support from schools (e.g., provision of venue), and building trust and support from children and parents.    

 

Conclusions: The findings demonstrated the feasibility and acceptability of implementing a SDT guided family-based physical activity classes from the perspective of facilitators. Further research could usefully explore perceptions from participants and long-term effects which may bring to participants. 

 

Key words: Self-determination theory; family-based; physical activity; facilitators.

Purpose: Young Australian adults’ exhibit poor dietary behaviours. These include increased consumption of Energy Dense, Nutrient Poor (EDNP) foods, sugar sweetened beverages and low consumption of fruits and vegetables. However, little is known about how the COVID-19 pandemic may have further accentuated young Australian adults’ pre-existing adverse dietary behaviours. Therefore, this research aimed to gain an understanding of the impact of the COVID-19 pandemic on food purchasing, planning and consumption behaviours by exploring views and experiences of young adults living in Australia. The innovation of this study resides in the unexpected timing of the pandemic which provided a unique opportunity to study this groups’ food behaviours under unforeseen, changing conditions.

Method: In this phenomenological study, semi-structured interviews were employed to gather data from participants. Three criteria for eligibility were outlined. Young adults needed to be aged between 18-30 years, English speaking and living in Australia. Thirty-eight participants were interviewed via online platforms or over the phone. The interviews were transcribed and analysed thematically. 

Results: Three themes emerged: First, changes in food practices. Second, factors associated with heightened psychological distress and lastly disruption of routine lifestyle and activities. This study identified more negative and few positive changes in food behaviours. The negative changes included an increase in consumption of EDNP foods, decreased purchase and consumption of fresh foods, increased consumption of foods prepared outside of the home, adverse eating patterns and lack of meal planning. Positive changes included decreased consumption of foods prepared outside of the home and smaller more frequent meals. Additionally, an increase in home-cooking and decreased consumption of EDNP foods were reported.

Conclusion: This study identified important changes in food behaviours that may have negatively intensified young Australian adults’ pre-existing poor food behaviours during the COVID-19 pandemic. This research is significant as it is one of the first studies that has qualitatively explored the impact of COVID-19 on food purchasing, planning and consumption behaviours of young Australian adults. Findings may help guide future behaviour change interventions and public health programs aimed at protecting and promoting community health either during this pandemic or the next such episode.

 

Purpose: Unfavorable fast-food and physical activity environments may contribute to Body Mass Index (BMI). However, current evidence on the association between exposure to fast-food outlets and physical activity facilities and BMI is mainly based on cross-sectional data. Furthermore, many studies used self-reported BMI measures instead of objectively measured BMI. We examine associations between residential exposure to fast-food outlets and physical activity facilities and changes in objectively measured BMI, and investigate to what extent these associations are moderated by changes in the exposure to fast-food outlets and physical activity facilities.

Methods: We will use adult (18+) data from two waves (mean (SD) follow-up time 3.9 (1.2) years) of the Lifelines Cohort Study. Participants’ residential addresses are linked to fast-food outlet and physical activity facility locations through geo-coding. Exposure to fast-food outlets and physical activity facilities will be computed in terms of proximity and 1-kilometre (km) density, and categorized into whether exposure increased, decreased, or remained the same. Multilevel linear regression analyses were used, taking the neighbourhood level effects into account. Analyses were adjusted for various individual-level and environmental potential confounders. To examine the impact of whether the exposure increased, decreased, or remained the same, we will test their interaction terms with the exposure of fast-food and physical activity facilities at baseline.

Results: The 106,059 participants had a mean (SD) baseline BMI of 26.0 (4.2). The median (IQR) change in BMI was 0.15 (-0.68 – 1.00). The baseline median (IQR) number of fast-food outlets within 1km was 3 (1 – 7). The baseline median (IQR) number of physical activity facilities within 1km was 1 (0 – 3). Overall, 30.7% of the participants experienced an increase in number of fast-food outlets within 1km. Besides, 22.2% experienced a decrease in number of fast-food outlets within 1km. Regarding the number of physical activity facilities within 1km, the percentage of participants that experienced an increase and a decrease was 23.7% and 18.9%, respectively.

Conclusions: Findings of this study will elucidate the potential influence of fast-food and physical activity environments on BMI. Furthermore, this study may inform policy-makers on how to design healthier environments.

Purpose: Contact centres have been identified as workplaces with high levels of sedentary behaviour and one in four members of staff regularly experience musculoskeletal problems. Stand Up for Health (SUH) is an intervention developed based on the socio-ecological model to target sedentary behaviour in contact centres.
The COVID-19 pandemic has changed the way contact centres work, with employees working from home, and restrictions and hygiene measures in place on site. Contact centres now face different barriers and enablers to reducing sedentary behaviour and increasing physical activity. This study explores these factors with the view of refining the SUH programme theory and adapting the intervention accordingly.
The aim of the study is to identify modifiable factors that would influence physical activity and sedentary behaviour during the COVID-19 pandemic among contact centre employees in the UK.
Methods: 64 interviews were conducted across 4 UK contact centres. An interview topic guide was developed to understand current barriers and enablers to sedentary behaviour and physical activity based on the socioecological model. Deductive coding was carried out using a codebook created by the analysis team, and thematic analysis is being used to identify themes in a sample of 33 transcripts.
Results/findings: Analysis is in progress. Many staff felt they were sitting more, moving less and had poorer mental health since the UK-wide lockdown. Reduced social interaction, lack of motivation, anxieties related to COVID-19 and general lockdown restrictions presented significant barriers to physical activity. Barriers to sedentary behaviour included reductions in incidental movement while working (eg. meetings, chatting to colleagues) as well as a general lack of opportunities and need to leave the desk space (whether in office or at home). Working from home proved beneficial for some, who noted the ability to break up sitting by completing housework on breaks and spending more time with family (including being physically active).
Conclusion: This study will provide learnings on the barriers and enablers to sedentary behaviour and physical activity in this complex work and research environment of contact centres, during a time when working practices are shifting significantly.

Purpose: Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults’ sedentary behavior (SB). However, little is known about self-monitoring interventions aimed at the reduction of older adults’ SB. The aim of this study is to evaluate engagement with, and efficacy of a self-monitoring–based mHealth intervention developed to reduce older adults’ SB.

Methods: A mixed methods study was performed among 28 community-dwelling older adults living in Belgium. The 3-week self-monitoring intervention consisted of general SB information as well as visual and tactile feedback (ie vibrations) on participants’ SB. Semi-structured interviews were conducted, and system usage data were recorded, to explore engagement with the intervention. Accelerometer data from the self-monitoring device and from the Activpal accelerometer were analyzed to assess the interventions’ efficacy. Qualitative data were thematically analyzed and presented using pen profiles; quantitative data were analyzed using descriptive statistics, and generalized estimating equations.

Results/findings: Participants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking, but not their actual behavior. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants. A total of 2601 vibrations were provided to the participants during the intervention period. Fourteen, twenty-one, and twenty-eight percent of the vibrations resulted in a sedentary behavior break respectively within one, three and five minutes. The percentage of sedentary behavior breaks was significantly higher if haptic feedback was provided in the afternoon, compared to the morning. No significant reductions were found in total sitting time after the intervention.

Conclusions: Although the intervention was well perceived by the majority of older adults, the number of SB breaks was limited, and total sitting time did not reduce. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual SB into conscious awareness might not be sufficient to achieve behavior change.

 

Purpose: Understanding the relative importance of determinants of changes in eating behavior throughout pregnancy and postpartum is crucial when developing interventions aiming to improve  eating behavior in this lifechanging phase. We aimed to investigate to what extent determinants of changes in eating behavior affect expecting and first-time parents’ eating behavior, taking sex into account. A second aim was to involve experts in the field of maternal health and/or nutrition/physical activity and/or public health prioritizing the determinants.

Methods: A list of 54 determinants was rated by first-time parents on a scale of 1 (no impact) to 10 (very high impact). Descriptive statistics were used to describe each determinant, independent samples t-tests to examine sex differences. Experts rated the determinants on a level of modifiability, relationship strength and population-level effect, after which a ‘priority for research’-score was generated based on these ratings.

Results: During pregnancy, the top three determinants receiving the highest scores for women were at the individual level, namely ‘health concerns’, ‘physiological changes’  and ‘fatigue’. For men the three most important determinants were at the individual level, namely ‘health concerns’ and ‘health consciousness’, and at the interpersonal level, namely ‘influence of the pregnant partner’. Postpartum, the three highest rated determinants by women were related to the baby (interpersonal), namely ‘adaptation to the rhythm of the baby’, ‘baby becomes priority’ and ‘practical constraints because of the baby’. For men, ‘adaptation to the rhythm of the baby’ (interpersonal) received the highest score, followed by ‘fatigue’ and ‘(lack of) anticipation’ (both at the individual level). According to the experts, the determinants ‘professional support’ (interpersonal), ‘food knowledge’ (individual) and ‘home food availability’ (environmental) were of highest priority for both sexes and during both periods, as these were rated as highly modifiable, strongly related to eating behavior and having a high population-level effect.

Conclusions: During pregnancy and postpartum, research priority should go to interventions supported through health professionals, aimed at both parents, and with a focus on food and health education. Postpartum, an additional focus towards supporting balance between one’s own health and care for the baby is advised.

Bioelectrical Impedance Analysis (BIA) body composition estimates of body composition currently require an overnight fast to minimize factors that influence BIA estimated body composition (e.g., food and liquid intake, timing of day). Requiring measures first thing in the morning limits the use of BIA in studies that employ opportunistic measures of body composition (e.g., at school, at the doctor’s office).

Purpose: This study examined the within- and between-day variability of BIA-estimated body composition in a sample of children (5-12 years old) and adults (25-58 years old).

Methods: Participants (20 children and 13 adults) collected BIA estimated body fat percentage (BF%) via the Tanita DC-430U six times per day (fasted at wake, 9am, 11am, 1pm, 5pm, before bed) for 2 full days. Multi-level mixed regressions (observations nested within days; days nested within participants) estimated within-day (i.e., measures on same day compared to fasted) and between-day (i.e., measures at same time on different days) variations in BIA-estimated BF%.

Results: For children, within-day BIA estimated BF% differed from fasted at 9am (0.59, 95%CI=0.34, 0.84), 11am (0.83, 95%CI=0.58, 1.09), 1pm (1.25, 95%CI=1.00, 1.51), 5pm (1.32, 95%CI=1.08, 1.56), and bedtime (1.13, 95%CI=0.89, 1.38), while between days differed at fasted (0.69, 95%CI=0.30, 1.08), 9am (0.47, 95%CI=0.02, 0.92), 11am (0.83, 95%CI=0.34, 1.32), 1pm (1.43, 95%CI=0.95, 1.92), 5pm (1.15, 95%CI=0.72, 1.59), and bed (1.39, 95%CI=1.03, 1.75). For adults, within-day BIA estimated BF% differed from fasted at 9am (2.02, 95%CI=1.55, 2.49), 11am (2.27, 95%CI=1.80, 2.74), 1pm (2.12, 95%CI 1.63, 2.61), 5pm (2.15, 95%CI 1.68, 2.62), and bed (1.26, 95%CI =0.80, 1.73), while between days differed at fasted (0.83, 95%CI=0.49, 1.17), 9am (1.15, 95%CI=0.71, 1.58), 11am (0.74, 95%CI=0.28, 1.19), 1pm (1.38. 95%CI=0.88, 1.88), 5pm (0.98, 95%CI=0.53, 1.43), and bed (1.15, 95%CI=0.82, 1.48).

Conclusion: Variability within and between days was generally smaller for children than adults and in the morning compared with the afternoon. These findings indicate that opportunistic measures of BIA may be more suited for capture in children and in the morning. Future studies should explore the impact dietary intake may have on BIA-produced body composition estimates, which could explain the increased variability as time from fasted is increased.

 

 

Purpose:  Home visiting programs are federally funded and part of a range of services that can help mitigate the developmental consequences of many risks during early childhood.  One area of support home visitors (HV) provide to families are connections to local food resources.  This paper aims to describe how home visiting programs in Texas adapted to the changing need for nutrition resources among families participating in their programs during the COVID-19 pandemic in Texas.

Methods:  Structured interviews were completed with home visiting programs in Texas in April and May 2020.  All participants were asked questions about how they identify families experiencing food insecurity, what kind of supports and referrals are provided, and how their program shifted because of COVID-19.  All interviews were voice recorded and transcribed.  Content and thematic coding was completed by trained research staff.

Results:  Overall, 18 interviews were completed with at least two individuals of different levels (director, supervisor, home visitor) from 14 of 15 federally funded home visiting programs in Texas.  Support for food access was commonly reported across programs as one of their most effective referrals, most often facilitated by a close, working relationship with their local food bank and/or pantries.  HV suggested that they commonly identify families with food insecurity through informal discussion with the family.  Results suggest the COVID-19 pandemic led to sharp increases in reported food needs by families.  To support families, HV described two primary ways they met the food needs of families during a pandemic: direct grocery gift card distribution to families and direct delivery of emergency food boxes from the local food bank by the HV.

Conclusions:  Access to nutritious food became a heightened concern for many families during COVID-19 pandemic.  To meet the immediate needs of families, home visiting programs stepped up to the challenge with innovative use of resources to meet the needs of families by leveraging funds to provide grocery store gift cards and community resources in the form of emergency food boxes.  Future innovations and program strategies in home visiting should consider providing this flexibility to meet the nutrition needs of families.

Introduction: Social support is an important tool for increased physical activity (PA; Casey et al., 2009). The type of supporter (friend versus family member) may particularly influence the amount of PA depending on socioeconomic status (SES). This study explored the differential impact of family and friend support on PA in female college students from poor, low-income, middle-income, and high-income backgrounds. A positive relationship between family support and PA was predicted, with family support strongly predicting PA for students from lower SES backgrounds. 

Methods: The study sample consisted of 150 female undergraduate students (ages 18-24; 51% identified as White, 11% as Black, 15% as Latino, 14% as Asian, and 9% as Other). Participants completed self-report questionnaires regarding their PA habits, supportive social relationships, and life stress. Social support was measured using The Social Support and Exercise survey. Family’s approximate income level was used to measure SES.

Results: Moderated regression analyses were used to examine the influence of SES on the association between family and friend support and PA. The overall model was significant (R² = .39, F(8, 112) = 8.13, p < .001). SES moderated the impact of both family support (β = -1.4, p < .01) and friend support (β = .84, p < .01) on PA. Correlations between family and friend support and PA were examined separately between each income group to assist the interpretation of interaction terms. In the lowest income group, family support and PA were positively correlated (r(14) = .72, p < .01). In the middle-income group, both family support and friend support were positively correlated p < .05) and (r(80) = .32, p < .01), respectively. In the highest income group, neither family nor friend support was significantly correlated with PA. 

Discussion: Family support is related to PA in lower income, but not high-income groups and that friend support is only related to PA in middle income students. Therefore, the role of family may be especially motivating for PA engagement in individuals with lower SES which has important physical health implications. Additional findings with social-cognitive correlates of family and friend support will be discussed. 

Purpose: The abrupt changes in daily routines due to the public health response to COVID-19 has likely impacted physical activity patterns. The purpose of our study is to describe physical activity and sedentary behaviour patterns in relation to the COVID-19 pandemic among community dwelling adults and children.

Methods: Between April and June 2020, a random sample of 1124 adults (≥18 years) from north central Calgary (Alberta, Canada) completed an online questionnaire. The questionnaire captured data from adults and children (via caregiver proxy) including current walking, moderate (MPA), and vigorous (VPA) and sedentary behaviour, perceived changes in physical activity, sedentary, and social behaviours since the pandemic, anxiety, and sociodemographic characteristics. Data collection coincided with the first three months of the Alberta declared state of public health emergency. Descriptive statistics were estimated to describe current and perceived changes in patterns of physical activity and sedentary behaviour.

Results/findings: Our sample included data for 1047 adults (60.3% women; ≥19.2%) and 345 children (5-17 years; 55% girls). One-third of adults (32.9%) and caregivers (35.7) felt extremely or very anxious about COVID-19. Adults, on average, undertook 221.8±202.5 min/week of walking, 170.9±192.9 min/week of MPA, 173.6±157.6 min/week of VPA, 196±167.8 min/day of screen time, and 329.1±221.3 min/day of sitting. Current total physical activity was higher (p<.05) and sitting time was lower (p<.05) among those who perceived their time outdoors had increased during the pandemic. The largest perceived change in behaviours included social distancing (increased), driving motor vehicles (decreased), use of screen-based devices (increased), watching television (increased), and interactions with neighbours (decreased). Children, on average, achieved ≥60 minutes of MVPA on 3.5±2.4 days/week, spent 4.5±2.7 days/week playing, and visited a park 4.8±6.4 days/month. Most children spent ≥2 hours/day watching television (74.1%), using a computer/gaming (63.7%), and using screen-based devices (60.7%). During the pandemic, over half of all children had increased television watching (58.8%), computing/gaming (56.4%), and using screen-based devices (75.9%) and one-half had decreased playing at the park (52.7%) and public spaces (53.7%).

Conclusion: Encouraging adults and children to be physically active outdoors while maintaining physical distancing could support the accumulation of physical activity during the pandemic.

Purpose:             To date, interventions aimed at promoting active transportation showed limited impact. As a result, there was a recent call to examine theory-based factors associated with this behaviour. Currently, behaviour change theories do not include constructs related to the environment and communication principles such as segmentation are seldom applied to design interventions. The aim of this study was to identify the determinants of cycling to commute to work using a theoretical and communicational perspective.

Methods:             This study is a secondary analysis from a larger experimental study aimed at testing messaging strategies to promote cycling to commute to work. Since no effect of the study conditions was observed on follow-up cycling, data were pooled to predict the behaviour. Cycling for transportation (at least once/week vs none) as well as constructs from the theory of planed behaviour and the norm activation model were assessed by a baseline questionnaire. The follow-up behaviour was assessed three weeks later. To perform the segmentation analysis, stratified analyses were conducted among participants who lived within a distance of 10 km from their workplace (n = 125) and those who lived farther (n = 187). All analyses were controlled for sex, education and annual household income.

Results/findings:   Results from the logistic regression analyses showed that intention (OR=41.4, 95%CI: 6.5-263.9) and awareness of consequences regarding car use and air pollution (OR=5.5, 95%CI: 1.0-29.0) predicted participants’ follow-up behaviour among those who lived within a distance of 10km from their workplace. Among those who lived farther, only perceived behavioural control (OR=33.7, 95%CI: 3.0-374.0) predicted cycling at follow-up.

Conclusions:        The segmentation approach adopted in the present study highlights significant variations in the patterns of behavioural prediction. Hence, public health interventions should focus on different strategies according to the geographical situations of individuals. For example, using a fear-based approach that highlights the negative consequences of using cars on air quality is not likely to prompt this behaviour among individuals who live far from their workplace. Among this specific segment, interventions should rather focus on developing self-efficacy to cope with barriers.

Purpose: Physical activity is beneficial for the physical and mental health of adolescents; however, an insufficient amount of physical activity is related to various diseases. Based on intersectionality approaches, this study examined associations between intersectional correlates and meeting Canadian 24-Hour Movement Guidelines for Children and Youth among Korean adolescents aged between 12 and 17 years.

Methods: Findings were based on 24,619 Korean adolescents (Mage = 14.77) who participated in the Korea Youth Risk Behaviour Survey (KYRBS) 2019 (N = 60,100). Exposures included sex, as the centre of analysis with social class: family economic status; parental education level; and academic performance. An outcome included moderate to vigorous physical activity (MVPA) that were categorized according to Canadian 24-Hour Movement Guidelines for Children and Youth: met or not met the guidelines. Covariates included age and body mass index (BMI) in each analysis model. Multiple logistic regression analyses were conducted.

Results: Overall, compared to female adolescents with low social class, being male with high family economic status (OR: 4.53, 95%CI: 3.90-5.27) and high academic performance (OR: 3.96, 95%CI: 3.55-4.43) was consistently and highly associated with meeting the guideline more than those with low family economic status (OR: 3.45, 95%CI: 2.89-4.11) and low academic performance (OR: 3.58, 95%CI: 3.15-4.05).

Conclusions: The findings support that being male regardless of social class considerably tends to meet the guideline compared to female adolescents with low social class. Intersectionality approach in quantitative research may be a useful framework to promote more inclusive physical activity participation among South Korean adolescents.

Purpose: Physical activity participation is known to vary across individuals with different social position. Intersectionality theory helps us to better understand experiences of multiple interlocking systems of oppression and privilege shaped by intersections of individuals’ social categories. The objectives of this systematic scoping review were (1) to summarize the findings of articles examining physical activity participation claimed operationalization of intersectionality and (2) to identify the scope and gaps pertaining to the operationalization of intersectionality theory in physical activity research.

Methods: A search was conducted in September 2019 in seven electronic databases (e.g., SPORTDiscus, Web of Science) for relevant research articles written in English. Key search terms included intersectionality, physical activity, and sport. Screening, extraction, descriptive, and content analyses, and narrative synthesis were conducted between September 2019 and May 2020.           

Results: Of 16,564 articles identified, 45 articles were included in this review. The majority of included articles used qualitative methods (n = 41), with two quantitative and two mixed-methods articles. The most frequently observed intersectional social position was sex/gender + race/ethnicity (n = 11), followed by sex/gender + race/ethnicity + sexuality (n = 6) and sex/gender + race/ethnicity + religion (n = 6). Most qualitative studies (n = 38) explicitly claimed operationalization of intersectionality as a key theoretical framework, and over half of these studies (n = 27) implicitly used intra-categorical intersectionality. Two quantitative studies examined a number of intersections simultaneously using inter-categorical intersectionality and various statistical techniques including additive, multiplicative, and/or stratified models to investigate intersectionality in physical activity participation.

Conclusions: This review found that complex processes of individual and social-structural level factors that drive inequalities in physical activity participation could be better elucidated using intersectionality theory. Intersectionality theory may serve as a useful framework in both qualitative and quantitative investigations; however, advancement in quantitative intersectionality is critical in order to produce knowledge that could inform more inclusive physical activity promotion efforts.

Purpose. Mobile health interventions offer a promising alternative to in-person weight management interventions, but their potential in children with overweight and obesity (OwOb) remains understudied. The Aim2Be app is a gamified app for children and their parents to adopt healthy lifestyle behaviours. This randomized controlled trial aimed to: 1) evaluate the effectiveness of the Aim2Be app plus a virtual live coach (LC) in changing health behaviours among children with OwOb and their parents; 2) assess whether participants exposed to Aim2Be plus LC experienced greater changes in outcomes compared to participants exposed only to Aim2Be (no LC).

Methods. From 2019 to 2020, participants were randomized into an intervention group (Aim2Be with LC for 6 months) or a waitlist control group (Aim2Be with no LC accessed after 3 months). Children’s assessments at baseline, 3- and 6- months included measured height and weight, 24-hour dietary recalls, and steps/day measured with a Fitbit. Self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of children and parents were collected. Mixed-effect models were used to examine 3-month changes in outcomes between the intervention and control groups.

Findings. A total of 214 parent-child dyads (child age 10-17 years) were randomized to the intervention or a control group. No significant differences were observed between groups for any of the outcomes among children or their parents over 3 months. These effects were unchanged when using multiple imputation to account for missing data. Children randomized to Aim2Be with LC reported more time being active outside of school compared to children who used Aim2Be with no LC over 3 months (P<0.05).

Conclusions. No intervention effects in this clinical sample of children and their parents were observed over a 3-month period. The addition of a LC appears to have supported greater physical activity among children. However, these findings should be interpreted with caution as seasonality could be an important factor in explaining these differences. Future studies should explore the potential mediators and predictors of engagement and retention to shed more light onto the results of this evaluation.

Purpose: Although researchers have investigated relationships among children’s motor skills (MS), perceived competence (PC), physical activity (PA) and health-related fitness (HRF), the bidirectional associations among these variables over time remain unexplored. This study was designed to discern the bidirectional relationships among elementary children’s MS, PC, PA and HRF over the course of one school year.

Methods: A total of 261 second and third grade children (127 boys; Mean_age = 8.27 years) were recruited from two Texas elementary schools. Children’s baseline data were assessed in September/October in 2012 (T1), and they underwent identical assessments in April/May in 2013 (T2). In detail, children’s motor skills were assessed using product-oriented skill tests (e.g., throw, kick, and jump). PC was assessed via the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children. Their daily minutes spent in moderate-to-vigorous PA (MVPA) was assessed using ActiGraph GT3X+ accelerometers for five days (including 3 weekdays and 2 weekends), and HRF was assessed by the PACER test.

Results:: Through a series of cross-lagged modeling tests, we observed that T1 MS significantly predicted T2 MS (β = 0.58; p < 0.01), T2 HRF (β = 0.28; p < 0.01), and T2 MVPA (β = 0.18; p < 0.01), but did not predict PC (β = -0.03). Children’s T1 PC was a positive predictor for T2 MS (β = 0.10; p < 0.01), but not for T2 PC (β = 0.04), T2 HRF (β = 0.04) nor T2 MVPA (β = 0.03). Additionally, T1 MVPA significantly predicted T2 MVPA (β = 0.30; p < 0.01) and T2 PC (β = -0.14; p < 0.01), but not T2 MS (β = 0.05) nor T2 HRF (β = 0.08). Lastly, T1 HRF was a predictor for T2 HRF (β = 0.56; p < 0.01) and T2 MS (β = 0.13; p < 0.01), but not for T2 MVPA (β = 0.03) nor T2 PC (β = -0.07).

Conclusion: Findings suggested a fully bidirectional relationship between elementary children’s MS and HRF. Other bidirectional relationships among the variables were only partially supported. Investigating the mediating role of PC between MVPA and MS/HRF may be further investigated.  

Purpose: At the onset of the COVID-19 pandemic, the Canadian government responded to the economic fallout with income relief to support Canadian families in need. In addition to the financial consequences, the pandemic poses many challenges to overall mental and physical health. Families adapted to accommodate social distancing guidelines by reducing the frequency and size of gatherings resulting in reports of loneliness and emotional isolation. Limited access to recreational facilities and organized sports have also made it difficult for youth to be physically active. The present study assessed Canadian adolescent emotional wellbeing and physical activity during the COVID-19 pandemic. We also investigated whether emotional wellbeing mediated the pathways linking family income and adolescents’ physical activity.

Methods: In May - June 2020, grade 7 British Columbian adolescents (N=265; 54% female; mean age=13 ± 0.1 years) and their mothers (N=259; mean age= 45.5 ± 5 years) completed an online survey assessing annual family income, mother and adolescent emotional wellbeing (i.e., self-esteem, optimism, depression and worry) and adolescents’ physical activity. Mediation analysis conducted using M-plus 7.3 was used to examine the indirect effect of mother and adolescents’ emotional wellbeing on the relationship between income and adolescents’ physical activity.

Results:  On average, adolescents partook in at least 10 minutes of physical activity 4 ± 2.4 days a week. We found a significant total effect of family income on adolescent physical activity (B = 0.21, SE = 0.07, 95% CI = [0.08, 0.34]) during the COVID-19 pandemic. This effect is explained by adolescents’ emotional wellbeing (B = 0.07, SE = 0.03, 95% CI = [0.02,  0.14]) but no such pathway was found via mothers’ emotional wellbeing.

Conclusions: Our study highlighted that family income via emotional wellbeing is associated with adolescents’ physical activity levels. It is believed that the pandemic has widened financial disparities and our results suggest that, among other things, this may influence children’s health behaviours such as engagement in physical activity. As physical activity has numerous health benefits, it is essential to enact policies that aim at reducing financial disparities to improve adolescent emotional wellbeing and engagement in physical activity.

Purpose: Although best practice recommendations exist regarding school-based healthy eating and physical activity policies, practices and programmes, research indicates that implementation is poor. The primary aim of this review was to examine the effectiveness of strategies that aim to improve the implementation of school‐based policies, practices or programmes to address child diet, physical activity, or obesity. The most recent systematic review of strategies to improve implementation of healthy eating and physical activity interventions in schools was published in the Cochrane Library in 2017. As the field of implementation science is rapidly evolving and a number of studies have been since published, an update of the review was required to reflect the current evidence-base.

 

Methods: A search of electronic databases and trial registries was conducted on 10th April 2019. Authors independently screened abstracts for eligibility, extracted trial data and assessed risk of bias. Studies with a parallel control group that compared any strategy to improve the implementation of a healthy eating or physical activity policy, practice or programme by school staff to no intervention, ‘usual’ practice or an alternative strategy were included. Due to substantial heterogeneity between studies, a narrative synthesis of included studies was conducted.

 

Results: In addition to the 22 studies included in the original Cochrane review, a further eight studies were identified as eligible. Collectively, the 30 studies sought to improve the implementation of healthy eating (16 studies), physical activity (11 studies) or both healthy eating and physical activity (three studies). Studies tested a range of implementation strategies, including educational materials and educational meetings. The narrative synthesis indicated that effect sizes of strategies to improve implementation were highly variable across studies. For example, among 10 studies reporting the proportion of schools implementing a targeted policy or practice, the median unadjusted effect size was 16.2%, ranging from –0.2% to 66.6%.

 

Conclusions: Despite considerable heterogeneity in the effects of implementation strategies, the findings provide some evidence to support the effectiveness of strategies in enhancing the nutritional quality of foods served at schools, the implementation of canteen policies and improvements in the time scheduled for physical education.

Purpose: Early childhood education and care services represent an important setting for implementing health-promoting strategies for young children. Despite this, there is no known review evidence available regarding the effectiveness of interventions to improve healthy eating and physical activity for children attending family day care. The aim of this study is to (i) identify and synthesise findings from interventions to improve the dietary intake, physical activity and weight status of children aged 0–6 years attending family day care services; and (ii) assess the impact of interventions on family day care environments, intervention cost and adverse outcomes.

Methods: Medline in Process, PsycINFO, ERIC, Embase, CINAHL, CENTRAL and Scopus databases were searched in March 2019. Studies were included if they i) evaluated an intervention to improve the diet, physical activity and/or weight of children aged 0-6 years; ii) were delivered in family day care services; iii) targeted child diet, physical activity and/or weight and; iv) used a parallel control group design. Two reviewers completed screening, data extraction and risk of bias for each study, with disagreements resolved by a third reviewer. Interventions and outcomes were narratively described.

Results/findings: The search yielded 8,977 title, with 199 full texts screened. Two studies met the inclusion criteria. Both the four year community-wide obesity prevention program, and the 12-month train–the-trainer program, reported statistically significant improvements in the healthy eating and physical activity environments of family day care, compared to cross-sectional state average control groups. Neither study reported on child outcomes, intervention costs or adverse outcomes. Two ongoing studies measuring outcomes at child levels were also identified.

Conclusions: Findings highlight few existing interventions in family day care services. While  results are promising, high-quality controlled trials in this setting are needed to identify the effectiveness of strategies on children’s diet, physical activity and weight. Further, the evaluation of intervention costs and adverse events during interventions is required to provide a more comprehensive understanding of the intervention, particularly for decision-makers.

Purpose: Physical activity (PA) is a complex and multifaceted behavior, which makes assessment of all aspects in one single method complicated. Questionnaires and accelerometers are most commonly used to assess PA in large-scale studies. As the ability to detect changes in PA (i.e. responsiveness) is critical in intervention studies and not yet studied extensively, we aimed to compare outcomes of the Short Questionnaire to Assess Health-enhancing PA (SQUASH) with ActiGraph outcomes in a population of prostate and colorectal cancer patients.

Methods: Prostate and colorectal patients (n=478) wore an ActiGraph GT3X-BT for seven days and completed the SQUASH questionnaire afterwards at two time points (baseline and 6 months). Validity and responsiveness were assessed using Spearman’s rho, intraclass correlation coefficients (ICC) and Bland-Altman plots. In addition, agreement, sensitivity and specificity between both measurement methods were assessed for the classification of participants having increased their PA or not (κ-statistic).

Results: At baseline correlations between both measures for time spent in light PA (LPA), moderate to vigorous PA (MVPA) and the number of days with ≥ 30 min PA were low to moderate (rho=.152, rho=.356 and rho=.387 respectively). Bland-Altman plots showed substantial higher MVPA and lower LPA for the SQUASH compared to the ActiGraph. Correlation and agreement for change in LPA were lacking and low for MVPA, but increased when both methods concerned the exact same measurement week at both time points. Agreement in the classification of individual participants having increased their MVPA was poor (MVPA: κ .13; Days with ≥ 30 min PA: κ .16).

Conclusions: Absolute MVPA from the SQUASH was substantially higher than ActiGraph MVPA, whereas SQUASH LPA was substantially lower than ActiGraph LPA. At the individual level classification of change in MVPA was limited, but at the group level the SQUASH has reasonable validity in assessing change in MVPA. Self-reported PA may be appropriate for ranking individuals or comparing groups, but may not provide accurate absolute values of PA. Absolute ActiGraph PA may be more reliable, yet accelerometers also have limitations with regard to measuring specific movements (e.g. cycling) or distinguishing the domain of PA (e.g. leisure time, occupational, etc). 

 

Purpose: To identify the core implementation components required for postpartum weight management intervention delivery and content. This study aimed to 1) determine the core components in intervention delivery through the TIDieR (Template for Intervention Description and Replication) and PIPE (penetration, implementation, participation, effect) framework analyses and 2) identify core components for intervention content through BCT (Behaviour Change Techniques) analysis.

 

Methods: Systematic review and meta-analysis of randomised controlled trials involving lifestyle modification of diet, exercise or behavioural interventions for postpartum women (within 2 years after birth) using a framework analysis of PIPE, TIDieR and BCTv1. MEDLINE, EMBASE and other databases were searched up to 3rd May 2019. The quality of the studies were appraised using the Cochrane Risk of Bias tool (2.0).

 

Results: Thirty-six trials (49 publications) were included (n=5315 women, age 18-36 years). Only one study provided sufficient information to calculate the population penetration rate (2.5%). Over half had low programme fidelity with no reported intervention manual or structured curriculum, checklist or other measures of quality assurance. Participation rate was available for nine studies (0.94% to 86%). Lifestyle intervention resulted in significant weight loss of (MD, mean difference -2.33 kg, 95% CI, confidence interval -3.10 to -1.56 kg). Health professional‐delivered interventions had significantly greater weight loss than those delivered by non health professionals (−3.22 kg vs −0.99 kg, P = 0.01 for subgroup differences). Diet and physical activity combined had significantly greater weight loss compared with physical activity‐only interventions (−3.15 kg vs −0.78 kg, P = 0.009 for subgroup differences). BCTs on problem-solving, goal setting of outcome, review outcome goal, feedback on behaviour, self-monitoring of behaviour, behavioural substitution and credible source were associated with lower energy intake.

 

Conclusions: The core components for intervention delivery for lifestyle intervention in postpartum women include both diet and physical activity, delivery by health professionals and behaviour change techniques covering self-regulation skills. While insufficient, the limited evidence available suggests low penetration and participation rates further highlighting the inadequacy of conventional RCTs to inform implementable interventions.

 

Purpose: Universities are identified as a key setting for health by the World Health Organisation. The academic achievement and health of university students predict future career success and health outcomes. The presented systematic review aimed to describe associations between health behaviours (dietary intake, physical activity, sedentary behaviour, alcohol intake, sleep, smoking, drug use) and academic performance and mental health outcomes among tertiary education students, using evidence from cohort studies.

Methods: Six electronic databases were searched for cohort studies published up to July 2020 that explored the association between one or more health behaviours with academic performance and/or mental health outcomes among tertiary education students. Data were analysed by vote counting, whereby if 0-33% of studies reported a significant association, it was classified as “no association”; if 34-59% reported a significant association, or if fewer than four studies reported on that outcome, it was classified as “inconsistent” and “uncertain”, respectively; and if 60% or more of studies reported a significant association, it was classified as “positive” or “negative” based on the direction.

Results: The search identified 8,457 articles. From this, 55 studies were included with 34 and 26 studies having academic performance and mental health outcomes respectively, including five studies with both. Eighty-percent of studies (n=44) were published in the last decade, and half were from the USA (n=27, 49%). The most commonly measured health behaviour was sleep (n=18 studies, 53%) for the association with academic performance outcomes. Twelve studies (67%) reported significant associations and the association was graded as “negative”, i.e. poor sleep was consistently associated with poorer academic performance. The most commonly measured health behaviour was alcohol intake (n=12 studies, 46%) for the association with mental health outcomes. Eight studies (67%) reported significant associations and the association was graded as “negative”, i.e. higher or more frequent alcohol intake was consistently associated with poorer mental health.

Conclusions: Knowledge of the associations between health behaviours with academic performance and mental health outcomes among tertiary education students can support advocacy for greater investment in health promotion services for students, and inform the development of targeted services.

Purpose: As a result of the COVID-19 pandemic, university students are facing new and unprecedented challenges which may impact their health and wellbeing. The purpose of this study was to examine the self-reported health, health behaviours (physical activity, screen time), and psychological wellbeing of university students during the early stages of the COVID-19 pandemic in Ontario, Canada. A secondary objective was to examine how gender, age, and education level (i.e., undergraduate vs. graduate) were related to health status, health behaviours, and psychological wellbeing.

Methods: University students were recruited to complete an online survey at the beginning of the COVID-19 pandemic in Ontario (March–April, 2020). Multiple online recruitment strategies (e.g., social media, mass email) were used, and students were eligible to participate if they were enrolled as an undergraduate or graduate student at a university in Ontario, Canada. Self-reported data pertaining to health status, moderate-to-vigorous physical activity (MVPA), screen time, and psychological wellbeing were collected. Descriptive and regression analyses were completed.

Results: Results from 2,008 university students (M_age = 22.4, SD = 4.8, 79.3% female) showed that 69.0% of students reported good or very good health. Only 5.5% of students reported levels of MVPA that met or exceeded Canadian physical activity guidelines, and 51.2% reported 5-8 hours of recreational screen time per day. With regard to psychological wellbeing, 59.8% of university students reported depressive symptoms and 47.2% of students reported anxiety symptoms. Regression analyses revealed that females and younger university students reported significantly higher levels of anxiety and depression than males and older students (p < .05), while males, younger students, and undergraduate students reported significantly better health (p < .05). Screen time was significantly higher among males and younger university students than for females and older students (p < .05).

Conclusions: These results suggest that the health behaviours and psychological wellbeing of some university students might have been negatively impacted at the start of the pandemic. This study provides important information for understanding the potential impact of COVID-19 on university students. Future research directions and implications for young people will be discussed.

 

Purpose: Regular physical activity has been recognized as an essential part of a healthy lifestyle. Using algorithms, current thigh-worn activity monitors are able to distinguish sitting, standing and stepping activities. Identification of cycling is an important next step, as it is part of both leisure-time physical activity and active travel. A newly developed algorithm for activPAL enables identification of cycling as a separate activity category. The validity and relevance of this algorithm was studied.

Methods: 10 adults wore the ActivPAL3 on their thigh for seven days continuously and registered cycling activities in a diary during the same seven days. We compared the number and duration of cycling events distinguished by the activPAL algorithm with the cycling events reported in the diaries. The relevance of using the algorithm was verified by calculating the time spent cycling as a ratio of the total active time. The estimated energy used for cycling was compared with the total estimated energy expenditure.

Results: The participants reported a total of 158 cycling events, with a median total duration per participant of 192.5 minutes/week (IQR: 73.8-263.8). The duration of reported cycling events ranged between 1 and 94 minutes; per participant the number of cycling events varied between 1 and 32 times. ActivPal was able to recognize 98.5% of the reported cycling events. Two of the reported cycling events were not identified by ActivPAL: a recumbent cycling event and a one-minute cycling event. Two active events of ice speed skating and field hockey were falsely classified as cycling. The percentage of energy spent cycling of the total energy expenditure ranged between 8.1 and 61.4% per participant. Estimated energy expenditure was 28% higher if cycling was distinguished from stepping time.

Conclusions: This study showed that the algorithm is sensitive to distinguish cycling from other physical activity events in thigh-worn accelerometry measurements by ActivPAL. In the population studied, cycling made up a significant part of daily activity and distinguishing cycling from general activity classifications significantly affected estimated energy expenditure. Through more specified estimates of physical activity, the utilization of this algorithm can enhance our understanding of physical activity behavior.

Purpose: Public health restrictions related to the COVID-19 pandemic have posed exceptional challenges for maintaining social connections, particularly for young people. The purpose of this study was to examine university students’ social media use (e.g., frequency, reported changes in use) and perceptions of online and in-person connectedness at the beginning of the COVID-19 pandemic in Ontario.

 

Methods: Data from a larger cross-sectional survey-based study (iBelong Phase 1) were used for the purpose of the present study. Participants were eligible for inclusion if they were enrolled as a student at any university in Ontario during the time of data collection (March/April, 2020). Only those who completed survey questions pertaining to social media use, online connectedness, and in-person connectedness were included in the present study.

 

Results: A large sample of university students (n = 1635; M_age = 22.38, SD = ±5.08) provided data for the present study. Analyses revealed that 97.9% of participants reported using social media; of these, 69.7% reported 3+ hours of social media use per day, and 85.4% reported that their use had increased “somewhat” or “greatly” during the pandemic. With regard to social connectedness, students reported feeling socially connected online (M_item = 3.80, SD = 0.67) as well as in-person (M_item= 4.39, SD = 0.81), as evidenced by mean item scores ≥3.5.

 

Conclusions: Generally speaking, university students reported relatively high levels of social media use and social connectedness—both online and in-person—at the beginning of the pandemic. These results, in conjunction with those stemming from our current and ongoing work in this area, will be discussed and explored further within the context of the pandemic and current literature.

Purpose: The use of inappropriate feeding practices is a significant problem in early care settings and contributes to negative effects on children’s eating behaviors and dietary intake. Through a stakeholder-engaged process, the study team developed a de-implementation strategy targeted at inappropriate feeding practices to augment an existing multi-faceted implementation strategy directed at uptake of evidence-based nutrition practices. The de-implementation strategy leveraged a peer learning collaborative and improvisation-based training. We hypothesized that the adoption of evidence-based practices would improve when combined with strategies that actively remove inappropriate feeding practices. We also examined 3 potential mechanisms of de-implementation suggested by i-PARIHS.

Methods: A pre-post design in 25 classrooms examined changes in feeding practices at meals and lessons. We also examined changes in targeted mechanisms of relationship quality in the classroom (e.g., trust), relationship quality with facilitators, and perceived barriers. Baseline data for feeding practices at both lessons and meals were taken by averaging across three time points from the prior school year. Teachers provided baseline data on proposed mechanisms at the training in August 2019. The research team collected all post-intervention data in January or February of 2020. Analyses used t-test comparisons to examine differences in outcomes and mechanisms between baseline and post-intervention data collection.

Results:  At nutrition lessons, educators decreased inappropriate feeding practices by an average of 3 per lesson overall (significant reductions for 5 inappropriate feeding practices, e.g., pressure to eat) and increased evidence-based practices by an average of 5 overall (significant improvements for 8 practices, e.g., hands-on exposures). At meals, overall classroom use of inappropriate feeding practices was significantly reduced by an average of 5 practices (t₂₄ = 2.0, p = .05). We observed 2 significant changes in the proposed mechanisms; co-teacher relationship quality improved significantly (t₄₄ = 2.7, p = .01), and perceived barriers to implementation reduced significantly (t₄₅ = 3.3, p = .002).

Conclusions: Findings from this study support the hypothesis that de-implementation of inappropriate practices can create space to improve adoption of evidence-based practices. Improvement in targeted mechanisms suggests strategies improved internal relationships and reduced perceived barriers toward the goal of de-implementation.

 

Purpose: Emerging research has shown an increase in internet use among young adults during the COVID-19 pandemic, raising concerns about the potential for increased internet-related adversities and risks. The purpose of this study was to examine: (1) the self-reported internet use and risks among university students both prior to and during the early stages of the COVID-19 pandemic; and (2) the adverse effects associated with social media use reported by students at the beginning of the pandemic.

Methods: University students (n = 1,635; Mage = 22.4, SD = 5.2; 79.4% female) completed relevant sections of an online survey during the early onset of the COVID-19 pandemic in Ontario, Canada (March-April 2020) as part of the larger “iBelong” project. Items used for the purpose of the present study were adapted from the Canadian Internet Use Survey (Statistics Canada, 2018) and included: (1) self-reported internet use and internet-related risks (e.g., bullying, harassment, discrimination) both prior to and during the pandemic; and (2) self-reported adverse effects associated with social media use (e.g., spending more time than intended online, feeling anxious, depressed, etc.).

Results: Results showed that 18.2% and 44.5% of students reported spending 40+ hours/week on the internet prior to and during COVID-19, respectively. With regard to online risks, students reported slight increases in bullying (%prior = 4.2; %during = 6.2) and discrimination (%prior = 6.9; %during = 7.6), and decreases in fraudulent identity use (%prior = 2.4; %during = 1.3), stalking (%prior = 4.5; %during = 2.7), and harassment (%prior = 5.8; %during = 5.0). With regard to the adverse effects of social media use, university students reported spending more time online than intended (49.1%), having trouble concentrating on school or work tasks (34.5%), losing sleep (26.2%), feeling envious of the lives of others (33.1%), and sometimes feeling anxious (30.5%) and depressed (23.4%).

Conclusion: Results will be discussed with a focus on implications for young people, as well as next steps for this area of research. The findings from this study provide an important basis from which we can understand the internet-related challenges experienced by university students during the COVID-19 pandemic.

Purpose: Tertiary education setting-based nutrition labelling studies show that point-of-purchase (POP) nutrition labelling interventions are well accepted but not significantly influential on diet choices. Health and nutrition are ranked low as a purchasing factor by university student (18-35 years) consumers in this setting. This presentation aims to show how the addition of nutrition education and positive marketing to POP nutrition labelling interventions can show a greater impact. However, several other purchasing factors need to be addressed to improve the food selection of university students.

 

Methods: Three nutrition labelling intervention studies: (1) kilojoule labelling alone (2) kilojoule labels with marketing ("8700 kJ campaign") and (3) tick symbols ✓ were placed next to the targeted healthier items. Food sales of labelled items were tracked before, during each intervention, and eight weeks after. A sub-sample of university students (n = 872; aged 18-35 years) was surveyed during the interventions to assess, purchasing factors, awareness, influence, sentiment and anticipated future impact of food labelling and positive marketing campaigns.

 

Results: Only 30 % university students were initially aware of the kJ labels on the menu without the marketing campaign. Seventy-five percent of students were accepting of kJ labelling with the marketing campaign. Respondents viewing the marketing campaign and then using kJ values on the menu selected meals with lower mean energy content, constituting a reduction of 978 kJ (p < 0.01). Sixty-eight percent of respondents noticed the tick symbols on targeted healthier items, and of that, 30 % reported being influenced. Taste was the most common purchasing factor, and people were less likely to select taste as a factor if they were influenced by nutrition labelling (P = 0·04).

 

Conclusions: Identifying healthier options with labelling at the POP increased sales over time. Increasing awareness and providing education about energy requirements and healthier options through a marketing campaign resulted in greater attention to, and use of, the labels to purchase lower energy menu choices. However, several purchasing factors (price, taste, and healthy food availability) need to be addressed to improve university students’ food selection.

 

 

Purpose: The World Health Organization launched the Global Action Plan for Physical Activity (GAPPA) in 2018, which set a global target of a 15% reduction in the prevalence of physical inactivity by 2030. This target, however, could be achieved in various ways. The purpose of this study was to examine the health impact of different approaches to meeting the GAPPA Target.

Methods: We use an established multi-state life table model to estimate the health and economic gains that would accrue over the lifetime of the 2011 New Zealand population if the GAPPA target was met under two different approaches: (1) an equal shift approach where physical activity increases by the same absolute amount for everyone; (2) a proportional shift approach where physical activity increases proportionally to current activity levels.

Findings: An equal shift approach to meeting the GAPPA target would result in 197,000 health-adjusted life-years (HALYs) gained (95% uncertainty interval (UI) 152,000 – 246,000) and healthcare system cost savings of US$1.57b (95%UI $1.16b - $2.03b; 0% discount rate). A proportional shift to the GAPPA target would result in 158,000 HALYs (95%UI 127,000 – 194,000) and US$1.29billion (95%UI $0.99b to $1.64b) savings to the healthcare system.

Conclusion: Achieving the GAPPA target would result in large health gains and savings to the healthcare system. However, not all population approaches to increasing physical activity are equal – some population shifts bring greater health benefits. Our results demonstrate the need to consider the entire population physical activity distribution in addition to evaluating progress towards a target.

Purpose: Older adults are the least active population group in the U.S. Low income and diverse communities have fewer physical activity (PA) resources and facilities, contributing to lower PA and health disparities. This study assessed the hypothesis that low income and diverse older adults participating in the multilevel Peer Empowerment Program 4 Physical Activity (PEP4PA) would increase moderate-to-vigorous PA (MVPA) and improve blood pressure (BP), physical function, perceived quality of life (PQoL), and depressive symptoms to a greater extent than those receiving usual senior center programming.

Methods: In a cluster-randomized controlled trial (RCT) in 12 senior centers, 476 older adults (mean age 71.4 years, 60% low income, 38% minority) were assigned to a PA intervention (n=267) or control (n=209) condition. The peer-led intervention included individual self-monitoring and counseling, group walks and social support, and community advocacy to improve walking conditions. Outcomes included daily minutes of MVPA (via accelerometry), systolic and diastolic BP, 6 minute walk test (6 MWT), PQoL (PQoL-20) and depressive symptoms (CES-D-10) at baseline, 6, 12, and 18 months. To account for multiple measurement days and clustering of participants within centers, mixed effects regression models with random effects estimated the intervention effects on all outcomes between groups over time. Models were adjusted for imbalanced baseline covariates. Three-way interactions assessed effect modification by sex and income.

Results: Compared to controls, intervention participants significantly increased MVPA from baseline at 6, 12, and 18 months by 9, 11 and 9 minutes/day, respectively (p<0.01). The intervention group also increased mean PQoL scores compared to controls at 6 and 18 months. No effects were observed for other outcomes. Increases in MVPA in the intervention group was greater among males and those with higher incomes, compared to females and low income participants.

Conclusions: This multilevel RCT achieved sustained increases in MVPA and PQoL in a diverse cohort of older adults. The community-based intervention provides a sustainable model to improve health behaviors in an at-risk and often difficult to reach aging population. Further exploration is needed to understand what components of the intervention may be modified to address the differential effects by sex and income.

Background: Augmented reality mobile game, Pokémon Go, leverages gamification and location tracking technology to encourage players to walk in different places to catch Pokémon characters in real-world settings. The systematic review sought to explore the impact Pokémon Go has on players’ physical activity, psychosocial and cognitive outcomes.

Methods: Six research databases (PubMed, SPORTDiscus, PsycInfo, Web of Science, Science Direct, and Scopus) were used to initially identify 400 articles published between July 2016 and December 2020. Databases were searched with the key terms used in combination: “Pokémon Go” AND “physical activity” OR “psychological” OR “cognitive”. The following inclusion criteria were used for each study: (1) published in English as peer-reviewed empirical research between 2016 and 2020; 2) conducted quantitative research; 3) examined the relationships between or impact of Pokémon Go on any of the following outcomes: physical activity, psychological, and cognitive outcomes; and 4) included participants played or exposed to Pokémon Go. 

Results: Thirty-one studies were included for the final analysis, with a total sample of 36,840 participants. Players had significantly greater physical activity than non-players in terms of daily steps, number of days spent in moderate physical activity and distance walked. Pokémon Go increased physical activity levels among obese and inactive people. Pokémon Go game also improved psychosocial well-being by increasing player's social interactions and improving their affect, anxiety and psychological distress. Selective attention and concentration levels in youth improved after 10 weeks of Pokémon Go intervention.

Conclusion: Findings indicate that Pokémon Go was associated with increased light PA and walking, improved mood and social interaction, and some aspects of cognitive ability including memory, attention and concentration.  However, future studies with rigorous study design, as well as validated and homogeneous outcome measures, are needed to confirm the findings and explore ways to improve the game’s current incapability for players’ long-term engagement and higher intensity PA. 

Background/Purpose: Studies suggest approximately 25% to 30% of college students are overweight or obese. Therefore, implementing innovative and effective PA interventions among this population with the goal of improving their PA and psychosocial outcomes is paramount.  The primary objective of this project was to investigate the efficacy of mobile app-integrated PA intervention on PA, exercise motivation and confidence in sedentary college students.

Method: A total of 13 sedentary college students (Mage = 20.5, SD= ± 1.02; 9 women; 93% white) were recruited via flyers and emails. Participant’s exercise confidence, objectively-measured PA, intrinsic and extrinsic motivation were assessed before and after this 4-week intervention. Participant’s initial and postintervention PA level was determined using Tri-Axis pedometer (OMRON) Model HJ-303. Self-Regulation Questionnaire-Exercise (SRQ-E) and Exercise Confidence Survey were used to assess participants’ intrinsic and extrinsic exercise motivation and exercise confidence, respectively. After the baseline assessment of participants’ exercise motivation and confidence, participants’ baseline 7-day PA were collected via pedometers. During the intervention, participants interacted with other participants in small groups facilitated by a research assistant once a week to discuss PA goals and barriers. Participants were also asked to interact using the mobile apps Samsung Health and Snapchat throughout the intervention. All post-assessment were conducted at the end of the 4th week. 

Analysis/Results: Step counts improved from 5794 steps to 6843 steps. Paired t-test revealed that average step counts (t (1,12) = -3.04, p < 0.05), and exercise confidence (t (1,12) = -3.09, p < 0.01) significantly improved from pretest to post-test. Interestingly, results showed an increase in extrinsic motivation but decrease in intrinsic motivation, which did not reach a significant level.

Conclusions: The findings of this study suggest that use of health and social media apps combined with in-person social interaction is feasible and effective in increasing sedentary college students’ steps count and exercise confidence. Although step counts significantly increased, post-intervention step count was not sufficient to meet the recommended PA guideline. For future studies, larger sample size with longer intervention period is warranted.

Purpose: Excessive sedentary behaviour is associated with a number of adverse health outcomes and increased all-cause mortality. General Practitioners (GPs) are at the coalface of the UK National Health Service (NHS), with unique opportunities for the promotion of healthy lifestyles. GPs who are more physically active are more likely to recommend physical activity to their patients. This study gained quantitative data on levels of sedentary behaviour among General Practitioners working in the UK NHS.

Methods: A multi-item sedentary behaviour questionnaire survey was disseminated to GPs working in the UK NHS in Northern Ireland. Subsequently, a purposive, maximally varied sample of 20 participants were recruited to wear thigh-worn accelerometers and complete a sleep/work log. This allowed comparison of subjective, self-reported data with objective, accelerometer data.

Results: Out of 1999 GPs in Northern Ireland, the questionnaire received 352 valid responses (response rate of 18%). Overall mean workday sedentary time for GPs was 10 hours 20 minutes. Overall mean non-workday sedentary time was 4 hrs 47 minutes. Only 6% of GPs had access to an active workstation, such as a sit-stand desk. 86% of those who didn’t have an active workstation would consider using one. GPs who would not consider using an active workstation were older than those who would consider using one (45 vs 40 years). Those that had access to an active workstation had an overall mean workday sedentary time of 7 hours 53 mins. Those that did not have access to an active workstation had an overall mean workday sedentary time of 10 hours 28 mins. This was a statistically significant difference of 2 hours 35 mins (t = 3.459; p = 0.001). 81% of GPs reported they are spending more time sitting in work now than prior to the COVID-19 pandemic. 87% of GPs would prefer less time sitting in work.

Conclusions: Sedentary behaviour among GPs has increased since the onset of the COVID-19 pandemic, with the vast majority of GPs exceeding the recommended daily levels of sedentary behaviour. Further research is therefore required to identify ways of reducing sedentary behaviour and increase physical activity among GPs.