Abstract

Purpose:

Decreasing sedentary behavior (SB) in the workplace is an important objective of health promotion. In Thailand, SB is a novel issue and lack of studying. This study aimed to explore office workers' knowledge, attitude, barriers, and strategies to develop an intervention to reduce occupational sitting time in university employees.

Methods:

A Mixed-methods approach was used, 48 non-academic office workers were recruited and surveyed. The Past-day Adults Sedentary Time-University (PAST-U) and workplace Sitting Break (SITBRQ) questionnaire were used to measure SB level, sitting bout, frequency, and duration of sitting interrupted in 1 hour and whole working hours SB break. An in-depth interview was used to recognize potential multi-component SB intervention strategies and barriers. Workplace environmental factors was also observed. 

Results:

Participants were females (n=26) and males (n = 13), aged 44 ± 10 years, worked for five days a week. Participants spend the common of their days in SB (66.6%), especially in the workplace, SB accounted for 77.87% of work-hours (8h). Most participants had 2-hour sitting-bout, 2-time breaks from work in 1 hour and 5 mins of light physical activity, 3-5-time breaks from work a day, and had 10-19 mins of physical activity during working hours. The interview indicated that interventions for reducing sitting time in workplace at organization level should include administrators’ policies for supporting and providing facilities, a campaign message to modify organizational culture, behavior, and environment related with SB. At individual level, SB interventions should enhance individual’s knowledge, motivation, tools, and peer support. This workplace lack of physical and material environments supported to reducing SB in the work setting.

Conclusion:

Office workers spent most of their time in SB. An intervention should include policy statements to change culture, behavior, and environment. Office workers should be enhanced knowledge and behavioral change strategies to reducing SB in workplace.

 

Purpose

Childcare workers show a high prevalence of high BMI and low cardiorespiratory fitness, thus facing increased risk of health problems. According to childcare curricula, the preschool teachers should encourage children to be more physically active, given the importance of physical activity for children. Childcare workers should therefore act as role models by actively participating in playful physical activities together with the children. However, no studies have investigated if these activities, primarily aiming at the children, also increase physical activity of childcare workers to an extent that improves their cardiorespiratory fitness (i.e. intensities above 60 % of heart rate reserve (HRR)). Therefore, this study investigates if designed playful physical activities (Goldilocks activities) elicit physical activity of sufficient intensity to increase cardiorespiratory fitness in childcare workers.

 

Method

Goldilocks activities were designed on basis of studies investigating facilitators for physical activity in day care, and pilot trials conducted in Danish kindergartens. These pilot trials revealed several important contextual factors influencing whether the childcare workers’ heart rate did, indeed, rise to more than 60 % HRR during playing activities with the children, as measured by heart rate monitors and accelerometers.  

 

Results

Results from pilot trials indicate that regular pedagogical playing activities performed for 10-15 minutes by children and childcare workers do not lead to significant time (i.e. more than 1 min) at HRR >60 % in the workers. In contrast, the designated Goldilocks activities (i.e. performed for 10-15 minutes) resulted in 3-5 minutes at HRR >60 %. Hence, if childcare workers perform 3-4 Goldilocks activities daily, they could get sufficient time in high intensity physical activity to improve their cardiorespiratory fitness as a natural part of work.  We will verify these pilot results in a proof of concept study among 30 childcare workers, and present results at the conference.

 

Conclusion

If designated Goldilocks activities engaging both children and childcare workers in physical activity induce sufficient time at high intensities to improve the childcare workers’ cardiorespiratory fitness, the concept could have a large potential for increasing health among childcare workers, thus supporting sustainable work in this occupational sector.

 

 

Purposes. It is common in Chinese culture to give body-related comments (BRC) to family and friends as a sign of showing care. The current study explored whether such comments are related to appearance-related motivation to exercise and using unhealthy weight control behaviors among Chinese young women.

Methods. College female students (N=236) at a comprehensive university in Southwest China filled an online survey. The frequency of receiving BRC was measured by three questions: “How often do [family members/romantic others/friends] make comments to you about your body weight and/or body shape?” Appearance-based exercise motivation was measured by asking participants whether they exercised to lose weight/gain weight/lose fat/gain muscle. Unhealthy weight control behaviors were measured by identifying whether they used ten unhealthy methods to lose/control weight in the past month. Regression analyses and t-test were used for data analyses.

Results. Approximately one-third of participants reported receiving BRC a few times a month and 16.3% a few times a week from friends. A quarter of participants receiving comments from parents a few times a month and 10.7% receiving a few times a week. Regression analyses showed that, controlling for BMI (M=19.8, SD=2.45), receiving BRC from romantic others and friends predicted exercise motivation to lose weight, b=.23, p<.05, b=.27, p<.01, respectively; Receiving BRC from romantic others and friends predicted exercise motivation to lose fat,b=.19, b =.20, both Ps<.05. Compared to those without unhealthy weight control behaviors, those "ate very little" received more BRC from romantic others (p<.05). Those used “dieting” received more BRC from parents and romantic others (Ps<.05).

Conclusions. Although Chinese college women are generally slim, they received frequent BRC from their social context. Receiving BRC is related to exercise motivations to lose weight and fat and more unhealthy weight control behaviors. Colleges and universities should implement comprehensive education programs to help Chinese college women and their parents, romantic others, and peers to recognize the impact of BRC.

Purpose: Physical inactivity and increased sedentary time in children are often linked to health risks like overweight and obesity. Limited information is available regarding this health risk behaviour and body composition of South African children during later childhood. Therefore, the purpose is to assess the relationship between body composition and low physical activity levels and also between body composition and sedentary behaviour in Grade 7 learners living in the Northwest Province of South Africa.

Methods: This study formed part of the NW-CHILD longitudinal study. Grade 7 learners (N=587, mean age 12.92±0.42, boys=302, girls=282, white=151, black=433, children from low (N=346) and high socio-economic schools (N=238) that were part of the 2016 measurements participated in the study. Fat percentage and BMI was used as body composition characteristics. PA levels were assessed with the PA Questionnaire for Children (PAQ-C) and sedentary behaviour by means of the Sedentary Behaviour Questionnaire. Descriptive and a non-parametric Spearman Rank Order Correlations we used (Statistica for Windows). Relationships were considered practically significant by applying the following cut-off values: 0.1 (small), 0.3 (medium) and 0.5 (large) were received.

Results/Findings: A percentage of 18.01% overweight and obesity were found in the group. A small percentage (10.79%) of the group was low active, while 58.56% were moderately active. Small relationships were established between BMI and fat percentage and physical activity which were influenced by race, gender and socio-economic status. Total sedentary time also showed small, although higher correlations with fat percentage compared to with BMI, which was influenced by television viewing hours, travelling time and by other sedentary technologies. High socio-economic status (SES) and girls showed the highest negative influence on the relationship between sedentary behaviour during the week and weekend.

Conclusion: South Africa is not excluded from the risks of increased sedentary behaviour and decreased physical activity and the relationship of these behaviours with increasing obesity. Health practitioners such as Kinderkineticists are therefore important to assist children to receive adequate opportunities to be physically active.

 

Objective: Office workers spend most of their workday being sedentary and this increases the risk of cardiometabolic diseases. Sedentary behaviour can be accumulated during and outside of occupation-related domains. The aim of this study is to determine the effectiveness of sit-stand desks and healthy messages on interrupting sitting time whilst at work in order to improve the cardiometabolic health profiles of office-bound workers.

 

Methods: We will conduct a randomised controlled trial with post-intervention focus groups. Participants will be recruited at an information management company in Johannesburg, South Africa and randomly assigned to one of two groups, a sit-stand group (n≥30) or a control group (n=30) for comparison. Both groups will be followed for 12 months in total. The intervention for the sit-stand group will include the introduction of a collapsible wooden desk stand placed on top of the participants’ existing workstation, with healthy messages sent weekly  to the participants to motivate a change in sedentary behaviour.

 

Results/findings: All participants will be screened and assessed at baseline, 3-, 6- and 12-months for behavioural (diet, physical activity, smoking/vaping, alcohol consumption), anthropometric (waist and body mass index), cardiometabolic disease risk and sleep parameters. Focus groups will take place post-intervention to determine the perceptions of participants towards using interventions to reduce sitting time during work hours.

 

Conclusion: There is an urgent need to address sedentary behaviour in the workplace. The findings from this study have the potential to inform future work-based interventions in office bound workers, and is particularly important in sub-Saharan African and other low- and middle-income regions where evidence is extremely limited.

 

Purpose: The transition from primary to secondary school is a critical period in children’s development due to its potential influence on health behaviours and wellbeing. Previous research has documented an increase in sedentary behaviour (SB) over the school transition; however, little is known about the accompanying changes in physical activity (PA) and sleep, which when combined are the behaviours that make up 24-hour movement patterns. This study aimed to systematically review and summarise evidence on individual and collective changes in PA, SB and sleep across the school transition. 

Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (CRD42018095573). Six electronic databases were searched from January 1990-May 2019. Eligible criteria included longitudinal studies reporting time spent in PA, SB and/or sleep, with baseline assessments conducted during the last two years of primary school and at least one follow-up during the first two years of secondary school. For studies reporting only SB outcomes, this review considered those published from November 2015 onwards to update a previous systematic review. A narrative synthesis was performed with a focus on the significance and direction of change to evaluate evidence on behavioural changes.

Results: Six articles reporting changes in PA (n=5) or PA and SB concurrently (n=1) were included in the review. Most articles (n=4/6) had a high risk of bias. There was evidence of a decrease in daily PA and for specific time periods (i.e., in-school, after-school and leisure time) over the school transition. A concurrent increase was observed in SB. No studies were identified that assessed changes in sleep, or all three movement behaviours concurrently.

Conclusions: Current evidence suggests the need for targeted period-specific intervention strategies to prevent a decrease in PA over the school transition. Further research is warranted to explore the changes in the 24-hour composition of all three movement behaviours and associated factors to inform future behavioural interventions during this critical developmental period. 

Purpose: Leisure-time and transport activity domains are studied most often because they are considered more amenable to intervention, but to date evidence on these domains is limited. The aim of the present study was to examine patterns of socio-demographic correlates of adults’ leisure-time and transport physical activity and how these associations varied across 17 cities in 12 countries.

Methods: Participants (N=13,745) aged 18-66 years in the IPEN Adult study and with complete data on socio-demographic and self-reported physical activity characteristics were included. Participants reported frequency and duration of leisure-time and transport activities in the last 7 days using the self-administered International Physical Activity Questionnaire-Long Form. Six physical activity outcomes were examined in relation with age, education, and sex, and analyses explored variations by city and curvilinear associations.

Results: Sex had the most consistent results, with five of six physical activity outcomes showing females were less active than males. Age had the most complex associations with self-report transport and leisure-time physical activity. Compared to older people, younger adults were less likely to engage in transport physical activity, but among those who did, younger people were likely to engage in more active minutes. Curvilinear associations were found between age and all three leisure-time physical activity outcomes, with the youngest and the oldest being more active. Positive associations with education were found for leisure-time physical activity only. There were significant interactions of city with sex and education for multiple physical activity outcomes.

Conclusions: Although socio-demographic correlates of physical activity are widely studied, the present results provide new information. City-specific findings suggest there will be value in conducting more detailed case studies. The curvilinear associations of age with leisure-time physical activity as well assignificant interactions of leisure-time activity with sex and education should be further investigated. The findings of lower leisure-time physical activity among females as well as people with low education suggest that greater and continued efforts in physical activity policies and programs tailored to these high-risk groups are needed internationally.

Purpose: The adolescent period offers a key opportunity to instil long term healthy eating and physical activity habits to prevent overweight and obesity and offset related co-morbidities such as heart diseases, diabetes and depression in adulthood. Interventions to facilitate these behaviors are important, especially for adolescents from ethnic and racial minorities who observe higher risks of overweight and obesity and are more likely to present with obesogenic lifestyles than their white counterparts. This systematic review is the first to summarise key findings on the effectiveness of interventions for adolescents from ethnic minority backgrounds to inform policy and practice on how to address overweight and obesity in this at-risk population.

Methods: Seven databases including Medline, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), ERIC and PsycINFO were searched from 2005 to March 2019 to identify relevant studies. Randomised controlled trials of lifestyle programs that included interventions focused on nutrition, and/or physical activity for prevention of overweight and obesity in adolescents aged 13-18 were selected. Interventions that targeted participants with chronic disease or obesity were excluded. Pharmacological and surgical interventions were also excluded. The main outcome measure was change in BMI or BMI z-score and secondary outcomes were changes in nutrition and/or physical activity levels. Intervention components for the included studies were coded according to the Behavior Change Taxonomy. Risk of bias for each study was established using the Cochrane assessment tool and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the body of evidence.

Results: From the 11365 articles initially retrieved, 30 met the inclusion criteria. Of the thirty, only six recruited and reported on effectiveness in ethnic and racial minority populations. None were effective in preventing harmful weight gain whereas 5 of 6 were successful in demonstrating changes in sugar sweetened beverages, physical activity and fruit and vegetable intake.

 Conclusions: The low quality and small body of evidence limits any conclusions drawn on behaviour change techniques, intervention components and duration effective for prevention of overweight and obesity in adolescents from ethnic minority populations.

Purpose:  The prevalence of physical inactivity remains high worldwide. Lack of motivation has been examined as one of the most cited reasons for not exercising.To better develop effective physical activity (PA) programs among young adults, the present study examined the effects of dance-based active video games (AVG) on Chinese college students’ PA and situational motivation as the comparison with traditional aerobic exercise.

Method: Forty participants (33 female, Mean_age = 21.6 years old, Standard Deviation = 2.1) completed two separate 20-minute exercise sessions with a 10-minute interval on the same day: (1) Xbox 360 Kinect Just Dance AVG session; and (2) traditional instructor-led aerobic dance. Participants’ PA (sedentary, light PA [LPA] and moderate-to-vigorous PA[MVPA]) were measured by the ActiGraph GT9X Link accelerometers, and their situational motivation (SM) was assessed via the established Situational Motivation Scale following each session. This 16-item survey included four constructs: intrinsic motivation, identified motivation, external regulation, and amotivation. The dependent t-test was used to detect mean differences for all outcomes between the two sessions, with the significance level being set at p < 0.05.

Results: Dependent t-test indicated significant differences on participants’ percent of time in LPA (t = -2.27, p = 0.03, Cohen’s d = 0.31) and intrinsic motivation (t = -2.90, p = 0.01, Cohen’s d = 0.44). Specifically, participants spent more time in LPA (M = 0.34, SD = 0.13) and had higher levels of intrinsic motivation (M = 5.69, SD = 0.99) in AVG session compared to aerobic dance session(M = 0.38, SD = 0.13; M = 6.08, SD = 0.75). There were no significant differences on other outcomes.

Conclusion: Although findings indicated participants in dance-based AVG had similar MVPA compared with aerobic dance, higher percentage of time spending in LPA and greater intrinsic motivation were observed during the AVG session. This suggests that AVG can be a motivational tool for promoting light intensity of PA and may facilitate the adherence to PA among Chinese college students.    

Purpose: Understanding behavioral health differences informs policy makers’ resource allocation. Therefore, we assessed German university students' demographic differences in physical activity (PA), sedentary behavior (SB) and performance indicators.

Methods: Summer academy participants (n=77; 37.7% female; age=21.0, SD=1.6 years; study areas: medicine=28.6%, natural sciences=27.3%, technical studies=14.3%; location: southern Germany [Bavaria/Baden-Württemberg]=46.8, northern Germany [all others]=44.2%; ≤4 semesters in university=58.4%) completed questionnaires and motoric tests about their PA, SB, strength, balance, flexibility and biometric indicators.

Results: Descriptives were: Moderate to vigorous PA=49.5, SD=43.1min/day. SB: sitting=7.9, SD=1.9hours/day; leisure screen time=3.0180.4, SD=2.3hours/day. Strength: standing long jump=184.1, SD=36.1cm; hand strength 37.1, SD=9.4kg. Balance: single leg stand 24.6, SD=21.1sec. Flexibility: stand and reach=-4.7, SD=14.1cm. Biometrics: BMI=21.5, SD=2.1kg/m². ANOVAs revealed 7/40 significant group comparisons (p<.05), however multiple comparison Bonferroni correction revealed only 2/40 significant comparisons (males outperformed females on standing long jump and hand strength; p<.001).

Conclusions: In large part, there were no demographic differences on PA, SB and performance indicators (except strength differences between males and females) in our sample. The participants were homogeneous in that they were all scholars of an academic foundation. However, they did represent a broad range of content areas allowing some confidence in the results’ generalizability.

This sample does engage in substantial SB (sitting and leisure screen time). We recommend interventions to decrease SBs and to maintain PA and motoric performance to prevent future onset of chronic diseases in this population. Future studies using a more representative sample are likely to be informative on University students PA, SB and performance indicators.

Ftan 2019 AG 8 (alphabetical): Lea Ade, Michael Blank, Alexandra Denk, Lina Fischer, Elisabeth Geller, Anna Gimpel Timo Hagenreiner, Vivian Lucas Keune, Luca Keunecke, Annika Liebich, Katharina Liebig, Daniel Schraffl, Sören Tumeltshammer, Paul Wagner.

Funding: Studienstiftung des Deutschen Volkes & Max Weber Program.

Purpose: Research suggests that overall sedentary behaviour (SB) and higher self-comparative levels of SB are negatively associated with subjective well-being (SWB) and mental health (i.e., depression and anxiety). However, the context/domain, of SB may influence these relationships. Hence, the purpose of this study was to determine the strength and direction of the relationship(s) between outcomes of SWB and mental health, and overall, domain-specific, and self-comparative levels of SB.

Methods: University students (M age=20.58, SD=2.92, n=821 females, n=160 males) from across Canada completed an online questionnaire. SWB (Warwick-Edinburgh Mental Well-Being Scale), depression (Center for Epidemiologic Studies Depression Scale), anxiety (State-Trait Anxiety Inventory Form-Y), overall weekly SB (International Physical Activity Questionnaire), and weekly self-comparative and domain-specific SB (Modified SIT-Q 7d) were assessed. Significant bivariate relations (p<0.05) were entered into standard multiple regression models to determine their unique predictive capability of SWB/mental health outcomes.

Results: Model 1: SWB overall model fit was R²=0.054 with WY breakfast (β=0.096, p=0.007), WY computer (β=-0.093, p=0.018), WD social (β=0.096, p=0.010), and WD music listening (β=-0.086, p=0.020) being significant predictors. Model 2: Depression overall model fit was R²=0.102 with self-perceived weekly SB (β =0.120, p=0.001), comparative break duration (β =-0.059, p=0.099), WY sleep (β =-0.085, p=0.007), WY napping (β=0.080, p=0.040), WD computer (β=0.087, p=0.014), and WD childcare (β=0.068, p=0.097) being significant predictors. Model 3: Anxiety overall model fit was R²=0.058 with self-comparative weekly SB (β =0.111, p=0.001) and WY breakfast (β =-0.099, p=0.002) being significant predictors.

Conclusions: Domain/context of SB appear to uniquely influence outcomes of SWB and mental health. Interventions modifying SB to improve these outcomes may be more effective if relevant domains are targeted.

Purpose: While practicing relaxation activities may be positively related to better diet quality, its association with eating behaviours is unclear. This study aims to explore whether eating behaviour traits and self-determined regulation of eating behaviours mediate the association between the practice of relaxation activities and diet quality, in a sample of French-speaking adults (Québec, Canada).

Methods: A total of 418 women and 482 men, aged between 18 and 65 years and recruited as part of the PREDISE study, were considered in the analyses. Participants had to report whether they practice one or more relaxation activities (e.g., yoga or meditation). Healthy Eating Index (HEI) was calculated from three web-based 24h dietary recalls. Intuitive Eating Scale, where Body-Food Choice Congruence subscale (BFCC) refers to the tendency to choose nutritious foods while respecting well-being and preferences, and Regulation of Eating Behaviour Scale, where the Self-Determination Index (SDI) indicates a more autonomous eating behaviour regulation style as opposed to controlled, were completed through online questionnaires. T-tests were conducted to compare individuals who currently engage in relaxation activities (practitioners) to those who do not (non-practitioners). Multiple regression analyses were performed to test the mediational model (PROCESS macro version 3.3). Analyses are adjusted for sociodemographic covariables.

Results: Overall, 88 women and 43 men were practitioners, and they had a higher HEI score than non-practitioners (62.9±13.0 vs. 55.6±14.3; p=0.0002). Parallel mediation models showed significant indirect effects of practitioner status on HEI score through BFCC (β = 1.51, SE = 0.40, 95% CI: 2.35, 0.81) and SDI (β = 1.55, SE = .38, 95% CI: 2.35, 0.86). The direct effect was not significant (β = 1.0, SE = 1.28, p = 0.4372, 95% CI: 3.52, -1.52).

Conclusions: These findings suggest that the current practice of relaxation activities is associated with a better diet quality, which can be explained by practitioners’ higher intuitive eating skills and more self-determined regulation of eating behaviours. Further studies should investigate potential impacts of relaxation activities on the development and maintenance of positive eating habits. (Funded by CIHR)

 

Purpose: The present study aimed to determine the factors related to treatment response and BMI z-score change as a result of a lifestyle modification program for obese children and adolescents.

Methods: A total of 242 subjects participated in the Intervention for Children and Adolescent obesity via Activity and Nutrition (ICAAN) study. Participants were split into three groups according to the degree of BMI z-score change after 6- and 18-months to investigate short- and long-term treatment response. Participants with zBMI increase were defined as non-responders, those with zBMI decrease ≥0 to <0.25 as moderate responders, and participants with zBMI decrease above 0.25 as high responders. One-way ANOVA and chi-square test were performed for continuous and categorical variables, respectively.

Results: According to univariate comparison after 6 months, children (<11 years) were more likely to respond to the intervention than adolescents (≥11 years) (p=.005), and mothers of non-responders had higher levels of depression (p<.001) and psychosocial stress (p=.001) compared with moderate responders. Also, non-responders had a higher level of total calorie (p=.013) and fat intake (p=.003). High responders had higher AST (p=.008), and ALT (p=.004) levels compared with non-responders. Meanwhile, adolescents (p=.035) and participants with Tanner stage ≥2 (p=.003) were more likely to be non-responders after 18 months. Also, moderate responders had higher levels of AST (p=.023), ALT (p=.036), FBS (p=.021) at baseline compared with non-responders. Early BMI z-score changes at 3 (p<.001), 6 (p=.001), and 12 months (p=.001) were related to longer-term treatment response after 18 months.

Conclusion: Participants who are younger and have a lower level of liver functioning may respond better to a short- and long-term lifestyle modification treatment. Also, initial BMI z-score change may be an early indication of treatment response. The results may help identifying patients who are less likely to be successful in lifestyle intervention.

Purpose: Theories and models of behaviour change can provide the theoretical underpinning for effective health interventions. The extent of their application in contemporary dietetic interventions has not been explored. This systematic review aimed to synthesise the evidence on the use of behaviour change theories and techniques in interventions delivered by dietitians in Primary Health Care (PHC) settings.

 

Methods: Medline, Cumulative Index to Nursing and Allied Health, PsycINFO, Embase, and Cochrane databases were searched for English language, randomised controlled trials up to August 2019. The review followed PRISMA guidelines and included studies of adults (≥ 18 years) who received face-to-face nutrition care delivered by a dietitian in PHC settings. The interventions had to be underpinned by recognised behaviour change theories. Comparison groups received usual, minimal or no care. Interventions delivered in hospitals or via telephone only were excluded. Screening was conducted independently in duplicate and data were extracted regarding study population, intervention design, behaviour change technique content, primary outcome measures such as measurable changes in health behaviours or health outcomes, and their key findings. The quality of each study was assessed using the Cochrane Risk of Bias tool.

 

Results: Nineteen studies met the eligibility criteria, representing 5172 adults. Social cognitive theory was the behaviour change theory most commonly applied in interventions (n=15) with 11 of those studies having significant intervention effects. The trans-theoretical model, health belief model, self-determination theory, and ecological model were also identified within the included studies to underpin intervention design. Goal setting, problem-solving, social support, and self-monitoring were the most commonly reported techniques (n=15; n=14; n=11; n=11 respectively). Studies had a high or unclear risk of bias (n=10; n=9 respectively).

 

Conclusions: The extensive range of health conditions seen by dietitians, alongside the complexities of behaviour change, highlight the importance of embedding theory-based interventions in dietetic care. The explicit reporting of theories and techniques in published studies is strongly recommended. Findings from this review should inform future PHC practice and research.

 

Purpose: The purpose of this study was to inform the development of a sleep education campaign to improve sleep duration and quality among high school students.

 

Methods: Twelve focus groups were conducted in a peri-urban high school in central north Georgia with students, parents/primary caregivers, and teachers and counselors to discuss the barriers and facilitators to teenage sleep duration and quality. Students were identified through systematic sampling using the school’s listserv to identify every 4th student for each grade level for a total of 50 students across 8 focus groups. Convenience sampling was used to invite caregivers through email and 17 caregivers participated across 2 focus groups. The high school principal identified school personnel to ensure representation across grade levels for a total of 12 participants across 2 focus groups. Questionnaires were completed by all of the participants prior to beginning the focus group discussion to obtain information about demographics, sleep knowledge and behavior, and typical student sleep patterns. Focus group discussions covered topics related to identifying barriers and facilitators of sleep, including: school activities, interpersonal conflict, homework, technology, work, napping, and stress. 

 

Results/Findings: Demographics of focus groups participants mimicked the distribution of the entire school’s existing demographics. Questionnaire results indicate that approximately half of students are getting ≤6 hours of sleep on a typical school night (50%) and are using some form of technology to fall asleep (54%). Slightly more than 50% of caregivers perceived that their child (student) received ≤6 hours of sleep on a typical school night. Almost 70% of school personnel perceived that students received ≤6 hours of sleep on a typical school night. Thematic analysis of the focus group sessions is currently underway and will be completed in early 2020.

 

Conclusions: Preliminary data indicates that more than half of the students in this school lack sufficient sleep and that technology plays a role in the sleep routine for most students. Further analysis of the qualitative data will provide insights into the school-based strategies most likely to have a positive impact high school students' sleep duration and quality.

Although existing workplace interventions have shown promise in increasing physical activity (PA), they are often prescriptive with varying adherence rates, and may not reflect real-world settings. It is important to examine feasibility of workplace PA programs to ensure health benefits of employees. The aim of this study was to evaluate employee perceptions of a health and wellbeing program at a large insurance company based in Queensland, Australia. 14 employees participated in one-to-one semi-structured in-depth interviews. Interview data were recorded, transcribed verbatim and analysed thematically using Nvivo software (version 11). Data were coded and compared, with themes developed into perceived barriers and motivations to participation in PA. An inductive approach to data analyses determined emergent themes generated from the participants’ responses. The emergent themes with regards to barriers to PA participation were psychosocial (e.g., lack of motivation), and environmental/organisational (e.g., work schedule and operational demands of job roles). Employees also identified numerous motivators including; physical (e.g., improving physical and mental health), psychosocial (e.g., social support, networking, external personal trainers) and organisational (e.g., strong management support, convenience) benefits that encouraged them to engage in the workplace PA opportunities. These findings suggest that future workplace PA programs should aim to reduce psychosocial and environmental/organisational barriers by targeting employees at the preintervention and planning phrase. This approach will facilitate their involvement and increase motivation for participation and enable strategies that are scalable and contextual to organisational needs and also cater to employees’ preferences. This has the potential to improve health outcomes and promote social interactions which improves productivity-related outcomes at the workplace.

 

 

Purpose: Sedentary behaviour has been linked to reduced mental and physical health, as well as lower job satisfaction and productivity. Contact centres have been identified as workplaces with high levels of sedentary behaviour, and it is reported that one in four members of staff regularly experience musculoskeletal problems. Stand Up for Health (SUH) is a workplace intervention developed based on the socio-ecological model to target sedentary behaviour in contact centres. The NIHR funded study has the following aims-

Aim 1: Test the acceptability and feasibility of implementing the Stand Up for Health intervention in contact centres

Aim 2: Assess the feasibility of using a cluster randomised controlled trial study design

Aim 3:  Scope the feasibility of a future health economic evaluation of Stand Up for Health

Method: This feasibility study uses a cluster randomised stepped wedge design to assess data collection methods and procure preliminary estimates of effectiveness for the following:

Primary outcome: Sedentary time in workplace, objectively measured using activPALs.

Secondary outcomes: Total sedentary behaviour, physical activity, mental wellbeing, work engagement and musculoskeletal health.

A process evaluation will be conducted to understand views and experiences of the SUH intervention activities, and implementation processes with a view to refining the theories of change.

Results: 11 contact centres from across the UK have been recruited and randomised. Intervention delivery has commenced in 5 centres consisting of the following elements to target the levels of the socio-ecological model:

(i)             Workshops conducted at each centre to introduce equipment and activities, and also serve as a forum to elicit staff preferences and suggestions to reduce sedentary behaviour.

(ii)            The SUH project team works with each contact centre to develop an action plan and theory of action, to create change at organisational, environmental, group and individual levels.

Conclusion: Contact centres present a complex work and research environment given the lack of autonomy among employees, shift patterns, and environmental and infrastructural constraints. This study will provide learnings on the implementation and acceptability of a novel, non-prescriptive programme to reduce work-place sedentary behaviour, and aid future implementation at a larger scale.

 

 

Physically active lifestyles and healthier dietary patterns could improve metabolic health markers in women

Background: Physical activity (PA) and dietary intake are important lifestyle factors impacting long-term health outcomes. The aim of this study was to investigate relationships between adherence to physical activity guidelines, dietary patterns and body composition and metabolic health markers.

Methods: Participants were 348 healthy women aged 16-45 years from the Women’s EXPLORE study. Sedentary behaviour, physical activity and adherence to the aerobic component of physical activity guidelines (≥150 min/week moderate intensity PA) was assessed via a 7-day hip-worn accelerometry protocol. A Recent Physical Activity Questionnaire was used to determine specific physical activities performed during recreation time. Fat and lean mass (total, regional) were assessed using air displacement plethysmography and dual x-ray absorptiometry. Metabolic biomarkers were assessed from fasting venous blood samples. Dietary patterns were extracted from dietary intake data obtained from a 220-item Food Frequency Questionnaire. All analyses were adjusted for relevant confounders.

Results: PA guidelines (≥150 min/week moderate intensity PA) were achieved by 66% of participants. The guidelines was met predominantly through walking (76.7% participation; 11.5 ± 19.7 min/day). Those participants meeting PA guidelines had significantly lower total and regional fat mass and percentages (p≤0.001), BMI (p<), insulin (p<0.001), total cholesterol (p<0.001) and triglycerides (p<0.005), and significantly higher HDL-c (p<0.001) compared to participants not meeting PA guidelines. Scores for the dietary patterns ‘sweet and savoury snacking’, ‘fruit and vegetable’ and ‘fats and meats’ did not differ between those who did and did not meet PA guidelines, however scores for the ‘refined and processed’ dietary pattern were significantly lower (p<0.001) among participants meeting PA guidelines compared to those not meeting the guidelines. Further analysis will examine interactions between meeting PA guidelines and following specific dietary patterns on metabolic and body composition markers.

Conclusion: Adherence to basic physical activity guidelines has the potential to significantly improve the long-term metabolic health prospects of women. Promotion of physically active lifestyles, combined with healthy eating behaviours should be a priority in public health messaging.

Purpose

A primarily qualitative phenomenological doctoral study was designed to explore the topic of exercise adherence through the lens of the lived experience of a consistent movement practice.  Movement practitioners (yoga n= 40; gym use n=8) self-selected as having a regular practice that they considered to be their primary modality of movement. 

 

Methods

A unique feature of the study is that the research protocol does not specify a yoga or gym ‘intervention’, but instead collates data on participants’ practice tenure, frequency, duration, intensity, and types of yoga practice / gym use (including a home practice), i.e. a lived or ‘real world’ experience of practice.  Self-regulation within the context of health habits is explored via an online survey tool incorporating self-efficacy (with respect to diet and physical activity), overall activity levels (in addition to participants’ primary movement practice) and a measure of interoceptive awareness to compare the internal felt landscape of yoga versus gym practitioners.  The inclusion of heart rate variability (HRV) as a quantitative objective biomarker provides a gauge of allostatic (stress) load and an opportunity to consider how a movement practice may support pro-health habits mediated by HRV.  Interpretative phenomenological analysis will uncover interview themes, to be triangulated against survey responses.

 

Findings

Data analysis is currently underway and due for completion by end April 2020.  The aim is to present preliminary findings at the Conference, which would be the first public presentation.

 

Conclusions

The innovative research design aims to broaden the conversation, particularly within the yoga literature, beyond the traditional interventional approach considering yoga for specific clinical conditions, to an exploration of a yoga practice as experienced by practitioners.  The use of HRV may offer insight regarding parasympathetic dominance and self-regulation (as it relates to health behavior).  The wider lens, of adherence to a movement practice, hopes to uncover the experience of committed practitioners in order to better understand pro-health habits (exercise adherence and healthy lifestyle choices) and concepts that may be applied in behavior change research and public health.

 

Purpose: Changing people’s behaviour by advice-giving and instruction, as typically used in traditional healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training adopts an empowerment approach in order to enhance health professionals’ communication skills for having conversations to engage and motivate people to make behaviour changes. These include eating more healthily and increasing physical activity levels. This study aimed to assess changes in health professionals’ i) competence in using ‘open discovery questions’ (a key HCS communication skill), and ii) barriers and facilitators to having behaviour change conversations, post-HCS training.

 

Methods: HCS training (2 x 4 hour interactive group sessions; 10-18 trainees/session) was conducted in October-November 2019. The training was reviewed for cultural safety and acceptability for Aboriginal staff and people. Pre (T1) and post (T2) training surveys collected data on demographics, and changes in competence and confidence (the latter reported on a 10-point Likert scale, where 10 = highest confidence) in having behaviour change conversations. The Theoretical Domains Framework (TDF) was used to examine changes in barriers and facilitators to having these conversations, specifically the domains: skills, social/professional role/identity, belief about capabilities, belief about consequences, intentions, goals, memory/attention/decision process, and behaviour regulation. Data were summarised using descriptive statistics and tested for equality using two-sided Wilcoxon signed rank tests.

 

Results: 45 participants completed the training (98% women; 18% Aboriginal and Torres Strait Islander Origin), including 33 health professionals employed within the local health district and/or 11 University lecturers/researchers. Competence in using ‘open discovery questions’ increased post-training (T1=41 responses; T2=167 responses, p<0.001), as did participants’ confidence ratings for having behaviour change conversations (T1=6.0 median (4.6-7.7 interquartile range); T2=8.1(7.0-8.9), p<0.001), including with Aboriginal clients (T1=5.0(3.2-6.5); T2=7.6(6.5-8.3), p<0.001). The training improved the TDF domains: skills (T1=4.3(3.3-5.3); T2=6.0(5.7-6.7), p<0.001), belief about capabilities (T1=5.0(4.0-6.0); T2=6.0(5.3-6.0), p<0.001), intentions (T1=5.3(4.1-6.5); T2=6.5(5.8-7.0), p<0.001) and goals (T1=4.3(3.7-5.0); T2=5.3(5.0-5.7), p<0.001).

 

Conclusion: HCS training increased health professionals’ competence in using HCS, and their confidence in having behaviour change conversations. Wider implementation of HCS training may be a capacity-building strategy to support health professionals to use person-centred approaches to behaviour change to improve population health.

Purpose: Neighborhood crime is a potential barrier to increasing physical activity (PA). Few studies designed to increase PA have examined the relationship between participants’ neighborhood crime rates and the success of the intervention.

Methods: Insufficiently-active adults were recruited from Phoenix, Arizona, USA neighborhoods stratified by four types (high vs. low walkability x high vs. low SES). Participants (n=337, 63.2% female, aged 18-60) were then randomized into a 2 (immediate vs. delayed financial reward) x 2 (adaptive vs. static goal setting) factorial design to promote PA over 1 year. Self-reported walking for transportation and leisure in the last week were measured using the International Physical Activity Questionnaire (IPAQ) at baseline, 6, and 12 months. Objective crime incidents (N=139,154) including violent (murder and nonnegligent homicide, rape, robbery, aggravated assault) and property (burglary, vehicle theft, larceny and arson) were measured using police incident report data from the year prior to randomization date. Crimes were geocoded and total crime rates estimated within 1km of participant households using GIS-calculated street network buffers. Crime rates were z-scored for the region.

Negative binomial hurdle models examined the effects of crime and the intervention on self-reported walking after adjusting for baseline activity, SES, and neighborhood walkability. Two submodels were estimated: a logistic regression examining likelihood of reporting any walking (versus none), and a zero-truncated negative binomial regression estimating total number of non-zero minutes walked. Transportation and leisure walking were analyzed separately.

Results/findings: Overall, both leisure and transportation walking increased over the course of the intervention. A significant 3-way interaction was observed across reward type, goal type, and total crime for the leisure walking count model (p=.02), with intervention effects on PA moderated by crime level. There were no significant 2- or 3-way interactions for transportation walking. Block-level SES independently predicted transportation walking minutes in the count model.

Conclusions: Total crime rate moderated the effects of reward and goal type for walking for leisure, but not transportation. The complex interplay between crime and intervention components on leisure walking will be discussed.

Portion sizes, especially in energy-dense foods have been associated with contributing to weight increase.  Energy-dense foods differ in their role in diet and in addition to portion size the frequency of consumption is crucial to the energy consumed. The objective was to study whether individuals differ in their use patterns of sweet and savoury foods (candy and crisps) related to their current weight status (BMI) and weight-related goals.

Survey (n=905; age 18-65 years) was conducted among randomly selected Danish participants.  Weight status as BMI was based on reported weight and height. Weight-related goal was asked with a question on whether respondents tried to lose weight, actively maintain their weight, or did not pay attention to weight. Candy and crisp consumption was measured with a eight-category scale containing pictures of candy/crisps in different amounts for respondents to choose from as normal consumption and the amount they would like to eat. In addition, they reported their use frequency of candy and crisps on a frequency scale that could be transformed into times per week of consumption.

The portion of candy and crisps eaten normally and desired amount to eat did not differ according to weight status (BMI). Those trying to maintain their weight (54% having normal BMI) reported significantly lower portion sizes as what they eat or would like to eat compared to those who do not pay attention to weight and those who try to lose weight.  They also had lower reported weekly consumption of candy, whereas consumption did not differ according to weight status. However, in crisps there were no differences between weight goals in reported normal or desired portion size, use frequency or weekly consumption of crisps.

Weight maintainers are an interesting group of individuals as they vary in their BMI and many have never been overweight. They seem to better adjust their portion size rather than consumption frequency when eating sweets, but they do not differ in the use of crisps. Better understanding of this group and how it restrains its eating provides valuable information to factors that be used to promote weight management.

Purpose: To identify facilitators and barriers to change sodium intake in the diet of a target population in Costa Rica to guide the development of a social marketing plan.

Methodology: The primary audience selected was mothers with one school-age child, in charge of purchasing and/or preparing food at home. The secondary audience was school age children. The behavior selected was the reduction of the use of discretionary salt and commercial condiments when cooking at home and their consumption at the table. The Social Ecological and Transtheoretical Models of Change guided the formative research. Data collection included 8 semi-structured interviews and 4 focus groups aimed at the primary segment in 4 communities in the metropolitan area of Costa Rica. Data were systematized into categories and analyzed to identify the 4P's of social marketing. Ethical approval was received.

Results: Mothers (n=49, mean 36 years, married or live as a couple, with secondary to university level education, SE medium and low, average 2 children school age) consider preparing foods for their family as a way to show love and protection. Homemade food has a high status and is associated with "healthy food". Benefits: healthier family members, lower risk of high blood pressure and looking better physically. Barriers: taste and preference of family members for saltier foods, linked to tradition; decrease in excessive salt use is not well accepted rationally, except when associated with feelings; commercial condiments (with hidden salt) are cheap, easy to use and considered typical. Report eating at restaurants once or twice biweekly, usually fast-food that is seen as an award. When grocery shopping purchases are planned, made quickly, no time to read labels. Participants report greater confidence if the spokesperson is from the health and education field. Behavioral changes are based on external motivators. Promotions are associated with convenience. The channels used and trusted are television, Facebook and WhatsApp.

Conclusion: Mothers play a vital role in the household decision-making around food. Strategies for reducing salt intake are sentimental (love and protection) and from a rational point of view (risk and prevention of diseases)

Background & Purpose: Current levels of meat intake are detrimental to human and planetary health. As such, effective strategies to reduce meat intake in favour of more sustainable protein sources are needed. Social norm-based messages, which detail that most people have reduced their meat intake, may be promising in promoting meat reduction, given the effectiveness of social-norm based messages in promoting healthy dietary changes (Cruwys et al., 2015). To be effective, social-norm based messages need to refer to a desirable and aspirational norm-referent group (e.g. Berger & Rand, 2008). Currently it is unclear how people who have reduced their meat (meat reducers) are perceived. For the first time, this research examined the perceptions of meat reducers compared to vegetarians and habitual meat consumers (pre-registered on OSF).

 

Methods: Two online surveys were used. Survey 1 used a free association task, whereby 366 UK-based participants (M: 42.6 ± 14.5 years; 47% male) listed the thoughts they most associated with meat reducers. Participants also rated the valence (positivity or negativity, 3-point scale) of these associations. Survey 2 used an experimental between-subjects design to assess participants’ [n = 420 (university students n = 206; university staff n = 214), M: 30.8 ± 12.14 years; 26% male] personality trait impressions of a hypothetical person described as either a meat reducer, vegetarian, or habitual meat consumer.

 

Results: Survey 1: The most common and important traits people associated with meat reducers were healthy, eco-friendly, conscious, animal lovers, and thoughtful. Analysis of variance on the valence scores showed that meat reducers were perceived significantly more positively compared to habitual meat consumers (p<.001, ηp² = .153). Survey 2: Meat reducers were rated as significantly more environmentally friendly, animal loving, health conscious, intelligent, and open-minded compared to habitual meat consumers (p<.05). No other trait ratings (e.g. likeability, attractiveness) significantly differed between meat reducers and habitual meat eaters.  

 

Conclusions: Results from these two studies confirm that meat-reducers are perceived positively amongst UK adults. These innovative findings will inform the development of social norm-based interventions to reduce meat intake.

Purpose:

Active Breed was a 12-week gender-tailored weight loss and health promotion program for men delivered through a professional National Rugby League club in South-Western Sydney, Australia.The intervention comprised 12 weekly 90-minute education and physical activity (PA) sessions delivered at the club’s home stadium. Education sessions focused on weight loss, PA, dietary intake, mental health, and domestic violence prevention, and PA sessions included training in the club’s gyms and rugby league-related games. Family members were invited to attend one ‘family night’ session in week 12. This study explored family members’ perceptions of the program and its broader impact on family health, wellbeing and relationships.

Methods:

Upon completion of the 12-week intervention, partners and children of program completers were invited to participate in one-on-one interviews (n=6) or semi-structured focus groups (2 partner-only, 2 child-only). Participants were 17 of the family members (10 female partners, 7 children [71.4% male]) related to 10 men who completed the program. Family members discussed their perceptions of the program, identified changes in their partner/father that they felt were attributable to program participation, and reflected on changes in their own health and lifestyle behaviours. Focus groups and interviews were audio recorded, transcribed verbatim, and analysed using hierarchical content analysis. 

Results:

Family members observed a range of changes in their partners/fathers that they felt were attributable to their participation in Active Breed. These included weight loss, increased health service engagement, and improved mood, confidence, and family relationships. Several family members reported engaging in more family PA, and as men started to make more healthful decisions about dietary intake, this positively influenced their family’s dietary choices. The mental health and domestic violence components resonated deeply with Active Breed participants, which led to ongoing conversations with partners and children about mental health and respectful relationships. Partners discussed the importance of family support for behaviour change and suggested actively engaging family members in future programs.

Conclusions:

The Active Breed program positively impacted men’s health and wellbeing, and had a spillover effect for their families. The impact of the program may be maximised by engaging families more frequently during the intervention.

Purpose: To synthesize and analyze the available evidences in the scientific literature on the effects of the use of Short Message Service (SMS) in self-care promotion in type 2 diabetes mellitus (T2DM). The guiding question of the study is: is there evidence in the literature that sending SMS to T2DM patients improves self-care practices? 



Methods: This is an integrative review that compiled studies published between 2007 and 2017, following 6 main steps: elaboration of the guiding question; carrying out the literature search; categorization of studies; evaluation of studies included in the work; interpretation of results; and synthesis of the review. The terms used in the search were: “diabetes mellitus”, “text messaging”, “mobile application”, “self-care”, and their variations according to the Medical Subject Headings and the Descriptors in Health Science (DeCs). ​In addition, the DeCs terms were also searched in Portuguese and Spanish languages. The search strategy was applied to the following databases: CINAHL, Cochrane Library, Scopus, Web of Science, Nursing database, Virtual Campus of Public Health, Collection of Information Sources of the Brazilian Unified Health System, Regional Health Coordination South, IBECS, LILACS and PubMed. The results obtained were independently reviewed by two authors.

Results: 739 articles were identified, of which 23 were classified as eligible. The main themes included in the content of the messages were: medications (n=15); self-monitoring of glucose levels (n=9); motivation (n=9); education (n=7); diet (n=7); physical exercise (n=6); and foot care (n=3). Positive results were reported from the studies as improvement in glycosylated hemoglobin levels, greater compliance with medications, improved self-care practices, increased knowledge about diabetes, and better foot care. It was observed in the review that in order to achieve statistical relevant results, the ideal duration of interventions with SMS is from 8 to 12 months.

Purpose: Research shows that active video games are being used to provide additional opportunities for increasing moderate-to vigorous physical activity (MVPA). However, the effect of virtual reality (VR) on MVPA is less understood. VR games can be played either as an active (AVR) or sedentary (SVR) setting, but there are no evidence of the MVPA that AVR is capable of inducing MVPA. We therefore compared the objectively measured MVPA produced by AVR and SVR using hip- and wrist-worn-accelerometers.

 

Methods:  Seventeen young adults (age: 22.1±1.3 years; body mass index: 22.9±3.9 kg×m^-1) underwent one AVR session and one SVR session. The AVR game played was Beat Saber (Beat Games®), which required the participants to move their arms holding virtual swords (saber lights) to cut through small blocks and evade larger blocks by crouching and moving side to side during the process. in the SVR session the participant played a game called Thumber (Drool®) using a game controller (Xbox One) connected to a computer. Each game session was preset to last for approximately 20 minutes. Time spent (minutes) in MVPA  was calculated using vector magnitude (VM) counts obtained from hip- and  wrist- worn accelerometers during the game sessions. 

 

Results: MVPA was significantly higher in the AVR session than in the SVR session, as  measured either in the wrist  (18.2 ± 1.1 vs. 0.3 ± 0.5; p < 0.001; d = 20.3) or in the hip (4.04 ± 3.97 vs. 0.01 ± 0.01; p = 0.001; d = 1.4). We found  also  that time spent in MVPA corresponded to 90 % of the active session when measured with wrist accelerometers and 20 % when measured with hip accelerometers.

 

Conclusions: We are among the first  to show that AVRs are capable of inducing MVPA. Additional research with alternatives to increase game engagement in AVR is now warranted. We suggest that a wrist accelerometer is a more sensible choice of instrument comared to a hip accelerometer to detect MVPA in during the VR game play that feasures significant upper body movement.

Purpose: Korean Massive Open Online Course (K-MOOC), called MOOC in Korean, is a form in which learners can learn university lectures online and conducts interactive learning such as questions and discussions. K-MOOC「Smart Diet Together: Healthy Body Weight Control and Individualized Nutrition」class was developed to provide easy and funny nutrition health information based on scientific evidence so that everyone can practice individualized body weight control smartly for themselves. Nutrition health information consisting of nutrition education, cooking, and yoga, etc. can be used as a nutrition intervention for everyone to lead a healthy body composition. This study was conducted to confirm the effects of this class on the changes in learners’ body composition.

Methods: Subjects were 379 Korean undergraduate students (223 male and 156 female) at university located in Incheon who completed the K-MOOC「Smart Diet Together: Healthy Body Weight Control and Individualized Nutrition」class during 15 weeks in 2 semesters from September 2018 to July 2019. Subjects participated in body composition measurement twice (weeks 3 and 13 out of 15 weeks) during this class. Subjects' body weight, skeletal muscle mass, and body fat mass were measured by using Inbody 370 (Biospace Co., Korea). Data were analyzed SPSS program version 20.0.

Results: During this class taking, in male students, average body fat and percent body fat significantly decreased from 17.0 kg to 16.6 kg (p<0.01) and from 22.3% to 21.7% (p<0.001), respectively. Skeletal muscle mass significantly increased from 32.5 kg to 32.7 kg (p<0.05). In female students, average body fat significantly decreased from 18.4kg to 18.0kg (p<0.05), and there was not significant but a tendency that percent body fat decreased from 32.1% to 31.4% (p=0.051). Subjects with positive changes in standard or below standard in percent body fat were 8.5% in male students and 9.6% in female subjects (p<0.001), respectively.

Conclusions: This e-learning class showed the effects on positive changes in body fat and skeletal muscle by providing nutrition health information. We suggest that this e-learning class should be continuously promoting and expanded.

Purpose: Self-administered eHealth interventions provide a potential low-cost solution for reducing diabetes risk by targeting lifestyle behaviours. Our aim was to evaluate the feasibility and preliminary efficacy of the Body Balance Beyond eHealth intervention in women with recent gestational diabetes mellitus (GDM).

Methods: Overweight/obese women with a diagnosis of GDM in the previous 24-months were randomised into one of three groups: High Personalisation (access to Body Balance Beyond healthy lifestyle website plus individual video coaching with a dietitian and exercise physiologist, and personalised text message support), Low Personalisation (website only), and waitlist control. A process evaluation was conducted at 3-months and 6-months. Primary outcome (weight) and secondary outcomes (HbA1c, cholesterol, diet quality, moderate-vigorous physical activity level) were analysed at baseline, 3-months and 6-months using linear mixed models (intention-to-treat).

Results/findings: Forty-two women (mean age 33.5±4.0 years, BMI 32.4±4.3 kg/m²) were randomised, of which 29 (69%) completed the 6-month assessment. Retention rates at 6-months were 80% for the High Personalisation group, 54% for the Low Personalisation group and 71% for the Waitlist control (Reasons: pregnant, n=2; personal/work commitments, n=4; placed on weight-loss diet, n=1; resources not useful, n=1; uncontactable, n=5). The majority (91%) of women in both intervention groups accessed the Body Balance Beyond website in the first 3 months, which fell to 57% at 6 months. The website provided useful information about lifestyle factors for 65-95% of women, while 25-30% found it motivating. Most women (85-92%) in the High Personalisation group felt the video coaching increased their confidence and helped achieve goals, while only 8-31% felt this way about the text messages. Overall satisfaction rates with the program were higher at 3-months (85% satisfied) than 6-months (62%). No significant group by time interactions were observed for any outcome, with the exception of HDL cholesterol where a difference was observed favouring the control group (p=0.028).

Conclusions: Retaining women with a recent diagnosis of GDM is challenging. The Body Balance Beyond website combined with video coaching appears to be acceptable and useful for women with previous GDM. Further analysis of the program’s efficacy on diabetes risk reduction in a larger study is underway.

Purpose: Commercial physical activity apps (e.g., Fitbit, Strava) have widespread reach and accessibility, and hold great potential to increase physical activity engagement. There is currently limited understanding of the capacity of such apps, and their social components to facilitate physical activity engagement. This study aimed to investigate the relationship between commercial physical activity app use and physical activity engagement. The social components of apps, in particular, app-specific communities (connecting with other app users) and existing social media platforms (e.g., Facebook, Instagram) were also examined in relation to physical activity levels. This included ascertaining the specific features (e.g., sharing, providing/ receiving encouragement, comparisons and competitions) of app-specific communities and existing social media platforms that were most beneficial in promoting physical activity.

Method: The study used a cross-sectional design. Participants completed an online survey assessing physical activity, commercial physical activity app use, and engagement with app-specific communities and existing social media platforms. Data were analysed with t-tests, Chi-square tests, Kruskall-Wallis tests and multiple linear regressions. Alpha was set at 0.05.

Results: Participants were 1432 adults aged 18-83 years (M_age = 34.1 ± 13.4 years, 76.6% female). Overall, 53.1% of the sample reported engaging with a commercial physical activity app. The most commonly used apps were Fitbit (22.5%), Strava (17.1%) and Garmin (13.4%). App users engaged in significantly more physical activity than non-users (p < .001, d = 0.42). The use of app-specific communities (p = .009, d = 0.25) and existing social media platforms (p = .004, d = 0.44) was associated with greater engagement in physical activity. The strongest predictors of physical activity were receiving encouragement from family (β = .271, p = .001), and engagement in competitions with public app-specific communities (β = .208, p = .007).

Conclusions: Commercial physical activity apps and their social components are associated with physical activity, and should be utilised in physical activity interventions. Randomised controlled trials to examine commercial physical activity apps and their social components are warranted.

 

 

Purpose

To examine if a fitness tracker intervention changes physical activity (PA) behaviour compared to a control condition or compared to an alternative intervention.

Methods

Data source; searches between 01/01/2010 - 01/01/2019 were conducted in Pubmed, CINAHL, Cochrane CENTRAL, EMBASE, and PsycINFO. Inclusion/exclusion criteria; randomised clinical trials of adults using a fitness tracker to change in physical activity behaviour were included. Non-clinical trials, studies that included the delivery of structured exercise, and/or studies that only used the fitness tracker to assess physical activity were excluded. Data extraction; extracted features included characteristics of the study population, intervention components, physical activity outcomes, and results. Data synthesis; papers were pooled in a statistical meta-analysis using a fixed-effects model. Where statistical pooling was not possible, standardised mean difference (SMD) and 95% confidence intervals (CI) were calculated. Findings were presented in a narrative form and tables.

Results

Of 2076 articles found, 21 were included in the review. A small yet significant positive effect (SMD = 0.25, 95% CI = 0.17, 0.32; p < 0.01; I² = 56.9%; p = 0.03) was found in step-count for interventions compared to control. A small yet significant negative effect (SMD = -0.11, 95% CI = -0.20, -0.02; p = 0.02; I² = 58.2%; p = 0.03) was found in moderate-to-vigorous physical activity for interventions compared to an alternative intervention.

Conclusion

Fitness trackers may enhance physical activity interventions as a positive effect is found in step-count compared to a control. However, there is no evidence of a positive effect when interventions are compared to an alternative intervention. It is unknown if results are due to other intervention components and/or clinical heterogeneity.

Purpose: Evidence suggests that digital health interventions are effective self-management solutions for addressing health behaviour change (BC) in cardiovascular disease (CVD) prevention, such as increased physical activity (PA). However, a proliferation of disparate digital health interventions are currently available to people living with CVD. We propose an innovative digital health platform structure, offering a variety of existing, evidence-based interventions to users based on their individual needs and preferences. This may be a more sustainable approach to health BC for those who are self-managing a complex long-term condition. This paper aims to better understand the perceptions of key stakeholders towards the proposed platform and identify the development considerations they may prioritise based on their experiences of CVD management.

Methods: A qualitative research design and triangulation of data collection methods were used to generate data. Data collection included focus group discussions, semi-structured interviews and guided conversations. Participants were people with a diagnosis of CVD (n=16) and relevant healthcare professionals (n=7). A thematic analysis was conducted to explore patterns and themes within the various participant contributions.

Results: Findings indicate that the proposed platform would be a beneficial solution for certain groups whose health BC is not currently supported by discrete solutions. Both participant groups perceive the digital health platform as more trustworthy than accessing multiple interventions through unsupported digital repositories. Healthcare professionals agree that they would endorse an evidence-based platform which had been rigorously developed and evaluated. CVD participants would prioritise a decision support tool to guide them through the platform, as they perceive an unstructured approach as overly complex. Both participant groups perceive selective data sharing to be a useful method for gaining support with health BC goals from certain self-selected individuals (e.g. spouse).

Conclusions: Improving health behaviour is a complex and life-long endeavour in CVD self-management. These findings suggest that an innovative digital health platform would offer a flexible and comprehensive solution for health BC to a wider and more diverse population. This paper makes a significant contribution to the rationale for developing an innovative digital health platform.

Purpose: The Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial was the first pragmatic randomised trial to investigate the effects of exercise using affordable technology to increase physical activity and mobility of patients admitted to hospital rehabilitation units. The trial found that performance-based mobility assessed with the Short Physical Performance Battery (SPPB) (0-3 continuous score) was significantly better in the intervention group than the control group (mean between-group change score 0.2 points; 95% CI 0.1 to 0.3; p= 0.006) over the 6 month trial period. However, the cost-effectiveness of this program is yet to be determined. The aim of this study is to investigate the trial-based cost-effectiveness and cost-utility of the physical activity intervention investigated in the AMOUNT trial.

Methods: This is a cost-effectiveness and cost utility analysis conducted alongside the AMOUNT trial, in which a total of 300 people receiving inpatient rehabilitation were randomised to the physical activity (technology enhanced mobility and physical activity plus usual care, n=149) and usual care control group (n=151). A health and community care funder perspective was used. Data were collected on health (from hospital records) and community service use (from calendars), using local or national costs as appropriate. The costs of intervention delivery were also calculated from trial records. All data is available, and we are finalising data analysis, which was specified a priori. Using the mean costs and the mean health outcomes in each trial arm, the incremental cost per 1) additional person achieving an improvement greater than the median SPPB change score, 2) QALY gained of the intervention group compared with control group at 6 months will be calculated. Bootstrapping will be used to estimate a distribution around costs and health outcomes, and to calculate the confidence intervals around the incremental cost-effectiveness ratios. Robustness of the results will be assessed through sensitivity analyses.

Results: The mean cost of the intervention was AUD 1,892 per patient, including costs associated with training, equipment and staff time. Full results will be available for presentation at the conference.

Conclusions: This study will contribute to the scarce cost-effectiveness evidence on physical activity interventions for people with mobility impairments.

Purpose: ParticipACTION is a national, physical activity (PA) social marketing organization. In February 2019, it launched a mobile PA app (PAC app) interlinked with a community challenge (CC) to find Canada’s most active community (June 2019). The app syncs to phone health apps and commercially available PA tracking devices. With content and features informed by the behaviour change wheel it guides users in increasing PA. The CC facilitates opportunities for PA through participation in community events. Communities compete to track the most PA over 3 weeks using the app. The purpose of this study is to examine uptake and adoption of the PAC app in its first six months and examine if the CC increased app uptake and adoption.   

 

Methods: A naturalistic observational study design was employed over the first 6 months of the app’s existence to determine uptake and adoption. User engagement metrics were recorded through the app analytics. Descriptive analyses were conducted.

 

Results: In the first 6 months, 117,765 users downloaded the app and 74,540 participants completed onboarding (self-reported PA). App users were 46.7±12.8 years old and 80% female. An average of ~2,869 users completed onboarding each week. Average user engagement, defined as opening the app at least once, was ~9,551 users/week. Of these users, an average of 8,447 users/week have device-recorded PA data recording a total 18.8±6.3 min of MVPA/day and 128.2±40.3 min/week of MVPA during the 6 months.  App use increased with the launch of the CC but was not sustained.  Onboarding peaked the week before the CC at 12,018 users/week and engagement peaked during the first week of the CC at 20,775 users who recorded 20.0 min of MVPA/day and 140.5 min/week.  App engagement declined by 37% in the week following the challenge and returned to pre-CC levels by 3-weeks post-CC.  

 

Conclusions: This 6-month natural observation of the PAC app revealed significant reach and uptake of the app; however, long-term engagement was not sustained.  Community challenges may increase app uptake and engagement, though user retention requires further investigation. The PAC app is continually evolving, and ongoing evaluation will identify improvements in user engagement and retention. 

Purpose: 

To test the feasibility of a Mediterranean diet (MEDI) program developed specifically for older Australians (AusMed). This novel program includes tailored eHealth support with foods and recipes modified for the population while maintaining the integrity of a traditional MEDI.

 

Methods: 

Phase 1: A process evaluation was conducted with a group of older Australians (n = 17, mean age 71.2 ± 4.2 years). Consumer research groups were presented with AusMed materials in three sections: 1. Education materials; 2. Program support materials; 3. Cooking demonstration/tasting and surveyed for opinion after each section. Semi-structured interviews (n = 6) were performed and thematically analysed using n-Vivo to identify barriers/enablers to adherence. Program materials were then modified according to results.

Phase 2: 2-week feasibility trial (n = 15). A dietitian delivered a group counselling session, provided program materials and food hampers prior to commencement of the trial. Text message support using the COM-B model was delivered throughout. Outcome was measured by validated 14-point Mediterranean diet score, food and support acceptability surveys.

 

Results/findings: 

Phase 1; Quantitative feedback: All participants (100%) agreed their knowledge of MEDI had improved and they were confident they could adhere to AusMed; support materials were acceptable, the majority preferring booklet format (70%) and group delivery (58%). Themes emerging from qualitative analysis; 1. Barriers (program complexity, perceived cost and food preferences); 2. Provision of additional behavioural support and 3. Simplification and individualisation of materials.

Phase 2; Trial participants were found to have increased their adherence from a mean score of 5.4 ± 2.4 (considered low adherence), to a mean score of 9.6 ± 2.0, (considered moderate to high adherence). All participants reported food satisfaction, confidence to continue with the dietary change and that eHealth support was acceptable and assisted in adherence.

 

Conclusions: 

Health benefits from dietary change take time to accrue. Tailoring interventions and including eHealth support can improve adherence. A sample of Australians significantly improved their adherence to MEDI and found both the foods and eHealth support were beneficial. Larger intervention studies over a longer period are needed to confirm long-term adherence and associated health benefits in an Australian setting.

 

Purpose:

 

Free-of-charge commercially available physical activity (PA) apps have the potential to reach widespread population groups. Voluntary engagement with these PA resources has the potential to make expensive professional intervention redundant. However, the enthusiasm associated with mHealth interventions for improving health and well-being remains unclear for commercially available PA-oriented products that are not facilitated by health professionals. Resultantly, the purpose of this research was to investigate whether voluntary adoption of a free-of-charge running app (Couch-to-5K) can produce beneficial health outcomes.

 Methods:

An anonymous online survey was developed to explore user experiences of, and adherence to, a Couch-to-5K running app. Data was collected over 12 weeks using a combination of open-ended and closed response questions. Data from open-ended questions were analysed thematically to explore experiences of using the app and changes in health and well-being were analysed in SPSS version 22.

 Results/Findings:

The survey reached 903 adult (females n=718; mean age 42.4; ±SD 9.89 years) Couch-to-5K users. Whilst only 165 (22%) of respondents reported having at least one health condition, 579 (77.2%) reported the app had a positive effect on their health, 184 reported no impact on health and 153 did not respond. Of 754 responses, 313 (41.5%) said that app adoption helped reduce stress. In addition, 521 respondents provided indications of further health advantages using an open-ended response option. Data reduction of these responses revealed improvements across the following themes:

 

1. Weight loss

2. Medication reduction

3. Mental Health improvement

4. General well-being improvement

5. Health condition improvement

6. Confidence

 Conclusions:

Effective management of chronic illness and mental health is a key public health agenda. Participation in Couch-to-5K showed improvements in the health and wellbeing of participants in this study. Adopting Couch-to-5K also seems to be effective for managing stress. Chronic illness and mental health concerns are costly to treat; therefore accessible interventions which alleviate the strain on health services to manage such conditions are important.  Understanding the specific components of the Couch-to-5K programme which led to positive health and well-being outcomes is crucial for developing and promoting PA apps for specific population groups and future research should consider this.

 

Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with physical inactivity being a modifiable risk factor for CVDs. Mobile health (mHealth) interventions have been shown to be cost-effective and successful in modifying behaviours of individuals in previous studies.

Aim: This study aims to assess the efficacy of adding text message interventions to activity tracker use on physical activity (PA) levels.

Methods: Using PRISMA guidelines, 4 electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE and PSYCINFO) were searched from their inception to June 2018. The Australian New Zealand Trial Registry and Google Scholar were also searched. Relevant studies with text message interventions focusing on promoting physical activity were identified. Two reviewers independently screened studies, data was extracted by one reviewer and cross-checked by a second reviewer. Trial quality was assessed by one reviewer.

Results: Of 96 records screened, only 4 randomised controlled trials were found to be eligible. Out of 4 studies, only 1 study demonstrated that daily text messaging in addition to self-monitoring of objectively measured step counts significantly increased physical activity levels. There was an overall decrease in step counts over the course of the studies in both control and intervention groups, the intervention groups experienced less of a decrease in step counts.

Conclusion: This review found that mobile phone text messaging might have a role in promoting physical activities. Future mHealth trials should aim to have larger sample sizes, longer study durations and collect similar data points in standardised units to provide robust evidence.

 

Purpose:  Today, there remains a gap in understanding how well adapted Diabetes Prevention Programs (DPP) work for individuals with low health literacy. Our study evaluated how the use of automated telephone calls to deliver DPP information applying teach-back and teach-to-goal health literacy (HL) techniques might influence overall participant comprehension and engagement in a technology-based DPP.

Methods: A sample of 425 (88.3% of eligible) participants (36.8±6.4 kg/m2, 52.5±12.1 years, 67.3% female) initiated the 22 possible interactive voice response (IVR) telephone lessons as part of this quasi-experimental study. During each lesson participants were provided with reinforcement messages based on how well they comprehended information provided. If needed for those that missed information initially, an additional opportunity to listen to the material and answer review questions was performed. Correct answers received 2 and 1 point, respectively. For an overall comprehension score, all points earned were divided by the number of IVR lesson questions completed. ANOVA, chi-square and multivariate regression modeling was used to test differences of descriptive characteristics and between IVR calls completed, overall comprehension score and health literacy levels. 

Results/findings: A total of 425 (LHL-75, 92.6%; HHL-350, 97.0%), 279 (LHL-50, 61.7%; HHL-229, 63.8%), 202 (LHL-44, 54.3%; HHL-158, 43.8%), and 126 (LHL-29, 35.8%; HHL-97, 26.7%) participants completed calls 1, 9, 16 and 22, respectively. While high health literacy (HHL) participants achieved a better overall comprehension score (LHL-16.8±13.1; HHL-16.9±13.3, p<0.01); the initial comprehension gap at call 1 between HHL and LHL disappeared by call 22. Additionally, low health literacy (LHL) participants completed a greater proportion of calls with 38.7% completing all 22 calls vs. 28.9% of HHL (p<0.001). Finally, multiple regression models revealed that the number of IVR calls completed were predicted by comprehension scores and health literacy (F(4, 420)=65.5, p<0.001, R²=0.52).

Conclusions: Regardless of HL levels, overall comprehension rates predicted the number of lessons completed suggesting both HL groups benefited from the additional reinforcement over the length of the intervention, thus reducing knowledge disparities. While our results suggests the potential benefit of using information reinforcement techniques to promote greater program engagement, future studies using experimental designs need to further evaluate these findings.

Purpose: Globally, physical inactivity is identified as one of the highest risk factors for morbidity and mortality. Promotion of active transportation (AT) is a viable option for many to increase their daily physical activity (PA). The development of mHealth interventions broadens the opportunity to reach larger populations in order to promote AT. The Smart City Active Mobile Phone Intervention (SCAMPI) study is a randomized controlled trial evaluating the use of a smartphone application (app) promoting AT to increase participants’ PA. This qualitative study examines the acceptance and usability of the SCAMPI app from a participant perspective.  
Methods: Seventeen participants (13 women; age range 25-61 years), living in the county of Stockholm, who had completed the 3-month intervention (behavior change program delivered through an app) in the SCAMPI randomized controlled trial during 2018 agreed to participate in a semi-structured telephone-based interview. These 17 participants were representative of the whole intervention group (n=127) considering baseline characteristics such as age, sex and area of residence. The interviews were audio recorded, transcribed verbatim and analyzed with an inductive qualitative content analysis.
Results: The analysis resulted in two themes. The first theme “The main motivators: monitoring and messages” highlighted that monitoring AT and being able to set up weekly goals in the app were perceived as the main motivators to use more AT. The second theme “Acceptable although refinement is appropriate” showed that the app was accepted and encouraged many participants to use more AT. Nevertheless, there were functions in the app that needed to be modified. For instance, although the automatized tracking of travel behavior was appreciated, it was reported to be time consuming and unreliable at times.
Conclusions: This study contributes with novel knowledge about healthy adults’ experiences of using an app for promoting AT. The results show that the app was well-accepted and that self- monitoring and goal-setting were the main motivators to use more AT. The automatized tracking of AT was appreciated; however, it was also reported to be energy- and time consuming when it failed to work. Thus, this feature should be improved in future research. 

Purpose

We sought to explore the perspectives of end-users on the features, current use and acceptance of “Nutrition and Diet” mHealth apps. Almost 43% of the world’s population now owns a smartphone and the number of nutrition apps is growing.

 

Methods

A multidisciplinary team of AI experts, computer scientists, dietitian-nutritionists, physicians, pharmacists and psychologists designed and setup the survey. Before its release, it has been pilot-tested by 21 end-users. The feedback was reviewed and the survey was finalised - resulting in a 19-item questionnaire translated into six languages: EN, DE, FR, ES, IT, EL. This has been disseminated through conferences, patient associations and social media.

 

Results

End-users (n=1000) from 31 countries and 5 continents (731 women, 262 men, 7 neither) with a mean age of 28.7 (SD: 9.8) have so far completed the survey. More than half of the participants (58.6%) have used a “Nutrition and Diet” app. The primary criteria for selecting such and app were to be free of charge, user-friendly and validated. It should also produce automatic results of caloric and macronutrient content (i.e. food type and/or the portion size are estimated by the system without any contribution by the user). An app is less likely to be selected if it wrongly estimates portion size, calories or nutrient content. Moreover, other important limitations include the use of a database that comprises non-local foods, and which may omit major foods. It seems that it is easier for the participants to select criteria for preference, rather than barriers, as expressed by the percentage of the selected “no opinion” responses on these questions (11% and 27%, respectively). Furthermore, on a scale of 1-5 (1: completely insignificant, 5: completely significant), end-users indicated that shared history records and also the possibility of sharing data with other apps (e.g. fitness apps) are completely unimportant for them.

 

Conclusion

To the best of our knowledge, this is the broadest survey of end-users on the subject of “Nutrition and Diet” apps. Understanding the needs of end-users will benefit both the research on innovative tools used for dietary assessment, as well as behavioural change research.

Introduction: Latino men in the U.S. are disproportionately affected by health conditions related to low physical activity (PA) levels. Engaging in regular PA can reduce risk of chronic diseases and yield many health benefits; yet, few Latino men (24%) meet national PA guidelines. Moreover, there is a paucity of PA interventions developed for Latino men. Our prior formative research with Latino men suggested that technology-based interventions may be ideal for helping to increase PA. Thus, we engaged 38 Latino men in focus groups to adapt an evidence-based Internet PA intervention that was originally developed for Latinas. This presentation will describe the resulting Hombres Saludables PA intervention and baseline participant characteristics.

Methods: Hombres Saludables is an ongoing 6-month Spanish language individually-tailored web- and text-message PA intervention for Latino men. Participants are randomized to the PA intervention arm or wellness control arm. The PA intervention includes: two check-in phone calls, an interactive website with PA tracking, goal setting and individually tailored PA content; automated SMS text messages, a pedometer, a six-month gym membership and access to a private Facebook group. PA is assessed via ActiGraph GT3X+ accelerometer and the 7-Day Physical Activity Recall at baseline and 6-months. Participants also complete pre and post questionnaires (e.g., self-efficacy, decisional balance, social and environmental PA determinants).

Results: Participants are Latino men (N= 43), mean age 38.5 years (SD=12.57), who are mostly employed full or part-time (72.1%). Participants’ educational levels are > college graduate (44.2%), some college (20.9%), and < high school degree (20.9%). More than half (55.9%) are married or living with a partner. At baseline, median accelerometer measured MVPA in 10-minute bouts was 13 min/week (IQR= 0-57) and self-reported MVPA median was 0 min/week (IQR= 0-45). This presentation will also report baseline values for participants’ personal, social and environmental PA determinants.

Conclusions: Hombres Saludables uses an innovative, interactive web and text-message based intervention for improving PA among Latino men, an underserved population at risk. If the intervention proves feasible and efficacious, we will refine and evaluate it in a larger randomized trial.

Purpose: People with HIV (PWH) frequently exhibit neurocognitive deficits and non-AIDS disorders, including cardiovascular disease (CVD). Identifying effective treatments is a high priority. Existing physical activity (PA) interventions for PWH require strenuous PA and multiple in-person visits that limit feasibility. Mediterranean-style diets (MedDiet) reduce CVD risk, but have not been widely tested in PWH. To address these challenges, we developed a novel 6-month smartphone-based Multimedia Message Service mHealth intervention (iSTEP) designed to increase moderate PA and promote MedDiet in PWH. We are conducting a 3-arm RCT to evaluate the efficacy of the iSTEP PA intervention alone compared to a combined PA and MedDiet protocol. We hypothesize that iSTEP will increase PA and improve neurocognition compared to control, while MedDiet will reduce CVD risk relative to PA alone. 

Methods: 150 adult PWH with low PA are randomly assigned to a control group (n = 50), a second group administered the iSTEP PA intervention (self-monitoring and goal-setting with daily PA messages and weekly PA goals via a smartphone platform), or a third group receiving both the PA and MedDiet intervention, including dietitian counseling, diet monitoring, and free walnuts (n = 50). iSTEP content is tailored to each participant, determined by preferred PA and MedDiet choices. PA is quantified by actigraphy and combined-sensing Fitbit data; MedDiet adherence is assessed by diet questionnaires and blood biomarkers (polyunsaturated fatty acids/carotenoids). CVD factors include BMI, cholesterol, inflammatory cytokines, and heart rate variability; neurocognitive evaluation incorporates executive function, learning, and memory. Measures are assessed at baseline and a follow-up visit after 6 months. Mixed effects model with repeated measures will analyze effects.

Results: The ongoing iSTEP RCT will finish in 2021. Data from an earlier separate pilot study evaluating the iSTEP PA intervention indicated that intervention participants (n=19) exhibited greater steps (2000 step increase) relative to control (n=21, p < 0.05). Reduced sedentary time associated with better cognition (p < 0.05).

Conclusions: Findings will enable implementation of large-scale mobile PA/diet interventions to improve neurocognition and cardiovascular health. The objective is to validate a scalable, low-cost mHealth protocol that is feasible for individuals with physical or socioeconomic limitations.  

Purpose: Poor eating patterns and larger portion sizes contributing to increased energy intake and excessive weight gain. Children and adults have difficulties in estimating food volumes and portion sizes and understanding food labels and kilojoule content. These tasks require basic mathematical skills. At the same time, worldwide interest and achievement in mathematics has declined in school-age children. This is partly due to the perceived misalignment with the school curriculum. Technology, gamification and real-life contexts can help make volume-learning fun and schools play a key role in promoting healthy lifestyles and healthy eating for children. This study aimed to develop and pilot-test a technology to embed aspects of the ‘Health and Physical Education’ syllabus within Mathematics to enhance learning experiences.

Methods: Our interdisciplinary team of Computer Scientists, Nutrition and Mathematics Education experts used co-design principles to develop an evidence-based tool to integrate mathematics and nutrition education. Primary school teacher surveys (N=101) and testing and interviews with children (N=14, age M=9.3, SD=0.8 years) and their parents (N=13 parents) informed the design of an augmented reality-based game application for food portion size and volume and unit learning that is aligned with the Australian curriculum was informed by

Results: Teachers expressed positive beliefs and interest in using digital games for teaching volume and capacity measurement. About 33% already used digital games, with 55% not currently using, but wanting to use them. SnackAR is an app, which displays a variety of virtual foods, and teaches children to estimate food portions using several different unit types, e.g. weight in grams, volume in millilitres, volume in cm³ and energy in kilojoules. The preliminary testing of the app indicates that 13 out of 14 children liked the application. Overall, the children perceived the estimations as challenging and further technological improvements relating to provision of feedback could be helpful.

Conclusions: Stakeholders reported that integration of a digital game to integrate nutrition and mathematics teaching is acceptable. However, usability and effectiveness of the prototype technology need to be tested in a randomised controlled trial to assess potential value of integration of the tool into the primary school curriculum.

Purpose: Innovative and effective child weight management interventions are needed to address the rising global prevalence of obesity. Web-based technology may enhance intervention by overcoming barriers including transportation, time or costs associated with attending clinic appointments. Given health services in rural areas might be harder to access than in urban areas, this study aimed to identify the perspectives of health professionals in rural New South Wales, Australia on the use of telehealth for childhood obesity treatment.

Methods: Four focus groups were conducted covering discussion topics including: i) current state of child weight management services, ii) the use of telehealth or technology-based interventions for childhood obesity, iii) barriers and enablers to parents and clinicians using telehealth, and iv) the implementation of telehealth in clinical settings and its benefits and/or disadvantages. Recordings of focus group discussions were transcribed verbatim. Data were interpreted using thematic analysis.

Results: Overall, 21 health professionals (n=18 female, n=3 male; n=10 dietitians, n=5 physiotherapists, n=3 paediatricians, n=2 occupational therapists, n=1 clinical nurse consultant in paediatrics) practiced in Tamworth or Armidale participated in the focus groups. When asked about how useful a technology-based childhood obesity program would be for families in the rural region, the group mean score was 8.1 out of 10 (n=18) with 67% (n=12) rated 8 or higher (i.e. useful to extremely useful). Health professionals felt that telehealth could be offered as an alternative to in-person consultations and were generally confident with using technology. However, they felt the need for additional training and troubleshooting support especially when the system breaks down. Perceived benefits to health service was increase in clinic efficiency by decreasing clinicians’ travel time to clients’ home and rural sites while increasing clinicians’ capacity to provide more appointments.

Conclusions: In conclusion, the sample of health professionals in this study believed that families will benefit positively from a technology-based childhood obesity program. Findings from this study further supports the implementation of an online technology-based lifestyle program targeting families with children in need of weight management interventions in health service settings.

Purpose: Depression and anxiety rate in college students are on the rise, and exercise has been shown to alleviate these symptoms. Virtual reality-based exercise has been an innovative means to motivate individuals to adhere to exercise. This study examined the acute effect of immersive virtual reality (VR) exercise bike on physiological and psychological outcomes in college students with depressive and anxiety symptoms.

Methods: Total of 20 participants (M_age= 20.45, SD=0.76 ;11 females; M_BMI=23.33, SD=2.86) participated in the study in 2018.  Penn State Worry Questionnaire (PSWQ) and Center for Epidemiologic Studies Depression (CES-D) were used to screen students with either symptomology of depression or anxiety. Participants participated in two 20-minute exercise sessions, each on a separate day: 1) VR bike exercise, and 2) traditional ergometer exercise. Brunel Mood Scale was used for mood assessment immediately before and after both sessions, and heart rate was assessed every 4 minutes during each session.

Results: Average score for PSWQ and CES-D was 52.06 and 16.65, respectively. Repeated two-way (Time and Condition) ANOVA indicated that there was a significant interaction effect on vigor (F (1,19) = 8.79, p < 0.01). Additionally, there were significant Time effect on depression (F (1,19) = 5.81, p < 0.05), tension (F (1,19) = 6.55, p < 0.05), and vigor (F (1,19) = 15.71, p = 0.01). Marginal significance of Time effect on Confusion (F (1,19) = 4.39, p = 0.05) was also shown. Paired t-test indicated that no significant difference on average heartrate between the two conditions.

Conclusions: College students who have moderate-to-high worry can benefit from 20 minutes of bike exercise. Although physiological responses may be comparable between the two exercise modes, VR bike exercise can be more effective in enhancing the positive mood compared to traditional bike exercise. 

Purpose:

Childhood is a critical time for growth and development, with eating habits and food preferences influenced by their environments. Two-thirds of Australian children (1-4 years) attend childcare with long day care (LDC) used most frequently and for the longest period. Child food intakes in LDC have been shown to be inconsistent with dietary recommendations and increased exposure to childcare associated with adiposity. LDC is therefore an important environment for public health intervention to prevent childhood obesity.

Methods:

A cross sectional qualitative study of newly graduating childcare educators across two campuses in Geelong and Melbourne, Victoria. Online surveys collected demographic data. Focus group discussions used photo elicitation to explore participant knowledge, attitudes and practices of the Childcare Food & Activity Practices Questionnaire (Gubbels et al 2015). 

Results:

Respecting child choice was considered important with pre-served versus self-served meals debated as preferred methods to facilitate self-regulation. Participants felt their role was to monitor types and amounts of foods offered, with children determining how much to consume. Self-regulation was challenged by childcare food monitoring procedures. Picky eating and emotional behaviours elicited personal beliefs and practices of coercion and pressure to eat. Role modelling was understood as important however often restricted by childcare policy. Participants described a gap between learnt knowledge and observed practice.

Conclusions:

Childcare educators agree they are influential in the health of children. Knowledge learnt appears to be shifting towards healthy feeding practices, however application is often challenged by childcare policy and procdure. Australian childcare is a regulated industry, therefore existing policy and procedures could be strengthened to support healthy feeding practices of young children.

 

Purpose:                                

Physical inactivity and excessive screen time in children is a global problem. The outside school hours periods are key time periods where children can accumulate physical activity. Approximately 10% of Australian children attend Out of School Hours Childcare (OSHC) and this is growing. In Australia, OSHC physical activity and screen time practices currently lack formal guidance/policy. This study aimed to engage multidisciplinary stakeholders and end-users to formulate national OSHC physical activity and screen time guidelines.

 

Methods:

A 4-round online Delphi survey was conducted (May - December 2019). Australian and international stakeholders were invited, representing academia, education sector, government, health professionals, OSHC staff and parents (n=110).  The first round comprised open-ended items exploring themes of physical activity, screen time and sedentary behaviour in the before school care, after school care and vacation care settings. Questions in subsequent rounds were based on stakeholder suggestions from previous rounds and designed to seek consensus for inclusion in national guidelines. Consensus was prospectively set at 80% agreement, and only statements deemed ‘critically important’ were included. Survey results were combined with findings from two systematic/scoping reviews to inform draft guidelines.

 

Results/findings:

Sixty-seven respondents participated (response rate 61%). “Critically important” consensus was reached for 47 statements, including  the types of activities available (e.g. free play, playground play and equipment), accessibility to indoor and outdoor play areas, provocations to stimulate physical activity, staff education, incorporating activity guidelines into OSHC practices and balancing physical and sedentary activities. Consensus was achieved immediately for restricting screen time in all OSHC time periods (before and after school and vacation care). The final Delphi round sought feedback on draft Australian guidelines for physical activity and screen time in OSHC.

 

Conclusions:  

A consensus approach based on extensive stakeholder engagement was used to develop Australian guidelines for physical activity and screen time in OSHC. It is envisaged these guidelines may be adopted into formal policy in future. Translational research to implement and evaluate the guidelines into OSHC services is warranted.

Purpose:                                

Most children are not doing enough physical activity and have excessive screen time. The outside school hours periods offer discretionary time use, and the activities children do in these times have an important influence on whether they meet or fail daily activity recommendations. Millions of school children globally attend outside school hours childcare, though in many jurisdictions their physical activity and screen time in this setting goes ungoverned. This review aimed to identify all published guidelines for physical activity and screen time in outside school hours care from around the world, to determine the level of physical activity and screen time recommended, and the methods used to create the guidelines.

 

Methods:

A prospectively registered scoping review was conducted (Medline, Emcare, Embase, Scopus, ERIC, Sportsdiscus, TROVE, ProQuest, UpToDate, NICE, SIGN and Google). Results were screened independently by two reviewers following the PRISMA-ScR guidelines, and data were synthesised narratively.

 

Results/findings:

269 documents were identified, of which 25 were reviewed in full-text, and nine included. Eight originated from the USA and one from Canada. The US guidelines consisted of both national (n=2) and regional (n=6) documents. All the guidelines focused predominantly on the after school care period (n=9) with only one of the guidelines also incorporating the before school care period. Seven of the nine included guidelines had both physical activity and screen time recommendations, whilst two guidelines had only physical activity guidelines. The guidelines varied considerably in the amount of recommended physical activity and/or screen time (for physical activity: duration/intensity/bouts; for screen time: duration/quality of content). Taken together, guidelines recommended between 30 and 60 minutes of MVPA and less than 30 to 60 minutes of recreational screen time per after school care session. All guidelines were developed by expert/stakeholder panels, though none used rigorous guideline development methods, such as GRADE or GIN-McMaster Checklist.

 

Conclusions:  

Guidelines for children’s activity behaviours in outside school hours settings have focused primarily on physical activity and the after school period. All published guidelines to date emanate from North America. Guidelines using recognised, rigorous guideline development methods and for other world regions are warranted.

Purpose 

Childcare centers are settings with a huge impact on children’s health and health behavior and should therefore be encouraged to implement policies and practices to promote physical activity. The project "QueB 2 – developing quality with and through physical activity" aims at exploring how stakeholders can be involved to identify childcare centers with need for action. For this purpose, an app-based quick assessment tool is developed.

 

Methods

First, stakeholders working with childcare centers (consultants and supervisors) were identified and invited to take part in group discussions about the following questions: Which role does physical activity play in your daily work? Which issues concerning physical activity arise in the childcare centers you work with? How can you identify childcare centers’ need for action concerning physical activity? What support do you need for that?

Second, a first draft of a quick assessment checklist building on scientific evidence and existing frameworks was created and sent to stakeholders for feedback. In the third step, the quick assessment tool is developed as a web app and tested by stakeholders.

 

Results

Physical activity plays only a small role in the work of childcare consultants and supervisors. However, they consider it an important issue for childcare centers and see the added value of an app-based assessment tool giving it a stronger weighting. The tool should be simple and suitable for use in counseling to give a first impulse to childcare centers with small expenditure and without consequences. The assessment should be combined with information material and an invitation to activities like workshops or trainings for childcare center staff.

 

Conclusions

Stakeholders can be involved to sensitize childcare centers to the issue of physical activity environments and practices with the help of an app-based quick assessment tool.

Purpose: Childcare programs, including out of school hours care (OSHC), are a fast-growing setting in Australia which can provide healthy foods and opportunities for physical activity to children. Yet, relatively little is known about what occurs in these settings.

​Methods: Data were collected during the afterschool period from 77 OSHC programs, on two non-consecutive weekdays (32 affiliated with an organisation, 37 independent programs and 8 attached to a long day care program). Structured interviews were conducted with program directors about healthy eating and physical activity practices and policies. Foods and beverages offered to children were observed and categorised into food groups aligned with the Australian Dietary Guidelines. Staff behaviour and program activities were recorded using the Systems for Observing Staff Promotion of Physical Activity and Nutrition. Associations between service type, healthy eating and physical activity behaviours were explored using parametric and nonparametric tests.

​Results: More than 50% of OSHC programs sampled reported having no nutrition or physical activity training. OSHC services associated with an organisation provided vegetables more frequently (p=0.036) and a greater variety (p=0.012) of vegetables to children. Programs affiliated with an organisations had the highest proportion of structured games (p=.081) yet played more elimination games (p=0.019) than independent and long day care services.

​Conclusion: There is a need for further OSHC staff training in healthy eating and physical activity best practice behaviours in NSW.  

Purpose: Healthy eating and physical activity interventions in early childhood education and care settings have the potential to reduce the prevalence of childhood obesity and its associated short and long-term health conditions. Research in this area has largely focussed on centre-based services, however, there is an emerging body of literature in family day care. The aim of this study was 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 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. Screening, data extraction and risk of bias was undertaken by two reviewers with disagreements resolved by a third reviewer.

Results/findings: In total, 8,977 titles were retrieved, and 199 full-texts reviewed. No studies met the inclusion criteria for the primary outcome, however two studies reporting on the secondary outcome of family day care environments were included. The four year community-wide obesity prevention program, and the 12-month train–the-trainer program both 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 intervention costs or adverse outcomes. Two ongoing studies measuring outcomes at child levels were also identified.

Conclusions: Findings indicate that healthy eating and physical activity interventions can be effective in improving family day care environments. Few existing studies were eligible for inclusion, highlighting a need for high quality, controlled trials to identify effective strategies to improve children’s diet, activity and weight in this setting. Future intervention research reporting child dietary intake, physical activity and weight status is required to assess impact on children’s health behaviours.

Background: As dietary behaviours developed during childhood track into adulthood, interventions to improve child nutrition within the early childhood education and care setting are recommended. Web-based modalities represent a promising means of supporting the delivery of ECEC-based healthy eating interventions at scale. The primary aim of this study is to examine the impact of a web-based intervention together with health promotion officer support on child dietary intake of fruit and vegetable serves in childcare. Secondary aims are to examine the impact on centre implementation of recommended healthy eating policies and practices

Methods: A cluster randomised controlled trial employing an effectiveness-implementation type-II hybrid design will be conducted with 22 ECEC centres within New South Wales, Australia. Centres allocated to the intervention group will receive access to a web-based program (incorporating audit and feedback, developing a formal implementation blueprint and educational materials) together with health promotion officer support (via an educational outreach visit, ongoing consultation and local technical assistance, identification of centre champion) to implement healthy eating practices to improve child diet in care. The primary outcome of the study is the mean serves of fruit and vegetables consumed by children whilst in care at six months follow-up, assessed through the measurement of 440 children’s lunchboxes. Secondary outcomes include the mean serves of fruit and vegetables packed within lunchboxes and centre’s healthy eating environments assessed via direct observations. Child and centre-level outcomes will be analysed using linear regression models. 

Results: Development of the web-based program, including selection of behaviour change techniques and implementation strategies employed via the web-based program to address ECEC barriers will be presented. Twenty-two centres have completed baseline data collection. Baseline child dietary intake of fruit and vegetable serves during care will also be presented. 

Conclusions: This is the first randomised controlled trial to examine the impact of a web-based intervention on child dietary intake in care. Results of the study will strengthen the evidence-base regarding the impact of healthy eating practices on child diet in care.  The web-based modality provides a novel approach for population-wide implementation support to centres given their potential reach and consistency with existing infrastructure.

 

 

Purpose: The aim was to develop a Physical Activity (PA) policy in consultation with early childhood education and care (ECEC) providers and stakeholders. The policy included ECEC specific PA recommendations clarifying the Australian National Quality Standards for ECEC.

 

Methods: The Delphi process was used to refine the content and coverage of the policy, identify and overcome any challenges with the proposed implementation procedures and confirm best-practice dissemination and evaluation. A national expert panel working in the fields of ECEC, pre-school education, PA-related research and PA-related policy review and development were invited to participate. 123 (response 67%) participated in the first round and 89 (response 35%) in the second round Delphi survey. Items were retained if they had >70% consensus from participants.

 

Results/findings: Overall, there was consensus on the key features that should constitute an ECEC PA policy. Key statements and recommendations for physical activity and sedentary time at ECEC were reported as acceptable as were implementation strategies targeting management/supervisors/educators, the physical environment and families. 10 strategies were identified as easy to implement and likely to have a strong level of influence and (e.g., foster awareness and understanding of the policy; program a range of learning experiences encouraging and using active play; embed the importance of active play in everyday experiences; break up prolonged periods of sedentary behaviours; provide many daily opportunities for outdoor play time; make the policy available to all staff, families and visitors). Key barriers and enablers to implementing strategies at the management/supervisor/educator, physical environment and family level were identified. Best practice policy dissemination and evaluation were also confirmed.

 

Conclusions: The Delphi process enabled refinement of the content of this Australian ECEC-specific PA policy and provided expert advice of where best to target implementation strategies and how to overcome barriers. These findings along with results from educator focus groups will be used to support the successful dissemination, implementation and evaluation of the PA policy in ECEC’s across Australia.

 

 Purpose: Educators’ feeding practices can impact children’s eating behaviours and dietary intake. Family Day Care (FDC) services care for children in small, intimate environments, where mealtimes can be challenging for the sole educator responsible for preparing and feeding up to four young children of different ages and abilities. This research examined the mealtime environments and educators’ feeding practices in FDC services.

 Methods: Twenty-six full-day observations in FDC services were conducted using the Environment Policy Assessment and Observation tools in two Local Health Districts.  Seventeen best practice items for mealtime environments and educator feeding practices were coded “yes” or “no” when observed during each mealtime. SPSS was used to calculate descriptive statistics.

 Results/findings: Seventy-seven meal occasions were observed (22 morning teas, 26 lunches, 25 afternoon teas and 4 additional meals). On average, children spent 71 minutes in mealtimes at FDC. Over half the educators (15 out of 26) spoke English as their second language. The following positive educator feeding practices were observed at every mealtime: seventeen educators sat with children, ten educators encouraged children to eat healthy foods while allowing them to make their own choices and only four led or encouraged pleasant conversation. No educators were observed to role model eating healthy foods or praise children for eating healthy foods at every observed mealtime. The following negative educator feeding practices were not observed at any mealtimes: pressuring children to eat (24 out of 26), requiring a child to sit at the table until they have finished the meal (25 out of 26), television on (21 out of 26), educator using a screen device (19 out of 26) and spoon feeding a child (who was able to feed themselves) to get them to eat (12 out of 26).

Conclusions: Most educators avoided the use of negative feeding practices, apart from spoon-feeding children. Conversely, many educators were not observed using positive feeding practices at every mealtime.  Future interventions should target mealtimes as a pedagogical opportunity for developing key life skills and healthy eating behaviors through positive feeding practices and enjoyable mealtimes.

Purpose: Adhering to pregnancy-related guidelines can lead to better health outcomes for both mother and their offspring. Presently, adherence to physical activity (PA) and gestational weight gain guidelines throughout pregnancy requires further investigation. The purpose of this study was to examine the PA behaviours and weight gain patterns during pregnancy related to guideline adherence using a sample of Canadian women from the validated Electronic Maternal (EMat) Health Survey.

Methods: Using the 2019 Canadian Physical Activity Guideline (CPAG), PA guideline adherence was defined by intensity (≥2x high, ≥3x medium, or ≥4x low) and by frequency (≥3 times/week), respectively. Adherence to IOM guidelines was based on pre-pregnancy body mass index (BMI) category (underweight, normal weight, overweight, and obese class) and whether gestational weight gained was within the recommended range. Multiple logistic regression analyses were conducted using IBM SPSS ver. 24. For both CPAG and IOM guidelines, adherence was the dichotomous outcome (met, unmet) for the logistic regression analyses, wherein statistical significance was defined at p ≥ 0.05. Covariates deemed statistically significant at p ≥ 0.1 during univariate analysis were included in the regression model.

Results: A total of 1,046 new mothers with a singleton pregnancy in the last five years  were included. Women who perceived themselves as overweight before pregnancy were 30% less likely to meet the 2019 CPAG by intensity (OR = 0.70, 95% CI = 0.51 – 0.95), by frequency of exercise (OR = 0.70, 95% CI = 0.52 – 0.94), and less likely to meet IOM guidelines (OR = 0.69, 95% CI = 0.50 – 0.95) relative to women who considered their weight category to be normal pre-pregnancy. Also, women who perceived themselves as obese before pregnancy were 46% less likely to meet the CPAG by frequency of exercise (OR = 0.54, 95% CI = 0.30 – 0.99), relative to women with normal pre-pregnancy weight. Overall, nearly 75% of women failed to meet both sets of pregnancy-related guidelines.

Conclusion: The results of PA behaviours and weight gain patterns from the EMat survey suggest that most new mothers are unable to meet both sets of pregnancy-related guidelines.

Introduction: The use of classroom physical activity (CPA) is becoming more widespread, as many teachers and administrators recognize the value of providing school-day PA opportunities to their students. However, not all teachers engage in moderate to vigorous PA themselves, which may affect their attitudes toward promoting PA to their students. The purpose of this investigation was to examine teachers’ self-reported PA engagement in relation to their perceptions about CPA, the extent of their implementation of a ten-week CPA intervention, and the average PA of their students.

 

Methods: Participants included 54 teachers across five elementary schools. Teachers attended a training on CPA implementation at the onset of the ten week intervention. During this training, the short form of the International Physical Activity Questionnaire (IPAQ) was administered to assess participant PA levels. The IPAQ scoring protocol was used to calculate metabolic equivalent of task (MET)-minutes per week, which is a single estimate of the frequency and intensity of weekly PA reported by each teacher. Total MET-minutes per week was used as the independent variable in the regression models. Dependent variables included teacher-perceived educational benefits of CPA (measured via baseline survey), total CPA provided throughout the ten week intervention period (reported weekly by each teacher), and average steps over one measurement week for students in each classroom (measured via accelerometer). Multilevel modeling was utilized to account for the nesting of teachers within schools.

 

Results: MET-minutes of teacher PA calculated from the IPAQ was not associated with teacher perceptions of the benefits of CPA, the number of CPA opportunities they offered to students, or their students’ average steps in a given week over the ten week period.

Conclusions: Teachers’ reported levels of personal PA were not significantly associated with their perceptions of the educational benefits of CPA for students, the extent to which they provided CPA to students, or how many steps their students took on average, in a given week. It is potentially encouraging that the extent to which a teacher values and promotes CPA to students is not systematically associated with their own PA behavior.

 

Background: National-level physical activity (PA) and sedentary behavior (SB) policy is of vital of importance for active living. There is growing interest in studying national-level PA and SB policy. However, little is known about the actual situation of health-enhancing PA and SB policy in China. This study aimed to evaluate China’s PA and SB policy using and then conduct a content analysis on these policies.

Methods: A comprehensive search based on web was conducted to collect PA and SB policy released in and after the year of 1995 in China. Inclusion criteria (e.g., policy is national-level; policy is related to health-enhancing aspects; policy is currently valid) was established for policy selection. Of all the selected policies, the 2nd version of the Health-enhancing physical activity policy audit tool (HEPA-PAT) including 17 assessing elements was used to evaluate them. Then, a content analysis was used to analyse 1) national recommendations on physical activity levels; 2) national goals and targets; 3) surveillance or health monitoring systems; and 4) public education; 5) strategies for promoting active living.

Results: Of all the included policies (N = 37). Data showed that 25 out of 37 policies were rated over 12 points (full score is 17 points). Content analysis indicated that most policies paid sufficient attention on promoting PA (e.g., exercise, sports), but not on limiting SB. Only few policies proposed national recommendations for PA levels. National goals of the policies were relatively unspecific and focused on children and adolescents. All the policies had approaches of public education. Most strategies of policies were prioritized in promoting PA through school contexts.

Discussion and Conclusion: Comparing with other evaluative studies using HEPA-PAT, PA and SB policy in China are relatively high-quality. Nonetheless, the strategies of the polices should be clearer and more viable. However, the effectiveness of the policies in China remains unknown. PA and SB policy in China should be improved and future studies should focus on the effects of PA and SB policy on populations’ active lifestyles and health outcomes.

Purpose: Women and girls are consistently found to be less physically active than men and boys. Mass media representation has been identified as an important influence on physical activity levels, with previous research finding that traditional forms of media underrepresent women and reinforce gender stereotypes. Social media is a new, rapidly evolving form of media and a platform where women can curate their own content and chose how to represent themselves. This study sought to evaluate how women and girls are represented in physical activity in social media.

Methods: Instagram and Twitter posts were searched using key text terms and hashtag searches using a combination of physical activity search terms. Physical activity brands and influential accounts were also searched for content posted about/by women relating to physical activity. Searches were conducted in April 2019. Text, videos and images were coded qualitatively using a pre-specified coding framework using content analysis. A combination of inductive and deductive coding was used. Codes were grouped together to form themes and sub-themes.

Results: A total of 1260 posts including images, videos and/or texts were identified and analysed. A total of 39% and 45% of content posted by brands on Twitter and Instagram respectively related to women. For the key physical activity text terms, 43% and 51% of the content on Twitter and Instagram respectively related to women. The identified themes demonstrate how social media largely serves to reinforce gender stereotypes in physical activity through demonstrating femininity and sexuality over performing activities or enjoyment of activities. Posts predominantly featured white, non-disabled women with little representation of ethnic minority groups or women or girls with disabilities.

Conclusions: The findings suggest that social media serves to reinforce pre-existing gender stereotypes, largely through content posted by brands and influential accounts. Such representation may serve to dissuade women and girls from participation in physical activity. Identifying strategies and campaigns to address the representation of women and girls in physical activity are needed if we are to address gender inequalities in physical activity.

Purpose: There are many health benefits of regular physical activity. Notably, regular physical activity can improve physical fitness. Higher levels of physical fitness is protective against chronic disease. Accumulating evidence suggests the neighborhood built environment is important for supporting physical activity and health however, few studies have investigated the contribution of the neighborhood built environment to fitness levels. Our study investigated the associations between objectively-measured and self-reported neighborhood walkability and perceived health-related fitness (cardiorespiratory, muscular strength, and flexibility) in adults.

 

Methods: In August (summer) of 2018, a random cross-sectional sample of 592 adults from established neighborhoods in Calgary (Canada) completed an online questionnaire. During the online questionnaire, participants reported their perceived cardiorespiratory fitness (CRF), muscular strength (MS), flexibility, moderate-to-vigorous physical activity (MVPA), strength training, health, and sociodemographic characteristics. The questionnaire also captured participant’s perceptions of their neighborhood’s walkability (Physical Activity Neighborhood Environment Scale; PANES) and the physical activity supportiveness of neighborhood parks (Park Perceptions Index; PPI). Using 6-digit residential postal codes, participant’s households were linked to an objective measure of walkability (Walk Score®). Multivariable linear regression models estimated adjusted unstandardized beta (b) for the associations between each Walk Score®, PANES, and PPI and perceived CRF, MS, and flexibility. Models were adjusted for age, sex, ethnicity, education, household income, dog ownership, access to a motor vehicle, tobacco use, frequency of MVPA, and frequency of strength training.

 

Results: The average (SD) age of participants was 46.0 (14.7) years and 67.2% were female. Participants, on average, participated in at least 30-minutes of MVPA on 3.4 (2.1) days/week and undertook strength training 2.0 (1.8) days/week. On a scale from 0 (low fitness) to 100 (high fitness) participants, on average, reported moderate CRF (65.2), MS (64.9), and flexibility (62.3).

Adjusting for covariates, Walk Score® was not associated with any fitness outcomes. Adjusting for covariates, the PANES was positively associated (p<.05) with CRF (b=6.47), MS (b=5.15), flexibility (b=7.01) and the PPI was positively associated (p<.05) with CRF (b=3.75) and flexibility (b=4.62) but not MS.

 

Conclusions: Our novel findings suggest the neighborhood built environment may be important for supporting higher health-related fitness levels in adults.

Purpose:  To better understand the persistently low diet quality of pregnant women and their children who participated in a lifestyle intervention, the study participants’ local food environments were measured.  This is the first comprehensive assessment of food environments in the rural Lower Mississippi Delta Region of the United States.

Methods:  Food environments of 5 towns in which participants resided were measured using the Nutrition Environment Measures Survey for grocery stores, convenience stores, full service restaurants, and fast food restaurants.  General linear models were used to test for ratio score differences among food outlet classes and subclasses.  Spatial analysis was used to explore geographic clusters of food outlets and to compute distances between study participants’ residence and the closest food outlet by class.

Results:  Of the 266 food outlets identified, 11 (4%), 86 (32%), 50 (19%), and 119 (45%) were classified as grocery stores, convenience stores, full service restaurants, and fast food restaurants, respectively.  Nutrition Environment Measures Survey mean total ratio scores among the 4 classes of food outlets were significantly different from one another except for convenience stores and full service restaurants.  On average, 54%, 21%, 16%, and 8% of maximum points possible was achieved by grocery stores, full service restaurants, convenience stores, and fast food restaurants, respectively.  Seventy-five percent, 50%, and 54% of study participants lived in or adjacent to a convenience store cluster, full service restaurant cluster, and fast food cluster, respectively.  On average, study participants lived closer to convenience stores and fast food restaurants (0.4 and 0.5 miles, respectively) than grocery stores and full service restaurants (1.6 and 1.1 miles, respectively).

Conclusions:  Food outlets in the 5 Lower Mississippi Delta towns scored low on nutrition environment measures associated with healthful eating and characteristics of food deserts and food swamps were prevalent in the towns.  Behavioral interventions designed to affect positive changes in dietary habits of rural residents are needed; however, prior assessment of nutrition environments is necessary to first ascertain if environmental supports that facilitate healthful eating are present.

Purpose: The release of an updated Canadian Food Guide (CFG) in January 2019 was a big departure from previous versions which shifted the focus from food groups and servings to a visual plate with messaging around increasing plant-based proteins, choosing water as the beverage of choice, and whole grains. This study aimed to investigate how traditional media framed the release of CFG and how audiences reacted to its release on social media.  

Methods: Titles of news articles, Facebook comments, and tweets from Twitter were collected using Meltwater and manual data collection. Leximancer software conducted conceptual extraction and relational analyses on written words and visual text, which involved mapping of relationships among the themes. Human coding was completed to contextualize the content, in which nine prominent frames (food guide, impact, health, plant-focussed, who will use?, Canadian culture, food, meat, and dairy) were identified.

Results: News headlines highlighted CFG release (with changes) and alluded to potential impacts (on industry). Analysis of Facebook comments revealed that the most commonly discussed frames were health, food, plant-focussed, and meat, while the majority of the tweets were in direct reference to CFG being released, oftentimes with a link to another webpage, and discussed the overlap between health and food.

Conclusion: The analysis revealed how frames emerged from social network users that shifted the discussion away from CFG release and impact (e.g., industry) to the influence of health and food and a plant-focussed vs. meat debate. As evidenced by the framing on social media, people are aware of the link between food and health, yet misinformation abounds. 

Purpose: Few studies have investigated whether or not associations between neighbourhood characteristics and physical activity differ for men and women. The main purpose of this study was to estimate associations between perceived neighbourhood characteristics and physical activity among Canadian adults.

Methods: This study included cross-sectional survey data obtained from urban participants enrolled in ‘Alberta’s Tomorrow Project’ (Alberta, Canada; n=14,078), a longitudinal study. The survey included socio-demographic items as well as the International Physical Activity Questionnaire and the abbreviated Neighbourhood Environment Walkability Scale (NEWS-A). Subscale and overall walkability scores were generated from NEWS-A responses. Adjusted generalized linear models estimated the associations of participation and minutes of different types of physical activity, including transportation walking (TW), leisure walking (LW), moderate-intensity physical activity (MPA), and vigorous-intensity physical activity (VPA) with walkability scores. Results were expressed as odds ratios (ORs) for participation and beta-coefficients (βs) for minutes and their 95% confidence intervals (CIs).

Results/findings: Approximately 61% of the sample participated in TW or LW, 29% in MPA, and 33% in VPA. Overall walkability was positively associated with participation in TW (OR 1.05; CI 1.04, 1.06), LW (OR 1.03; CI 1.02, 1.04), MPA (OR 1.02; CI 1.01, 1.03), and VPA (OR 1.02; CI 1.01, 1.03) and minutes of TW (β 1.41; CI 0.43, 2.40), LW (β 1.01; CI 0.08, 1.94), and VPA (β 1.37; CI 0.39, 2.35). Among men, street connectivity was negatively associated with VPA participation (OR 0.98; CI 0.97, 0.99), and crime safety was negatively associated with VPA minutes (β -10.58; CI -19.69, -1.46). Among women, pedestrian infrastructure was positively associated with LW participation (OR 1.03; CI 1.02, 1.04), and overall walkability was positively associated with VPA minutes (β 2.05; CI 0.94, 3.16). Notably, overall walkability was positively associated with LW participation among men (OR 1.005; CI 1.002, 1.008) and women (OR 1.009; CI 1.007, 1.01).

Conclusions: Perceived neighbourhood characteristics are associated with participation and time spent in different physical activities among Albertan adults. Interventions designed to modify perceptions of neighbourhood characteristics might affect initiation or maintenance of different types of physical activity.

Background: Public health food guidance could help shape adolescent dietary behaviors. However, food and nutrition-related terms are likely inconsistently defined and understood among adolescents. Investigating these concepts among adolescents may elucidate how best to communicate them. Objective: Assess how adolescents define terms commonly used in the health and nutrition field. Methods: This was a qualitative study conducted with 21 adolescents (12.05±1.32 years old, 57.1% male) from Houston, USA. Telephone interviews were conducted in a private office. Semi-structured questions and prompts were developed by the research team and content was informed by a literature review and the Dietary Guidelines for Americans. Script questions were pre-tested with five staff members from the research center and revisions were made as necessary. The script was divided into: demographics, terms, description of someone (un) healthy, and ratings. Interviews were digitally recorded and transcribed verbatim. Hybrid thematic analysis was used to code and analyze data by three independent trained qualitative researchers. Findings: Adolescents defined "healthy" in terms of wellness-type behaviors related to diet, physical activity, and body weight. Adolescents' ratings of their personal health varied from "not healthy or unhealthy" to "healthy" just based on their diet and physical activity behaviors. Examples of healthy individuals were specific persons (e.g., parents) or someone engaged in a particular profession (e.g., athlete) or being active. Examples of unhealthy individuals included specific persons (e.g., siblings) or someone engaged in unhealthy lifestyle behaviors (e.g., unhealthy diet and physical activity). Most adolescents reported that healthy individuals should eat a healthy diet and be active. Few mentioned adequate sleep or weight status. Clear descriptions for healthy and unhealthy foods were provided, while energy-dense, nutrient-dense, and processed foods adolescents struggled to define. Fast-foods and junk-foods were identified with non-health benefits, except for being convenient and tasty. Natural and organic foods were used as interchangeable terms with health benefits. Conclusion: Adolescents have a limited understanding of common health and nutrition-related terms. National dietary guidelines should use terms that are easily understood by adolescents. More comprehensive research is needed in this regard.

Purpose: Nutritional warnings are being adopted in many countries in Latin America to enable citizens to identify food products with excessive content of nutrients associated with non-communicable diseases. The efficacy of this public policy is expected to increase if it is accompanied by a communication campaign that raises awareness of the existence of nutritional warnings and encourages citizens to use them when making their food choices. In this context, the aim of the present work was to use a co-creation approach to design a communication campaign to promote the use of nutritional warnings in Uruguay.

Methods: Three online studies involving a total of 2190 participants were conducted. In the first study, a qualitative approach was used to select the key contents, phrases and images to be included in a communication campaign. In the second study, a quali-quantitative approach was used to explore how citizens perceived a series of expressions. Using results from the first two studies, a series of graphic pieces were created and tested in the final quantitative study.

Results: Participants provided valuable insights for the design of the communication campaign, which were in line with the health belief model. The developed graphic pieces were positively perceived by participants. Pieces stressing promotion informed choices, emphasizing the negative consequences of excessive consumption of sugars, fat and sodium or promoting healthy eating did not lead to differences in participants’ behavior in a simulated choice task.

Conclusions: Results from the present work suggest that an effective communication campaign to promote the use of nutritional warnings should include three main elements: position warnings as a cue to action for changing eating habits, increase the perceived risk of excessive consumption of sodium, fat and sugar, and emphasize the health-related benefits of using the warnings for making food choices. 

 

Objective:                    Fast-food restaurants have received some positive attention in recent years for introducing healthier menu items. However, fast food remains generally high in calories, fat, sugar and salt, and the extent to which the nutrition profile of fast-food restaurant menus has changed in advance of national menu labeling in the US is unknown.

                                   

Methods:                     We use data from 2,472 food items on the menus of 14 top-earning burger fast-food chain restaurants in the US, available from 2012-2016. Data were obtained from the MenuStat project and analyzed in 2019. The Nutrient Profile Index (NPI) scores were estimated and used to categorize foods as healthy (≥64/100). Generalized linear models were used to examine mean NPI scores and the proportion of “healthy” menu items among items offered in all years (2012-2016) and items offered in 2012 only compared to items newly introduced in subsequent years.

Results:                       Overall, less then 20% of menu items were classified as healthy with no change from 2012-2016 (p=0.91). Mean NPI score was relatively constant across the study period among all food items (≈50 points, p=0.59) and among children’s menu items (≈56 points, p=0.73). The only notable change in NPI score or in proportion of healthy items was in the direction of menu items becoming less healthy. NPI scores for appetizers and sides newly introduced in 2015 were 13.69 points lower than appetizers and sides on the menu in 2012 only (p<0.001) and appetizers and sides introduced in 2016 were 9.13 points lower than 2012 items (p=0.02).

 

Conclusions:               Top burger fast-food restaurants have not improved the nutritional profile of the items on their menus overall, among core menu items, among newly introduced items, or on children’s menus. To make positive changes, restaurants will have to make larger changes to the nutritional composition of the foods they offer.

Objective: A currency devaluation influences food prices and populations’ diet, especially in developing countries and within poorer households, resulting in the consumption of cheaper, and therefore often lower quality diets. Reduced consumption of high-quality foods restrains the protective health benefits of these foods towards the incidence of NCDs, and increases the risk of micro- and macronutrient deficiencies among populations that are already subject to food and nutrition insecurity. Despite global evidence of higher food prices directly affecting populations’ health status, and as such possibly jeopardizing economic performance and rural development, there has been no research conducted on the effect of rising food prices on food intake in Suriname yet. As such, the objective of this study was to assemble primary food consumption data, with respect to pre-and post-devaluation food intake patterns of Surinamese households. This with the goal to report changes in post-devaluation dietary intake, in order to better comprehend the future implications for health, facilitating evidence-based policy development and nutrition intervention planning.

Results: Higher food prices resulted in low, - middle - and high-income groups increasing the expenditures on food (p <0.01). Reductions in the proportion of households’ significantly lowering the post-devaluation intake of high-quality foods, such as fruits, vegetables, lean meat and fatty fish were observed (p<0.01). Furthermore, changes in the intake of low-quality foods were witnessed as well, with proportions of households significantly reducing the intake of discretionary foods and terminating eating out-of-home (p <0.01).

Conclusion: The fall of the Surinamese currency, in combination with country’s dependency on imported foods, increased local food prices and with salaries remaining the same, resulted in both lower- and higher- income households increasing their food expenditures. Post-devaluation changes in regular dietary pattern and food intake enrolled, with a significant reduction in the consumption of high-quality foods being noticed, especially within lower-economic households. On the one hand, significant proportions of Surinamese households possess a decreased probability of consuming healthy diets. On the other hand, households with also a significant reduction in the intake of low-quality foods might encounter a beneficial health impact if already coping with overweight and related non-communicable diseases.

Keywords: Food price rises, nutrition, Food consumption, LMIC

Purpose

Ample research on factors associated with sedentary behaviour (SB) in Australia, North America and Europe exist. SB correlates in diverse Asia have received less attention. In this review, we aimed to identify multilevel correlates of SB in Asian adults. 

Methods

We conducted a systematic search in nine databases using terms related to SB, correlates and Asia. We included studies that were observational and used quantitative methods to examine correlates of total and domain-specific SB in Asian adults living in Asia; no language restrictions were set. Two reviewers conducted title, abstract and full-text screening independently. We extracted study characteristics, correlates studied and SB outcomes from included studies. Due to study diversity, we employed narrative syntheses to summarise the evidence on individual, physical environment, social environment and political/cultural correlates of total and domain-specific SB (PROSPERO ID: CRD42018095268).

Results

Of 13249 papers screened, we included 49 cross-sectional studies from 12 countries. Most were from East Asia (n=28), followed by the Middle East, South-East Asia and South Asia, with four including mixed samples. The majority assessed total SB (n=31), eight used accelerometers. Screen-time, leisure-time SB, transport-related SB and occupational SB were studied less often. Researchers examined 118 correlates, with 75% of studies investigating individual factors. Increasing age and education were positively associated with total SB, while higher income was associated with more leisure-time SB. Physical environment correlates were examined in 23 studies, mainly from East Asia. Living in an urban area and a higher number of transit points in the neighbourhood were positively associated with SB, but only in East Asia. Social environment correlates featured in 19 studies. Being unmarried was associated with increased total SB; this was especially apparent for females in the Middle East. Only two studies investigated policy and culture-related correlates.

Conclusions

Increasing age, higher education and income were associated with SB across Asia.  We recommend the following: conduct studies in lower- and middle-income countries; investigate psychological, (micro-) environmental, policy and cultural factors; conduct longitudinal research; use validated tools to measure SB.

 

Purpose: To investigate the extent to which food taxes lead to changes in demand of food substitutes (e.g., from unhealthier to healthier alternatives within food-groups). Additionally, we aimed to investigate substitutions from name-brand to home-brand alternatives and differential effects by household income level.

Methods: Data from a virtual supermarket experiment were used, wherein 1,038 adults completed at least one of five weekly grocery shops, with 4,259 observations in total. Each shopping occasion was randomly allocated to control or one or more pricing options. Food groups were constructed by classifying products within food categories (e.g., grains and snacks) into low, medium or high sugar, sodium or saturated fat content (e.g., low sugar snacks, medium sugar snacks and high sugar snacks) based on recommendations. Outcome measures included the change in food purchases within food-groups due to changes in own or close substitutes’ price, measured as a price elasticity of demand for the full sample and by income groups. Analyses were conducted using the Almost Ideal Demand System model.

Results: Preliminary results show that as prices increased, demand for the taxed products declined (albeit with greater declines among the foods with low/medium levels of unhealthy nutrients compared to those with high levels). Cross-price elasticities within food-groups consisted of mainly complementary effects, but also some substitution effects. For example, a 10% increase in price of high sugar snacks was associated with a 1% and 10% decrease in purchases of low and high sugar snacks and a 2% increase in purchases of medium sugar snacks. Also, if the price of name-brand beverages increased by 10%, purchases of home-brand beverages fell by 1% and vice versa. Price elasticities were only slightly higher for low-income compared to high-income participants.

Conclusion: Contrary to our hypothesis, price increases on foods high in unhealthy nutrients mostly did not lead to substitutions with healthier foods. Given the relatively low own-price elasticities of food-groups high in unhealthy nutrients, policies involving relatively high taxes and broad base taxes would be needed to decrease overall unhealthy food purchases and consumption.

Purpose

Findings on relationships between sitting time at work and cardio-metabolic risk are mixed. We examined associations of occupational sitting time with adiposity measures for workers in office and non-office settings.

 

Methods

Data were from 6146 full-time workers in the 2014–15 Australian National Health Survey, categorised into those who mostly sit in office settings (office sitters, n=2705), who mostly sit in non-office settings (non-office sitters, n=523) and who mostly stand, walk or engage in physical labour at work (‘others’, n=2918) based on occupation group and predominant work activity. Linear regression models examined associations of measured waist circumference and body mass index (BMI) with self-reported time spent sitting at work for each of the three groups, who were further stratified by gender and physical activity level.

 

Results

Longer sitting time at work was associated with greater waist circumference in office sitters: one additional hour/day of sitting was associated with 0.40 cm greater waist circumference (95%CI: 0.03, 0.78; p=0.037). However, the relationship was not significant for non-office sitters nor for ‘others’. Gender-specific analyses among office sitters found significant sitting-time associations with waist circumference in men but not in women. Stratified analyses also found significant associations in those with <150 min/week of leisure-time physical activity but not in sufficiently active office sitters. For BMI, no significant associations were found for any groups.

 

Conclusions

We found differential associations of workplace sitting with waist circumference across work settings. Occupational sitting was detrimentally associated with waist circumference in office workers (particularly men and those with insufficient leisure-time physical activity) but not in non-office workers. Possible explanations include different ways sitting time is accumulated during work hours between subgroups who may differ in job autonomy and in physical and social work environments. Further research is needed to better understand how associations of workplace sitting with adiposity may be related to differences in occupation and workplace contexts and why occupational sitting can be associated with abdominal adiposity but not with BMI.

 

Purpose:

The Esports market is a fast-growing industry worldwide, including in Hong Kong. Newzoo, the global leader in Esports, games, and mobile intelligence in 2017 estimated the Esports’ economy would have a year-on-year growth of 41.3%. Responding to the rapid development of Esports, the Hong Kong Policy Address of 2017/18 described Esports as “a new sector with economic development potential”. While reviewing Esports related literature, only a few studies in Hong Kong were open to the public. Existing study gaps were identified, including unrepresentative sampling, not theory-based, not in individual perspective (i.e. determinant of participating in Esports), and not data-driven. The current study aims to collect data on the participation in, recognition of, as well as attitude towards Esports in secondary school and university students as well as the general public.

 

Method:

This study will adopt the mixed-methods sequential explanatory design, consisting of two distinct phases: qualitative study followed by a quantitative study. Regarding the determinants of students participating in Esports, a pilot qualitative study through interview will first be conducted. This interview data together with the Theory of Planned Behaviour (TPB; Ajzen,1991) the construct will be used to develop the instruments of the quantitative study. The TPB construct includes the elements of behaviour, intention to participate, attitude, subjective norms and perceived behavioural control. The determinants will be revealed through Structural Equation Modelling, in which approximately 1600 sample size is required. Senior form secondary schools students will be invited using stratified random sampling according to the 18 districts, and the university students will be recruited randomly from the 8 Government-funded universities. Moreover, a tele-survey with a sample size of 1551, targeting Hong Kong Chinese general public aged 15 or above, will be used to examine the public’s understanding of Esports. The survey items include but not limited to their understanding, perception and attitude towards the governance structure and development of Esports.

 

Conclusion:

The results of this study will help identify the determinants of students’ participation in Esports. It will also identify the possible health problems induced by intensive participation in Esports and recommend measures, supporting system, and policy for regulating its development among students in Hong Kong.

Purpose: Evidence to support the effectiveness of moderate-to-vigorous-intensity physical activity (MVPA) on weight management is well established in the literature. However, few studies have examined the relationship between light-intensity physical activity (LPA) and obesity. This study intends to examine the relationship between LPA and central and general obesity among children and adolescents.

Methods: In 2013, a cross-sectional study was conducted with 19 ,848 children and adolescents between the ages of 6 and 18 from seven provinces in China. Height, weight, and waist circumference were measured objectively. The time of LPA and MVPA over the preceding seven days were collected using the questionnaire modified according to short last 7-day self-administered International Physical Activity Questionnaire. The Chi-square test and logistic regression analysis were conducted.

Results: After controlling for covariates, children and adolescents who were active in LPA had a lower risk for central obesity (OR = 0.885, 95% CI: 0.797–0.982, P = 0.022) and a marginally lower risk for general obesity (OR = 0.924, 95% CI: 0.843–1.014, P = 0.095) compared with those who were inactive in LPA independent of MVPA. Children and adolescents with inactive MVPA showed a lower risk for central obesity or a marginally lower risk for general obesity if they were active in LPA compared with those who were inactive in either LPA or MVPA (OR = 0.843, 95% CI: 0.728–0.976, P=0.022, for central obesity; OR = 0.893, 95% CI: 0.784–1.107, P=0.087, for general obesity).

Conclusions: LPA independent of MVPA is inversely associated with obesity among children and adolescents. Participating in active LPA may exert an important role in the prevention of adiposity, especially for those who are inactive in MVPA, which deserves further investigation and calls for formulating the recommendation time for LPA. Future longitudinal research that will focus on the effects of LPA on adiposity is required to verify this finding.

Purpose: Physical activity levels decline as students transition from high school to university. This is coupled with an increased prevalence of mental health concerns in student populations, which could be attenuated by regular physical activity. Universities represent a unique setting to promote physical activity and have potential to reach a high proportion of students. This research aimed to explore the experiences of students as they transitioned from high school to university and to identify barriers and facilitators to physical activity during this period.

Methods: Focus groups and individual interviews were held with inactive first year students and university stakeholders, including lecturers, health promotion staff, mental health practitioners, disability officers, and physical activity practitioners (n = 30). Focus groups and interviews were audio recorded and transcribed. Transcriptions were coded qualitatively using thematic analysis. Codes were grouped together to form themes and sub-themes.

Results: The school to university transition was identified as a major life event for young people requiring adjustment to a new environment and culture, often away from family and friends. Students were largely positive about their experiences of the transition, however most students felt that coming to university had negatively impacted their physical activity levels and other health behaviours. A range of barriers and facilitators to physical activity at the individual, social, community and environmental level were identified. Students with mental health issues, disabilities, from low income backgrounds, and from ethnic minority groups were identified as being particularly at risk of physical activity declines. Potential strategies to address the barriers and build on physical activity facilitators were proposed.  

Conclusions: The findings highlight the complex and unique experiences of students as they transition to university and the need to develop interventions that support students to maintain positive health behaviours during this period. Services and environments that are inclusive and accessible were identified as central to enabling physical activity, with an identified need for strategies that effectively target students at greater risk of physical inactivity.

 

Purpose: Advancement of technology has allowed employees to shift from working in a traditional office space to working in their residence. However, the long-term effects of transitioning the workforce from maintained and regulated offices to a home environment are unknown. This purpose of this exploratory study was to assess the baseline differences in sedentary behaviors in home office workers and those in a traditional office setting.

 

 

 

Method: This longitudinal cohort study took place from March – June 2019 in Central Texas, United States. Traditional office workers were recruited from a university population of administrative personnel. Members of the community who worked from their residence full-time were recruited to represent the remote working cohort. Participants were asked to wear an activPAL accelerometer to collect total time sitting/lying, time standing, step count, energy expenditure, and sit-to-stand transitions for five consecutive days during their work week. A repeated measures ANOVA was performed to compare the traditional office and home office cohort during traditional working hours (9:00 am- 5:00 pm) and the 24-hour day.

 

 

 

Results: The daily totals of time sitting/lying, standing, and stepping were not statistically different between the home office and traditional office environment. Energy expenditure of traditional office employees and individuals working from home was not statistically significant. When the data was restricted to traditional working hours, time sitting/lying, standing, and stepping in the traditional office environment and the home office did not significantly differ between traditional office workers and home office employees. Total step count and total energy expenditure also did not statistically differ and neither group met recommendations for daily movement.

 

 

 

Conclusion: This study suggests that with the transition of the work environment from commercial office buildings to private residences, it is important to continue to encourage physical activity for computer-based workers regardless of their physical location. Ergonomists and employers should be sure to design for movement and ergonomics. It is mutually beneficial for companies to educate their workers on the benefits of reducing sedentary behaviors and providing resources and equipment to encourage this throughout the workday.

 

Purpose: Limited progress in nutrition policy action is often blamed on the close relationships the food industry has with health policy decision-makers. This analysis sought to examine this belief through the analysis of health ministers’ and other key ministers’ diaries.

Method: Six years’ of diary entries were downloaded from fourteen different ministers’ diaries in two states in Australia. A coding framework was developed based on initial data. It classified interest groups into four broad categories: advocacy, business, university or general business, as well as the professional focus of the organisation meeting with the minister, for example, bank, food company, cancer organisation. In addition, any meeting topics related to nutrition policy were identified. The coding framework was applied to the diary entries (n = 23,790). A descriptive analysis was then undertaken.  

Results: Analysis of health ministers’ diaries found that the food industry had limited documented interaction with the two state health ministers; however  they had a much higher level of interaction with other more senior ministers. For health ministers, medical associations, private hospitals and health services, and sporting associations (rugby league associations) had the most interactions. Poor representation was seen on nutrition issues, and there was an apparent lack of nutrition advocates interacting with the health and other ministers.

Conclusion and recommendations: There are opportunities for nutrition advocates to increase their level of interaction with state ministers. This could include building alliances with medical associations, as they are in a powerful position, to advocate directly to health ministers. It could also involve targeting other, more senior ministers. Ministers’ diaries can provide valuable insights into who is meeting officially with ministers. However, there are also limitations with this type of dataset.

Purpose: To determine how rural and urban schools differ in their school wellness policy writing and implementation. Results can inform large-scale interventions addressing the rural/urban obesity disparity.

Methods: Schools from eight states participated in this cross-sectional study during the 2016-2017 academic year. Written district wellness policies were assessed for strength and comprehensiveness using the Wellness School Assessment Tool (WellSAT). Schools from within participating districts had key informant interviews to assess wellness policy implementation using the Wellness School Assessment Tool Interview (WellSAT-I). Regression analyses were used to examine the relationship between wellness policy writing and implementation and rural/urban location while controlling for percent of non-white students and percent free and reduced price lunch within schools. Ultimately, 95 schools were included in analyses.

Results: The majority of schools (n=63) were elementary and enrollment among all schools ranged from 40 to 1,916 students. Approximately half of all students were non-white and over 60% received free or reduced lunch. Of the 95 total schools, 62 were located in city or suburban areas (65%). A number of rural/urban differences were seen in both the written quality scores and implementation of each item examined. Of the 56 written items examined, approximately 70% (n=39) differed. There were differing items in each of the five WellSAT sections, and of the 37 items that differed, approximately one-third (n=13) were higher (better) scores among rural schools. Of the 56 implementation items examined, approximately 50% (n=29) differed. There were differing items in each of the five WellSAT-I sections, and of the 29 items that differed, only 4 items were scored higher (better) among rural schools.

Conclusions: A striking number of differences in the writing and implementation of school wellness policies exist between rural and urban schools, with rural schools generally having worse scores. Written policy quality could be improved in both settings by using a standard template that includes all federally required information plus best practices. Supports for implementation should be explored, focusing on potential differences between rural and urban schools.

Purpose: School districts that participate in national meal programs are required to have a school wellness policy.Previous studies examining the relationship between written policy quality and the degree of policy implementation have drawn inconsistent conclusions, which may stem from differences in the items within the assessment tools formerly available. Therefore, the purpose of this project was to assess the relationship between the quality of written school wellness policies and the degree of policy implementation using matched tools.  Results can be used to inform strategies to support school wellness efforts.

 Methods: Written policy quality and degree of policy implementation were assessed in this cross-sectional study using the Wellness School Assessment Tool 2.0 (WellSAT 2.0) and the WellSATInterview (WellSAT-I), respectively, in 95 schools from eight states. Fifty-six items were matched between the tools and used for data analysis.  Linear regression was used to examine the relationship between written policy quality and implementation. The frequency of schools that were writing and implementing, implementing but not writing, writing but not implementing, and not writing and not implementing was calculated for each matched item. ​

 Results/Findings: There was no overall relationship between written policy quality and the degree of policy implementation. Out of the 56 matched items, three were positively related. For 31 of 56 items (55%), the majority of schools were both writing and implementing. For 21 of 56 items (38%), the majority of schools were implementing but not writing. There were three items (5%) that schools predominately wrote about but did not implement (there is a school garden; elementary school students receive at least 150 minutes/week of PE; and there is a clear evaluation plan to assess wellness policy implementation at the school building level). Only one item (2%) was predominately neither written about nor implemented (there is a school-level wellness committee). ​

 Conclusions: Methods of support are needed to aid districts in writing policies that are comprehensive of the efforts taking place at the school level and to aid schools in utilizing the written policy to guide school wellness efforts that are a priority for implementation. ​

Purpose: More Australians than ever are living in apartments (currently 2.3 million) and this is a key response to housing Australia’s growing urban population. Apartments are often much smaller than traditional detached houses, and the shift to apartment living brings lifestyle changes for many occupants. Many of the health implications of living in apartments remain under-investigated. Specifically, while food practices (the purchasing, preparation and consumption of food as well as broader factors such as meal planning, cooking skills, and socialising) play a vital role in the overall well-being of the population, the interrelations between apartment living and food practices remains unknown. We sought to explore apartment living and its influence on food practices.

Methods: We conducted a pilot study in 2019 to explore how apartment living influences food practices in Melbourne, Australia using photo-elicited qualitative interviews (Deakin University Human Ethics Advisory Group approval HEAG HEAG-H 118_2019). Four suburbs within 8km of the CBD were selected and these neighbourhoods represented a mix of both high and low socioeconomic status (SES) areas. Random addresses within these neighbourhoods were mailed invites and subsequently 12 participants were chosen for interviews. Basic thematic analysis was undertaken on the interview transcripts.

Results: Preliminary evidence suggests that the higher levels of commercialisation in areas where apartments are located may make it easier to access food of all types. When purchasing food for home, restrictions on the amount and type of groceries that were purchase were evident. These included the inability to carry or transport items, limited storage space within the apartment, and restrictions of what they could cook. This latter point was due to the size of the preparation space, ability to own (due to storage) particularly cooking equipment, and issues related to both ventilation and internal smoke alarms.

 

Conclusion: With apartment living becoming more prevalent in Australian cities, it is timely to observe the potential impact of this shift on food practices. Food practices play a vital role in the well-being of the population but there is limited guidance about the ways apartments should be designed to encourage healthier food practices.

Purpose: Competitive food and beverage policies (“CF&B policies”) have been adopted to help prevent childhood obesity. However, few studies have examined their influence on obesity among high school students. The purpose of this study is to investigate whether California’s CF&B policies influenced overweight/obesity trends among high school students and whether those effects varied by race/ethnicity.

 

Methods: Using statewide California data from 9^thgrade students in public schools along with a quasi-experimental design, gender-stratified multilevel logistic models estimated trends in overweight/obesity between the periods before 2002-2007 and after 2008-2012 the California CF&B policies took effect and assessed whether those trends differed by race/ethnicity. Models were adjusted for student-level variables (age, race/ethnicity, physical fitness), school-level, and school neighborhood socioeconomic factors.

 

Results/findings: Before the policies were enacted (2002-2007), obesity was significantly increasing among both boys and girls and across all race/ethnic groups. In the post-policy period (2008-2012), overweight/obesity declined over time among boys of all racial/ethnic groups though the decline was not significant among Asian students.  Obesity was no longer significantly increasing for Asian, African American and White girls, and showed slight, though non-significant, annual declines among Latina girls. The association between the policies and overweight/obesity varied significantly by race/ethnicity. Asian girls experienced the largest change in the overweight/obesity trends, followed by Latinx, White and African American girls. Among boys,Latino children saw the largest change in overweight/obesity trends, followed by African Americans, Asians and Whites.

 

Conclusions: In California, CF&B policies are associated with favorable changes in population-level overweight/obesity prevalence among students in high schools, with differences in the magnitude of those improvements by race/ethnicity. Policies to regulate junk food and sugary drinks in schools may be an effective strategy to prevent obesity among students in high schools. Examining the joint role of policies to modify the food environment within and outside, but near, schools may provide additional strategies to fully reverse the obesity epidemic.

 

Purpose: It has been hypothesized that one of the reasons children, particularly girls, may not be active at school is due to the impracticability of their school uniforms. Within Australia most schools require children to wear traditional uniforms, that is, leather shoes with shirts and pants for boys, and a dress, tunic or skirt and shirt with leather shoes and socks or stockings for girls This study aimed to assess Australian primary school principals’, teachers’ and parents’ attitudes to changing school uniform policies which require students’ to wear traditional uniforms to allow students to wear sports uniforms every day, and to assess associations between participant characteristics and attitudes to uniform changes. A secondary aim was to identify principals’ and teachers’ perceived barriers to uniform changes.

 

Methods: Cross-sectional surveys of principals, teachers and parents of children in grades 2-3 (age 7-10) from 62 primary schools within the Hunter New England region of New South Wales, Australia (October 2017-March 2018). Mixed logistic regression at the school level measured associations between participant demographics and attitude to uniform changes.

 

Results: Seventy three percent of principals (38/52) reported that their uniform policy only allowed children to wear a sports uniform on sports days. Thirty-eight percent of principals (18/47), 63% of teachers (334/579) and 78% of parents (965/1231) reported that they would support the adoption of a school uniform policy that allowed children to wear a sports uniform every day. The most commonly reported barriers to change were school status and the perception that sports uniforms were not appropriate for formal occasions.

 

Conclusion: Although the majority of principals were not supportive of a change to sports uniform every day, the majority of teachers and parents were. Given the low prevalence of children, particularly girls, meeting physical activity guidelines and the decline in physical activity as children age allowing students the opportunity to wear more activity friendly uniforms may be worth investigating as an inexpensive and scalable strategy in achieving population level improvements in children’s physical activity.

 

Purpose: Car use is endemic in Australian cities. Time spent sitting in cars has been associated with cardiometabolic risk, including overweight and obesity. Less is known about whether active transport, such as walking, may protect against adverse associations between car time and adiposity. We examined whether walking for transport moderates associations between car time with adiposity. ​

Methods: Data from 4,223 adults from the third wave of the AusDiab study (55% women, mean age: 62.8±10.8 years) were analysed. Car time (min/day) was calculated from reported previous week duration and frequency of car use. Walking for transport (yes/no) was based on reported frequency in the previous week. Body mass index (BMI) and waist circumference were measured by trained assessors. Linear mixed models, adjusted for socio-demographic characteristics and leisure-time physical activity, assessed associations between car time with waist circumference and BMI, stratified by walking for transport.

Results: Only 29.3% of participants reported any walking for transport in the previous week. These participants had slightly lower car time (mean±sd=53.0±51.6 min/day) than participants who did not walk for transport (mean±sd=56.9±59.5 min/day). Among those who did not walk for transport each additional 30 minutes/day of car time was associated with 0.40 cm greater waist circumference (95% CI: 0.16, 0.64 cm) and 0.12 kg/m2 greater BMI (b=0.12; 95% CI: 0.02, 0.22). For those who reported walking for transport, associations with waist circumference (b=0.10; 95% CI: -0.31, 0.51) and BMI (b=0.08; 95% CI: -0.08, 0.24) were not significant.

Conclusions: For the majority of participants who did not report any walking for transport, longer durations of car use were adversely associated with waist circumference and BMI. However, the magnitude of these associations was smaller and not statistically significant in participants who reported some transport-related walking. Within this car dependent population, even occasional walking for transport may be beneficial. Further research is needed to quantify the amount of walking required to offset health risks from sedentary car time.

Purpose: Policy, systems, and environmental (PSE) approaches are a growing strategy to reduce obesity in rural communities where health disparities related to poor nutrition and physical inactivity are prominent. These approaches are extensive and multifaceted; therefore, it is challenging to evaluate the impact of PSE strategies due to the complexity of the work. Although many PSE studies employ process evaluations, novel approaches to evaluate health outcomes related to behavior change are needed. 

Methods: A prospective cohort study was initiated to evaluate individual behavior change in response to a series of PSE strategies in a rural, Appalachian county in Kentucky (obesity >40%). Validated survey instruments were used to develop a survey assessing dietary practices and active living behaviors. Participants completed a baseline survey and will be re-administered annually for the next four years. 

Results/Findings: In fall 2019, residents were invited to participate through social media, flyers, and sampling at community events. Of 177 invited adults, 152 participated (85.9% participation rate), with 65% being women (n=99). Participants’ mean age was 54.7 years (Standard Deviation (SD) 15.3; range 22-84), with mean BMI of 34.0 kg/m² (SD 9.2; range 14.7-69.0), and 67% (n=101) classified as obese. Overall, 43.4% have less than a high school education, 60.4% reported annual household income <$20,000, and 29.1% of participants conveyed food insecurity. Among participants, 46.7% do not feel they eat as many fruits/vegetables as they need, with 41.4% reporting eight or fewer servings of fruit and 62.5% reporting eight or fewer servings of vegetables (besides potatoes and lettuce) in the past month. For physical activity, 82.8% reported no vigorous-intensity activities within the past week, while 68.4% reported at least 10 minutes of continuous moderate-intensity activity. 

Conclusion: Baseline findings reveal there is ample opportunity for outcome improvement. The establishment of this cohort allows for longitudinal assessment of nutrition and physical activity patterns in a rural Appalachian environment. Additionally, it provides a unique opportunity to examine the multitude of impacts on individual-level health behaviors as a result of community-level PSE approaches to reduce obesity.

Purpose

The paper highlights the importance of integrating perspectives of consumers, markets, and governmentsin public health research and intervention development. 

We illustrate this by a project in Vietnam, where salt reduction is important due to current high salt consumption (±10 g/day). Salt, Bot Canh and fish sauce constitute ±70% of dietary sodium consumed, which provides ample opportunities for interventions. 

The project aims were to develop a sodium-reduced fish sauce and to assess consumer sensory acceptability, market feasibility and the cost effectiveness of introducing salt substitutes. 

 

Methods

Different studies and methods were applied

- Product development and consumer testing providing manufacturer and consumer perspectives:

A sodium-reduced fish sauce was developed with a salt substitute (potassium salt). Foods and meals with salt substitutes will be tested in a consumer sensory test. 

- Feasibility study providing market and government perspectives: 

Semi-structured interviews (n=20) were held with market stakeholders (e.g. manufacturers, retail) and government stakeholders (e.g. federal/local government)

- Cost effectiveness study to inform government:

A health economic cost-effectiveness model was built for three scenarios: 1) no government intervention: voluntary introduction of salt-substituted products 2) government subsidies 3) government regulation allowing only low-sodium varieties

 

Findings

- Product development and consumer testing:

Preliminary findings demonstrate it’s possible to develop a 35% sodium-reduced fish sauce while maintaining microbial safety and essential features. Consumer acceptability and sensory properties of salt-substitutes foods will be presented. 

- Feasibility study: 

The interviews highlighted current consumer and market trends, drivers and barriers for salt substitutes and sodium-reduced foods in Vietnam, expectations of different stakeholders, and parallels with iodine fortification. 

-Cost effectiveness study: 

The model shows all three scenarios are cost saving, the government regulation strategy being the least costly and most effective. This demonstrates population sodium reduction interventions aimed at lowering blood pressure are cost-effective in Vietnam.

 

Conclusions 

The Vietnam project provided proof of principle and a roadmap for introducing salt-substitutes as a sodium-reduction strategy. It shows the possibilities and advantages for both Vietnamese consumers, markets and government. Overall, we recommend that public health research and intervention development focuses more on multiple perspectives to better advance health impact and implementation. 

Purpose: Obesity often begins early in life, with many children entering school already overweight or obese. Accordingly, a leading grant-maker funded multiple grants aimed at reducing early childhood obesity (RECO) in Los Angeles County, California. RECO adopted a wide variety of innovative strategies (nutrition education, media campaigns, financial incentives, changes to physical activity environments, policy changes), focusing on low-income communities. Over 1,000 activities took place in different communities and at different times over six years (2011-2017). This study capitalizes on variations in strategy, timing, and location of the RECO activities and has two goals 1) describe the RECO strategies used to target early child obesity in communities across Los Angeles County and 2) assess the community-level impact of these strategies, individually and combined.

Methods: The study team gathered data on RECO activities and their timing and location through review of documents and interviews with organizations implementing RECO activities. Activities were then categorized into four obesity reduction strategies based on those identified by the Centers for Disease Control and Prevention (CDC). Census-tract level child obesity data (n=1,223 census tracts) were aggregated from the Public Health Foundation Enterprises (PHFE) Women Infants and Children (WIC) administrative data. A Comparative Interrupted Time Series analysis approach was used, comparing trends in outcomes before and after a specific RECO activity was implemented within a community, as well as trends across other communities in Los Angeles County not affected by the activity.  

Results:  Descriptive analyses demonstrated that RECO activities adopted all four strategies; the strategy of supporting healthy food and beverages was used across the most census tracts. Impact analyses revealed that RECO as a whole significantly reduced early childhood obesity rates by .59 percentage points in communities where RECO activities occurred.  RECO activities that encouraged breastfeeding and those that encouraged communities to organize for change significantly reduced early childhood obesity, but impacts of the different strategies were not significantly different from each other. There were also greater impacts on reducing early childhood obesity in majority non-white communities.  

Conclusions: The findings have implications for the community-level effectiveness of different strategies to address early childhood obesity.

 

Purpose: We discuss how we successfully performed a Health Impact Assessment (HIA) to inform the decisions of public land managers as they designed a re-route of the Continental Divide National Scenic Trail (CDT).   The HIA was used to assess the effects of trail placement and construction on health, economic development and social capital in a nearby rural, tri-ethnic, under-resourced community, and it provided an important model for public land managers.

 

Methods: Researchers gathered data from public health and recreation literature and surveys of potential users of the CDT regarding preferences for trail location, trail design and trailhead access. Extrapolation of these data provided projections of future use and consequent improved health, economic benefit and social capital in the community. A report was prepared for agency and public review, and its findings were subsequently integrated with the US National Environmental Policy Act (NEPA) environmental assessment (EA), required before construction of new trails on public lands in the United States.

 

Results/findings: The HIA findings indicated that more people would use the trail if access was closer to town and trailhead amenities such as parking were included. Findings also identified aspects of trail design that would maximize use by local people and visitors. Two federal public land agencies, the United States Forest Service and Bureau of Land Management included findings from the report in their EA. A portion of the re-route was recently completed and celebrated with a two-day event on National Public Lands Day. Local residents, visitors and dignitaries joined in the celebration by taking a walk on the new section of the CDT through a scenic forest environment. HIA findings also influenced planning by the nearby village, in its role as a CDT Gateway Community, to participate in a statewide initiative to promote outdoor recreation and tourism.

 

Conclusions: HIA can be successfully integrated into the policy and decision-making process for trails on public lands, thereby providing positive effect on health, economic development and social capital in nearby communities.

 

 

 

Purpose: Nutrition labelling has been suggested as one tool to curb the rise in diet-related non-communicable diseases (NCD). In Costa Rica, nutrition labelling is not mandatory and therefore the nutritional composition of packaged foods is little known. This study a) analyzed the content of critical nutrients for NCD (sodium, saturated fat and sugars) declared on labels of processed foods sold in Costa Rican supermarkets between 2018-2019, and b) compared those contents to United Kingdom Traffic Light labelling (UK-TLL) nutrient profiling system.

Methods: Data (n=6,842) were collected in three supermarkets with different socioeconomic levels in great metropolitan area during 2018-2019. The Food Label Information Program for Latin America (FLIP-LAC) was used for data collection and capture. FLIP-LAC is a smartphone-based technology and methodology developed at The University of Toronto. Foods and non-alcoholic beverages available at grocery supermarkets were collected and classified into 23 major food categories. Data included nutrient declarations and ingredients list. Analyses were conducted for 10 categories (n=5,353) identified as critical due their contribution to diets in the Costa Rican population. Contents of sodium, saturated fat and sugars (mean±DS) were calculated and compared to the UK-TLL thresholds.

Results: 70% (n=3,752) of the products declared sodium, 64% (n=3,436) saturated fat and 55% (n=2,943) sugars. Categories with the highest and lowest sodium content (mg per 100g/ml±DS) were Sauces and Condiments (3463±7483) and Beverages (25±61), respectively. Categories with the highest and lowest saturated fat content (g per 100g/ml±DS) were Sugars and Sweets (12±9.6) and Beverages (0.7±2.5), respectively, while categories with the highest and lowest sugar content (g per 100g/ml±DS) were Sugars and Sweets (50±31.7) and Soups (2.7±3.9), respectively. Fifty-three percent of products had a low sodium content (i.e., green), 39% a median (i.e., yellow) and 8% high (i.e., red). With respect to saturated fat content, 34% of products were classified as green, 20% were yellow and 37% were red. Most products (50%) were classified as red in terms of their content of sugar, 37% were green and 26% were yellow.

Conclusion: Mandatory regulation of nutrition labeling is urgently needed in Costa Rica to supports public policies in favor of healthier food environments.

Purpose: The inclusion of front of pack nutritional warnings has emerged as a potential alternative to empower consumers in selecting healthier food options. The present work was aimed at exploring consumers’ reaction towards sodium reduction in the context of the implementation of warnings. The effect of sodium warnings on consumers’ expectations, food selection and hedonic perception was assessed using white bread as case study. 

Methods:A total of 171 consumers participated in the study that encompassed four parts. Firstly, consumers received two bread samples with different salt content (2.00% and 1.38% salt) and were asked to rate their overall liking and to indicate which sample they preferred under a blind condition. The second task consisted of looking at four bread packages, rating their expected liking and indicating which one they would buy. Packages of bread with 2.00% salt featured the sodium warning while those with 1.38% salt did not. For each salt level, two packages with different graphical design (fictitious brands) were considered. Then, consumers were asked to try the bread they had previously chosen, assess their overall liking and indicate their willingness to buy it again. Finally, data on consumers’ socio-demographic profile, attitudes and behaviour related to health and salt consumption was collected. 

Results:Salt content significantly affected consumers’ hedonic perception of breads. Two consumer segments with different pattern of preferences for salt in bread were identified: 58% of consumers preferred the bread with 2.00% salt while 42% preferred breads with 1.38% salt. However, the two consumer groups elicited similar responses when asked to rate the expected liking based on bread packages (without trying). Both groups showed similar choice patterns and 74% of consumers selected bread packages that did not feature warnings, reinforcing their potential to discourage unhealthy food choices. In addition, after having tried the bread, most consumers were willing to buy it again, which is promising in terms of reaching sustainable shifts towards lower salt levels.

Conclusions:Results suggests that, in the case of bread, nutritional warnings have potential to shift consumers’ preferences to lower sodium content, even after trying the products. 

 

Purpose: Early childhood obesity is of great concern given its links to adverse health outcomes, social marginalization, and discrimination (Reilly & Kelly, 2010). Accordingly, there has been an increase in national and regional efforts to address early childhood obesity. In LA County, a leading public grant-making and child advocacy organization funded a diverse portfolio of investments to reduce early childhood obesity (RECO). RECO adopted a wide variety of strategies (education, media campaigns, financial incentives, changes to the built environment, policy changes) primarily targeting nutrition and physical activity as a means to reducing early childhood obesity. This study examines the county-level impacts of RECO on early childhood obesity and overweight in LA County.

Methods: Given the unique characteristics of LA County, particularly its size and diversity, it is difficult to identify appropriate comparison counties in order to estimate county-level impacts. To address this challenge, this study uses the innovative synthetic comparison group method (Abadie, 2010), which relies on a pool of “donor” counties in southern California and weights them to create a “synthetic” county that is similar to LA County prior to RECO. Our analysis then compares LA County and the synthetic county after RECO to test for a county-level impact. We use overweight (BMIs > 85^th percentile) and obesity (BMIs > 95^th percentile) data for children aged 2-5 from Southern California Kaiser Permanente.

Results: Examining early childhood overweight and obesity rates over time in LA County reveals that rates were lower after RECO compared to before. After accounting for what might have happened in the absence of RECO by introducing the synthetic comparison group, we find a significant county-level impact of RECO on early childhood overweight and obesity: full implementation of RECO across LA County would significantly reduce early childhood overweight by almost 5 percentage points (Impact Estimate = -4.88, p<.001) and obesity by 1.5 percentage points (Impact Estimate = -1.52, p<.05) in LA County compared to the synthetic comparison county. 

Conclusions: These findings demonstrate the potential utility of a diverse set of nutrition and physical activity strategies to reduce early childhood obesity at the county-level.

Urban parks are key settings in the community that can promote healthy lifestyles, however the lack and low maintenance of facilities could reduce participation. Objectives were to identify public open spaces (POS) into public databases, and to evaluate internal and external features of these spaces in Mexico City. Methodology. POS were those green spaces, grey areas and natural environments, regardless of the size, with recreation purposes, accessible to the general public, mostly free of charge or with low cost (<5 USD). An exhaustive review of the national public geostatistical databases was carried out on the “Digital Map” platform. Previous searches were complemented by performing a visual review on the Roji Guide (a jumbo format that has 31 state plans plus Mexico City). Trained field workers visited and evaluated POS in Mexico City using the Mexican Parks Instrument. This instrument was divided into 5 different themes: geographic and weather characteristics (GWC), physical activity facilities (PAF), support facilities (SF), internal environment (IE), neighborhood surrounding (NS). Results. A total of 944 POS were mapped and evaluated. The second largest municipality within the city holds only 0.3% of POS. GWC - there are no site maps in 96.5% of the POS. PAF - 85.7% of the parks had tracks within their facilities. SF - 43.1% of the POS are unattractive, public security police were identified in 16.5% POS, 9.5% of these spaces have bathrooms. IE - 98.9% of them do not have a medical service, only 4% of the POS have drinking fountains and 13.4% of the these have food sales inside. NS - 59% of these spaces have at least one nearby public transportation station, most POS are surrounded by residential units, advertising of food and beverages around were found in 3.6% of the POS. Conclusion. In order to increase participation, local and federal government should identify some strategies to improve these spaces in Mexico City.

Purpose: Physical inactivity in the United States remains a concern among public health organizations, leading to legislation that requires schools to develop comprehensive wellness policies for children's health promotion. Given pressure exerted on schools to create and maintain environments conducive to children’s physical activity (PA), it is prudent to understand how schools promote movement through physical education (PE) and the school day, and the degree to which this subject plays a role in shaping children’s health behavior. The purpose of this study was to understand how PE contributes to the overall PA that children receive in a school recognized for health promotion.

Methods: A case study was conducted with a school in the United States that received recognition from a national health and wellness organization for health and wellness. To examine the contribution of PE to overall PA levels, students in grades 4-8 (ages 9-14; N=105) wore ActiGraph wGT3X+ accelerometers over seven days to capture habitual behaviors. Data were analyzed using ActiLife software and grouped into low, moderate, and high activity levels based on a tertile split for daily PA. Data were analyzed on an aggregate scale (i.e. average for seven-day wear period) before being segmented into PE, school day, and daily PA. A 2-way ANOVA (sex*activity level) was conducted to determine the ratio of physical activity accumulated in physical education to school and overall daily physical activity.

Results: Analyses revealed a non-significant interaction between sex and activity level to predict contribution of PE to school MVPA F(2, 99) = .284, p=.753. One-way ANOVA analyses revealed significant differences in the amount of MVPA attained in PE F(2, 102) = 9.948, p=.000, school F(2, 102) = 57.818, p=.000, and over the entire day F(2, 102) = 149.684, p=.000 between low, moderate, and high activity groups, respectively. Highly active participants obtained almost twice as much PA during PE as low active participants.

Conclusions: PE contributes significantly to children’s school day and overall PA, especially for those who are least active. Policies that increase the frequency of PE in schools may help to bridge the gap in activity inequality in the United States.

Purpose

Children’s sugar-sweetened beverages (SSBs) consumption presents significant risks for obesity, type 2 diabetes and dental health. But there is a lack of objective data on beverages in children’s overall environments. This study aimed to determine the nature and extent of children’s beverage availability, purchase and consumption, throughout their days, using wearable cameras for data collection.

Method

Data were sourced from ‘Kids’Cam NZ’, a study in which randomly-selected New Zealand children (n=168; 11-14y, mean 12.6y) wore cameras for four days (Thursday-Sunday), automatically taking a photo every 7s. Using content analysis, Thursday and Saturday images (n=700,201) were systematically analysed.

Results

On average, 18.9 (95% CI 16.8, 21.4) drinks/day were available to the children (n=158), of which 7.5 (95% CI 5.8, 9.7; 39.7%) were non-core drinks, including 6.4 (95% CI 5.0, 8.3; 33.9%) SSBs. At school and home, core drinks (water, unflavoured milk) were the most available. In all other locations in which children spent time (e.g., recreation venues and food retail outlets) non-core drinks dominated, at rates 1.5-5 times that of core drinks availability. Almost all drinks (n=17; 10.8%) the children purchased were non-core. On average, children (n=111; 70.3%) consumed a drink 2.6 (95% CI 2.1, 3.1) times/day, including one (95% CI 0.7, 1.3) SSB.

Conclusion

At school and home core drinks predominated. SSBs were available to most children in all locations in which they spent time, and dominated their drinks purchases and consumption. SSBs appear to be a typical feature of children’s everyday environments, almost certainly making it difficult for children’s beverage intakes to align with guidelines. The findings support calls for governments to urgently enact the SSB-related actions in the WHO Commission’s Ending Childhood Obesity implementation plan and, in turn, improve child health.

Background: Classroom teachers are important stakeholders in pediatric obesity prevention, particularly for low-income students with less access to health-promoting environments outside of school. Teachers can promote healthy diet and physical activity behaviors in the classroom, and may also play a role in building students’ advocacy and leadership skills for obesity prevention in schools and communities. This study investigates the hypothesis that students in low-income schools who perceive their teachers’ classroom practices and role modeling as health-promoting will be more likely to perceive themselves as health leaders among their peers and as advocates for healthier environments. 

Methods: Survey data were collected among 4^th to 8^th graders in 21 low- and middle-income schools in 3 school districts, including two validated scales: 16-items assessing teacher/classroom policies and practices (Likert-type response set, range 0-64, Cronbach’s alpha=0.79), and the 17-item Youth Advocacy for Obesity Prevention survey (YAOP; Likert-type response set, range: 0-68, Cronbach’s alpha=0.82). Multi-level linear regression models examined associations between teacher/classroom practices sum scores and YAOP sum scores, accounting for school-level effects and adjusting for gender, race/ethnicity, and BMI z-score (calculated via height/weight collection). 

Results: Students (n=289) were 67.8% female, 61.2% elementary, 52.7% African American, and 16.1% Hispanic/Latino. Half (49.8%) were overweight or obese. Mean teacher/classroom policies and practices sum score was 30.5 (SD=9.93, Range=9-55), and mean YAOP score was 41.3 (SD=10.7, Range=12-64). Adjusted linear regression models showed a significant, positive association between teacher/classroom practices and YAOP scores (b=0.48, SE=0.06), p<0.001). Gender was also significantly associated with higher advocacy sum scores, with females having higher scores than males (b=3.3, SE=1.2, p=0.009). No differences were found by race/ethnicity or BMI z-score. 

Conclusions: Findings indicate that when students attending schools serving low- and middle-income students perceived their teachers as role models for healthy eating and physical activity, they were more likely to see themselves as advocates for obesity prevention. Additionally, females were more likely to perceive themselves as advocates than males. School-based obesity prevention efforts should bolster the role of teachers not only as classroom rule makers, but also as role models for students to advocate for healthy eating and physical activity in schools and communities.

Purpose:  Community leadership readiness (CLR) has been identified as a community-level contextual factor influencing the success of community-based obesity interventions; however, measures of CLR have not been assessed in relation to community-level obesity outcomes. This study evaluated: (a) the impact of baseline CLR and change in CLR on weight change over time in 4-5-year-old children; and (b) whether the impact of CLR on children’s weight change varied according to area-level SES.  Methods: South Australia’s community-based childhood Obesity Prevention and Lifestyle program (OPAL) was implemented in 20 communities. Each community received 5 years of intervention. OPAL was evaluated using a quasi-experimental design.  This presentation reports on the intervention condition only.  CLR was assessed across 168 suburbs in the 20 intervention communities. Using a validated online CLR survey, four stakeholders from each community rated each suburb within their community on a 9-point scale for CLR at baseline and follow-up. Annual community prevalence of overweight/obesity was based on BMI derived from measured height and weight for 4-5-year-old pre-school children. BMI data were obtained from an administrative dataset with addresses geocoded and assigned to suburbs nested in communities. Area-level SES measures, sourced from the ABS 2011 Census, included the proportion of residents with a bachelor’s degree or higher and median household income.  Data were analyzed using multilevel binomial regression models.  Results:  Mean CLR scores were 3.34 (SD 0.81) and 5.19 (SD 1.23) at baseline and follow-up, respectively, with a mean change of 1.85 (SD 0.89). Baseline CLR was related to baseline overweight/obesity (Beta=0.0444, 95%CI 0.0158 to 0.0729) and over time predicted reductions in overweight/ obesity prevalence (Beta=-0.0087, 95%CI -0.0150 to -0.0025). Change in CLR was associated with reductions in overweight/obesity over time (Beta=-0.0128, 95%CI -0.0182 to -0.0074). These relationships varied by area-level SES and were only associated with reductions in overweight/ obesity amongst communities with low SES at baseline.  Conclusions:  The impact of CLR on weight change over time was modified by area-level SES. Local leadership may be more important in lower SES areas, potentially for leveraging resources to reach families living in more impoverished conditions, to promote and support physical activity and healthy eating activities.

Purpose:

Supermarkets are a key food environment for improving population’s diet. 87% of New Zealanders purchase groceries from supermarkets weekly, and pricing and other promotional strategies are used by retailers to influence shoppers’ choices. Our aim was to examine the frequency of promotions on breakfast cereals over a 12-week period and determine whether healthier or less healthy products were promoted more frequently at a major food retailer in New Zealand.

Methods:

Weekly cross-sectional surveys of 198 breakfast cereals and drinks were conducted for 12 weeks in six Auckland supermarket stores. Data collected included on-shelf regular and discounted price, features in weekly mailers, in-store product promotional displays, and type of promotional strategy used. Product was considered promoted if it was promoted in at least one of the six stores. The weekly frequency of promotions and an estimate of the resulting price reductions were calculated. Product nutritional composition (energy, sugar, sodium and fibre) and overall Health Star Rating were used to determine the healthiness of promoted versus non-promoted breakfast items. 

Results/findings:

During the study period, 56.1% to 71.7% of breakfast items were promoted through at least one strategy each week. Of these, 3.0% to 16.7% were simultaneously promoted via on-shelf promotions, in-store extra promotional displays, and weekly mailers. The weekly frequencies of promotions were 53.0% to 71.2% for on-shelf promotions, 3.0% to 19.2% for weekly mailers, and 20.2% to 29.3% for in‑store extra promotional displays. Price reduction was used in 25.8% to 46.5% of on-shelf promotions, and cost savings relative to the regular price ranged from 2% to 54%. Generally, the healthiness of the promoted and non-promoted breakfast foods was comparable, with promoted products having slightly higher mean Health Star Rating for weekly mailers (4.1 versus 3.9) and in-store extra promotional displays (4.0 versus 3.9), with no difference for on-shelf promotions (3.9).

Conclusion

Promotions are a frequently used strategy to influence shopper product selection but the healthiness of promoted versus non-promoted items does not vary greatly. Marketing strategies focused on healthier products only could be an important means to improve the healthiness of supermarket food purchases and thus population diets and health.

Purpose

Consuming food and beverages low in added sugar is widely recommended as part of a healthy eating pattern. Consumer demand for lower sugar products has increased, as has the number and variety of products containing intense sweeteners as a replacement for sugars. The objectives of this study were to 1) determine the prevalence of intense sweeteners in packaged foods and beverages available for purchase in New Zealand supermarkets; 2) determine the main types of intense sweeteners used; and 3) examine if the prevalence and type of intense sweeteners in packaged supermarket products changed between 2013 and 2019.

Methods

This study used Nutritrack, an annually updated database of all packaged food and beverage products available in four major supermarkets in New Zealand (approximately 15 000 products per year). Descriptive analyses were used to explore the prevalence and type of intense sweeteners overall and by food category, in 2013 and 2019. Permitted sweeteners were classified according to the Food Standards Australia New Zealand and US Food and Drug Administration standards. The difference in prevalence between 2013 and 2019 was analysed and changes in the types of sweeteners described.

Results

There are 12 intense sweeteners permitted for use in New Zealand and seven permitted in the USA. Full findings will be presented for the first time at the ISBNPA conference in 2020.

Conclusions

Results will identify if there have been changes over time in the prevalence and type of intense sweeteners in the New Zealand food supply and will inform a larger investigation into ingredients used in the reformulation of packaged food products.

Background: Over the 40 years since the reform and opening-up, China's policies on adolescent physical health have undergone four stages: adjustment and recovery (1979-1986), perfection and standardization (1987-1996), reform and deepening (1997-2006), top-level design and collaborative innovation (2007-2017), and besides, the policies have been upgraded and perfected along with the development of the times. Nevertheless, test data on Chinese students' physical health suggest that teenagers' physical health is still confronted with a grim situation.

Methods: This paper collects and sorts out the policies and regulations on adolescent physical health from January 1, 1979, to December 31, 2018. Sources include the China Sports Yearbook 1979-2016, the Compilation of Sports Laws and Regulations of the People's Republic of China: 1989-1992, the Compilation of Sports Laws and Regulations of the People's Republic of China: 1993-1996, the Compilation of Sports Laws and Regulations of the People's Republic of China：2009-2014, the Ten Years of Chinese Sports Legal System: 1995-2005, etc. Meanwhile, this paper makes use of the database of China Law and Regulations Network to search and supplement relevant policy documents.

Findings: the inherent limitations of policies result in target deviation, value displacement and effect deviation; poor policy execution mechanism results in poor coordination, insufficient motivation and ineffective supervision; the selfishness of the target group results in insufficient policy identification, deviation from the direction and low effectiveness; the change of examination-oriented education system and modern lifestyle leads to a weak environment for policy execution. To further perfect the policies associated with the physical health of Chinese teenagers, it is urgent to enhance the effectiveness of policy execution.

Conclusions: It is necessary to set up a strategic committee on the physical health of Chinese teenagers to plan the policy system for the physical health of teenagers as a whole; it is required to create a cross-border, linked and efficient policy execution mechanism and expand policy execution resources; it is essential to enhance the target group's policy identification and improve the policy execution environment.

[BACKGROUND] Natural disasters have changed our lifestyles for long-term.  As the neighborhood environments associated with the levels of habitual physical activity, the inactivity caused by the natural disasters increases the risk of the physical deconditions.  It remains unclear that the effects of the natural disasters on the habitual physical activity.  The purpose of the present investigation was to examine the changes in physical activity levels and the neighborhood environment walkability associated with the torrential rain.  

[METHODS] The participants of the present investigation were 857 individuals (322 Men and 535 Women, aged 67.6±10.6 years old), and were recruited from the area damaged by the torrential rain in 2018.  All subjects completed a questioner including about the physical activity levels and the neighborhood environment walkability before-, after, and effects of the torrential rain.  The physical activity levels were evaluated based on the duration and frequency.  The neighborhood environment walkability was assessed by eleven questions (basic + recommended) from the International Physical Activity Questionnaire Environmental Module (IPAQ-E).  

[RESULTS] Two percent of total subjects answered that the physical activity decreased compared with that before the torrential rain. The subjects who broken their house had significantly lower physical activity compared with the subjects not broken their house (p<0.05).  The physical activity environmental did not differ significantly among two measurements points.

[DISCUSSION] The results of the present investigation demonstrated that the effects of the torrential rain on the habitual physical activity would be not significant where the neighborhood environment did not change, and the damages for housing was significant contributor for the decreases in physical activity. 

Purpose: Diabetes is estimated to effect 451 million adults worldwide. Adults with type 2 diabetes (T2D) have high amounts of sedentary behaviour (SB) and accumulate more SB than those without T2D. SB is any waking behavior with a low energy expenditure (≤ 1.5 metabolic equivalents) while in a sitting, reclining, or lying posture. Increasing SB elevates the risk of premature mortality regardless of physical activity and augments cardiometabolic risk factors (CRF). To our knowledge no reviews have investigated (1) if reducing SB can improve CRF in individuals with T2D and (2) whether SB reductions and CRF improvements can be sustained. Hence, we conducted a scoping review to address these two issues.

Methods: Our protocol was developed using the scoping review methodological framework proposed by Arksey & O’malley (2005). Three electronic databases (MEDLINE, PubMed, and SPORTDiscus) were searched using a Boolean search strategy. In addition, reference lists of included studies and review articles were checked manually for more potential suitable articles. The titles and abstracts of articles were reviewed by two independent researchers and the remaining articles were reviewed in full and any disagreements were resolved by discussion with a third researcher. Studies were included if: (1) all participants were adults (18 years) and had been clinically diagnosed with T2D; (2) it included a SB intervention; (3) it included a SB and/or cardiometabolic outcome; (4) were published in English. Observation studies were excluded. Data were extracted, quality was not assessed (consistent with guidelines on scoping review conduct), and results were described using a narrative approach.

Results: A total of 10 studies met the inclusion and exclusion criteria. The included studies provide preliminary evidence that breaking up SB for hours to days can produce significant improvements in CRF and targeting reductions in SB over time (minimum = 12 weeks and maximum = 3 years) can produce significant sustained improvements in SB in adults with T2D.

Conclusions: T2D is a worldwide health burden and pragmatic behavior change interventions are needed. Reducing SB could be a sustainable way to improve CRF in individuals with T2D and warrants investigation.

Most childhood obesity prevention interventions have not worked. When the changes attained statistical significance, the changes were small (and thereby not adequate to prevent obesity in populations). A number of the interventions which worked the first time, did not for a second implementation, suggesting a type 1 error on the first implementation.

All these childhood obesity prevention interventions have been predicated on the simple energy balance model, wherein weight gain is the result of energy intake exceeding energy expenditure, and the reverse for weight loss. A recent theoretical formulation of the simple energy balance model was rejected as inadequate for accounting for the known homeostatic, non-homeostatic, and cognitive feedback mechanisms among intake, expenditure and body composition. This led to the formulation of a complex energy balance model including these feedback mechanisms. The complex energy balance model has been used primarily among the obese to understand weight maintenance, and not among the lean to understand who grows into overweight and obesity. The primary insight of the complex energy balance model for the initiation of obesity has been the hedonic overconsumption of food. However, hedonic overconsumption alone faces the same feedback mechanisms.

A substantial number of influences on childhood obesity, perhaps in combination with the complex energy balance model, but apparently sometimes not, have been proposed. These non-complex energy balance models of obesity initiation factors likely include genetics, epigenetics, the microbiome, air pollution, infection with Adenovirus 36, antibiotic use before 2 years of age, and stress, among many others. This presentation selects the microbiome, and will identify the evidence for this influence on obesity and dietary behaviors which likely influence the microbiome-obesity relationship. A research agenda for behavioral nutrition and physical activity will be outlined.

Thus, the multi-etiological approach to childhood obesity prevention is an attempt both to move beyond the simple energy balance model of childhood obesity prevention (and has not worked) and to reconnect behavioral science with advances in medical science.

Background:

Rapid socio-economic transitions along with genetic vulnerability have led to an upsurge in diabetes epidemic among Indians living in urban as well as rural areas. The aim of the study is to explore the lived-experiences of individuals with diabetes from different social, cultural and contextual backgrounds.

Methods:

A qualitative study was conducted with 35 individuals (13 women and 12 men), above the age of 40, who have been living with Type 2 Diabetes for at least 6 months. The participants were interviewed at a multi-disciplinary clinic in India, using purposive sampling technique. Semi-structured interviews were conducted. The data was analysed using thematic analysis with the constant comparative method.

Results:

Several themes emerged in the data including acceptance of diabetes as “a part of my life” and “a challenge given by God” in contrast to “I want it to go away”. The disease was perceived as “a silent killer that weakens everything” and “it is never cured”. Cognitive adaptations such as “it’s a common disease” “I feel better with the changes” were seen. Behaviour related themes related to diet and exercise were also observed.

Conclusion and implications:

Findings highlight cultural and gender differences in diabetes perception and management, along with challenges influenced by social and contextual factors. Understanding these lived-experiences in diabetes care can aid in developing more personalized interventions.  

Purpose: Louisiana is currently one of the US leaders in the prevalence of obesity. Health disparities have been prominent in access to obesity treatment, particularly bariatric surgery. One of the State’s largest insurers, the Office of Group Benefits (OGB), partnered with Pennington Biomedical Research Center (PBRC) to examine the feasibility and potential financial and health benefits of providing treatment to its adult members with severe obesity (HEADS UP study).  The proposed poster will examine the level of participation in HEADS UP by eligible African American and Caucasian members OGB.

Methods: HEADS UP is an observational study. The initial contact with OGB members (approximately 250,000) occurred through a letter explaining the program, basic inclusion/exclusion criteria, and how to navigate the screening process. Eligible participants were directed to a website for further screening and those who met this second level of eligibility attended on-site screening and evaluation for treatment.

Results: A total of 6,800 interested OGB members contacted the study website. A total of 2,730 met the project eligibility requirements and visited PBRC for on-site screening and evaluation for the treatment of their choice of surgical (1,114 requested) or nonsurgical, intensive medical intervention-IMI (1,616 requested).  The HEADS UP program completed its 5 year initial contract on June 30, 2016.  It provided bariatric surgery treatment for obesity (gastric banding, gastric bypass of gastric sleeve) to 490 severely obese adults and nonsurgical weight management treatment (liquid diet, lifestyle modification) to 922 severely obese adults. Weight loss was successful in the surgical group which averaged over 30% of baseline weight lost and in the non-surgical treatment program which averaged 6.3% of baseline weight lost or about 16 pounds). HEADS UP has a very unique and diverse group of participants, with 38.6% of participants African American.

Conclusions:  The number of OGB members who expressed an interest in the study was consistent with the estimated number of African American and Caucasian individuals with severe obesity among the membership of OGB. Providing insurance coverage for obesity treatment may help alleviate health disparities in obesity care.

Purpose

Poor diet, physical inactivity and overweight/obesity are leading causes of the burden of disease in Australia. This study aimed to investigate the prevention system (physical activity, nutrition and obesity), of a large area health service (>725,000 residents) in Perth, Western Australia.

Methods

A health profile and inventory of nutrition, physical activity and overweight/obesity interventions by organisations within the area health service was undertaken to determine their objectives, target groups and strategies. A subset of organisations (n=30) were then identified to participate in the organisational network survey. Survey questions related to organisations sharing of information, knowledge, and resources, joint program planning, funding, length of partnerships and frequency of contact. Social Network Analysis (SNA) was then undertaken on the data.

Results /Findings

Of residents aged 16+ years in the health service area, 90% were not eating the recommended intake of vegetables, 50% were not meeting fruit recommendations, 38% were insufficiently active, and 66.6% were classified as overweight /obese.  A total of 189 prevention programs were identified, 66 nutrition, 95 physical activity and 28 overweight/ obesity. The major objectives of these programs were to influence attitudes (n=164) change behaviour (n=162) and increase knowledge (n=160). The SNA data is currently being analysed and will show the organisations connections, degrees of centrality and reciprocation within the area health service.

Conclusion:

A significant number of nutrition, physical activity and overweight/obesity interventions were identified in the area health service. However, considering the poor diet, low levels of physical activity and high levels of overweight/obesity, it would seem they may be having limited impact. Data from the SNA will reveal connections and collaborations to inform how the network operates and how it can be strengthened to become more impactful. Stronger relationships between organisations and a reorientation of partnerships to facilitate resource sharing are essential for sound health promotion outcomes.

Purpose: In the United States (U.S.), 1 in 3 adults are obese. Obesity rates are even higher in rural communities, compounded by poor dietary choices, specifically with few adults meeting recommended daily fruit and vegetable (FV) intakes. These health disparities are amplified for residents of rural Appalachian communities in the eastern U.S. due to limited resources, which are exacerbated by geographic isolation and low socioeconomic status. Therefore, the purpose of this qualitative research is to understand perceived barriers and facilitators influencing FV intakes in rural Appalachia. A better understanding of what impedes health-promoting behaviors will provide guidance for policy, systems, and environmental (PSE) changes to decrease obesity prevalence in these communities.

Methods: Five focus groups were conducted among community leaders and residents (n=34) in one highly obese (>40%) rural Appalachian community in the eastern U.S. Focus groups ranged from 53-76 minutes with 4-11 participants per session and 24% (n=8) reporting an annual household income <$20,000. A semi-structured moderator guide was developed to examine barriers and facilitators to FV intakes of individuals and the community. The focus group discussions were digitally recorded and transcribed verbatim before thematic content analysis was performed using a grounded theory approach.

Results: Consensus among participants indicated lack of access and Appalachian cultural norms as major community-level barriers to FV intakes. The majority of participants reported lack of nutrition-related knowledge and high prices as individual-level barriers to FV consumption. For individuals, facilitators centered on freshness of produce, primarily offered through small family gardens and preserved for the off-season. Social support was recognized as a key facilitator for consumption of FV for the community.

Conclusions: Understanding cultural context for health behavior in rural Appalachia is vital to successfully implement relevant PSE changes to decrease obesity in these communities. Overcoming barriers, coupled with PSE changes, may encourage increased FV intakes among rural populations at an increased risk of high obesity. Further research is warranted to integrate food access initiatives with nutrition education in order to appropriately address community needs that cultivate healthier lifestyles.  

Purpose: Obesity and non-communicable disease are rapidly increasing in sub-Saharan Africa. Prevention efforts are critical, particularly for women preconception to maximise intergenerational effects. We sought to examine perceptions of health, and everyday factors that influence nutrition, exercise, and other health behaviours.

Methods: ​Young nulliparous women aged 18-24 years recruited using snowball sampling. Four focus groups each with 6-10 participants were conducted in Urban Soweto, South Africa, using semi-structured interview guides . to understand health behaviours of young women during the preconception period, and barriers and facilitators to these behaviours. Following inductive thematic analysis, data were further interpreted within the theoretical framework of the Behaviour Change Wheel (BCW).

Results:​The findings suggest that, in this urban African township, young women understand the importance of a healthy diet and physical activity but lack knowledge on the impact of overweight and obesity on health and disease. The data suggest an obesogenic environment where structural, and social factors strongly influence young women’s health choices, and limit their capacity for behaviour change.

Conclusions: Interventions to improve young women’s diet, physical activity and health must recognise: (i) the home and social contexts as a source of both role models and barriers to change; (ii) the current normalisation of obesity; and (iii) contextual issues of safety and violence within the community. Better understanding young women who strive to overcome these barriers to health in the community could be hugely beneficial.

Purpose: Physical activity may be fundamental for people to live well with a long-term condition. However, research consistently reports physical activity engagement for people living with the chronic, disabling consequences of illness remains low. While exercise-based rehabilitation is routinely offered in the acute or sub-acute phase of illness, the focus is on managing the immediate impact of acute illness events or symptom management versus building capability for longer term physical activity engagement. In this presentation, we synthesise evidence from a series of qualitative studies exploring experiences of physical activity engagement in the context of a long-term condition to critically consider the potential for a greater focus on physical activity for health and well-being in routine rehabilitation practice.

Methods: We drew on Qualitative Descriptive methodology to carry out a secondary analysis of semi-structured interview data from a purposive sample of people with Stroke (n=5), Multiple Sclerosis (MS; n=5) and Cancer Survivors (n=10). Interviews explored participant experiences of physical activity engagement. Participants were diverse in terms of time since diagnosis, gender, clinical course (Multiple Sclerosis), and type (Cancer). Data were analysed using conventional content analysis.

Findings: Participants highlighted physical activity is important for managing symptoms and treatment-related side effects, preventing recurrence, establishing a sense of normality, mental health and social engagement. However, navigating physical activity was complex in the context of the residual and ongoing impacts of their condition. They expressed concerns about safety, risk of harm, injury or exacerbation, fatigue, and uncertain illness trajectory. These concerns co-existed with broader existential threats around body image, perceived capability, and the meanings ascribed to physical activity. Participants reported limited (or no) access to targeted and tailored advice to navigate these complexities.  

Conclusion: Navigating physical activity in the context of a long-term condition is complex and requires active management, tailored to experience and context. Rehabilitation has potential as a site for building capability for managing the inherent complexities. However, a shift away from medicalised notions of exercise as treatment, to a focus on optimising what happens at the point of care for longer term health and well-being may be critical to realising this potential.

Purpose: Given the increase in anxiety and depression symptoms, and high prevalence of sleep deprivation among adolescents, there is a need to understand the relationship between mental health and sleep. The study objective is to examine the associations between self-reported mental health symptoms and sleep duration and hygiene.

Methods: Self-administered survey data on demographics, sleep practices and symptoms of anxiety and depression were collected in Spring 2019 from 222 (out of 545) 9^th grade students at an ethnically and economically diverse, semi-rural high school in Georgia, U.S. Independent two sample t-tests were conducted to examine the associations between mental health symptoms and several outcomes: average hours of sleep during weekday, change in sleep duration between weekday and weekend, and components (cognitive/emotional, sleep environment, behavioral arousal, physiological and bedtime routine) of the Adolescent Sleep Hygiene Scale (ASHS).

Results/findings: There were no significant differences in demographics between respondents and non-respondents. Participants were 15.3 (SD 0.49) years old and 53% were female. Those with anxiety symptoms reported a mean of 6.7 (SD 1.5) hours of sleep per night during the weekdays, compared to a mean of 7.4 (SD 1.2) hours of sleep among those without anxiety symptoms (p=0.0003). Participants with anxiety symptoms also scored lower on the cognitive/emotional factor of ASHS (p <0.0001); there were no differences in other ASHS factors (p>0.05). Those with depression symptoms had a mean of 6.9 (SD 1.5) hours of sleep, compared to a mean of 7.3 (SD 1.2) hours of sleep among those without depression symptoms (p=0.03). On average, individuals with depression symptoms scored lower on the cognitive/emotional, sleep environment, behavioral arousal and physiological factor of ASHS than those without depression symptoms (p<0.0001 to 0.02).

Conclusions: Symptoms of anxiety and depression were associated with shorter sleep duration and poorer sleep hygiene among a diverse sample of high school students. Chronic sleep deprivation and mental health symptoms both have long-term health implications for adolescents’ development. Interventions to improve sleep behaviors among adolescents should consider the impacts of mental health.

Purpose:

Despite rising mental health problems worldwide, engaging men to seek mental health support is challenging. Male-only lifestyle interventions have shown promise for improving men’s physical health, but the overall impact of these programs on psychological outcomes is unclear. This review aimed to evaluate the impact of male-only lifestyle interventions on men’s mental health and to identify key intervention features associated with effectiveness.  

Method:

A systematic literature search with no date restrictions was conducted across four databases. All studies used a randomised design to evaluate the impact of a male-only lifestyle behaviour change intervention on one or more mental health outcomes (e.g., depression). Studies included men with and/or without pre-existing mental health conditions. Risk of bias was assessed using criteria modified from the CONSORT statement and recent reviews. A fixed effects meta-analyses calculated aggregated change effects. 

Results:

The search returned 15,946 citations. Nine studies were eligible for inclusion, representing 1,427 participants. Eight of the studies tested interventions targeting multiple lifestyle behaviours (e.g., physical activity, diet) and seven studies had weight as the primary outcome. No studies targeted men with pre-existing mental health conditions. Overall, significant group-by-time effects were reported for 7 of 27 (26%) mental health outcomes. Risk of bias was generally low across studies, though only one intervention assessed mental health ≥12m after baseline and no studies were specifically powered to detect changes in mental health. In the fixed effects meta-analyses, small-to-medium intervention effects were observed for mental health-related quality of life (d=0.24), self-esteem (d=0.51) and positive affect (d=0.58). Insights into effective study or intervention features were limited due to the low number of heterogeneous studies. 

Conclusion:

While male-only lifestyle interventions have improved men’s mental health in some circumstances, studies that are specifically powered to detect long-term changes are urgently required, particularly in men with pre-existing mental health concerns. These studies will also help to illuminate which intervention components or targeted health behaviours are most important to optimise participant outcomes. This is critical, given men are reluctant to participate in traditional mental health treatments and require tailored solutions to prevent and treat mental health concerns. 

Purpose: To examine the metabolic profile of obese adult north Indian patients from middle-income families with ultrasound proven Non-Alcoholic Fatty Liver Disease (NAFLD), visiting the metabolic clinic of a tertiary care government hospital.

Methods: Obese patients (25-39.9kg/m²) aged 18-60 years with an ultrasound diagnosed NAFLD were included. Blood samples were analyzed for glycemia, aminotransferases and lipid profile. Anthropometry, body composition (Bodyvis BCA-2A) and Controlled Attenuation Parameter (CAP, FibroScan touch 502) were done.

Results: A total of 122 NAFLD patients (74 males), with age 41.4±10.4 yrs and BMI 30.12 ± 9.14 kg/m² were studied. Half of the patients had Grade I fatty liver (50.8%) followed by Grade II (45.08%) and Grade III (4.1%). The mean CAP values were reported as 329±36 dB/m. Anthropometric measurements included waist circumference (101.5 ± 9.6cm.in males and 106.7±9.5 cm in females), hip circumference (101.1 ± 8.8cm in males and 105.8±8.0cm in females) and waist-hip ratio (1.00±0.04 in males and 1.01 ± 0.06 in females). The body composition analysis showed a significantly higher body fat%, Trunk fat mass and Visceral Fat Index in women as compared to men (p<0.0001). Fasting blood glucose was 99.8±14.6 mg/dL. Serum total cholesterol was 182±36mg/dL and triglycerides were 168.7± 81.2mg/dL. The mean Aspartate transaminase (AST), Alanine Transaminase (ALT) levels were 40.3 ± 25.6 IU/L and 55.4 ± 37.8 IU/L respectively. No significant gender differences were seen in blood parameters.

Conclusion: Adverse metabolic profile can be seen in obese NAFLD patients from middle-income backgrounds in North India. It is important to develop and implement lifestyle interventions targeting middle-income patients to prevent the progression of metabolic diseases in India.

Purpose: Intuitive eating (i.e., eating according to internal hunger and satiety cues) is associated with better psychological well-being and lower body mass index, but relatively little is known about its behavioral correlates. The purpose of this study was to examine how intuitive eating is associated with health behaviors aligned with those Tribole & Resch suggest may cultivate attunement to internal cues (i.e., eating breakfast daily, yoga practice, and adequate sleep) and disrupt attunement to internal cues (i.e., self-weighing, dieting, and unhealthy weight control behaviors [UWCBs]). Methods: Cross-sectional data from 765 men and 1,009 women (mean age = 31.1 years) who participated in Project EAT-IV (Eating and Activity in Teens and Young Adults) were used for the present study. Intuitive eating was assessed via seven items (e.g., "I trust my body to tell me when to stop eating") adapted from the Intuitive Eating Scale (IES) and IES-2, with responses recorded on a 4-point Likert-type agreement scale (McDonald's omega = .85 in both men and women). Responses were averaged, and participants who, on average, agreed with all seven items were classified as intuitive eaters. Logistic regression was used to generate sex-stratified, demographics-adjusted prevalence estimates of each health behavior. Results: At EAT-IV, 41.5% of men and 43.2% of women were classified as intuitive eaters. Among men, intuitive eaters were less likely than non-intuitive eaters to report past-year dieting (29.7% vs. 57.5%, p < .001) and UWCBs (29.0% vs. 47.3%, p < .001). Among women, intuitive eaters were more likely than non-intuitive eaters to eat breakfast daily (46.4% vs. 36.0%, p = .003) and to get at least seven hours of sleep per night on average (90.6% vs. 85.3%, p = .03), and intuitive eaters were less likely than non-intuitive eaters to report past-year dieting (59.9% vs. 74.7%, p < .001) and UWCBs (51.9% vs. 62.2%, p = .004). No associations were observed for regular yoga practice or frequent self-weighing among either sex. Conclusions: Results suggest a cluster of modifiable health behaviors that may influence attunement to internal cues, though longitudinal research is needed to elucidate temporality of these relationships.

Purpose: Internalizing disorders are common co-morbidities of metabolic diseases including Type 2 Diabetes; yet the acute associations between metabolic biomarkers and internalizing symptoms are understudied. This study experimentally investigated the associations between glycemic metabolic biomarkers (glucose, insulin, and C-peptide) and internalizing symptoms (positive affect, negative affect, and state anxiety) among adolescents; and assessed if these associations differed by weight status (healthy weight vs. overweight/obese defined by body mass index percentile).

Methods: Adolescents (N=34, mean age= 14.1 years, 58.8% female, 32.4% overweight/obese, 50.0% Hispanic) completed two in-lab, three-hour oral glucose tolerance tests (OGTT). Serum glucose (mg/dL), insulin (mIU/dL), and C-peptide (ng/dL) were measured at baseline and every 30 minutes after, and area under the curves (AUC) were calculated using the trapezoidal method. Adolescents reported on positive affect, negative affect, and state anxiety at pre-test and post-test using validated measures. Multilevel models stratified by weight status tested the associations between each metabolic biomarker AUC and each post-test internalizing symptom, controlling for participant demographic characteristics, randomization order, and respective internalizing symptoms at pre-test.

Results: Glucose AUC was positively related to negative affect among the participants of healthy weight (ß=0.0001, p<.05), but not among those with overweight/obesity. Insulin AUC was inversely related to positive affect (ß=-0.0002, p<.05), negative affect (ß=-0.0001, p<.001), and state anxiety (ß=-0.0002, p<.05) among the participants with overweight/obesity, but was positively related to negative affect among participants of healthy weight (ß=0.0001, p<.01). C-peptide AUC was inversely related to negative affect (ß=-0.002, p<.01) and state anxiety (ß=-0.005, p<.05) among participants with overweight/obesity, while C-peptide AUC was positively related to negative affect (ß=0.002, p<.01) among participants of healthy weight. 

Conclusions: Affective responses to glucose, insulin, and C-peptide differed by weight status among a sample of healthy adolescents. Affective responses were more negative following elevated metabolic biomarkers among participants of healthy weight compared to those with overweight/obesity. Among the three biomarkers investigated, glucose AUC had the weakest associations with affective states.Additional research on these differential associations is needed to inform behavioral intervention strategies targeting the regulation of metabolic biomarkers for improving emotional health.

 

Purpose: Physical inactivity may contribute to disparities in physical activity (PA) behavior and health among Black women. Achieving PA benefits requires long-term engagement. Leveraging behavioral and cognitive aspects of individuals who regularly perform PA may provide an understanding of maintenance-specific determinants of PA, among this group.  This study examined associations between PA characteristics (dose, maintenance, and intensity) and (1) health condition prevalence, and (2) perceptions of health and fitness.

 Methods: Black women with health conditions currently maintaining PA (persistent behavior >6 months) completed a web-based survey and self-reported leisure-time PA dose (amount per week), PA maintenance (≤2 years vs. >2 years), PA intensity (perceived PA effort per session assessed by the Borg scale), existing health conditions (i.e., obesity, diabetes, high blood pressure (HBP), high cholesterol, polycystic ovarian syndrome, and cancer), and perceived health and fitness. Associations between PA characteristics, health conditions, and self-rated health and fitness were examined with multinomial logistic regression analyses, controlling for age, income, education, body mass index, and intensity.

 Results: Of the 103 participants, 72.8% reported having ≤3 conditions (27.2% with ≥2 conditions); 43.7% reported having HBP and 37.9% reported having obesity. PA dose was not associated with any outcomes. PA maintenance was associated with having obesity (adjusted relative risk (RR) [95% confidence interval]: 0.35 [0.14 - 0.89], p=0.03). PA intensity was associated with HBP (adjusted RR 0.70, 95% CI: 0.53 - 0.92, p=0.01) and having ≥2 conditions (adjusted RR 0.72, 95% CI: 0.54 - 0.95, p=0.02). PA characteristics were not associated with perceived health and fitness.

 Conclusions: A better understanding of the factors associated with PA maintenance among Black women has implications for reversing the cycle of physical inactivity and health disparities among Black women. Our findings suggest that strategies focusing on promoting consistent PA behavior and a high degree of effort per session may be more beneficial and efficacious than the amount of PA performed each week for Black women living with chronic health conditions. Future studies are needed to explore these associations further.

 

Purpose: Excessive intake of energy and less desirable food choices are preferred during the episode of binge eating. Less is known of the energy intake and diet quality among middle-aged adults with behaviors and attitudes related to binge eating that serves as criteria of either Bulimia Nervosa or Binge Eating Disorder. 

Methods: Among 3903 adults who were assessed of their eating behaviors at CARDIA study Year 10 (age 27-41 in 1995-96),  2739 participants were further assessed of their energy intake and A Priori Diet Quality Score (APDQS) and 2411 participants were assessed of four serum carotenoids (Sum4Carot) in Year 20 (2005-2006).  Behaviors and attitudes related to binge eating include compensatory behaviors, anxiety associated with food or eating, chronic dieting, concerns about weight and shape, and distress about binge eating. Energy intake and APDQS were assessed using the interviewer-administered Diet History Questionnaire; Sum4Carot was assessed using modified high-performance liquid chromatography. Analysis of Covariance (ANCOVA) was used to examine the association between behaviors and attitudes related to binge eating and diet-related variables adjusted for demographic, behavioral variables, energy intake, and BMI.

Results: Energy intake, energy-adjusted APDQS score, and BMI-adjusted Sum4Carot in Year 20 were greater among participants with behaviors and attitudes related to binge eating. The findings were graded by the number of behaviors and attitudes endorsed (all p <0.01).  

Conclusions: Despite the greater energy intake, the diet quality among participants with behaviors and attitudes related to binge eating is not inferior compared to participants without such behaviors and attitudes.

Purpose: To investigate the associations of physical activity and sedentary behaviors with psychological status and sleep quality in Chinese university students.

Methods: Participants 214 (aged 19.0 ± 1.1 years, 46.3% women) were college students recruited from a university in Shanghai, China. Physical activity was objectively measured using hip-mounted accelerometry monitors (Actigraph GT3X+ and wGT3X-BT, Pensacola, FL, USA).  Time spent on screen use and smartphone use was used as indicators of sedentary behaviors, which was surveyed by a questionnaire. The Self-rating anxiety scale (SAS) and the Self-rating depression scale (SDS) were used to measure anxiety and depressive status, respectively. Sleep quality was assessed by Pittsburgh sleep quality index (PSQI). Linear regression modelling was conducted to assess the association of physical activity and sedentary behaviors with psychological and sleep variables.

Results: Female students accumulated more time spent on light physical activity (LPA) (157.2±37.7 vs. 131.1±48.0 mins, P < 0.05) and moderate-to-vigorous physical activity (MVPA, 49.6±22.3 vs. 38.6±17.0 mins, P < 0.05), and had higher total PA (326.9±119.6 vs. 271.7±114.8 CPM, P < 0.05) than males. After adjustment for wear time of accelerometers, age and gender, physical activity variables were not associated with psychological and sleep variables. However, longer time spent on smartphone use was associated worse scores on depression (P < 0.05), anxiety (P < 0.05) and sleep quality (P < 0.05).

Conclusion: Smartphone use was associated worse scores on depression, anxiety and sleep quality. Therefore, interventions targeting university students should be developed to reduce sedentary behaviors, especially smartphone use.

 

Purpose:  Weight stigma is highly prevalent and associated with problems of public health concern.  For example, cross-sectional and longitudinal studies have consistently shown associations between weight stigma and higher prevalence of disordered eating in adolescents and young adults.  Because of the vital role of family members and the home environment in adolescent psychosocial development, we are interested in understanding the weight stigma-disordered eating relationship within the familial context.  The goal of this study is to build on the extant literature to examine the relative importance of weight stigma, family functioning, and parenting practices during adolescence to unhealthy weight control behaviors (UWCB) eight years later. 

Methods:  Ethnically and socioeconomically diverse adolescents in this prospective cohort study were surveyed within local public schools in the Project EAT 2010-2018 study (mean age=14.4 years at baseline, N=1534).  Adolescents reported on eight weight stigma, parenting practices, and family functioning variables.  The outcome, young adult UWCB (e.g. fasting, vomiting, laxative use), was self-reported via online and mail surveys.  Logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) of UWCB for hurtful weight-related comments from family, weight teasing from peers and/or family, poor family functioning, low parental connection, low parental monitoring, and high psychological control, adjusting for demographics.

Results/findings:  All eight weight stigma, family functioning, and parenting practices during adolescence were associated with significantly higher odds of UWCB eight years later.  For example, weight teasing from any source was associated with 60% higher odds of UWCB compared to no weight teasing (p<0.001).  Weight teasing from family (OR: 1.42, 95% CI: 1.08, 1.87), hurtful weight-related comments from family (OR: 1.34, 95% CI: 1.06, 1.70), and poor family functioning (OR: 1.44, 95% CI: 1.14, 1.81) remained statistically significantly associated with subsequent UWCB after additionally adjusting for baseline UWCB and measured BMI percentile.

Conclusions:  This study demonstrates that there are long-term consequences of weight teasing from family, hurtful weight-related comments from family, and low family functioning on disordered eating behaviors.  Future research and prevention efforts should support families to refrain from weight teasing and hurtful weight-related comments, and to create a more supportive home environment for adolescents. 

Purpose: Perceptions of one’s physical self – a sub-domain of global self-concept – are particularly important when considering physical activity engagement, in that individuals who feel more positively about their physical appearance are more likely to engage in physical activity behaviour for purposes of self-enhancement. The association between self-perceptions and physical activity has focused almost exclusively on sport and leisure-time physical activity, precluding an understanding of the high school physical education (PE) context. This is despite the dramatic declines in PE participation that are reported once PE is made optional after Grade 9 in Canadian high schools. As such, the purpose of this research was to examine the influence of self-perceptions (i.e., physical appearance, global self-concept) in Grade 9 on sustained (i.e., participation status when optional) in PE among high school students in Grades 10 and 11. 

 

Methods: The present sample was drawn from the longitudinal COMPASS study and consisted of a 3-year linked sample of students in Canadian secondary schools (n = 867) in Grades 9, 10, and 11 (Years 2016-2018). Self-reported measures included physical appearance perceptions and global self-concept at each year, and optional participation in PE class assessed in Grades 10 and 11. Longitudinal regression models were used to test the effects of self-perceptions (i.e., physical appearance, global self-concept) on the likelihood of physical education class participation in grades 10 and 11, adjusting for grade 9 race/ethnicity and school area median household income.

 

Results: As hypothesized, adolescents with positive evaluations of their physical appearance in Grade 9 (“True”: OR = 1.10, 95% CI: 0.95-1.27; “Mostly True”: OR = 1.14, 95% CI: 1.01-1.30) were more likely to remain in PE class, compared to those with negative evaluations of their physical appearance.

 

Conclusion: Adolescents that perceived their physical appearance more negatively while enrolled in PE were more likely to disengage from PE participation once no longer mandatory. This preliminary data suggests that future institutional efforts should focus on creating positive opportunities for promoting positive self-concept in Grade 9, in order to keep adolescents engaged in PE throughout high school.

Introduction

The association between physical activity and mental well-being in young people is well established. Current global recommendations for young people require at least 60 minutes of moderate- to vigorous-intensity physical activity every day of the week. However, these are based on epidemiological evidence for the relationship of physical activity with cardiovascular and metabolic health outcomes. We aim to use existing data to explore the relevance of these recommendations to mental well-being outcomes in young people, with a particular focus on the frequency throughout the week and total duration of physical activity participation.

 

Methods

We examined the nationally representative 2016-2019 Active NZ survey data (n=5,841). This comprised survey items for health-enhancing recreational physical activity (frequency, duration) and mental well-being (single-item score). We used logistic regressions to examine the association of meeting physical activity duration recommendations (420minutes/week) with mental well-being (dichotomised: “at-risk” threshold) adjusted for age, sex, education and ethnicity. We repeated these analyses for incremental increases in the frequency of physical activity on days throughout the week independent of duration. We then repeated these analyses for incremental increases in the duration of physical activity independent of frequency throughout the week.

 

Results

There was a positive association between meeting current physical activity recommendations and mental wellbeing (OR=1.45, 95%CI:1.28-1.65). For physical activity frequency, there was a statistically significant association with mental wellbeing only when participating on seven days/week (OR=1.41, 95%CI:1.13-1.77). For physical activity duration, there was a statistically significant association with mental wellbeing when participating at least 120 minutes/week (OR=1.52, 95%CI:1.20-1.92).

 

Conclusion

Current global physical activity recommendations may not be appropriate for mental well-being outcomes in young people. Our results support the need to be active on every day of the week, but suggest that the weekly duration of physical activity may not need to be as high as currently recommended to realise significant mental health benefits. This is particularly pertinent in populations experiencing mental illness, who often have low motivation to be physically active. Further research is indicated to establish causation and understand how other components of physical activity dose influence mental health outcomes in young people (e.g. intensity, type).

Background: Stress is associated with weight-related health behaviors and obesity, yet it is unclear whether stress influences relationships between health behaviors and obesity. Little is known about which weight-related health behaviors are most strongly related to obesity among rural Latino adults. This study examines the relationship between health behaviors (physical activity, sedentary behavior, daytime dysfunction), perceived health status, and % body fat, and whether stress moderates these relationships, among rural Latino adults.

Methods: 109 Latinas/os (M_age=37.1 years, 89% female, 80.4% completed high school) were recruited from rural counties in South Texas. Accelerometers assessed past week time in moderate-to-vigorous physical activity (MVPA). Participants self-reported time spent on a typical weekday or weekend day engaging in sedentary activities (e.g., watching T.V., browsing social network sites). Responses were summed to create weekday and weekend index scores. Participants self-reported health status [poor to excellent] and past month stress and daytime functioning. Stress and daytime functioning items were summed, respectively. Higher scores indicated better health, greater time sedentary, more daytime dysfunction, and greater stress. Bioelectrical impedance analysis measured % body fat. Hierarchical multiple regression examined relationships between study variables and % body fat and tested for interactions between stress and study variables on % body fat. Analyses controlled for age, sex, and education.

Results: Better health status was associated with lower % body fat (β=-2.00, SE=.74, p=.01). Stress moderated relationships between health status and % body fat (β=-.21, SE=.09, p=.03) and MVPA and % body fat (β=-.03, SE=.02, p=.05). For those with less stress, greater time in MVPA is associated with higher body fat % (β=.23, SE=.01, p=.04). MVPA and % body fat were not associated among individuals experiencing higher stress. For individuals with high stress, poorer health is associated with greater body fat %(β=-3.65, SE=1.00, p=.001). Health status and % body fat were not associated among low stress individuals. No other significant associations were found.  

Conclusion: Future research should investigate mechanisms through which stress exerts influence on relationships between health status, MVPA, and % body fat and causes of stress among this understudied population to inform design of appropriate interventions.

Purpose: Exploring diet-disease associations based on long-term diet exposure across the lifespan is a promising and comparatively under-utilised approach. This systematic literature review aims to evaluate the current evidence on associations between individual long-term diet, from childhood to adulthood, and cardiometabolic outcomes.

Methods: The review protocol was developed according to PRISMA guidelines. Seven journal databases were searched; eligible papers included original analyses of cohort studies of healthy populations, in journal articles published in English at any date. The exposure of interest was long-term diet based on repeated, quantitative measures from childhood to adulthood and spanning five or more years. Outcomes of interest were cardiovascular disease, obesity, type 2 diabetes and related clinical risk measures.

Results: Out of 7,725 papers screened, 37 eligible articles were identified representing nine cohorts across six countries. The review synthesises findings from over 150,000 subjects, ranging from 3-18 years in childhood and 19-90 years in adulthood, with individuals’ diets re-measured across 6 to 60-year periods. The most common diet exposures were intakes of macronutrients, fruit, vegetables and sugar-sweetened beverages, diet quality scores and breakfast consumption habits. The most common outcomes were weight-related measures, blood pressure and serum lipids. Persistent high or increasing values for fruit intake, vegetable intake, breakfast consumption and diet quality scores were generally associated with favourable cardiometabolic outcomes compared to persistent low or decreasing values. Persistent high or increasing values for sugar-sweetened beverage intake were generally associated with unfavourable outcomes.

Conclusions: Dietary intake and behaviours at both childhood and adulthood are associated with cardiometabolic outcomes. The findings from this review will help clarify the importance of diet throughout life stages and provide insights for how and when diet is promoted from a public health perspective.

Purpose

Schools in South Africa, particularly those situated in disadvantaged communities, face various challenges and are subsequently not conducive to promoting a healthy and active lifestyle. One of the aims of this study therefore was to assess the incidence of non-communicable disease risk factors among grade 4 to 6 children (ages 8 to 13 years) in government primary schools situated within disadvantaged communities.

Method

A cross-sectional survey was conducted in eight randomly selected primary schools in Nelson Mandela Bay. In total 973 schoolchildren participated in the study. The study measured anthropometric variables (height, weight, waist circumference), body composition (body mass index), blood pressure, HbA1c, total cholesterol, grip strength, cardiorespiratory fitness (20-m shuttle run), and objectively measured physical activity by means of accelerometery.

Results/findings

Results indicated that 14% of the sample presented with elevated blood pressure ≥ 90th percentile. In respect of hypercholesterolemia, 14% presented with borderline high values and 3% presented with high values. The hyperglycaemia test categorised 8% as prediabetic and 0.1% as diabetic. Waist circumference measurements identified 6% of girls and 4% of boys as high risk and for BMI, 25% were classified as overweight/obese. In respect of estimated VO2max, 47% of children were categorised with very low to low fitness levels while only 40% had high to very high fitness levels. More than half of the children (52%) did not meet the requirement of 60 minutes of moderate-to-vigorous physical activity per day.  

 Conclusions

 

In conclusion, a prevalence of cardiovascular disease risk factors was identified. Concerning numbers of children also presented with low cardiorespiratory fitness and sedentary behaviour. Regular monitoring of cardiovascular disease risk factors is essential to identify children at risk. This study contributes to other evidence-based data that could assist in raising public attention and justifying the need for further engagement in health-promoting policies and primary prevention programmes among the most vulnerable groups within South Africa.

Purpose:

Risk communication is recognised as an effective behaviour change technique (BCT) for health behaviours. The online Australian Diabetes Risk Assessment (AUSDRISK) provides individuals with a score based on known risk factors for type 2 diabetes. If a high-risk score (>12) is calculated, a generic text-based message is provided with follow-up advice-to consult a doctor for further testing and improve lifestyle behaviours. Effectiveness of the AUSDRISK as a BCT for health behaviours is unknown. This study examined changes in physical activity behaviours and visits to health professionals after completion of the AUSDRISK.

Methods:

This two-arm randomised trial consisted of adults over 35 years of age, randomly allocated to receive a tailored video-based or text-based feedback message regarding their score and follow-up advice. Survey data was collected at baseline and one- and three-months follow-up and included socio-demographic characteristics, physical activity behaviours (Active Australia Survey), intention to change and consultations with health professionals. Primary outcomes included change in physical activity and visits to health professionals. Data from both groups were pooled for this secondary analysis that includes descriptive statistics and adjusted logistic regressions.

Results:

Of 1212 adults screened, 533 were eligible, 477 completed baseline and 249 (Mean age 52.2 ±9.5 years; 78% female) completed follow-up surveys. At baseline, 30.8% were classified sufficiently active, 11% healthy weight (29.7% overweight; 59.4% obese), and 91.2% intended to change activity levels. At three-months, 51% had recorded an increase in physical activity, 46% had consulted their doctor and 39% other health professionals (dietitian/nutritionist (19%); exercise consultant (21%)) and (28 % had consulted both). Increased physical activity less likely in those classified obese (OR 0.38, CI 0.16-0.91; p=0.03) and more likely in in those who consulted their doctor (OR 1.84, CI: 1.07-3.15; p=0.03) or an exercise consultant (OR 3.47, CI: 1.67-7.11); p=0.001)

Conclusions:

This study highlights the positive role of risk communication (by text-based or video messages) and the AUSDRISK in promoting health behaviour change in adults with high risk of type 2 diabetes. General Practitioners and exercise consultants play an important role in supporting individuals to maintain change in physical activity over-time, but additional strategies are necessary to support those with obesity.

Purpose: REACH-HF is an effective and cost-effective home-based rehabilitation programme for people with heart failure and their caregivers. This 12-week programme is delivered at home with facilitation from a specifically trained healthcare professional, via a paper-based Heart Failure manual, resource for caregivers, and progress tracker. In addition, patients receive a CD with instructions for relaxation techniques and a DVD with chair-based exercise videos. In preparation for the wider roll-out of REACH-HF in the UK’s National Health Service, this project aimed to identify key targets for optimisation of the delivery of, and engagement with, the intervention. 

Methods: A mixed-methods synthesis was conducted using the findings from the feasibility study, multi-site randomised controlled trial, and process evaluation to identify key areas for optimisation in relation to the determinants in the REACH-HF logic model. The intervention development group, a patient advisory group workshop, and a facilitator telephone consultation discussed, added to, and prioritised the identified targets. In discussion with the patient advisory group and REACH-HF facilitator’s, potential practical refinements targeting these areas were generated.

Results: Key areas for optimisation included: (a) self-monitoring of symptoms and progress, (b) the exercise programmes and general physical activity, (c) the personalised approach to facilitation, (d) engaging the caregivers, and (e) ending of the facilitated intervention and ongoing use of self-management strategies. This resulted in changes in the intervention materials including: (a) clearer information and instructions for self-monitoring of symptoms, (b) a restructured progress tracker with detailed instructions and examples of use, and (c) an additional section in the manual about ongoing self-management. In addition, changes were made to the facilitator training. These included: (a) a revised training manual detailing the facilitation process with scenarios, tips, and good practice examples, (b) a detailed procedure on how to identify the patient’s starting level for their chosen exercise programme, and (c) audio snippets of good practice face-to-face and telephone consultations.

Conclusion: This project showcases how learnings from trials can be used beyond providing evidence for effectiveness. Making the most of available data helps refine and prepare interventions in the transition from research to practice. Enhancing the likelihood of successful implementation. 

 

Purpose: There is strong evidence that physical activity is associated with lower likelihood of depression. However, most existing studies have investigated aerobic physical activity (e.g. walking/running), with few population studies examining the association between muscle-strengthening exercise (push ups, using weight machines) with depression. The aim of this study is to examine associations between weekly frequency of muscle-strengthening exercise and depressive symptoms among a representative sample of German adults.

Methods: Cross-sectional analyses were conducted on the 2014 German Health Update, a population-based cross-sectional health interview survey conducted by the German Federal Ministry of Health. Previously validated questionnaires were used to assess muscle-strengthening exercise (European Health Interview Survey Physical Activity Questionnaire) and depression symptom severity (eight-item Personal Health Questionnaire Depression Scale). Generalized linear models with Poisson regression with a robust error variance were used to assess prevalence ratios of depression symptom severity (mild, moderate, moderately severe/severe) across weekly muscle-strengthening exercise frequency (None [reference]; 1, 2, 3-4 and ≥5 times/week), adjusting for potential cofounders (e.g. age, sex, socioeconomic status, self-rated health, smoking, hazardous alcohol consumption, aerobic exercise).

Results: Data were available on 23,635 adults (≥18 years) (response rate = 27.6%). When compared with those reporting no muscle-strengthening exercise, for all levels of depressive symptom severity, there were reduced adjusted prevalence ratios (APR) across all muscle-strengthening exercise frequencies. Compared to the higher muscle-strengthening exercise frequency groups (3-≥5 times/week), the prevalence ratios (APR range: 0.53-0.85) were similar among lower frequency groups (1-2 times/week) (APR range: 0.46-0.85). All associations remained after adjustment for sociodemographic, lifestyle characteristics and aerobic physical activity.

Conclusion: Among a large sample of German adults, muscle-strengthening exercise was associated with a lower likelihood of depressive symptoms severity. Although longitudinal studies are needed to better understand the direction of associations, our preliminary epidemiological evidence suggests that small-to-moderate increases in muscle-strengthening exercise at the population-level are likely to positively contribute to reducing of the significant public health burden of depression.

 

Purpose: To investigate the sleep quality in children with ASD using subjective and objective measurements

Methods: A total of 156 subjects (mean age = 10.05; SD = 1.08) were recruited in this matched case-control study. This group comprised 78 ASD cases and an equal number of matched controls by age in year (8-12), gender and BMI (±5%). Cases were defined as those diagnosed with ASD by physicians based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, American Psychiatric Association, 2016) and were recruited from five local special schools for intelligence disability in Hong Kong. Subjects with one or more comorbid psychiatric disorders, complex neurological disorders (e.g., epilepsy, phenylketonuria, fragile X syndrome, tuberous sclerosis), or taking drugs that might affect sleep (e.g. melatonin supplements, anti-depressants), were excluded from the study. Control was defined as the one who did not have previous medical history of ASD and was selected for each ASD subject by matching age, gender and BMI.

Results/findings: Results showed that children with ASD had a shorter sleep duration, reduced sleep efficiency, longer sleep onset latency and wake after sleep onset than children with TD (ps <.05).

Conclusions: The present study was the first large scale study investigating the sleep quality in children with ASD in Asia region using objective and subjective sleep assessments. It is concluded that children with ASD have poor sleep quality than children with TD as shown by both types of measurements.

 

Purpose: Canada was the first to adopt comprehensive 24-hour movement guidelines that include recommendations for physical activity, screen time and sleep to promote health benefits. No studies have investigated the concurrent development of these behaviours in North American youth. The objectives were to assess adherence to the Canadian 24-hour movement guidelines for children and youth and identify joint trajectories of moderate-to-vigorous physical activity (MVPA), screen time and sleep from childhood to adolescence.

Methods: Nine hundred and thirty eight participants of the MATCH study self-reported their MVPA, screen time and sleep duration over 8 years. MVPA and screen time were measured three times per year (24 cycles), and sleep was measured once per year (8 cycles). Guideline adherence was dichotomised as meeting the recommendations for each specific health behaviour or not. Multi-group trajectory modeling was used to identify unique trajectories of behavioural co-development. Analyses were stratified by sex.

Results: Between 10% and 39% of youth did not meet any recommendation at the various cycles of data collection. More than half of youth met one or two recommendation, and less than 5% of participants met all three recommendations at a study cycle throughout the 8 years of follow-up. Four different trajectories of behavioural co-development were identified for boys and for girls: a complier (good adherence to the guidelines; 12% boys and 9% girls), a decliner (decreasing adherence to the guidelines; 23% boys and 18% girls) and a non-complier group (low adherence to the guidelines; 42% boys and 42% girls) were identified. In boys, a physical activity-complier group (high MVPA-low screen time; 23%) was identified, whereas in girls a screen-complier group (moderate screen time-low MVPA; 30%) was identified.

Conclusions:  There is a need to recognise that variations from general trends of decreasing MVPA, increasing screen time and decreasing sleep exist. Specifically, we found that although it is uncommon for youth to adhere to the Canadian 24-hour movement guidelines, some youth displayed a high likelihood of attaining one or multiple of the behavioural recommendations. Further, patterns of adherence to the guidelines can differ across different sub-groups of youth.

Purpose: To evaluate the effect of aerobic and anaerobic fatigue on the technical skill performance of sub-elite female soccer players, and determine the aerobic and anaerobic fitness characteristics of sub-elite female soccer players. Methods: Forty-eight female soccer players participated in the study. Players completed the Loughborough Soccer Passing Test (LSPT) before and directly following the execution of the repeated sprint ability (RSA) test on day 1. On day 2, players completed the LSPT before and directly following the execution of the Yo-Yo Intermittent Recovery Level 1 (Yo-Yo IR1) test. Maximal heart rate and blood lactate concentration were obtained following the fatiguing exercises. Results: Players covered a mean distance of 560 m in the Yo-Yo IR1 and 614 m in the RSA test. Maximal heart rate values of 190 bpm and 186 bpm were recorded following the aerobic and anaerobic tests respectively. A decline in the LSPT was found in terms of passing, penalty and total time following both fatiguing exercises, and displayed small to moderate effect sizes. A significant (p<0.001) increase in penalty time (32.6%) and total performance time (10.1%) was recorded following the Yo-Yo IR1. Penalty time (20.4%) and total performance time (8.5%) also increased following the RSA test. Conclusions: Physical fatigue has a detrimental effect on short-passing ability, with aerobic fatigue influencing passing accuracy more than anaerobic fatigue, resulting in a larger decline in technical skill performance. These results suggest that the fatigue-related decline in technical performance seems to be related to the fitness level of a player.

Purpose: During recent years, wheelchair basketball has gained worldwide popularity. Several studies have demonstrated a high prevalence of injuries amongst wheelchair basketball players. Few studies, however, have investigated the prevalence of musculoskeletal pain in the context of different point classifications – an integral part of wheelchair sport. The aim of this study was to determine the prevalence of musculoskeletal pain in wheelchair basketball players of different point classifications in South Africa and to provide information on patterns of pain distribution in relation to point classification.

Methods: A questionnaire was completed by 48 wheelchair basketball players participating in the SuperSport League Games of South Africa with point classifications ranging from 1.0 to 4.5. The results were used to determine the patterns of musculoskeletal pain distribution in relation to the different point classifications. 

Results: Forty-three completed questionnaires were analysed. The prevalence of total musculoskeletal pain was 58% (n=25). Shoulder pain presented the highest overall prevalence, regardless of point classification (n=23; 92% since the start of players’ wheelchair basketball careers and n=19; 76% over the last 12 months). It was found that lower point classification (1.0-2.5) players commonly experienced arm pain since the start of their wheelchair basketball careers (ƞ=0.358), as well as specifically over the last 12 months (ƞ=0.319), unlike higher point classification (3.0-4.5) players.

Conclusion: The study contextualises the prevalence of musculoskeletal pain to overall point classification in wheelchair basketball. Such data are important in the formation of injury prevention strategies, as athletes with impairments are predisposed to different types of musculoskeletal pain based on point classification.

 

Purpose: Carers often put their own needs behind the needs of those they care for; they also tend not to seek assistance for their own physical and psychological health concerns. This can place Carers at increased risk of illness and mental health issues. This mixed method study aimed to understand how habitual activity and health behaviours of Carers of Veterans related to Carers’ physical and psychological well-being.

Methods: Participants (n=28) completed a six-minute walk test and surveys related to physical activity (IPAQ-SF) and psychological well-being (resilience, mental health continuum, psychological distress). Participants wore a GENEActiv accelerometer for seven days, to collect data on movement behaviour and sleep. Twenty-two Carers participated in a face-to-face interview, to examine barriers to Carers attending to their own physical and psychological well-being needs, as a means of contextualising the quantitative data. Descriptive statistics were produced and correlational analysis performed for quantitative data (IBM SPSS v25). Interview transcripts were uploaded to NVivo (QSR v12) and analysed, using a thematic analysis approach, to understand participants’ experiences.

Results: Forty percent of Carers met physical activity guidelines. There were significant relationships between fitness and resilience (r=0.610, p=0.007), and MVPA and resilience (r=0.494, p=0.037). Carers who had higher scores for resilience were also fitter and did more PA. Carers with evidence of psychological distress slept more than Carers without psychological distress (r=0.525, p=0.025). Carers had higher psychological distress and lower fitness compared to population norms. Qualitative findings indicated that Carers did not always know where to find support to enable them to undertake their caring role and meet their own physical and psychological well-being needs.

Conclusions: Findings suggest a need for accessible and multi-faceted support services for Carers of Veterans, that target physical and psychological well-being. Translating these findings into meaningful interventions and strategies for Carers is the next step in this process. Programs designed to increase physical activity, build resilience, and reduce psychological distress may be beneficial for Carers, and should be developed, implemented, and evaluated within this population.

Purpose

Health and obesity related knowledge possessed by health professionals during higher education is known to influence their professional practice and treatment of individuals under their care. This includes pre-service dietitians, doctors, school educators and allied health professionals whose roles involve health and nutrition education on a daily basis.  

Amongst this group of professionals, nutrition knowledge has been shown to be lower than professional practice requires and weight related attitudes are negatively skewed towards individuals are at a higher weight. Common perceptions of overweight and obese individuals are that they are lazy, unmotivated, have poor hygiene and low intelligence and are responsible for their weight due to a lack of willpower and poor food selection. Without appropriate levels of knowledge or skewed attitudes, the professional practice and accuracy of health education provided risks being affected.

 

Whilst previous research has measured and treated nutrition knowledge and weight-based attitudes amongst pre-service health educators, an intervention targeting both factors simultaneously had not been completed. The study presented addressed this gap through the design and implementation of a higher education based intervention that aimed to increase nutrition knowledge and decrease negative weight based opinions. 

Methods

Spanning 12 weeks, the intervention was embedded in lectures and tutorials of an elective offered to higher education students (n=111) and enrolments included health, non-health and education related degrees. The intervention was based on theoretical frameworks including Health At Every Size and Fitness not Fatness that take a holistic approach to health education. Baseline and post-test measures of nutrition knowledge and weight bias were conducted to determine the effectiveness of the intervention. 

Results

A series of t-tests on baseline and post-intervention scores revealed that nutrition knowledge increased by 8% (p<.05), the degree of weight bias decreased by 9 points (p<.05) and degree of fat stereotyping decreased by 33% (p>.05). 

Conclusions

These results indicate that the design and implementation of the intervention were moderately successful. Applications of this intervention design extend for use in specific groups of health educators or professionals like dietitians if content is contextualised and tailored to each group’s specific learning and professional practice needs.

Purpose: Incomplete descriptions of interventions are a barrier to evidence use and are a common problem in reports of randomised controlled trials, but no study has investigated the extent of this in public health physical activity interventions. This study aimed to evaluate the completeness of the descriptions of school-based physical activity interventions in a representative sample of research articles.

Methods: We searched PubMed from May 2012 to May 2017 to identify studies investigating the effects of population-level physical activity interventions in school settings. We included experimental and quasi-experimental studies where the physical activity intervention was compared to a control intervention. The completeness of intervention description for both groups was investigated using the Template for Intervention Description and Replication for Public Health and Policy (TIDieR-PHP) checklist, a 11-item checklist aimed to provide guidance on complete intervention reporting.

Results: Our search yielded 589 articles, with a total of 68 articles included after full-text assessment. Overall the level of intervention description was low. For intervention groups, only 4 articles (6%) reported all 11 items in the TIDieR-PHP checklist, and 12 (18%) articles did not describe at least half of the items. Reporting was worse for control groups, no article reported all items and 51 (75%) articles described less than half of the 11 items in the TIDieR-PHP checklist. The least frequently reported items were “Materials (description of any materials used in the intervention)”, “Unplanned variation” and “How well (fidelity and adherence)”. The most commonly reported items across articles were “Brief name” and “Why (rationale of the intervention)”.

Conclusions: Descriptions of interventions in articles investigating school-based physical activity programs are typically incomplete. Insufficient intervention information hinders replication and is a source of research waste. Authors and journals should provide complete descriptions of interventions, so research users such as policy-makers and other decision makers are well equipped to reliably translate effective interventions to other settings. Better reporting of physical activity interventions will contribute to reducing the current research-to-practice gap, where only a minority of useful and effective interventions move from research to practice.

Purpose:          Since the publication of the Salamanca Statement in 1994, there has been calls for greater inclusion of children with special educational needs and disabilities (SEND) in physical education (PE). The purpose of this study is to explore the extent to which PE teachers have positive, negative, or neutral attitudes towards the inclusion of SEND children.        

 

Methods:         A systematic review and a meta-analysis of published studies was conducted. Quantitative studies were sourced from electronic databases and were included in the systematic review if they were written in English, peer reviewed, and published between the 1975-2018. Studies were included in the meta-analysis if they  used a validated questionnaire, and reported the mean and the standard deviation of the questionnaire items, and the sample size.

 

Results:        The search yielded 1835 records, of which 28 met the inclusion criteria. Of 25 articles that used a validated questionnaire, 15 were eligible for the inclusion in a meta-analysis to assess the extent to which teachers held positive or negative attitudes towards including SEND children in PE. The pooled meta-analytic mean was positive, but small, and there was a large amount of heterogeneity in attitudes across studies. Subgroup analysis of differences in attitudes between males and females were unclear. Academic preparation and in-service attendance of professional courses, as well as previous experience working with SEND pupils, were positively associated with teachers’ attitudes. Age was mostly negatively associated with attitudes towards inclusion of SEND children. Further post-hoc analysis revealed substantial differences in teacher attitudes comparing studies dated before and after the publication of the Salamanca Statement. The effect of years of teaching experience on teachers’ attitudes was mixed, and differences between males and females in respect of these attitudes were unclear.

 

 

Conclusion:   This systematic review highlights that, although there is still a great deal of variability, there have also been positive changes in teachers’ attitudes towards including SEND children in PE lessons over the past four decades. Further research is clearly needed to assess more rigorously the factors affecting, not only teacher present attitudes, but also attitudinal formation over time.

 

Purpose: Youth should accumulate at least 30 minutes of daily recommended 60 minutes of moderate-to-vigorous physical activity (MVPA) during school hours. The purpose of this study is to conduct a systematic review and meta-analysis of the amount of time youth spend physically active and sedentary during different structured settings (Prospero number: 42018111804). Methods: Observational and experimental/quasi-experimental studies (baseline data only) with full-text available, written in English and published in a peer-reviewed journal were included for analysis. Studies reporting objectively measured physical activity (light, moderate, or vigorous physical activity) and/or time spent sedentary (SED) during structured settings among youth (0 to 18 years) were eligible. Results: A total of 190 studies (childcare n=62; school n=92; afterschool program n=14; summer camp n=4; and sport program n=18) from 30 countries (47.9% United States), representing 74,073 youth (3 to 16 years) were included. A High degree of heterogeneity was observed across the studies due to differences in study design, sample size and the protocol used to measure PA and SED. The meta-analyses revealed, on average, youth spend 248.3 min (68%) in SED and 31.5min (8.6%) in MVPA during childcare hours, and 220.5 min (60.1%) in SED and 27.8 min in MVPA at school. Youth attained proportionally higher levels of MVPA in afterschool programs (19.4%; 21.5 min), sport programs (31.4%; 16.7 min), and summer camps (13.4%; 56.2 min) when compared to school and childcare. Increased SED was observed as youth age (40min/h at age 3 to 55 min/h at age 5) in childcare and during school (32min/h at age 6 to 45 min/h at age 15), while MVPA did not decrease with age in both settings. Conclusions: MVPA accumulated during childcare and schools hours seemed closed to the recommendation, despite high proportion of SED. Afterschool, summer camp and sport programs are important settings that can contribute to daily PA. Ensuring youth have access to these structured settings may be an important step forward for public health.

Methods: A self-report online survey was used to assess physical activity, sedentary behaviour, fatigue, quality of life, balance confidence and walking limitation in adults aged 18-80 years with MG with stable self-reported symptoms. Analyses included descriptive statistics and multiple linear regression models.

Results: Respondents included 85 adults with MG (48±15.5 years; 74.1 % female) with 96.5% generalized MG and 3.5% ocular MG. Most participants (n=53, 62.4%) reported sufficient physical activity (≥500 METminutes.wk^-1), however participants also reported an average of 9 h/day of sedentary behaviour (mean 8.9±3.5). Meeting physical activity guidelines (≥500 METminutes.wk^-1) was significantly (p<0.05) associated with reduced fatigue (R²=0.196, B=-17.65, 95% CI 45.22, 99.32), increased quality of life (R²=0.330, B=-8.83, 95% CI -11.88, -5.79), reduced walking limitation (R²=0.305, B=-11.06, 95% CI -15.54, -6.57) and increased balance confidence (R²=0.304, B=20.70, 95% CI 12.28, 29.12). No significant associations were found for sedentary behaviour. When patterns of physical activity and sedentary behaviour were combined, greater fatigue (R²=0.213), lower quality of life (R²=0.364), increased walking limitation (R²=0.341) and lower balance confidence (R²=0.279) was observed in patients who met physical activity guidelines and had lower sedentary time (<10 h/day) (p<0.05).

Conclusions: Physical activity and sedentary behaviour is associated with favorable health and wellbeing outcomes in adults with MG. Findings highlight that physical activity and sedentary behaviour may be possible intervention targets, however longitudinal and intervention studies are needed to determine causality.

Purpose: To examine the acceptability and feasibility of a 12 week community based physical activity intervention, Passport to Natal Health, to improve maternal health.

Methods: Thirty-four (age: 31 ±3 years), pregnant (n=11, 24.3 ±7.5 weeks gestation) and postpartum (n=23, 11.2 ±5.6 weeks since birth) women were offered 10 free 45-60 minutes exercise classes over a 12 week period. Three weekly classes (Aquanatal, Buggy fit, and Fit mummies) were available to choose from and performed in groups of maximum 15 women. Classes took place in local community facilities in Leeds, UK, and were designed for pregnant and postpartum women and run by fully-qualified midwives and fitness-instructors. Participants’ experiences with taking part in the intervention, including satisfaction, adherence, as well as motives and barriers for attending the classes were assessed post-intervention using a self-reported questionnaire and focus groups.

Results: Thirty-two (94%) participants attended at least one class. The mean number of classes attended was 4.7± 2.9. The majority (70%) of participants attended between 3-8 classes. For pregnant women, the highest proportion used 3-5 vouchers reporting that as pregnancy progressed they found it more difficult to participate, whereas the highest proportion of postpartum women attended 6-8 classes. In terms of retention, 28 (82%) returned for follow up measurements and completed a questionnaire after the intervention assessing their experience with the programme. All participants reported increased motivation to continue exercising and would recommend the programme to pregnant friends. All would attend a similar programme in the event of a new pregnancy and 96% (n=27) of participants would be willing to pay £2-£5 for a class. Reported perceived health benefits from the intervention included socialising with group members, exercise enjoyment, enhanced mood and increased motivation to continue exercising. No harmful effects of the intervention were noted in the mother. 

Conclusions: findings showed implementing a community based physical activity intervention was feasible, safe, and well tolerated, which support incorporating this programme into a routine health care setting to improve maternal health.

 

 

Purpose

Research into intercultural education indicates that:

1) Many teachers and coaches don't have sufficient professional competencies to perform intercultural education through sports;

2) Initial teacher and trainer education (pre-service) and continuing professional development (in-service) neither provides them with the necessary knowledge nor covers practices, skills, competencies, and appropriate models of the everyday reality in classrooms and training sessions, respectively, due to a lack of consistent guidelines and didactical concepts.

EDU-PACT is an Erasmus+ funded project aiming at improving the quality of pre-service and in-service education strengthening the professional profile of both sports-related teaching, professions preparing teachers, and coaches for inclusive intercultural education in and through Physical Activity (PA) and sports.

Methods

A rapid evidence analysis was conducted to scope the scientific literature and obtain knowledge about the field. The analysis formed the basis for a need-analysis template to be fulfilled by each participating project partner to identify existing knowledge and wishes related to intercultural learning through PA and sport - from an academic perspective, PE teacher perspective and sports coach perspective. This information was obtained by interviews and/or focus groups with relevant stakeholders. 

Findings from each partner were put together in a combined needs-analysis and those findings formed the basis of the development of a module related to intercultural learning containing of four module units.

Results/findings

Initial outlines of each module unit are presented below:

Unit 1: "Understanding yourself" related to Self-Confidence, Self-Awareness, and Adaptability.

Unit 2: "Understanding others" related to Communication, Cooperation, Leadership, Respect, Tolerance, and Empathy. 

Unit 3: "Planning and delivering sessions" related to Critical Thinking, Decision Making, Problem Solving, Organizing, and Managing.

Unit 4: "Reflection and evaluation" related to Teaching, Reflecting, Monitoring, Reviewing Intercultural Learning Approaches and Strategies.

Conclusion

The module and module units will be available as an online tool to be used in various settings - however, primarily targeting PE teaches and sports coaches. For PE teachers or sports coaches working with children and youth with diverse ethnical backgrounds, the module and module units can help improve intercultural education through PA and sports.

 

Purpose: Caffeinated beverages are often consumed to enhance mental performance. Previous studies examined associations of academic performance with single types of caffeinated beverages or combined several types of caffeinated beverages to represent total caffeine intake. This investigation is innovative in studying types of beverages separately in relationship to academic performance among university students. 

Methods: A cross-sectional design administered a pilot-tested online questionnaire to undergraduate student volunteers at one medium sized U.S. university to obtain an availability sample of 252 responses. Measures were self-reported and included coffee consumption, use of other caffeinated beverages (tea, energy drinks, and soft drinks), reported grade point average (GPA), and reasons for coffee consumption. Analyses used descriptive, bivariate, and multivariate statistics. 

Results/findings: One-fourth of students reported they did not drink coffee, and 75% reported drinking coffee, 74% tea, 5% energy drinks, and 3% soft drinks. The association between amount of coffee use and GPA was curvilinear and not statistically significant. The most important reasons for coffee drinking were to keep awake during the day, liking the taste, waking up in the morning, helping to focus, pep up during the day, daily routine, and keeping awake at night. Significant associations between tea drinking and GPA were positive, and associations of energy drinks and soft drinks with GPA were negative.

Conclusions: Congruent with most prior studies, coffee consumption was not associated with academic grades, while energy drink use was negatively related to academic grades. With little prior research, positive associations of tea and grades and negative associations of soft drinks and grades were unexpected. Most, but not all, of the reasons for coffee use were related to remaining awake and alert. A variety of student subcultures may use caffeinated beverages differently, with coffee drinking subcultures offering a mainstream strategy for staying awake, tea drinking subcultures emphasizing both tea use and strong academic performance, and energy and soft drink consuming subcultures reacting to poor grades by increasing caffeinated beverage use. Behavioral nutritionists may use these and related findings to educate students about the mixed associations between coffee and other caffeinated beverages and academic performance.

 

Purpose: Despite a growing body of literature investigating the relationship between physical activity (PA), sedentary behaviour (SB), and educational outcomes (EO), this relationship is still not clearly understood, particularly in the university student population.  Therefore, this study aimed to systematically review available evidence focusing on the relationship between PA, SB and EO among university students.

 Methods: Articles published in English and up to April 2019 were identified through a search of eight electronic databases. Papers were included in the review if they: (a) focused on undergraduate students, (b) included either PA or SB outcomes and a measure of EO, and (c) examined associations between these variables.  The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the methodological quality of the included studies.

 Results: Thirty-five papers met the eligibility criteria and were subsequently included in the review.  Majority of papers were cross-sectional (n=31), and used self-report questionnaires to assess either PA (n=32) or SB (n=9).  The most common PA outcomes examined were overall PA (n=12) or aerobic activity alone (n=14).  The most common measures of SB were overall sitting time (n=5) and screen time (n=7). Self-report grade point average was the most common measure of EO (n=30).  From 35 included papers, 107 statistical associations were reported.  Notably, over two-thirds (71%) of associations between PA and EO were non-significant (25/32), and 40% of associations between time spent sitting for leisure and EO were negative (5/9).  Most papers were rated as demonstrating poor quality (22/35), with only about a fifth of included papers scored as fair quality (13/35).

Conclusions: This systematic review found mixed associations between PA, SB, and EO.  Further, several methodological issues were identified with included studies, which limits the ability to draw firm conclusions. Future studies should consider using more rigorous designs, including objective measures of PA, SB and EO, to further our understanding of this area.

 

Purpose: The purpose of the study was to evaluate associations between critical health behaviors (sleep and physical activity) with self-reported health (physical and mental) of students, faculty, and staff of a U.S. university campus. This study provides a needs assessment to better understand a college campus’s health behaviors and health status. Being a workplace for faculty and staff plus a place where young adults establish lifetime health behaviors, a higher education environment presents an important opportunity for intervening on negative health behaviors.

Methods: The study utilized a cross-sectional design. Participants were included if they were current students, faculty, or staff at the University of Arkansas in Fayetteville and could complete the questionnaires in English. The measures utilized included the Pittsburg Sleep Quality Index (PSQI), International Physical Activity Questionnaire-long (IPAQ), and SF-12 self-reported health (mental and physical). Regression, adjusted for sex and age with α = .05, was used to evaluate the associations between physical activity and sleep with physical and mental health outcomes.

Results: 311 participants (32.1 years, SD 14.0; 46.2 female) completed all measures. The median score (25^th-75^th percentiles) of the PSQI was 5 (3, 7) and 53.3% were considered “poor” sleepers. From the IPAQ, the following medians (25^th-75^th percentiles) were found: vigorous activity (MET-min/week): 480 (0, 1,440), moderate activity (MET-min/week): 870 (300, 2025), walking (MET-min/week): 1,014 (462, 2,772). PSQI score was negatively associated with self-reported mental health (-1.4, 95%CI [-1.7, -1.1], p<.001), but had no association with physical health. Vigorous activity was positively associated with physical health score (.0002 MET-min/week, 95%CI [.00001, .0004], p=.035) while moderate activity (p=.542) and walking (p=.244) were not. No physical activity measures were statistically associated with mental health.

Discussion: The majority of campus participants had poor self-reported sleep. The current needs assessment found negative associations between sleep and mental health and vigorous physical activity with physical health, but these associations need confirmation with objective sleep and physical activity measures. Innovative interventions to improve sleep quality and perform more vigorous activity may improve mental and physical health on a college campus, and both sleep and physical activity behaviors should be targets of future studies.

Purpose: Participation in physical activity (PA) is shown to play a role in predicting a variety of mental health outcomes, including lower levels of anxiety and depression, and improved mental wellbeing. While objective participation in PA is beneficial, some literature suggests individual’s perception of their engagement in a socially-valued health behavior– relative to others – can independently influence health outcomes. Relative self-perceptions are driven largely by social influence and tend to draw on comparisons to similar reference groups, whereby individuals may have more adaptive psychological function when they perceive themselves to be attaining social standards. Despite theoretical assertions, limited examination on how relative perceptions of PA – beyond the effects of actual PA engagement – may relate to mental. As such, the present study explored the relationship between relative perceptions of PA status and indices of mental health.

Methods: Participants (n = 374, M_age ­= 60% between 18 - 24, SD = 1.83) completed a cross-sectional survey. In addition to demographics and a purpose-built item evaluating relative perceptions of PA status; the Godin Leisure-Time Exercise Questionnaire, Centre for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory, (STAI) and Warwick-Edinburgh Mental Well-being Scale were administered. A one-way between-subjects MANCOVA was conducted to examine the effect of relative perceptions of PA status on depression, anxiety, and mental wellbeing while controlling for reported PA levels.

Results/Findings: In the overall model, depressive symptoms, trait anxiety symptoms, and wellbeing were significantly related to relative perceptions of PA status (F(24, 986.70) = 1.582, p = .038, Wilks' Λ = .896, partial η² = .036). Significant main effects were found for depressive symptoms (F (8, 342) =  3.08, p = .002 partial η² = .067), trait anxiety symptoms (F (8, 342) =  2.85, p =.004 partial η² = .063), and mental wellbeing (F (8, 342) =  2.90, p =.004 partial η² = .064), when controlling for reported PA levels.

Conclusion: Preliminary findings suggest an individual’s perceptions of PA status relative to others has a significant effect on their mental health – beyond the actual levels of PA engagement.  Utilizing a social comparison framework may provide further understanding into PA and mental health. 

Purpose: To determine if undergraduate student participation in a comprehensive professional development model (CPDM) during a cross-age teaching internship results in the delivery of experiential food literacy education with adequate fidelity

Methods: Undergraduate students (n=15) from two universities attended a three-day workshop on learner-centered, experiential education and inquiry-based facilitation strategies. Undergraduates engaged in experiential professional development by observing and facilitating lessons from the learner-centered curriculum Teens CAN: Comprehensive Food Literacy in Cooking, Agriculture, and Nutrition. Throughout the training, undergraduate students engaged in reflective practice. Additionally, they were trained to collect lesson fidelity observations. Based on previous research, 80% fidelity to lesson procedures was considered adequate to achieve intended student outcomes. Upon completion of the training, undergraduates began teaching Teens CAN to adolescents through after-school programs in underserved communities. Two undergraduates co-facilitated each lesson and five observed and recorded lesson fidelity using structured observation sheets. Fidelity scores were calculated for each lesson and lesson components. Scores were converted to percentages for the average overall delivery. Inter-rater reliability was assessed to determine the level of consensus between observers.

Results: Seven of 12 lessons from Teens CAN have been implemented thus far. Preliminary results indicate that fidelity for all lesson components exceeded the 80% threshold associated with measurable student outcomes. Additionally, preliminary results indicate that average fidelity of lesson implementation was 96%. Furthermore, the five lesson observers had high agreement with an inter-rater reliability of 0.94.

Conclusions: These findings suggest that the CPDM may be effective in preparing undergraduate students to deliver learner-centered lessons with high fidelity. The strong inter-rater reliability also suggests that there is consistent understanding between undergraduate students on what is required to successfully implement the lessons. Development of a CPDM for undergraduate students that results in lesson fidelity exceeding 80% has the potential to broaden the reach of health-focused programming delivered by agencies with limited staff working in underserved communities. Future assessments include self-efficacy for teaching cooking, nutrition, and agriculture and self-perceived improvements in efficacy over time.

Purpose: The prevalence of adolescents meeting physical activity guidelines is low internationally. Although active transport to school is a potential way to increase adolescents’ daily physical activity, the proportion of adolescents travelling to school by car has increased in many countries in recent decades. Walking and cycling to school have been extensively studied in urban settings, whereas rural information is sparse. This study compared perceptions of walking and cycling to school among adolescents living ≤4.8 km from school in rural New Zealand.

Methods: Adolescents (n=71; 54.9% female; 15.5±1.5 years) residing in rural areas (population <1000) and attending one of 11 secondary schools in the Otago region, New Zealand, completed an online survey about their school travel and perceptions of walking and cycling to school. Distance to school was calculated using Geographic Information Systems shortest network path analysis.

Results: Overall, 68% of rural adolescents actively travelled to school, with 63% walking and 13% cycling. Compared to cycling, a greater proportion of adolescents perceived walking to school as an opportunity to socialise (59% vs 25%; p<.001) with more peer (71% vs 30%) and parental (74% vs 38%) support and role-modelling, greater availability of footpaths versus cycle paths (79% vs 32%), and greater desire (53% vs 24%) and intention (66% vs 13%) to walk to school (all p<.001). Over three-quarters of adolescents were confident they could walk or cycle to school. More than 90% of adolescents perceived walking and cycling to school as safe and reported that their parents held the same belief. Trip duration, distance, and cold/wet weather were perceived as more common barriers for walking than for cycling to school. Over two-thirds of adolescents reported that cycle-friendly uniforms would encourage cycling to school more often.

Conclusions: Compared to cycling, walking to school was more common, the preferred mode, and perceived by adolescents as having greater social and infrastructural support. Findings suggest that environments with adequate infrastructure and social support appear to encourage walking to school. Thus, mode-specific approaches may be required to encourage active school travel among rural adolescents, with special attention on the social and built environments related to cycling.

 

Purpose: To determine the pattern of sedentary behaviour and associated factors in desk-based office workers in Bangladesh.

Background: Prolonged sitting time is associated with poor cardiovascular outcomes. People in modern workplaces spend much of their time sitting; thus, office environments are important contexts in which to implement interventions to reduce sedentary time. Most estimates of workplace sitting are based on findings from high-income countries even though almost three-fourths of non-communicable disease-related deaths occur in Low-and-Middle-Income Countries (LMICs). This study addresses this gap with evidence from Bangladesh. 

Methods: A cross-sectional survey of 360 desk-based workers (>4hrs/day deskwork) was conducted in three workplaces in Bangladesh. Total and domain-specific sedentary time were measured using the SIT-Q-7d questionnaire and cardiovascular risk factors were assessed using the WHO STEPS survey. A multiple linear and a logistic regression model for identifying the associates of total sedentary time (TST) and occupational sitting time (OST) (dichotomized at median value 6.5 hours) were developed, respectively.

Results: Daily TST in the study population was 11.3 hours/day, with 6.4 hours/day identified as OST. Employees who were younger (35-39 years), male, and more educated (postgraduate) had a significantly higher TST than older employees (>=55 years), female or less educated employees. There was a statistically positive association with obesity and a negative association with moderate-to-vigorous physical activity with TST. Male sex and higher household income were significantly associated with OST. In both models, there was a statistically significant association with sitting break pattern (less frequent than 60minute interruption). 

Conclusions: Urban Bangladesh ranks high from a global standpoint in terms of TST and OST. LMICs should include sedentary behaviour measures in national health surveys to establish its impact. Interventions to reduce sedentary time should be targeted to office-based workplaces, where around half of all sitting time occurs. Frequent breaks from sitting during the workday maybe a potential intervention for employers that wish to invest in the health of their employees in the absence of acceptable and low-cost physical activity interventions.