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BackgroundInsufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals. ObjectiveThis study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability–based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps. MethodsIn total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events). ResultsAll participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P

Abstract Background Prechoolers’ significant portions of sedentary time (ST) is a public-health concern due to its high prevalence and negative health consequences. However, few studies have explored correlates of preschoolers’ ST covering individual-, home- and preschool- factors within one study. The aim of this study was to identify the associations between multiple individual-, home- and preschool-level factors and preschoolers’ ST. In addition, it was studied how much individual-, home- and preschool-level factors explained the variance in children’s ST. Methods A total of 864 children aged three to six, their parents and 66 preschools participated in the cross-sectional DAGIS study, which occurred between 2015 and 2016. The children wore an accelerometer for 1 week. Guardians, principals and early educators completed questionnaires covering the potential correlates of children’s ST, for example, temperament, practices, self-efficacy and regulations. Multilevel regression analyses were conducted in multiple steps; calculation of marginal and conditional R2 values occurred in the final phase. Results Of the 29 studied correlates, the following factors remained significant in the final models. Being a boy (p

Abstract Background Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations. Methods Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline (n = 5024), height, weight and WC were measured in a health examination. At follow-up (n = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses. Results Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI (R 2 = 0.048) and WC (R 2 = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI (P = 0.007 for the interaction) and WC (P = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI (P

Background: Visualisations and readily-accessible web-based supplementary files can improve data reporting and transparency. In this paper, we make use of recent developments in software and psychological network analysis to describe the baseline cohort of a trial testing the Let’s Move It intervention, which aimed to increase physical activity (PA) and reduce sedentary behaviours (SB) among vocational school students. Methods: At baseline, 1166 adolescents, distributed across 6 school clusters and four educational tracks, completed measures of PA and SB, theoretical predictors of these behaviours, and body composition. Within a comprehensive website supplement, which includes all code and analyses, data were tabulated and visualised, and network analyses explored relations between predictor variables and outcomes. Results: Average daily moderate-to-vigorous PA was 65 min (CI95: 57min–73 min), and SB 8h44 min (CI95: 8h04min–9h24 min), with 25.8 (CI95: 23.5–28.0) interruptions to sitting. Cluster randomisation appeared to result in balanced distributions for baseline characteristics between intervention and control groups, but differences emerged across the four educational tracks. Self-reported behaviour change technique (BCT) use was low for many but not all techniques. A network analysis revealed direct relationships between PA and behavioural experiments, planning and autonomous motivation, and several BCTs were connected to PA via autonomous motivation. Visualisation uncovered a case of Simpson’s paradox. Conclusions: Data-visualisation and data exploration techniques (e.g. network analysis) can help reveal the dynamics involved in complex multi-causal systems – a challenging task with traditional data presentations. The benefits of presenting complex data visually should encourage researchers to publish extensive analyses and descriptions as website supplements, which would increase the speed and quality of scientific communication, as well as help to address the crisis of reduced confidence in research findings. We hope that this example will serve as a template for other investigators to improve upon in the future.

Abstract Background Literature on persuasion suggests compliance increases when requests are accompanied with a reason (i.e. the “because-heuristic”). The reliability of outcomes in physical activity research is dependent on sufficient accelerometer wear-time. This study tested whether SMS reminders—especially those that provided a rationale—are associated with increased accelerometer wear-time. Methods We conducted a within-trial partially randomised controlled trial during baseline data collection in a school-based physical activity intervention trial. Of 375 participants (mean age = 18.1), 280 (75%) opted to receive daily SMS reminders to wear their accelerometers. These 280 participants were then randomised to receive either succinct reminders or reminders including a rationale. Data was analyzed across groups using both frequentist and Bayesian methods. Results No differences in total accelerometer wear minutes were detected between the succinct reminder group (Mdn = 4909, IQR = 3429–5857) and the rationale group (Mdn = 4808, IQR = 3571–5743); W = 8860, p = 0.65, CI95 = − 280.90–447.20. Similarly, we found no differences in wear time between participants receiving SMS reminders (Mdn = 4859, IQR = 3527–5808) and those not receiving them (Mdn = 5067, IQR = 3201–5885); W = 10,642.5, p = 0.77, CI95 = − 424.20–305.30. Bayesian ANOVA favored a model of equal weartime means, over one of unequal means, by a Bayes Factor of 12.05. Accumulated days of valid accelerometer wear data did not differ either. Equivalence testing indicated rejection of effects more extreme than a Cohen’s d (standardised mean difference) of ±~0.3. Conclusions This study casts doubt on the effectiveness of using the because-heuristic via SMS messaging, to promote accelerometer wear time among youth. The because-heuristic might be limited to face-to-face communication and situations where no intention for or commitment to the behavior has yet been made. Other explanations for null effects include non-reading of messages, and reminder messages undermining the self-reminding strategies which would occur naturally in the absence of reminders. Trial registration DRKS DRKS00007721. Registered 14.04.2015. Retrospectively registered.

Abstract Background Designing evidence-based interventions to address socioeconomic disparities in health and health behaviours requires a better understanding of the specific explanatory mechanisms. We aimed to investigate a comprehensive range of potential theoretical mediators of physical activity (PA) and screen time in different socioeconomic status (SES) groups: a high SES group of high school students, and a low SES group of vocational school students. The COM-B system, including the Theoretical Domains Framework (TDF), was used as a heuristic framework to synthesise different theoretical determinants in this exploratory study. Methods Finnish vocational and high school students (N = 659) aged 16–19, responded to a survey assessing psychological, social and environmental determinants of activity (PA and screen time). These determinants are mappable into the COM-B domains: capability, opportunity and motivation. The outcome measures were validated self-report measures for PA and screen time. The statistical analyses included a bootstrapping-based mediation procedure. Results Regarding PA, there were SES differences in all of the COM-B domains. For example, vocational school students reported using less self-monitoring of PA, weaker injunctive norms to engage in regular PA, and fewer intentions than high school students. Mediation analyses identified potential mediators of the SES-PA relationship in all of three domains: The most important candidates included self-monitoring (CI95 for b: 0.19–0.47), identity (0.04–0.25) and material resources available (0.01–0.16). However, SES was not related to most determinants of screentime, where there were mainly gender differences. Most determinants were similarly related with both behaviours in both SES groups, indicating no major moderation effect of SES on these relationships. Conclusions This study revealed that already in the first years of educational differentiation, levels of key PA determinants differ, contributing to socioeconomic differences in PA. The analyses identified the strongest mediators of the SES-PA association, but additional investigation utilising longitudinal and experimental designs are needed. This study demonstrates the usefulness of combining constructs from various theoretical approaches to better understand the role of distinct mechanisms that underpin socioeconomic health behaviour disparities.

Abstract Background Physical activity (PA) has been shown to decline during adolescence, and those with lower education have lower levels of activity already at this age, calling for targeted efforts for them. No previous study has demonstrated lasting effects of school-based PA interventions among older adolescents. Furthermore, these interventions have rarely targeted sedentary behaviour (SB) despite its relevance to health. The Let’s Move It trial aims to evaluate the effectiveness and the cost-effectiveness of a school-based, multi-level intervention, on PA and SB, among vocational school students. We hypothesise that the intervention is effective in increasing moderate-to-vigorous-intensity physical activity (MVPA), particularly among those with low or moderate baseline levels, and decreasing SB among all students. Methods The design is a cluster-randomised parallel group trial with an internal pilot study. The trial is conducted in six vocational schools in the Helsinki Metropolitan area, Finland. The intervention is carried out in 30 intervention classes, and 27 control classes retain the standard curriculum. The randomisation occurs at school-level to avoid contamination and to aid delivery. Three of the six schools, randomly allocated, receive the ‘Let’s Move It’ intervention which consists of 1) group sessions and poster campaign targeting students’ autonomous PA motivation and self-regulation skills, 2) sitting reduction in classrooms via alterations in choice architecture and teacher behaviour, and 3) enhancement of PA opportunities in school, home and community environments. At baseline, student participants are blind to group allocation. The trial is carried out in six batches in 2015–2017, with main measurements at pre-intervention baseline, and 2-month and 14-month follow-ups. Primary outcomes are for PA, MVPA measured by accelerometry and self-report, and for SB, sedentary time and breaks in sedentary time (accelerometry). Key secondary outcomes include measured body composition, self-reported well-being, and psychological variables. Process variables include measures of psychosocial determinants of PA (e.g. autonomous motivation) and use of behaviour change techniques. Process evaluation also includes qualitative interviews. Intervention fidelity is monitored. Discussion The study will establish whether the Let’s Move It intervention is effective in increasing PA and reducing SB in vocational school students, and identify key processes explaining the results. Trial registration ISRCTN10979479 . Registered: 31.12.2015

This study investigated the association between interpersonal conflicts and the trajectory of self-esteem from adolescence to mid-adulthood. The directionality of effects between self-esteem and interpersonal conflicts was also studied. Participants of a Finnish cohort study in 1983 at age 16 (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471) and 42 (N = 1334) using postal questionnaires. Measures covered self-esteem and interpersonal conflicts including, conflicts with parents, friends, colleagues, superiors, partners, break-ups with girl/boyfriends, and divorces. Participants were grouped using latent profile analysis to those having "consistently low", "decreasing", or "increasing" number of interpersonal conflicts from adolescence to adulthood. Analyses were done using latent growth curve models and autoregressive cross-lagged models. Among both females and males the self-esteem growth trajectory was most favorable in the group with a consistently low number of interpersonal conflicts. Compared to the low group, the group with a decreasing number of interpersonal conflicts had a self-esteem trajectory that started and remained at a lower level throughout the study period. The group with an increasing number of interpersonal conflicts had a significantly slower self-esteem growth rate compared to the other groups, and also the lowest self-esteem level at the end of the study period. Cross-lagged autoregressive models indicated small, but significant lagged effects from low self-esteem to later interpersonal conflicts, although only among males. There were no effects to the opposite direction among either gender. Our results show that those reporting more and an increasing number of interpersonal conflicts have a lower and more slowly developing self-esteem trajectory from adolescence to mid-adulthood. While the result was expected, it does not seem to imply an effect from interpersonal conflicts to low self-esteem. Rather, if anything, our results seem to suggest that those with low self-esteem are more prone to later interpersonal conflicts.

Objective: The majority of past findings indicate that smokers are more likely than non-smokers to report depressive symptoms and that depression may act as an impediment to smoking cessation. The aim of the present study is to examine the stability of the relationship between depressive symptoms and smoking status and to determine whether the presence of depressivesymptoms predicts continued smoking. Methods Subjects were initially healthy men (n = 2208) from the Veterans Administration Normative Aging Study, an ongoing cohort of older men who have been re-assessed every 3-5 years for a period of 25 years. Depressive symptoms measures employed were the Cornell Medical Index, the MMPI-2 Content Depression Scale, and the Center for Epidemiological Studies Depression Scale. Results: Depression scores were higher among continuing smokers compared to never and former smokers and those who quit after entering the study. None of the three depressive symptoms measures were associated with decreased likelihood of smoking cessation. The change in MMPI-2 depression scores observed in a 4-year follow-up was the same among those who quit and those who remained smokers. Conclusions: Higher prevalence of depressive symptoms among male smokers is stable across time and is likely to contribute to higher morbidity and mortality among these smokers. However, presence of depressive symptoms did not have a significant impact on smoking cessation. [ABSTRACT FROM AUTHOR]