Do young people perceive their smartphone addiction as problematic? A study in Danish university college students.

As smartphone addiction has been linked to poor mental health and lower levels of physical activity, it is of public health interest to explore the behavior behind problematic smartphone use and develop interventions to reduce smartphone use. This study aimed to investigate the risk of smartphone addiction and examine perceived problematic smartphone behavior among university college students. This online survey conducted amongst 1251 Danish University College students studied smartphone addiction in conjunction with physical- and mental health dimensions. The risk of smartphone addiction was estimated using the Smartphone Addiction Scale-Short Version (SAS-SV). The main results are presented as odds ratios from multivariate logistic regressions. One in four (23%) were at high risk of smartphone addiction. Of this high-risk group, 74% identified their smartphone behavior as problematic, with 91% having considered reducing their smartphone use. Students with a high risk of smartphone addiction perceiving their behavior as problematic were more likely to report low mental health and well-being. In conclusion, students at high risk of smartphone addiction acknowledge their problematic behavior and have actively considered behavior modifications. This knowledge can enable teachers, parents, and social and health workers to understand that a majority of heavy smartphone users are open to reducing their smartphone usage, albeit with the appropriate support.

User experience, game satisfaction and engagement with the virtual simulation VR FestLab for alcohol prevention: A quantitative analysis among Danish adolescents.

VR FestLab is a virtual reality party simulation application. The tool allows users to make decisions while experiencing a virtual party where they are offered alcohol. This study examines the user experience, game satisfaction, and engagement of 181 adolescent users (aged 15-18) with VR FestLab involving seven schools in Denmark. All user experience factors of the short user experience questionnaire were rated positively or neutral, and 66% of the students liked the VR experience. Neither the user experience score nor a score for game satisfaction and engagement were associated with sex, age, perceived family affluence, school performance, alcohol consumption and attitudes or mental health of students. Overall, positive user experiences and game satisfaction of VR FestLab were found not to differ according to student characteristics. We conclude that virtual simulations offer new ways for developing drinking refusal skills that are attractive and acceptable for adolescent users.

Are changes in physical activity during COVID-19 associated with mental health among Danish university students?

Aims: The benefits associated with being physical active on mental health is well-established, but little is known on how rapid changes in physical activity are associated with mental health. This study investigated the association between changes in physical activity and mental health among Danish university students during the first COVID-19 lockdown. Methods: Online survey data were collected among 2,280 university students at the University of Southern Denmark and University of Copenhagen in May-June 2020 as part the "COVID-19 International Student Well-being Study." Multiple linear regressions were used to analyze associations between changes in physical activity and mental health (depression and stress scores) adjusted for potential socio-economic confounders. Results: During the first COVID-19 lockdown, 40% decreased their moderate and 44% their vigorous physical activity, while 16% increased their moderate and 13% their vigorous physical activity. Overall, students with a stable physical activity level had the lowest mean depressive and stress scores. Adjusted analyses showed that a decrease in vigorous and moderate physical activity level was significantly associated with a higher depression score (mean difference (vigorous): 1.36, p < 0.001 and mean difference (moderate): 1.55, p < 0.001). A decrease in vigorous physical activity and an increase in moderate physical activity was associated with a 1-point increase in the PSS-4 stress score (p < 0.001). Conclusion: A substantial proportion of students changed their physical activity level during lockdown. Our findings emphasize the importance of staying physically active during COVID-19 lockdown. This knowledge might be important for relevant health authorities to bridle post-pandemic mental health challenges.

Efficacy of the Virtual Reality Intervention VR FestLab on Alcohol Refusal Self-Efficacy: A Cluster-Randomized Controlled Trial.

It is currently unknown whether a virtual social environment can support young people in building their skills to overcome peer pressure when offered alcohol. This study evaluated the efficacy of the newly developed virtual reality simulation game VR FestLab on the refusal self-efficacy regarding social pressures to drink of Danish male and female students aged 15-18. VR FestLab features a party setting where adolescents can "steer" their own party experience. Eleven schools were included in a cluster-randomized controlled trial and allocated to either the intervention (n = 181) or the active control group (n = 191). Students in intervention schools played VR FestLab, while those in the control group played the VR game Oculus Quest-First Steps. The primary outcome measure was the social pressure subscale of the drinking refusal self-efficacy scale (DRSEQ-RA). The intervention effects were measured immediately after the intervention/control session (T1) and after a 6-week follow-up (T2). Data were examined using linear mixed regression models. Our study did not demonstrate a significant effect of drinking refusal self-efficacy at T1. For all secondary outcomes, we observed no substantial differences between the intervention and control groups. This study provides new insights into the feasibility and effectiveness of an innovative virtual reality alcohol prevention tool. VR FestLab can be an innovative and promising contribution to complement existing school-based alcohol prevention, but more research is needed to improve its effectiveness.

Academic stress in Danish medical and health science students during the COVID-19 lock-down.

INTRODUCTION: COVID-19 has disrupted normal life and resulted in an online transformation of teaching. Little is known about how these changes affected academic stress in students. This study examined the role of changes of teaching methods on academic stress among university students during the first lockdown in Denmark. METHODS: The cross-sectional survey was part of the international "COVID-19 International Student Well-being Study" and included responses on socio-economic characteristics, infection worries, academic stress, work capacity and satisfaction with teaching from 1,541 Danish health and medical science university students in May-June 2020. Changes in academic stress were analysed using descriptive statistics and multi-variable analyses using stepwise logistic regression. RESULTS: A considerable part (39%) of students reported academic stress due to COVID-19. One third reported that their study workload had increased significantly due to the COVID-19 outbreak and that they were concerned about their ability to complete the academic year. Factors associated with academic stress were female sex, young age, bachelor level, knowing a COVID-19 patient and being worried about becoming infected, whereas immigration background, sufficient financial resources and living arrangements were not. CONCLUSIONS: Our findings suggest that the COVID-19 outbreak has influenced university students' academic stress. It is important to set up structures to support students' mental health and educational trajectory during the pandemic. FUNDING: none. TRIAL REGISTRATION: not relevant.

Co-creating Virtual Reality Interventions for Alcohol Prevention: Living Lab vs. Co-design.

Addressing the need for collaborative involvement in health intervention design requires application of processes that researchers and practitioners can apply confidently to actively involve end-users and wider stakeholder groups. Co-creation enables participation by focusing on empowering a range of stakeholders with opportunities to influence the final intervention design. While collaboration with users and stakeholders during intervention design processes are considered vital, clear articulation of procedures and considerations for various co-creation methodologies warrants further research attention. This paper is based on two case studies conducted in Australia and Denmark where researchers co-created virtual reality interventions in an alcohol prevention context. This paper explored and reflected on two co-creation methods-co-design and the Living Lab-and showcased the different processes and procedures of each approach. The study demonstrates that both approaches have merit, yet highlights tensions in distinguishing between the application of each of the respective steps undertaken in each of the processes. While a lot of similarities exist between approaches, differences are evident. Overall, it can be said that the Living Lab is broader in scope and processes applied within the Living Labs approach are more abstract. The co-design process that we applied in the first case study is described more granularly delivering a clear a step-by-step guide that practitioners can implement to co-design solutions that end-users value and that stakeholders support. An agenda to guide future research is outlined challenging researchers to identify the most effective co-creation approach.

User Experiences with a Virtual Alcohol Prevention Simulation for Danish Adolescents.

This pilot study explores 31 Danish adolescent user experiences for the newly developed virtual party simulation app-Virtual Reality (VR) FestLab. The main objective of this study was to investigate usability for VR FestLab, which aims to improve alcohol resistance skills for Danish adolescents. A secondary objective was to understand gameplay experiences. The study is a mixed method study that draws on questionnaire data (n = 31) and focus group interviews (n = 10) of boarding school students participating in the pilot study. Descriptive statistics were used to examine quantitative data, and qualitative data were analyzed thematically. Quantitative findings indicated that gameplay experiences of the VR simulation were positive, and all User Experience Questionnaire (UEQ) items were answered positively. The focus group interviews showed that adolescents found the simulation to be realistic. Feedback indicated that the group pressure experienced in the simulation was regarded to be less than in real life. Adolescents had varying approaches to playing the VR simulation, they thought the quality of the simulation was good, and only a few users experienced technical difficulties. These initial study findings indicate that VR FestLab is a promising tool for the prevention of alcohol use among adolescents.

Do student social background and school context affect implementation of a school-based physical activity program?

This study examined the relationship between student- and school- characteristics and different implementation parameters of "Active All Year Round", a nationwide Danish school-based physical activity program. The study is based on data from multiple sources: questionnaire data from students from 16 fifth-grade school classes (n = 276) and their teachers (n = 16), in-class observations (n = 15) and register data. Predictors included the student-level characteristics of gender, family affluence, immigration background, and perception of school connectedness as well as the school-level characteristics of school size, school parental education level, school physical activity policy and school's prioritization of health promotion. Implementation was assessed by creating an implementation score from data on program psychological reach, dose delivered, dose received and fidelity. Data were analyzed by multilevel linear regression analysis. Findings indicated that the program was more easily implemented for students with higher school connectedness. To conclude, school-based health promotion programs can be improved by knowing, before the program is implemented, which factors increase the odds of better implementation.