A Web-Based Intervention for Insufficiently Active College Students: Feasibility and Preliminary Efficacy.

BACKGROUND: One third of college students do not achieve aerobic activity levels recommended for physical and mental health. The web-based "I Can Be Active!" intervention was designed to help college students increase their physical activity. The intervention was grounded in the Multi-Process Action Control (M-PAC) framework which emphasizes translating intention into sustainable action. OBJECTIVE: The primary purpose was to evaluate the feasibility of the intervention with insufficiently active young adult college students. The secondary purposes were to describe the preliminary effects of the intervention on: (1) the M-PAC constructs and (2) physical activity. METHODS: Twenty-one college students, ages 18 to 24, were enrolled in the pre-post quasi-experimental study to test the 8-week intervention during Spring 2021. Data were collected via self-report questionnaires, web-analytics, and interviews. Feasibility outcomes included recruitment, retention, acceptability, practicality, and implementation. Preliminary efficacy outcomes were self-report M-PAC constructs and physical activity. Data analyses included descriptive statistics, t tests, Wilcoxon signed rank tests, Hedge's g, and thematic analysis. RESULTS: Recruitment and retention rates were 70% and 71%, respectively. Participants reacted positively to the program, content, and features, except the manual entry step tracker and private social media group. Positive trends and significant increases were found in the regulatory and reflexive M-PAC constructs (self-regulation, habit, and identity) and physical activity. CONCLUSIONS: Findings support the feasibility and preliminary effects of the intervention for insufficiently active college students and highlight implications for intervention refinement. Future research will test intervention effectiveness using a randomized controlled trial with a larger diverse sample of college students.

Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review.

BACKGROUND: Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors. OBJECTIVE: This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults. METHODS: The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance. RESULTS: The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance. CONCLUSIONS: The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults. TRIAL REGISTRATION: PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279156.

Affective Response to Exercise and Affective Judgments as Predictors of Physical Activity Intention and Behavior among New Mothers in their first 6-Months Postpartum.

BACKGROUND: Understanding the predictors of moderate to vigorous physical activity (MVPA) during early postpartum is important to improve promotion efforts. Affect-related constructs are key predictors of MVPA but have limited research in mothers during the postpartum period. PURPOSE: To examine two affect-related constructs (affective response to exercise and affective judgments) as predictors of MVPA intention and behavior across three months, among a sample of new mothers. METHODS: Participants were 105 mothers (M age = 30.64 years; SD = 3.93) who completed measures during postpartum at 2-months post-birth of their first child. The affective response to exercise (assessed at baseline [2-months postpartum] during a submaximal treadmill test), affective judgments and intention (baseline, 6-weeks after baseline), and MVPA (baseline, 6- and 12-weeks after baseline) were assessed via self-report. RESULTS: Path analysis, using ordinary least squares regression, showed that the affective response during exercise was a significant predictor of intention (baseline, 6-weeks), as well as change in intention from baseline to 6-weeks. By contrast, affective judgments predicted intention at 6-weeks, but not at baseline or in the change model. Past MVPA did not moderate these findings, although the affective response during exercise also had a significant indirect effect on MVPA through intention at 6-weeks and 12-weeks. CONCLUSIONS: Interventions targeting women's affective response during exercise may be important during postpartum, perhaps through self-paced physical activity guidance. Affective judgments may not be predictive of MVPA, in part due to unanticipated changes during early postpartum leading to inaccurate expectations of the physical activity experience.

Understanding the predictors of moderate to vigorous physical activity (MVPA) during early postpartum is important to improve promotion efforts. Affect-related constructs are key predictors of MVPA but have limited research in mothers during the postpartum period. The purpose of this study was examine two affect-related constructs (affective response to exercise and affective judgments) as predictors of MVPA intention and behavior across three months, among a sample of new mothers. Participants were 105 mothers who completed measures of affective response to exercise (assessed at 2 months postpartum during a sub-maximal treadmill test), affective judgments and intention (2 months postpartum, and 6-weeks after), and MVPA (2 months postpartum, 6- and 12-weeks after). The affective response during exercise was a significant predictor of intention as well as change in intention over time. By contrast, affective judgments was a less reliable predictor across the study. Interventions targeting women's affective response during exercise may be important during postpartum, perhaps through self-paced physical activity guidance. Affective judgments may not be predictive of MVPA, in part due to unanticipated changes during early postpartum leading to inaccurate expectations of the physical activity experience.

Associations between sleep disturbance, physical activity, and anxiety sensitivity among college students during the COVID-19 pandemic.

The present study sought to examine associations between anxiety sensitivity and both sleep and physical activity among college students, who are particularly vulnerable to sleep disturbance, decreased physical activity, and the development of psychopathology, especially in the wake of the COVID-19 pandemic. Participants were 683 college students (Mage = 20.33, SD = 3.58; 72% female; 70.3% White) who completed self-report measures online for course credit. Results indicated that after controlling for the effects of age, gender identity, and race, greater sleep disturbance was significantly associated with higher overall anxiety sensitivity (7% unique variance; ß = 0.27, t = 6.67, p < .001) as well as its three subdomains (physical concerns: 4% variance; ß = 0.21, t = 4.97, p < .001; cognitive concerns: 6% variance; ß = 0.25, t = 6.17, p < .001; social concerns: 6% variance; ß = 0.26, t = 6.22, p < .001). Additionally, more time spent walking was associated with greater anxiety sensitivity physical concerns (1% variance; ß = 0.11, t = 2.52, p = .012) and greater vigorous intensity physical activity was associated with lower anxiety sensitivity social concerns (1% variance; ß = -0.13, t = -2.76, p = .006). These findings suggest that sleep problems may be more universally relevant to anxiety sensitivity than physical activity and interventions to promote healthier sleep may be useful for decreasing anxiety sensitivity in college students.

Stressors and resilience are associated with well-being in young adult college students.

Objective: The purposes were to describe stressors and resilience behaviors of college students and examine the relationships among stressors, resilience, and well-being. Hypothesis: Resilience will modify the relationship between stressors and well-being. Participants: The sample included 1,010 college students, ages 18-26, from an urban Midwestern university. Methods: A secondary analysis of cross-sectional data from an anonymous survey was conducted using multiple regression and simple slopes analysis. Results: Resilience did not modify the relationship between stressors and well-being. Stressors (ß = -.44, p < .0001) and resilience (ß = .33, p < .0001) accounted for 42% of the variance in well-being (adjusted R2 = .42, F2,999 = 365.98, p < .0001). The most frequently endorsed stressors were sleep problems, anxiety, and relationships. Conclusions: Stressors and resilience warrant special attention in the allocation of resources and development of programs to improve student well-being.

Testing the Effects of Two Field-to-Fork Programs on the Nutritional Outcomes of Elementary School Students From Diverse and Lower-Income Communities.

The purpose of this quasi-experimental study was to evaluate the effects of two farm-to-school programs, specifically the Field-to-Fork Multi-visit Program (N = 264) and the Field-to-Fork After-school Club (N = 56), on nutritional outcomes of elementary school students (third to fifth grade) from urban, diverse, and lower-income communities. Data were collected via self-report surveys measuring: (a) knowledge of recommendations for daily fruit and vegetable intake; (b) fruit and vegetable consumption; (c) knowledge of cooking a healthy recipe using vegetables; and (d) desire for farm fresh foods at school. Statistical analyses included McNemar's and Wilcoxon signed rank tests. The proportion of students knowing how to cook a vegetable rich recipe increased with both programs (Multi-visit Program p < .001; After-school Club p = .002). Vegetable consumption increased with the After-school Club (p = .002). Farm-to-school programming can increase knowledge of cooking vegetable rich recipes and vegetable intake among elementary school students from diverse, urban, and lower-income communities.

Students' perceptions of a community health advocacy skills building activity: A descriptive analysis.

BACKGROUND: Skills to promote advocacy, a nursing competency, are vital to today's cohorts of nursing students, who often struggle with discourse. Opportunities to develop, defend, and rebut science-based arguments enhance resilience and self-efficacy when advocating for health policy. A community health discussion activity was developed to enhance advocacy skills in undergraduate and graduate nursing students at a midwestern university. OBJECTIVES: The purposes of this study were to explore students' perceptions of the benefits of a discussion activity about a controversial health issue, and to describe the impact of the opportunities to form valid arguments using empirical evidence on students' perceptions of their ability to be advocates. DESIGN: Cross-sectional post-activity survey evaluation. SETTINGS: Enrollment in a community health nursing course. PARTICIPANTS: Students from two undergraduate (n = 110) and one graduate (n = 20) nursing cohorts. METHODS: Following completion of the online discussion activity, students were invited to provide feedback on their perceptions of activity benefits. Descriptive analyses were conducted. RESULTS: Undergraduate and graduate nursing students reported the activity helped them learn to form a valid argument using scientific evidence (88.6 %), use credible sources when forming their own opinions (91.7 %), and begin to see themselves as advocates for improving the health of individuals and communities (87.1 %). CONCLUSIONS: Online discussion boards are potential venues for development of advocacy skills.

Application of the IDEAS Framework in Adapting a Web-Based Physical Activity Intervention for Young Adult College Students.

User-centered developmental processes are critical to ensuring acceptability of e-health behavioral interventions, and yet physical activity research continues to be inundated with top-down developmental approaches. The IDEAS (Integrate, Design, Assess, and Share) framework outlines a user-centered process for development of e-health interventions. The purpose of this manuscript is to describe the application of the IDEAS framework in adapting a web-based physical activity intervention for young adult college students. Steps 1-3 emphasized integrating insights from users and theory and Steps 4-7 focused on iterative and rapid design with user feedback. Data were collected via repeat qualitative interviews with young adult college students (N = 7). Resulting qualitative metathemes were engagement, accountability, and cultural fit. Therefore, intervention modifications focused on strategies to foster ongoing engagement with the program (e.g., increase interactivity), support personal and social accountability (e.g., private social media group), and provide a cultural fit within the college lifestyle (e.g., images relevant to student life). The resulting web-based intervention included eight weekly lessons, an expanded resource library, "how-to" videos, step and goal trackers, and a private social media group to be led by a wellness coach. In conclusion, the IDEAS framework guided an efficient, user-centered adaptation process that integrated empirical evidence and behavior change theory with user preferences and feedback. Furthermore, the process allowed us to address barriers to acceptability during the design and build stages rather than at later stages of pilot and efficacy testing.

In the eye of the beholder: Body weight misperceptions among African Americans living in Kentucky.

Body weight status misperception, perceiving one's self to be thinner than one's body mass index (BMI), is growing in the United States. At risk for lifestyle-related disease, African Americans face more dire consequences with respect to this misperception than others. In a sample of African American Kentuckians, we found a moderate level of body weight status misperception. Educational attainment was the strongest predictor of body weight status misperception, with more education associated with less misperception. These findings suggest that health communication for African Americans should address body weight status misperception and be tailored for individuals' level of educational attainment.

Association between Physical Activity and Sport Participation on Hemoglobin A1c Among Children and Adolescents with Type 1 Diabetes.

PURPOSE: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). METHOD: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. RESULTS: Participants consisted of 71 females and 81 males, were 13 ± 3 years old with an average HbA1c level of 8.75 ± 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p < 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p < 0.05). CONCLUSION: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner.

Opposing Discourses Surrounding Type 2 Diabetes in Eastern Appalachian Kentucky.

Type 2 diabetes disproportionately affects individuals in Appalachia. This study investigated discourse among friends and family with different diabetes risk levels in Central Appalachia. Eighteen semistructured, in-depth interviews were conducted with Appalachian Kentuckians. Thematic analysis revealed 2 dialectic tensions centered on disease management (health as a personal problem vs diabetes management requiring social support) and disclosure (openness vs closedness). Health professionals should consider the powerful influence of speech with respect to family relations and support, along with the need to communicate early, clearly, and often in a manner that emphasizes family, friends, and connectedness.

Predictors of Physical Activity in a Predominantly Hispanic Sample of Adolescents.

In the United States, the vast majority of Hispanic high school students do not meet physical activity recommendations. This prospective, observational study tested the Theory of Planned Behavior (TPB) to predict physical activity in a convenience sample of 232 high school students from a predominantly Hispanic, rural-fringe, lower-income community in Southwestern United States. Mindfulness was tested as a moderator of the intention-physical activity relationship. Data were collected via self-report questionnaires. Statistical analysis included structural equation modeling (SEM) and moderation analysis. The model explained 60% and 43% of the variance in intention and physical activity, respectively. Attitude (ß = 0.49, p < 0.001) and subjective norm (ß = 0.44, p < 0.001) predicted intention. Intention (ß = 0.58, p < 0.001) and perceived behavioral control (ß = 0.13, p < 0.027) predicted physical activity. Mindfulness did not moderate the intention-physical activity relationship. The results support using the TPB to predict physical activity in this population and may inspire ideas for targeted interventions.

Correlates of Physical Activity and Sedentary Behaviors Among Overweight Hispanic School-aged Children.

PURPOSE: The purpose of this study was to explore potential correlates of physical activity and sedentary screen time behaviors among overweight Hispanic school-aged children, ages 7 to 14years. DESIGN AND METHODS: We conducted an exploratory correlation analysis using baseline data of 40 child-parent dyads from the "Mind Exercise Nutrition Do It!" program conducted in the Western United States. RESULTS: Child self-esteem and parental vegetable intake were moderately associated with physical activity, while parental vegetable intake and child fruit intake were strongly associated with physical activity among males. Physical activity was not significantly associated with body mass index percentile, sedentary screen time behaviors, or body esteem. Only decreased body esteem in males was correlated with sedentary screen time behaviors. CONCLUSIONS AND PRACTICE IMPLICATIONS: Understanding the correlates of physical activity and sedentary screen time behaviors in this underrepresented population allows nurses to better understand the connections between physical activity and other aspects of well-being in children. Further investigation is needed to determine how these relationships can be incorporated into physical activity interventions that improve the health of overweight Hispanic school-aged children.

Bidirectional Relationships Between Fatigue and Everyday Experiences in Persons Living With HIV.

Fatigue symptoms are very common among persons living with HIV (PLWH). Fatigue is related to functional and psychological problems and to treatment nonadherence. Using secondary data from ecological momentary assessment, we examined fatigue as a predictor of PLWH everyday experiences. In bidirectional analyses based on the shape shifters model, we also examined these experiences as predictors of fatigue. Data were examined from 67 PLWH who completed daily surveys on a handheld computer. Brief validated scales were used to assess participants' control beliefs, mood, stress, coping, social support, experience of stigma, and motivation. At the beginning and end of the study, fatigue was measured with two CES-D items that have been used in past HIV symptom research. Multilevel models and logistic regression were used to test reciprocal predictive relationships between variables. Moderate to severe fatigue affected 45% of PLWH in the study. Initial fatigue predicted PLWH subsequent overall level of control beliefs, mood, stress, coping, and social support, all p < .05. These state variables remained relatively constant over time, regardless of participants' initial fatigue. In tests for reciprocal relationships with 33 PLWH, average daily stress, OR = 4.74, and stigma, OR = 4.86, also predicted later fatigue. Fatigue predicted several daily survey variables including stress and social support. Stress and support in turn predicted fatigue at a later time, suggesting a self-perpetuating cycle but also a possible avenue for intervention. Future studies should examine daily variation in fatigue among PLWH and its relation to other everyday experiences and behaviors. © 2016 Wiley Periodicals, Inc.