Supporting adolescents' participation in muscle-strengthening physical activity: protocol for the 'Resistance Training for Teens' (RT4T) hybrid type III implementation-effectiveness trial.

INTRODUCTION: In Australia, only 22% of male and 8% of female adolescents meet the muscle-strengthening physical activity guidelines, and few school-based interventions support participation in resistance training (RT). After promising findings from our effectiveness trial, we conducted a state-wide dissemination of the 'Resistance Training for Teens' (RT4T) intervention from 2015 to 2020. Despite high estimated reach, we found considerable variability in programme delivery and teachers reported numerous barriers to implementation. Supporting schools when they first adopt evidence-based programmes may strengthen programme fidelity, sustainability, and by extension, programme impact. However, the most effective implementation support model for RT4T is unclear. OBJECTIVE: To compare the effects of three implementation support models on the reach (primary outcome), dose delivered, fidelity, sustainability, impact and cost of RT4T. METHODS AND ANALYSIS: We will conduct a hybrid type III implementation-effectiveness trial involving grade 9 and 10 (aged 14-16 years) students from 90 secondary schools in New South Wales (NSW), Australia. Schools will be recruited across one cohort in 2023, stratified by school type, socioeconomic status and location, and randomised in a 1:1:1 ratio to receive one of the following levels of implementation support: (1) 'low' (training and resources), (2) 'moderate' (training and resources+external support) or 'high' (training and resources+external support+equipment). Training includes a teacher workshop related to RT4T programme content (theory and practical sessions) and the related resources. Additional support will be provided by trained project officers from five local health districts. Equipment will consist of a pack of semiportable RT equipment (ie, weighted bars, dumbbells, resistance bands and inverted pull up bar stands) valued at ~$A1000 per school. Study outcomes will be assessed at baseline (T0), 6 months (T1) and 18 months (T2). A range of quantitative (teacher logs, observations and teacher surveys) and qualitative (semistructured interviews with teachers) methods will be used to assess primary (reach) and secondary outcomes (dose delivered, fidelity, sustainability, impact and cost of RT4T). Quantitative analyses will use logistic mixed models for dichotomous outcomes, and ordinal or linear mixed effects regression models for continuous outcomes, with alpha levels set at p<0.025 for the outcomes and cost comparisons of the moderate and high support arms against the low support arm. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the University of Newcastle (H-2021-0418), the NSW Department of Education (SERAP:2022215), Hunter New England Human Research Ethics Committee (2023/ETH00052) and the Catholic Schools Office. The design, conduct and reporting will adhere to the Consolidated Standards of Reporting Trials statement, the Standards for Reporting Implementation Studies statement and the Template for Intervention Description and Replication checklist. Findings will be published in open access peer-reviewed journals, key stakeholders will be provided with a detailed report. We will support ongoing dissemination of RT4T in Australian schools via professional learning for teachers. TRIAL REGISTRATION NUMBER: ACTRN12622000861752.

The International Framework for School Health Promotion: Supporting Young People Through and After the COVID-19 Pandemic.

BACKGROUND: The worldwide COVID-19 government restrictions imposed on young people to limit virus spread have precipitated a growing and long-term educational and health crisis. CONTRIBUTIONS TO THE THEORY: This novel study used Sen's Capabilities Approach as a theoretical framework to examine the current health and educational impacts of COVID-19 on youth, referencing emerging literature. The objective was to inform the design of an internationally relevant framework for school health promotion to support young people through and after the COVID-19 pandemic. Mapping of existing health resources, internal/external conversion factors and capabilities were used to identify classroom, school and system level strategies that will enable young people to flourish. Four central enablers were identified and used in the design of the International Framework for School Health Promotion (IFSHP). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE AND EQUITY: The IFSHP can be used by educational institutions, school leaders and teachers to innovate existing health promotion programs, policies and practices to support young people through and after the COVID-19 pandemic. CONCLUSIONS: School systems, schools and teachers are encouraged to utilize the IFSHP to review and innovate existing school health programs to ensure they meet the increased physical and mental health needs of young people.

Sleep health of young adults in Western Australia and associations with physical and mental health: A population-level cross-sectional study.

OBJECTIVES: This article aims to report on the sleep health characteristics of a population-level sample of young Australian adults and examine associations with measures of physical and mental health. METHODS: A cross-sectional study using data from the Raine Study. Data from participants (n = 1234) born into the study (Generation 2) at the 22-year follow-up were used, including data from a self-report questionnaire and polysomnography. RESULTS: The highest prevalence of suboptimal sleep health was seen on measures of sleep duration (30%), onset latency (18%), satisfaction (25%) and regularity (60%). Dissatisfaction with sleep (physical health: ß =0.08; mental health: ß =0.34) and impaired daytime alertness (physical health: ß =0.09; mental health: ß =0.08) were significantly associated with poorer physical and mental health and inadequate polysomnography-measured sleep duration was associated poorer mental health (ß =0.07) (all ps<0.05). CONCLUSIONS: Satisfaction with sleep and daytime alertness, both of which are assessed via self-report, are essential aspects of sleep health for young adults. IMPLICATIONS FOR PUBLIC HEALTH: Findings could inform public health interventions, including screening guidelines, to improve the sleep health and, in turn, the physical and mental health of young adults in Australia.

A novel skin cancer prevention strategy: Preservice teachers' perceptions of a sun safety intervention and experiences in schools.

ISSUE ADDRESSED: Teachers play a vital role in developing children's sun protection routines however upskilling preservice teachers (PSTs) while at university has not yet been trialled as a targeted skin cancer prevention strategy. Hence, this study investigated PSTs perceptions and experiences of sun safety following a brief pilot intervention and placement in primary schools in Western Australia. METHODS: This study used a triangulation mixed methods design. Participants (n = 161) completed a post intervention survey which was analysed quantitatively. A random sub-sample was invited to participate in focus groups (three groups, n = 21) and one-on-one interviews (n = 4). This data was transcribed and uploaded in NVIVO software for thematic analysis. RESULTS: Participants felt the intervention increased their awareness of the dangers of overexposure to ultraviolet radiation (UVR) with many feeling more knowledgeable, skilled and confident to teach sun safety in school settings. Most reported clear sun safety messages in their placement schools. However, only 34.4% reported they had been briefed on the school's sun safety procedures. There was consensus among PSTs that sun protection in primary schools needs to be improved to maximise the protection of children from harmful UVR overexposure. Participants supported a need for consistent sun protection messaging across primary schools with greater emphasis on education rather than compliance management to sun protection. CONCLUSION: Enhancing existing teacher education programs to include more rigorous curriculum content and pedagogical approaches to sun protection education is a novel skin cancer prevention strategy and could feasibly support PSTs self-efficacy to effectively deliver sun safety curriculum in Australian schools.

Investigating primary preservice teachers' ultraviolet radiation awareness and perceived ability to teach sun safety.

ISSUE ADDRESSED: Sun protection practices in Australian primary schools remain inconsistent. Therefore, this study investigates primary PSTs sun protective sun behaviours, ultraviolet (UV) radiation awareness and perceived ability to teach sun safety. METHODS: A convenience sample of undergraduate PSTs (N = 275; mean age = 23.13 years) enrolled at one Western Australian university completed an online survey. Descriptive analyses provided features of the data. Factors associated with sun protection behaviours and perceived knowledge and skill to teach sun safety were explored using multivariable logistic regression models. RESULTS: Lesser than 10% of participants reported using sun protective measures daily (midday shade use: 6.5%; sunscreen: 7.6%; hat: 4.4%). Only 56.3% reported they understand the UV index, with 68.0% rarely/never using it to aid sun protection. Under half the participants reported they felt they had the knowledge (38.5%) or skills (40%) to effectively teach sun safety in primary schools. Regression analysis revealed gender, undergraduate, year and skin sensitivity were not predictors of UV index use (P > .05) or perceived knowledge of sun safety (P > .05). Skin sensitivity was the strongest predictor for shade usage (P = .02), hat usage (P = .05) and perceived skill to teach sun safety (P = .02). CONCLUSIONS: Survey data indicate UV radiation is inconsistently understood by PSTs. Many felt that they did not have the required knowledge or skill to teach sun safety effectively. SO WHAT?: Improving PSTs UV radiation knowledge while at university is a potential opportunity to improve sun safety delivery in primary schools. A targeted intervention for PSTs is warranted.

Comparability and feasibility of wrist- and hip-worn accelerometers in free-living adolescents.

OBJECTIVE: To determine the comparability and feasibility of wrist- and hip-worn accelerometers among free-living adolescents. DESIGN: 89 adolescents (age=13-14years old) from eight secondary schools in New South Wales (NSW), Australia wore wrist-worn GENEActiv and hip-worn ActiGraph (GT3X+) accelerometers simultaneously for seven days and completed an accelerometry behavior questionnaire. METHODS: Bivariate correlations between the wrist- and hip-worn out-put were used to determine concurrent validity. Paired samples t-test were used to compare minutes per day in moderate-to-vigorous physical activity (MVPA). Group means and paired sample t-tests were used to analyze participants' perceptions of the wrist- and hip-worn monitoring protocols to assist with determining the feasibility. RESULTS: Wrist-worn accelerometry compared favorably with the hip-worn in average activity (r=0.88, p<0.001) and MVPA (r=0.84 p<0.001, mean difference=3.54min/day, SD=12.37). The wrist-worn accelerometer had 50% fewer non-valid days (75 days, 12%) than the hip-worn accelerometer (n=152, 24.4%). Participants reported they liked to wear the device on the wrist (p<0.01), and that it was less uncomfortable (p=0.02) and less embarrassing to wear on the wrist (p<0.01). Furthermore, that they would be more willing to wear the device again on the wrist over the hip (p<0.01). CONCLUSIONS: Our findings reveal there is a strong linear relationship between wrist- and hip-worn accelerometer out-put among adolescents in free-living conditions. Adolescent compliance was significantly higher with wrist placement, with participants reporting that it was more comfortable and less embarrassing to wear on the wrist.

Reliability and validity of a single-item physical activity measure for adolescents.

AIMS: The aim of this study was to examine the test-retest reliability and concurrent validity of an adolescent single-item physical activity measure by comparing it with the existing Oxford Physical Activity Questionnaire (OPAQ) and accelerometer output. METHODS: Participants were 123 adolescents (14.7 ± 0.5 years) from three secondary schools in New South Wales, Australia. To determine reliability, participants completed both questionnaires on two occasions separated by 2 weeks. To assess validity, participants wore Actigraph GT3X+ accelerometers for a 7-day monitoring period and completed both physical activity questionnaires. Bivariate correlations between self-reported moderate-to-vigorous physical activity (MVPA) and accelerometer MVPA min/day were calculated. RESULTS: The single-item (intra-class correlation coefficient (ICC) = 0.75, 95% confidence interval (CI) = 0.64-0.83, P < 0.001) ) and the OPAQ (ICC = 0.79, 95% CI = 0.69-0.86, P < 0.001) were both found to have moderate-to-strong reliability. Correlations between self-reported and objectively measured MVPA were similar for the single-item measure (r = 0.44, 95% CI = 0.24-0.63, P < 0.001) and the OPAQ (r = 0.50, 95% CI = 0.30-0.65, P < 0.001). CONCLUSIONS: These findings suggest the single-item measure can provide a reliable and valid assessment of youth physical activity.