Motivation for physical activity in the Jordanian military: Possible determinants of physical activity in male and female recruits.

Given the obligatory nature of physical fitness training in the military and in order to guide intervention development, our study assessed possible motivational determinants as suggested by self-determination theory in addition to other possible determinants. A cross-sectional study was conducted among 218 military recruits during their basic training in Jordan. Physical activity and lifestyle behaviors were measured using the Arab Teens Lifestyle Study (ATLS). Psychosocial variables were assessed using the Exercise Self-Efficacy Scale (ESE), Behavioral Regulation Exercise Scale (BREQ-2) and Exercise Benefits/Barriers Scale (EBBS). Bivariate correlation analysis revealed that identified self-regulation, introjected regulation and exercise self-efficacy scores were positively associated with higher Metabolic Equivalent of Task (METs) and minutes per week of physical activity among male recruits and the overall sample respectively. Among females, only external regulation was positively associated with the total METs/week. Being a male was significantly associated with higher minutes of physical activity among the overall sample. Multivariate regression analyses showed that identified regulation was significantly and positively associated with higher minutes of physical activity among the overall sample and male recruits in addition to higher METs per week among the male recruits. Also, the amotivation score was significantly and positively associated with higher minutes of physical activity among the overall sample and male recruits. A multivariate regression analysis for female recruits showed no significant associations. Intervention developers are advised to increase autonomous forms of motivation through structured enjoyable physical fitness programs in order to enhance intrinsic motivation in the long term.

Both short and long sleep durations are associated with type 2 diabetes, independent from traditional lifestyle risk factors-The Maastricht Study.

OBJECTIVES: This study examined the cross-sectional association between sleep duration, prediabetes, and type 2 diabetes, and its independence from the traditional lifestyle risk factors diet, physical activity, smoking behavior, and alcohol consumption. METHODS: Cross-sectional data from 5561 people aged 40-75 years recruited into The Maastricht Study between 2010 and 2018 were used (1:1 female:male and mean age: 60.1 years [standard deviation: 8.6]). Sleep duration was operationalized as in-bed time, algorithmically derived from activPAL3 accelerometer data (median 7 nights, IQR 1). Glucose metabolism status was determined with an oral glucose tolerance test. Multinomial logistic regression was used to assess the association of sleep duration as restricted cubic spline with prediabetes and type 2 diabetes. We adjusted for sex, age, educational level, the use of sleep medication or antidepressants, and the following lifestyle risk factors: diet quality, physical activity, smoking behavior, and alcohol consumption. RESULTS: A U-shaped association between sleep duration and type 2 diabetes was found. Compared to those with a sleep duration of 8 hours, participants with a sleep duration of 5 and 12 hours had higher odds of type 2 diabetes (OR: 2.9 [95% CI 1.9 to 4.4] and OR 3.2 [2.0 to 5.2], respectively). This association remained after further adjustment for the lifestyle risk factors (OR: 2.6 [1.7 to 4.1] and OR 1.8 [1.1 to 3.1]). No such association was observed between sleep duration and prediabetes. CONCLUSIONS: Both short and long sleep durations are associated positively and independently of lifestyle and cardiovascular risk factors with type 2 diabetes, but not with prediabetes.

Correlates of Dietary Behaviors Among Young Emirati Males Completing Compulsory Military Service.

INTRODUCTION: It is important to understand the correlates of different dietary behaviors in a military context in the United Arab Emirates (UAE) to guide intervention development to prevent and treat obesity as it has a significant impact at the country and regional level. This study aimed to assess different dietary behaviors and their association with potential correlates including age, marital status, educational level, smoking status, screen time, dietary knowledge, eating self-efficacy, and general self-efficacy. MATERIALS AND METHODS: The study used a cross-sectional design and included 153 (M = 25.9 years, SD = ± 3.2) military recruits completing their basic training at a single military camp in the UAE. Dietary behaviors of these recruits were measured using the Arab Teens Lifestyle Study. Other potential correlates included dietary knowledge, general self-efficacy, and eating efficacy. The ethical approval was obtained from the research ethics committee in the UAE university. RESULTS: Daily intake of fruits, vegetables, and breakfast was reported by 14.4%, 25.5%, and 22.9% of the military recruits, respectively. Almost half of the recruits (46.4%) consumed sugar-sweetened drinks more than 3 times a week, 39.2% consumed fast food more than 3 times a week, and 37.3% consumed sweets/chocolates more than 3 times a week. Bivariate regression analyses revealed that eating self-efficacy was positively associated with breakfast and dairy food consumption, although it was inversely associated with sugar, fast-food, and French fries intake. Age was significantly and inversely associated with sugar, fast-food, and energy drink intake. Moreover, nutrition knowledge was significantly and positively correlated with vegetable intake and negatively correlated with energy drink consumption. Multiple regressions showed that lower age and lower eating self-efficacy were found to be the main predictors for sugar-sweetened drinks (adjusted R2 = 0.112) and fast-food intake (adjusted R2 = 0.084). Also, a higher dietary knowledge score was a predictor of vegetable intake (adjusted R2 = 0.093), although age and smoking predict energy drink intake (adjusted R2 = 0.225). CONCLUSIONS: The results show that unhealthy eating patterns are common among new recruits in the UAE military. The study suggests that age, eating self-efficacy, and nutrition knowledge are the main correlates of selected dietary behaviors. Interventions are advised to target these correlates to achieve healthier dietary habits inside the military.

The Association between Sleep Quality and Fatigue in Colorectal Cancer Survivors up until Two Years after Treatment: A Cross-Sectional and Longitudinal Analysis.

Fatigue is a distressing complaint with high detriment to quality of life that persists in one-third of colorectal cancer survivors after cancer treatment. Previous studies in mixed groups of cancer patients have suggested sleep quality is associated with fatigue. We aimed to investigate this association in colorectal cancer survivors up until two years post-treatment. Data on n = 388 stage I-III colorectal cancer patients were utilized from the EnCoRe study. Sleep quality and fatigue were measured at 6 weeks and 6, 12, and 24 months post-treatment. Sleep quality was measured using the Pittsburgh Sleep Quality Index (cross-sectional analysis only) and the single-item insomnia scale from the EORTC QLQ-C30. Fatigue was measured by the Checklist Individual Strength. Linear and mixed-model regression analyses analysed associations between sleep quality and fatigue cross-sectionally and longitudinally. Longitudinal analysis revealed worsening sleep quality over time was significantly associated with increased levels of fatigue over time (ß per 0.5 SD increase in the EORTC-insomnia score = 2.56, 95% Cl: 1.91, 3.22). Significant cross-sectional associations were observed between worse sleep quality and higher levels of fatigue at all time points. Worse sleep quality in colorectal cancer patients was associated with higher levels of fatigue during the first two years post-treatment.

Dietary, physical activity, and weight management interventions among active-duty military personnel: a systematic review.

BACKGROUND: Research has been conducted to assess the effectiveness of weight management, dietary and physical activity interventions in military settings. However, a recent and comprehensive overview is lacking. The aim of this systematic review is to examine the evidence and describe key components of effective interventions in terms of improving body composition, dietary behaviors, and physical activity among active-duty military personnel. METHODS: PubMed, PsycInfo, and CINAHL were searched on the 17th of November 2017 to identify interventions that promoted diet and/or physical activity among active-duty military personnel. Studies were included if they assessed outcomes related to anthropometric measurements, dietary behaviors, or fitness/physical activity levels. There were no restrictions regarding publication date, follow-up duration, and sex. After screening, a total of 136 studies were eligible. Of these studies, 38 included an educational and/or behavioral change component, and 98 had only physical or fitness training as part of basic military training. Only studies that included an educational and/or behavioral change component were assessed for quality using the Effective Public Health Practice Project tool and included in the qualitative synthesis of the results. RESULTS: Based on consistent evidence from studies that were rated as moderate or strong, there is good evidence that military weight management interventions are effective in improving body composition for durations of up to 12 months. Effective interventions are more likely to be high intensity (have a greater number of sessions), are more often delivered by specialists, and use theoretical base/behavioral change techniques and a standardized guideline. Dietary interventions can potentially reduce total fat and saturated fat intake. Dietary interventions that target the kitchen staff and/or increase the availability of healthy food are more likely to be effective in the short term. The results regarding military physical fitness interventions were inconclusive. CONCLUSION: Despite limitations such as the diversity and heterogeneity of the included interventions, outcome measurements, and follow-up duration, this systematic review found good evidence that weight management interventions are effective, especially in terms of weight loss. More studies are needed to acquire solid evidence for effectiveness for durations longer than 12 months and to identify key components of the effective dietary and physical activity educational and/or behavioral change interventions, especially in countries outside Europe and the US.

Long Live Love. The implementation of a school-based sex-education program in The Netherlands.

Implementation of health education programs is often inadequately considered or not considered at all in planning, developing and evaluating interventions. With the focus being predominantly on the adoption stage, little is known about the factors influencing the implementation and continuation stages of the diffusion process. This study contributes to the understanding of factors that promote or impede each stage of the diffusion process in the school setting using the sex education program Long Live Love (LLL) as an example. A survey integrating different diffusion-related concepts was completed by 130 teachers. Results showed that teacher curriculum-related beliefs were associated with all stages in the diffusion process. Although adoption of LLL was predominantly related to teacher curriculum-related beliefs, implementation completeness and fidelity and continued use of LLL were also enhanced by contextual factors, namely teacher training and interactive context variables (school policy, governing body support and student response), respectively. The results of this study can be used to optimize the adoption, implementation and continuation of school-based (sexual) health promotion programs.

Prevention praised, cure preferred: results of between-subjects experimental studies comparing (monetary) appreciation for preventive and curative interventions.

BACKGROUND: 'An ounce of prevention is worth a pound of cure' is a common saying, and indeed, most health economic studies conclude that people are more willing to pay for preventive measures than for treatment activities. This may be because most health economic studies ask respondents to compare preventive measures with treatment, and thus prompt respondents to consider other uses of resources. However, psychological theorizing suggests that, when methods do not challenge subjects to consider other uses of resources, curative treatment is favored over prevention. Could it be that while prevention is praised, cure is preferred? METHODS: In two experimental studies, we investigated, from a psychological perspective and using a between-subjects design, whether prevention or treatment is preferred and why. In both studies, participants first read a lung cancer prevention or treatment intervention scenario that varied on the prevention-treatment dimension, but that were the same on factors like 'costs per saved life' and kind of disease. Then participants completed a survey measuring appreciation (general and monetary) as well as a number of potential mediating variables. RESULTS: Both studies clearly demonstrated that, when the design was between-subjects, participants had greater (general and monetary) appreciation for treatment interventions than for preventive interventions with perceived urgency of the intervention quite consistently mediating this effect. Differences in appreciation of treatment over preventive treatment were shown to be .59 (Study 1) and .45 (Study 2) on a 5-point scale. Furthermore, participants thought that health insurance should compensate more for the treatment than for preventive measures, differences of 16% (Study 1), and 22% (Study 2). When participants were asked to directly compare both interventions on the basis of a short description, they preferred the preventive intervention. CONCLUSION: It appears that people claim to prefer prevention when they are asked to consider other use of resources, but otherwise they prefer treatment. This preference is related to perceived urgency. The preference for treatment may be related to the prevention-treatment dimension itself, but also to variations on other dimensions that are inherently linked to prevention and treatment (like different efficacy rates and costs per treatment).

Bedtime stories: the effects of self-constructed risk scenarios on imaginability and perceived susceptibility to sexually transmitted infections.

Various authors (e.g. Kahnemann, D., & Tversky, A. (1982). The simulation heuristic. In D. Kahnemann, P. Slovic, & A. Tversky (Eds.), Judgment under uncertainty: Heuristics and biases (pp. 201-208). New York, NY: Cambridge University Press) have suggested that imagining an event and its consequences influences the perceived likelihood that it might happen in reality (simulation heuristic). A scenario--a description of how a certain activity can lead to a certain outcome--may stimulate one to imagine the outcomes and may influence one's likelihood judgement. The present research studied the effect of risk scenarios on perceptions of susceptibility to sexually transmitted infections and the role of imaginability therein. In a randomised experimental study, we examined the effects of a prefabricated risk scenario and a self-constructed risk scenario against a non-message condition on perceived susceptibility to get infected with Chlamydia. Participants considered themselves more susceptible to Chlamydia after writing their own risk scenario but not after reading the prefabricated risk scenario. The imaginability of the event seemed to mediate the effect of self-constructed scenario information on perceived susceptibility. Recommendations for health education practices are discussed.

Justify your love: testing an online STI-risk communication intervention designed to promote condom use and STI-testing.

The efficacy of a tailored, web-based intervention communicating the risks of sexually transmitted infections (STI) for heterosexual young adults was examined in a randomised, controlled trial. The main aims of the relationship-oriented intervention were to influence risk perceptions and to promote (maintenance of) condom use and STI-testing among young adults who reported being recently engaged in a heterosexual relationship. The intervention addressed risk perceptions, attitudes, normative beliefs, self-efficacy and skills related to condom use and STI-testing. Outcomes were compared immediately after the intervention (N = 171) and 3 months later (N = 115) to a non-tailored intervention group and to a control group. Cognitive and behavioural outcomes showed that the tailored intervention was efficacious in influencing perceived susceptibility to STI and STI-testing intentions immediately after the intervention, and in reducing rates of unprotected sex at 3 months.

Testing implicit assumptions and explicit recommendations: the effects of probability information on risk perception.

When people underestimate a risk, often probability information is communicated because of the implicit assumption that it will raise people's risk estimates as a result of these objective facts. Also, scientific literature suggested that stressing the cumulative aspects of a risk might lead to higher susceptibility perceptions than only emphasizing the single incident probability. Empirical evidence that supports the effectiveness of these strategies, however, is lacking. In two studies, we examined whether cumulative and single incident probability information on sexually transmitted infections leads to higher perceived susceptibility for Chlamydia and HIV. Contrary to assumptions and recommendations, results showed that both types of probability information may result in people feeling less susceptible toward Chlamydia and having less intention to reduce the risk. For HIV, no effects were found. These results contradict implicit assumptions and explicit recommendations concerning the effects of probability information on risk perceptions.

The effects of scenario-based risk information on perceptions of susceptibility to Chlamydia and HIV.

The simulation heuristic of Kahnemann and Tversky (1982) suggests that the subjective ease by which a risky situation can be mentally construed, positively influences the person's perceived susceptibility to the presented threat. Assuming that a detailed outline of how a risky event can end up negatively increases the ease of imagination, we tested the hypothesis that scenario-based risk information enhances perceived susceptibility towards contracting a sexually transmitted infection (STI). In an experimental design, undergraduate students were exposed to one or two risk scenario messages or no scenario message (control). The results confirmed the hypothesis, but only when more than one risk scenario message was provided. This adds to the evidence that presenting scenario-based messages could be a feasible method to influence risk perceptions.

HIV/STI risk communication: the effects of scenario-based risk information and frequency-based risk information on perceived susceptibility to chlamydia and HIV.

Health risk judgments are not merely based on risk statistics but also on the ease with which hypothetical events are imagined. We explored the effects of scenario information as opposed to frequency information on susceptibility perceptions regarding Chlamydia and HIV. Results showed that participants felt more susceptible to Chlamydia after reading frequency information. Scenario information only seemed to affect feelings of susceptibility in participants with no intimate relationship. No effects on perceived susceptibility for HIV were found. Results are discussed in terms of severity of the disease and defensive reactions.

Probability information in risk communication: a review of the research literature.

Communicating probability information about risks to the public is more difficult than might be expected. Many studies have examined this subject, so that their resulting recommendations are scattered over various publications, diverse research fields, and are about different presentation formats. An integration of empirical findings in one review would be useful therefore to describe the evidence base for communication about probability information and to present the recommendations that can be made so far. We categorized the studies in the following presentation formats: frequencies, percentages, base rates and proportions, absolute and relative risk reduction, cumulative probabilities, verbal probability information, numerical versus verbal probability information, graphs, and risk ladders. We suggest several recommendations for these formats. Based on the results of our review, we show that the effects of presentation format depend not only on the type of format, but also on the context in which the format is used. We therefore argue that the presentation format has the strongest effect when the receiver processes probability information heuristically instead of systematically. We conclude that future research and risk communication practitioners should not only concentrate on the presentation format of the probability information but also on the situation in which this message is presented, as this may predict how people process the information and how this may influence their interpretation of the risk.

How does the general public evaluate risk information? The impact of associations with other risks.

There is a considerable body of knowledge about the way people perceive risks using heuristics and qualitative characteristics, and about how risk information should be communicated to the public. However, little is known about the way people use the perception of known risks (associated risks) to judge an unknown risk. In a first, qualitative study, six different risks were discussed in in-depth interviews and focus group interviews. The interviews showed that risk associations played a prominent role in forming risk perceptions. Associated risks were often mentioned spontaneously. Second, a survey study was conducted to confirm the importance of risk associations quantitatively. This study investigated whether people related unknown risks to known risks. This was indeed confirmed. Furthermore, some insight was gained into how and why people form risk associations. Results showed that the semantic category of the unknown risks was more important in forming associations than the perceived level of risk or specific risk characteristics. These findings were in line with the semantic network theory. Based on these two studies, we recommend using the mental models approach in developing new risk communications.

The effects of warnings and an educational brochure on computer working posture: a test of the C-HIP model in the context of RSI-relevant behaviour.

This study tested whether warnings can result in a better working posture with respect to RSI prevention compared with an educational brochure. By using a warning, the information provision on how to prevent RSI can be shorter and only interrupts with the task at hand for a short time. Five conditions were created to compare the effects on position adjustments of a warning displayed on the computer screen, a warning hanging on the wall, an educational brochure, a neutral interruption on the computer screen, and no intervention. Systematic observations of respondents' working postures showed that the computer warning led to significantly more correct position adjustments than the educational brochure and the two control situations, whereas the wall warning condition did not differ significantly from all other conditions. Questionnaires were used to study whether the number of position adjustments in the conditions could be explained by Wogalter's communication-human information processing (C-HIP) model. The questionnaire data suggest that the effect of the computer warning is caused by heightened attention for this type of intervention. The other stages of the C-HIP model--knowledge, attitude change, and motivation--might not be necessary in this situation in the explanation of behavioural changes. The conclusion is that warnings may be able to successfully replace educational brochures to produce behavioural changes.

Priorities in information desire about unknown risks.

Research on risk perception aims to explain how people perceive risks in order to better communicate about them. Most of this research has tended to view people as passive risk perceivers. However, if confronted with an unknown risk, people can also actively seek information. The main purpose of this study was to investigate what kind of risk information people desire when confronted with an unknown risk and how this desire for information relates to the main dimensions underlying risk perception. Nine focus-group interviews were conducted. The main results of the focus groups were backed up by a paper-and-pencil questionnaire that was distributed among a random sample of 500 households in the Netherlands. Overall, people desire information with which they can determine the personal relevance of the risk confronting them. This pattern is similar to appraisal steps described by health behavior models. The focus-group results provide a dynamic picture of the way risk aspects might interact to create a final risk judgment.