Changes in Daily Steps and Body Mass Index and Waist to Height Ratio during Four Year Follow-Up in Adults: Cardiovascular Risk in Young Finns Study

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.

The Relationships between Adolescents' Obesity and the Built Environment: Are They City Dependent?

There is evidence that the built environment can promote unhealthy habits which may increase the risk for obesity among adolescents. However, the majority of evidence is from North America, Europe and Australia, and less is known about other world regions. The purpose of this study was to examine how the number of overweight and obese adolescents may vary in relation to the built environment, area socioeconomic status (SES), physical activity (PA) and nutritional home environment. We performed a telephone survey of 904 adolescents ages 15-18 from three different cities in Israel. The questionnaire included: reported PA, sedentary behaviors and nutritional home environment. Body Mass Index (BMI) was attained from records of Maccabi Healthcare Services (MHS). The built environment measures were calculated by Geographic Information System (GIS). Multivariable logistic regression analysis was performed to identify variables associated with adolescents' overweight and obesity. The highest level of overweight and obese adolescents was in Beer Sheva (29.2%). The three cities did not differ in built environment characteristics, PA and sedentary behaviors. In Haifa, a more positive nutritional home environment was reported (p = 0.001). Boys, in all three cities presented higher rates of overweight and obesity (29%). After adjusting for covariates, adolescents' overweight and obesity was associated with built environment measures only in a low SES peripheral city (OR = 0.72; 95% CI: 0.56-0.92), and positively associated with higher level of sedentary behavior in the total sample (OR = 1.23; 95% CI:1.03-1.47). This may imply a much more complex causal pathway between the built environment, SES and obesity than suggested in previous literature.