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Sánchez-Franco S, Montgomery SC, Torres-Narvaez ES, Ramírez AM, Murray JM, Tate C, Llorente B, Bauld L, Hunter RF, Kee F, Sarmiento OL. How Do Adolescent Smoking Prevention Interventions Work in Different Contextual Settings? A Qualitative Comparative Study Between the UK and Colombia. Int J Behav Med 2023:10.1007/s12529-023-10211-z. [PMID: 37697141 DOI: 10.1007/s12529-023-10211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Adolescent smoking is associated with significant health and social risks. Previous research has demonstrated the effectiveness of interventions based on behavior change theories in preventing adolescent smoking uptake. However, evidence from the theory-based perspective of evaluation is limited, especially for how such complex interventions work, and how they work when implemented in different contextual settings. METHOD A comparative qualitative analysis was conducted to explore various influences on behavior change among participants taking part in two smoking prevention interventions in Northern Ireland and Bogotá. Twenty-seven focus groups were conducted in 12 schools (6 in Northern Ireland and 6 in Bogota, n = 195 pupils participated; aged 11-15 years). The Theoretical Domains Framework guided a content analysis of the data. RESULTS We found similarities across settings in terms of knowledge, skills, and beliefs related to smoking or vaping behavior change, as well as differences in contextual resources and social influence. Different environmental resources included availability to purchase tobacco products in the neighborhoods and previous information about tobacco risk. Participants in both interventions perceived behavioral change outcomes related to personal skills and intention to not smoke or vape. CONCLUSION These findings have highlighted how both individual factors and contextual resources influence behavior change for smoking prevention in practice. Local contextual factors and social influences affecting pupils should be taken into account in the implementation and evaluation of health behavior change interventions. In particular, this study supports using social and contextual influence strategies in interventions to reduce the onset of adolescent smoking and vaping.
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Affiliation(s)
- Sharon Sánchez-Franco
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia
| | | | - Erika S Torres-Narvaez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia
| | - Ana M Ramírez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia
| | - Jennifer M Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Christopher Tate
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Linda Bauld
- College of Medicine and Veterinary Medicine, Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Olga L Sarmiento
- School of Medicine, Universidad de los Andes, Carrera 1 # 18A-10 Block Q, 111711018, Bogotá, Colombia.
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Moore SE, Brennan SF, Lavelle F, Dean M, McKinley MC, Olgacher D, McCole P, Hunter RF, Dunne L, O’Connell NE, Elliott CT, McCarthy D, Woodside JV. Capturing the whole-school food environment in primary schools. Public Health Nutr 2023; 26:1671-1678. [PMID: 37272413 PMCID: PMC10410367 DOI: 10.1017/s1368980023001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations. DESIGN SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion. SETTING Primary schools. PARTICIPANTS An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16). RESULTS The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %). CONCLUSIONS The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.
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Affiliation(s)
- Sarah E Moore
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Sarah F Brennan
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Lavelle
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Moira Dean
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Michelle C McKinley
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Dilara Olgacher
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
| | - Patrick McCole
- Queen’s Management School, Queen’s University Belfast, BelfastBT9 5EE, United Kingdom of Great Britain and Northern Ireland
| | - Ruth F Hunter
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Niamh E O’Connell
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Chris T Elliott
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Danielle McCarthy
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
| | - Jayne V Woodside
- Institute for Global Food Security, Queen’s University Belfast, BelfastBT9 5AG, United Kingdom of Great Britain and Northern Ireland
- Centre for Public Health, Queen’s University Belfast, BelfastBT12 6BA, United Kingdom of Great Britain and Northern Ireland
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Hunter RF, Hassan S, Whitmee S, Haines A. A call for natural experiment guidance for planetary health. BMJ 2023; 380:668. [PMID: 36977514 DOI: 10.1136/bmj.p668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BJ, UK
| | - Syreen Hassan
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sarah Whitmee
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Montes F, Blanco M, Useche AF, Sanchez-Franco S, Caro C, Tong L, Li J, Zhou H, Murray JM, Sarmiento OL, Kee F, Hunter RF. Exploring the mechanistic pathways of how social network influences social norms in adolescent smoking prevention interventions. Sci Rep 2023; 13:3017. [PMID: 36810585 PMCID: PMC9944961 DOI: 10.1038/s41598-023-28161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
We know little about how smoking prevention interventions might leverage social network structures to enhance protective social norms. In this study we combined statistical and network science methods to explore how social networks influence social norms related to adolescent smoking in school-specific settings in Northern Ireland and Colombia. Pupils (12-15 years old) participated in two smoking prevention interventions in both countries (n = 1344). A Latent Transition Analysis identified three groups characterized by descriptive and injunctive norms towards smoking. We employed a Separable Temporal Random Graph Model to analyze homophily in social norms and conducted a descriptive analysis of the changes in the students' and their friends' social norms over time to account for social influence. The results showed that students were more likely to be friends with others who had social norms against smoking. However, students with social norms favorable towards smoking had more friends with similar views than the students with perceived norms against smoking, underlining the importance of network thresholds. Our results support the notation that the ASSIST intervention takes advantage of friendship networks to leverage greater change in the students' smoking social norms than the Dead Cool intervention, reiterating that social norms are subject to social influence.
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Affiliation(s)
- Felipe Montes
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de Los Andes, Bogotá, Colombia.
| | - Martha Blanco
- grid.7247.60000000419370714Department of Industrial Engineering, Social and Health Complexity Center, Universidad de Los Andes, Bogotá, Colombia
| | - Andres F. Useche
- grid.7247.60000000419370714Department of Industrial Engineering, Social and Health Complexity Center, Universidad de Los Andes, Bogotá, Colombia
| | - Sharon Sanchez-Franco
- grid.7247.60000000419370714Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Carlos Caro
- grid.7247.60000000419370714Department of Industrial Engineering, Social and Health Complexity Center, Universidad de Los Andes, Bogotá, Colombia
| | - Lei Tong
- grid.9918.90000 0004 1936 8411School of Informatics, University of Leicester, Leicester, UK
| | - Jie Li
- grid.64938.300000 0000 9558 9911College of Electronic and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Huiyu Zhou
- grid.9918.90000 0004 1936 8411School of Informatics, University of Leicester, Leicester, UK
| | - Jennifer M. Murray
- grid.416232.00000 0004 0399 1866Centre for Public Health, Institute of Clinical Sciences, Block B, Queen’s University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, 02890978955 UK
| | - Olga L. Sarmiento
- grid.7247.60000000419370714Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Frank Kee
- grid.4777.30000 0004 0374 7521Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, BT12 6BJ UK
| | - Ruth F. Hunter
- grid.4777.30000 0004 0374 7521Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, BT12 6BJ UK
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Alsarrani A, Hunter RF, Dunne L, Garcia L. Association between friendship quality and subjective wellbeing among adolescents: a systematic review. BMC Public Health 2022; 22:2420. [PMID: 36564745 PMCID: PMC9784006 DOI: 10.1186/s12889-022-14776-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/17/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Social integration with friends has an important role in shaping adolescents' behavior and determining their wellbeing. Friendship features such as companionship, trust, closeness, intimacy, and conflicts all form the concept of friendship quality. The quality of friendships can either enhance or impede mental development during adolescence. Therefore, this systematic review was conducted to understand the association between friendship quality and adolescents' mental wellbeing. METHODS In November 2020 and later in August 2022, the search for evidence was conducted on five databases (Medline, Embase, ProQuest, Scopus, and PsycINFO). Only peer-reviewed quantitative studies published from January 2000 to August 2022 that investigated friendship quality as their exposure variable in relation to six constructs of subjective wellbeing (mood, loneliness, life satisfaction, happiness, self-esteem, and subjective wellbeing) were included. After screening for eligibility, two reviewers independently extracted the data based on population characteristics, study design, exposure and outcome variables, outcome measures used, and results. Risk of bias assessment was performed utilizing the NIH Quality Assessment Tool. Narrative evidence synthesis was performed based on the constructs of subjective wellbeing. RESULTS Forty-three articles out of 21,585 records were included in the review. The relationship between friendship quality and depression has been investigated extensively in the literature and negative (beneficial) associations were found in eighteen studies out of twenty-three. Poor peer relationship was associated with loneliness in nine studies out of ten. All seven studies on life satisfaction and quality of peer connection found a positive association. In five studies, better peer relationship was found to be associated with happiness. A positive association between friendship quality and self-esteem was observed in five out of six applicable studies. Friendship quality was found to be positively associated with subjective well-being in all of five included studies. CONCLUSIONS Although majority of the included studies were cross-sectional in nature, this review demonstrates the paramount value of promoting healthy friendship to adolescents' subjective wellbeing constructs. Interventions that aim to promote subjective wellbeing among adolescents should consider the development and maintenance of healthy friendships. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020219312.
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Affiliation(s)
- Abdullah Alsarrani
- grid.4777.30000 0004 0374 7521Center for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, Belfast, BT12 6BA Northern Ireland, UK ,grid.412892.40000 0004 1754 9358College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Ruth F. Hunter
- grid.4777.30000 0004 0374 7521Center for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, Belfast, BT12 6BA Northern Ireland, UK
| | - Laura Dunne
- grid.4777.30000 0004 0374 7521School of Social Sciences, Education, and Social Work, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Leandro Garcia
- grid.4777.30000 0004 0374 7521Center for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, Belfast, BT12 6BA Northern Ireland, UK
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O’Kane N, McKinley MC, Gough A, Hunter RF. Investigating the feasibility and acceptability of using Instagram to engage post-graduate students in a mass communication social media-based health intervention, #WeeStepsToHealth. Pilot Feasibility Stud 2022; 8:254. [PMID: 36510310 PMCID: PMC9743718 DOI: 10.1186/s40814-022-01207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/19/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Instagram's popularity among young adults continues to rise, and previous work has identified diffusion of unhealthy messages and misinformation throughout the platform. However, we know little about how to use Instagram to promote health messages. This study aims to assess the feasibility and acceptability of using Instagram to engage post-graduate students in a mass communication social media (SM)-based health intervention. METHODS A 4-week intervention targeting post-graduate students with physical activity (PA), nutrition, and general wellbeing messages was conducted via Instagram. Feasibility and acceptability were assessed using SM metrics (likes, comments, and shares), pre- and post-intervention online surveys (knowledge, attitude, and behavioural outcomes), and a focus group conducted with a sample of individuals in the target population (to assess intervention recall, feedback on message framing, and acceptability of Instagram). RESULTS The two independent samples captured by online surveys (pre-intervention, n = 43, post-intervention, n = 41, representing 12.3% and 11.7% of Instagram followers, respectively) were predominantly female (88.4%, 80.5%) aged 18-34 (95.4%, 95.1%). Respondents in the second survey reported higher weekly PA levels (+ 13.7%) and more frequent nutritional behaviours including consumption of five or more fruits and vegetables (+ 23.3%) and looking at nutritional labels (+ 10.3%). However, respondents in the second survey also reported less frequent meal preparation (- 18.0%) and a small increase in fast food consumption (+ 2.8% consuming fast food 3-4 days a week). A total of 247 'likes' were collected from 28 Instagram posts (mean 8.8 likes per post). Humorous posts achieved a moderately higher level of engagement than non-humorous posts (median 10 and 8 likes, respectively). Focus group participants liked the campaign content and trusted the information source. CONCLUSIONS Findings indicate that Instagram could be a feasible and acceptable platform for engaging post-graduate students in a SM-based mass communication health intervention, and that humour may have the potential to encourage further engagement.
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Affiliation(s)
- Niamh O’Kane
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BJ UK
| | - Michelle C. McKinley
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BJ UK
| | - Aisling Gough
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BJ UK
| | - Ruth F. Hunter
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BJ UK
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Ding D, Carson V, Hunter RF, Jáuregui A, Kolbe-Alexander T, Lee EY, Mair JL, Mielke GI, Oyeyemi AL, Ramírez Varela A, Salvo D, Siefken K, Tassitano RM, van Sluijs E, Hallal PC. Science has no Borders, so Should Scientific Publishing: A Position Statement from the Journal of Physical Activity and Health. J Phys Act Health 2022; 19:809-810. [PMID: 36318917 DOI: 10.1123/jpah.2022-0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ding Ding
- Australian Systems Approaches to Physical Activity (ASAPa) Project, Prevention Research Collaboration, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW,Australia
- The Charles Perkins Centre, The University of Sydney, Camperdown, NSW,Australia
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB,Canada
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast,United Kingdom
| | - Alejandra Jáuregui
- Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca,Mexico
| | - Tracy Kolbe-Alexander
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, QLD,Australia
| | - Eun-Young Lee
- School of Kinesiology and Health Studies (cross-appointment with the Department of Gender Studies), Queen's University, Kingston, ON,Canada
| | - Jacqueline L Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise, Singapore,Singapore
| | - Gregore Iven Mielke
- School of Public Health, The University of Queensland, Brisbane, QLD,Australia
| | - Adewale L Oyeyemi
- Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State,Nigeria
| | | | - Deborah Salvo
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, TX,USA
| | - Katja Siefken
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg,Germany
| | - Rafael M Tassitano
- Department of Physical Education, Federal Rural University of Pernambuco, Recife, PE,Brazil
| | - Esther van Sluijs
- MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Cambridge,United Kingdom
| | - Pedro C Hallal
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL,USA
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Hunter RF, Cleland CL, Busby J, Nightingale G, Kee F, Williams AJ, Kelly P, Kelly MP, Milton K, Kokka K, Jepson R. Investigating the impact of a 20 miles per hour speed limit intervention on road traffic collisions, casualties, speed and volume in Belfast, UK: 3 year follow-up outcomes of a natural experiment. J Epidemiol Community Health 2022; 77:jech-2022-219729. [PMID: 36379715 PMCID: PMC9763225 DOI: 10.1136/jech-2022-219729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation. METHODS An observational, repeated cross-sectional design was implemented, using routinely collected data for road traffic collisions, casualties, speed and volume. We evaluated difference-in-differences in collisions and casualties (intervention vs control) across three different time series and traffic speed and volume pre-implementation, at 1 and 3 years post-implementation. RESULTS Small reductions in road traffic collisions were observed at year 1 (3%; p=0.82) and year 3 post-implementation (15%; p=0.31) at the intervention site. Difference-in-differences analyses showed no statistically significant differences between the intervention and control sites over time for road traffic collisions. There were 16% (p=0.18) and 22% (p=0.06) reductions in casualty rates at years 1 and 3 post-implementation, respectively, at the intervention site. Results showed little change in mean traffic speed at year 1 (0.2 mph, 95% CI -0.3 to 2.4, p=0.14) and year 3 post-implementation (0.8, 95% CI -1.5 to 2.5, p=0.17). For traffic volume, a decrease in 57 vehicles per week was observed at year 1 (95% CI -162 to -14, p<0.00) and 71 vehicles at year 3 (95% CI -213 to 1, p=0.05) post-implementation. CONCLUSION A 20 mph speed limit intervention implemented at city centre scale had little impact on long-term outcomes including road traffic collisions, casualties and speed, except for a reduction in traffic volume. Policymakers considering implementing 20 mph speed limit interventions should consider the fidelity, context and scale of implementation.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Claire L Cleland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Paul Kelly
- Physical Activity for Health Research Centre (PHARC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, England, UK
| | - Kelly Kokka
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, Scotland, UK
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9
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Avila-Palencia I, Garcia L, Cleland C, McGuinness B, Meehan C, Hunter RF. Mapping the complex systems that connects the urban environment to cognitive decline in adults aged 50 years and older: a group model building study. Lancet 2022; 400 Suppl 1:S8. [PMID: 36930028 DOI: 10.1016/s0140-6736(22)02218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A supportive urban environment can prevent or delay the progress of cognitive decline. There is evidence for the existence of mechanistic pathways between the urban environment and cognitive decline, but the interrelations between these pathways are unclear. In this study, we aimed to map the mechanistic pathways by which urban environment factors affect cognitive decline in adults older than 50 years. METHODS This group model building study was part of the Supportive environments for Physical and social Activity, healthy ageing, and CognitivE health (SPACE) project. We held a 2-day workshop with theSPACE investigators based on the Group Model Building (GMB) methodology. The workshop aimed to create a causal-loop diagram (CLD) that identifies established and potential urban environment, lifestyle, health, and physiological determinants of cognitive decline in adults older than 50 years, and the dynamic interrelations between these factors. A facilitation team guided the activities (IA-P, LG, CM, and RFH). The workshop was held online following appropriately adapted scripts. After the workshop, the modelling team reviewed the CLD to ensure that main potential causal pathways and mechanisms were captured. FINDINGS The workshop ran from Dec 6-7, 2021, and 12 experts from ten different disciplines identified 83 factors and 221 connections between them. After review, the CLD presented 45 factors and 110 connections. All factors were classified in ten main domains: urban design (eg, walkability), social environment (eg, social relationships), travel behaviours (eg, active travel), by-products (eg, air pollution), lifestyle (eg, recreational physical activity), mental health (eg, stress), disease or physiology (eg, molecular risk), exogenous factors (eg, industrial pollution sources), and cognitive decline outcomes (eg, dementia). The main output was a CLD of the complex system of how the urban environment can influence cognitive decline in older adults, created by, and agreed with, the SPACE investigators. INTERPRETATION Our findings suggested that GMB can engage experts and help them view problems, such as the determinants of cognitive decline in adults, through the lens of complex systems. FUNDING UK Research and Innovation.
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Affiliation(s)
- Ione Avila-Palencia
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Leandro Garcia
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Claire Cleland
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bernadette McGuinness
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Conor Meehan
- Innovation Lab of the Northern Irish Civil Service, Belfast, Northern Ireland, UK
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
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Hunter RF, Rodgers SE, Hilton J, Clarke M, Garcia L, Ward Thompson C, Geary R, Green MA, O'Neill C, Longo A, Lovell R, Nurse A, Wheeler BW, Clement S, Porroche-Escudero A, Mitchell R, Barr B, Barry J, Bell S, Bryan D, Buchan I, Butters O, Clemens T, Clewley N, Corcoran R, Elliott L, Ellis G, Guell C, Jurek-Loughrey A, Kee F, Maguire A, Maskell S, Murtagh B, Smith G, Taylor T, Jepson R. GroundsWell: Community-engaged and data-informed systems transformation of Urban Green and Blue Space for population health - a new initiative. Wellcome Open Res 2022; 7:237. [PMID: 36865374 PMCID: PMC9971655 DOI: 10.12688/wellcomeopenres.18175.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Natural environments, such as parks, woodlands and lakes, have positive impacts on health and wellbeing. Urban Green and Blue Spaces (UGBS), and the activities that take place in them, can significantly influence the health outcomes of all communities, and reduce health inequalities. Improving access and quality of UGBS needs understanding of the range of systems (e.g. planning, transport, environment, community) in which UGBS are located. UGBS offers an ideal exemplar for testing systems innovations as it reflects place-based and whole society processes , with potential to reduce non-communicable disease (NCD) risk and associated social inequalities in health. UGBS can impact multiple behavioural and environmental aetiological pathways. However, the systems which desire, design, develop, and deliver UGBS are fragmented and siloed, with ineffective mechanisms for data generation, knowledge exchange and mobilisation. Further, UGBS need to be co-designed with and by those whose health could benefit most from them, so they are appropriate, accessible, valued and used well. This paper describes a major new prevention research programme and partnership, GroundsWell, which aims to transform UGBS-related systems by improving how we plan, design, evaluate and manage UGBS so that it benefits all communities, especially those who are in poorest health. We use a broad definition of health to include physical, mental, social wellbeing and quality of life. Our objectives are to transform systems so that UGBS are planned, developed, implemented, maintained and evaluated with our communities and data systems to enhance health and reduce inequalities. GroundsWell will use interdisciplinary, problem-solving approaches to accelerate and optimise community collaborations among citizens, users, implementers, policymakers and researchers to impact research, policy, practice and active citizenship. GroundsWell will be shaped and developed in three pioneer cities (Belfast, Edinburgh, Liverpool) and their regional contexts, with embedded translational mechanisms to ensure that outputs and impact have UK-wide and international application.
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Affiliation(s)
- Ruth F. Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK,
| | - Sarah E. Rodgers
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK,
| | - Jeremy Hilton
- School of Defence and Security, Cranfield University, Bedfordshire, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Rebecca Geary
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Mark A. Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alberto Longo
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Alex Nurse
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - Benedict W. Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Sarah Clement
- Department of Geography and Planning, University of Western Australia, Perth, Australia
| | | | - Rich Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ben Barr
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - John Barry
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Sarah Bell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Dominic Bryan
- School of History, Anthropology, Philosophy and Politics, Queen's University Belfast, Belfast, UK
| | - Iain Buchan
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Olly Butters
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Tom Clemens
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Natalie Clewley
- School of Defence and Security, Cranfield University, Bedfordshire, UK
| | - Rhiannon Corcoran
- Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Lewis Elliott
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Geraint Ellis
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Anna Jurek-Loughrey
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Simon Maskell
- Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Brendan Murtagh
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Grahame Smith
- Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Timothy Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), University of Edinburgh, Edinburgh, UK,
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11
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Hill C, Avila-Palencia I, Maxwell AP, Hunter RF, McKnight AJ. Harnessing the Full Potential of Multi-Omic Analyses to Advance the Study and Treatment of Chronic Kidney Disease. Front Nephrol 2022; 2:923068. [PMID: 37674991 PMCID: PMC10479694 DOI: 10.3389/fneph.2022.923068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/30/2022] [Indexed: 09/08/2023]
Abstract
Chronic kidney disease (CKD) was the 12th leading cause of death globally in 2017 with the prevalence of CKD estimated at ~9%. Early detection and intervention for CKD may improve patient outcomes, but standard testing approaches even in developed countries do not facilitate identification of patients at high risk of developing CKD, nor those progressing to end-stage kidney disease (ESKD). Recent advances in CKD research are moving towards a more personalised approach for CKD. Heritability for CKD ranges from 30% to 75%, yet identified genetic risk factors account for only a small proportion of the inherited contribution to CKD. More in depth analysis of genomic sequencing data in large cohorts is revealing new genetic risk factors for common diagnoses of CKD and providing novel diagnoses for rare forms of CKD. Multi-omic approaches are now being harnessed to improve our understanding of CKD and explain some of the so-called 'missing heritability'. The most common omic analyses employed for CKD are genomics, epigenomics, transcriptomics, metabolomics, proteomics and phenomics. While each of these omics have been reviewed individually, considering integrated multi-omic analysis offers considerable scope to improve our understanding and treatment of CKD. This narrative review summarises current understanding of multi-omic research alongside recent experimental and analytical approaches, discusses current challenges and future perspectives, and offers new insights for CKD.
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Affiliation(s)
| | | | | | | | - Amy Jayne McKnight
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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12
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Giles-Corti B, Moudon AV, Lowe M, Adlakha D, Cerin E, Boeing G, Higgs C, Arundel J, Liu S, Hinckson E, Salvo D, Adams MA, Badland H, Florindo AA, Gebel K, Hunter RF, Mitáš J, Oyeyemi AL, Puig-Ribera A, Queralt A, Santos MP, Schipperijn J, Stevenson M, Dyck DV, Vich G, Sallis JF. Creating healthy and sustainable cities: what gets measured, gets done. Lancet Glob Health 2022; 10:e782-e785. [PMID: 35561709 DOI: 10.1016/s2214-109x(22)00070-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/04/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Billie Giles-Corti
- Healthy Liveable Cities Lab, RMIT University, Melbourne, 3000, VIC, Australia; Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Anne Vernez Moudon
- Department of Urban Design and Planning, Urban Form Lab, University of Washington, Seattle, WA, USA
| | - Melanie Lowe
- Melbourne Centre for Cities, University of Melbourne, Melbourne, VIC, Australia
| | - Deepti Adlakha
- Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC, USA
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Geoff Boeing
- Department of Urban Planning and Spatial Analysis, Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Carl Higgs
- Healthy Liveable Cities Lab, RMIT University, Melbourne, 3000, VIC, Australia
| | - Jonathan Arundel
- Healthy Liveable Cities Lab, RMIT University, Melbourne, 3000, VIC, Australia
| | - Shiqin Liu
- School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA
| | - Erica Hinckson
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Salvo
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Marc A Adams
- College of Health Solutions, Senior Global Futures Scientist, Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Phoenix, AZ, USA
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, 3000, VIC, Australia
| | - Alex A Florindo
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| | - Klaus Gebel
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Josef Mitáš
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Adewale L Oyeyemi
- Department of Physiotherapy, University of Maiduguri, Maiduguri, Nigeria
| | - Anna Puig-Ribera
- Sport and Physical Activity Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Vic, Spain
| | - Ana Queralt
- AFIPS research group, Department of Nursing, University of Valencia, Valencia, Spain
| | - Maria Paula Santos
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Jasper Schipperijn
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mark Stevenson
- Transport, Health and Urban Design Research Lab, University of Melbourne, Melbourne, VIC, Australia
| | - Delfien Van Dyck
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Guillem Vich
- Barcelona's Institute for Global Health, Barcelona, Spain; Department of Geography, Rovira I Virgili University, Vila-seca, Spain
| | - James F Sallis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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13
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Nightingale GF, Williams AJ, Hunter RF, Woodcock J, Turner K, Cleland CL, Baker G, Kelly M, Cope A, Kee F, Milton K, Foster C, Jepson R, Kelly P. Evaluating the citywide Edinburgh 20mph speed limit intervention effects on traffic speed and volume: A pre-post observational evaluation. PLoS One 2021; 16:e0261383. [PMID: 34972123 PMCID: PMC8719778 DOI: 10.1371/journal.pone.0261383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Traffic speed is important to public health as it is a major contributory factor to collision risk and casualty severity. 20mph (32km/h) speed limit interventions are an increasingly common approach to address this transport and health challenge, but a more developed evidence base is needed to understand their effects. This study describes the changes in traffic speed and traffic volume in the City of Edinburgh, pre- and 12 months post-implementation of phased city-wide 20mph speed limits from 2016-2018. METHODS The City of Edinburgh Council collected speed and volume data across one full week (24 hours a day) pre- and post-20mph speed limits for 66 streets. The pre- and post-speed limit intervention data were compared using measures of central tendency, dispersion, and basic t-tests. The changes were assessed at different aggregations and evaluated for statistical significance (alpha = 0.05). A mixed effects model was used to model speed reduction, in the presence of key variables such as baseline traffic speed and time of day. RESULTS City-wide, a statistically significant reduction in mean speed of 1.34mph (95% CI 0.95 to 1.72) was observed at 12 months post-implementation, representing a 5.7% reduction. Reductions in speed were observed throughout the day and across the week, and larger reductions in speed were observed on roads with higher initial speeds. Mean 7-day volume of traffic was found to be lower by 86 vehicles (95% CI: -112 to 286) representing a reduction of 2.4% across the city of Edinburgh (p = 0.39) but with the direction of effect uncertain. CONCLUSIONS The implementation of the city-wide 20mph speed limit intervention was associated with meaningful reductions in traffic speeds but not volume. The reduction observed in road traffic speed may act as a mechanism to lessen the frequency and severity of collisions and casualties, increase road safety, and improve liveability.
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Affiliation(s)
- Glenna F. Nightingale
- The Scottish Collaboration for Public Health Research (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew James Williams
- Population and Behavioural Science, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Ruth F. Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - James Woodcock
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kieran Turner
- The Scottish Collaboration for Public Health Research (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Claire L. Cleland
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael Kelly
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Andy Cope
- Sustrans, Cathedral Square, College Green, Bristol, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - Ruth Jepson
- The Scottish Collaboration for Public Health Research (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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14
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Hunter RF, Adlakha D, Cardwell C, Cupples ME, Donnelly M, Ellis G, Gough A, Hutchinson G, Kearney T, Longo A, Prior L, McAneney H, Ferguson S, Johnston B, Stevenson M, Kee F, Tully MA. Investigating the physical activity, health, wellbeing, social and environmental effects of a new urban greenway: a natural experiment (the PARC study). Int J Behav Nutr Phys Act 2021; 18:142. [PMID: 34717650 PMCID: PMC8557552 DOI: 10.1186/s12966-021-01213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes. METHODS A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata. RESULTS The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI - 14.5 to - 7.4); - 30.5 (95% CI - 37.9 to - 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased. CONCLUSIONS Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK.
| | - Deepti Adlakha
- Department of Landscape Architecture and Environmental Planning, Natural Learning Initiative, College of Design, North Carolina State University, Raleigh, NC, 27607, USA.,School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | - Christopher Cardwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Margaret E Cupples
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Geraint Ellis
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | - Aisling Gough
- School of Nursing, Queen's University Belfast, Belfast, Northern Ireland
| | - George Hutchinson
- Gibson Institute and Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Therese Kearney
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Alberto Longo
- Gibson Institute and Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Lindsay Prior
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Helen McAneney
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Sara Ferguson
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | - Brian Johnston
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | - Michael Stevenson
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, Northern Ireland
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15
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Sarmiento OL, Rubio MA, King AC, Serrano N, Hino AAF, Hunter RF, Aguilar-Farias N, Parra DC, Salvo D, Jáuregui A, Lee RE, Kohl B. [El entorno construido en los programas diseñados para promover la actividad física entre las niñas, niños y jóvenes latinos que viven en Estados Unidos y América Latina]. Obes Rev 2021; 22 Suppl 5:e13345. [PMID: 34708530 DOI: 10.1111/obr.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Olga L Sarmiento
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | | | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, California, EE. UU.,Stanford Prevention Research Center, Department of Medicine, Stanford University School Medicine, Stanford, California, EE. UU
| | - Natalicio Serrano
- Prevention Research Center, Brown School at Washington University in St. Louis, San Luis, Misuri, EE. UU
| | - Adriano Akira F Hino
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Reino Unido
| | - Nicolas Aguilar-Farias
- Departamento de Educación Física, Deportes y Recreación, Universidad de La Frontera, Temuco, Chile
| | - Diana C Parra
- Prevention Research Center, Brown School at Washington University in St. Louis, San Luis, Misuri, EE. UU
| | - Deborah Salvo
- Prevention Research Center, Brown School at Washington University in St. Louis, San Luis, Misuri, EE. UU.,Departamento de Actividad Física y Estilos de Vida Saludables, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Alejandra Jáuregui
- Departamento de Actividad Física y Estilos de Vida Saludables, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, EE. UU
| | - Bill Kohl
- School of Public Health in Austin Department of Epidemiology, Human Genetics and Environmental Sciences Michael and Susan Dell Center for Advancement of Health Living, Austin, Texas, EE. UU
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16
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Garcia LMT, Hunter RF, de la Haye K, Economos CD, King AC. [Un marco conceptual orientado a la acción para soluciones sistémicas de prevención de la obesidad infantil en Latinoamérica y en las poblaciones latinas de Estados Unidos]. Obes Rev 2021; 22 Suppl 5:e13354. [PMID: 34708532 DOI: 10.1111/obr.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Leandro M T Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, Reino Unido
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, Reino Unido
| | - Kayla de la Haye
- Keck School of Medicine, University of Southern California, Los Ángeles, California, EE. UU
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, EE. UU
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, EE. UU.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, EE. UU
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17
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O’Regan AC, Hunter RF, Nyhan MM. "Biophilic Cities": Quantifying the Impact of Google Street View-Derived Greenspace Exposures on Socioeconomic Factors and Self-Reported Health. Environ Sci Technol 2021; 55:9063-9073. [PMID: 34159777 PMCID: PMC8277136 DOI: 10.1021/acs.est.1c01326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 05/30/2023]
Abstract
According to the biophilia hypothesis, humans have evolved to prefer natural environments that are essential to their thriving. With urbanization occurring at an unprecedented rate globally, urban greenspace has gained increased attention due to its environmental, health, and socioeconomic benefits. To unlock its full potential, an increased understanding of greenspace metrics is urgently required. In this first-of-a-kind study, we quantified street-level greenspace using 751 644 Google Street View images and computer vision methods for 125 274 locations in Ireland's major cities. We quantified population-weighted exposure to greenspace and investigated the impact of greenspace on health and socioeconomic determinants. To investigate the association between greenspace and self-reported health, a negative binomial regression analysis was applied. While controlling for other factors, an interquartile range increase in street-level greenspace was associated with a 2.78% increase in self-reported "good or very good" health [95% confidence interval: 2.25-3.31]. Additionally, we observed that populations in upper quartiles of greenspace exposure had higher levels of income and education than those in lower quartiles. This study provides groundbreaking insights into how urban greenspace can be quantified in unprecedented resolution, accuracy, and scale while also having important implications for urban planning and environmental health research and policy.
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Affiliation(s)
- Anna C. O’Regan
- Discipline of Civil, Structural &
Environmental Engineering, School of Engineering & Architecture, University College Cork, Cork, Ireland
- MaREI
Centre for Energy, Climate & Marine and Environmental Research
Institute, University College Cork, Cork, Ireland
| | - Ruth F. Hunter
- Centre
for Public Health, Queen’s University
Belfast, Belfast BT12 6BA, Northern Ireland, United Kingdom
| | - Marguerite M. Nyhan
- Discipline of Civil, Structural &
Environmental Engineering, School of Engineering & Architecture, University College Cork, Cork, Ireland
- MaREI
Centre for Energy, Climate & Marine and Environmental Research
Institute, University College Cork, Cork, Ireland
- Harvard
T.H. Chan School of Public Health, Harvard
University, Boston, Massachusetts 02215, United States
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18
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Hunter RF, Garcia L, de Sa TH, Zapata-Diomedi B, Millett C, Woodcock J, Pentland A'S, Moro E. Effect of COVID-19 response policies on walking behavior in US cities. Nat Commun 2021; 12:3652. [PMID: 34135325 PMCID: PMC8209100 DOI: 10.1038/s41467-021-23937-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic is causing mass disruption to our daily lives. We integrate mobility data from mobile devices and area-level data to study the walking patterns of 1.62 million anonymous users in 10 metropolitan areas in the United States. The data covers the period from mid-February 2020 (pre-lockdown) to late June 2020 (easing of lockdown restrictions). We detect when users were walking, distance walked and time of the walk, and classify each walk as recreational or utilitarian. Our results reveal dramatic declines in walking, particularly utilitarian walking, while recreational walking has recovered and even surpassed pre-pandemic levels. Our findings also demonstrate important social patterns, widening existing inequalities in walking behavior. COVID-19 response measures have a larger impact on walking behavior for those from low-income areas and high use of public transportation. Provision of equal opportunities to support walking is key to opening up our society and economy.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Leandro Garcia
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Thiago Herick de Sa
- Center for Epidemiological Research in Nutrition and Health, Universtiy of São Paulo, São Paulo, Brazil
| | - Belen Zapata-Diomedi
- Healthy Liveable Cities Group, Centre for Urban Research, RMIT University, Melbourne, VIC, Australia
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - James Woodcock
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Esteban Moro
- Connection Science, Institute for Data Science and Society, MIT, Cambridge, MA, USA.
- Department of Mathematics and GISC, Universidad Carlos III de Madrid, Leganés, Spain.
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19
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Sarmiento OL, Rubio MA, King AC, Serrano N, Hino AAF, Hunter RF, Aguilar-Farias N, Parra DC, Salvo D, Jáuregui A, Lee RE, Kohl B. Built environment in programs to promote physical activity among Latino children and youth living in the United States and in Latin America. Obes Rev 2021; 22 Suppl 3:e13236. [PMID: 33825294 PMCID: PMC8365655 DOI: 10.1111/obr.13236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/17/2023]
Abstract
To prevent obesity among Latino youth in the United States and Latin America, it is necessary to understand the specific context and interplay of physical activity (PA) and the built environment (BE). This paper aims to advance the research agenda of BE and PA for obesity prevention in Latin America and among Latino youth in the United States by (1) identifying environmental indicators to inform the design of interventions and policy, (2) identifying interdisciplinary methodological approaches for the study of the complex association between BE and PA, and (3) presenting case studies of PA-promoting BE programs. A group of U.S. and Latin American scientists collaboratively worked to propose innovative indicators of the BE, methodological approaches for the study of the complex association between BE and PA, and review case studies of PA-promoting BE programs in both regions. The results identified gaps in knowledge, proposed environmental indicators (e.g., landscape, street design, mobility patterns, and crime and safety), reviewed methodological approaches (social network analysis, citizen science methods), and case studies illustrating PA-promoting BE programs (i.e., play streets, active school transport, and school setting interventions). The obesity prevention among Latino and Latin American youth requires advanced research on BE and PA addressing context-specific priorities and exchanging lessons learned.
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Affiliation(s)
| | | | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School Medicine, Stanford, California, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School Medicine, Stanford, California, USA
| | - Natalicio Serrano
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adriano Akira F Hino
- Health Sciences Graduate Program, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Nicolas Aguilar-Farias
- Department of Physical Education, Sports and Recreation, Universidad de La Frontera, Temuco, Chile
| | - Diana C Parra
- Prevention Research Center, Brown School at Washington University in St. Louis Scholar Institute of Public Health, St. Louis, Missouri, USA
| | - Deborah Salvo
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Bill Kohl
- School of Public Health in Austin Department of Epidemiology, Human Genetics and Environmental Sciences Michael and Susan Dell Center for Advancement of Health Living, Austin, Texas, USA
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20
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Garcia LMT, Hunter RF, de la Haye K, Economos CD, King AC. An action-oriented framework for systems-based solutions aimed at childhood obesity prevention in US Latinx and Latin American populations. Obes Rev 2021; 22 Suppl 3:e13241. [PMID: 33825301 PMCID: PMC8217154 DOI: 10.1111/obr.13241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Abstract
Childhood obesity in US Latinx and Latin American populations is a persistent, complex public health issue and, as such, requires solutions grounded on systems science theory and methods. In this paper, we introduce an action-oriented framework to design, implement, evaluate, and sustain whole-of-community systems changes for childhood obesity prevention in US Latinx and Latin American populations. Our framework covers six action steps: (1) foster multisectoral team; (2) map the system, its context, and drivers; (3) envision system-wide changes; (4) effect system-wide changes; (5) monitor, learn, and adapt; and (6) scale and sustain. We also propose 10 principles that put human and environmental rights and systems thinking at the center of these systems-based solutions. For each action step, we provide a list of concrete activities, methods, approaches, and examples that can be used to guide and inform the work needed to achieve the expected outputs. Finally, we discuss how a wider adoption of systems science for childhood obesity prevention among US Latinx and Latin American populations can be encouraged and sustained.
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Affiliation(s)
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Kayla de la Haye
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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21
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Sánchez-Franco S, Arias LF, Jaramillo J, Murray JM, Hunter RF, Llorente B, Bauld L, Good S, West J, Kee F, Sarmiento OL. Cultural adaptation of two school-based smoking prevention programs in Bogotá, Colombia. Transl Behav Med 2021; 11:1567-1578. [PMID: 33899915 PMCID: PMC8499713 DOI: 10.1093/tbm/ibab019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Smoking prevention among adolescents is a public health challenge that is even more significant in low- and middle-income countries where local evidence is limited and smoking rates remain high. Evidence-based interventions could be transferred to low- and middle-income country settings but only after appropriate cultural adaptation. This paper aims to describe the process of the cultural adaptation of two school-based smoking prevention interventions, A Stop Smoking in Schools Trial and Dead Cool, to be implemented in Bogotá, Colombia. A recognized heuristic framework guided the cultural adaptation through five stages. We conducted a concurrent nested mixed-methods study consisting of a qualitative descriptive case study and a quantitative pre- and post quasi-experiment without a control. Contextual, content, training, and implementation modifications were made to the programs to address cultural factors, to maintain the fidelity of implementation, and to increase the pupils' engagement with the programs. Modifications incorporated the suggestions of stakeholders, the original developers, and local community members, whilst considering the feasibility of delivering the programs. Involving stakeholders, original program developers, and community members in the cultural adaptation of evidence-based interventions is essential to properly adapt them to the local context, and to maintain the fidelity of program implementation.
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Affiliation(s)
- Sharon Sánchez-Franco
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Luis Fernando Arias
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Joaquin Jaramillo
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Jennifer M Murray
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ruth F Hunter
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Linda Bauld
- The Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Frank Kee
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Olga L Sarmiento
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
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22
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Brennan SF, Lavelle F, Moore SE, Dean M, McKinley MC, McCole P, Hunter RF, Dunne L, O'Connell NE, Cardwell CR, Elliott CT, McCarthy D, Woodside JV. Food environment intervention improves food knowledge, wellbeing and dietary habits in primary school children: Project Daire, a randomised-controlled, factorial design cluster trial. Int J Behav Nutr Phys Act 2021; 18:23. [PMID: 33541372 PMCID: PMC7859905 DOI: 10.1186/s12966-021-01086-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evidence suggests that dietary intake of UK children is suboptimal. As schools provide an ideal natural environment for public health interventions, effective and sustainable methods of improving food knowledge and dietary habits in this population must be identified. Project Daire aimed to improve children’s health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions. Methods Daire was a randomised-controlled, factorial design trial evaluating two interventions across four arms. Primary schools in Northern Ireland were randomised to one of four 6-month intervention arms: i) ‘Nourish’, ii) ‘Engage’, iii) ‘Nourish’ and ‘Engage’ and iv) Control (Delayed). ‘Nourish’ was an intervention aiming to alter the whole-school food environment, provide food-related experiences and exposure to locally produced foods. ‘Engage’ was an age-appropriate, cross-curricular educational intervention on food, agriculture, nutrition science and related careers. Primary outcomes were emotional and behavioural wellbeing and health-related quality of life. A number of secondary outcomes, including dietary intake, cooking competence and food-related knowledge, were also measured. Results Fifteen schools from areas of varying socio-economic status participated in the randomised trial. A total of 903 (n = 445 aged 6–7 years and n = 458 aged 10–11 years) primary school pupils took part. Total Difficulties Score improved in all pupils (6–7 and 10–11 year old pupils) who received the ‘Nourish’ intervention compared with those that did not (adjusted difference in mean = − 0.82; 95% CI -1.46, − 0.17; P < 0.02). No statistically significant difference in Health-Related Quality of Life was observed. The ‘Nourish’ intervention also produced some changes in school-based dietary behaviour, which were most apparent in the 10–11 year old pupils. The ‘Nourish’ intervention also produced improvements in understanding of food labels (adjusted difference in mean = 0.15; 95% CI 0.05, 0.25; P < 0.01) and knowledge of vegetables in season (adjusted difference in mean = 0.29; 95% CI 0.01,0.56; P = 0.04) whilst an increased willingness to try new foods and improved perceived cooking competence was also observed. Conclusions Improvements in childhood emotional and behavioural wellbeing, dietary intake, knowledge about food, cooking skills and willingness to try new foods were associated with the ‘Nourish’ whole-school food environment intervention. Exploration of the sustainability and long-term effectiveness of such whole-school food interventions should be conducted. Trial registration National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312). Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01086-y.
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Affiliation(s)
- Sarah F Brennan
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK. .,Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, UK.
| | - Fiona Lavelle
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK
| | - Sarah E Moore
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK.,Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, UK
| | - Moira Dean
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK
| | - Michelle C McKinley
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK.,Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Patrick McCole
- Queen's Management School, Queen's University Belfast, Belfast, BT9 5EE, UK
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, UK
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Niamh E O'Connell
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, UK
| | - Chris T Elliott
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK
| | - Danielle McCarthy
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK
| | - Jayne V Woodside
- Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5AG, UK.,Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
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23
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Montgomery SC, Donnelly M, Badham J, Kee F, Dunne L, Hunter RF. A multi-method exploration into the social networks of young teenagers and their physical activity behavior. BMC Public Health 2021; 21:77. [PMID: 33413221 PMCID: PMC7792163 DOI: 10.1186/s12889-020-10081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 12/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background There is a need for novel interventions to target inadequate levels of adolescent physical activity behavior. Previous research indicates that better understanding of the processes by which social networks influence physical activity behavior in adolescents may be useful to enhance intervention design. Methods This study used a multi-methods approach to aid our understanding about the role of social networks for adolescent physical activity behavior. The quantitative phase of data collection was analyzed using a three-step linear regression model using cross-sectional data from the WiSe study (n = 529 participants, 48.6% female, mean age 14.38 years (SD 0.32)). A demographically reflective sub-sample of schools were invited to take part in the qualitative phase, which involved focus group discussions. Thematic analysis was used to explore findings from the quantitative phase in greater depth, and identify other themes pertaining to the association between social networks and physical activity behavior. Results Males’ physical activity behavior was predicted by their friend group (0.46, p = 0.007) whereas females’ physical activity was predicted by their best friend (0.21, p = 0.03). The three main findings that were uncovered by the regression analysis were explored during the qualitative phase: 1) friends have similar physical activity behaviors; 2) friendship social networks may influence differently early adolescent male and female physical activity behavior; 3) popularity and sociability were not associated with physical activity behavior. Two additional themes emerged from the analysis of focus group data: 4) social norms and 5) external factors that may impact the relationship between adolescent physical activity behavior and social networks. Conclusions The investigation of the interplay between the findings from each phase of the inquiry indicated that social networks influence in different ways and to different degrees the physical activity of adolescent males and females. In turn, these insights point to the need for a systematic tailoring process for the development and implementation of physical activity behavior interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10081-0.
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Affiliation(s)
- Shannon C Montgomery
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Michael Donnelly
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jennifer Badham
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Laura Dunne
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Ruth F Hunter
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
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24
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Murray JM, Coleman HG, Hunter RF. Physical activity and cancer risk: Findings from the UK Biobank, a large prospective cohort study. Cancer Epidemiol 2020; 68:101780. [DOI: 10.1016/j.canep.2020.101780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
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25
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Hunter RF, Murray JM, Coleman HG. The association between recreational screen time and cancer risk: findings from the UK Biobank, a large prospective cohort study. Int J Behav Nutr Phys Act 2020; 17:97. [PMID: 32746843 PMCID: PMC7398067 DOI: 10.1186/s12966-020-00997-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Evidence is suggestive of sedentary behaviour being associated with an increased risk of endometrial cancer, but the evidence base is too limited to draw any conclusions for other cancers. The aim of the study was to investigate the association between recreational screen time and site-specific cancer risk. Methods We analysed data from the prospective UK Biobank cohort study. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between daily recreational screen time (including television (TV) viewing time, computer use time and total screen time) and site-specific cancer risk. Partition models and isotemporal substitution models investigated the impact of substituting recreational screen time with physical activity. Results During a mean follow-up of 7.6 years, 28,992 incident cancers were identified among 470,578 adults. A 1-h increase in daily TV viewing time was associated with higher risks of oropharyngeal, oesophago-gastric and colon cancer in fully adjusted models. Participants who reported ≤1, compared with 1- ≤ 3, hours/day of TV viewing time had lower risks of lung, breast, and oesophago-gastric cancer. Findings were inconsistent for daily recreational computer use and daily total recreational screen time. The majority of observed associations were small, and were attenuated after excluding cancers diagnosed within the first two years of follow-up, except for oesophago-gastric and colon cancers (HR 1.05, 95% CI: 1.01, 1.10; and HR 1.04, 95% CI: 1.01, 1.07 per 1-h increase in daily TV viewing time, respectively). However, isotemporal substitution models showed reduced risk of some site-specific (oropharyngeal, lung, breast and colorectal) cancers when replacing 1-h/day of TV viewing with 1-h of moderate-intensity physical activity or walking. Conclusions Our findings show that daily recreational screen time, particularly TV viewing, was associated with small increased risks of oesophago-gastric and colon cancer. Replacing 1-h/day of TV viewing with 1-h of moderate-intensity physical activity or walking was associated with lower risk of oropharyngeal, lung, breast and colorectal cancers. Further research from other large prospective cohort studies is required, while mechanistic research is warranted to enhance the biological plausibility of these findings.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - Jennifer M Murray
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - Helen G Coleman
- Centre for Public Health and Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
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26
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Cleland CL, Ferguson S, McCrorie P, Schipperijn J, Ellis G, Hunter RF. Considerations in Processing Accelerometry Data to Explore Physical Activity and Sedentary Time in Older Adults. J Aging Phys Act 2020; 28:623-633. [PMID: 31968305 DOI: 10.1123/japa.2019-0244] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/02/2019] [Accepted: 11/21/2019] [Indexed: 10/27/2023]
Abstract
Processing decisions for accelerometry data can have important implications for outcome measures, yet little evidence exists exploring these in older adults. The aim of the current study was to investigate the impact of three potentially important criteria on older adults, physical activity, and sedentary time. Participants (n = 222: mean age 71.75 years [SD = 6.58], 57% male) wore ActiGraph GT3X+ for 7 days. Eight data processing combinations from three criteria were explored: low-frequency extension (on/off), nonwear time (90/120 min), and intensity cut points (moderate-to-vigorous physical activity ≥1,041 and >2,000 counts/min). Analyses included Wilcoxon signed-rank test, paired t tests, and correlation coefficients (significance, p < .05). Results for low-frequency extension on 90-min nonwear time and >1,041 counts/min showed significantly higher light and moderate-to-vigorous physical activity and lower sedentary time. Cut points had the greatest impact on physical activity and sedentary time. Processing criteria can significantly impact physical activity and/or sedentary time, potentially leading to data inaccuracies, preventing cross-study comparisons and influencing the accuracy of population surveillance.
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27
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Pearson AL, Pfeiffer KA, Gardiner J, Horton T, Buxton RT, Hunter RF, Breeze V, McDade T. Study of active neighborhoods in Detroit (StAND): study protocol for a natural experiment evaluating the health benefits of ecological restoration of parks. BMC Public Health 2020; 20:638. [PMID: 32380967 PMCID: PMC7204306 DOI: 10.1186/s12889-020-08716-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes. METHODS The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models. DISCUSSION Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods. STUDY REGISTRATION Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI 48824 USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, 27R Intramural Rec Sports- Circle, 308 West Circle Drive, East Lansing, MI 48824 USA
| | - Joseph Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, Room B601, East Lansing, MI 48824 USA
| | - Teresa Horton
- Department of Anthropology, Northwestern University, 1810 Hinman Ave, Evanston, IL 60208 USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, 209 Nesbitt Biology Building, Ottawa, ON K1S 5B6 Canada
| | - Ruth F. Hunter
- Centre for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN Northern Ireland, UK
| | - Victoria Breeze
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI 48824 USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, 1810 Hinman Ave, Evanston, IL 60208 USA
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28
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Murray JM, French DP, Kee F, Gough A, Tang J, Hunter RF. Mechanisms of physical activity behavior change in an incentive-based intervention: Mediation analysis. Health Psychol 2020; 39:281-297. [PMID: 31999174 DOI: 10.1037/hea0000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The physical activity loyalty (PAL) scheme was a cluster randomized controlled trial of a 6-month complex intervention targeting workplace physical activity. Financial incentives were incorporated in an evidence-based behavior change program, including self-regulation techniques. This article examines short-term (< 6 months) and long-term (≥ 6 months) mediation effects on physical activity. METHOD Participants included 853 adults (457 intervention, 396 control). Physical activity was objectively assessed using pedometers at baseline and at 6 and 12 months. Hypothesized short-term mediators (e.g., self-efficacy, intentions) were assessed at baseline and 4 weeks. Hypothesized long-term mediators (e.g., habit, intrinsic motivation) were assessed at baseline and 6 months. Mediation models employed the structural equation modeling product-of-coefficients approach. RESULTS Intervention participants experienced significant decreases in 6-month pedometer steps/day versus controls (b = -336, p = .02), which were partially mitigated by positive indirect effects through 6-month integrated regulation (ab = 94.7, 95% CI [18.7, 204.4]), intrinsic motivation (ab = 59.0, 95% CI [3.09, 154.5]), and habit (ab = 198.7, 95% CI [84.3, 369.9]). There were no between-groups differences in 12-month pedometer steps/day but positive indirect effects through 6-month integrated regulation (ab = 128.0, 95% CI [27.3, 313.2]), planning (ab = 115.0, 95% CI [3.71, 285.5]), and habit (ab = 153.3, 95% CI [39.3, 333.1]). CONCLUSIONS Most examined mediators were nonsignificant, and mediation analyses did not explain decreases in physical activity for interventions versus controls. Results show that, contrary to self-determination theory hypotheses, intrinsic motivation is not necessarily adversely impacted if financial incentives are embedded in a complex intervention. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Jianjun Tang
- School of Agricultural Economics and Rural Development
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Hunter RF, Montes F, Murray JM, Sanchez-Franco SC, Montgomery SC, Jaramillo J, Tate C, Kumar R, Dunne L, Ramalingam A, Kimbrough EO, Krupka E, Zhou H, Moore L, Bauld L, Llorente B, Sarmiento OL, Kee F. MECHANISMS Study: Using Game Theory to Assess the Effects of Social Norms and Social Networks on Adolescent Smoking in Schools-Study Protocol. Front Public Health 2020; 8:377. [PMID: 32850598 PMCID: PMC7417659 DOI: 10.3389/fpubh.2020.00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
This proof of concept study harnesses novel transdisciplinary insights to contrast two school-based smoking prevention interventions among adolescents in the UK and Colombia. We compare schools in these locations because smoking rates and norms are different, in order to better understand social norms based mechanisms of action related to smoking. We aim to: (1) improve the measurement of social norms for smoking behaviors in adolescents and reveal how they spread in schools; (2) to better characterize the mechanisms of action of smoking prevention interventions in schools, learning lessons for future intervention research. The A Stop Smoking in Schools Trial (ASSIST) intervention harnesses peer influence, while the Dead Cool intervention uses classroom pedagogy. Both interventions were originally developed in the UK but culturally adapted for a Colombian setting. In a before and after design, we will obtain psychosocial, friendship, and behavioral data (e.g., attitudes and intentions toward smoking and vaping) from ~300 students in three schools for each intervention in the UK and the same number in Colombia (i.e., ~1,200 participants in total). Pre-intervention, participants take part in a Rule Following task, and in Coordination Games that allow us to assess their judgments about the social appropriateness of a range of smoking-related and unrelated behaviors, and elicit individual sensitivity to social norms. After the interventions, these behavioral economic experiments are repeated, so we can assess how social norms related to smoking have changed, how sensitivity to classroom and school year group norms have changed and how individual changes are related to changes among friends. This Game Theoretic approach allows us to estimate proxies for norms and norm sensitivity parameters and to test for the influence of individual student attributes and their social networks within a Markov Chain Monte Carlo modeling framework. We identify hypothesized mechanisms by triangulating results with qualitative data from participants. The MECHANISMS study is innovative in the interplay of Game Theory and longitudinal social network analytical approaches, and in its transdisciplinary research approach. This study will help us to better understand the mechanisms of smoking prevention interventions in high and middle income settings.
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Affiliation(s)
- Ruth F. Hunter
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
- *Correspondence: Ruth F. Hunter
| | - Felipe Montes
- Department of Industrial Engineering, Social and Health Complexity Center, Universidad de Los Andes, Bogotá, Colombia
| | - Jennifer M. Murray
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Shannon C. Montgomery
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Joaquín Jaramillo
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Christopher Tate
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Rajnish Kumar
- Queen's Management School, Queen's University Belfast, Belfast, United Kingdom
| | - Laura Dunne
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, United Kingdom
| | - Abhijit Ramalingam
- Department of Economics, Appalachian State University, Boone, NC, United States
| | - Erik O. Kimbrough
- The George L. Argyros School of Business and Economics, Smith Institute for Political Economy and Philosophy, Chapman University, Orange, CA, United States
| | - Erin Krupka
- Behavioral and Experimental Economics Laboratory, School of Information, University of Michigan, Ann Abhor, MI, United States
| | - Huiyu Zhou
- School of Informatics, University of Leicester, Leicester, United Kingdom
| | - Laurence Moore
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Linda Bauld
- The Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Olga L. Sarmiento
- Department of Public Health, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Frank Kee
- Centre for Public Health, Institute of Health Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Montgomery SC, Donnelly M, Bhatnagar P, Carlin A, Kee F, Hunter RF. Peer social network processes and adolescent health behaviors: A systematic review. Prev Med 2020; 130:105900. [PMID: 31733224 DOI: 10.1016/j.ypmed.2019.105900] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
Abstract
Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n = 41, 73%) and cross-sectional (n = 14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa Scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n = 2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.
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Affiliation(s)
- Shannon C Montgomery
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
| | - Michael Donnelly
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
| | - Prachi Bhatnagar
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road Campus, OX3 7LF, UK.
| | - Angela Carlin
- Sport and Exercise Sciences Research Institute, Ulster University, Northern Ireland, UK.
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
| | - Ruth F Hunter
- UKCRC Centre of Excellence for Public Health (Northern Ireland)/Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
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Murray JM, Brennan SF, French DP, Patterson CC, Kee F, Hunter RF. Mediators of Behavior Change Maintenance in Physical Activity Interventions for Young and Middle-Aged Adults: A Systematic Review. Ann Behav Med 2019; 52:513-529. [PMID: 29672666 DOI: 10.1093/abm/kay012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Regular physical activity is important for maintaining physical and mental health. Benefits are optimized when physical activity is maintained. Understanding causal mechanisms is important to inform future interventions. Purpose To investigate mediators of physical activity maintenance. Methods Six databases were searched (Medline, EMBASE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, and Web of Science). Eligibility criteria included adult nonclinical populations, validated measure of physical activity behavior at baseline and at least 6 months postbaseline, control/comparison group(s), and reported mediators of physical activity behavior change. Mediators were examined according to (i) formal mediation tests, (ii) mediator association with physical activity outcome, and (iii) intervention effects on mediators. Results There were few formal mediation tests conducted (n = 12/39 included studies), and various other methodological limitations were identified. There was some evidence that effective mediators in formal mediation tests at 6 months and later included the "behavioral processes of change" (n = 5/6). Many of the included interventions were not effective for changing targeted mediators (only 34% of 413 tests of mediator changes were significant). Conclusions There were a number of methodological and statistical limitations in the evidence base. In future, prespecified formal mediation tests should be carried out and could be aided by a formal framework. Social and environmental variables should be considered in addition to intrapersonal variables. Improving knowledge of how to change hypothesized mediators, based on theory and evidence, will reveal how physical activity behavior change maintenance can be achieved. Maintenance research would be enhanced by establishing a formal definition of behavior change "maintenance." PROSPERO registration: PROSPERO 2015:CRD- 42015025462.
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Affiliation(s)
- Jennifer M Murray
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Sarah F Brennan
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - David P French
- Department for Health Psychology, Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher C Patterson
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Frank Kee
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Ruth F Hunter
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
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Hunter RF, Cleland C, Cleary A, Droomers M, Wheeler BW, Sinnett D, Nieuwenhuijsen MJ, Braubach M. Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis. Environ Int 2019; 130:104923. [PMID: 31228780 DOI: 10.1016/j.envint.2019.104923] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity. OBJECTIVES To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions. DATA SOURCES Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS. STUDY APPRAISAL AND SYNTHESIS METHODS Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research. RESULTS Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised.
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Affiliation(s)
- R F Hunter
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - C Cleland
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - A Cleary
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - M Droomers
- University of Amsterdam, Amsterdam, the Netherlands.
| | - B W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, England, United Kingdom.
| | - D Sinnett
- University of the West of England, Bristol, England, United Kingdom.
| | - M J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - M Braubach
- WHO Regional Office for Europe, European Centre for Environment and Health, Bonn, Germany.
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Badham J, McAneney H, Dunne L, Kee F, Thurston A, Hunter RF. The importance of social environment in preventing smoking: an analysis of the Dead Cool intervention. BMC Public Health 2019; 19:1182. [PMID: 31462249 PMCID: PMC6714405 DOI: 10.1186/s12889-019-7485-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/13/2019] [Indexed: 12/01/2022] Open
Abstract
Background An adolescent’s perceptions of their family’s and friends’ smoking attitudes and behaviour can influence their own uptake of smoking. There are two broad sources of such social influence: observing the behaviour directly, and assimilating attitudes. Methods We analysed data collected for the evaluation of Dead Cool, a school based smoking prevention intervention in Northern Ireland (n=480 in 20 clusters). The main analysis fits three nested logistic regression models predicting pre-intervention susceptibility to taking up smoking, as reflected in responses to three attitudinal questions. Model 1 includes only personal characteristics as explanatory factors. Model 2 adds the behaviour of friends and family that would provide an opportunity for social influence through observational learning. Model 3 adds the susceptibility of friends. Results Each additional group of variables improved the model fit (with reduced AIC and BIC). However, in the final model, only three variables were found to be statistically significant (p<0.05) in predicting susceptibility to smoking initiation: rebelliousness (OR [1.1,1.3]) from the personal characteristics group; and, in the observational learning group, being friends with a smoker (OR [1.0,2.9]) and frequency of being in the same room or car with someone smoking (OR [2.0,9.0] for most frequent). Adding the two measures of diffusion of susceptibility through the friendship network improved the model fit, but neither was found to be statistically significant. Conclusions The analysis provides additional evidence to support policies that could reduce children’s exposure to smoking behaviour, and potential subsequent smoking initiation. No conclusions could be drawn about the diffusion of smoking attitudes through the school friendship networks of children. Electronic supplementary material The online version of this article (10.1186/s12889-019-7485-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Badham
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Helen McAneney
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Laura Dunne
- Centre for Evidence and Social Innovation, Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Allen Thurston
- School of Social Sciences, Education & Social Work, Queen's University Belfast, College Green, Belfast, BT7 1LN, UK
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
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Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ, Carlin A, Patterson C, Longo A, Hutchinson G, Prior L, Tully MA, French DP, Adams J, McIntosh E, Xin Y, Kee F. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. Public Health Res 2019. [DOI: 10.3310/phr07150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.
Objectives
To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.
Design
A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting
Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.
Participants
A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.
Intervention
The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main outcome measures
The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.
Results
The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).
Limitations
Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions
Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
Trial registration
Current Controlled Trials ISRCTN17975376.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jennifer M Murray
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jianjun Tang
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Sarah F Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | | | | | - Chris Patterson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Alberto Longo
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
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Hunter RF, Wickramasinghe K, Ergüder T, Bolat A, Arı HO, Yıldırım HH, Ursu P, Robinson G, Breda J, Mikkelsen B, Connolly P, Clarke M, Kee F. National action plans to tackle NCDs: role of stakeholder network analysis. BMJ 2019; 365:l1871. [PMID: 31110055 PMCID: PMC6526679 DOI: 10.1136/bmj.l1871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Network science approaches can enhance global and national coordinated efforts to prevent and manage non-communicable diseases, say Ruth Hunter and colleagues
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Kremlin Wickramasinghe
- WHO European Office for Prevention and Control of Non-communicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | | | | | - Hakan Oğuz Arı
- Turkish Institute for Health Policies, Health Institutes of Turkey, Ankara, Turkey
| | | | | | - Gareth Robinson
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Joao Breda
- WHO European Office for Prevention and Control of Non-communicable Diseases, WHO Regional Office for Europe, Moscow, Russia
| | - Bente Mikkelsen
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Moscow, Russia
| | - Paul Connolly
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Mike Clarke
- Centre for Public Health/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Evidence Aid, Oxford, UK
| | - Frank Kee
- Centre for Public Health/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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Tully MA, Cunningham C, Wright A, McMullan I, Doherty J, Collins D, Tudor-Locke C, Morgan J, Phair G, Laventure B, Simpson EEA, McDonough SM, Gardner E, Kee F, Murphy MH, Agus A, Hunter RF, Hardeman W, Cupples ME. Peer-led walking programme to increase physical activity in inactive 60- to 70-year-olds: Walk with Me pilot RCT. Public Health Res 2019. [DOI: 10.3310/phr07100] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background
Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those with a lower rather than a higher socioeconomic position, are also the most inactive. Peer-led physical activity interventions may offer a model to increase physical activity in these older adults and thus help reduce associated health inequalities. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socioeconomically disadvantaged community-dwelling older adults.
Objectives
The study aimed to develop a peer-led intervention through a rapid review of previous peer-led interventions and interviews with members of the target population. A proposed protocol to evaluate its effectiveness was tested in a pilot randomised controlled trial (RCT).
Design
A rapid review of the literature and the pilot study informed the intervention design; a pilot RCT included a process evaluation of intervention delivery.
Setting
Socioeconomically disadvantaged communities in the South Eastern Health and Social Care Trust and the Northern Health and Social Care Trust in Northern Ireland.
Participants
Fifty adults aged 60–70 years, with low levels of physical activity, living in socioeconomically disadvantaged communities, recruited though community organisations and general practices.
Interventions
‘Walk with Me’ is a 12-week peer-led walking intervention based on social cognitive theory. Participants met weekly with peer mentors. During the initial period (weeks 1–4), each intervention group participant wore a pedometer and set weekly step goals with their mentor’s support. During weeks 5–8 participants and mentors met regularly to walk and discuss step goals and barriers to increasing physical activity. In the final phase (weeks 9–12), participants and mentors continued to set step goals and planned activities to maintain their activity levels beyond the intervention period. The control group received only an information booklet on active ageing.
Main outcome measures
Rates of recruitment, retention of participants and completeness of the primary outcome [moderate- and vigorous-intensity physical activity measured using an ActiGraph GT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL, USA) at baseline, 12 weeks (post intervention) and 6 months]; acceptability assessed through interviews with participants and mentors.
Results
The study planned to recruit 60 participants. In fact, 50 eligible individuals participated, of whom 66% (33/50) were female and 80% (40/50) were recruited from general practices. At 6 months, 86% (43/50) attended for review, 93% (40/43) of whom returned valid accelerometer data. Intervention fidelity was assessed by using weekly step diaries, which were completed by both mentors and participants for all 12 weeks, and checklists for the level of delivery of intervention components, which was high for the first 3 weeks (range 49–83%). However, the rate of return of checklists by both mentors and participants diminished thereafter. Outcome data indicate that a sample size of 214 is required for a definitive trial.
Limitations
The sample was predominantly female and somewhat active.
Conclusions
The ‘Walk with Me’ intervention is acceptable to a socioeconomically disadvantaged community of older adults and a definitive RCT to evaluate its effectiveness is feasible. Some modifications are required to ensure fidelity of intervention delivery is optimised. Future research needs to identify methods to recruit males and less active older adults into physical activity interventions.
Trial registration
Current Controlled Trials ISRCTN23051918.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 10. See the NIHR Journals Library website for further project information. Funding for the intervention was gratefully received from the Health Improvement Division of the Public Health Agency.
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Affiliation(s)
- Mark A Tully
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Conor Cunningham
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Ashlene Wright
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Ilona McMullan
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Julie Doherty
- Psychology Research Institute, Ulster University, Coleraine, UK
| | - Debbie Collins
- Department of General Practice, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Catrine Tudor-Locke
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Joanne Morgan
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Community Development and Health Network, Newry, UK
| | - Glenn Phair
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | | | | | - Suzanne M McDonough
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Evie Gardner
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Marie H Murphy
- Centre for Physical Activity and Health Research, Ulster University, Newtownabbey, UK
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Wendy Hardeman
- Health Promotion Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Margaret E Cupples
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
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Murray JM, French DP, Patterson CC, Kee F, Gough A, Tang J, Hunter RF. Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial. J Med Internet Res 2019; 21:e11394. [PMID: 31002304 PMCID: PMC6498305 DOI: 10.2196/11394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/28/2018] [Accepted: 01/06/2019] [Indexed: 01/12/2023] Open
Abstract
Background Investigating participant engagement and nonusage attrition can help identify the likely active ingredients of electronic health interventions. Research on engagement can identify which intervention components predict health outcomes. Research on nonusage attrition is important to make recommendations for retaining participants in future studies. Objective This study aimed to investigate engagement and nonusage attrition in the Physical Activity Loyalty (PAL) scheme, a 6-month complex physical activity intervention in workplaces in Northern Ireland. The intervention included financial incentives with reward redemption and self-regulation techniques. Specific objectives were (1) to determine whether engagement in specific intervention components predicted physical activity at 6 months, (2) to determine whether engagement in specific intervention components predicted targeted mediators at 6 months, and (3) to investigate predictors of nonusage attrition for participants recording daily activity via the PAL scheme physical activity monitoring system and logging onto the website. Methods Physical activity was assessed at baseline and 6 months using pedometers (Yamax Digiwalker CW-701, Japan). Markers of engagement and website use, monitoring system use, and reward redemption were collected throughout the scheme. Random-effects generalized least-squares regressions determined whether engagement with specific intervention components predicted 6-month physical activity and mediators. Cox proportional hazards regressions were used to investigate predictors of nonusage attrition (days until first 2-week lapse). Results A multivariable generalized least-squares regression model (n=230) showed that the frequency of hits on the website’s monitoring and feedback component (regression coefficient [b]=50.2; SE=24.5; P=.04) and the percentage of earned points redeemed for financial incentives (b=9.1; SE=3.3; P=.005) were positively related to 6-month pedometer steps per day. The frequency of hits on the discussion forum (b=−69.3; SE=26.6; P=.009) was negatively related to 6-month pedometer steps per day. Reward redemption was not related to levels of more internal forms of motivation. Multivariable Cox proportional hazards regression models identified several baseline predictors associated with nonusage attrition. These included identified regulation (hazard ratio [HR] 0.88, 95% CI 0.81-0.97), recovery self-efficacy (HR 0.88, 95% CI 0.80-0.98), and perceived workplace environment safety (HR 1.07, 95% CI 1.02-1.11) for using the physical activity monitoring system. The EuroQoL health index (HR 0.33, 95% CI 0.12-0.91), financial motivation (HR 0.93, 95% CI 0.87-0.99), and perceived availability of physical activity opportunities in the workplace environment (HR 0.96, 95% CI 0.93-0.99) were associated with website nonusage attrition. Conclusions Our results provide evidence opposing one of the main hypotheses of self-determination theory by showing that financial rewards are not necessarily associated with decreases in more internal forms of motivation when offered as part of a complex multicomponent intervention. Identifying baseline predictors of nonusage attrition can help researchers to develop strategies to ensure maximum intervention adherence. Trial Registration ISRCTN Registry ISRCTN17975376; http://www.isrctn.com/ISRCTN17975376 (Archived by WebCite at http://www.webcitation.org/76VGZsZug)
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Affiliation(s)
- Jennifer M Murray
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - David P French
- Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Christopher C Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Aisling Gough
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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Cleland C, Ferguson S, Ellis G, Hunter RF. Validity of the International Physical Activity Questionnaire (IPAQ) for assessing moderate-to-vigorous physical activity and sedentary behaviour of older adults in the United Kingdom. BMC Med Res Methodol 2018; 18:176. [PMID: 30577770 PMCID: PMC6303992 DOI: 10.1186/s12874-018-0642-3] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to accurately measure and monitor levels of moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) in older adults, cost efficient and valid instruments are required. To date, the International Physical Activity Questionnaire (IPAQ) has not been validated with older adults (aged 60 years plus) in the United Kingdom. The current study aimed to test the validity of the IPAQ in a group of older adults for both MVPA and SB. METHODS Participants wore an Actigraph GT3X+ for seven consecutive days and following the monitor wear participants were asked to complete the IPAQ. Statistical analysis included: Kolmogorov-Smirnov tests; descriptive analyses; Spearman's rho coefficients; and Bland-Altman analyses. RESULTS A sample of 253 older adults were recruited (mean age 71.8 years (SD 6.6) and 57% male). In total, 226 had valid accelerometer and IPAQ data for MVPA and 228 had valid data for SB. Results showed the IPAQ had moderate/acceptable levels of validity (r = .430-.557) for MVPA. For SB, there was substantial levels of validity on weekdays (r = .702) and fair levels of validity (r = .257) on weekend days. Bland-Altman analysis showed inherent measurement error with the majority of participants tending to under-report both MVPA and SB. Results showed the majority of older adult's under-report their level of MVPA and SB when completing the IPAQ and the linear relationship above the mean shows an error from under to over reporting as the mean increases. CONCLUSIONS Findings from the current study suggest that the IPAQ is better implemented in larger surveillance studies comparing groups within or between countries rather than on an individual basis. Findings also suggest that the IPAQ validity scores could be strengthened by providing additional detail of types of activities older adults might do on a daily basis, improving recall; and it may also be necessary to provide an example of a daily break down of typical activities performed. This may enable older adults to more fully comprehend the amount of time they may spend active, sitting and/or lying during waking hours.
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Affiliation(s)
- Claire Cleland
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute for Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, UK
| | - Sara Ferguson
- School of Natural and Built Environment, Queen’s University Belfast, David Keir Building, Belfast, UK
| | - Geraint Ellis
- School of Natural and Built Environment, Queen’s University Belfast, David Keir Building, Belfast, UK
| | - Ruth F. Hunter
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute for Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, UK
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Hunter RF, Tang J, Hutchinson G, Chilton S, Holmes D, Kee F. Association between time preference, present-bias and physical activity: implications for designing behavior change interventions. BMC Public Health 2018; 18:1388. [PMID: 30567532 PMCID: PMC6300013 DOI: 10.1186/s12889-018-6305-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/05/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The decision to initiate or maintain a healthy habit, such as physical activity involves a trade-off between a short-term cost, such as time and effort, which are commonly identified as barriers to physical activity, and a long-term health benefit. Research suggests that individual time preference may be associated with unhealthy behaviors. However, empirical evidence of this for physical activity is scant. This study investigated the relationship between time preference and physical activity, and how this might influence behavior change. METHODS Employees (n = 176; mean age 42.2 years) who participated in a physical activity intervention were invited to take part in a behavioral economic field experiment. Two economic experiments, using multiple price lists and monetary trade-off tables involving real money choices, were conducted face-to-face with participants to measure the two components of time preference, namely present-bias and discount rate. Together with individual risk preferences, these three variables were jointly estimated by maximum likelihood. These three parameters were expressed as a linear function of the levels of physical activity while controlling for socio-demographic variables within the same maximum likelihood framework. RESULTS Those who were present-biased and who had higher discount rates did significantly less physical activity than their patient and non present-biased counterparts. A 3% lower discount rate and 1.14 unit decrement in the present-bias parameter was associated with a 30 min increase of physical activity per week. This negative association was more significant for certain sub-groups, such as younger and married adults and those with higher staff grade and those who have children. Participants who dropped out of the study earlier were more present-biased. CONCLUSIONS Results demonstrated that discount rate and present-biasedness have a significant impact on physical activity levels. Such concepts have been largely overlooked and underutilized in physical activity interventions. Promising implications include 1) utilizing individuals' time preferences to better target interventions; 2) taking account of time preferences in the intervention design; 3) interventions attempting to correct for present-biasedness.
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Affiliation(s)
- Ruth F. Hunter
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
| | - Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, 100872 China
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
- Gibson Institute for Land, Food and Environment, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
- Institute of Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Susan Chilton
- Business School—Economics, Newcastle University, Newcastle, England UK
| | - David Holmes
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
- Gibson Institute for Land, Food and Environment, School of Biological Sciences, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI)/Centre for Public Health, Queen’s University Belfast, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BJ UK
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Hunter RF, Murray JM, Gough A, Tang J, Patterson CC, French DP, McIntosh E, Xin Y, Kee F. Effectiveness and cost-effectiveness of a loyalty scheme for physical activity behaviour change maintenance: results from a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2018; 15:127. [PMID: 30541563 PMCID: PMC6291971 DOI: 10.1186/s12966-018-0758-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/25/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We evaluated the effectiveness and cost-effectiveness of a loyalty scheme based intervention involving rewards for increasing physical activity in public sector employees. METHODS A cluster randomised wait-list controlled trial in public sector organisations in Northern Ireland. We randomly assigned clusters (1:1) using a computer generated random sequence. Researchers were masked to allocation, but participants were not. Employees aged 18-65 years with no self-reported medical contraindications to physical activity were included. The Physical Activity Loyalty Scheme (PAL) intervention was based on high-street loyalty cards where participants earned points for minutes of activity that could be redeemed for rewards, complemented by evidence-based behaviour change techniques. The primary outcome was objectively measured mean steps/day at 6 months using a validated pedometer (Yamax Digi-Walker CW-701) over 7 days, assessed with intention to treat analysis. Secondary outcomes included health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Cost-effectiveness, cost-benefit and mediation analyses were conducted. Trial registered with Current Controlled Trials, number ISRCTN17975376. RESULTS Between September 2014 and October 2015, we recruited and randomly assigned 37 clusters (from nine organisations; mean clusters per organisation = four) and 853 participants to the intervention (n = 19 with 457 participants) or control group (n = 18 with 396 participants). Primary outcome data were available for 249 (54·4%) intervention and 236 (59·6%) control participants. Mean steps/day were significantly lower in the intervention vs control group (adjusted mean difference = - 336, 95% CI: -612 to - 60, p = 0·02) at 6 months. Participants redeemed only 39% (SD 43%) of their earned points. Using the Quality Adjusted Life Year outcome, the intervention was not cost effective from an NHS/PSS perspective. A net cost analysis from an employer perspective demonstrated the intervention group was associated with a mean of 2·97 h less absenteeism over a 4 week period (p = 0·62), which could result in net savings ranging from £66 to £735 depending on the wage rate employed. At 4-weeks post-baseline there were significant increases in identified regulation, integrated regulation, intrinsic motivation, social norms and intentions in intervention compared to control participants. CONCLUSIONS Our mixed results pose challenges that are too infrequently exposed in public heath intervention trials. Although the intervention successfully altered several hypothesised mediating constructs it did not translate into long-term behaviour change. Our incentive level may have been too low to incentivise change, despite being designed a priori by a Contingent Valuation Survey. There were also major re-structuring of several organisations which presented significant implementation challenges, and technical limitations. TRIAL REGISTRATION ISRCTN17975376 (Registered 19/09/2014).
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Affiliation(s)
- Ruth F. Hunter
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - Jennifer M. Murray
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - Aisling Gough
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - Jianjun Tang
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Christopher C. Patterson
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - David P. French
- School of Health Sciences, University of Manchester, Manchester, England
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
| | - on behalf of the Physical Activity Loyalty (PAL) Study team
- UKCRC Centre of Excellence for Public Health Research (NI)/Centre for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ Northern Ireland
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
- School of Health Sciences, University of Manchester, Manchester, England
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland
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Badham J, Chattoe-Brown E, Gilbert N, Chalabi Z, Kee F, Hunter RF. Developing agent-based models of complex health behaviour. Health Place 2018; 54:170-177. [PMID: 30290315 PMCID: PMC6284360 DOI: 10.1016/j.healthplace.2018.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/23/2018] [Accepted: 08/29/2018] [Indexed: 12/21/2022]
Abstract
Managing non-communicable diseases requires policy makers to adopt a whole systems perspective that adequately represents the complex causal architecture of human behaviour. Agent-based modelling is a computational method to understand the behaviour of complex systems by simulating the actions of entities within the system, including the way these individuals influence and are influenced by their physical and social environment. The potential benefits of this method have led to several calls for greater use in public health research. We discuss three challenges facing potential modellers: model specification, obtaining required data, and developing good practices. We also present steps to assist researchers to meet these challenges and implement their agent-based model.
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Affiliation(s)
- Jennifer Badham
- UKCRC Centre of Excellence for Public Health Research Northern Ireland, Queen's University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom.
| | - Edmund Chattoe-Brown
- School of Media, Communication and Sociology, University of Leicester, Bankfield House, 132 New Walk, Leicester LE1 7JA, United Kingdom
| | - Nigel Gilbert
- Centre for Research in Social Simulation, Department of Sociology, University of Surrey, Guildford GU 2 7XH, United Kingdom
| | - Zaid Chalabi
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research Northern Ireland, Queen's University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
| | - Ruth F Hunter
- UKCRC Centre of Excellence for Public Health Research Northern Ireland, Queen's University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast BT12 6BA, United Kingdom
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Affiliation(s)
- Aisling Gough
- UKCRC Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Frank Kee
- UKCRC Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Ruth F. Hunter
- UKCRC Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
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Kunzmann AT, Mallon KP, Hunter RF, Cardwell CR, McMenamin ÚC, Spence AD, Coleman HG. Physical activity, sedentary behaviour and risk of oesophago-gastric cancer: A prospective cohort study within UK Biobank. United European Gastroenterol J 2018; 6:1144-1154. [PMID: 30288276 PMCID: PMC6169059 DOI: 10.1177/2050640618783558] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/19/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few observational studies have assessed the role of physical activity in oesophago-gastric cancer risk. OBJECTIVE This prospective cohort study aimed to assess the association between physical activity and risk of oesophageal or gastric cancer. METHODS A cohort of 359,033 adults aged 40-69 years were identified from the UK Biobank, which recruited participants between 2006 and 2010. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between self-reported levels of physical activity and screen-based sedentary behaviour and risk of oesophageal and gastric cancer were calculated using Cox proportional hazards models. RESULTS During eight years of follow-up (mean = 5.5), 294 oesophageal cancer and 217 gastric cancer cases were identified. Physical activity and screen-based sedentary behaviour levels were not associated with overall oesophago-gastric cancer risk. However, when compared with low levels, high physical activity levels were associated with a significantly reduced risk of gastric non-cardia cancer (HR 0.58, 95% CI 0.37-0.95). Moderate physical activity levels were associated with a 38% reduced risk of oesophageal adenocarcinoma (HR 0.62, 95% CI 0.43-0.89), although no dose-response association was apparent. CONCLUSION Moderate, rather than high, physical activity levels were associated with the strongest reductions in oesophageal adenocarcinoma risk in this large UK prospective cohort.
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Affiliation(s)
- Andrew T Kunzmann
- Cancer Epidemiology Group,
Centre
for Public Health, Queen’s University
Belfast, Belfast, UK
| | - Kristian P Mallon
- Cancer Epidemiology Group,
Centre
for Public Health, Queen’s University
Belfast, Belfast, UK
| | - Ruth F Hunter
- UKCRC Centre of Excellence for Public
Health (NI),
Queen’s
University Belfast, Belfast, UK
| | - Chris R Cardwell
- Cancer Epidemiology Group,
Centre
for Public Health, Queen’s University
Belfast, Belfast, UK
| | - Úna C McMenamin
- Cancer Epidemiology Group,
Centre
for Public Health, Queen’s University
Belfast, Belfast, UK
| | - Andrew D Spence
- Cancer Epidemiology Group,
Centre
for Public Health, Queen’s University
Belfast, Belfast, UK
| | - Helen G Coleman
- Cancer Epidemiology Group,
Centre
for Public Health, Queen’s University
Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public
Health (NI),
Queen’s
University Belfast, Belfast, UK
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Ellis G, Hunter RF, Hino AAF, Cleland CL, Ferguson S, Murtagh B, Anez CRR, Melo S, Tully M, Kee F, Sengupta U, Reis R. Study protocol: healthy urban living and ageing in place (HULAP): an international, mixed methods study examining the associations between physical activity, built and social environments for older adults the UK and Brazil. BMC Public Health 2018; 18:1135. [PMID: 30241475 PMCID: PMC6150980 DOI: 10.1186/s12889-018-6018-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/04/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The ability to 'age in place' is dependent on a range of inter-personal, social and built environment attributes, with the latter being a key area for potential intervention. There is an emerging body of evidence that indicates the type of built environment features that may best support age friendly communities, but there is a need to expand and consolidate this, while generating a better understanding of how on how research findings can be most effectively be translated in to policy and practice. METHODS The study is based on two case study cities, Curtiba (Brazil) and Belfast (UK), which have highly contrasting physical, social and policy environments. The study deploys a mix methods approach, mirrored in each city. This includes the recruitment of 300 participants in each city to wear GPS and accelerometers, a survey capturing physical functioning and other personal attributes, as well as their perception of their local environment using NEWS-A. The study will also measure the built environments of the cities using GIS and develop a tool for auditing the routes used by participants around their neighbourhoods. The study seeks to comparatively map the policy actors and resources involved in healthy ageing in the two cities through interviews, focus groups and discourse analysis. Finally, the study has a significant knowledge exchange component, including the development of a tool to assess the capacities of both researchers and research users to maximise the impact of the research findings. DISCUSSION The HULAP study has been designed and implemented by a multi-disciplinary team and integrates differing methodologies to purposefully impact on policy and practice on healthy ageing in high and low-middle income countries. It has particular strengths in its combination of objective and self-reported measures using validated tools and the integration of GPS, accelerometer and GIS data to provide a robust assessment of 'spatial energetics'. The strong knowledge exchange strand means that the study is expected to also contribute to our understanding of how to maximise research impact in this field and create effective evidence for linking older adult's physical activity with the social, built and policy environments.
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Affiliation(s)
- Geraint Ellis
- School of Natural and Built Environment, David Keir Building, Stranmillis Road, Belfast, BT9 5AG UK
| | - Ruth F. Hunter
- UKCRC Centre of Excellence for Public Health (NI), Queen’s University Belfast, Belfast, BT12 6BA UK
| | - Adriano Akira F. Hino
- Postgraduate in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Claire L. Cleland
- School of Natural and Built Environment, David Keir Building, Stranmillis Road, Belfast, BT9 5AG UK
| | - Sara Ferguson
- School of Natural and Built Environment, David Keir Building, Stranmillis Road, Belfast, BT9 5AG UK
| | - Brendan Murtagh
- School of Natural and Built Environment, David Keir Building, Stranmillis Road, Belfast, BT9 5AG UK
| | | | - Sara Melo
- Queen’s Management School, Queen’s University Belfast, Belfast, BT9 5EE UK
| | - Mark Tully
- UKCRC Centre of Excellence for Public Health (NI), Queen’s University Belfast, Belfast, BT12 6BA UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI), Queen’s University Belfast, Belfast, BT12 6BA UK
| | - Urmi Sengupta
- School of Natural and Built Environment, David Keir Building, Stranmillis Road, Belfast, BT9 5AG UK
| | - Rodrigo Reis
- Prevention Research Center, Brown School, Washington University in St. Louis, St Louis, USA
- Research Group in Physical Actity and Quality of Life (GPAQ), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
- Postgraduate Program in Urban Management (PPGTU), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Tully MA, Cunningham C, Cupples ME, Farrell D, Hardeman W, Hunter RF, Laventure B, McDonough SM, Morgan J, Murphy MH, Simpson EEA, Tudor-Locke C, Wright A, Kee F. Walk with Me: a protocol for a pilot RCT of a peer-led walking programme to increase physical activity in inactive older adults. Pilot Feasibility Stud 2018; 4:117. [PMID: 29977592 PMCID: PMC6013941 DOI: 10.1186/s40814-018-0308-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those from lower socio-economic position, are also the most inactive. Increasing physical activity levels, particularly among those most inactive, is a public health priority. Peer-led physical activity interventions may offer a model to increase physical activity in the older adult population. This study aims to test the feasibility of a peer-led, multicomponent physical activity intervention in socio-economically disadvantaged community dwelling older adults. Methods The Medical Research Council framework for developing and evaluating complex interventions will be used to design and test the feasibility of a randomised controlled trial (RCT) of a multicomponent peer-led physical activity intervention. Data will be collected at baseline, immediately after the intervention (12 weeks) and 6 months after baseline measures. The pilot RCT will provide information on recruitment of peer mentors and participants and attrition rates, intervention fidelity, and data on the variability of the primary outcome (minutes of moderate to vigorous physical activity measured with an accelerometer). The pilot trail will also assess the acceptability of the intervention and identify potential resources needed to undertake a definitive study. Data analyses will be descriptive and include an evaluation of eligibility, recruitment, and retention rates. The findings will be used to estimate the sample size required for a definitive trial. A detailed process evaluation using qualitative and quantitative methods will be conducted with a variety of stakeholders to identify areas of success and necessary improvements. Discussion This paper describes the protocol for the 'Walk with Me' pilot RCT which will provide the information necessary to inform the design and delivery of a fully powered trial should the Walk with Me intervention prove feasible. Trial registration ISRCTN Number ISRCTN23051918. Date of registration, November 18, 2015.
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Affiliation(s)
- Mark A Tully
- 1Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK
| | - Conor Cunningham
- 1Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Margaret E Cupples
- 1Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK
| | | | - Wendy Hardeman
- 4Health Promotion Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ruth F Hunter
- 1Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK
| | | | - Suzanne M McDonough
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK.,6Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK.,7School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Joanne Morgan
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK.,Community Development and Health Network, Newry, UK
| | - Marie H Murphy
- 9Centre for Physical Activity and Health Research, Ulster University, Newtownabbey, UK
| | | | - Catrine Tudor-Locke
- 11Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA USA
| | - Ashlene Wright
- 1Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK
| | - Frank Kee
- 1Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.,UKCRC Centre of Excellence for Public Health (Northern Ireland), Belfast, UK
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Corepal R, Tully MA, Kee F, Miller SJ, Hunter RF. Behavioural incentive interventions for health behaviour change in young people (5-18 years old): A systematic review and meta-analysis. Prev Med 2018; 110:55-66. [PMID: 29432789 DOI: 10.1016/j.ypmed.2018.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
Physical inactivity, an unhealthy diet, smoking, and alcohol consumption are key determinants of morbidity and mortality. These health behaviours often begin at a young age and track into adulthood, emphasising a need for interventions in children and young people. Previous research has demonstrated the potential effectiveness of behavioural incentive (BI) interventions in adults. However, little is known about their effectiveness in children and adolescents. Eight bibliographic databases were searched. Eligibility criteria included controlled trials using behavioural incentives (rewards provided contingent on successful performance of the target behaviour) as an intervention component for health behaviour change in children and adolescents. Intervention effects (standardised mean differences or odds ratios) were calculated and pooled by health behaviour, using a random effects model. Twenty-two studies were included (of n = 8392 identified), 19 of which were eligible for meta-analysis: physical activity (n = 8); healthier eating (n = 3); and smoking (n = 8). There was strong evidence that behavioural incentives may encourage healthier eating behaviours, some evidence that behavioural incentives were effective for encouraging physical activity behaviour, and limited evidence to support the use of behavioural incentives for smoking cessation and prevention in adolescents. Findings suggest that behavioural incentives may encourage uptake and initiation of healthy eating and physical activity in young people. However, this is a limited evidence base and a wide range of incentive designs have yet to be explored. Future research should further investigate the acceptability of these intervention approaches for young people.
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Affiliation(s)
- Rekesh Corepal
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK; UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Northern Ireland, UK.
| | - Mark A Tully
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK; UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Northern Ireland, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK; UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Northern Ireland, UK
| | - Sarah J Miller
- UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Northern Ireland, UK; School of Social Sciences, Education and Social Work, Queen's University Belfast, Northern Ireland, UK
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK; UKCRC Centre of Excellence for Public Health Research (NI), Queen's University Belfast, Northern Ireland, UK.
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Corepal R, Best P, O'Neill R, Tully MA, Edwards M, Jago R, Miller SJ, Kee F, Hunter RF. Exploring the use of a gamified intervention for encouraging physical activity in adolescents: a qualitative longitudinal study in Northern Ireland. BMJ Open 2018; 8:e019663. [PMID: 29678971 PMCID: PMC5914771 DOI: 10.1136/bmjopen-2017-019663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To explore the temporal changes of adolescents' views and experiences of participating in a gamified intervention to encourage physical activity behaviour and associated processes of behaviour change. DESIGN A qualitative longitudinal design was adopted whereby focus groups were conducted with the same participants in each intervention school (n=3) at four time-points (baseline, end of each of two intervention phases and 1-year follow-up). The framework method was used to thematically analyse the data. SETTING Secondary schools (n=3), Belfast (Northern Ireland). PARTICIPANTS A subsample (n=19 at four time-points) of individuals aged 12-14 years who participated in the StepSmart Challenge, a gamified intervention involving a pedometer competition and material rewards to encourage physical activity behaviour change. RESULTS Three core themes were identified: (1) competition; (2) incentives and (3) influence of friends. Participants indicated that a pedometer competition may help initiate physical activity but suggested that there were a number of barriers such as participants finding it 'boring', and feeling as though they had a remote chance of 'winning'. 'Incentives' were viewed favourably, although there were participants who found not winning a prize 'annoying'. Friends were a motivator to be more physically active, particularly for girls who felt encouraged to walk more when with a friend. CONCLUSIONS The intervention in general and specific gamified elements were generally viewed positively and deemed acceptable. Results suggest that gamification may have an important role to play in encouraging adolescents to engage in physical activity and in creating interventions that are fun and enjoyable. The longitudinal approach added additional depth to the analysis as themes were refined and tested with participants over time. The findings also suggest that gamified Behaviour Change Techniques align well with core concepts of Self-determination Theory and that various game elements may require tailoring for specific populations, for example, different genders. TRIAL REGISTRATION NUMBER NCT02455986; Pre-results.
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Affiliation(s)
- Rekesh Corepal
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Paul Best
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Roisin O'Neill
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mark A Tully
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mark Edwards
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russell Jago
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah J Miller
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ruth F Hunter
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, UK
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Hunter RF, Gough A, O'Kane N, McKeown G, Fitzpatrick A, Walker T, McKinley M, Lee M, Kee F. Ethical Issues in Social Media Research for Public Health. Am J Public Health 2018; 108:343-348. [PMID: 29346005 DOI: 10.2105/ajph.2017.304249] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Social media (SM) offer huge potential for public health research, serving as a vehicle for surveillance, delivery of health interventions, recruitment to trials, collection of data, and dissemination. However, the networked nature of the data means they are riddled with ethical challenges, and no clear consensus has emerged as to the ethical handling of such data. This article outlines the key ethical concerns for public health researchers using SM and discusses how these concerns might best be addressed. Key issues discussed include privacy; anonymity and confidentiality; authenticity; the rapidly changing SM environment; informed consent; recruitment, voluntary participation, and sampling; minimizing harm; and data security and management. Despite the obvious need, producing a set of prescriptive guidelines for researchers using SM is difficult because the field is evolving quickly. What is clear, however, is that the ethical issues connected to SM-related public health research are also growing. Most importantly, public health researchers must work within the ethical principles set out by the Declaration of Helsinki that protect individual users first and foremost.
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Affiliation(s)
- Ruth F Hunter
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling Gough
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Niamh O'Kane
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Gary McKeown
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aine Fitzpatrick
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tom Walker
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Michelle McKinley
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mandy Lee
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Frank Kee
- Ruth F. Hunter, Aisling Gough, Niamh O'Kane, Michelle McKinley, and Frank Kee are with the United Kingdom Clinical Research Collaboration Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast. Gary McKeown and Aine Fitzpatrick are with the School of Psychology, Queen's University Belfast. Tom Walker is with the School of History, Anthropology, Philosophy and Politics, Queen's University Belfast. Mandy Lee is with the Centre for Health Policy and Management School of Medicine, Trinity College Dublin, Dublin, Ireland
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Best P, Badham J, Corepal R, O’Neill RF, Tully MA, Kee F, Hunter RF. Network methods to support user involvement in qualitative data analyses: an introduction to Participatory Theme Elicitation. Trials 2017; 18:559. [PMID: 29169378 PMCID: PMC5701364 DOI: 10.1186/s13063-017-2289-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While Patient and Public Involvement (PPI) is encouraged throughout the research process, engagement is typically limited to intervention design and post-analysis stages. There are few approaches to participatory data analyses within complex health interventions. METHODS Using qualitative data from a feasibility randomised controlled trial (RCT), this proof-of-concept study tests the value of a new approach to participatory data analysis called Participatory Theme Elicitation (PTE). Forty excerpts were given to eight members of a youth advisory PPI panel to sort into piles based on their perception of related thematic content. Using algorithms to detect communities in networks, excerpts were then assigned to a thematic cluster that combined the panel members' perspectives. Network analysis techniques were also used to identify key excerpts in each grouping that were then further explored qualitatively. RESULTS While PTE analysis was, for the most part, consistent with the researcher-led analysis, young people also identified new emerging thematic content. CONCLUSIONS PTE appears promising for encouraging user led identification of themes arising from qualitative data collected during complex interventions. Further work is required to validate and extend this method. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02455986 . Retrospectively Registered on 21 May 2015.
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Affiliation(s)
- Paul Best
- School of Social Sciences, Education and Social Work, Queen’s University, Belfast, UK
| | - Jennifer Badham
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Rekesh Corepal
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Roisin F. O’Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Mark A. Tully
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
| | - Ruth F. Hunter
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, UK
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Murray JM, Brennan SF, French DP, Patterson CC, Kee F, Hunter RF. Effectiveness of physical activity interventions in achieving behaviour change maintenance in young and middle aged adults: A systematic review and meta-analysis. Soc Sci Med 2017; 192:125-133. [PMID: 28965003 DOI: 10.1016/j.socscimed.2017.09.021] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 08/31/2017] [Accepted: 09/14/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Physical activity (PA) interventions are generally effective in supporting short-term behaviour change, but increases are not always maintained. This review examined the effectiveness of PA interventions for behaviour change maintenance in young and middle-aged adults, and investigated which Behaviour Change Techniques (BCTs) and other intervention features were associated with maintenance. METHODS Six databases (Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL, Web of Science) were systematically searched. Eligibility criteria were controlled trials investigating the effectiveness of PA interventions with adult (mean age 18-64 years) non-clinical populations using validated measures of PA behaviour at baseline and ≥six months' post-baseline. Results were pooled in meta-analyses using standardised mean differences (SMD) at five time intervals (6-9, 9-15, 15-21, 21-24, >24 months). Moderator analyses investigated the influence of sample and intervention characteristics on PA maintenance at 6-9 months. RESULTS Sixty-two studies were included. PA interventions had a significant effect on behaviour maintenance 6-15 months post-baseline relative to controls. Interventions had a larger effect on maintenance at 6-9 months (SMD = 0.28; 95% CI: 0.20, 0.35; I2 = 73%) compared to 9-15 months (SMD = 0.20; 95% CI: 0.13, 0.26; I2 = 70%). Beyond 15 months, PA measurements were infrequent with little evidence supporting maintenance. Moderator analyses showed some BCTs and intervention settings moderated PA outcomes at 6-9 months. A multivariable meta-regression model showed interventions using the BCTs 'Prompt self-monitoring of behavioural outcome' (b = 1.46, p < 0.01) and 'Use of follow-up prompts' (b = 0.38, p < 0.01) demonstrated greater effectiveness at promoting PA maintenance at 6-9 months. Interventions implemented in primary care (versus community or workplace/university) settings (b = -0.13, p = 0.10) tended to demonstrate less effectiveness. CONCLUSIONS This review provides evidence of some effective BCTs for maintaining behaviour to 15 months. Greater consideration must be given to how future interventions encourage and measure maintenance of changes, and investigate broader psychological, social and environmental influences of PA behaviour. PROSPERO REGISTRATION PROSPERO 2015:CRD42015025462.
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Affiliation(s)
- Jennifer M Murray
- UKCRC Centre of Excellence for Public Health/Centre for Public Health Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT 12 6BJ, UK.
| | - Sarah F Brennan
- UKCRC Centre of Excellence for Public Health/Centre for Public Health Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT 12 6BJ, UK.
| | - David P French
- Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, UK.
| | - Christopher C Patterson
- UKCRC Centre of Excellence for Public Health/Centre for Public Health Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT 12 6BJ, UK.
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health/Centre for Public Health Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT 12 6BJ, UK.
| | - Ruth F Hunter
- UKCRC Centre of Excellence for Public Health/Centre for Public Health Queen's University Belfast, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT 12 6BJ, UK.
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