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Whitton C, Wong YHM, Lau J, Chua XH, Müller AM, Tan CS, van Dam RM, Müller-Riemenschneider F, Rebello SA. Ecological momentary assessment of digital food and beverage marketing exposure and impact in young adults: A feasibility study. Appetite 2024; 197:107338. [PMID: 38579981 DOI: 10.1016/j.appet.2024.107338] [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: 01/11/2024] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Unhealthy food marketing is contributing to the obesity epidemic, but real-time insights into the mechanisms of this relationship are under-studied. Digital marketing is growing and following food and beverage (F&B) brands on social media is common, but measurement of exposure and impact of such marketing presents novel challenges. Thus, this study aimed to evaluate the feasibility of collecting data on exposure and impact of digital F&B marketing (DFM) using a smartphone-based ecological momentary assessment (EMA) methodology. We hypothesized that DFM-induced food cravings would vary based on whether (or not) participants engaged with F&B brands online. Participants were Singapore residents (n = 95, 21-40 years), recruited via telephone from an existing cohort. Participants were asked to upload screenshots of all sightings of online F&B marketing messages for seven days, and answer in-app contextual questions about sightings including whether any cravings were induced. Participants provided a total of 1310 uploads (median 9 per participant, Q1-Q3: 4-21) of F&B marketing messages, 27% of which were provided on Day 1, significantly more than on other days (P < 0.001). Followers of food/beverage brands on social media encountered 25.6 percentage points (95% CI 11.4, 39.7) more marketing messages that induced cravings than participants who were not followers. University education was also associated with more (18.1 percentage points; 95% CI 3.1, 33.1) encounters with marketing messages that induced cravings. It was practical and acceptable to participants to gather insights into digital F&B marketing exposure and impact using EMA in young adults, although a shorter study period is recommended in future studies. Followers of food and beverage brands on social media appear to be more prone to experience cravings after exposure to digital F&B marketing.
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Affiliation(s)
- Clare Whitton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Yvonne Hui Min Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Department of Nutrition and Exercise Sciences and Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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Chan CMJ, Müller-Riemenschneider F, Chia MYH, Hildon ZJL, Chong MFF. Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore. Pilot Feasibility Stud 2024; 10:52. [PMID: 38521958 PMCID: PMC10960416 DOI: 10.1186/s40814-024-01479-3] [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: 09/25/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention-Promoting hEatlthy Eating and Active Lifestyle (PEDAL). METHODS Underpinned by Kincaid's ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10-12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed. DISCUSSION This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial. TRIAL REGISTRATION Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.
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Affiliation(s)
- Cindy Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
- Center for Digital Health, Berlin Institute of Health (BIH), Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Michael Yong Hwa Chia
- Physical Education & Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Zoe Jane-Lara Hildon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
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Padmapriya N, Fogel A, Tan SYX, Goh CMJL, Tan SL, Chia A, Chu AHY, Chong YS, Tan KH, Chan SY, Yap F, Godfrey KM, Lee YS, Eriksson JG, Tan CS, Bernard JY, Müller-Riemenschneider F. The cross-sectional and prospective associations of parental practices and environmental factors with 24-hour movement behaviours among school-aged Asian children. Int J Behav Nutr Phys Act 2024; 21:27. [PMID: 38438945 PMCID: PMC10913559 DOI: 10.1186/s12966-024-01574-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Parental practices and neighbourhood environmental factors may influence children's movement behaviours. We aimed to investigate the cross-sectional and prospective associations of parental practices and neighbourhood environmental factors with accelerometer-measured 24-hour movement behaviours (24 h-MBs) among school-aged children in Singapore. METHODS The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study collected information on dimensions of parental practices and neighbourhood environment at age 5.5 years. Confirmatory factor analyses were performed to generate latent variables and used to compute overall parental practices [involvement in PA + support for PA + control of screen viewing context] and environmental scores [facilities for active play + active mobility facilitators + barriers*-1]. Children wore an accelerometer on their non-dominant wrist for seven consecutive days at ages 5.5 and 8 years. The R-package GGIR 2.6 was used to derive moderate-to-vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), inactivity, and total-sleep (napping+night sleep) minutes per day. Associations were determined using compositional data analysis with multivariate linear regression models, taking into account potential confounders. RESULTS Among 425 children (48% girls, 59% Chinese), higher parental involvement in PA, parental support for PA and overall parental practices were associated with 24 h-MBs at ages 5.5 and 8 years, specifically with greater time spent in MVPA and less time being inactive relative to the remaining movement behaviours. The corresponding mean changes in the overall 24 h-MB for increasing parental practices from lowest to highest scores (- 2 to + 2 z-scores) indicated potential increases of up to 15-minutes in MVPA, 20-minutes in LPA, 5-minutes in sleep duration, and a reduction of 40-minutes in inactivity at age 5.5 years. At age 8 years, this could translate to approximately 15-minutes more of MVPA, 20-minutes more of LPA, a 20-minute reduction in sleep duration, and a 20-minute reduction in inactivity. Parental control of screen viewing contexts and neighbourhood environmental factors were not associated with 24 h-MBs. CONCLUSIONS Parental practices but not environmental factors were associated with higher MVPA and lower inactivity among Singaporean children, even at a later age. Further research may provide insights that support development of targeted public health strategies to promote healthier movement behaviours among children. STUDY REGISTRATION This study was registered on 4th August 2010 and is available online at ClinicalTrials.gov: NCT01174875.
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Affiliation(s)
- Natarajan Padmapriya
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Anna Fogel
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Sarah Yi Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Shuen Lin Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Anne Hin Yee Chu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, F-75004, France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Lim SX, Lim CGY, Müller-Riemenschneider F, van Dam RM, Sim X, Chong MFF, Chia A. Development and validation of a lifestyle risk index to screen for metabolic syndrome and its components in two multi-ethnic cohorts. Prev Med 2024; 179:107821. [PMID: 38122937 DOI: 10.1016/j.ypmed.2023.107821] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is a precursor to cardiovascular diseases and type 2 diabetes. Existing MetS prediction models relied heavily on biochemical measures and those based on non-invasive predictors such as lifestyle behaviours were limited. We aim to (1) develop a weighted lifestyle risk index for MetS and (2) externally validate this index using two Asian-based cohorts in Singapore. METHODS Using data from the Multi-Ethnic Cohort (MEC) 1 (n = 2873, 41% male), multiple logistic regression was used to identify predictors associated with MetS. A weighted lifestyle risk index was generated using coefficients of the selected predictors in the development cohort (MEC1). Subsequently, the performance of the lifestyle risk index in predicting the occurrence of MetS within 10 years was assessed by discrimination and calibration in an external validation cohort (MEC2) (n = 6070, 43% male). RESULTS A lifestyle risk index for MetS with nine predictors was developed (age, sex, ethnicity, having a family history of diabetes, BMI, diet, physical activity, smoking status, and screen time). This index demonstrated acceptable discrimination in the development cohort [AUC (95% CI) = 0.74 (0.71, 0.76)] and the validation cohort [AUC (95% CI) = 0.79 (0.77, 0.81)]. CONCLUSION This lifestyle risk index exhibits potential for risk stratification in population-based screening programmes. Future research could apply a similar methodology to develop disease-specific lifestyle risk indices using nationwide registry-based data.
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Affiliation(s)
- Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Charlie Guan Yi Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Digital Health Centre, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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5
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Chia A, Toh JY, Natarajan P, Cai S, Ong YY, Descarpentrie A, Lioret S, Bernard JY, Müller-Riemenschneider F, Godfrey KM, Tan KH, Chong YS, Eriksson JG, Chong MFF. Trajectories of lifestyle patterns from 2 to 8 years of age and cardiometabolic risk in children: the GUSTO study. Int J Behav Nutr Phys Act 2024; 21:9. [PMID: 38279175 PMCID: PMC10811908 DOI: 10.1186/s12966-024-01564-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Tracking combinations of lifestyle behaviours during childhood ("lifestyle pattern trajectories") can identify subgroups of children that might benefit from lifestyle interventions aiming to improve health outcomes later in life. However, studies on the critical transition period from early to middle childhood are limited. We aimed to describe lifestyle patterns trajectories in children from 2 to 8 years of age and evaluated their associations with cardiometabolic risk markers at age 8 years in a multi-ethnic Asian cohort. METHODS Twelve lifestyle behaviours related to child's diet, physical activity, screen use, and sleep were ascertained using questionnaires at ages 2, 5, and 8 years. Age-specific lifestyle patterns were derived using principal component analysis and trajectories were determined using group-based multi-trajectory modelling. Child cardiometabolic risk markers were assessed at age 8 years, and associations with trajectories examined using multiple regression, adjusted for confounders. RESULTS Among 546 children, two lifestyle patterns "healthy" and "unhealthy" were observed at ages 2, 5, and 8 years separately. Three trajectory groups from 2 to 8 years were identified: consistently healthy (11%), consistently unhealthy (18%), and mixed pattern (71%). Children in the consistently unhealthy group (vs. mixed pattern) had increased odds of pre-hypertension (OR = 2.96 [95% CI 1.18-7.41]) and higher levels of diastolic blood pressure (β = 1.91 [0.27-3.55] mmHg), homeostasis model assessment of insulin resistance (β = 0.43 [0.13-0.74]), triglycerides (β = 0.11 [0.00-0.22] mmol/L), and metabolic syndrome score (β = 0.85 [0.20-1.49]), but not with BMI z-score or any anthropometric measurements. The consistently healthy group showed no differences in cardiometabolic outcomes compared to the mixed pattern group. CONCLUSION Three distinct lifestyle pattern trajectories were identified from early to middle childhood. Children in the consistently unhealthy lifestyle group did not have a raised BMI but was associated with several elevated cardiometabolic risk markers. These findings suggest the potential benefits of initiating holistic lifestyle interventions to improve children's health and well-being from an early age. TRIAL REGISTRATION Trial registration number: NCT01174875. Name of registry: ClinicalTrials.gov. URL of registry: https://classic. CLINICALTRIALS gov/ct2/show/NCT01174875 . Date of registration: August 4, 2010. Date of enrolment of the first participant to the trial: June 2009.
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Affiliation(s)
- Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #12 - 01, Singapore, 117549, Singapore.
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Padmapriya Natarajan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #12 - 01, Singapore, 117549, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Ying Ong
- Department of Social and Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexandra Descarpentrie
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, INRAE, Paris, F-75004, France
| | - Sandrine Lioret
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, INRAE, Paris, F-75004, France
| | - Jonathan Y Bernard
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, INRAE, Paris, F-75004, France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #12 - 01, Singapore, 117549, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Mary F-F Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #12 - 01, Singapore, 117549, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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Poncet L, Saïd M, Yang S, Müller-Riemenschneider F, Berticat C, Raymond M, Barkat-Defradas M, Charles MA, Bernard JY. Associations between screen viewing at 2 and 3.5 years and drawing ability at 3.5 years among children from the French nationwide Elfe birth cohort. Sci Rep 2024; 14:348. [PMID: 38172606 PMCID: PMC10764867 DOI: 10.1038/s41598-023-50767-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
The effect of screen viewing on children's cognitive development has been of concern among parents and researchers. This study investigated the association between children screen time, as reported by parents, and drawing ability, and the confounding effects of socioeconomic characteristics (such as parental education, household income, migration status) and children's competing activities (such as drawing practice, extracurricular activity, outdoor time, sleep time, time playing with parents). Participants included 7577 children aged 3.5 years (50% girls) who underwent the Draw-a-person test (McCarthy score [range = 0-12 points]) in the French nationwide Elfe birth cohort, initiated in 2011. Sex-stratified zero-inflated Poisson regression models were used. Increased screen time was associated with a higher likelihood to obtain a null score in boys (OR 1.15, 95% CI 1.07-1.23) and girls (1.13 [1.03-1.24]) and a lower score in girls only (β = - 0.02, 95% CI - 0.04; - 0.01). After adjusting for SES, associations were no longer observed, indicating that the association between screen time and drawing abilities was confounded by socioeconomic characteristics.
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Affiliation(s)
- Lorraine Poncet
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Mélèa Saïd
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Shuai Yang
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany
| | - Claire Berticat
- ISEM, CNRS, EPHE, IRD, University of Montpellier, 34095, Montpellier, France
| | - Michel Raymond
- ISEM, CNRS, EPHE, IRD, University of Montpellier, 34095, Montpellier, France
| | | | - Marie-Aline Charles
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Unité mixte Elfe, Ined, Inserm, EFS, 93322, Aubervilliers, France
| | - Jonathan Y Bernard
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France.
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
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Zheng S, Edney SM, Goh CH, Tai BC, Mair JL, Castro O, Salamanca-Sanabria A, Kowatsch T, van Dam RM, Müller-Riemenschneider F. Effectiveness of holistic mobile health interventions on diet, and physical, and mental health outcomes: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102309. [PMID: 38053536 PMCID: PMC10694579 DOI: 10.1016/j.eclinm.2023.102309] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
Background Good physical and mental health are essential for healthy ageing. Holistic mobile health (mHealth) interventions-including at least three components: physical activity, diet, and mental health-could support both physical and mental health and be scaled to the population level. This review aims to describe the characteristics of holistic mHealth interventions and their effects on related behavioural and health outcomes among adults from the general population. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, China National Knowledge Infrastructure, and Google Scholar (first 200 records). The initial search covered January 1, 2011, to April 13, 2022, and an updated search extended from April 13, 2022 to August 30, 2023. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were included if they (i) were delivered via mHealth technologies, (ii) included content on physical activity, diet, and mental health, and (iii) targeted adults (≥18 years old) from the general population or those at risk of non-communicable diseases (NCDs) or mental disorders. Studies were excluded if they targeted pregnant women (due to distinct physiological responses), individuals with pre-existing NCDs or mental disorders (to emphasise prevention), or primarily utilised web, email, or structured phone support (to focus on mobile technologies without exclusive human support). Data (summary data from published reports) extraction and risk-of-bias assessment were completed by two reviewers using a standard template and Cochrane risk-of-bias tools, respectively. Narrative syntheses were conducted for all studies, and random-effects models were used in the meta-analyses to estimate the pooled effect of interventions for outcomes with comparable data in the RCTs. The study was registered in PROSPERO, CRD42022315166. Findings After screening 5488 identified records, 34 studies (25 RCTs and 9 pre-post NRSIs) reported in 43 articles with 5691 participants (mean age 39 years, SD 12.5) were included. Most (91.2%, n = 31/34) were conducted in high-income countries. The median intervention duration was 3 months, and only 23.5% (n = 8/34) of studies reported follow-up data. Mobile applications, short-message services, and mobile device-compatible websites were the most common mHealth delivery modes; 47.1% (n = 16/34) studies used multiple mHealth delivery modes. Of 15 studies reporting on weight change, 9 showed significant reductions (6 targeted on individuals with overweight or obesity), and in 10 studies reporting perceived stress levels, 4 found significant reductions (all targeted on general adults). In the meta-analysis, holistic mHealth interventions were associated with significant weight loss (9 RCTs; mean difference -1.70 kg, 95% CI -2.45 to -0.95; I2 = 89.00%) and a significant reduction in perceived stress levels (6 RCTs; standardised mean difference [SMD] -0.32; 95% CI -0.52 to -0.12; I2 = 14.52%). There were no significant intervention effects on self-reported moderate-to-vigorous physical activity (5 RCTs; SMD 0.21; 95%CI -0.25 to 0.67; I2 = 74.28%) or diet quality scores (5 RCTs; SMD 0.21; 95%CI -0.47 to 0.65; I2 = 62.27%). All NRSIs were labelled as having a serious risk of bias overall; 56% (n = 14/25) of RCTs were classified as having some concerns, and the others as having a high risk of bias. Interpretation Findings from identified studies suggest that holistic mHealth interventions may aid reductions in weight and in perceived stress levels, with small to medium effect sizes. The observed effects on diet quality scores and self-reported moderate-to-vigorous physical activity were less clear and require more research. High-quality RCTs with longer follow-up durations are needed to provide more robust evidence. To promote population health, future research should focus on vulnerable populations and those in middle- and low-income countries. Optimal combinations of delivery modes and components to improve efficacy and sustain long-term effects should also be explored. Funding National Research Foundation, Prime Minister's Office, Singapore, under its Campus for Research Excellence and Technological Enterprise (CREATE) Programme and Physical Activity and Nutrition Determinants in Asia (PANDA) Research Programme.
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Affiliation(s)
- Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chin Hao Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jacqueline Louise Mair
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Alicia Salamanca-Sanabria
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics ETH Zürich, Zürich, Switzerland
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Tan SYX, Padmapriya N, Bernard JY, Toh JY, Wee HL, Tan KH, Yap FKP, Lee YS, Chong YS, Godfrey K, Eriksson JG, Shek LPC, Tan CS, Chong MFF, Müller-Riemenschneider F. Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach. Lancet Reg Health West Pac 2023; 41:100918. [PMID: 37842643 PMCID: PMC10570705 DOI: 10.1016/j.lanwpc.2023.100918] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Background Promoting active, balanced lifestyles among children may be an important approach to optimising their health-related quality of life (HRQoL). However, the relationships between children's movement behaviours and HRQoL remain unclear. Methods We examined the associations between movement behaviours (sleep, inactivity, light and moderate-to-vigorous intensity physical activity) assessed using accelerometers at ages 8 and 10 years and self-reported HRQoL scores (overall, and physical and emotional well-being, self-esteem, relationship with family and friends, and school functioning domains) at age 10 years among 370 children in a local birth cohort using compositional isotemporal substitution techniques. Findings Cross-sectionally, light and moderate-to-vigorous intensity physical activities were associated with better self-esteem (β = 15.94 [2.71, 29.18]) and relationship with friends (β = 10.28 [3.81, 16.74]) scores respectively. Prospectively, inactivity was associated with lower overall HRQoL (β = -10.00 [-19.13, -0.87]), relationship with friends (β = -16.41 [-31.60, -1.23]) and school functioning (β = -15.30 [-29.16, -1.44]) scores, while sleep showed a positive trend with overall HRQoL (β = 10.76 [-1.09, 22.61]) and school functioning (β = 17.12 [-0.87, 35.10]) scores. Children's movement behaviours were not associated with their physical and emotional well-being, or relationship with family scores. The isotemporal substitution analyses suggest that increasing time spent in physical activity and/or sleep at the expense of inactivity may benefit children's HRQoL. Interpretation Our findings suggest that sleep and physical activity may be associated with better HRQoL, with the inverse for inactivity. However, the relationship between children's movement behaviours and HRQoL is complex and warrants further research. Funding Singapore National Research Foundation, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research.
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Affiliation(s)
- Sarah Yi Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Natarajan Padmapriya
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonathan Y. Bernard
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Université Paris Cité and Université Sorbonne Paris Nord, Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, Inrae, F-75004, Paris, France
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Fabian Kok Peng Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Keith Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Johan Gunnar Eriksson
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Edney S, Goh CM, Chua XH, Low A, Chia J, S Koek D, Cheong K, van Dam R, Tan CS, Müller-Riemenschneider F. Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials. J Med Internet Res 2023; 25:e45764. [PMID: 37856188 PMCID: PMC10623229 DOI: 10.2196/45764] [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: 01/16/2023] [Revised: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Ecological momentary assessments (EMAs) are short, repeated surveys designed to collect information on experiences in real-time, real-life contexts. Embedding periodic bursts of EMAs within cohort studies enables the study of experiences on multiple timescales and could greatly enhance the accuracy of self-reported information. However, the burden on participants may be high and should be minimized to optimize EMA response rates. OBJECTIVE We aimed to evaluate the effects of study design features on EMA response rates. METHODS Embedded within an ongoing cohort study (Health@NUS), 3 bursts of EMAs were implemented over a 7-month period (April to October 2021). The response rate (percentage of completed EMA surveys from all sent EMA surveys; 30-42 individual EMA surveys sent/burst) for each burst was examined. Following a low response rate in burst 1, changes were made to the subsequent implementation strategy (SMS text message announcements instead of emails). In addition, 2 consecutive randomized controlled trials were conducted to evaluate the efficacy of 4 different reward structures (with fixed and bonus components) and 2 different schedule lengths (7 or 14 d) on changes to the EMA response rate. Analyses were conducted from 2021 to 2022 using ANOVA and analysis of covariance to examine group differences and mixed models to assess changes across all 3 bursts. RESULTS Participants (N=384) were university students (n=232, 60.4% female; mean age 23, SD 1.3 y) in Singapore. Changing the reward structure did not significantly change the response rate (F3,380=1.75; P=.16). Changing the schedule length did significantly change the response rate (F1,382=6.23; P=.01); the response rate was higher for the longer schedule (14 d; mean 48.34%, SD 33.17%) than the shorter schedule (7 d; mean 38.52%, SD 33.44%). The average response rate was higher in burst 2 and burst 3 (mean 50.56, SD 33.61 and mean 48.34, SD 33.17, respectively) than in burst 1 (mean 25.78, SD 30.12), and the difference was statistically significant (F2,766=93.83; P<.001). CONCLUSIONS Small changes to the implementation strategy (SMS text messages instead of emails) may have contributed to increasing the response rate over time. Changing the available rewards did not lead to a significant difference in the response rate, whereas changing the schedule length did lead to a significant difference in the response rate. Our study provides novel insights on how to implement EMA surveys in ongoing cohort studies. This knowledge is essential for conducting high-quality studies using EMA surveys. TRIAL REGISTRATION ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/ct2/show/NCT05154227.
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Affiliation(s)
- Sarah Edney
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Claire Marie Goh
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xin Hui Chua
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alicia Low
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Janelle Chia
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Daphne S Koek
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Karen Cheong
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Rob van Dam
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Exercise and Nutrition Sciences and Epidemiology, Milken Institute of Public Health, The George Washington University, Washington DC, VA, United States
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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Topothai T, Tangcharoensathien V, Edney SM, Suphanchaimat R, Lekagul A, Waleewong O, Topothai C, Kulthanmanusorn A, Müller-Riemenschneider F. Patterns and correlates of physical activity and sedentary behavior among Bangkok residents: A cross-sectional study. PLoS One 2023; 18:e0292222. [PMID: 37792743 PMCID: PMC10550145 DOI: 10.1371/journal.pone.0292222] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Physical inactivity and sedentary behavior are significant risk factors for various non-communicable diseases. Bangkok, Thailand's capital, is one of the fastest-growing metropolitans in Southeast Asia. Few studies have investigated the epidemiology of physical activity and sedentary behavior among Bangkok residents. This study aims to investigate the prevalence of combined physical activity and sedentary behavior patterns among Bangkok residents and examine relationships between participants' characteristics and the combined movement patterns. METHODS We analyzed data from the nationally representative 2021 Health Behavior Survey conducted by the Thailand National Statistical Office. The Global Physical Activity Questionnaire was used to assess physical activity and sedentary behavior. 'Sufficiently active' was defined as meeting the World Health Organization's guidelines for aerobic physical activity (≥150 minutes of moderate-to-vigorous physical activity per week). 'Low sedentary time' was defined as sitting for ≤7 hours per day. Participants were categorized into one of four movement patterns: highly active/low sedentary, highly active/highly sedentary, low active/low sedentary, and low active/highly sedentary. Multinomial logistic regression was used to identify the factors associated with each group of four movement patterns. RESULTS Among the 3,137 individuals included in the study, the majority were categorized as highly active/highly sedentary (64.8%), followed by highly active/low sedentary (17.9%) and low active/highly sedentary (14.3%). Only a few (3.0%) of participants were categorized as being low active/low sedentary. Compared to males, female participants had a significantly higher likelihood of belonging to the highly active/low sedentary (AOR = 1.69, 95%CI: 1.25, 2.28) or highly active/highly sedentary (AOR = 1.51, 95%CI: 1.19, 1.93) group, rather than the low active/high sedentary group. Compared to unemployed/retired participants, those in labor-intensive occupations had a significantly higher likelihood of being in the highly active/low sedentary group (AOR = 1.89, 95%CI: 1.22, 2.94). Compared to participants with no chronic physical conditions, participants who reported multimorbidity had a significantly lower likelihood of being in the highly active/low sedentary group (AOR = 0.60, 95%CI: 0.37, 0.98). CONCLUSION This study provides valuable insights into the patterns of physical activity and sedentary behavior among residents of Bangkok using up-to-date data. The majority belonged to the highly active/highly sedentary group, followed by the highly active/low sedentary group. Correlates such as sex, occupation, and chronic conditions were associated with these patterns. Targeted interventions in recreational activities, workplaces, and urban areas, including screen time control measures, movement breaks and improved built environments, are crucial in reducing sedentary behavior and promoting physical activity.
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Affiliation(s)
- Thitikorn Topothai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Division of Physical Activity and Health, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Angkana Lekagul
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Orratai Waleewong
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Chompoonut Topothai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
- Bureau of Health Promotion, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Anond Kulthanmanusorn
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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11
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Chu AHY, Padmapriya N, Tan SL, Goh CMJL, Chong YS, Shek LP, Tan KH, Gluckman PD, Yap FKP, Lee YS, Loy SL, Chan JKY, Godfrey KM, Eriksson JG, Chan SY, Bernard JY, Müller-Riemenschneider F. Longitudinal Analysis of Patterns and Correlates of Physical Activity and Sedentary Behavior in Women From Preconception to Postpartum: The Singapore Preconception Study of Long-Term Maternal and Child Outcomes Cohort. J Phys Act Health 2023; 20:850-859. [PMID: 37146982 DOI: 10.1123/jpah.2022-0642] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Longitudinal changes in physical activity (PA) and sedentary behavior patterns from preconception to postpartum are not fully characterized. We examined changes and baseline sociodemographic/clinical correlates of PA and sedentary behavior in women from preconception to postpartum. METHODS The Singapore Preconception Study of Long-Term Maternal and Child Outcomes cohort recruited 1032 women planning pregnancy. Participants completed questionnaires at preconception, 34 to 36 weeks gestation, and 12 months postpartum. Repeated-measures linear regression models were used to analyze changes in walking, moderate to vigorous PA (MVPA), screen time, and total sedentary time, and to identify sociodemographic/clinical correlates associated with these changes. RESULTS Of the 373 women who delivered singleton live births, 281 provided questionnaires for all time points. Walking time increased from preconception to late pregnancy but decreased postpartum (adjusted means [95% CI]: 454 [333-575], 542 [433-651], and 434 [320-547] min/wk, respectively). Vigorous-intensity PA and MVPA decreased from preconception to late pregnancy but increased postpartum (vigorous-intensity PA: 44 [11-76], 1 [-3-5], and 11 [4-19] min/wk, MVPA: 273 [174-372], 165 [95-234], and 226 [126-325] min/wk, respectively). Screen time and total sedentary time remained consistent from preconception to pregnancy but decreased postpartum (screen: 238 [199-277], 244 [211-277], and 162 [136-189] min/d, total: 552 [506-598], 555 [514-596], and 454 [410-498] min/d, respectively). Individual characteristics of ethnicity, body mass index, employment, parity, and self-rated general health significantly influenced women's activity patterns. CONCLUSION During late pregnancy, walking time increased, while MVPA declined significantly, and partially returned to preconception levels postpartum. Sedentary time remained stable during pregnancy but decreased postpartum. The identified set of sociodemographic/clinical correlates underscores need for targeted strategies.
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Affiliation(s)
- Anne H Y Chu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
| | - Natarajan Padmapriya
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore
| | - Shuen Lin Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
| | - Claire Marie J L Goh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore
| | - Lynette P Shek
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore,Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
- Liggins Institute, University of Auckland, Auckland,New Zealand
| | - Fabian K P Yap
- Duke-NUS Medical School, Singapore,Singapore
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore,Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore
| | - See Ling Loy
- Duke-NUS Medical School, Singapore,Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore,Singapore
| | - Jerry K Y Chan
- Duke-NUS Medical School, Singapore,Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore,Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton,UK
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki,Finland
- Folkhälsan Research Center, Helsinki,Finland
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Singapore
| | - Jonathan Y Bernard
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics, Paris,France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore,Singapore
- Berlin Institute of Health, Charite University Medical Centre, Berlin,Germany
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12
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Seah JYH, Yao J, Hong Y, Lim CGY, Sabanayagam C, Nusinovici S, Gardner DSL, Loh M, Müller-Riemenschneider F, Tan CS, Yeo KK, Wong TY, Cheng CY, Ma S, Tai ES, Chambers JC, van Dam RM, Sim X. Risk prediction models for type 2 diabetes using either fasting plasma glucose or HbA1c in Chinese, Malay, and Indians: Results from three multi-ethnic Singapore cohorts. Diabetes Res Clin Pract 2023; 203:110878. [PMID: 37591346 DOI: 10.1016/j.diabres.2023.110878] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
AIMS To assess three well-established type 2 diabetes (T2D) risk prediction models based on fasting plasma glucose (FPG) in Chinese, Malays, and Indians, and to develop simplified risk models based on either FPG or HbA1c. METHODS We used a prospective multiethnic Singapore cohort to evaluate the established models and develop simplified models. 6,217 participants without T2D at baseline were included, with an average follow-up duration of 8.3 years. The simplified risk models were validated in two independent multiethnic Singapore cohorts (N = 12,720). RESULTS The established risk models had moderate-to-good discrimination (area under the receiver operating characteristic curves, AUCs 0.762 - 0.828) but a lack of fit (P-values < 0.05). Simplified risk models that included fewer predictors (age, BMI, systolic blood pressure, triglycerides, and HbA1c or FPG) showed good discrimination in all cohorts (AUCs ≥ 0.810), and sufficiently captured differences between the ethnic groups. While recalibration improved fit the simplified models in validation cohorts, there remained evidence of miscalibration in Chinese (p ≤ 0.012). CONCLUSIONS Simplified risk models including HbA1c or FPG had good discrimination in predicting incidence of T2D in three major Asian ethnic groups. Risk functions with HbA1c performed as well as those with FPG.
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Affiliation(s)
- Jowy Yi Hong Seah
- Centre for Population Health Research and Implementation, SingHealth, Singapore 150167, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Yueheng Hong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Charlie Guan Yi Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
| | - Daphne Su-Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; Research Division, National Skin Centre, Singapore 308205, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore; Center for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore 169854, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - John C Chambers
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, United States.
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
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13
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Park SH, Lee YQ, Müller-Riemenschneider F, Dickens BSL, van Dam RM. Acculturation as a Determinant of Obesity and Related Lifestyle Behaviors in a Multi-Ethnic Asian Population. Nutrients 2023; 15:3619. [PMID: 37630809 PMCID: PMC10459113 DOI: 10.3390/nu15163619] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Limited attention has been given to the role of cultural orientation towards different ethnic groups in multi-ethnic settings without a dominant host culture. We evaluated whether acculturation levels, reflecting cultural orientation towards other ethnic groups, were associated with obesity and related lifestyle behaviors in a cosmopolitan Asian population. We conducted the current study based on data from the Singapore Multi-Ethnic Cohort (N = 10,622) consisting of ethnic Chinese, Malays, and Indians aged 21 to 75 years. Multivariable linear and logistic regression analyses were used to examine associations between the acculturation level (z-score), obesity, and related lifestyle behaviors, including dietary habits and physical activity. A higher acculturation level was directly associated with a higher prevalence of obesity among Chinese, whereas an inverse association was found for ethnic Indians, and no significant association in Malays. In ethnic Malays, greater acculturation was significantly associated with higher dietary quality and less sedentary time. Furthermore, a high acculturation level was significantly associated with higher sugar-sweetened beverage consumption and more leisure-time PA in all ethnic groups. Our findings suggest that greater cultural orientation towards other ethnic groups was associated with convergence in obesity levels. More research is required to understand how acculturation affects obesity-related lifestyle factors in multi-ethnic settings.
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Affiliation(s)
- Su Hyun Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (Y.Q.L.); (F.M.-R.); (B.S.L.D.); (R.M.v.D.)
| | - Yu Qi Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (Y.Q.L.); (F.M.-R.); (B.S.L.D.); (R.M.v.D.)
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (Y.Q.L.); (F.M.-R.); (B.S.L.D.); (R.M.v.D.)
- Digital Health Center, Berlin Institute of Health, Charité-Universitäts Medizin Berlin, 10117 Berlin, Germany
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (Y.Q.L.); (F.M.-R.); (B.S.L.D.); (R.M.v.D.)
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (Y.Q.L.); (F.M.-R.); (B.S.L.D.); (R.M.v.D.)
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
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14
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Tan KML, Chee J, Lim KLM, Ng M, Gong M, Xu J, Tin F, Natarajan P, Lee BL, Ong CN, Tint MT, Kee MZL, Müller-Riemenschneider F, Gluckman PD, Meaney MJ, Kumar M, Karnani N, Eriksson JG, Nandanan B, Wyss A, Cameron-Smith D. Safety, Tolerability, and Pharmacokinetics of β-Cryptoxanthin Supplementation in Healthy Women: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. Nutrients 2023; 15:nu15102325. [PMID: 37242207 DOI: 10.3390/nu15102325] [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: 04/12/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND β-cryptoxanthin is a dietary carotenoid for which there have been few studies on the safety and pharmacokinetics following daily oral supplementation. METHODS 90 healthy Asian women between 21 and 35 years were randomized into three groups: 3 and 6 mg/day oral β-cryptoxanthin, and placebo. At 2, 4, and 8 weeks of supplementation, plasma carotenoid levels were measured. The effects of β-cryptoxanthin on blood retinoid-dependent gene expression, mood, physical activity and sleep, metabolic parameters, and fecal microbial composition were investigated. RESULTS β-cryptoxanthin supplementation for 8 weeks (3 and 6 mg/day) was found to be safe and well tolerated. Plasma β-cryptoxanthin concentration was significantly higher in the 6 mg/day group (9.0 ± 4.1 µmol/L) compared to 3 mg/day group (6.0 ± 2.6 µmol/L) (p < 0.03), and placebo (0.4 ± 0.1 µmol/L) (p < 0.001) after 8 weeks. Plasma all-trans retinol, α-cryptoxanthin, α-carotene, β-carotene, lycopene, lutein, and zeaxanthin levels were not significantly changed. No effects were found on blood retinol-dependent gene expression, mood, physical activity and sleep, metabolic parameters, and fecal microbial composition. CONCLUSIONS Oral β-cryptoxanthin supplementation over 8 weeks lead to high plasma concentrations of β-cryptoxanthin, with no impact on other carotenoids, and was well tolerated in healthy women.
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Affiliation(s)
- Karen M L Tan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Singapore
| | - Jolene Chee
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
| | - Kezlyn L M Lim
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
| | - Maisie Ng
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research Singapore, Singapore 138671, Singapore
| | - Min Gong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
| | - Jia Xu
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
| | - Felicia Tin
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
| | - Padmapriya Natarajan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Bee Lan Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Choon Nam Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Michelle Z L Kee
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 10179 Berlin, Germany
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Douglas Mental Health University Institute, McGill University, Montreal, QC H4H 1R3, Canada
| | - Mukkesh Kumar
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research Singapore, Singapore 138671, Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research Singapore, Singapore 138671, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki, 00100 Helsinki, Finland
- Folkhälsan Research Center, 00250 Helsinki, Finland
| | | | - Adrian Wyss
- DSM Nutritional Products Ltd., 4001 Basel, Switzerland
| | - David Cameron-Smith
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research Singapore, Singapore 117609, Singapore
- School of Environmental and Life Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
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15
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Castro O, Mair JL, Salamanca-Sanabria A, Alattas A, Keller R, Zheng S, Jabir A, Lin X, Frese BF, Lim CS, Santhanam P, van Dam RM, Car J, Lee J, Tai ES, Fleisch E, von Wangenheim F, Tudor Car L, Müller-Riemenschneider F, Kowatsch T. Development of "LvL UP 1.0": a smartphone-based, conversational agent-delivered holistic lifestyle intervention for the prevention of non-communicable diseases and common mental disorders. Front Digit Health 2023; 5:1039171. [PMID: 37234382 PMCID: PMC10207359 DOI: 10.3389/fdgth.2023.1039171] [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: 09/07/2022] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
Background Non-communicable diseases (NCDs) and common mental disorders (CMDs) are the leading causes of death and disability worldwide. Lifestyle interventions via mobile apps and conversational agents present themselves as low-cost, scalable solutions to prevent these conditions. This paper describes the rationale for, and development of, "LvL UP 1.0″, a smartphone-based lifestyle intervention aimed at preventing NCDs and CMDs. Materials and Methods A multidisciplinary team led the intervention design process of LvL UP 1.0, involving four phases: (i) preliminary research (stakeholder consultations, systematic market reviews), (ii) selecting intervention components and developing the conceptual model, (iii) whiteboarding and prototype design, and (iv) testing and refinement. The Multiphase Optimization Strategy and the UK Medical Research Council framework for developing and evaluating complex interventions were used to guide the intervention development. Results Preliminary research highlighted the importance of targeting holistic wellbeing (i.e., both physical and mental health). Accordingly, the first version of LvL UP features a scalable, smartphone-based, and conversational agent-delivered holistic lifestyle intervention built around three pillars: Move More (physical activity), Eat Well (nutrition and healthy eating), and Stress Less (emotional regulation and wellbeing). Intervention components include health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), breathing exercises, and journaling. In addition to the intervention components, formative research also stressed the need to introduce engagement-specific components to maximise uptake and long-term use. LvL UP includes a motivational interviewing and storytelling approach to deliver the coaching sessions, as well as progress feedback and gamification. Offline materials are also offered to allow users access to essential intervention content without needing a mobile device. Conclusions The development process of LvL UP 1.0 led to an evidence-based and user-informed smartphone-based intervention aimed at preventing NCDs and CMDs. LvL UP is designed to be a scalable, engaging, prevention-oriented, holistic intervention for adults at risk of NCDs and CMDs. A feasibility study, and subsequent optimisation and randomised-controlled trials are planned to further refine the intervention and establish effectiveness. The development process described here may prove helpful to other intervention developers.
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Affiliation(s)
- Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Aishah Alattas
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roman Keller
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ahmad Jabir
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Xiaowen Lin
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Bea Franziska Frese
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions,Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Chang Siang Lim
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington DC, DC, United States
| | - Josip Car
- Centre for Population Health Sciences, LKCMedicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jimmy Lee
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
- North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - E Shyong Tai
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elgar Fleisch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions,Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Florian von Wangenheim
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Falk Müller-Riemenschneider
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charite University Medical Centre Berlin, Berlin, Germany
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
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16
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Ge L, Hilal S, Müller-Riemenschneider F, Tan CS. Association Between Domain-Specific Physical Activity and Cardiometabolic Factors in a Multiethnic Asian Population: A Longitudinal Study. J Phys Act Health 2023:1-14. [PMID: 37156541 DOI: 10.1123/jpah.2022-0502] [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: 09/18/2022] [Revised: 01/31/2023] [Accepted: 03/19/2023] [Indexed: 05/10/2023]
Abstract
AIMS To examine the association between domain-specific physical activity (PA) and cardiometabolic factors with longitudinal data, which is limited in current literature. METHODS Participants who attended the Singapore Multi-Ethnic Cohort and follow-up surveys were included in this study (N = 3950, mean age: 44.7 y, female: 57.9%). Self-reported moderate- to vigorous-intensity PA (MVPA) for each domain (leisure-time, transportation, occupation, and household) was categorized into 4 levels: no, low, middle, and high MVPA. The longitudinal associations of domain-specific MVPA with cardiometabolic factors including systolic and diastolic blood pressures, low-density and high-density lipoprotein cholesterols, triglycerides, and body mass index were examined using Generalized Estimating Equations, accounting for confounding factors and repeated measurements. RESULTS There were 5.2% participants who had no MVPA. For each domain, this rate ranged from 22.6% (household) to 83.3% (occupation). Leisure-time and occupation MVPAs had positive and linear associations with high-density lipoprotein cholesterols, corresponding to 0.030 (95% confidence interval, 0.015 to 0.045) mmol/L (leisure-time) and 0.063 (95% confidence interval, 0.043 to 0.083) mmol/L (occupation), when compared high with no respective MVPA. Occupation and household MVPAs were associated with low-density lipoprotein cholesterol. Transportation and occupation exhibited a positive and linear relationship with diastolic blood pressure. None of the domains were associated with body mass index, systolic blood pressures, or triglycerides. CONCLUSIONS This study showed that each domain had differential association with individual cardiometabolic risk factors. As occupation, transportation, or household PA had unfavorable associations with low-density lipoprotein cholesterol or diastolic blood pressure, the overall beneficial impact of higher PA levels may not necessarily hold in the context of domain-specific PA and cardiovascular health. Further investigation is needed to corroborate our findings.
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Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, Singapore,Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore,Singapore
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore,Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore,Singapore
- Digital Health Centre, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin,Germany
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore,Singapore
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17
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Zheng S, Edney SM, Mair JL, Kowatsch T, Castro O, Salamanca-Sanabria A, Müller-Riemenschneider F. Holistic mHealth interventions for the promotion of healthy ageing: protocol for a systematic review. BMJ Open 2023; 13:e066662. [PMID: 37130675 PMCID: PMC10163532 DOI: 10.1136/bmjopen-2022-066662] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Maintaining physical and mental health is essential for healthy ageing. It can be supported by modifying lifestyle factors such as physical activity and diet. Poor mental health, in turn, contributes to the opposing effect. The promotion of healthy ageing may therefore benefit from holistic interventions integrating physical activity, diet and mental health. These interventions can be scaled up to the population level by using mobile technologies. However, systematic evidence regarding the characteristics and effectiveness of such holistic mHealth interventions remains limited. This paper presents a protocol for a systematic review that aims to provide an overview of the current state of the evidence for holistic mHealth interventions, including their characteristics and effects on behavioural and health outcomes in general adult populations . METHODS AND ANALYSIS We will conduct a comprehensive search for randomised controlled trials and non-randomised studies of interventions published between January 2011 and April 2022 in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, China National Knowledge Infrastructure and Google Scholar (first 200 records). Eligible studies will be mHealth interventions targeting general adult populations with content on physical activity, diet and mental health. We will extract information on all relevant behavioural and health outcomes, as well as those related to intervention feasibility. Screening and data extraction processes will be carried out independently by two reviewers. Cochrane risk-of-bias tools will be used to assess risk of bias. We will provide a narrative overview of the findings from eligible studies. With sufficient data, a meta-analysis will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required because this study is a systematic review based on published data. We intend to publish our findings in a peer-reviewed journal and present the study at international conferences. PROSPERO REGISTRATION NUMBER CRD42022315166.
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Affiliation(s)
- Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Jacqueline Louise Mair
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zürich, Zürich, Switzerland
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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18
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Mair JL, Castro O, Salamanca-Sanabria A, Frese BF, von Wangenheim F, Tai ES, Kowatsch T, Müller-Riemenschneider F. Exploring the potential of mobile health interventions to address behavioural risk factors for the prevention of non-communicable diseases in Asian populations: a qualitative study. BMC Public Health 2023; 23:753. [PMID: 37095486 PMCID: PMC10123969 DOI: 10.1186/s12889-023-15598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Changing lifestyle patterns over the last decades have seen growing numbers of people in Asia affected by non-communicable diseases and common mental health disorders, including diabetes, cancer, and/or depression. Interventions targeting healthy lifestyle behaviours through mobile technologies, including new approaches such as chatbots, may be an effective, low-cost approach to prevent these conditions. To ensure uptake and engagement with mobile health interventions, however, it is essential to understand the end-users' perspectives on using such interventions. The aim of this study was to explore perceptions, barriers, and facilitators to the use of mobile health interventions for lifestyle behaviour change in Singapore. METHODS Six virtual focus group discussions were conducted with a total of 34 participants (mean ± SD; aged 45 ± 3.6 years; 64.7% females). Focus group recordings were transcribed verbatim and analysed using an inductive thematic analysis approach, followed by deductive mapping according to perceptions, barriers, facilitators, mixed factors, or strategies. RESULTS Five themes were identified: (i) holistic wellbeing is central to healthy living (i.e., the importance of both physical and mental health); (ii) encouraging uptake of a mobile health intervention is influenced by factors such as incentives and government backing; (iii) trying out a mobile health intervention is one thing, sticking to it long term is another and there are key factors, such as personalisation and ease of use that influence sustained engagement with mobile health interventions; (iv) perceptions of chatbots as a tool to support healthy lifestyle behaviour are influenced by previous negative experiences with chatbots, which might hamper uptake; and (v) sharing health-related data is OK, but with conditions such as clarity on who will have access to the data, how it will be stored, and for what purpose it will be used. CONCLUSIONS Findings highlight several factors that are relevant for the development and implementation of mobile health interventions in Singapore and other Asian countries. Recommendations include: (i) targeting holistic wellbeing, (ii) tailoring content to address environment-specific barriers, (iii) partnering with government and/or local (non-profit) institutions in the development and/or promotion of mobile health interventions, (iv) managing expectations regarding the use of incentives, and (iv) identifying potential alternatives or complementary approaches to the use of chatbots, particularly for mental health.
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Affiliation(s)
- Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore.
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Bea Franziska Frese
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Florian von Wangenheim
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - E Shyong Tai
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
| | - Falk Müller-Riemenschneider
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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19
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Liew SJ, Petrunoff NA, Neelakantan N, van Dam RM, Müller-Riemenschneider F. Device-Measured Physical Activity and Sedentary Behavior in Relation to Cardiovascular Diseases and All-Cause Mortality: Systematic Review and Meta-Analysis of Prospective Cohort Studies. AJPM Focus 2023; 2:100054. [PMID: 37789935 PMCID: PMC10546582 DOI: 10.1016/j.focus.2022.100054] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction This review synthesized evidence from prospective cohort studies on the association of device-measured physical activity and sedentary behavior with cardiovascular disease and all-cause mortality among adults. Methods Five databases were searched from 2000 through April 29, 2020. Study quality was appraised using the NIH Quality Assessment Tool. Pooled hazard ratio and 95% CI were obtained from random-effects meta-analyses. Subgroup analyses by age and sex were conducted for studies on all-cause mortality. Results Of 29 articles included in the systematic review, 5 studies on cardiovascular disease mortality and 15 studies on all-cause mortality were included in meta-analyses. Comparing the highest with the lowest exposure categories, the pooled hazard ratios (95% CIs) for cardiovascular disease mortality were 0.29 (CI=0.18, 0.47) for total physical activity, 0.37 (CI=0.25, 0.55) for moderate-to-vigorous physical activity, 0.62 (0.41-0.93) for light physical activity, and 1.89 (CI=1.09, 3.29) for sedentary behavior. The pooled hazard ratios (95% CIs) for all-cause mortality were 0.42 (CI=0.34, 0.53) for total physical activity, 0.43 (CI=0.35, 0.53) for moderate-to-vigorous physical activity, 0.58 (CI=0.43, 0.80) for light physical activity, and 1.58 (CI=1.19, 2.09) for sedentary behavior. The pooled hazard ratio (95% CI) for all-cause mortality was 0.35 (CI=0.29, 0.42) for steps per day, but the studies available for analysis were conducted in older adults. The results of subgroup analyses were consistent with the main results. Discussion Rapidly accumulating evidence suggests that more physical activity and less sedentary behavior are associated with a lower risk of cardiovascular disease and all-cause mortality. Similar beneficial relationships were found for step counts and all-cause mortality among older adults. Future studies employing standardized research methodologies and up-to-date data processing approaches are warranted to recommend specific amounts of physical activity and limits to sedentary behavior.
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Affiliation(s)
- Seaw Jia Liew
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Nicholas A. Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Nithya Neelakantan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Berlin Institute of Health, Charité University Medical Centre, Berlin, Germany
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20
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Ang G, Edney SM, Tan CS, Lim N, Tan J, Müller-Riemenschneider F, Chen C. Physical Activity Trends Among Adults in a National Mobile Health Program: A Population-Based Cohort Study of 411,528 Adults. Am J Epidemiol 2023; 192:397-407. [PMID: 36345089 PMCID: PMC9985108 DOI: 10.1093/aje/kwac193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/14/2021] [Revised: 09/13/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Physical inactivity is a global public health challenge, and effective, large-scale interventions are needed. We examined the effectiveness of a population-wide mobile health (mHealth) intervention in Singapore, National Steps Challenge Season 3 (NSC3) and 2 booster challenges (Personal Pledge and Corporate Challenge). The study includes 411,528 participants. We used regression discontinuity design and difference-in-difference with fixed-effects regression to examine the association of NSC3 and the additional booster challenges on daily step counts. Participants tended to be female (58.5%), with an average age of 41.5 years (standard deviation, 13.9) and body mass index (weight (kg)/height (m)2) of 23.8 (standard deviation, 4.5). We observed that NSC3 was associated with a mean increase of 1,437 steps (95% confidence interval (CI): 1,408, 1,467) per day. Enrollments in Personal Pledge and Corporate Challenge were associated with additional mean increases of 1,172 (95% CI: 1,123, 1,222) and 896 (95% CI: 862, 930) steps per day, respectively. For NSC3, the associated mean increase in the step counts across different sex and age groups varied, with greater increases for female participants and those in the oldest age group. We provide real-world evidence suggesting that NSC3 was associated with improvements in participants' step counts. Results suggest NSC3 is an effective and appealing population-wide mHealth physical activity intervention.
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Affiliation(s)
- Gregory Ang
- Department of Statistics and Data Science, National University of Singapore, Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole Lim
- Health Promotion Board, Ministry of Health, Singapore
| | - Jeremy Tan
- Health Promotion Board, Ministry of Health, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Berlin Institute of Health, Charité University Medical Centre, Berlin, Germany
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Schaeffer Center for Health Policy and Economics, University of Southern California, USA.,Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, UK
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21
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Tay Z, Chen B, Kui KY, Padmapriya N, Chong MFF, Müller AM, Lee EL, Troy E, Müller-Riemenschneider F. Results from the Singapore 2022 report card on physical activity for children and adolescents. J Exerc Sci Fit 2023; 21:20-25. [PMID: 36349304 PMCID: PMC9634474 DOI: 10.1016/j.jesf.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background While it has been established that physical activity (PA) is key to promote overall health and well-being, insufficient physical activity among children and adolescents is a global problem, including Singapore. It is important to understand the local PA landscape among children and adolescents to decrease surveillance gaps and identify areas for improvement in promoting PA. The present article provides an overview of the development of the 2022 Active Healthy Kids Singapore Report Card and the results, as well as underscore limitations and gaps in the available evidence related to PA among children and adolescents in Singapore. Methods Following the Global Matrix 4.0, the available data between July 2010 to July 2020 was synthesized for all 10 indicators by the work group and reviewed by a panel of experts. Data sources included published scientific articles, government and non-government reports, national surveys, and unpublished data from on-going research studies. Where possible, grades were informed by nationally representative surveys or large-scale longitudinal studies. Results The grades assigned were: Overall Physical Activity (C-), Organized Sport and Physical Activity (B-), Active Play (C-), Active Transportation (C), Sedentary Behaviours (C-), Physical Fitness (Incomplete), Family and Peers (C-), School (Incomplete), Community and Environment (A+), Government (B). Conclusion This is the first comprehensive evaluation of PA among children and adolescents in Singapore. It provides baseline grades valuable for future comparison. It also illustrates gaps in the existing evidence which can inform future surveillance, facilitate international comparisons and enable global efforts in promoting physical activity.
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22
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Gorny AW, Yap J, Neo JW, Chow WE, Yeo KK, Tan CS, Müller-Riemenschneider F. Cardiorespiratory fitness, body mass index, cardiovascular disease, and mortality in young men: A cohort study. Front Public Health 2023; 11:1076065. [PMID: 36875358 PMCID: PMC9975166 DOI: 10.3389/fpubh.2023.1076065] [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: 10/21/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
Objective We examined the association between cardiorespiratory fitness (CRF), body mass index (BMI), incidence of major acute cardiovascular events (MACE), and all-cause mortality (ACM). Methods We conducted a retrospective cohort study involving 212,631 healthy young men aged 16 to 25 years who had undergone medical examination and fitness testing (2.4 km run) from 1995 to 2015. Information on the outcomes of major acute cardiovascular events (MACE) and all-cause mortality (ACM) were obtained from the national registry data. Results During 2,043,278 person-years of follow-up, 371 first MACE and 243 ACM events were recorded. Compared against the first run-time quintile, adjusted hazard ratios (HR) for MACE in the second to fifth quintiles were 1.26 (95% CI 0.84-1.91), 1.60 (95% CI 1.09-2.35), 1.60 (95% CI 1.10-2.33), and 1.58 (95% CI 1.09-2.30). Compared against the "acceptable risk" BMI category, the adjusted HRs for MACE in the "underweight," "increased risk," and "high-risk" categories were 0.97 (95% CI 0.69-1.37), 1.71 (95% CI 1.33-2.21), and 3.51 (95% CI 2.61-4.72), respectively. The adjusted HRs for ACM were increased in participants from the fifth run-time quintile in the "underweight" and "high-risk" BMI categories. The combined associations of CRF and BMI with MACE showed elevated hazard in the "BMI≥23-fit" category, which was more pronounced in the "BMI≥23-unfit" category. The hazards for ACM were elevated across the "BMI<23-unfit," "BMI≥23-fit," and "BMI≥23-unfit" categories. Conclusion Lower CRF and elevated BMI were associated with increased hazards of MACE and ACM. A higher CRF did not fully compensate for elevated BMI in the combined models. CRF and BMI remain important targets for public health intervention in young men.
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Affiliation(s)
- Alexander Wilhelm Gorny
- Centre of Excellence for Soldier Performance, Singapore Armed Forces, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jia Wei Neo
- Centre of Excellence for Soldier Performance, Singapore Armed Forces, Singapore, Singapore
| | - Wei En Chow
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Khung Keong Yeo
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Digital Health Center, Berlin Institute of Health, Berlin, Germany
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23
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Lee EY, Shih AC, Collins M, Kim YB, Nader PA, Bhawra J, Katapally TR, Tanaka C, Saonuam P, Katewongsa P, Widyastari DA, Huang WY, Wong SH, Khan A, Subedi N, Paudel S, Chang CK, Wu CL, Jeon JY, Kim YS, Loney T, Müller-Riemenschneider F, Chen B, Cagas JY, Wong JE, Shahril MR, Mahendra A, Tremblay MS. Report card grades on physical activity for children and adolescents from 18 Asian countries: Patterns, trends, gaps, and future recommendations. J Exerc Sci Fit 2023; 21:34-44. [DOI: 10.1016/j.jesf.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022] Open
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24
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Akksilp K, Koh JJE, Tan V, Tong EH, Budtarad N, Xueying G, Dieterich AV, Tai BC, Müller AM, Isaranuwatchai W, Rouyard T, Nakamura R, Müller-Riemenschneider F, Teerawattananon Y, Chen C. The physical activity at work (PAW) study: a cluster randomised trial of a multicomponent short-break intervention to reduce sitting time and increase physical activity among office workers in Thailand. Lancet Reg Health Southeast Asia 2023; 8:100086. [PMID: 37384135 PMCID: PMC10305858 DOI: 10.1016/j.lansea.2022.100086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Sedentary behaviour increases the risks of non-communicable diseases. The objective of this trial was to evaluate the effect of the Physical Activity at Work multicomponent intervention to reduce sedentary behaviour in Thai office workers. Methods Offices under the Ministry of Public Health Thailand, were randomly allocated to the intervention and control group in a 1:1 ratio, stratified by office size. The intervention included individual (pedometer and lottery-based financial incentives), social (group movement breaks), environmental (posters), and organisational (leader encouragement) components. At baseline and 6-month follow-up, participants wore ActiGraphTM on the waist for ten days. The primary outcome was the between-group difference in sedentary time at 6-month, analysed using a linear mixed-effects model. Other outcomes were physical activity, biomarkers, productivity, and musculoskeletal health. Trial registration: The PAW study was registered at the Thai Clinical Trials Registry (ID TCTR20200604007) on 02 June 2020. Findings 282 office workers were recruited and randomly allocated to the control group (142 participants, nine offices) and the intervention group (140 participants, nine offices). The mean age was 38.6 years (SD = 10.4), and 81% were women. There was no evidence of intervention effects on sedentary time during waking hours (-26.8; 95% CI = -69.2 to 15.7 min), physical activity levels, or biomarkers between groups at 6-month. In the adjusted analysis, increases in time spent in moderate-to-vigorous physical activity (5.45; 95% CI = -0.15 to 11.1 min) and step count (718; 95% CI = -45 to 1481 steps) during waking hours were observed, although there was no evidence of a difference between groups. Interpretation The intervention did not significantly reduce sedentary time in Thai office workers. Suboptimal intervention uptake due to Covid-19 pandemic restrictions and loss of statistical power associated with recruitment constraints may explain this result. Further investigations are needed to evaluate the processes of the trial. Funding The Thai Health Promotion Foundation and the International Decision Support Initiative (iDSI).
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Affiliation(s)
- Katika Akksilp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Jemima Jia En Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Eunice Huiying Tong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Nuttakarn Budtarad
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Guo Xueying
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Anna Valeria Dieterich
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Thomas Rouyard
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Public Health, Thailand
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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25
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Loo BKG, Okely A, Taylor R, Novotny R, Wickramasinghe P, Müller-Riemenschneider F, Waqa G, Pulungan A, Kusuda S, Tan KH. Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years. Lancet Reg Health West Pac 2022; 32:100641. [PMID: 36785856 PMCID: PMC9918766 DOI: 10.1016/j.lanwpc.2022.100641] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
Abstract
Background Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children. Method Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework. Findings These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance. Interpretation Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region. Funding Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.
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Affiliation(s)
- Benny Kai Guo Loo
- Sport and Exercise Medicine Service, KK Women’s and Children’s Hospital, Singapore,Corresponding author. Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Anthony Okely
- School of Health and Society, University of Wollongong, Sydney, New South Wales, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | | | | | - Gade Waqa
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
| | - Aman Pulungan
- Endocrinology Division, Child Health Department, Faculty of Medicine, Universitas Indonesia – Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Mitaka, Tokyo, Japan
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
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26
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Sydow H, Prescher S, Koehler F, Koehler K, Dorenkamp M, Spethmann S, Westerhoff B, Wagner CJ, Liersch S, Rebscher H, Wobbe-Ribinski S, Rindfleisch H, Müller-Riemenschneider F, Willich SN, Reinhold T. Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial. Clin Res Cardiol 2022; 111:1231-1244. [PMID: 34894273 PMCID: PMC9622523 DOI: 10.1007/s00392-021-01980-2] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. METHODS AND RESULTS A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284-15,539) in the RPM group and € 17,537 (95% CI 16,179-18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). CONCLUSION The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness.
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Affiliation(s)
- Hanna Sydow
- Division of Health Economics and Health Services Research, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany.
| | - Sandra Prescher
- Centre for Cardiovascular Telemedicine, Medical Department, Division of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Medical Department, Division of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Koehler
- Centre for Cardiovascular Telemedicine, Medical Department, Division of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Dorenkamp
- Department of Cardiology (Campus Virchow-Klinikum), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Spethmann
- Department of Cardiology and Angiology (Campus Charité Mitte), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christoph J Wagner
- AOK Nordost-Die Gesundheitskasse, Health Services Management, Berlin, Germany
| | - Sebastian Liersch
- AOK Nordost-Die Gesundheitskasse, Health Services Management, Berlin, Germany
| | - Herbert Rebscher
- IGVresearch-Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg, Germany
- Faculty of Law, Business and Economics, University of Bayreuth, Bayreuth, Germany
| | | | - Heike Rindfleisch
- Internal Medicine with Gastroenterology and Nephrology (CC 13), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Falk Müller-Riemenschneider
- Division of Health Economics and Health Services Research, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Stefan N Willich
- Division of Health Economics and Health Services Research, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany
| | - Thomas Reinhold
- Division of Health Economics and Health Services Research, Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117, Berlin, Germany
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Chen B, Kui KY, Padmapriya N, Müller AM, Müller-Riemenschneider F. Correlates of sedentary behavior in Asian preschool-aged children: A systematic review. Obes Rev 2022; 23:e13485. [PMID: 35698280 DOI: 10.1111/obr.13485] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7 years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.
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Affiliation(s)
- Bozhi Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kiran Yan Kui
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Natarajan Padmapriya
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Centre for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre Berlin, Berlin, Germany
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Lau T, Ong JL, Ng BKL, Chan LF, Koek D, Tan CS, Müller-Riemenschneider F, Cheong K, Massar SAA, Chee MWL. Minimum number of nights for reliable estimation of habitual sleep using a consumer sleep tracker. Sleep Adv 2022; 3:zpac026. [PMID: 37193398 PMCID: PMC10104388 DOI: 10.1093/sleepadvances/zpac026] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/18/2022] [Indexed: 05/18/2023]
Abstract
Study Objectives To determine the minimum number of nights required to reliably estimate weekly and monthly mean sleep duration and sleep variability measures from a consumer sleep technology (CST) device (Fitbit). Methods Data comprised 107 144 nights from 1041 working adults aged 21-40 years. Intraclass correlation (ICC) analyses were conducted on both weekly and monthly time windows to determine the number of nights required to achieve ICC values of 0.60 and 0.80, corresponding to "good" and "very good" reliability thresholds. These minimum numbers were then validated on data collected 1-month and 1-year later. Results Minimally, 3 and 5 nights were required to obtain "good" and "very good" mean weekly total sleep time (TST) estimates, while 5 and 10 nights were required for monthly TST estimates. For weekday-only estimates, 2 and 3 nights were sufficient for weekly time windows while 3 and 7 nights sufficed for monthly time windows. Weekend-only estimates of monthly TST required 3 and 5 nights. TST variability required 5 and 6 nights for weekly time windows, and 11 and 18 nights for monthly time windows. Weekday-only weekly variability required 4 nights for both "good" and "very good" estimates while monthly variability required 9 and 14 nights. Weekend-only estimates of monthly variability required 5 and 7 nights. Error estimates made using data collected 1-month and 1-year later with these parameters were comparable to those associated with the original dataset. Conclusions Studies should consider the metric, measurement window of interest, and desired reliability threshold to decide on the minimum number of nights required to assess habitual sleep using CST devices.
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Affiliation(s)
- TeYang Lau
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Ju Lynn Ong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Ben K L Ng
- Health Promotion Board, 3 Second Hospital Ave, Singapore 168937, Singapore
| | - Lit Fai Chan
- Health Promotion Board, 3 Second Hospital Ave, Singapore 168937, Singapore
| | - Daphne Koek
- Health Promotion Board, 3 Second Hospital Ave, Singapore 168937, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany
| | - Karen Cheong
- Health Promotion Board, 3 Second Hospital Ave, Singapore 168937, Singapore
| | - Stijn A A Massar
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
| | - Michael W L Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
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Poncet L, Saïd M, Gassama M, Dufourg MN, Müller-Riemenschneider F, Lioret S, Dargent-Molina P, Charles MA, Bernard JY. Sociodemographic and behavioural factors of adherence to the no-screen guideline for toddlers among parents from the French nationwide Elfe birth cohort. Int J Behav Nutr Phys Act 2022; 19:104. [PMID: 35962431 PMCID: PMC9373389 DOI: 10.1186/s12966-022-01342-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/12/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background Excessive screen time in infancy and childhood has been associated with consequences on children’s development and health. International guidelines call for no screen time before age 2 years, whereas in France, the most prominent guidelines recommend no screen before age 3 years. However, data are lacking on parental adherence to the no-screen guideline for toddlers and factors of adherence in France. Using data from the French nationwide Elfe birth cohort, we estimated adherence to the no-screen guideline at age 2 years and examined related factors, including sociodemographic characteristics, parental leisure activities and screen time. Methods In 2011, 18,329 newborns and their parents were enrolled in 349 randomly selected maternity units across mainland France. At age 2 years, screen exposure of 13,117 toddlers was reported by parents in phone interviews. Data on sociodemographic characteristics, parental leisure activities and screen time were collected from both parents. Three patterns of parental leisure activities were derived by principal component analysis: literate (e.g.,reading), screen-based, and physical/artistic activities. Multivariable logistic regression models were used to examine the associations of sociodemographic characteristics, parental leisure activities and parental screen time with adherence to the no-screen guideline for toddlers. Results Overall, 1809/13,117 (13.5%) families adhered to the no-screen guideline for toddlers. Adherence was reduced with maternal age < 40 years, low parental education, single-parent household and parental migration status. After adjusting for sociodemographic characteristics, adherence to the guideline was positively associated with a parental literate activity pattern (mothers: odds ratio [95% confidence interval]: 1.15 [1.08, 1.22]); fathers: 1.15 [1.07, 1.23]) and negatively with a screen-based activity pattern (mothers: 0.73 [0.69, 0.77]; fathers: 0.81 [0.76, 0.87]). With each additional hour of parental screen time, mothers and fathers were less likely to adhere to the guideline (mothers: adjusted odds ratio 0.80 [0.77, 0.83]; fathers: 0.88 [0.85, 0.91]). Conclusions Adherence to the no-screen guideline for toddlers in France was low. Parental leisure activities and parental screen time are major factors of adherence to the no-screen guideline and could be considered in targeted public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01342-9.
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Affiliation(s)
- Lorraine Poncet
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, 75004, Paris, France
| | - Mélèa Saïd
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, 75004, Paris, France
| | - Malamine Gassama
- Unité Mixte Inserm-Ined-EFS Elfe, 93322, Aubervilliers, Ined, France
| | | | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany
| | - Sandrine Lioret
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, 75004, Paris, France
| | - Patricia Dargent-Molina
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, 75004, Paris, France
| | - Marie-Aline Charles
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, 75004, Paris, France.,Unité Mixte Inserm-Ined-EFS Elfe, 93322, Aubervilliers, Ined, France
| | - Jonathan Y Bernard
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, 75004, Paris, France. .,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
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30
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Tan SYX, Chia A, Tai BC, Natarajan P, Goh CMJL, Shek LP, Saw SM, Chong MFF, Müller-Riemenschneider F. A Web-Based, Time-Use App To Assess Children's Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL). JMIR Pediatr Parent 2022; 5:e33312. [PMID: 35749208 PMCID: PMC9270708 DOI: 10.2196/33312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. OBJECTIVE This study evaluated the validity of MEDAL for assessing children's movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years. METHODS Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports. RESULTS Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors. CONCLUSIONS MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days.
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Affiliation(s)
- Sarah Yi Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Padmapriya Natarajan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Claire Marie Jie Lin Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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31
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Yao J, Lim N, Tan J, Matthias Müller A, Martinus van Dam R, Chen C, Tan CS, Müller-Riemenschneider F. Evaluation of a Population-Wide Mobile Health Physical Activity Program in 696 907 Adults in Singapore. J Am Heart Assoc 2022; 11:e022508. [PMID: 35699174 PMCID: PMC9238668 DOI: 10.1161/jaha.121.022508] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Evidence of scaled‐up physical activity interventions is scarce. This study evaluates the uptake, engagement, and effectiveness of one such intervention program. Methods and Results The program was open to individuals aged ≥17 years in Singapore. The main intervention components comprised device‐based daily physical activity recording paired with step count goals and financial rewards. According to the different reward opportunities, we divided the evaluation period (August 2017 to June 2018) into the baseline monitoring phase, the main challenge phase, and the maintenance phase. Uptake was assessed by the number of individuals registered, and engagement by the step recording duration after registration. The effectiveness was defined as changes in mean daily step count from baseline to the main challenge phase and the maintenance phase. A total of 696 907 participants registered, including more Singapore citizens (versus noncitizens), women, and younger (aged 17–39 years) individuals. The evaluation of engagement and effectiveness included 421 388 (60.5%) participants who provided plausible characteristic information and step count data. The median duration of engagement was 74 (IQR, 14–149) days. Compared with the baseline of 7509 (SD, 3467) steps, mean daily step count increased by 1579 (95% CI, 1564–1594) steps during the main challenge phase and 934 (95% CI, 916–952) steps during the maintenance phase. Greater engagement and activity increase were found in participants who are citizens, women, aged ≥40 years, non‐obese, and using separate wearables (versus smartphones). Conclusions Mobile health physical activity interventions can successfully reach a large population and be effective in increasing physical activity, despite declining program engagement over time.
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Affiliation(s)
- Jiali Yao
- Saw Swee Hock School of Public Health National University of Singapore Singapore
| | - Nicole Lim
- Policy, Research and Surveillance Division Health Promotion Board Singapore
| | - Jeremy Tan
- Policy, Research and Surveillance Division Health Promotion Board Singapore
| | | | - Rob Martinus van Dam
- Saw Swee Hock School of Public Health National University of Singapore Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health National University of Singapore Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health National University of Singapore Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health National University of Singapore Singapore.,Berlin Institute of HealthCharite University Medical Centre Berlin Germany
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Koh YS, Asharani PV, Devi F, Roystonn K, Wang P, Vaingankar JA, Abdin E, Sum CF, Lee ES, Müller-Riemenschneider F, Chong SA, Subramaniam M. A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behaviour. BMC Public Health 2022; 22:1051. [PMID: 35614402 PMCID: PMC9132675 DOI: 10.1186/s12889-022-13431-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 02/26/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Physical inactivity and sedentary behaviour have detrimental consequences to the individual and the economy. Our study examined the prevalence of perceived barriers to physical activity in Singapore’s adult population and their associations with physical activity and sedentary behaviour. Methods This cross-sectional analysis utilised data from a nationwide survey in Singapore. Participants (n = 2867) were recruited from February 2019 to March 2020. The independent variables were internal (e.g. fatigue, age) and external (e.g. weather, cost) perceived barriers to physical activity. The outcomes were domain-specific physical activity (work, transport and leisure) and sedentary behaviour, all of which were assessed using the Global Physical Activity Questionnaire. The associations were examined using zero-inflated negative binomial regressions for physical activity and linear regression for sedentary behaviour. Results The median (Interquartile range) for work-related, transport-related and leisure-related physical activity were 0 (0 – 1440), 600 (160 – 1120) and 360 (0 – 1080) MET (metabolic equivalent)-minutes per week. The median sedentary behaviour (IQR) was 360 (240 – 540) minutes per day. The top three barriers were lack of time (65.3%), fatigue (64.7%) and pollution (56.1%). After adjustment, the level of transport-related physical activity was lower for respondents who cited lacking pavement or parks as a barrier, but higher for those who indicated cost and safety concerns. Respondents who reported pollution as a barrier were more likely to engage in transport-related physical activity. The level of leisure-related physical activity was lower for respondents indicating weather, lack of time and age as barriers, but higher for those reporting safety concerns. The odds of engaging in leisure-related physical activity was lower for those citing age, cost and fatigue as barriers, but higher for those indicating the weather. Sedentary behaviour was positively associated with work and limited accessibility to exercise facilities, but negatively with safety concerns. Conclusion Individuals can be motivated to overcome internal barriers (fatigue, lack of time, cost and age) through social support and emphasis on exercise benefits. External barriers (weather and lack of pavements or parks) can be reduced by raising awareness of existing infrastructure. Sedentary behaviour can be improved by implementing workplace measures, such as reducing the time spent sitting. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-13431-2.
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Affiliation(s)
- Yen Sin Koh
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - P V Asharani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Chee Fang Sum
- Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Petrunoff NA, Edney S, Yi NX, Dickens BL, Joel KR, Xin WN, Sia A, Leong D, van Dam RM, Cook AR, Sallis JF, Chandrabose M, Owen N, Müller-Riemenschneider F. Associations of park features with park use and park-based physical activity in an urban environment in Asia: A cross-sectional study. Health Place 2022; 75:102790. [PMID: 35316722 DOI: 10.1016/j.healthplace.2022.102790] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/01/2021] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
Abstract
Park use is associated with health, yet our understanding of park features related to their use is limited. Singapore's parks were audited for 30 micro-features, then geospatial analysis characterized micro-features scores for parks nearest to participants' homes. Adults (3,435) reported their park use and park-based physical activity. Using linear regression models, we found living near a park with higher micro-features scores was associated with more time in parks and park-based physical activity. Specific micro-features were associated with more park time (wildlife areas, water features, forested areas, unpaved trails (2-2.6 h/month, p < 0.05)) and with physical activity in parks (water features, forested areas, large playground, open green spaces (1.8-2.2 h/month, p < 0.05)). These findings could inform parks planning to support population-health.
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Affiliation(s)
- Nicholas A Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Sarah Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ng Xian Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Koo Ruihan Joel
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Wang Nan Xin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Angelia Sia
- Centre for Urban Greenery & Ecology, National Parks Board Singapore, Singapore Botanic Gardens, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Duncan Leong
- GIS Hub, National Parks Board Singapore, Singapore Botanic Gardens, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - James F Sallis
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Manoj Chandrabose
- Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne, Australia; Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
| | - Neville Owen
- Behavioural Epidemiology Laboratory, Baker Heart & Diabetes Institute, Melbourne, Australia; Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Digital Health Center, Berlin Institute of Health, Germany
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Loo BKG, Tan B, Chia MYH, Chan PC, Sirisena D, Zainuddin MA, Oh JY, Teoh OH, Tan TSZ, Lim MCM, Lim EJK, Müller-Riemenschneider F, Tan NC, Siriamornsarp R, Teo TCC, Quah PL, Rajadurai VS, Tan KH, Ng KC. Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents. Ann Acad Med Singap 2022; 51:292-299. [PMID: 35658152 DOI: 10.47102/annals-acadmedsg.202141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7-17 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health. METHODS The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results. CONCLUSION This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period.
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Affiliation(s)
- Benny Kai Guo Loo
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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Tham XC, Whitton C, Müller-Riemenschneider F, Petrunoff NA. Young Adults’ Use of Mobile Food Delivery Applications and the Potential Impacts on Diets during COVID-19 Pandemic in Singapore: A Mixed Methods Study (Preprint). JMIR Form Res 2022; 7:e38959. [PMID: 37018540 PMCID: PMC10173705 DOI: 10.2196/38959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Poor diet contributes significantly to the development of non-communicable diseases (NCDs). In Singapore, it is recommended to consume at least two servings of fruits and vegetables (FV) daily to reduce the risk of developing NCDs. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of Mobile Food Delivery Applications (MFDAs) adopting unhealthy eating habits including high consumption of sugar-sweetened beverages (SSBs), making it crucial to gain a deeper understanding of the underlying factors driving their usage patterns. OBJECTIVE This study aimed to examine the usage patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA usage and socio-demographic factors, dietary factors, and body mass index (BMI); identify the underlying reasons for the observed usage patterns of MFDAs among users; compare the influences of MFDA usage between frequent and infrequent users. METHODS A sequential mixed methods design was used, involving an online survey and in-depth interviews with a subset of questionnaire respondents. Poisson regression and thematic analysis were employed to analyze the quantitative and the qualitative data respectively. RESULTS The quantitative results revealed that 41.7% (150/360) of the participants reported using MFDAs frequently, defined as at least once-a-week use. Although not significant, the study found that frequent users were less likely to consume two servings of vegetables per day and more likely to drink SSBs. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified four primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with the cost being the most significant influential factor. A conceptual framework based on these themes is presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent usage. CONCLUSIONS The study suggests that interventions should focus on promoting healthy dietary patterns among young adults who frequently use MFDAs. Teaching cooking skills, especially among young males, and time management skills could be useful to reduce reliance on MFDAs. The study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic such as reduced physical activity or sedentary behavior and altered eating pattern, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and to assess the impact of the "new normal" post-COVID on dietary patterns and physical activity levels.
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Affiliation(s)
- Xiang Cong Tham
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Clare Whitton
- School of Population Health, Curtin University, Perth, Australia
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Edney S, Chua XH, Müller AM, Kui KY, Müller-Riemenschneider F. mHealth interventions targeting movement behaviors in Asia: A scoping review. Obes Rev 2022; 23:e13396. [PMID: 34927346 DOI: 10.1111/obr.13396] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/05/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022]
Abstract
mHealth interventions can promote healthy movement behaviors (physical activity, sedentary behavior, and sleep). However, recent reviews include few studies from Asia, despite it being home to over 60% of the world population. The aim is to map the current evidence for mHealth interventions targeting movement behaviors in Asia. Six databases were searched up until August 2021. Included studies described an mHealth intervention targeting one or more movement behaviors, delivered in a country/territory in Asia, to a general population. A total of 3986 unique records were screened for eligibility in duplicate. Eighty studies with 1,413,652 participants were included. Most were randomized (38.8%) or quasi-experimental (27.5%) trials. Studies were from 17 countries/territories (out of 55); majority were high- (65.0%) or upper middle-income (28.7%). Physical activity was targeted most often (93.8%), few targeted sedentary behavior (7.5%), or sleep (8.8%). Most targeted one movement behavior (90.0%), and none targeted all three together. Interventions typically incorporated a single mHealth component (70.0%; app, pedometer, text messages, wearable) and were delivered remotely (66.3%). The average intervention length was 121.8 (SD 127.6) days. mHealth interventions in Asia have primarily targeted physical activity in high- and upper middle-income countries. There are few interventions targeting sedentary behavior or sleep, and no interventions in low-income countries.
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Affiliation(s)
- Sarah Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kiran Yan Kui
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Chia A, Descarpentrie A, Cheong RN, Toh JY, Natarajan P, Sugianto R, Cai S, Saldanha-Gomes C, Dargent-Molina P, de Lauzon-Guillain B, Plancoulaine S, Lança C, Saw SM, Godfrey KM, Shek LP, Tan KH, Charles MA, Chong YS, Heude B, Eriksson JG, Müller-Riemenschneider F, Lioret S, Chong MFF, Bernard JY. Family-focused contextual factors associated with lifestyle patterns in young children from two mother-offspring cohorts: GUSTO and EDEN. Int J Behav Nutr Phys Act 2022; 19:26. [PMID: 35292047 PMCID: PMC8922741 DOI: 10.1186/s12966-022-01266-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/06/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrated patterns of energy balance-related behaviours of preschool children in Asia are sparse, with few comparative analyses. PURPOSE Using cohorts in Singapore (GUSTO) and France (EDEN), we characterized lifestyle patterns of children and investigated their associations with family-focused contextual factors. METHODS Ten behavioural variables related to child's diet, walking, outdoor play and screen time were ascertained by parental questionnaires at age 5-6 years. Using principal component analysis, sex-specific lifestyle patterns were derived independently for 630 GUSTO and 989 EDEN children. Contextual variables were organised into distal (family socio-economics, demographics), intermediate (parental health, lifestyle habits) and proximal (parent-child interaction factors) levels of influence and analysed with hierarchical linear regression. RESULTS Three broadly similar lifestyle patterns were identified in both cohorts: "discretionary consumption and high screen time", "fruit, vegetables, and low screen time" and "high outdoor playtime and walking". The latter two patterns showed small differences between cohorts and sexes. The "discretionary consumption and high screen time" pattern was consistently similar in both cohorts; distal associated factors were lower maternal education (EDEN boys), no younger siblings (GUSTO boys) and Malay/Indian ethnicity (GUSTO), while intermediate and proximal associated factors in both cohorts and sexes were poor maternal diets during pregnancy, parents allowing high child control over food intake, snacking between meals and having television on while eating. CONCLUSIONS Three similar lifestyle patterns were observed among preschool children in Singapore and France. There were more common associated proximal factors than distal ones. Cohort specific family-focused contextual factors likely reflect differences in social and cultural settings. Findings will aid development of strategies to improve child health.
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Affiliation(s)
- Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alexandra Descarpentrie
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Rene N Cheong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Padmapriya Natarajan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ray Sugianto
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cécilia Saldanha-Gomes
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Patricia Dargent-Molina
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Blandine de Lauzon-Guillain
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Sabine Plancoulaine
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Carla Lança
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marie-Aline Charles
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Barbara Heude
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sandrine Lioret
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France.
| | - Mary F-F Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jonathan Y Bernard
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Inserm, INRAE, F-75004, Paris, France
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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Chong MFF, Lim HX, Wong BWX, Chi ZH, Inthujaa JK, Müller-Riemenschneider F, Cheon BK, Gorny AW, Chia KS. Transiting Out of Full-Time National Service: A Qualitative Study of Barriers and Motivators of Weight Change in Young Adult Men in Singapore. Am J Mens Health 2022; 16:15579883221074788. [PMID: 35272525 PMCID: PMC8921754 DOI: 10.1177/15579883221074788] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Higher prevalence of obesity in men compared with women, particularly among those 18 to 40 years of age, has been observed in Singapore. We explored young men's perceptions of weight change after transiting out of National Service (NS) over a 12-month period and sought to understand the underlying drivers. In-depth interviews, guided by the Health Belief Model (HBM), were conducted with young men 12 months after they had completed full-time NS. Six constructs from the HBM, namely, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and perceived self-efficacy, were utilized to guide the analysis. Thematic analysis revealed that participants generally perceived a gain in body weight after the transition and attributed this to decreased exercise-related physical activity (PA) levels and increased consumption of unhealthy food. However, many did not display immediate concerns nor view leading a healthy lifestyle as priority, citing time constraints, inertia to comply, or lack of access to sports facilities and healthy food options as barriers. Healthy lifestyle behaviors, mainly PA, were mostly pursued for physical health and appearance. Motivators toward a healthy lifestyle tended to be internal factors such as self-motivation, personal preference, and habit, whereas external motivators included peer or familial influence and environmental factors. Our findings align with key concepts of the HBM and suggest a need to educate young men transiting out of NS on lifestyle, weight, and health, in particular addressing their misconceptions.
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Affiliation(s)
- Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Hui Xian Lim
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Beverly W X Wong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Zi Han Chi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - J K Inthujaa
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Bobby K Cheon
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.,School of Social Sciences, Nanyang Technological University, Singapore
| | - Alexander W Gorny
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Singapore Armed Forces, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Lee YQ, Colega M, Sugianto R, Lai JS, Godfrey KM, Tan KH, Shek LPC, Loy SL, Müller-Riemenschneider F, Padmapriya N, Chong YS, Eriksson JG, Chan JKY, Chan SY, Tai BC, Chong MFF. Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. Eur J Nutr 2022; 61:985-1001. [PMID: 34686887 PMCID: PMC7612407 DOI: 10.1007/s00394-021-02703-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Few studies have described adherence to dietary patterns over time in women of childbearing age. This study aims to describe, examine the stability and changes in dietary patterns between pregnancy and 6 years post-pregnancy and the sociodemographic and lifestyle factors influencing the adherence over time. METHODS During pregnancy and at 6 years post-pregnancy, 24-h recalls and food frequency questionnaires were collected, respectively, from 709 women. Data on sociodemographic and lifestyle factors were collected via questionnaires. Dietary patterns were identified using principal component analysis and stability assessed using Pearson's correlation coefficients (r) and Cohen's weighted kappa (κ). Associations with sociodemographic characteristics were assessed by multiple logistic regression. RESULTS The 'Fruits, Vegetables and Legumes' (FVL) and 'Seafood, Noodle, Soup' (SNS) patterns were identified at both time points, with low correlation for the dietary pattern z scores (r 0.2 and 0.3, respectively) and modest agreement in tertile assignment, suggesting poor stability. An 'unhealthy' pattern was only observed at 6 years post-pregnancy. Women who showed increased adherence to FVL pattern had higher educational attainment and exhibited healthy lifestyle behaviours. Women who had gestational diabetes during pregnancy were less likely to decrease adherence to FVL pattern over time. Women who adhered more closely to the 'unhealthy' pattern at 6 years post-pregnancy tended to be younger, of Malay ethnicity, had lower socioeconomic status, were less physically active and had additional pregnancies. CONCLUSIONS Dietary habits of women became less healthy during the transition from pregnancy to 6 years post-pregnancy. However, results should be interpreted with caution due to the different dietary assessment tools used at the two time points.
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Affiliation(s)
- Yu Qi Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore.
| | - Marjorelee Colega
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
| | - Ray Sugianto
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
| | - Jun Shi Lai
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Kok Hian Tan
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Graduate Medical School, Duke-National University of Singapore, Singapore, 169857, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore
| | - See Ling Loy
- Graduate Medical School, Duke-National University of Singapore, Singapore, 169857, Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
- Digital Health Center, Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany
| | - Natarajan Padmapriya
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117597, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117597, Singapore
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117597, Singapore
- Folkhälsan Research Center, 00250, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland
| | - Jerry Kok Yen Chan
- Graduate Medical School, Duke-National University of Singapore, Singapore, 169857, Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117597, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore
- Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore
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Leu J, Tay Z, van Dam RM, Müller-Riemenschneider F, Lean MEJ, Nikolaou CK, Rebello SA. "You know what, I'm in the trend as well" - Understanding the inter-play between digital and real-life social influences on the food and activity choices of young adults. Public Health Nutr 2022; 25:1-50. [PMID: 35184791 PMCID: PMC9991798 DOI: 10.1017/s1368980022000398] [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: 09/23/2021] [Revised: 01/22/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To understand young adults' perceptions of online and real-life social influences on their food and activity choices. DESIGN A qualitative study involving seven focus groups. Thematic analyses using both deductive and inductive techniques were performed. SETTING A polytechnic and a university in Singapore. PARTICIPANTS A total of 46 full-time students, 19-24 years of age. RESULTS Participants revealed that social media meets multiple needs, contributing to its ubiquitous use and facilitating content spread between social networks. Food-related content shared on social media were mostly commercial posts, marketing foods and eateries showcasing price-promotions, emphasizing sensory properties of foods, or creating narratives that activated trends. Subsequently, real-life social activities frequently revolve around marketed foods that were not necessarily healthy. In contrast, physical activity posts were rarely being followed up in real life. Portrayals describing a toxic gym culture could contribute to negative perceptions of peers' physical activity posts and a disinclination towards sharing such posts. Participants expressed that close, supportive social networks in real-life strongly influenced initiating and maintaining healthy lifestyles. However, in a society that highly values academic achievements, participants prioritized studying and socializing over healthy eating and physical activity. CONCLUSIONS Overall, our findings reveal that virtual and real-life social influences have complex interactions affecting Asian young adults' behavioral choices and should be considered when designing interventions for this group. Regulations related to the digital marketing of unhealthy food, and improving the availability, accessibility, and affordability of healthier food options, particularly in the foodservice sector, would be of value to consider.
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Affiliation(s)
- Jodie Leu
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10–01, 117549Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10–01, 117549Singapore, Singapore
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10–01, 117549Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Michael EJ Lean
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland
- Edgar Diabetes and Obesity Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Charoula Konstantia Nikolaou
- Natural Resources Institute, Faculty of Engineering and Science, University of Greenwich, Kent, UK
- Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10–01, 117549Singapore, Singapore
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Chan MJ, Tay GWN, Kembhavi G, Lim J, Rebello SA, Ng H, Lin C, Wang MC, Müller-Riemenschneider F, Chong MFF. Understanding children's perspectives of the influences on their dietary behaviours. Public Health Nutr 2022; 25:1-11. [PMID: 35184794 PMCID: PMC9991721 DOI: 10.1017/s1368980022000404] [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: 08/05/2021] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to examine the intrapersonal, interpersonal, environmental and macrosystem influences on dietary behaviours among primary school children in Singapore. DESIGN A qualitative interpretive approach was used in this study. Focus group discussions guided by the socio-ecological model (sem), of which transcripts were analysed deductively using the sem and inductively using thematic analysis to identify themes at each sem level. SETTING Two co-educational public primary schools in Singapore. PARTICIPANTS A total of 48 children (n 26 girls) took part in the semi-structured focus group discussions. Their mean age was 10·8 years (sd = 0·9, range 9-12 years), and the majority of the children were Chinese (n 36), along with some Indians (n 8) and Malays (n 4). RESULTS Children's knowledge of healthy eating did not necessarily translate into healthy dietary practices and concern for health was a low priority. Instead, food and taste preferences were pivotal influences in their food choices. Parents had a large influence on children with regards to their accessibility to food, their attitudes and values towards food. Parental food restriction led to some children eating in secrecy. Peer influence was not frequently reported by children. Competitions in school incentivised children to consume fruits and vegetables, but reinforcements from teachers were inconsistent. The proximity of fast-food chains in the neighbourhood provided children easy access to less healthy foods. Health advertisements on social media rather than posters worked better in drawing children's attention. CONCLUSIONS Findings highlighted important factors that should be considered in future nutrition interventions targeting children.
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Affiliation(s)
- Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, 117549 Singapore, Singapore
| | - Gabrielle Wann Nii Tay
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, 117549 Singapore, Singapore
| | | | - Jubilee Lim
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, 117549 Singapore, Singapore
| | - Hazyl Ng
- Health Promotion Board, Singapore, Singapore
| | - Congren Lin
- Health Promotion Board, Singapore, Singapore
| | - May C Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, 117549 Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, 117549 Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, 117609 Singapore, Singapore
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Gorny AW, Chee WCD, Müller-Riemenschneider F. Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study. JMIR Form Res 2022; 6:e33798. [PMID: 35076399 PMCID: PMC8826145 DOI: 10.2196/33798] [Citation(s) in RCA: 4] [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: 09/23/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings. Objective To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program. Methods A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior. Results Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors. Conclusions Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change.
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Affiliation(s)
- Alexander Wilhelm Gorny
- Centre of Excellence for Soldier Performance, Singapore Armed Forces, Singapore, Singapore.,Headquarters Medical Corps, Singapore Armed Forces, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wei Chian Douglas Chee
- Centre of Excellence for Soldier Performance, Singapore Armed Forces, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Digital Health Center, Berlin Institute of Health, Berlin, Germany
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43
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Keller R, Hartmann S, Teepe GW, Lohse KM, Alattas A, Tudor Car L, Müller-Riemenschneider F, von Wangenheim F, Mair JL, Kowatsch T. Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis. J Med Internet Res 2022; 24:e33348. [PMID: 34994693 PMCID: PMC8783286 DOI: 10.2196/33348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Advancements in technology offer new opportunities for the prevention and management of type 2 diabetes. Venture capital companies have been investing in digital diabetes companies that offer digital behavior change interventions (DBCIs). However, little is known about the scientific evidence underpinning such interventions or the degree to which these interventions leverage novel technology-driven automated developments such as conversational agents (CAs) or just-in-time adaptive intervention (JITAI) approaches. OBJECTIVE Our objectives were to identify the top-funded companies offering DBCIs for type 2 diabetes management and prevention, review the level of scientific evidence underpinning the DBCIs, identify which DBCIs are recognized as evidence-based programs by quality assurance authorities, and examine the degree to which these DBCIs include novel automated approaches such as CAs and JITAI mechanisms. METHODS A systematic search was conducted using 2 venture capital databases (Crunchbase Pro and Pitchbook) to identify the top-funded companies offering interventions for type 2 diabetes prevention and management. Scientific publications relating to the identified DBCIs were identified via PubMed, Google Scholar, and the DBCIs' websites, and data regarding intervention effectiveness were extracted. The Diabetes Prevention Recognition Program (DPRP) of the Center for Disease Control and Prevention in the United States was used to identify the recognition status. The DBCIs' publications, websites, and mobile apps were reviewed with regard to the intervention characteristics. RESULTS The 16 top-funded companies offering DBCIs for type 2 diabetes received a total funding of US $2.4 billion as of June 15, 2021. Only 4 out of the 50 identified publications associated with these DBCIs were fully powered randomized controlled trials (RCTs). Further, 1 of those 4 RCTs showed a significant difference in glycated hemoglobin A1c (HbA1c) outcomes between the intervention and control groups. However, all the studies reported HbA1c improvements ranging from 0.2% to 1.9% over the course of 12 months. In addition, 6 interventions were fully recognized by the DPRP to deliver evidence-based programs, and 2 interventions had a pending recognition status. Health professionals were included in the majority of DBCIs (13/16, 81%,), whereas only 10% (1/10) of accessible apps involved a CA as part of the intervention delivery. Self-reports represented most of the data sources (74/119, 62%) that could be used to tailor JITAIs. CONCLUSIONS Our findings suggest that the level of funding received by companies offering DBCIs for type 2 diabetes prevention and management does not coincide with the level of evidence on the intervention effectiveness. There is considerable variation in the level of evidence underpinning the different DBCIs and an overall need for more rigorous effectiveness trials and transparent reporting by quality assurance authorities. Currently, very few DBCIs use automated approaches such as CAs and JITAIs, limiting the scalability and reach of these solutions.
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Affiliation(s)
- Roman Keller
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sven Hartmann
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Gisbert Wilhelm Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Kim-Morgaine Lohse
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Aishah Alattas
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Florian von Wangenheim
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore.,Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Jacqueline Louise Mair
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Tobias Kowatsch
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland.,Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
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44
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Edney SM, Park SH, Tan L, Chua XH, Dickens BSL, Rebello SA, Petrunoff N, Müller AM, Tan CS, Müller-Riemenschneider F, van Dam RM. Advancing understanding of dietary and movement behaviours in an Asian population through real-time monitoring: Protocol of the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). Digit Health 2022; 8:20552076221110534. [PMID: 35795338 PMCID: PMC9251970 DOI: 10.1177/20552076221110534] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Modifiable risk factors for non-communicable diseases, including eating an unhealthy diet and being physically inactive, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real life is essential to enable the design of precision public health interventions. Objective This paper describes the protocol for the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). The study uses real-time data capture methods to gain a comprehensive understanding of eating and movement behaviours, including how these differ by socio-demographic characteristics and are shaped by people's interaction with their social and physical environment. Methods COBRA is an observational study in free-living conditions. We will recruit 1500 adults aged 21-69 years from a large prospective cohort study. Real-time data capture methods will be used for nine consecutive days: an ecological momentary assessment app with a global positioning system enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA surveys per day between 8 a.m. and 9.30 p.m. to capture information on behavioural risk factors including eating behaviours and diet composition movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. The second wave of ecological momentary assessment surveys with a global positioning system enabled will be sent 6 months later. Data will be analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants. Discussion Findings from this study will advance our understanding of dietary and movement behaviours as they occur in real-life and inform the development of personalised interventions to prevent chronic diseases.
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Affiliation(s)
- Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Su Hyun Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Linda Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nick Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Cheun Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute of Public Health, The George Washington University, Washington, DC, USA
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45
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Ollier J, Neff S, Dworschak C, Sejdiji A, Santhanam P, Keller R, Xiao G, Asisof A, Rüegger D, Bérubé C, Hilfiker Tomas L, Neff J, Yao J, Alattas A, Varela-Mato V, Pitkethly A, Vara MD, Herrero R, Baños RM, Parada C, Agatheswaran RS, Villalobos V, Keller OC, Chan WS, Mishra V, Jacobson N, Stanger C, He X, von Wyl V, Weidt S, Haug S, Schaub M, Kleim B, Barth J, Witt C, Scholz U, Fleisch E, von Wangenheim F, Car LT, Müller-Riemenschneider F, Hauser-Ulrich S, Asomoza AN, Salamanca-Sanabria A, Mair JL, Kowatsch T. Corrigendum: Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol. Front Public Health 2021; 9:809278. [PMID: 34900930 PMCID: PMC8662939 DOI: 10.3389/fpubh.2021.809278] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2021.625640.].
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Affiliation(s)
- Joseph Ollier
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Simon Neff
- Department of Management, Technology, and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | | | - Arber Sejdiji
- Department of Management, Technology, and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Roman Keller
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Grace Xiao
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alina Asisof
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Dominik Rüegger
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Caterina Bérubé
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Lena Hilfiker Tomas
- Executive School of Management, Technology and Law, University of St. Gallen, St. Gallen, Switzerland
| | - Joël Neff
- Executive School of Management, Technology and Law, University of St. Gallen, St. Gallen, Switzerland
| | - Jiali Yao
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Aishah Alattas
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Amanda Pitkethly
- Sport, Exercise and Health Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Mª Dolores Vara
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Herrero
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Mª Baños
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Carolina Parada
- Department of Psychology, Universidad San Buenaventura, Bogotá, Colombia
| | | | - Victor Villalobos
- Interdisciplinary Center for Health Workplaces, University of California, Berkeley, Berkeley, CA, United States
| | - Olivia Clare Keller
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Wai Sze Chan
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, SAR China
| | - Varun Mishra
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Nicholas Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Hanover, NH, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Hanover, NH, United States
| | - Xinming He
- Business School, Durham University, Durham, United Kingdom
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Steffi Weidt
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Michael Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudia Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Florian von Wangenheim
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Lorainne Tudor Car
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Department of Medicine, Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Center for Digital Health, Berlin Institute of Health and Charité, Berlin, Germany
| | - Sandra Hauser-Ulrich
- Department of Applied Psychology, University of Applied Sciences Zurich, Zurich, Switzerland
| | | | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore.,Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
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Padmapriya N, Chen B, Goh CMJL, Shek LPC, Chong YS, Tan KH, Chan SY, Yap F, Godfrey KM, Lee YS, Eriksson JG, Bernard JY, Müller-Riemenschneider F. 24-hour movement behaviour profiles and their transition in children aged 5.5 and 8 years - findings from a prospective cohort study. Int J Behav Nutr Phys Act 2021; 18:145. [PMID: 34742314 PMCID: PMC8572484 DOI: 10.1186/s12966-021-01210-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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Time spent in movement behaviours, including physical activity (PA), sedentary behaviour (SB) and sleep, across the 24-h day may have distinct health consequences. We aimed to describe 24-h movement behaviour (24 h-MB) profiles in children and how profile membership changed from age 5.5 to 8 years. METHODS Children in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort were asked to wear an accelerometer (ActiGraph-GT3X+) on their wrist for seven consecutive days at ages 5.5 and 8 years to measure 24 h-MB patterns. Time spent in night sleep, inactivity (proxy for SB), light PA, moderate PA (MPA), and vigorous PA (VPA) per day were calculated using the R-package GGIR 2.0. Using latent profile analyses (n = 442) we identified 24 h-MB profiles, which were given animal names to convey key characteristics. Latent transition analyses were used to describe the profile membership transition from ages 5.5 to 8 years. Associations with sex and ethnicity were examined. RESULTS We identified four profiles, "Rabbits" (very high-MPA/VPA, low-inactivity and average-night-sleep), "Chimpanzees" (high-MPA, low-inactivity and average-night-sleep), "Pandas" (low-PA, high-inactivity and high-night-sleep) and "Owls" (low-PA, high-inactivity and low-night-sleep), among children at both time points. At ages 5.5 and 8 years, the majority of children were classified into profiles of "Chimpanzees" (51 and 39%, respectively) and "Pandas" (24 and 37%). Half of the sample (49%), particularly "Rabbits", remained in the same profile at ages 5.5 and 8 years: among children who changed profile the predominant transitions occurred from "Chimpanzees" (27%) and "Owls" (56%) profiles to "Pandas". Sex, but not ethnicity, was associated with profile membership: compared to girls, boys were more likely to be in the "Rabbits" profile (adjusted OR [95% CI]: 3.6 [1.4, 9.7] and 4.5 [1.8, 10.9] at ages 5.5 and 8 years, respectively) and less likely to be in the "Pandas" profile (0.5 [0.3, 0.9] and 0.4 [0.2, 0.6]) at both ages. CONCLUSIONS With increasing age about half the children stayed in the same of four 24 h-MB profiles, while the predominant transition for the remaining children was towards lower PA, higher inactivity and longer sleep duration. These findings can aid development and implementation of public health strategies to promote better health. STUDY REGISTRATION This study was registered on 4th August 2010 and is available online at ClinicalTrials.gov: NCT01174875 .
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Affiliation(s)
- Natarajan Padmapriya
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building, Level 12, Singapore, 117549, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Bozhi Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Lynette Pei Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building, Level 12, Singapore, 117549, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building, Level 12, Singapore, 117549, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 12 Science Drive 2, MD1 Tahir Foundation Building, Level 12, Singapore, 117549, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Folkhälsan Research Center, Helsinki, Finland
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Université de Paris, Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, Inrae, F-75004, Paris, France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany
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47
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Lau JH, Nair A, Abdin E, Kumarasan R, Wang P, Devi F, Sum CF, Lee ES, Müller-Riemenschneider F, Subramaniam M. Prevalence and patterns of physical activity, sedentary behaviour, and their association with health-related quality of life within a multi-ethnic Asian population. BMC Public Health 2021; 21:1939. [PMID: 34696751 PMCID: PMC8544627 DOI: 10.1186/s12889-021-11902-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 05/17/2021] [Accepted: 10/01/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The study aimed to examine the prevalence and sociodemographic correlates of physical activity and sedentary behaviour in the general population of the multi-ethnic nation of Singapore as part of the Knowledge, Practice and Attitudes towards Diabetes study, a cross-sectional and population-based survey. It also examined the relationship between physical activity, sedentary behaviour, and health-related quality of life (HRQoL). METHODS Physical activity and sedentary behaviour were assessed via the Global Physical Activity Questionnaire (GPAQ), while physical and mental HRQoL was assessed via the Short Form Health Survey (SF-12v2). Survey weights were employed to account for complex survey design. Multivariable logistic regression models were utilized to examine sociodemographic correlates of physical activity (insufficient vs. sufficient physical activity) and sedentary behaviour (< 7 h/day vs ≥7 h/day). Descriptive statistics were calculated to examine the percentage of time spent in different domains of physical activity. Multivariable linear regressions were conducted to examine the association between physical activity and sedentary behaviour with physical and mental HRQoL. RESULTS Two thousand eight hundred sixty seven participants recruited from February 2019 to March 2020 (prior to COVID-19 lockdown and related restrictions in Singapore) were included in the analyses. 83.3% of respondents had sufficient physical activity. Age (65 years and above) and income (SGD 2000 to 3999) were associated with a higher likelihood of insufficient physical activity. In contrast, those of Malay ethnicity and having one chronic physical condition were associated with a lower likelihood of insufficient physical activity. 47.7% reported that they had sedentary behaviour of ≥7 h/day. Older age and a primary school education were related to a lower likelihood of sedentary behaviour, while being single, having higher income, obesity, and multimorbidity were associated with higher sedentary behaviour. Insufficient physical activity was significantly associated with lower physical HRQoL but was not significantly associated with mental HRQoL. Sedentary behaviour was not significantly associated with mental or physical HRQoL. CONCLUSION About 17% of the population did not meet the minimum requirements for physical activity, while around half of the population spent a considerable time being sedentary. As insufficient physical activity was associated with poorer physical HRQoL, policymakers should promote moderate physical activity and encouraging the breaking up of prolonged sedentary periods within the middle- and high-income groups, especially at the workplace. Increased leisure-time exercise should be encouraged for those in the lower- income group.
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Affiliation(s)
- Jue Hua Lau
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Asharani Nair
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Roystonn Kumarasan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Chee Fang Sum
- Admiralty Medical Centre and Khoo Teck Puat Hospital, Singapore, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
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Ollier J, Neff S, Dworschak C, Sejdiji A, Santhanam P, Keller R, Xiao G, Asisof A, Rüegger D, Bérubé C, Hilfiker Tomas L, Neff J, Yao J, Alattas A, Varela-Mato V, Pitkethly A, Vara MD, Herrero R, Baños RM, Parada C, Agatheswaran RS, Villalobos V, Keller OC, Chan WS, Mishra V, Jacobson N, Stanger C, He X, von Wyl V, Weidt S, Haug S, Schaub M, Kleim B, Barth J, Witt C, Scholz U, Fleisch E, von Wangenheim F, Car LT, Müller-Riemenschneider F, Hauser-Ulrich S, Asomoza AN, Salamanca-Sanabria A, Mair JL, Kowatsch T. Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol. Front Public Health 2021; 9:625640. [PMID: 34746067 PMCID: PMC8566727 DOI: 10.3389/fpubh.2021.625640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/03/2020] [Accepted: 09/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals' health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention. Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics. Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations.
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Affiliation(s)
- Joseph Ollier
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Simon Neff
- Department of Management, Technology, and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | | | - Arber Sejdiji
- Department of Management, Technology, and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Roman Keller
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Grace Xiao
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Alina Asisof
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Dominik Rüegger
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Caterina Bérubé
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
| | - Lena Hilfiker Tomas
- Executive School of Management, Technology and Law, University of St. Gallen, St. Gallen, Switzerland
| | - Joël Neff
- Executive School of Management, Technology and Law, University of St. Gallen, St. Gallen, Switzerland
| | - Jiali Yao
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Aishah Alattas
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Amanda Pitkethly
- Sport, Exercise and Health Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Mª Dolores Vara
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Herrero
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Mª Baños
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Carolina Parada
- Department of Psychology, Universidad San Buenaventura, Bogotá, Colombia
| | | | - Victor Villalobos
- Interdisciplinary Center for Health Workplaces, University of California, Berkeley, Berkeley, CA, United States
| | - Olivia Clare Keller
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Wai Sze Chan
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, SAR China
| | - Varun Mishra
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Nicholas Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Hanover, NH, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Hanover, NH, United States
| | - Xinming He
- Business School, Durham University, Durham, United Kingdom
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Steffi Weidt
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Michael Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudia Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Florian von Wangenheim
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Lorainne Tudor Car
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Department of Medicine, Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Center for Digital Health, Berlin Institute of Health and Charité, Berlin, Germany
| | - Sandra Hauser-Ulrich
- Department of Applied Psychology, University of Applied Sciences Zurich, Zurich, Switzerland
| | | | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, Eidgenössische Technische Hochschule (ETH) Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
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49
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Tay GWN, Chan MJ, Kembhavi G, Lim J, Rebello SA, Ng H, Lin C, Shek LP, Lança C, Müller-Riemenschneider F, Chong MFF. Children's perceptions of factors influencing their physical activity: a focus group study on primary school children. Int J Qual Stud Health Well-being 2021; 16:1980279. [PMID: 34661503 PMCID: PMC8525992 DOI: 10.1080/17482631.2021.1980279] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Establishing healthy lifestyle behaviours in primary school children is important, as these behaviours are likely to track into adulthood. This study aimed to explore the factors influencing physical activity (PA) in primary school children through their perspectives. Approach Eleven focus group discussions and one interview were conducted with 52 children (n = 29 girls) aged 9–12 years from two primary schools in Singapore. Data analyses were conducted using thematic analysis, deductively following the socio-ecological model (SEM) and inductively for themes at each SEM level. Results At individual level, children’s perceived enjoyment, health benefits and expectation of rewards motivated them to engage in PA, while time constraints and their apathy towards PA hindered PA engagement. Children’s PA occasions at home were reported to be influenced by parental permission, priorities and availability, and the availability of preferred peers. Physical environmental factors such as opportunities for PA in school, access to facilities for PA and weather influenced children’s time spent on PA and the types of activities they engaged in. Conclusion This study summarized some factors that children have reported to influence their PA behaviour. These findings could help inform future interventions aimed at promoting PA among primary school children in Singapore.
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Affiliation(s)
| | - Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Jubilee Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Hazyl Ng
- Health Promotion Board, Singapore
| | | | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | | | | | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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50
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Padmapriya N, Tint MT, Sadananthan SA, Michael N, Chen B, Cai S, Toh JY, Lanca C, Tan KH, Saw SM, Shek LPC, Chong YS, Gluckman PD, Lee YS, Yap F, Fortier MV, Chong MFF, Godfrey KM, Eriksson JG, Velan SS, Kramer MS, Bernard JY, Müller-Riemenschneider F. The longitudinal association between early-life screen viewing and abdominal adiposity-findings from a multiethnic birth cohort study. Int J Obes (Lond) 2021; 45:1995-2005. [PMID: 34108642 PMCID: PMC7611569 DOI: 10.1038/s41366-021-00864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/02/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Screen viewing in adults has been associated with greater abdominal adiposity, with the magnitude of associations varying by sex and ethnicity, but the evidence is lacking at younger ages. We aimed to investigate sex- and ethnic-specific associations of screen-viewing time at ages 2 and 3 years with abdominal adiposity measured by magnetic resonance imaging at age 4.5 years. METHODS The Growing Up in Singapore Towards healthy Outcomes is an ongoing prospective mother-offspring cohort study. Parents/caregivers reported the time their child spent viewing television, handheld devices, and computer screens at ages 2 and 3 years. Superficial and deep subcutaneous and visceral abdominal adipose tissue volumes were quantified from magnetic resonance images acquired at age 4.5 years. Associations between screen-viewing time and abdominal adipose tissue volumes were examined by multivariable linear regression adjusting for confounding factors. RESULTS In the overall sample (n = 307), greater total screen-viewing time and handheld device times were associated with higher superficial and deep subcutaneous adipose tissue volumes, but not with visceral adipose tissue volumes. Interactions with child sex were found, with significant associations with superficial and deep subcutaneous and visceral adipose tissue volumes in boys, but not in girls. Among boys, the increases in mean (95% CI) superficial and deep subcutaneous and visceral adipose tissue volumes were 24.3 (9.9, 38.7), 17.6 (7.4, 27.8), and 7.8 (2.1, 13.6) mL per hour increase in daily total screen-viewing time, respectively. Ethnicity-specific analyses showed associations of total screen-viewing time with abdominal adiposity only in Malay children. Television viewing time was not associated with abdominal adiposity. CONCLUSION Greater total screen-viewing time (and in particular, handheld device viewing time) was associated with higher abdominal adiposity in boys and Malay children. Additional studies are necessary to confirm these associations and to examine screen-viewing interventions for preventing excessive abdominal adiposity and its adverse cardiometabolic consequences.
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Affiliation(s)
- Natarajan Padmapriya
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Mya-Thway Tint
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Bozhi Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shirong Cai
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Institute for Bioengineering and Bioimaging, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Michael S Kramer
- Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, Canada
- Department of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Centre for Research in Epidemiology and Statistics (CRESS), Université de Paris, Inserm, INRAE, Paris, France
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany
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