The association between time of day outdoors and sleep.

<p>The association between time of day outdoors and sleep.</p

Demographic, physical activity, and sleep characteristics of the adult female convenience sample (N = 352).

<p>Demographic, physical activity, and sleep characteristics of the adult female convenience sample (N = 352).</p

The moderation of the relationship between Moderate to Vigorous Physical Activity (MVPA) and sleep by outdoor time.

<p>The moderation of the relationship between Moderate to Vigorous Physical Activity (MVPA) and sleep by outdoor time.</p

Psychosocial Assessments for HIV+ African Adolescents: Establishing Construct Validity and Exploring Under-Appreciated Correlates of Adherence

<div><p>Study Objectives</p><p>Psychosocial factors such as outcome expectancy, perceived stigma, socio-emotional support, consideration of future consequences, and psychological reactance likely influence adolescent adherence to antiretroviral treatments. Culturally-adapted and validated tools for measuring these factors in African adolescents are lacking. We aimed to identify culturally-specific factors of importance to establishing local construct validity in Botswana.</p><p>Methods</p><p>Using in-depth interviews of 34 HIV+ adolescents, we explored how the psychosocial factors listed above are perceived in this cultural context. We evaluated six scales that have been validated in other contexts. We also probed for additional factors that the adolescents considered important to their HIV medication adherence. Analyses were conducted with an analytic framework approach using NVivo9 software.</p><p>Results</p><p>While the construct validity of some Western-derived assessment tools was confirmed, other tools were poorly representative of their constructs in this cultural context. Tools chosen to evaluate HIV-related outcome expectancy and perceived stigma were well-understood and relevant to the adolescents. Feedback from the adolescents suggested that tools to measure all other constructs need major modifications to obtain construct validity in Botswana. The scale regarding future consequences was poorly understood and contained several items that lacked relevance for the Batswana adolescents. They thought psychological reactance played an important role in adherence, but did not relate well to many components of the reactance scale. Measurement of socio-emotional support needs to focus on the adolescent-parent relationship, rather than peer-support in this cultural context. Denial of being HIV-infected was an unexpectedly common theme. Ambivalence about taking medicines was also expressed.</p><p>Discussion</p><p>In-depth interviews of Batswana adolescents confirmed the construct validity of some Western-developed psychosocial assessment tools, but demonstrated limitations in others. Previously underappreciated factors related to HIV medication adherence, such as denial and ambivalence, should be further explored.</p></div

Denial and Ambivalence Statements from Adolescents.

<p>Denial and Ambivalence Statements from Adolescents.</p

Psychosocial Factors to Be Measured.

<p>Psychosocial Factors to Be Measured.</p

Quotations Illustrating Key Themes.

<p>Quotations Illustrating Key Themes.</p

Additional file 1: Table S1. of Within-person associations of young adolescents’ physical activity across five primary locations: is there evidence of cross-location compensation?

Interactions of within-person associations (i.e., compensation) among MVPA minutes/day across 5 primary locations (N = 3776 days). (DOC 41 kb

Variation in actigraphy-estimated rest-activity patterns by demographic factors

<p>Rest-activity patterns provide an indication of circadian rhythmicity in the free-living setting. We aimed to describe the distributions of rest-activity patterns in a sample of adults and children across demographic variables. A sample of adults (<i>N</i> = 590) and children (<i>N</i> = 58) wore an actigraph on their nondominant wrist for 7 days and nights. We generated rest-activity patterns from cosinor analysis (MESOR, acrophase and magnitude) and nonparametric circadian rhythm analysis (IS: interdaily stability; IV: intradaily variability; L5: least active 5-hour period; M10: most active 10-hour period; and RA: relative amplitude). Demographic variables included age, sex, race, education, marital status, and income. Linear mixed-effects models were used to test for demographic differences in rest-activity patterns. Adolescents, compared to younger children, had (1) later M10 midpoints (<i>β</i> = 1.12 hours [95% CI: 0.43, 1.18] and lower M10 activity levels; (2) later L5 midpoints (<i>β</i> = 1.6 hours [95% CI: 0.9, 2.3]) and lower L5 activity levels; (3) less regular rest-activity patterns (lower IS and higher IV); and 4) lower magnitudes (<i>β</i> = −0.95 [95% CI: −1.28, −0.63]) and relative amplitudes (<i>β</i> = −0.1 [95% CI: −0.14, −0.06]). Mid-to-older adults, compared to younger adults (aged 18–29 years), had (1) earlier M10 midpoints (<i>β</i> = −1.0 hours [95% CI: −1.6, −0.4]; (2) earlier L5 midpoints (<i>β</i> = −0.7 hours [95% CI: −1.2, −0.2]); and (3) more regular rest-activity patterns (higher IS and lower IV). The magnitudes and relative amplitudes were similar across the adult age categories. Sex, race and education level rest-activity differences were also observed. Rest-activity patterns vary across the lifespan, and differ by race, sex and education. Understanding population variation in these patterns provides a foundation for further elucidating the health implications of rest-activity patterns across the lifespan.</p