Factors Associated with Sustained Exergaming: Longitudinal Investigation.

International audienceBACKGROUND: Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming.OBJECTIVE: The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming.METHODS: Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montréal, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression.RESULTS: Of 186 exergamers at T1, 81 (44%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming.CONCLUSIONS: Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming

To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction

Background: The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual’s subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage. Objective: Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors. Methods: A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0). Results: Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ23=20.5; P<.001), gaming (χ23=35.6; P<.001), and social networking (χ23=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted. Conclusions: We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress

Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review

Abstract Background Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status. Methods Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies. Results Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies. Conclusions Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature

Differences in the Risk of Cardiovascular Disease among People with HIV, Hepatitis C, or Co-infection

Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Community & Preventive Medicine, 2010.Background: With the availability of effective antiretrovirals, HIV patients are living longer, and cardiovascular disease (CVD) risk is a growing concern. One third of HIV patients are co-infected with Hepatitis C (HCV), but the risk of CVD in this population is not well defined. The total cholesterol/high-density lipoprotein ratio (TC/HDL-C ratio) and the Framingham Risk Score (FRS) are robust measures of CVD risk but have not been examined in the context of HIV/HCV co-infected patients. Methods: Our study had four specific aims and utilized data from Strong Memorial Hospital, AIDS Community Health Center, Unity Health and the National Health and Nutrition Examination Survey (NHANES). Aim 1: We compared the TC/HDL-C ratio among subjects with HIV (n=221), HCV (n=194), or HIV/HCV co-infection (n=153) that were not on HIV antiretrovirals. Aim 2: We compared the mean change in the baseline TC/HDL-C ratio after greater than six months of HIV antiretroviral use between HIV (n=132) and HIV/HCV co-infected subjects (n=74). Aim 3: We compared the FRS among subjects with HIV (n=262), HCV (n=181), or HIV/HCV co-infection (n=196). Aim 4: We compared the FRS from our subjects in Aim 3 matched 3:1 on age and sex to subjects from the 2003-2006 NHANES. Multivariate analyses included linear and logistic regressions and adjusted for important demographic and health characteristics identified in the bivariate analyses. Results: For each aim, study population characteristics differed slightly due to different inclusion and exclusion criteria. In general, our Rochester subjects were primarily African American (~45%), White (~40%) or Hispanic (~20%) with a mean age of 48 years of age, and a mean body mass index (BMI) of 28. More than half of the subjects were current smokers, and approximately half either current or former drug users. Subjects were noted to have a number of comorbidities such as hypertension, diabetes, or dyslipidemia. The NHANES subjects were primarily White (56%), African American (23%) or Hispanic (21%). Approximately one-quarter were current smokers, and one-fifth were current or former drug users. Subjects also had hypertension, diabetes and dyslipidemia. Aim 1: After controlling for age, sex, race, BMI, lipid lowering use, diabetes and drug use, our multivariate linear regression results indicate HCV mono-infected subjects have a significantly lower TC/HDL-C ratio (parameter estimate: -0.56) than HIV mono-infected persons (p=0.0001). The TC/HDL-C ratio is not significantly different between HIV/HCV co-infected and HIV mono-infected persons in multivariate analyses (parameter estimate: -0.26, p=0.09). Aim 2: After controlling for CD4 cell counts, HIV antiretroviral duration, calendar time, previous exposure to HIV antiretrovirals, dyslipidemia, and pharmacotherapy for dyslipidemia, there is no significant difference in the TC/HDL-C ratio after at least six months of HAART among either the HIV mono-infected, or HIV/HCV co-infected persons, and the difference between groups is not statistically significant. Aim 3: After controlling for age, sex, pharmacotherapy for dyslipidemia, calendar year, and use of HIV antiretrovirals, the FRS is not significantly different between HIV, HCV and HIV/HCV co-infected persons in multivariate analyses. Aim 4: After controlling for age, sex, race, ethnicity, BMI, marital status, pharmacotherapy for dyslipidemia and use of HIV antiretrovirals, the 10-year risk of general cardiovascular disease among persons mono-infected with HCV is 7% greater than the risk among their age and sex matched controls (p=0.01), and the 10-year risk is 9% greater among the HIV/HCV co-infected persons compared to their age and sex matched controls (p=0.01). The 10 year risk is not significantly greater among HIV mono-infected persons compared to their controls. Conclusion: Study results indicate the risk of abnormal lipid profiles are not likely to be statistically lower in persons with HIV/HCV co-infection when compared with persons with HIV mono-infection. Previous studies have reported that in comparison to HIV mono-infection, HIV and HCV co-infection was associated with lower lipids, suggesting a potentially ‘protective’ effect against cardiovascular disease risk. However, previous studies have primarily analyzed lipids in separate measures, and research has shown the TC/HDL-C ratio is a more sensitive and predictive measure of cardiovascular disease than analyzing lipid profile measurements separately. Thus the risk of cardiovascular disease among persons co-infected with HIV and HCV may be greater than is currently appreciated. Our analyses also suggest that the risk of cardiovascular disease is significantly greater among persons with HCV mono-infection and HIV/HCV co-infection compared to the general population. In particular, our study found persons mono-infected with HCV had statistically lower lipids than persons mono-infected with HIV or co-infected with HIV and HCV but an elevated Framingham Risk Score. Lower lipid profiles in persons mono-infected with HCV or co-infected with HIV and HCV may incorrectly influence clinicians and patients into assuming there is little risk of cardiovascular disease. This incorrect assumption may translate into ignoring other cardiovascular disease risk factors such as hypertension or diabetes. Future studies are needed to further explore the risk of cardiovascular disease in these populations

Differences in HIV vaccine acceptability between genders

This is the accepted manuscript of an article published in AIDS care by Taylor & Francis in 2008.The development of safe and efficacious preventive HIV vaccines offers the best long-term hope of controlling the AIDS pandemic. Nevertheless, suboptimal uptake of safe and efficacious vaccines that already exist suggest that HIV vaccine acceptability cannot be assumed, particularly among communities most vulnerable to HIV. The present study aimed to identify barriers and motivators to future HIV vaccine acceptability among low socioeconomic, ethnically diverse men and women in Los Angeles County. Participants completed a cross-sectional survey assessing their attitudes and beliefs regarding future HIV vaccines. Hypothetical HIV vaccine scenarios were administered to determine HIV vaccine acceptability. Two-sided t-tests were performed, stratified by gender, to examine the association between vaccine acceptability and potential barriers and motivators. Barriers to HIV vaccine acceptability differed between men and women. For women, barriers to HIV vaccine acceptability were related to their intimate relationships (p<0.05), negative experiences with health care providers (p<0.05) and anticipated difficulties procuring insurance (p<0.01). Men were concerned that the vaccine would weaken the immune system (p<0.005) or would affect their HIV test results (p<0.05). Motivators for women included the ability to conceive a child without worrying about contracting HIV (p<0.10) and support from their spouse/significant other for being vaccinated (p<0.10). Motivators for men included feeling safer with sex partners (p<0.05) and social influence from friends to get vaccinated (p<0.005). Family support for HIV immunization was a motivator for both men and women (p<0.10). Gender-specific interventions may increase vaccine acceptability among men and women at elevated risk for HIV infection. Among women, interventions need to focus on addressing barriers due to gendered power dynamics in relationships and discrimination in health care. Among men, education that addresses fears and misconceptions about adverse effects of HIV vaccination on health and the importance of vaccination as one component of integrated HIV prevention may increase vaccine acceptability

Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort

Both low socioeconomic status (SES) and behavioural problems in childhood are associated with cardiovascular disease (CVD) in adulthood, but their combined effects on CVD are unknown. Study objectives were to investigate the effect of neighbourhood level SES and behavioural problems during childhood on the development of CVD risk factors and events during adulthood. Participants were from a longitudinal cohort (n=3792, baseline: 6–13years of age) of Montreal children, followed from 1976 to 2010. SES was a composite measure of neighbourhood income, employment, education, and single-parent households separately assessed from census micro data sets in 1976, 2001, and 2006. Behavioural problems were assessed based on sex-specific peer assessments. CVD events were from medical records. Sex-stratified multivariable Cox regression models adjusted for age, frequency of medical visits, and parental history of CVD. Males from disadvantaged neighbourhoods during childhood were 2.06 (95% CI: 1.09–3.90, p=0.03) and 2.51 (95% CI: 1.49–4.22, p=0.0005) times more likely to develop a CVD risk factor or an event, respectively, than males not from disadvantaged neighbourhoods. Aggressive males were also 50% more likely to develop a CVD risk factor or event. Females from disadvantaged neighbourhoods during childhood were 1.85 (95% CI: 1.33–2.59, p=0.0003) times more likely to develop a CVD risk factor. Future studies should aim to disentangle the interpersonal from the socioeconomic effects on CVD incidence. Keywords: Neighbourhood disadvantage, Cardiovascular risk, Prospective cohort, Socioeconomic status, Longitudina

The association between income and leisure-time physical activity is moderated by utilitarian lifestyles: A nationally representative US population (NHANES 1999–2014)

International audienceThe objective of this study was to determine whether the relationship between income and leisure-time physical activity (LTPA) persists after accounting for a person's utilitarian PA (all non-LTPA), sociodemographic characteristics and transportation PA. Data were from eight cycles (1999-2014) of the nationally representative samples of the US adult population from the National Health and Nutrition Examination Survey (n = 35,239). Whether the poverty income ratio (0-1.3, 1.3-1.86, 1.86+ [reference]) was associated with minutes of LTPA (moderate, vigorous) after stratifying for utilitarian PA (sedentary, light, moderate, and vigorous) was assessed in multiple linear regressions adjusted for age, sex, race, education, marital status, weight status, hours worked, and minutes of transportation-related PA in the past week. Likelihood of meeting national physical activity recommendations was also assessed in multiple logistic regressions adjusting for the covariates described. For both sedentary and light utilitarian PA levels, compared to the reference, persons living in households of the lowest poverty income ratio were consistently associated with approximately 17-30 less minutes of moderate LTPA minutes per week, and 20-25 less minutes of vigorous LTPA across all survey cycles. Compared to the reference, the likelihood of meeting national PA recommendations was approximately 31-55% less for these households. The known association between lower income and lower LTPA persist, but is the most persistent and consistent for those with less active utilitarian (such as sedentary) lifestyles. Interventions aimed at increasing LTPA among people with low income and sedentary utilitarian lifestyles whether or not they are in the workforce are particularly needed

Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort

Both low socioeconomic status (SES) and behavioural problems in childhood are associated with cardiovascular disease (CVD) in adulthood, but their combined effects on CVD are unknown. Study objectives were to investigate the effect of neighbourhood level SES and behavioural problems during childhood on the development of CVD risk factors and events during adulthood. Participants were from a longitudinal cohort (n=3792, baseline: 6–13years of age) of Montreal children, followed from 1976 to 2010. SES was a composite measure of neighbourhood income, employment, education, and single-parent households separately assessed from census micro data sets in 1976, 2001, and 2006. Behavioural problems were assessed based on sex-specific peer assessments. CVD events were from medical records. Sex-stratified multivariable Cox regression models adjusted for age, frequency of medical visits, and parental history of CVD. Males from disadvantaged neighbourhoods during childhood were 2.06 (95% CI: 1.09–3.90, p=0.03) and 2.51 (95% CI: 1.49–4.22, p=0.0005) times more likely to develop a CVD risk factor or an event, respectively, than males not from disadvantaged neighbourhoods. Aggressive males were also 50% more likely to develop a CVD risk factor or event. Females from disadvantaged neighbourhoods during childhood were 1.85 (95% CI: 1.33–2.59, p=0.0003) times more likely to develop a CVD risk factor. Future studies should aim to disentangle the interpersonal from the socioeconomic effects on CVD incidence. Keywords: Neighbourhood disadvantage, Cardiovascular risk, Prospective cohort, Socioeconomic status, Longitudina

Development and Validation of the Reasons to Exergame (RTEX) Scale in Young Adults: Exploratory Factors Analysis

International audienceBackground Exergaming is associated with positive health benefits; however, little is known about what motivates young people to exergame. Objective This study aimed to develop a new Reasons to Exergame (RTEX) scale and describe its psychometric properties (Study 1) including test-retest reliability (Study 2). We also examined the test-retest reliability of self-report exergaming behavior measures (Study 2). Methods We identified scale items in consultation with experts. In Study 1, we conducted an Exploratory Factor Analysis of RTEX and examined how the factors identified relate to exergaming frequency and intensity in a population-based sample of 272 young adults. In Study 2, we examined the test-retest reliability of RTEX factors and self-report measures of past-week exergaming frequency and intensity among 147 college students. Results We identified four factors in RTEX: exergaming for fitness, exergaming for enjoyment, preferring exergaming over other gaming options, and choosing exergaming over competing interests (eg, sports). Test-retest reliability of RTEX factors (ICC 0.7-0.8) and self-report exergaming frequency (ICC 0.4-0.9) was adequate. Exergaming for fitness and enjoyment were positively associated with the frequency of exergaming with friends and family, and with exergaming intensity. Preferring exergaming over other gaming options and choosing exergaming over competing interests (eg, sports) were not related to exergaming behavior. Conclusions RTEX is a psychometrically sound scale with four factors that measure reasons to exergame. Replication of these findings is needed in larger, more diverse samples

Meeting fruit and vegetable consumption and physical activity recommendations among adolescents intending to lose weight

Two-thirds of adolescents who are overweight or have obesity report weight loss intentions. Most report using weight loss strategies consistent with expert recommendations for obesity prevention; however whether they meet recommended fruit and vegetable (F&V) intake and physical activity (PA) recommendations is unknown. We investigated whether weight loss attempts, and weight loss strategies were associated with meeting F&V and PA recommendations. Data were from the 2010 National Youth Physical Activity and Nutrition Study, which surveyed a cross-sectional, nationally representative sample of U.S. high school students. Analyses were restricted to overweight/obese students (n = 2841). Adjusted logistic regression models assessed the odds of meeting daily F&V and weekly PA recommendations after adjusting for grade, sex, race/ethnicity and perceived weight status. Compared to students who were overweight and were not currently intending to lose weight, students who were overweight and intending to lose weight were not more likely to meet F&V or PA. Among students with obesity, those who intended to lose weight were more likely than students who were not currently intending to lose weight to meet F&V recommendations (OR: 3.62, 95% CI: 1.70–7.73). Students who were overweight/obese and used F&V or PA for weight loss were significantly more likely to meet the corresponding recommendation than students intending to lose weight without specific strategies. Weight loss attempts alone do not affect the likelihood of meeting most expert recommendations. Public health efforts emphasizing recommended strategies for healthy eating and active living still need to be encouraged for overweight/obese youth. Keywords: Weight loss strategy, Adolescents, NYPANS, Cross-sectional, Weight loss attempt, Overweight, Obesity, Weight statu