Synergising youth empowerment and co-design to transform Pasifika youth into agents of social change : a novel approach to advance healthy lifestyles in Pasifika communities : a thesis presented in partial fulfilment of the requirements of Doctor of Philosophy in Public Health at Massey University, Wellington campus, New Zealand

Current population health statistics demonstrate the need for innovative approaches to improve health outcomes and prevent non-communicable disease (NCD) for Pasifika peoples. This research builds off pilot studies on the effects of youth empowerment programmes to address obesity-related issues amongst Pasifika communities. It developed and tested an original model of co-design embedded within the youth empowerment framework of the Pasifika Prediabetes Youth Empowerment Programme. The programme was co-delivered with two community health service providers (one rural and one urban), employing Community-Based Participatory Research (CBPR) methodology. N=29 youth (aged 15-24 years) participated in eleven educational and capacity-building modules that comprised the empowerment and co-design components during weekly sessions from MayOctober 2018. At the end of the programme, the model of co-design generated two individualised community intervention action plans to reduce prediabetes in their communities. This research employed a qualitative research design with four data collection techniques and thematic analysis to evaluate the effects of the tested programme. It used an original framework of social change to determine the impacts on the youth’s values, knowledge, and behaviours as well as the community organisations, and the socio-cultural norms of each community. It also explicated the contextual considerations of programme uptake in each location. Overall, this research illustrated that co-design is an effective addition to empowerment frameworks. It demonstrated how to operationalise co-design in a community-based setting with youth, and the tested model provided a practical framework to translate empowerment ii outcomes into the community. The programme analyses also led to a more nuanced understanding of social change. This research developed a concept of the process of social change that can be used to inform future programme development and evaluation. This research suggests future translations of the programme to maximise uptake and postulates different community contexts and settings for delivery, beyond Pasifika prediabetes prevention

Increasing Nonsedentary Behaviors in University Students Using Text Messages: Randomized Controlled Trial

BACKGROUND: Sedentary behavior (SB) has been linked to many health problems such as type 2 diabetes and heart disease. Increasing the length and frequency of breaks from sitting and increasing the time spent standing and engaged in light and moderate physical activity are ways to decrease SB. Text message-based interventions have succeeded in aiding smoking cessation and increase both physical activity and healthy eating, but they have not been shown to reduce SB. OBJECTIVE: The primary purpose of this pilot study was to determine the effectiveness of a text message-based intervention in increasing nonsedentary behaviors in university students. A secondary purpose was to (1) determine whether the intervention could enhance self-efficacy beliefs for decreasing SB and (2) whether these efficacious beliefs could predict actual SB. METHODS: Eighty-two university students were recruited via mass emails and randomized into intervention (SB-related text messages) or control (text messages unrelated to SB) groups. Participants received daily text messages scheduled by the researcher encouraging breaks from sitting, standing, light- and moderate-intensity physical activity (PA). They then reported various SBs via Web-based questionnaires at four time points (baseline, 2, 4, and 6 weeks). Self-efficacious beliefs toward taking breaks from sitting and decreasing the amount of time spent sitting were assessed at the same time points. RESULTS: Last observation carried forward (LOCF) method was used for incomplete data as an intent-to-treat (ITT) analysis (intervention group n=15, control group n=11). Small-to-moderate effects favoring the text intervention group were found at 6 weeks for break frequency -14.64 minutes, break length +.59 minutes, standing +24.30 min/day, light-intensity +74.34 min/day, and moderate-intensity + 9.97 min/day PA. Only light-intensity PA approached significance (P=.07). Self-efficacy beliefs also favored the text intervention group and reached significance (P=.032) for sitting less. Significant (P CONCLUSIONS: Text messages have the potential to increase nonsedentary behaviors in university students. These messages can increase self-efficacy beliefs to take more breaks and reduce sitting time. Efficacious beliefs can predict actual SB and to a lesser extent light- and moderate-intensity PA. TRIAL REGISTRATION: ClinicalTrials.gov NCT02562937; https://clinicaltrials.gov/ct2/show/NCT02562937 (Archived by WebCite at http://www.webcitation.org/6jVLwXE5M)

Effects of Caffeine and Acute Aerobic Exercise on Working Memory and Caffeine Withdrawal

Studies show that a single bout of exercise confers cognitive benefits. However, many individuals use psychoactive substances such as caffeine to enhance cognitive performance. The effects of acute exercise in comparison to caffeine on cognition remain unknown. Furthermore, caffeine use is associated with withdrawal symptoms upon cessation. Whether acute exercise can reduce withdrawal symptoms also remains unknown. The objectives of this study were to compare the effects of acute moderate intensity aerobic exercise to caffeine on working memory (WM) and caffeine withdrawal symptoms (CWS). In Phase I, non-caffeine (n = 29) and caffeine consumers (n = 30) completed a WM assessment, followed by acute exercise and caffeine. In Phase II, caffeine consumers (n = 25) from Phase I underwent the WM assessment and reported CWS following a 12-hour deprivation period. Acute moderate intensity aerobic exercise and caffeine (1.2 mg/kg) significantly improved WM accuracy and reduced CWS comparably. WM performance was not reduced following caffeine deprivation

Public Health Guidelines for Physical Activity: Is There an App for That? A Review of Android and Apple App Stores

BACKGROUND: Physical activity participation is an important behavior for modifying lifestyle-related disease risk. Mobile health apps for chronic disease management and prevention are being developed at a rapid rate. However, it is unclear whether these apps are evidence-based. Current public health recommendations for physical activity participation for adults highlight the importance of engaging in 150 minutes weekly of purposeful exercise, and muscle strengthening activities on at least 2 days of the week. OBJECTIVE: The aims of the present review were to (1) identify available evidence-based physical activity apps, and (2) identify technological features that could be leveraged to improve health outcomes. METHODS: iTunes and Google Play mobile app stores were searched using keyword and category searching during a single day (February 18, 2014) for physical activity apps available in English. The description pages of eligible apps were reviewed by 4 independent reviewers for evidence-based content, technological, and descriptive features. An a priori subset of apps was downloaded for further review (n=6 affiliated with a non-commercial agency; n=10 top rated; n=10 random selection), and developers were contacted for information regarding evidence-informed content. RESULTS: The initial search yielded 2400 apps, of which 379 apps (n=206 iTunes; n=173 Google Play) were eligible. Primary results demonstrated no apps (n=0) adhering to evidence-based guidelines for aerobic physical activity, and 7 out of 379 implementing evidence-based guidelines for resistance training physical activity. Technological features of apps included social networking (n=207), pairing with a peripheral health device (n=61), and measuring additional health parameters (n=139). Secondary results revealed 1 app that referenced physical activity guidelines (150 minutes/weekly of exercise), and demonstrated that apps were based on various physical activity reports (n=4) or personal expertise (n=2). CONCLUSIONS: The present study demonstrated a shortage of evidence-based physical activity apps. This gap underscores the need for development of evidence-informed mobile apps. Results highlight the opportunity to develop evidence-informed mobile apps that can be used clinically to enhance health outcomes

The Utility of a Protection Motivation Theory Framework for Understanding Sedentary Behavior

Multilevel determinants of sedentary behavior (SB), including constructs couched within evidence-based psychological frameworks, can contribute to more efficacious interventions designed to decrease sitting time. This study aimed to: (1) examine the factor structure and composition of sedentary-derived protection motivation theory (PMT) constructs and (2) determine the utility of these constructs in predicting general and leisure sedentary goal intention (GI), implementation intention (II), and self-reported SB. Sedentary-derived PMT (perceived severity, PS; perceived vulnerability, PV; response efficacy, RE; self-efficacy, SE), GI, and II constructs, and a modified SB questionnaire were completed by undergraduate students (n = 596). SE was broken into three psychological (productive, focused, tired), and two situational (studying, leisure) constructs to capture the main barriers to reducing sitting time. After completing socio-demographics and the PMT items, participants were randomized to complete general or leisure GI and II. Based on model assignment, they completed either the general or leisure SB questionnaire one week later. Irrespective of model, exploratory followed by confirmatory factor analysis revealed that the PMT items grouped into eight coherent and interpretable factors consistent with the theory\u27s threat and coping appraisal tenets: PV, PS, RE, and five scheduling SE constructs (tired, productive/focused, TV/video games/computer, studying at home, studying in library/Wi-Fi area). Using linear regression, general and leisure models predicted 5% and 1% of the variance in GI, 10% and 16% of the variance in II, and 3% and 1% of the variance in SB, respectively. Variables that made unique and significant contributions were: RE (general) and SE (leisure) for goal intention; PV and RE (general), PV, RE, and SE (leisure) for implementation intention; and only goal intention (leisure) for SB. Support now exists for the tenability of an eight-factor PMT sedentary model and its utility in predicting II and to a lesser extent GI and behavior

Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: a 24-week matched case control study

Background: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results: The main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p \u3c 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects

Informing population-specific smoking policy development for college campuses: An observational study

INTRODUCTION In Canada, young adults have the highest smoking rates among all other population groups and specifically college students are at a higher risk. To implement effective policies that can prevent smoking and increase cessation, a populationspecific approach is recommended. METHODS Smoking and non-smoking young adults enrolled in a college program were recruited. Participants who did not smoke were asked to complete questionnaires about their demographics, college experience and the college environment. Additionally, they completed The Perceived Stress Scale and The Center for Epidemiologic Studies – Depression Scale. Students who were current smokers completed the same questionnaires with the addition of one questionnaire about their smoking behaviors. Percentages, means and standard deviations were used to describe the variables of interest and a chi-squared analysis was performed, when possible, to test the difference in response frequency between smoking and nonsmoking participants. RESULTS Differences were observed between smoking (n=65) and non-smoking students (n=214). Specifically, smokers were more likely to have a family member that smoked and to participate in binge drinking. Both groups indicated that they are unaware of campus smoking regulations; however smokers were more opposed to implementing smoke-free policies. CONCLUSIONS College students are unaware of campus smoking regulations. The descriptive information and differences observed between smoking and non-smoking students in this study should be taken into consideration when developing future smoking regulations/policies on college campuses

Couch potatoes to jumping beans: A pilot study of the effect of active video games on physical activity in children

The primary objective of this pilot study was to evaluate the effect of active video games on children's physical activity levels