Obesity-related Health Behaviors Research Articles

Real-world public health interventions demonstrate how research evidence informs program scale-up.

Evidence-based population interventions rely on intervention testing (efficacy and effectiveness trials) to determine what works to improve public health. We investigated the characteristics of real-world public health interventions to address obesity and explored the extent to which research testing was undertaken prior to scale-up. We identified 90 population health interventions targeting physical activity, nutrition or obesity-related health behaviours and collected publicly available information on their key characteristics and outcomes. We then assessed the differences between interventions that followed a research pathway and those that did not. Two-thirds (n = 60) of the interventions were reported as having followed a research pathway. Univariate logistic regression analysis revealed that these interventions were more likely to be health education interventions [odds ratio (OR): 5.56; 95% confidence interval (CI): 1.38-22.38], developed by research institutes (OR: 12.81; 95% CI: 3.47-47.34), delivered in North America (OR: 4.13; 95% CI: 1.61-10.62), and less likely to be owned (OR: 0.35; 95% CI: 0.14-0.88) or funded by government organizations (OR: 0.37; 95% CI: 0.14-0.95). Interventions that followed a research pathway were nearly three times more likely to have a positive impact on population health (OR: 2.72; 95% CI: 1.04-7.14). Interventions that followed a research pathway to scale-up were no more likely to be sustained longer than those that did not. Differences exist across real-world interventions between those that follow a research pathway to population-scale delivery and those that do not, regarding organizational and environmental context. A key benefit of research pathway to scale-up is the impact it has on health outcomes.

Implicit attitudes toward obesity-related cues and their relation to body mass index, psychosocial functioning, and health behavior.

Differences in automatic cognitive processes exist among individuals with overweight and obesity, thus there is a need to expand our conceptualization of overweight and obesity to emphasize the predictive utility of these automatic processes, rather than focusing solely on behavioral outputs. Implicit association tests (IATs) may afford a noninvasive method of examining automatic preferences that might contribute to overweight and obesity; namely, preferences for unhealthy foods and sedentary behavior versus healthy foods and physical activity. The purpose of the current study was to examine whether implicit attitudes toward foods and physical activity differed based on body mass index (BMI) status. The relationships between implicit attitudes and key psychosocial factors and health behaviors were also examined. Participants (N = 127) included undergraduate students with an average age of 19.05 years old (SD = 1.52). Average BMI of the sample was 24.20 (SD = 4.93); 33.8% met criteria for overweight or obesity. Participants completed an IAT and questionnaires. There were no differences in implicit preferences based on BMI or BMI status. Overall, the sample demonstrated implicit preferences for healthy foods and active words, and preferences were not linked to the corresponding behavioral outputs, though preferences were linked to various indices of emotion and emotion regulation. Future research should explore an extended model to examine how implicit preferences might impact intentions to engage in protective versus risky obesity-related health behaviors, and the various psychosocial factors that might impact the translation of those preferences and intentions in actual behavioral outputs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sex-Difference in Obesity Prevalence and Obesity-Related Health Behaviors in South Korea: Korea National Health and Nutrition Examination Survey 2007–2022

Sex-Difference in Obesity Prevalence and Obesity-Related Health Behaviors in South Korea: Korea National Health and Nutrition Examination Survey 2007–2022

“Healthier health in more ways than one”: Perspectives on a program for changing both smoking and obesity-related health behaviors

IntroductionIndividuals with obesity who smoke cigarettes have increased risk of morbidity and mortality. The goal of the current study was to inform the development of a multiple health behavior change intervention designed to facilitate smoking cessation while also targeting weight gain. MethodsFour qualitative focus groups were conducted with individuals who smoked cigarettes and had overweight or obesity (n = 16) to explore the combined effects of smoking and obesity, past attempts to quit smoking or lose weight, and preferences for a combined health intervention. ResultsFocus groups converged on five themes including: the interactive effects of weight and smoking; lack of experience with evidence-based weight loss approaches; a desire and expectation to lose weight quickly; rapid weight gain during past attempts at smoking cessation; and interest in a multiple health behavior change intervention with weight management preceding smoking cessation and an emphasis on planning for the future and receiving encouragement and support. ConclusionsGroups provided insight into key topics to highlight in a combined intervention and key issues that have interfered with success in both domains.

Meta-synthesis of qualitative studies to explore fathers’ perspectives of their influence on children’s obesity-related health behaviors

BackgroundIn nursing research and practice, there is a paucity of information about how fathers perceive their role in shaping their children’s health behaviors. Most studies on the parental factors affecting children’s health behaviors have focused on the role of mothers. However, recent studies showed that fathers’ health behaviors can influence those of their children. Therefore, the aim of this study was to synthesize existing qualitative studies to explore fathers’ perspectives regarding how they influence children’s obesity-related health behaviors.MethodsWe conducted a descriptive meta-synthesis. To retrieve relevant articles, we used databases including PubMed, CINAHL, and Web of Science. Only qualitative studies published in English-language peer-reviewed journals, targeting fathers of children aged 2–18 years, and focusing on fathers’ perspectives were included. All the quotes collected from the studies were reviewed and coded, and thematic analysis was used to derive themes.ResultsArticle screening and review yielded a total of 13 qualitative studies, from which the following themes emerged: (1) fathers’ parenting practices and role-modeling behaviors, (2) fathers’ roles in their relationships with their family members, and (3) fathers’ resource-seeking behaviors and contributions to their home food environment. Fathers were aware that their parenting practices and role-modeling behaviors could influence their children’s health behaviors. Furthermore, fathers recognized the importance of their relationships with family members, which was reflected in their family roles; that is, whether they took responsibility for childcare and household work, whether their parenting practices were similar to those of their spouses, and whether they involved their children in their activities. Fathers also reported their resource-seeking behaviors as well as their contribution to the home food environment, which affected their children’s health behaviors.ConclusionFathers’ perspectives on their influence on children’s health behaviors reveal their unique paternal role in influencing children’s health behaviors. Fathers’ perspectives could be incorporated into future nursing research to examine the relationship between fathers’ roles and children’s health behaviors to develop better health intervention programs.

Differences in obesity-related health behaviors and health outcomes by rural and Appalachian residency

PurposeObesity and health behaviors are the major modifiable contributors to cancer and health disparities. We examined the differences in obesity-related health behaviors, and health outcomes by rural and Appalachian residency in Ohio.MethodsCross-sectional survey data from the 2011–2019 Behavioral Risk Factor Surveillance System were obtained from the Ohio Department of Health. County-level identifiers were used to classify urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian residency. Self-reported weight, height, health behaviors, and health conditions were used. Logistic regression was used to assess the difference in health behaviors and health outcomes by rural and Appalachian residency. All analyses incorporated with sample weights.ResultsAmong Ohio residents, compared to urban non-Appalachian residents, urban Appalachian and rural Appalachian residents had a higher prevalence of obesity, hypertension, high cholesterol, and cardiovascular diseases, as well as lower rates of healthy diet and physical activity. No difference was found in trends of obesity and obesity-related health outcomes in 2011–2019 by rural and Appalachian residency. However, rural Appalachian residents had a greater increase in obesity, hypertension, and diabetes, whereas rural non-Appalachian had favorable changes in obesity-related health behaviors. Additionally, associations between health behaviors and obesity-related health outcomes differed by rural and Appalachian residency.ConclusionsFindings underscore the importance of distinguishing between urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian populations when assessing health disparities. While the trends of obesity and obesity-related health outcomes did not differ, the association between health behaviors and obesity-related outcomes differed by rural and Appalachian residency.

Deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone location data for enhancing obesity estimation

BackgroundObesity is a serious public health problem. Existing research has shown a strong association between obesity and an individual’s diet and physical activity. If we extend such an association to the neighborhood level, information about the diet and physical activity of the residents of a neighborhood may improve the estimate of neighborhood-level obesity prevalence and help identify the neighborhoods that are more likely to suffer from obesity. However, it is challenging to measure neighborhood-level diet and physical activity through surveys and interviews, especially for a large geographic area.MethodsWe propose a method for deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone location data, and examine the extent to which the derived measurements can enhance obesity estimation, in addition to the socioeconomic and demographic variables typically used in the literature. We conduct case studies in three different U.S. cities, which are New York City, Los Angeles, and Buffalo, using anonymized mobile phone location data from the company SafeGraph. We employ five different statistical and machine learning models to test the potential enhancement brought by the derived measurements for obesity estimation.ResultsWe find that it is feasible to derive neighborhood-level diet and physical activity measurements from anonymized mobile phone location data. The derived measurements provide only a small enhancement for obesity estimation, compared with using a comprehensive set of socioeconomic and demographic variables. However, using these derived measurements alone can achieve a moderate accuracy for obesity estimation, and they may provide a stronger enhancement when comprehensive socioeconomic and demographic data are not available (e.g., in some developing countries). From a methodological perspective, spatially explicit models overall perform better than non-spatial models for neighborhood-level obesity estimation.ConclusionsOur proposed method can be used for deriving neighborhood-level diet and physical activity measurements from anonymized mobile phone data. The derived measurements can enhance obesity estimation, and can be especially useful when comprehensive socioeconomic and demographic data are not available. In addition, these derived measurements can be used to study obesity-related health behaviors, such as visit frequency of neighborhood residents to fast-food restaurants, and to identify primary places contributing to obesity-related issues.

Association of the built environment and neighborhood resources with obesity-related health behaviors in older veterans with hypertension.

To evaluate the association of the built environment and neighborhood resources with exercise, diet, and body mass index (BMI). Person-level data were collected from 533 veterans with uncontrolled hypertension. Neighborhood measures were: (a) census-tract level walkability; and (b) healthy food proximity (HFP). Robust or logistic regression (adjusting for age, race, education, comorbidity, and clustered by provider) was used to evaluate associations between neighborhood and exercise duration (hours/week), exercise adherence (% adherent), saturated fat index (0-10), Healthy Eating Index (HEI; 0-100), HEI adherence (≥ 74 score), stage of change (SOC) for exercise and diet (% in action/maintenance), BMI (kg/m²), and obesity (BMI ≥ 30 kg/m²). The adjusted difference in HEI score (standard error [SE]) between the highest and lowest walkability tertiles was 3.67 (1.35), p = .006; the corresponding comparison for the saturated fat index was 1.03 (.50), p = .041 and BMI was -1.12 (.45), p = .013. The adjusted odds ratio (OR; 95% confidence intervals [CI]) between the highest and lowest walkability tertiles for HEI adherence was 2.16 [1.22, 3.82], p = .009 and for action/maintenance for exercise SOC was 1.78 [1.15, 2.76], p = .011. The adjusted difference (SE) between the highest and lowest HFP tertiles for exercise duration was .65 (.31), p = .03. The adjusted OR [95% CI] between the highest and lowest HFP tertiles for exercise adherence was 1.74 [1.08, 2.79], p = .023 and for action/maintenance for exercise SOC was 1.75 [1.10, 2.79], p = .034. Geographical location is associated with exercise and diet. Environment-tailored health recommendations could promote healthier lifestyles and decrease obesity-related cardiovascular disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of Group-delivered Stress-reduction Guided Imagery on Salivary Cortisol, Salivary Amylase, and Stress Mood in Urban, Predominantly Latino Adolescents.

ObjectivesTo determine acute effects of stress-reduction guided imagery delivered in group format on stress biomarkers salivary cortisol and salivary amylase, and on self-reported stress mood, in healthy, predominantly Latino adolescents.Study Design111 adolescent participants (94% Latino), a subset from a large, randomized controlled lifestyle intervention to improve obesity-related health behaviors, received either 4 weekly lifestyle education sessions (Lifestyle group; LS) or the same weekly lifestyle education sessions plus an additional weekly stress-reduction guided imagery session delivered in group format (Guided imagery group; GI). Salivary cortisol, salivary amylase, and self-reported stress moods were assessed before and after sessions on intervention weeks 3 and 4. Statistics: Linear mixed effects models examined within- and between-session and group differences in pre- to post-session changes.ResultsBoth groups showed decreases in salivary cortisol, 5% decrease in LS group and 32% in GI group (within-group differences all P < .05), with between-group difference in salivary cortisol of moderate size (P = .05; Cohen’s d = .44). Within the GI group alone, salivary cortisol decrease was similar following either the lifestyle or GI sessions (P = .64). There were no statistically significant amylase changes within or between groups. All 5 individual stress moods declined by 27% to 46% in the GI group (all P < .05), while only 1 of the 5 declined in LS group.ConclusionsGroup stress-reduction guided imagery reduces the stress biomarker salivary cortisol, as well as reducing subjective stress mood states, making it a viable modality for large scale stress-reduction interventions.

Contextualising individual, household and community level factors associated with sugar-sweetened beverage intake and screen time in Soweto, South Africa

ABSTRACT This study examined the relationship between individual, household, and community-level factors with obesity-related health behaviors. Households (n = 6110) were enumerated, and participants (>18 years) reported their screen time and how many sugar-sweetened beverages they consumed per day. Individuals from food insecure and higher SES households were more likely to report higher sugar-sweetened beverage consumption. Screen time was negatively associated with age (p < .01), and being female was associated with 35 minutes more screen time per day (p < .01). Community and household factors were independent drivers of behavior that need to be incorporated into individual level interventions, or considered in analyses.

Supplemental Material for Association of the Built Environment and Neighborhood Resources With Obesity-Related Health Behaviors in Older Veterans With Hypertension

Supplemental Material for Association of the Built Environment and Neighborhood Resources With Obesity-Related Health Behaviors in Older Veterans With Hypertension

Reflections on obesity-related health behaviors over time and suggestions for health promotion programs from African American women

ABSTRACT African American (AA) women have the highest rate of obesity in the United States. To date, there are mixed findings on AA women’s perception on obesity and their perceived changes in health behaviors over time that may have contributed to obesity. Therefore, the aims of this current qualitative descriptive study were to explore: 1) AA women’s perception on obesity and perceived changes in health behaviors related to obesity through their reflection on life; 2) AA women’s perceived facilitators and barriers to maintaining healthy behaviors; and 3) AA women’s suggestions for future health promotion programs to manage obesity. Semi-structured interviews with ended questions were conducted with 21 AA women. Luborsky’s method for thematic analysis was used to analyze data. Three main themes with subthemes were identified. First main theme was the AA culture that served as a facilitator and barrier to maintaining healthy lifestyle from childhood to young adulthood. Second main theme was gradual changes in their healthy lifestyle due to social and physical environment from young adulthood to middle adulthood. Third main theme was AA women’s various suggestions for future health promotion programs. This study found obesity to be a multifactorial phenomenon that is a result of complex interaction of culture, environment, and social networks. Therefore, clinicians need to address the issue of obesity from a holistic perspective for AA women to actively engage with their primary health care. Future health promotion programs should incorporate culturally tailored lifestyle components and increase knowledge on healthy lifestyle against obesity through community-based programs.

Are the factors associated with overweight/general obesity and abdominal obesity different depending on menopausal status?

Rapid modernization in China has impacted the daily lives and health of women, including a rise in obesity. However, little is known about the impact of menopausal status, behavior, and psychosocial factors on the risk of obesity for rural women in China. The aim of this study is to identify risk factors, including demographic information (education, family history of T2DM, menopausal status), obesity-related behavior, and psychosocial factors associated with overweight/general obesity and abdominal obesity. In a cross-sectional study design, participants had their weight, height, and waist circumference measured and completed questionnaires regarding family demographics, obesity-related health behaviors (physical activity, diet, sleep), and psychosocial information (stress, social support, and self-efficacy related to physical activity and healthy diet). A total of 646 women were included in this study; 46.6% were overweight/generally obese, and 48% had abdominal obesity. Postmenopausal women had a higher prevalence of general and central obesity. Regular physical activity decreased the risk for overweight/general obesity and abdominal obesity (OR = .41 and .31, respectively, p = .04) in premenopausal women. Postmenopausal women who had not breastfed their infants and reported moderate/high-stress had a higher risk for overweight/general obesity (OR = 3.93, and 2, respectively) and those who reported less than 6 hours of sleep per day increased their risk for abdominal obesity (OR = 2.08). Different factors associated with obesity were found in Chinese women, depending on menopausal status. Future studies should examine the impact of menopause on a woman’s risk for obesity, as well as develop tailored interventions to improve health, well-being and reduce the risk of obesity.

Cross-Sectional Relationship between Regular Bedtime and Weight Status and Obesity-Related Behaviors among Preschool and Elementary School Children: TX CORD Study.

Background: This study examines the relations between a regular weekday bedtime with weight status, diet quality, physical activity, wellbeing, and parental rules among children 2 to 12 years of age from low-income populations. Methods: The study used baseline data collected in 2012, as part of a larger quasiexperimental study design. A convenience sample of parents of children in preschools, second, or fifth grade attending Head Start centers or elementary schools located in low-income catchment areas, in Houston and Austin, TX, were recruited to participate in the study (n = 32 elementary schools; n = 12 Head Start centers). Regular weekday bedtime was measured with the question "Does your child have a regular weekday bedtime?" Results: The sample of 1467 child-parent dyads were split approximately evenly by sex, and consisted of 44.4% Pre-K, 30.4% second grade, and 25.2% fifth grade students. Six hundred twenty-two (43.6%) children were overweight or obese. Children who had a regular bedtime had 15% lower odds of being overweight or obese (adjusted odds ratio [aOR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p-value: 0.017). Also, children who had a regular bedtime had 45% higher odds of eating the recommended number of fruits and vegetables (aOR: 1.45, 95% CI: 1.02-2.07, p-value: 0.039) and had physical activity more days of the week (β: 0.42, 95% CI: 0.26-0.57, p-value: <0.001). Conclusions: Having a regular weekday bedtime is associated with better weight status and several obesity-related health behaviors in children. Parental report of regular bedtimes for their children may be an indication of parenting skills related to other health-related behaviors for prevention of childhood obesity.

Hyperactivity is associated with higher fat-free mass and physical activity in Swedish preschoolers: A cross-sectional study.

AimWe investigated psychological strengths and difficulties in a Swedish population of preschool children and analysed how these behavioural variables were related to body composition, cardiorespiratory fitness, physical activity levels, sedentary behaviour and diet.MethodsThree hundred and fifteen boys and girls were recruited during 2014‐2015. Body composition was measured using air‐displacement plethysmography, and anthropometric measures were taken. Parents responded to questions about age, sex and educational attainment, diet, physical activity levels and smoking habits, as well as the Strengths and Difficulties Questionnaire (SDQ). Regression models were created to analyse associations between psychological variables, body composition and health behaviours.ResultsHyperactivity scores were positively related to fat‐free mass (β = 0.20, P = .001) and moderate‐to‐vigorous physical activity (β = 0.16, P = .003) and negatively associated with sedentary behaviours (β = 0.18, P = .001), but showed no statistically significant associations with fat mass.ConclusionOur findings suggest that the adverse health consequences of hyperactivity on obesity and obesity‐related health behaviours may be established after the preschool period. Questions about the time frame of contributing and modulating factors in obesity development are discussed.

Role of sleep duration and obesity-related health behaviors in young children.

Adverse health outcomes and obesity are especially high among children with sleep deficiencies. Such health consequences may differentially affect children 2–5 years of age, during which time children undergo drastic shifts in sleep patterns and neurological development. To date, little epidemiologic research has examined the link between sleep and obesity-related health behaviors among this age group. We investigated the relationship between sleep and eating/physical activity behaviors among children aged 2–5 years old. In fall 2018, parents and teachers of 1,169 children attending 34 Early Childcare Education (ECE) centers in Georgia completed surveys on sleep patterns and obesity-related health and eating behaviors. In this analysis, sleep was not associated with various child eating behaviors either at home or in the classroom, however, shorter sleep duration was found to be associated with lower physical activity during the school day (p < 0.01). Furthermore, when stratifying by gender, girls sleeping <10 h were less likely to eat more than one vegetable at home than those sleeping ≥10 h (p = 0.04). This preliminary evidence is a starting point, from which researchers may continue elucidating the drivers of obesity in this understudied population.

What factors are associated with obesity-related health behaviours among child refugees following resettlement in developed countries? A systematic review and synthesis of qualitative and quantitative evidence.

Refugee children are likely to become less active and eat more unhealthily after their resettlement in developed countries. This review aims to identify and synthesize research about factors that influence unhealthy behaviours related to obesity in this population. Six electronic databases were searched systematically to identify studies that sampled refugee children or parents of refugee children aged 2 to 16 years who have resettled in a developed country. Methodological and cultural study quality was assessed and factors associated with obesity-related health behaviours investigated. Twenty studies fulfilled the inclusion criteria. Five major themes, representing factors influencing health behaviours, were identified from the data synthesis process: Acculturation, Environmental, Socioeconomic, Cognitive, and Family. The analysis revealed that refugee's health behaviours are influenced by several complex factors that are common to immigrant groups but have a greater influence among refugees. The review also revealed parental practices influence the health behaviours of children, especially those aged 2 to 10 years. Research is needed to understand further the role that parents have in influencing health behaviours and weight trajectories of children following resettlement.

Diet quality of elementary and middle school teachers is associated with healthier nutrition-related classroom practices.

Many schools have implemented policies and programs to address childhood obesity. However, few have evaluated obesity-related health behaviors among teachers, or how these behaviors may be associated with teachers' nutrition-related practices in the classroom setting. This cross-sectional study utilized data from teachers employed in 20 schools representing three public school districts in a mid-Atlantic state from 2017 to 2019 to examine associations between teachers' diet quality and their nutrition-related classroom practices (e.g. rewarding students with food; modeling healthy diet behaviors). Measures included: one 24-h dietary recall summarized via healthy eating index (HEI-2015; higher scores indicate better diet quality; Range: 0-100); demographics, self-reported height/weight (BMI; ≥25kg/m2=overweight/obese), and nutrition-related classroom practices (10 item survey; sum score range: 0-40; alpha=0.65; higher score=more health-promoting practices). Associations between HEI and nutrition-related classroom practices were assessed in multilevel models, adjusting for covariates (gender, race/ethnicity, age, income, BMI, years teaching) and controlling for within-school effects. Of 331 teachers recruited, 116 (35.0%) completed both the optional dietary recall and incentivized survey (analytic sample: 89% female; 45% black; 79% overweight/obese; BMI=30.5±7.1; aged 41.1±11.8years). Means and standard deviations were calculated for HEI (52.2±12.2) and nutrition-related classroom practices sum score (25.4±5.9). For every one-unit increase in HEI, there was a 0.20 increase in nutrition-related classroom practices score (SE=0.05; p<0.001), which remained significant in the adjusted model. To better inform obesity prevention efforts, future studies should collect data among both students and teachers and explore the mechanisms through which teacher health behaviors may impact student health behaviors.

A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study.

BackgroundPromotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology.ObjectiveThis study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds.MethodsA total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires.ResultsFor the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology.ConclusionsIncorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial.

Cross-Sectional Associations of Neighborhood Perception, Physical Activity, and Sedentary Time in Community-Dwelling, Socioeconomically Diverse Adults.

Background: Little is known about the role of perceived neighborhood environment as a determinant of physical activity (PA) and sedentary time (ST) in understanding obesity-related health behaviors. We focus on a biracial, socioeconomically diverse population using objectively measured ST, which is under-represented in the literature.Methods: We examined the association between self-reported neighborhood perception (Likert-scale questions), PA using the Baecke questionnaire, and both non-sedentary time and ST using accelerometry from wave 4 of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 2,167). After applying exclusion criteria, the sample size was n = 1,359 for analyses of self-reported PA and n = 404 for analyses of accelerometry data. Factor analysis identified key neighborhood characteristics to develop a total neighborhood perception score (NPS). Higher NPS indicated less favorable neighborhood perception. Linear regression was used to determine the relationship between NPS, PA, non-sedentary time, and ST.Results: Complete data were available for n = 1,359 [age 56.6(9.0) years, 59.5% female, 62.2% African American] for whom we identified four neighborhood perception factors: (1) concern about crime, (2) physical environment, (3) location of violent crime, and (4) social environment. Worsening perception of the overall neighborhood [β = −0.13 (SE = 0.03); p = 0.001], the physical environment [−0.11 (0.05); p = 0.03], and the social environment [−0.46 (0.07); p < 0.0001] were associated with decreased PA. Worsening perception of the overall neighborhood [1.14 (0.49); p = 0.02] and neighborhood social environment [3.59 (1.18); p = 0.003] were associated with increased ST over the day. There were no interactions for race, sex, poverty status, or economic index.Conclusion: Poor overall neighborhood perception, perceived social environment, and perceived neighborhood physical environment are associated with PA and ST in a multi-racial, socioeconomically diverse cohort of urban adults.Clinical Trial Registration: The HANDLS study is registered at ClinicalTrials.gov as NCT01323322.