App-Based Addiction Prevention at German Vocational Schools: Implementation and Reach for a Cluster-Randomized Controlled Trial.

This article examines the implementation, participation rates, and potential determinants of participation in the digital addiction prevention program "ready4life." A two-arm cluster-randomized trial recruited German vocational students via class-based strategies. Intervention group received 16 weeks of in-app coaching; the control group received health behavior information, with coaching offered after 12 months. Potential determinants of participation were analyzed based on class and individual characteristics. Out of 525 contacted schools, 35 participated, enrolling 376 classes. Implementation during the pandemic required flexible adjustments, with 49.7% of introductions conducted in person, 43.1% digitally via online streaming, and 7.2% received a video link via email. Despite challenges, 72.3% of the vocational students downloaded the app, and 46.7% gave informed consent. Participation rates were highest among (associate) professionals, vocational grammar school classes, classes introduced by females, younger individuals, members of the project team, and classes introduced face-to-face. Female gender, lower social competencies, lifetime cannabis use, higher problematic internet use, and higher perceived stress were associated with higher individual participation. The study highlights the importance of proactive outreach and personalized interventions for addiction prevention programs in vocational schools. While reached students aligned with the aims of the app, tailored recruitment strategies could enhance engagement among under-represented groups. The trial was registered in the German Clinical Trials Register (DRKS): DRKS00022328; registration date 09.10.2020.

Associations of accelerometer-based sedentary bouts with adiposity markers among German adults - results from a cross-sectional study.

BACKGROUND: Long periods of uninterrupted sitting, i.e., sedentary bouts, and their relationship with adverse health outcomes have moved into focus of public health recommendations. However, evidence on associations between sedentary bouts and adiposity markers is limited. Our aim was to investigate associations of the daily number of sedentary bouts with waist circumference (WC) and body mass index (BMI) in a sample of middle-aged to older adults. METHODS: In this cross-sectional study, data were collected from three different studies that took place in the area of Greifswald, Northern Germany, between 2012 and 2018. In total, 460 adults from the general population aged 40 to 75 years and without known cardiovascular disease wore tri-axial accelerometers (ActiGraph Model GT3X+, Pensacola, FL) on the hip for seven consecutive days. A wear time of ≥ 10 h on ≥ 4 days was required for analyses. WC (cm) and BMI (kg m- 2) were measured in a standardized way. Separate multilevel mixed-effects linear regression analyses were used to investigate associations of sedentary bouts (1 to 10 min, >10 to 30 min, and >30 min) with WC and BMI. Models were adjusted for potential confounders including sex, age, school education, employment, current smoking, season of data collection, and composition of accelerometer-based time use. RESULTS: Participants (66% females) were on average 57.1 (standard deviation, SD 8.5) years old and 36% had a school education >10 years. The mean number of sedentary bouts per day was 95.1 (SD 25.0) for 1-to-10-minute bouts, 13.3 (SD 3.4) for >10-to-30-minute bouts and 3.5 (SD 1.9) for >30-minute bouts. Mean WC was 91.1 cm (SD 12.3) and mean BMI was 26.9 kg m- 2 (SD 3.8). The daily number of 1-to-10-minute bouts was inversely associated with BMI (b = -0.027; p = 0.047) and the daily number of >30-minute bouts was positively associated with WC (b = 0.330; p = 0.001). All other associations were not statistically significant. CONCLUSION: The findings provide some evidence on favourable associations of short sedentary bouts as well as unfavourable associations of long sedentary bouts with adiposity markers. Our results may contribute to a growing body of literature that can help to define public health recommendations for interrupting prolonged sedentary periods. TRIAL REGISTRATION: Study 1: German Clinical Trials Register (DRKS00010996); study 2: ClinicalTrials.gov (NCT02990039); study 3: ClinicalTrials.gov (NCT03539237).

Association between Alcohol Consumption and Health-Related Quality of Life among Hospital and Ambulatory Care Patients with Past Year Depressive Symptoms.

BACKGROUND: Little is known about how substance use affects health-related quality of life (HRQOL) in depressed individuals. Here, associations between alcohol consumption and HRQOL in hospital and ambulatory care patients with past-year depressive symptoms are analyzed. METHOD: The sample consisted of 590 participants (26.8% non-drinkers) recruited via consecutive screenings. Individuals with alcohol use disorders were excluded. HRQOL was assessed with the Veterans Rand 12-item health survey (VR-12). Multivariable fractional polynomials (MFP) regression analyses were conducted (1) to test for non-linear associations between average daily consumption and HRQOL and (2) to analyze associations between alcohol consumption and the physical and mental health component summaries of the VR-12 and their subdomains. RESULTS: Alcohol consumption was positively associated with the physical health component summary of the VR-12 (p = 0.001) and its subdomains general health (p = 0.006), physical functioning (p < 0.001), and bodily pain (p = 0.017), but not with the mental health component summary (p = 0.941) or any of its subdomains. Average daily alcohol consumption was not associated with HRQOL. CONCLUSION: Alcohol consumption was associated with better physical HRQOL. Findings do not justify ascribing alcohol positive effects on HRQOL. Data indicate that non-drinkers may suffer from serious health disorders. The results of this study can inform the development of future alcohol- and depression-related interventions.

Longitudinal measurement invariance of the patient health questionnaire in a German sample.

BACKGROUND: The Patient Health Questionnaire-8 (PHQ-8) is a screening questionnaire of depressive symptoms. However, it is unknown whether it is equivalent across time and between groups of individuals. The aim of our paper was to test whether the PHQ-8 has the same meaning in two groups of individuals over time. METHODS: Primary care patients were proactively recruited from three German cities. PHQ-8 data from a baseline assessment (n = 588), two assessments during the intervention (n = 246/225), and a six (n = 437) and 12 months (n = 447) follow-up assessment were first used to examine the factor structure of the PHQ-8 by confirmatory factor analysis (CFA). The best fitting factor solution was then used to test longitudinal invariance across time and between intervention and control group by Multiple Group CFA. RESULTS: A two-factor structure consistently showed the best model fit. Only configural longitudinal invariance was evidenced when the baseline assessment was included in the analysis. Without the baseline assessment, strict longitudinal invariance was shown across the intervention and the follow-up assessments. Scalar invariance was established between the intervention and control group for the baseline assessment and strict invariance between groups and across the 6- and 12-month follow-up assessments. CONCLUSIONS: The lack of longitudinal invariance might be attributed to various differences between the baseline assessments and all following assessments, e.g., assessment mode (iPad vs telephone), potential changes in symptom perception, and setting. TRIAL REGISTRATION: DRKS0001163 5, date of trial registration: 20.01.2017; DRKS00011637 , date of trial registration: 25.01.2017.

Latent alcohol use patterns and their link to depressive symptomatology in medical care patients.

AIMS: To investigate latent patterns of alcohol use and bingeing by gender and their association with depressive symptom severity and individual depressive symptoms. DESIGN: Cross-sectional data were collected from January 2017 to March 2018 as part of a joint screening recruiting for different intervention studies. SETTING: Ambulatory practices and general hospitals from three sites in Germany. PARTICIPANTS: A total of 5208 male and 5469 female proactively recruited alcohol users aged 18-64 years. MEASUREMENTS: Frequency and typical quantity of alcohol use, frequency of bingeing, alcohol-related problems (assessed by the Alcohol Use Disorder Identification Test); depressive symptom severity, individual depressive symptoms (assessed with the Patient Health Questionnaire-8); and socio-demographics and health-related variables. FINDINGS: Latent categorical analysis identified six patterns of alcohol use, with the majority of patients engaging in 'light use plus no or occasional bingeing' (males: 41.85%; females: 64.04%), followed by 'regular use plus occasional bingeing' (males: 34.03%; females: 16.17%). Multinomial logistic regression analyses (three-step approach with correction for classification uncertainty, as implemented in the Mplus R3STEP command) controlling for socio-demographics and health-related variables revealed that severity of depressive symptoms was positively associated with 'frequent use plus frequent bingeing' when compared with 'light use plus no or occasional bingeing' [relative risk ratio (RRR)male  = 1.07, 95% confidence interval (CI) = 1.03-1.11; RRRfemale  = 1.09, 95% CI = 1.04-1.14]. Severity of depressive symptoms was negatively associated with 'regular use plus occasional bingeing' for males (RRRmale  = 0.98, 95% CI = 0.95-1.00) and positively with 'occasional use plus occasional bingeing' for females (RRRfemale  = 1.03, 95% CI = 1.01-1.05) when compared with 'light use plus no or occasional bingeing'. Individual depressive symptoms were differentially associated with alcohol use patterns, with depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation, being especially pronounced in the 'frequent use plus frequent bingeing' class (RRRsmale  = 1.72-2.36; RRRsfemale  = 1.99-2.17). CONCLUSIONS: Patterns of 'frequent alcohol use plus frequent bingeing' and 'occasional alcohol use plus occasional bingeing' appear to have positive associations with depression when compared with 'light alcohol use plus no or occasional bingeing'.

Copattern of depression and alcohol use in medical care patients: cross-sectional study in Germany.

OBJECTIVE: To predict depressive symptom severity and presence of major depression along the full alcohol use continuum. DESIGN: Cross-sectional study. SETTING: Ambulatory practices and general hospitals from three sites in Germany. PARTICIPANTS: Consecutive patients aged 18-64 years were proactively approached for an anonymous health screening (participation rate=87%, N=12 828). Four continuous alcohol use measures were derived from an expanded Alcohol Use Disorder Identification Test (AUDIT): alcohol consumption in grams per day and occasion, excessive consumption in days per months and the AUDIT sum score. Depressive symptoms were assessed for the worst 2-week period in the last 12 months using the Patient Health Questionnaire (PHQ-8). Negative binomial and logistic regression analyses were used to predict depressive symptom severity (PHQ-8 sum score) and presence of major depression (PHQ-8 sum score≥10) by the alcohol use measures. RESULTS: Analyses revealed that depressive symptom severity and presence of major depression were significantly predicted by all alcohol use measures after controlling for sociodemographics and health behaviours (p<0.05). The relationships were curvilinear: lowest depressive symptom severity and odds of major depression were found for alcohol consumptions of 1.1 g/day, 10.5 g/occasion, 1 excessive consumption day/month, and those with an AUDIT score of 2. Higher depressive symptom severity and odds of major depression were found for both abstinence from and higher levels of alcohol consumption. Interaction analyses revealed steeper risk increases in women and younger individuals for most alcohol use measures. CONCLUSION: Findings indicate that alcohol use and depression in medical care patients are associated in a curvilinear manner and that moderation by gender and age is present.

Do accelerometer-based physical activity patterns differentially affect cardiorespiratory fitness? A growth mixture modeling approach.

Findings on the association between cardiorespiratory fitness (CRF) and moderate-to-vigorous physical activity (MVPA) may be distorted if patterns of accumulated MVPA over a week exist but are ignored. Our aim was to identify MVPA patterns and to associate them to CRF. Two hundred twenty-four 40-75-year-old adults wore accelerometers for 7 days. CRF was measured by peak oxygen uptake (V'O2,peak) assessed on a cycle ergometer via standardized cardiopulmonary exercise testing. Growth mixture modeling indicated four MVPA patterns: "low/stable" (57%, Mean MVPA time (M) = 21 min day-1), "medium/stable" (20%, M = 46 min day-1), "medium/weekend high" (14%, M = 47 min day-1), and "high/weekend low" (9%, M = 71 min day-1). V'O2,peak was higher for persons with "high/weekend low" and "medium/weekend high" patterns compared to "low/stable" and "medium/stable" (p values < 0.001). The same total amount of MVPA may have greater benefit if performed on fewer days during the week but with a longer duration than if performed every day but with a lower duration.

Feasibility and Acceptability of an Intervention Providing Computer-Generated Tailored Feedback to Target Alcohol Consumption and Depressive Symptoms in Proactively Recruited Health Care Patients and Reactively Recruited Media Volunteers: Results of a Pilot Study.

BACKGROUND: A pre-post pilot study was conducted to test the feasibility, acceptability, and potential effectiveness of a fully automatized computer-based intervention targeting hazardous drinking and depressiveness in proactively recruited health care patients (HCPs). To address the importance of the sample selection when testing interventions, HCPs were compared to media recruited volunteers (MVs). METHOD: In a multicenter screening program 2,773 HCPs were screened for hazardous drinking and depressive symptoms. MVs were recruited via media solicitation. Over a period of 6 months, study participants received 6 individualized counseling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. RESULTS: MVs showed higher problem severity and motivation to change than HCPs. Over the course of the intervention both subsamples reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily alcohol consumption (p = 0.034). The intervention received positive ratings from both subsamples, the alcohol module was rated more favorably by MVs than by HCPs (p = 0.012). Subsamples further differed in terms of intervention usage (p = 0.013). CONCLUSION: The intervention was technically and logistically feasible, well accepted, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations. Subsamples differed in terms of problem severity, motivation to change, intervention usage, pre-post changes, and attitudes toward the intervention, showing that intervention development should involve the intended target populations to avoid biased conclusions on intervention effectiveness and acceptability.

Proactive multipurpose health risk screening in health care settings: Methods, design, and reach.

OBJECTIVES: Real world implementation of proactive screening and brief intervention in health care is threatened by high cost. Using e-health interventions and screening for multiple health risk factors may provide more efficiency. We describe methodological details of a proactive multipurpose health risk screening in health care settings and report on participation rates, participants' characteristics, and participation factors. METHODS: Patients between 18 and 64 years from ambulatory practices and hospitals were proactively approached by study assistants at three sites for a computerized screening on harmful alcohol and tobacco consumption, depressive symptoms, insufficient fruit/vegetable consumption, physical inactivity and overweight. On the basis of their health risk pattern, a computerized algorithm allocated patients to one of five studies each of them addressing a psychiatric research question. RESULTS: Among all eligible patients, 13,763 (86.5%) were screened. Younger age and being female predicted screening participation. Of those with complete data (n = 12,828), 82.9% reported at least two health risks and 34.0% were eligible for a study. Study participation ranged between 35.2% and 50.8%, and was associated with socio-demographics and problem severity. CONCLUSIONS: This study supports the use of systematic proactive screening for multiple health risks in health care settings as it is more resource-saving than single focused screening.

Measurement invariance of the alcohol use disorders identification test: Establishing its factor structure in different settings and across gender.

INTRODUCTION: The Alcohol Use Disorders Identification Test (AUDIT) is an internationally well-established screening tool for the assessment of hazardous and harmful alcohol consumption. To be valid for group comparisons, the AUDIT should measure the same latent construct with the same structure across groups. This is determined by measurement invariance. So far, measurement invariance of the AUDIT has rarely been investigated. We analyzed measurement invariance across gender and samples from different settings (i.e., inpatients from general hospital, patients from general medical practices, general population). METHODS: A sample of n = 28,345 participants from general hospitals, general medical practices and the general population was provided from six studies. First, we used Confirmatory Factor Analysis (CFA) to establish the factorial structure of the AUDIT by comparing a single-factor model to a two-factor model for each group. Next, Multiple Group CFA was used to investigate measurement invariance. RESULTS: The two-factor structure was shown to be preferable for all groups. Furthermore, strict measurement invariance was established across all groups for the AUDIT. CONCLUSION: A two-factor structure for the AUDIT is preferred. Nevertheless, the one-factor structure also showed a good fit to the data. The findings support the AUDIT as a psychometrically valid and reliable screening instrument.

Explaining the relation between pathological gambling and depression: Rumination as an underlying common cause.

Background and aims Symptoms of pathological gambling (SPG) and depression often co-occur. The nature of this relationship remains unclear. Rumination, which is well known to be associated with depression, might act as a common underlying factor explaining the frequent co-occurrence of both conditions. The aim of this study is to analyze associations between the rumination subfactors brooding and reflection and SPG. Methods Participants aged 14-64 years were recruited within an epidemiological study on pathological gambling in Germany. Cross-sectional data of 506 (80.4% male) individuals with a history of gambling problems were analyzed. The assessment included a standardized clinical interview. To examine the effects of rumination across different levels of problem gambling severity, sequential quantile regression was used to analyze the association between the rumination subfactors and SPG. Results Brooding (p = .005) was positively associated with the severity of problem gambling after adjusting for reflection, depressive symptoms, and sociodemographic variables. Along the distribution of problem gambling severity, findings hold for all but the lowest severity level. Reflection (p = .347) was not associated with the severity of problem gambling at the median. Along the distribution of problem gambling severity, there was an inverse association at only one quantile. Discussion and conclusions Brooding might be important in the development and maintenance of problem gambling. With its relations to depression and problem gambling, it might be crucial when it comes to explaining the high comorbidity rates between SPG and depression. The role of reflection in SPG remains inconclusive.

Reach of Individuals at Risk for Cardiovascular Disease by Proactive Recruitment Strategies in General Practices, Job Centers, and Health Insurance.

PURPOSE: Reach of individuals at risk for cardiovascular disease (CVD) constitutes a major determinant of the population impact of preventive effort. This study compares three proactive recruitment strategies regarding their reach of individuals with CVD risk factors. METHOD: Individuals aged 40-65 years were invited to a two-stage cardio-preventive program including an on-site health screening and a cardiovascular examination program (CEP) using face-to-face recruitment in general practices (n = 671), job centers (n = 1049), and mail invitations from health insurance (n = 894). The recruitment strategies were compared regarding the following: (1) participation rate; (2) participants' characteristics, i.e., socio-demographics, self-reported health, and CVD risk factors (smoking, physical activity, fruit/vegetable consumption, body mass index, blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin); and (3) participation factors, i.e., differences between participants and non-participants. RESULTS: Screening participation rates were 56.0, 32.8, and 23.5 % for the general practices, the job centers, and the health insurance, respectively. Among eligible individuals for the CEP, respectively, 80.3, 65.5, and 96.1 % participated in the CEP. Job center clients showed the lowest socio-economic status and the most adverse CVD risk pattern. Being female predicted screening participation across all strategies (OR = 1.45, 95 % CI 1.07-1.98; OR = 1.34, 95 % CI 1.04-1.74; OR = 1.62, 95 % CI 1.16-2.27). Age predicted screening participation only within health insurance (OR = 1.04, 95 % CI 1.01-1.06). Within the general practices and the job centers, CEP participants were less likely to be smokers than non-participants (OR = 0.49, 95 % CI 0.26-0.94; OR = 0.42, 95 % CI 0.20-0.89). CONCLUSION: The recruitment in general practices yielded the highest reach. However, job centers may be useful to reduce health inequalities induced by social gradient.

Agreement between activPAL3c accelerometers placed at different thigh positions.

ActivPAL3c triaxial accelerometers are increasingly used to assess physical activity and sedentary behaviours. However, little is known how attachment site (left vs. right or upper vs. lower thigh) affects activPAL3c accelerometer outcomes. Twenty-eight adults wore four activPAL3c accelerometers attached 2cm above and below the midpoint of the left and right thigh during five minutes of laboratory-based walking at a self-selected pace, treadmill walking at 0.89 and 1.56m/s, and treadmill running at 2.22m/s, and during approximately seven hours of free-living conditions. One-way ANOVA revealed no statistically significant differences in accelerometer output between ActivPAL3c accelerometers at these locations during both laboratory-based, and free-living conditions. Intraclass correlation coefficients showed a high level of agreement between activPAL3c accelerometers during laboratory and free living activities (ICC(2,1) 0.76-1.00). The attachment sites used in this study do not appear to significantly influence outcomes for step count, sitting or walking time, or number of postural transitions from triaxial activPAL3c accelerometers during laboratory-based walking or free-living conditions. Therefore if necessary, to enhance participant compliance during monitoring periods, these sites could be used interchangeably. Studies of longer duration incorporating additional laboratory and recreational activities are needed to confirm these findings.

Interest and preferences for using advanced physical activity tracking devices: results of a national cross-sectional survey.

OBJECTIVES: Pedometers are an effective self-monitoring tool to increase users' physical activity. However, a range of advanced trackers that measure physical activity 24 hours per day have emerged (eg, Fitbit). The current study aims to determine people's current use, interest and preferences for advanced trackers. DESIGN AND PARTICIPANTS: A cross-sectional national telephone survey was conducted in Australia with 1349 respondents. OUTCOME MEASURES: Regression analyses were used to determine whether tracker interest and use, and use of advanced trackers over pedometers is a function of demographics. Preferences for tracker features and reasons for not wanting to wear a tracker are also presented. RESULTS: Over one-third of participants (35%) had used a tracker, and 16% are interested in using one. Multinomial regression (n=1257) revealed that the use of trackers was lower in males (OR=0.48, 95% CI 0.36 to 0.65), non-working participants (OR=0.43, 95% CI 0.30 to 0.61), participants with lower education (OR=0.52, 95% CI 0.38 to 0.72) and inactive participants (OR=0.52, 95% CI 0.39 to 0.70). Interest in using a tracker was higher in younger participants (OR=1.73, 95% CI 1.15 to 2.58). The most frequently used tracker was a pedometer (59%). Logistic regression (n=445) revealed that use of advanced trackers compared with pedometers was higher in males (OR=1.67, 95% CI 1.01 to 2.79) and younger participants (OR=2.96, 95% CI 1.71 to 5.13), and lower in inactive participants (OR=0.35, 95% CI 0.19 to 0.63). Over half of current or interested tracker users (53%) prefer to wear it on their wrist, 31% considered counting steps the most important function and 30% regarded accuracy as the most important characteristic. The main reasons for not wanting to use a tracker were, 'I don't think it would help me' (39%), and 'I don't want to increase my activity' (47%). CONCLUSIONS: Activity trackers are a promising tool to engage people in self-monitoring a physical activity. Trackers used in physical activity interventions should align with the preferences of target groups, and should be able to be worn on the wrist, measure steps and be accurate.

Engagement and Nonusage Attrition With a Free Physical Activity Promotion Program: The Case of 10,000 Steps Australia.

BACKGROUND: Data from controlled trials indicate that Web-based interventions generally suffer from low engagement and high attrition. This is important because the level of exposure to intervention content is linked to intervention effectiveness. However, data from real-life Web-based behavior change interventions are scarce, especially when looking at physical activity promotion. OBJECTIVE: The aims of this study were to (1) examine the engagement with the freely available physical activity promotion program 10,000 Steps, (2) examine how the use of a smartphone app may be helpful in increasing engagement with the intervention and in decreasing nonusage attrition, and (3) identify sociodemographic- and engagement-related determinants of nonusage attrition. METHODS: Users (N=16,948) were grouped based on which platform (website, app) they logged their physical activity: Web only, app only, or Web and app. Groups were compared on sociodemographics and engagement parameters (duration of usage, number of individual and workplace challenges started, and number of physical activity log days) using ANOVA and chi-square tests. For a subsample of users that had been members for at least 3 months (n=11,651), Kaplan-Meier survival curves were estimated to plot attrition over the first 3 months after registration. A Cox regression model was used to determine predictors of nonusage attrition. RESULTS: In the overall sample, user groups differed significantly in all sociodemographics and engagement parameters. Engagement with the program was highest for Web-and-app users. In the subsample, 50.00% (5826/11,651) of users stopped logging physical activity through the program after 30 days. Cox regression showed that user group predicted nonusage attrition: Web-and-app users (hazard ratio=0.86, 95% CI 0.81-0.93, P<.001) and app-only users (hazard ratio=0.63, 95% CI 0.58-0.68, P<.001) showed a reduced attrition risk compared to Web-only users. Further, having a higher number of individual challenges (hazard ratio=0.62, 95% CI 0.59-0.66, P<.001), workplace challenges (hazard ratio=0.94, 95% CI 0.90-0.97, P<.001), physical activity logging days (hazard ratio=0.921, 95% CI 0.919-0.922, P<.001), and steps logged per day (hazard ratio=0.99999, 95% CI 0.99998-0.99999, P<.001) were associated with reduced nonusage attrition risk as well as older age (hazard ratio=0.992, 95% CI 0.991-0.994, P<.001), being male (hazard ratio=0.85, 95% CI 0.82-0.89, P<.001), and being non-Australian (hazard ratio=0.87, 95% CI 0.82-0.91, P<.001). CONCLUSIONS: Compared to other freely accessible Web-based health behavior interventions, the 10,000 Steps program showed high engagement. The use of an app alone or in addition to the website can enhance program engagement and reduce risk of attrition. Better understanding of participant reasons for reducing engagement can assist in clarifying how to best address this issue to maximize behavior change.

The association between physical activity, sitting time, sleep duration, and sleep quality as correlates of presenteeism.

OBJECTIVE: This study aims to examine the relationship of lifestyle behaviors (physical activity, work and non-work sitting time, sleep quality, and sleep duration) with presenteeism while controlling for sociodemographics, work- and health-related variables. METHODS: Data were collected from 710 workers (aged 20 to 76 years; 47.9% women) from randomly selected Australian adults who completed an online survey. Linear regression was used to examine the relationship between lifestyle behaviors and presenteeism. RESULTS: Poorer sleep quality (standardized regression coefficients [B] = 0.112; P < 0.05), suboptimal duration (B = 0.081; P < 0.05), and lower work sitting time (B = -0.086; P < 0.05) were significantly associated with higher presenteeism when controlling for all lifestyle behaviors. Engaging in three risky lifestyle behaviors was associated with higher presenteeism (B = 0.150; P < 0.01) compared with engaging in none or one. CONCLUSIONS: The results of this study highlight the importance of sleep behaviors for presenteeism and call for behavioral interventions that simultaneously address sleep in conjunction with other activity-related behaviors.

Characteristics associated with non-participation in 7-day accelerometry.

OBJECTIVE: To assess levels of physical activity the use of objective physical activity measures like accelerometers is promising. We investigated characteristics associated with non-participation in accelerometry within an apparently healthy sample. METHODS: Among German participants of a cardiovascular examination program (CEP; 2012-2013), 470 participants aged 40-75 years were invited to wear an accelerometer for 7 days. We used multivariate logistic regression to estimate the association between non-participation and the following characteristics of participants: sex, age, education, smoking, setting of recruitment for the CEP (general medical practices, job agencies, statutory health insurance), self-reported general health, and objective health criteria such as cardiorespiratory fitness and absolute number of cardiometabolic risk factors (elevated waist circumference, blood pressure, triglycerides, blood glucose, and reduced high-density lipoprotein). Subsequently, we stratified this analysis by sex. RESULTS: Among all invited individuals, N = 235 (60.0% women) gave consent to participate in accelerometry. Women were more likely to decline participation (odds ratio, 1.7; 95% confidence interval, 1.1-2.7) compared to men. Stratified analyses revealed the absolute number of risk factors as predictor of non-participation for men (1.4; 1.01-2.0), while there was no predictor found in women. CONCLUSION: We found a self-selection bias in participation in accelerometry. Women declined study participation more likely than men. The number of cardiometabolic risk factors decreased compliance only in men. Future studies should consider strategies to reduce this bias.

Validation of a pouch-mounted activPAL3 accelerometer.

The activPAL accelerometer is a commonly used device for the assessment of physical activity in cross-sectional and intervention research. These devices are usually attached directly to the skin; however, recent studies report problems such as skin irritation associated with this attachment method and therefore adequate alternate methods are needed. The aim of this study was to validate the use of an elasticised pouch to secure an activPAL3c (PAL Technologies, Glasgow, UK) accelerometer for the assessment of sedentary and physical activity behaviours during laboratory and free-living conditions. Twenty-eight healthy adults wore two activPAL3c accelerometers, one secured in an elasticised pouch, and one directly attached to the skin, on the anterior surface of the right thigh during laboratory-based walking at a self-selected pace, treadmill walking at 0.89 ms(-1), 1.56 ms(-1) and running at 2.2 ms(-1), and during free-living conditions. Paired samples t-tests and intraclass correlation coefficients were used to investigate the difference and agreement between accelerometer outputs. No statistically significant difference in step count between pouch-mounted and skin-mounted activPAL3c accelerometers was evident during walking at any speed under laboratory conditions. No statistically significant difference in step count, upright time, sitting time or postural transitions was found between pouch-mounted and skin-mounted activPAL3c accelerometers during free-living conditions. Intraclass correlation coefficients showed a high to very high level of agreement between pouch-mounted and skin-mounted activPAL3c accelerometers for each outcome variable. The use of an elasticised pouch to secure the activPAL3c accelerometer appears to be a valid method of attachment and may offer advantages over direct skin mounting.

Association of sociodemographic, psychopathological and gambling-related factors with treatment utilization for pathological gambling.

BACKGROUND/AIMS: Only a small percentage of pathological gamblers utilizes professional treatment for gambling problems. Little is known about which social and gambling-related factors are associated with treatment utilization. The aim of this study was to look for factors associated with treatment utilization for pathological gambling. METHODS: The study followed a sampling design with 3 different recruitment channels, namely (1) a general population-based telephone sample, (2) a gambling location sample and (3) a project telephone hotline. Pathological gambling was diagnosed in a telephone interview. Participants with pathological gambling (n=395) received an in-depth clinical interview concerning treatment utilization, comorbid psychiatric disorders and social characteristics. RESULTS: Variables associated with treatment were higher age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.08], an increased number of DSM-IV criteria for pathological gambling (OR 1.34, 95% CI 1.06-1.70), more adverse consequences from gambling (OR 1.10, 95% CI 1.03-1.16) and more social pressure from significant others (OR 1.17, 95% CI 1.07-1.27). Affective disorders were associated with treatment utilization in the univariate analysis (OR 1.81, 95% CI 1.19-2.73), but multivariate analysis showed that comorbid psychiatric disorders were not independently associated. CONCLUSION: These results indicate that individuals with more severe gambling problems utilize treatment at an older age when more adverse consequences have occurred. Further research should focus on proactive early interventions.

Factor structure of the compulsive internet use scale.

An important step in Internet addiction research is to develop standardized instruments for assessing Internet addiction-related symptoms. The Compulsive Internet Use Scale (CIUS) is a promising brief questionnaire. The aim of this study was to examine the factor structure of a German version of the CIUS with confirmatory factor analysis in a general population sample. In addition, the best fitting structure was tested for factorial invariance across sex, age, education level, and weekly Internet use. We used a weighted general population sample (N=8,132) of 14-64 years olds spending at least 1 hour online for private purposes per typical working or weekend day. Findings include that a one-factor model was found to fit well. It was invariant across sex, age, education level, and weekly Internet use. The findings support the validity of the CIUS as a short screening instrument.