Social participation in the city: exploring the moderating effect of walkability on the associations between active mobility, neighborhood perceptions, and social activities in urban adults.

BACKGROUND: Living in urban environments is associated with several health risks (e.g., noise, and air pollution). However, there are also beneficial aspects such as various opportunities for social activities, which might increase levels of social participation and (physically) active mobility that in turn have positive effects on health and well-being. However, how aspects of the environment, active mobility, and social participation are associated is not well established. This study investigates the moderating effect of low vs. high walkability neighborhoods on the associations between active mobility, and social participation and integrates individuals' subjective perception of the neighborhood environment they are living in. METHODS: Cross-sectional data from 219 adults (48% female, mean age = 46 ± 3.8 years) from 12 urban neighborhoods (six low, six high walkability) were analyzed: First, social participation, active mobility, and subjective neighborhood perceptions were compared between people living in a low vs. high walkability neighborhood via t-tests. Second, multigroup path analyses were computed to explore potential differences in the associations between these variables in low vs. high walkability neighborhoods. RESULTS: Social participation, active mobility, and subjective neighborhood perceptions didn't differ in low vs. high walkability neighborhoods (p: 0.37 - 0.71). Active mobility and subjective neighborhood perceptions were significantly stronger related to social participation in low vs. high walkability neighborhoods (active mobility in low: ß = 0.35, p < .01 vs. high: ß = 0.09, p = .36; subjective neighborhood perceptions in low: ß = 0.27, p < .01 vs. high: ß = 0.15, p = .18). CONCLUSIONS: Despite living in neighborhoods with objectively different walkability, participants rated social participation and active mobility equally and perceived their neighborhoods similarly. However, zooming into the interrelations of these variables reveals that social participation of residents from low walkability neighborhoods depends stronger on active mobility and perceiving the environment positively. Positive perceptions of the environment and active mobility might buffer the objectively worse walkability. Future research should focus on underlying mechanisms and determinants of subjective neighborhood perceptions and active mobility, especially in low walkability neighborhoods.

Mental Health in Urban Environments: Uncovering the Black Box of Person-Place Interactions Requires Interdisciplinary Approaches.

Living in urban environments affects individuals' mental health through different pathways. For instance, physical activity and social participation are seen as mediators. However, aiming to understand underlying mechanisms, it is necessary to consider that the individual is interacting with its environment. In this regard, this viewpoint discusses how urban health research benefits from integration of socioecological and interdisciplinary perspectives, combined with innovative ambulatory data assessments that enable researchers to integrate different data sources. It is stated that neither focusing on the objective and accurate assessment of the environment (from the perspective of spatial sciences) nor focusing on subjectively measured individual variables (from the public health as well as a psychosocial perspective) alone is suitable to further develop the field. Addressing person-place interactions requires an interdisciplinary view on the level of theory (eg, which variables should be focused on?), assessment methods (eg, combination of time-varying objective and subjective measures), as well as data analysis and interpretation. Firstly, this viewpoint gives an overview on previous findings addressing the relationship of environmental characteristics to physical activity and mental health outcomes. We emphasize the need for approaches that allow us to appropriately assess the real-time interaction between a person and a specific environment and examine within-subject associations. This requires the assessment of environmental features, the spatial-temporal behavior of the individual, and the subjective experiences of the situation together with other individual factors, such as momentary affective states. Therefore, we finally focused on triggered study designs as an innovative ambulatory data assessment approach that allows us to capture real-time data in predefined situations (eg, while walking through a specific urban area).

Associations of parents' and adolescents' active travel behavior across various destinations - a sex/gender analysis.

BACKGROUND: Active travel behavior such as walking and cycling is associated with several health benefits. Especially the family environment seems to be important for active travel in children and adolescents. Currently, little is known regarding travel behavior in leisure time and associations of travel behavior within parent-adolescent dyads. METHODS: The present analysis is based on the German ARRIVE study (Active tRavel behavioR in the famIly enVironmEnt), which incorporated a large scale, representative cross-sectional online survey including 517 parent-child dyads consisting of adolescents (N = 517; boys = 263, girls = 254) aged 11-15 years and one of their parents (N = 517; fathers = 259, mothers = 258). Based on that survey which took place in June 2021 (during the COVID-19 pandemic), we calculated the prevalence of active travel to four commonly visited destinations (school/work, friends/relatives, shopping stores and recreational activities) using an adapted version of the travel to school questionnaire by Segura-Diaz JM, Rojas-Jimenez A, Barranco-Ruiz Y, Murillo-Pardo B, Saucedo-Araujo RG, Aranda-Balboa MJ, et al. (Int J Environ Res Public Health 17(14), 2020). In addition, we investigated the associations between parents' and adolescents' travel behavior using scores for school/work, leisure time (friends/relatives, shopping stores and recreational activities) and overall (school/work and leisure time). RESULTS: Across all destinations, prevalence of active travel in adolescents (63.08%) was higher than in parents (29.21%). Active travel to school (47.33%) as well as to work (20.43%) indicated the lowest prevalence. Linear regression models revealed significant associations in overall active travel between mothers and adolescents (girls: ß = 0.308, p < 0.001; boys: ß = 0.302, p = 0.001) and in leisure time active travel behavior between mothers and daughters (ß = 0.316, p < 0.001). Related to school/work active travel there were no associations between parents and adolescents. CONCLUSION: The associations between adolescents' and parents' travel behavior differ depending on gender: they are solely seen in mother-adolescents dyads. Furthermore, our findings conclude that travel is a routine and independent of the destination.

Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries.

BACKGROUND: Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints. OBJECTIVE: This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies. METHODS: The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 (±300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary. RESULTS: Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9%) reconstructed walking routes. Further, in 838 of 1206 (69.5%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4% vs 19% of these situations). CONCLUSIONS: Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy.

How do people feel while walking in the city? Using walking-triggered e-diaries to investigate the association of social interaction and environmental greenness during everyday life walking.

Background: Light to moderate physical activity, which includes walking, is associated with positive effects on physical and mental health. However, concerning mental health, social and physical environmental factors are likely to play an important role in this association. This study investigates person-place interactions between environmental characteristics (greenness, social interaction) and momentary affective states during walking episodes. A within-subject design is implemented, in which affective states and environmental characteristics are assessed while participants are walking outside. Methods: On smartphones, coupled with a motion sensor (move3), e-diaries were triggered as soon as people walked 100 m outside. E-diaries assessed momentary affective states (valence, calmness, energetic arousal), and social interaction (walking alone; seeing other people while walking; interacting with other people; walking with a known person) between 6 am and 10 pm over nine days. The percentage of greenness was determined afterward from recorded GPS and GIS data. Demographics were collected in advance via an online questionnaire. Multilevel models were calculated with R for 46 individuals (age = 41.2, ± 13.2; 52% female). Results: Affective state dimension energetic arousal showed a significant association with social interaction and greenness, i.e., participants rated energetic arousal lower when walking alone, and if there was less greenness vs. when interacting shortly with someone while walking (ß = 0.13, p = 0.02), and being in situations with more greenness (ß = 0.08, p = 0.02). Furthermore, associations with social interaction and greenness were found for dimension calmness: walking together with someone was associated with higher calmness (ß = 0.16, p = 0.02), and the higher the proportion of surrounding greenness during a walk, the higher calmness was rated, i.e., participants were calmer (ß = 0.09, p = 0.01). Significant associations with valence were not present. Conclusion: The findings indicate that the affective states varied significantly due to different social and physical environmental factors. In the future, the importance of environmental factors should be further investigated, e.g., by assessing environmental factors right in situations contrary to a subsequent imputation. Within-subject designs, and in particular triggered assessments with the addition of GPS, can aid in developing interventions for health-promoting urban environments.

The context matters - not all prolonged sitting bouts are equally related to momentary affective states: an ambulatory assessment with sedentary-triggered E-diaries.

BACKGROUND: Sedentary behaviors (SB) and especially prolonged sitting bouts are highly prevalent in daily life and studies indicated an association with an increased risk for several non-communicable diseases. Consequently, guidelines to reduce SB were developed. At the same time, an in-depth knowledge regarding SB such as where, what and with whom people spend time sedentary as well as correlates such as affective states of prolonged sitting bouts, is still lacking. A more differentiated view on SB is necessary to identify detrimental and modifiable sedentary bouts. We addressed this gap by conducting an ambulatory assessment study including accelerometer and sedentary-triggered e-diaries that captures data during prolonged sitting bouts (> 20 min). We investigated how contextual factors of prolonged sitting bouts are associated with momentary affective states. METHOD: Four studies were combined with a final sample of 308 participants (50.3% female, Mage, 27.4, range, 17-66). SB was assessed objectively with thigh-worn accelerometers for four to five days. Whenever a participant was sitting for 20 or 30 min the accelerometer triggered questions assessing social (not alone vs. alone) and environmental (leisure vs. working) factors as well as momentary affective states (valence, energetic arousal and calmness). Multilevel analyses were used to examine within-person associations between different contexts and mood during prolonged sitting. RESULTS: Momentary affective states varied significantly due to different social and environmental contexts (ps < 0.001): Sitting together with others was associated with higher levels of valence and energetic arousal. Furthermore, sitting during leisure time was associated with higher levels of valence and calmness and lower levels of energetic arousal. Significant interaction analyses revealed that participants had the highest ratings while sitting during leisure episodes together with others. CONCLUSION: Findings showed that prolonged sitting bouts differ regarding their association with affect. Sitting with others, sitting during leisure time and especially sitting during leisure time and with others, was associated with higher levels of momentary affective states, respectively. Thus, SB guidelines should focus on reducing those SB episodes that are associated with lower levels of affect, for example during working episodes.

Family health climate: a qualitative exploration of everyday family life and health.

BACKGROUND: The family is an important social environment for children's, adolescents' and adults' health. However, studies mostly focused on dyadic and unidirectional influences of parents on their children. Studies addressing influences arising from daily family life and including family-level influences are rare and the existing studies solely focus on the relevance for children's health or health-related behaviors. We use a qualitative approach to explore how daily family life and its inherent health-related cues affect family members' physical activity and eating behavior. METHODS: Semi-structured interviews utilizing an interview guide were conducted. Since we aimed to examine family life, we analyzed both parents' and their children's views on health-related interaction patterns and family environmental influences on individuals' health-related behavior. Twenty-two members of seven families were interviewed. Transcripts of the interviews were systematically analyzed following Grounded Theory principles. RESULTS: The interviews revealed that various individual as well as environmental factors shape health-related aspects of daily family life. A model was developed that organizes these influencing factors on family life with regard to health-related interactions and the emergence of the Family Health Climate (FHC) - reflecting shared perceptions and cognitions regarding a healthy lifestyle within families - and its consequences. Family interactions and family time, often realized through shared family meals, are key factors for families' health with regard to nutrition and physical activity. The FHC showed to affect various aspects related to health behavior of individual family members. CONCLUSIONS: The model sheds light on underlying processes and mechanisms of family life that influences individuals' health-related behavior. Based on a better understanding of the association between family life and individual health behavior the development of family-based interventions can be informed. Furthermore, the insights can help to guide further research focusing on families as a system.

Effects of a Collective Family-Based Mobile Health Intervention Called "SMARTFAMILY" on Promoting Physical Activity and Healthy Eating: Protocol for a Randomized Controlled Trial.

BACKGROUND: Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited. OBJECTIVE: The aim of this study was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features. METHODS: A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Existing evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T0) and postintervention measurements (T1) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T1, a follow-up assessment (T2) is completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation. RESULTS: This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022. CONCLUSIONS: In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects. TRIAL REGISTRATION: German Clinical Trials Register DRKS00010415; https://tinyurl.com/yyo87yyu. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/20534.

Accuracy of Sedentary Behavior-Triggered Ecological Momentary Assessment for Collecting Contextual Information: Development and Feasibility Study.

BACKGROUND: Sedentary behavior has received much attention in the scientific community over the past decade. There is growing evidence that sedentary behavior is negatively associated with physical and mental health. However, an in-depth understanding of the social and environmental context of sedentary behavior is missing. Information about sedentary behavior, such as how everyday sedentary behavior occurs throughout the day (eg, number and length of sedentary bouts), where, when, and with whom it takes place, and what people are doing while being sedentary, is useful to inform the development of interventions aimed at reducing sedentary time. However, examining everyday sedentary behavior requires specific methods. OBJECTIVE: The purpose of this paper is (1) to introduce sedentary behavior-triggered Ecological Momentary Assessment (EMA) as a methodological advancement in the field of sedentary behavior research and (2) to examine the accuracy of sedentary behavior-triggered EMA in 3 different studies in healthy adults. Moreover, we compare the accuracy of sedentary behavior-triggered EMA to simulations of random-trigger designs. METHODS: Sedentary behavior-triggered EMA comprises a continuous assessment of sedentary behavior via accelerometers and repeated contextual assessments via electronic diaries (ie, an application on a smartphone). More specifically, the accelerometer analyzes and transfers data regarding body position (a sitting or lying position, or an upright position) via Bluetooth Low Energy (BLE) to a smartphone in real time and triggers the deployment of questionnaires. Each time a participant spends a specified time (eg, 20 minutes) in a sedentary position, the e-diary triggers contextual assessments. To test the accuracy of this method, we calculated a percentage score for all triggered prompts in relation to the total number of bouts that could trigger a prompt. RESULTS: Based on the accelerometer recordings, 29.3% (5062/17278) of all sedentary bouts were classified as moderate-to-long (20-40 minutes) and long bouts (≥ 41 minutes). On average, the accuracy by participant was 82.77% (3339/4034; SD 21.01%, range 71.00-88.22%) on the study level. Compared to simulations of random prompts (every 120 minutes), the number of triggered prompts was up to 47.9% (n=704) higher through the sedentary behavior-triggered EMA approach. Nearly 40% (799/2001) of all prolonged sedentary bouts (≥ 20 minutes) occurred during work, and in 57% (1140/2001) of all bouts, the participants were not alone. CONCLUSIONS: Sedentary behavior-triggered EMA is an accurate method for collecting contextual information on sedentary behavior in daily life. Given the growing interest in sedentary behavior research, this sophisticated approach offers a real advancement as it can be used to collect social and environmental contextual information or to unravel dynamic associations. Furthermore, it can be modified to develop sedentary behavior-triggered mHealth interventions.

Conceptualizing Family Influences on Children's Energy Balance-Related Behaviors: Levels of Interacting Family Environmental Subsystems (The LIFES Framework).

Healthy or unhealthy behavioral patterns develop and are maintained in a family context. The importance of the family environment for children's and adolescents' energy balance-related behaviors (EBRBs) has been shown previously. However, the way different family environmental factors are interrelated and interact with personal factors (e.g., motivation) are not well understood. Furthermore, the majority of studies have focused on the parent-child subsystem. However, there are family-level socialization dynamics that affect the development of a healthy lifestyle beyond the impact of parenting behaviors. The current paper aims to synthesize theoretical and empirical literature on different types of family influences. The Levels of Interacting Family Environmental Subsystems (LIFES) framework incorporates family influences on three levels (immediate, proximal, distal) and of three subsystems (individual, parent-child, family), relates them to each other and postulates potential paths of influence on children's EBRBs. Several studies examining specific sections of the framework provide empirical support for LIFES' propositions. Future studies should place their research in the context of the interrelationship of different family environmental influences. A better understanding of the interrelated influences would enhance the understanding of the development and maintenance of overweight and obesity among children and is crucial for the development of effective interventions.

Physical Activity, Screen Time, and Dietary Intake in Families: A Cluster-Analysis With Mother-Father-Child Triads.

Background: The co-occurrence of multiple health behaviors such as physical activity, diet, and sedentary behavior affects individuals' health. Co-occurence of different health behaviors has been shown in a large number of studies. This study extended this perspective by addressing the co-occurrence of multiple health behaviors in multiple persons. The objective was to examine familial health behavioral patterns by (1) identifying clusters of families with similar behavior patterns and (2) characterizing the clusters by analyzing their correlates. Methods: Cross-sectional data were collected from 198 families (mother, father, and child). Mothers, fathers, and children completed questionnaires assessing health related behaviors (physical activity, consumption of "healthy" and "unhealthy" foods, and screen time), the perception of Family Health Climate (regarding physical activity and nutrition) and demographics. Twelve variables (four health behaviors of three family members) were included in a cluster analysis conducted with Ward's Method and K-means analysis. Chi-square tests and analyses of variance were performed to characterize the family clusters regarding their demographics and their perception of Family Health Climate. Results: Three clusters of families with specific behavioral patterns were identified: "healthy behavior families" with levels of physical activity and consumption of healthful foods above average and levels of media use and consumption of sweets below average; "unhealthy behavior families" with low levels of consumption of healthful foods and high levels of screen time; "divergent behavior families" with unhealthier behavioral patterns in parents and healthier screen time and eating behaviors combined with low physical activity levels in children. Family Health Climate differed between family clusters with most positive ratings in "healthy behavior families" and least positive ratings in "unhealthy behavior families." "Divergent behavior families" rated the nutrition climate nearly as high as "healthy behavior families" while they rated the physical activity climate nearly as low as the "unhealthy behavior families." Conclusions: The study shows that co-occurrence of multiple health behaviors occurs on the family level. Therefore, focusing the family as a whole instead of individuals and targeting aspects related to the Family Health Climate in interventions could result in benefits for both children and adults and enhance effectivity of intervention programs.

[German Translation of the COPD Self-Efficacy Scale: Development and Validation of a Short Form]. / Deutsche Übersetzung der COPD Self-Efficacy Scale: Entwicklung und Validierung einer Kurzform.

Illness-specific self-efficacy is important in the disease-management of patients with COPD (Chronic Obstructive Pulmonary Disease). Nevertheless, there is no instrument to measure the illness-specific self-efficacy in the German speaking countries. The purposes of the study were to translate the COPD Self-Efficacy Scale (CSES) into German (CSES-D) and to determine the psychometric criteria. Another objective was to construct a short form of the CSES-D. A total of 199 participants with COPD were recruited. The factorial structure of the CSES including 5 dimensions could not be confirmed with exploratory and confirmatory factor analyses. However, the short form of the CSES-D indicated acceptable fit indices. The internal consistencies of the subscales psychological stress (α=0.95) and physical exertion (α=0.92) were good. The correlations between the CSES-Dkurz and convergent and discriminant questionnaires confirmed the validity of the instrument. The results indicate that the CSES-Dkurz is a valid and reliable instrument to assess illness-specific self-efficacy of COPD-patients. Further, studies are needed to verify the factorial construct validity of the CSES-Dkurz.

Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia: Study Protocol for a Multicenter Randomized Controlled Trial.

BACKGROUND: The increasing prevalence of dementia in the next decades is accompanied by various societal and economic problems. Previous studies have suggested that physical activity positively affects motor and cognitive skills in individuals with dementia (IWD). However, there is insufficient evidence probably related to several methodological limitations. Moreover, to date adequate physical activity interventions specifically developed for IWD are lacking. OBJECTIVE: This study aims to investigate the effectiveness of a multimodal exercise program (MEP) on motor and cognitive skills in IWD in a high-quality multicenter trial. METHODS: A multicenter randomized controlled trial with baseline and postassessments will be performed. It is planned to enroll 405 participants with dementia of mild to moderate stage, aged 65 years and older. The intervention group will participate in a 16-week ritualized MEP especially developed for IWD. The effectiveness of the MEP on the primary outcomes balance, mobility, and gait will be examined using a comprehensive test battery. Secondary outcomes are strength and function of lower limbs, activities of daily living, and cognition (overall cognition, language, processing speed, learning and memory, and visual spatial cognition). RESULTS: Enrollment for the study started in May 2015. It is planned to complete postassessments by the beginning of 2017. Results are expected to be available in the first half of 2017. CONCLUSIONS: This study will contribute to enhancing evidence for the effects of physical activity on motor and cognitive skills in IWD. Compared to previous studies, this study is characterized by a dementia-specific intervention based on scientific knowledge, a combination of motor and cognitive tasks in the intervention, and high standards regarding methodology. Findings are highly relevant to influence the multiple motor and cognitive impairments of IWD who are often participating in limited physical activity. TRIAL REGISTRATION: German Clinical Trials Register DRKS00010538; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010538 (Archived by WebCite at http://www.webcitation.org/6oVGMbbMD).

Context matters! The relationship between mother-reported family nutrition climate, general parenting, food parenting practices and children's BMI.

BACKGROUND: Efforts to explain children's nutrition behavior or weight often involve investigating the parent-child relationship, typically studying the associations between food parenting practices (FPPs) and child outcomes. However, these behaviors are embedded in a broader system: general parenting (GP, the general emotional climate at home), and the family health climate (an aspect of the broader family system in the context of health). In the current study, we combined the parent-child measures of parenting (FPPs and GP) and the nutritional dimension of the family health climate (family nutrition climate, FNC) to get a broader view of how these concepts are interrelated. The current study had two aims: predicting FPPs using GP and FNC as predictor variables, and investigating the relationship between FPPs and children's weight in different groups of parents, based on low and high GP and FNC scores. METHODS: We collected cross-sectional data via an online survey panel. Mothers of 267 children aged 5-12 years filled out a questionnaire assessing demographics (e.g., children's weight and height), GP, FPPs, and FNC. Bivariate correlation coefficients were calculated between all constructs. Structural equation modeling was performed to test the hypothesized relationships between GP, FNC and FPPs. Hereafter, different groups of parents were identified, using median split, based on a low or high score on GP or a low or high score on FNC. Bivariate correlation coefficients were calculated between FPPs and children's BMI z-score for these different groups. RESULTS: GP and FNC were consistently positively correlated (all r's ≥.177), and both concepts were positively associated with healthy FPPs (all r's ≥.214). In families with a positive context (i.e. scoring high on GP and on FNC), healthy FPPs were associated with lower BMI z-scores of the children (r -.229). This association was not found for children with a more negative family context. CONCLUSIONS: FNC and GP are valuable additional concepts to investigate relationships between FPPs and child outcomes. We recommend that more studies, next to investigating the parent-child system, include a measure of the broader family system, in order to get a broader view of the mechanisms explaining child health behaviors and weight status.

Affect and Subsequent Physical Activity: An Ambulatory Assessment Study Examining the Affect-Activity Association in a Real-Life Context.

Traditionally, cognitive, motivational, and volitional determinants have been used to explain and predict health behaviors such as physical activity. Recently, the role of affect in influencing and regulating health behaviors received more attention. Affects as internal cues may automatically activate unconscious processes of behavior regulation. The aim of our study was to examine the association between affect and physical activity in daily life. In addition, we studied the influence of the habit of being physically active on this relationship. An ambulatory assessment study in 89 persons (33.7% male, 25 to 65 years, M = 45.2, SD = 8.1) was conducted. Affect was assessed in the afternoon on 5 weekdays using smartphones. Physical activity was measured continuously objectively using accelerometers and subjectively using smartphones in the evening. Habit strength was assessed at the beginning of the diary period. The outcomes were objectively and subjectively measured moderate-to-vigorous physical activity (MVPA) performed after work. Multilevel regression models were used to analyze the association between affect and after work MVPA. In addition, the cross-level interaction of habit strength and affect on after work MVPA was tested. Positive affect was positively related to objectively measured and self-reported after work MVPA: the greater the positive affect the more time persons subsequently spent on MVPA. An inverse relationship was found for negative affect: the greater the negative affect the less time persons spent on MVPA. The cross-level interaction effect was significant only for objectively measured MVPA. A strong habit seems to strengthen both the positive influence of positive affect and the negative influence of negative affect. The results of this study confirm previous results and indicate that affect plays an important role for the regulation of physical activity behavior in daily life. The results for positive affect were consistent. However, in contrast to previous reports of no or an inverse association, negative affect decreased subsequent MVPA. These inconsistencies may be-in part-explained by the different measurements of affect in our and other studies. Therefore, further research is warranted to gain more insight into the association between affect and physical activity.

Oligophrenin1 protects mice against myocardial ischemia and reperfusion injury by modulating inflammation and myocardial apoptosis.

The Rho family of small GTPases has been analyzed in cardiac physiology and pathophysiology including myocardial infarction (MI) in the last years. Contradictory results show either a protective or a declined effect of RhoA and the RhoA effector Rho-associated protein kinase (ROCK) in myocardial ischemia and reperfusion injury that is associated with cardiomyocyte survival and caspase-3 activation. Cardiac-specific deletion of Rac1 reduced ischemia reperfusion injury in diabetic hearts, whereas cardiomyocyte specific overexpression of active Rac1 predisposes the heart to increased myocardial injury with enhanced contractile dysfunction. GTPase-activating proteins (GAPs) control the activation of Rho proteins through stimulation of GTP hydrolysis. However, the impact of GAPs in myocardial ischemia and reperfusion injury remains elusive. Here we analyzed the role of oligophrenin1 (OPHN1), a RhoGAP with Bin/Amphiphysin/Rvs (BAR) domain known to regulate the activity of RhoA, Rac1 and Cdc42 in MI. The expression of Ophn1, RhoA and Rac1 is strongly upregulated 24h after myocardial ischemia. Loss of OPHN1 induced enhanced activity of Rho effector molecules leading to elevated cardiomyocyte apoptosis and increased migration of inflammatory cells into the infarct border zone of OPHN1 deficient mice. Consequently, echocardiography 24h after myocardial ischemia revealed declined left ventricle function in OPHN1 deficient mice. Our results indicate that OPHN1 mediated regulation of RhoA, Rac1 and Cdc42 is crucial for the preservation of cardiac function after myocardial injury.

Family Health Climate and Adolescents' Physical Activity and Healthy Eating: A Cross-Sectional Study with Mother-Father-Adolescent Triads.

INTRODUCTION: The importance of the family environment for children's and adolescents' health behavior has been demonstrated, the underlying mechanisms of this influence remain unclear. Therefore, the aim of the study was to investigate the relationship between family environmental and individual determinants. It was hypothesized that the Family Health Climate (FHC) is associated with adolescents' physical activity and dietary behavior and that intrinsic motivation mediates this association. METHODS: Cross-sectional data were collected from 198 families (mother, father, and child) using questionnaires. Perceptions of FHC of mothers, fathers, and their children were assessed using the FHC-scales for physical activity (FHC-PA) and nutrition (FHC-NU). The adolescents also rated their intrinsic motivation for exercise and healthy eating, their physical activity and consumption of healthful food. A structural equation model was analyzed and a bootstrapping procedure was used to test direct and indirect effects. RESULTS: The FHC-PA was related to the amount of weekly physical activity and the FHC-NU to the consumption of fruit, vegetables and salad. These effects were mediated by adolescents' intrinsic motivation; the indirect effects were significant for both behaviors. DISCUSSION: These results emphasize the importance of the FHC in shaping adolescents' physical activity and dietary behavior. Individual motivational factors are potential mediators of family and parental influences. Considering family-level variables and their interaction with individual factors contributes to the understanding of adolescents' health behavior.

Pivotal role of phospholipase D1 in tumor necrosis factor-α-mediated inflammation and scar formation after myocardial ischemia and reperfusion in mice.

Myocardial inflammation is critical for ventricular remodeling after ischemia. Phospholipid mediators play an important role in inflammatory processes. In the plasma membrane they are degraded by phospholipase D1 (PLD1). PLD1 was shown to be critically involved in ischemic cardiovascular events. Moreover, PLD1 is coupled to tumor necrosis factor-α signaling and inflammatory processes. However, the impact of PLD1 in inflammatory cardiovascular disease remains elusive. Here, we analyzed the impact of PLD1 in tumor necrosis factor-α-mediated activation of monocytes after myocardial ischemia and reperfusion using a mouse model of myocardial infarction. PLD1 expression was highly up-regulated in the myocardium after ischemia/reperfusion. Genetic ablation of PLD1 led to defective cell adhesion and migration of inflammatory cells into the infarct border zone 24 hours after ischemia/reperfusion injury, likely owing to reduced tumor necrosis factor-α expression and release, followed by impaired nuclear factor-κB activation and interleukin-1 release. Moreover, PLD1 was found to be important for transforming growth factor-ß secretion and smooth muscle α-actin expression of cardiac fibroblasts because myofibroblast differentiation and interstitial collagen deposition were altered in Pld1(-/-) mice. Consequently, infarct size was increased and left ventricular function was impaired 28 days after myocardial infarction in Pld1(-/-) mice. Our results indicate that PLD1 is crucial for tumor necrosis factor-α-mediated inflammation and transforming growth factor-ß-mediated collagen scar formation, thereby augmenting cardiac left ventricular function after ischemia/reperfusion.

Family health climate scale (FHC-scale): development and validation.

BACKGROUND: The family environment is important for explaining individual health behaviour. While previous research mostly focused on influences among family members and dyadic interactions (parent-child), the purpose of this study was to develop a new measure, the Family Health Climate Scale (FHC-Scale), using a family-based approach. The FHC is an attribute of the whole family and describes an aspect of the family environment that is related to health and health behaviour. Specifically, a questionnaire measuring the FHC (a) for nutrition (FHC-NU) and (b) for activity behaviour (FHC-PA) was developed and validated. METHODS: In Study 1 (N=787) the FHC scales were refined and validated. The sample was randomly divided into two subsamples. With random sample I exploratory factor analyses were conducted and items were selected according to their psychometric quality. In a second step, confirmatory factor analyses were conducted using the random sample II. In Study 2 (N=210 parental couples) the construct validity was tested by correlating the FHC to self-determined motivation of healthy eating and physical activity as well as the families' food environment and joint physical activities. RESULTS: Exploratory factor analyses with random sample I (Study 1) revealed a four (FHC-NU) and a three (FHC-PA) factor model. These models were cross-validated with random sample II and demonstrated an acceptable fit [FHC-PA: χ(2)=222.69, df=74, p<.01; χ(2)/df=3.01; CFI=.96; SRMR=.04; RMSEA=.07, CI .06/.08; FHC-NU: χ(2)=278.30, df=113, p<.01, χ(2)/df=2.46, CFI=.96; SRMR=.04; RMSEA=.06, CI .05/.07]. The perception of FHC correlated (p<.01) with the intrinsic motivation of healthy eating (r=.42) and physical activity (r=.56). Moreover, parental perceptions of FHC-NU correlated with household soft drink availability (r=-.31) and perceptions of FHC-PA with the frequency of joint physical activities with the child (r=.51). These patterns were found on the intraindividual and interindividual level. CONCLUSIONS: Two valid instruments measuring the FHC within families were developed. The use of different informants' ratings demonstrated that the FHC is a family level variable. The results confirm the high relevance of the FHC for individuals' health behaviour. The FHC and the measurement instruments are useful for examining health-related aspects of the family environment.

Long-term health benefits of physical activity--a systematic review of longitudinal studies.

BACKGROUND: The treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer's disease and dementia. METHODS: Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included. RESULTS: The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases. CONCLUSIONS: This review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.