Preoperative cognitive function as a risk factor of postoperative delirium in cancer surgeries: A systematic review and meta-analysis.

Postoperative delirium (POD) after cancer surgeries can be a result of chemo brain, anesthesia, surgery duration, and preoperative cognitive impairment. Although older age and preoperative cognitive dysfunction were reported to increase the risk of POD in noncardiac surgery, the role of preoperative cognitive function and age in the development of POD after all types of cancer surgeries is not clear. This study aimed to determine the relationship between preoperative cognitive function and likelihood of POD after cancer surgeries. This study used three main online databases and followed PRISMA guidelines. English language original articles that examined preoperative cognitive function before solid tumor cancer surgery and assessed patients for postoperative delirium were included. We employed the random effect meta-analysis method. The overall incidence of POD ranged from 8.7% to 50.9%. The confusion assessment method was the most common tool used to assess delirium. Mini-mental state evaluation (MMSE), Mini-cog, and Montreal cognitive assessment were the most common tools to assess cognitive function. The pooled (total observation = 4676) random effects SMD was estimated at -0.84 (95% confidence interval [CI]: -1.30 to -0.31), indicating that lower MMSE scores before surgery are associated with a higher risk of POD. The pooled (total observation = 2668) random effects OR was estimated at 5.17 (95% CI: 2.51 to -10.63), indicating preoperative cognitive dysfunction can significantly predict the occurrence of POD after cancer surgeries. In conclusion, preoperative cognitive function is an independent and significant predictor of POD after solid tumor cancer surgeries.

Happy Family, Healthy Kids: A Healthy Eating and Stress Management Program in Low-Income Parent-Preschooler Dyads.

BACKGROUND: Substantial effort has been invested to combat childhood obesity, but overall effects are disappointing, especially in low-income racial minority children. One possible reason is a lack of focus on the important stress-eating connection. Stress can negatively influence eating behaviors, leading to an increased appetite for high-fat and energy-dense foods. OBJECTIVE: This study aimed to evaluate the preliminary effects of a healthy eating and stress management program targeting multiple theoretical variables on improving eating behavior (dyads' fruit/vegetable intake, emotional eating), food insecurity, anthropometric characteristics (dyads' body mass index, % body fat), cardiovascular health (dyads' blood pressure), and mental well-being (parental stress). METHODS: A one-group, quasi-experimental pilot study was conducted among 107 low-income parent-preschooler dyads. The 14-week program included a parent component, a parent-preschooler learning component, and a day care-based preschooler component. RESULTS: The program had positive effects on improving dyads' fruit/vegetable intake, food insecurity, body mass index, and blood pressure and parents' nutrition knowledge, self-efficacy, support, food resource management behavior, problem-focused coping, and home eating environment. The overall satisfaction rate was 95.2%, and 88.1% stated that the program assisted their families with having a healthy lifestyle. DISCUSSION: Results support the preliminary effects of the program on improving health outcomes in rural and urban low-income families. Although warranting further investigation with a more rigorous randomized controlled trial, the healthy eating and stress management program provides a potential solution to the current coexistence of an obesity epidemic and mental health crisis.

The role of psychosocial factors and biological sex on rural Thai adolescents' drinking intention and behaviours: A structural equation model.

AIMS: To examine the contributions of psychosocial factors (attitude towards drinking, perceived drinking norms [PDNs], perceived behavioural control [PBC]), and biological sex on drinking intention and behaviours among rural Thai adolescents. DESIGN: A cross-sectional study design. METHODS: In 2022, stratified by sex and grade, we randomly selected 474 rural Thai adolescents (Mage = 14.5 years; SD = 0.92; 50.6% male) from eight public district schools in Chiang Mai Province, Thailand, to complete a self-administered questionnaire. Structural equation modelling with the weighted least square mean and variance adjusted was used for data analysis. RESULTS: All adolescents' psychosocial factors contributed significantly to the prediction of drinking intention, which subsequently influenced their drinking onset, current drinking and binge drinking pattern in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention, followed by PBC. Rural adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviours either fully or partially. The path coefficient between drinking attitude and drinking intention was significantly different between males and females. CONCLUSION: Different from previous studies focus on adolescents' drinking attitude, rural Thai adolescents' PDNs play a significant role on their drinking intention and subsequently their drinking onset and patterns. This nuanced understanding supports a paradigm shift to target adolescents' perceived drinking norms as a means to delay their drinking onset and problematic drinking behaviours. IMPACT: Higher levels of perceived drinking norms significantly led to the increase in drinking intention among adolescents. Minimizing adolescents' perceptions of favourable drinking norms and promoting their capacity to resist drinking, especially due to peer pressure, are recommended for nursing roles as essential components of health education campaigns and future efforts to prevent underage drinking. PATIENT OR PUBLIC CONTRIBUTION: In this study, there was no public or patient involvement.

Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis.

BACKGROUND: Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed. AIMS: The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents. METHODS: Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators. RESULTS: The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17). CONCLUSIONS: These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

Psychometric properties of the Arabic version of Physical Activity Questionnaire for Adolescents (PAQ-A).

AIM: To evaluate the psychometric properties of the Arabic version of the Physical Activity Questionnaire for Adolescents (PAQ-A). BACKGROUND: Physical inactivity is a major risk factor for becoming overweight or obese and developing chronic conditions that lead to an increase in mortality globally. Inadequate physical activity (PA) has been a problem among Arabic-speaking populations, including female adolescents in Saudi Arabia. Unfortunately, psychometrically sound measures to assess PA among female adolescents in Saudi Arabia are lacking, indicating that a reliable, valid and feasible self-report measure is urgently needed for use with this young Arabic-speaking population. METHODS: A cross-sectional study approved by a university institutional review board was conducted with 383 Saudi female adolescents, 13-18 years of age, who were recruited from 10 all-female public schools in Jeddah, Saudi Arabia. Physical activity was measured via the PAQ-A, which assesses the level of PA engagement during the school year for 7 days. Internal consistency was estimated. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the measure's construct validity and the Pearson correlation coefficient was used to assess convergent validity. RESULTS: Cronbach's alpha was 0.81, indicating acceptable internal consistency. Item-total correlation coefficients ranged from 0.11 to 0.61. Both EFA and CFA indicated a single-factor. The scale was significantly correlated with other cognitive and affective variables that reflected the physical activity perceptions among the female adolescents, such as enjoyment of PA, PA self-efficacy and social support for PA. CONCLUSIONS: The Arabic version of the PAQ-A is reliable and valid measure for assessing PA among Arabic-speaking female adolescents.

Organized Physical Activity Program Participation, Physical Activity, and Related Psychosocial Factors Among Urban Adolescents.

The study purpose was to examine whether adolescents who participated in organized physical activity (PA) programs differed from nonparticipants in motivation, social support, and self-efficacy related to PA; PA (min/hr); and sedentary screen time behavior. Thirty-nine 5th-7th grade adolescents participated in organized PA programs; 41 did not. Approximately 56.3% were Black, and 52.5% had annual family incomes <$20,000. Compared to nonparticipants, those who participated reported significantly higher social support (M = 2.32 vs. 3.13, p < .001) and fewer hours watching television or movies on a usual weekend day (M = 2.49 vs. 1.59, p = .016); and had higher accelerometer-measured vigorous PA (M = 0.58 vs. 1.04, p = .009) and moderate-to-vigorous PA (M = 2.48 vs. 3.45, p = .035). Involving adolescents in organized PA programs may be important for improving their moderate-to-vigorous PA, vigorous PA, and related psychosocial factors, as well as reducing sedentary screen time behavior.

Anaesthesia-related cognitive dysfunction following cardiothoracic surgery in late middle-age and younger adults: A scoping review.

AIM: This review aimed to evaluate factors associated with anaesthesia-related postoperative cognitive dysfunction (POCD) among adults younger than 65 years who underwent cardiothoracic surgeries. STUDY DESIGN: A systematic keyword search, following the scoping review framework, was performed in the PubMed and CINAHL databases. Original English-language studies that included adults younger than 65 years and addressed cognitive function after surgery along with anaesthesia management were included. Retrospective studies, animal research and in vitro and in vivo studies were excluded. RESULTS: Twenty-three articles were included (65.2% interventional studies). All studies lacked theoretical or conceptual frameworks. Ketamine's neuroprotective potential is questionable, and intravenous lidocaine may be considered a possible early agent for preventing POCD, but long-term effectiveness is uncertain. Compared to inhalational anaesthesia, total intravenous anaesthesia (TIVA) may be related to a decreased incidence of POCD. Variation in POCD assessment impacted the lack of homogeneity in obtained data. Moreover, the shorter-term timing of POCD evaluation such as in early days after surgery could be greatly influenced by medication and delirium. CONCLUSION: Although strategies such as TIVA, the use of neuroprotective anaesthetics and comprehensive preoperative assessments are suggested to prevent POCD, this multifactorial phenomenon cannot be explicitly attributed solely to anaesthetics or anaesthesia-related techniques. Use of standardized, reliable and valid tools for POCD assessment is encouraged for cross-study comparison. RELEVANCE TO CLINICAL PRACTICE: Nurses and certified nurse anaesthetists must be aware of risk factors for postoperative delirium and POCD so they can assess patients before and after surgery. Patients and caregivers need to be educated about cognitive changes after surgery and advised to report them to their health care provider if they occur.

Lifestyle Behaviors and Parents' Mental Well-Being Among Low-Income Families During COVID-19 Pandemic.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has negatively altered many families' lifestyles and the mental well-being of parents, especially those who have a low income and young children. To improve low-income parents' mental well-being, especially during a pandemic, understanding parents' and children's lifestyle behaviors and the relationship between their lifestyle behaviors and parents' mental well-being is essential. OBJECTIVE: This cross-sectional study examined relationships between lifestyle behaviors (sleep, physical activity, screen time, and eating behavior of parents and children) and low-income parents' well-being (stress, anxiety, and depression) during COVID-19. METHODS: Parents were recruited from two Michigan Head Start organizations as well as across the United States; 408 parents completed an online survey. Demographic characteristics were assessed, along with parents' sleep, physical activity, screen time, and dietary intake; stress, anxiety, and depression were also examined. Children's sleep time, physical activity, screen time, and fruit/vegetable intake were assessed. Descriptive statistics, correlations, and the multivariate general linear model procedure were used. RESULTS: Approximately 69.4% of parents reported moderate stress levels, and 17.2% reported high levels. Most parents had sleep disturbances, attained minimal physical activity, and consumed <5 fruits/vegetables per day; average screen time was >2 hours per day. Only 41% of preschoolers were active 7 days a week and slept ≥10 hours per day. Two thirds had >2 hours per day of screen time, and less than one fifth consumed ≥5 fruits/vegetables per day. After adjusting for parents' demographics and children's lifestyle behaviors, parents' sleep disturbance was positively correlated with their levels of stress, anxiety, and depression. After controlling for parents' demographics and lifestyle behaviors, child sleep time was negatively associated with parents' stress levels. Family demographics and parents' and children's lifestyle behaviors explained 33.4%, 29.8%, and 28.1% of the variances in parents' stress, anxiety, and depression, respectively. DISCUSSION: Most parents and preschoolers were not meeting many lifestyle behavior recommendations, indicating a need for interventions. Improving parents' sleep quality and reducing bedtime challenges involving their preschoolers may be necessary for enhancing parental mental well-being.

Enjoyment of Physical Activity among Children and Adolescents: A Concept Analysis.

Although enjoyment has been linked to participation in physical activity (PA), a thorough analysis of the concept is lacking. Health-related behavior research emphasizes the necessity of focusing on individual psychological requirements, such as enjoyment in PA, to boost children and adolescents' motivation for PA. The current paper is a report on a conceptual analysis of the enjoyment of PA among children and adolescents. We adopted the concept analysis procedure by Walker and Avant. Several databases (PubMed, CINAHL, ERIC, PsychInfo, and Sport Discus) were searched and used to extract relevant articles about the enjoyment of PA. The review process yielded a final set of 72 papers. A refined definition of enjoyment in PA, attributes, cases, antecedents, and consequences of enjoyment in PA were presented. A conceptual understanding of enjoyment in PA can enable nurses to plan interventions that help children and adolescents get appropriate PA and improve their health habits.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Heart up! RCT protocol to increase physical activity in cardiac patients who report hopelessness: Amended for the COVID-19 pandemic.

Hopelessness is associated with decreased physical activity (PA) and increased adverse events and death in patients with ischemic heart disease (IHD). Rates of PA in patients with IHD continue to be low in both hospital-based cardiac rehabilitation and home settings. While researchers have investigated strategies to increase PA among patients with IHD, interventions to promote PA specifically in IHD patients who report hopelessness are lacking. We describe the protocol for a NIH-funded randomized controlled trial designed to establish the effectiveness of a 6-week intervention (Heart Up!) to promote increased PA in IHD patients who report hopelessness. Participants (n = 225) are randomized to one of three groups: (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse plus significant other support (SOS), or (3) attention control. Aims are to: (1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA; (2) determine the effects of change in moderate to vigorous PA on hopelessness; and (3) determine if perceived social support and motivation (exercise self-regulation) mediate the effects of the intervention on PA. A total of 69 participants have been enrolled to date. The protocol has been consistently and accurately used by research personnel. We address the protocol challenges presented by the COVID-19 pandemic and steps taken to maintain fidelity to the intervention. Findings from this study could transform care for IHD patients who report hopelessness by promoting self-management of important PA goals that can contribute to better health outcomes.

Moderators in a physical activity intervention for adolescent girls.

BACKGROUND: The purpose was to explore whether baseline sociodemographic and physical characteristics moderated effects of an intervention on moderate-to-vigorous physical activity (MVPA), percent body fat, body mass index z-score, and cardiorespiratory fitness (CRF) at post intervention, relative to the control condition. METHODS: A secondary analysis of data from a group randomized trial including 24 schools (12 intervention and 12 control; N = 1519 girls) was conducted. Age, ethnicity, race, socioeconomic status, and pubertal stage were assessed via survey. Height, weight, MVPA (min/h), percent body fat, and CRF were measured. Mixed-effects linear models were performed. RESULTS: Compared to the control, the intervention increased overweight and obese girls' CRF (b = 0.28, p = 0.049; b = 0.31, p < 0.01, respectively), but not healthy weight girls' CRF (b = 0.04, p = 0.706). Pre- to mid-puberty girls in the intervention group had slightly lower post-intervention MVPA than those in the control (3.04 vs. 3.31, p = 0.055), while late to post-puberty intervention and control girls' post-intervention MVPA was similar (3.12 vs. 3.04, p = 0.542). CONCLUSIONS: A PA intervention can improve overweight and obese girls' CRF, possibly attenuating their cardiovascular risk. Effective strategies are needed to assist adolescent girls, especially those in pre- to mid-puberty, in maintaining their MVPA after an intervention ends. IMPACT: Moderators of physical activity intervention effects among adolescent girls are important to identify because the effectiveness of these interventions to date in this population has been limited. This article contributes to the notable gap in knowledge regarding moderators in physical activity interventions involving adolescent girls, particularly baseline characteristics that may moderate their responses to physical activity interventions. Awareness of the moderators can be useful for determining the type of intervention that may be successful in subgroups of adolescent girls and for tailoring a physical activity intervention to optimally meet each girl's needs to achieve maximal effects. Findings show that weight status moderated the intervention effects on cardiorespiratory fitness. Compared to the control condition, the intervention increased overweight and obese, but not healthy weight, girls' cardiorespiratory fitness. A physical activity intervention can improve overweight and obese girls' cardiorespiratory fitness, possibly attenuating their cardiovascular risk. Therefore, it is essential to include overweight and obese girls in PA interventions to help them reap this important benefit.

Parent-Child Dyad's Collective Family Efficacy and Risky Adolescent Health Behaviors.

BACKGROUND: Parents play an influential role in their children's health behaviors. Research has shown that individuals' efficacy beliefs (personal and collective efficacy) are closely related to their behaviors and can be modified to improve health outcomes. Existing evidence confirms the effect of self-efficacy on various health outcomes. However, the effects of parent-child dyads' collective efficacy beliefs on adolescents' health outcomes are less clear. Bandura and his colleagues postulated that family members' perceived collective family efficacy plays an important role in their psychological well-being and possibly their health behaviors. However, few study results have delineated the relationship between collective family efficacy and risky adolescent health behaviors. OBJECTIVES: This study was conducted to examine the relationships among parent-adolescent dyads' collective family efficacy, satisfaction with family functioning, depressive symptoms, personal efficacy beliefs, and adolescent risky health behaviors. METHODS: This cross-sectional study surveyed 158 parent-adolescent dyads from the Midwestern region of the United States. Linear regression and path modeling were conducted to examine the influences of dyads' personal and collective efficacy beliefs on the adolescents' negative attitudes toward healthy lifestyle practices, injury prevention, safe sex practices, substance use prevention, and depressive symptoms. RESULTS: Risky adolescent health behaviors were strongly correlated with higher depressive symptoms. The dyads' personal and collective efficacy beliefs emerged as protective factors for adolescent health risks directly and indirectly through depressive symptoms. Both adolescents' and parents' perceived collective family efficacy buffered the effect of parent-adolescent dyads' depressive symptoms on adolescent risky health behaviors with significant direct and indirect effects. Adolescents' family efficacy, satisfaction with family functioning, and filial efficacy significantly mediated the relationship between depressive symptoms and risky health behaviors. DISCUSSION: Parent-adolescent dyads' perceived collective family efficacy buffers adolescents from depressive symptoms and risky health behaviors. This finding suggests that family interventions should not only address adolescents' personal-level efficacy but also their collective aspects of efficacy beliefs within the family context.

Mediators of intervention effects on dietary fat intake in low-income overweight or obese women with young children.

PURPOSE: We investigated whether autonomous motivation and self-efficacy might mediate the association between a lifestyle behavior intervention and dietary fat intake in low-income overweight or obese women with young children. METHODS: Participants were randomized to an intervention or comparison group. Intervention participants received a 16-week intervention aimed to prevent weight gain through promotion of stress management, healthy eating and physical activity. During the intervention phase, participants viewed a designated video lesson at home and dialed in a peer support group teleconference every week (weeks 1-4) then every other week (weeks 5-16). Potential mediation effects were analyzed using sequential mixed-effects linear models and path analysis. RESULTS: The intervention led to increased autonomous motivation (ß = 0.34, standard error [SE] = 0.15, P = 0.005), which subsequently increased self-efficacy (ß = 0.18, SE = 0.35, P < 0.001), and higher levels of self-efficacy were associated with decreased dietary fat intake (ß = -0.22, SE = 0.28, P < 0.001). In other words, autonomous motivation and self-efficacy mediated the association between the lifestyle behavior intervention and dietary fat intake. CONCLUSION: To decrease dietary fat intake for low-income overweight or obese women with young children, strategies, such as those promoting peer encouragement, may be warranted in interventions to enhance autonomous motivation and/or practical skills for increasing self-efficacy.

Obesity and Hair Cortisol: Relationships Varied Between Low-Income Preschoolers and Mothers.

PURPOSE: Literature on the relationship between hair cortisol concentration (HCC) and body mass index (BMI) is scarce and inconsistent in both preschoolers and parents. Thus, the study aimed to examine the relationships among HCC, perceived distress, coping, and BMI among low-income Head Start preschoolers and mothers. METHODS: A cross-sectional, correlational study was conducted with a non-random sample of 35 mother-preschooler dyads. Height and weight were measured using a ShorrBoard Stadiometer and a Seca portable electronic scale, respectively. HCC was extracted using the enzyme immunoassay approach. Mothers' perceived distress and coping were assessed by Cohen's Perceived Stress Scale. RESULTS: Mothers' mean age was 29.74 years, and preschoolers' mean age was 4.69 years. The sample included 17% Hispanic, 54% Black, and 60% single mothers; and 23% Hispanic and 60% Black preschoolers. Compared to mothers in low HCC group (< 4.1 pg/mg), mothers in high HCC group (≥ 4.1 pg/mg) had lower BMI (B = - 4.62, p = .049). The indirect effects of mothers' HCC on BMI via perceived distress and coping was 15% of the total effects. Preschoolers with mothers in high HCC group had significantly lower BMI z-score than those with mothers in low HCC group (B = - 0.94, p = .043). Preschoolers' HCC had a small positive correlation with their BMI z-score (B = 0.01, p = .112). CONCLUSIONS: Relationships between HCC and BMI varied between low-income mothers and preschoolers. A stress management component may need to be integrated into future obesity interventions. Given the limitation of small sample size and cross-sectional study design, the findings need to be interpreted with caution, and further investigation is warranted.

Concept Analysis of Relatedness in Physical Activity Among Adolescents.

AIM: This analysis seeks to clarify the concept of relatedness in physical activity (PA) among adolescents. BACKGROUND: Health-related behavior research highlights the importance of focusing on individual psychological needs such as relatedness in PA to improve adolescents' motivation toward PA. Although relatedness in PA has been associated with PA participation among adolescents, a thorough analysis of the concept is lacking. Conceptual clarification of relatedness in the context of PA is needed for promoting consistency between conceptual and operational definitions and refining empirical measurement. DESIGN: The 6-steps of Rodgers' (2000) evolutionary method of concept analysis was used to analyze the data and identify attributes, surrogate/related terms, antecedents, and consequences of the relatedness concept. METHOD: Several databases were used to extract relevant articles. A total of 113 were identified. Forty articles met the inclusion criteria. In addition, twenty-six articles were included through other sources. The review process yielded a final set of 66 articles. RESULT: A refined definition of relatedness in PA is an adolescent's perception of feeling socially connected with significant people in a reciprocal, caring, and trusting relationship that is a self-system process and promotes a sense of belonging and internalization within PA contexts. Attributes, surrogate/related terms, antecedents and consequences of relatedness in PA were identified from extant literature. CONCLUSION: This comprehensive analysis provides a clarification of the conceptual definition of relatedness in PA among adolescents. The concept can guide nurses in designing interventions to improve health behavior or promoting changes in health policy. Future research is needed to refine operational definitions of relatedness so that they represent the defining attributes of the concept.

Adolescent Autonomous Motivation for Physical Activity: A Concept Analysis.

PURPOSE: The purpose of this concept analysis is to develop a clear definition of adolescent autonomous motivation for physical activity (PA) based on all existing theoretical and operational definitions of autonomous motivation noted in the literature. For providers, understanding this is essential to elucidate why some adolescents choose to participate in a health-promoting behavior like PA. Researchers need to identify if they are evaluating autonomous motivation or a different type. METHODS: Rodgers' Evolutionary Method of concept analysis was used. PubMed, CINAHL, ERIC, PsychInfo, and Sport Discus were searched. RESULTS: No concept analysis of adolescent autonomous motivation for PA was found. Autonomous motivation may include intrinsic motivation and two forms of extrinsic motivation, integrated and identified behavioral regulations. Defining attributes include being: 1) dynamic and 2) on a continuum. Adolescent autonomous motivation for PA is a personal desire to attain PA because the behavior is fun and enjoyable, or it is an important part of how the adolescent self-identifies. The adolescent views the self as being healthy so maintains a healthy lifestyle; or views the self as athletic so needs to attain adequate MVPA. CONCLUSION: Findings are that an autonomy-supportive environment and positive perceptions of PA are needed in order to have the outcome of increased PA. The information may be helpful for promoting consistency of measurement across disciplines. Future research with adolescents is warranted to examine underlying differences between males and females, by age, weight status, and developmental stage. PRACTICE IMPLICATIONS: An in-depth understanding is needed for providers who are interested in developing interventions to assist adolescents in regularly attaining adequate PA.

A School- and Home-Based Intervention to Improve Adolescents' Physical Activity and Healthy Eating: A Pilot Study.

This study evaluated feasibility, acceptability, and preliminary efficacy of a 12-week Guys/Girls Opt for Activities for Life (GOAL) intervention on 10- to 13-year-old adolescents' body mass index (BMI), percent body fat, physical activity (PA), diet quality, and psychosocial perceptions related to PA and healthy eating. Parent-adolescent dyads from two schools were enrolled. Schools were assigned to either GOAL (38 dyads) or control (43 dyads) condition. The intervention included an after-school club for adolescents 2 days/week, parent-adolescent dyad meeting, and parent Facebook group. Intervention adolescents had greater autonomous motivation for PA and self-efficacy for healthy eating than control adolescents (both p < .05). Although between-group differences were not significant, close-to-moderate effect sizes resulted for accelerometer-measured moderate-to-vigorous PA and diet quality measured via 24-hr dietary recall (d = .46 and .44, respectively). A trivial effect size occurred for percent body fat (d = -.10). No differences emerged for BMI. Efficacy testing with a larger sample may be warranted.

Intervention Effects of "Girls on the Move" on Increasing Physical Activity: A Group Randomized Trial.

BACKGROUND: Limited intervention success in increasing and sustaining girls' moderate-to-vigorous physical activity (MVPA) underscores a need for continued research. PURPOSE: The aim of this study was to evaluate the effect of a 17-week Girls on the Move (GOTM) intervention on increasing MVPA among fifth- to eighth-grade girls. METHODS: This study is a group (cluster) randomized trial, including 24 schools, pair matched and assigned to intervention (n = 12) or control (n = 12) conditions. Participants included 1,519 girls in racially diverse public schools in urban, underserved areas of the Midwestern USA. The intervention included three components: (i) 90-min after-school physical activity (PA) club offered 3 days/week; (ii) two motivational, individually tailored counseling sessions; and (iii) an interactive Internet-based session at the midpoint of the intervention. Main outcome measures were weighted mean minutes of MVPA per week post-intervention and at 9-month follow-up measured via accelerometer. RESULTS: No between-group differences occurred for weighted mean minutes of MVPA per week at post-intervention (B = -0.08, p = .207) or 9-month follow-up (B = -0.09, p = .118) while controlling for baseline MVPA. CONCLUSIONS: Research is needed to identify interventions that assist girls in attaining and maintaining adequate PA. CLINICALTRIALS.GOV IDENTIFIER: NCT01503333.

Mediators of Physical Activity Behavior Change in the "Girls on the Move" Intervention.

BACKGROUND: The minimal effect of interventions to date on increasing young adolescent girls' physical activity (PA) may be due to inadequate understanding of the mechanisms underlying behavior change, yet sparse research testing a PA intervention has examined the capacity of theories to explain PA, particularly when using objective measures. OBJECTIVES: The aim of the study was to examine whether constructs from the health promotion model and self-determination theory mediated changes in moderate-to-vigorous physical activity (MVPA) following a 17-week intervention. METHODS: The study was a secondary analysis of data from a group randomized trial, including 12 intervention and 12 control schools in the Midwestern United States. Data were collected in 2012-2016. Girls (fifth- to eighth-grade, N = 1,519) completed surveys on perceived benefits and enjoyment of PA, PA self-efficacy, social support and motivation for PA, and barriers to PA and wore accelerometers. RESULTS: The final path model had a good fit: χ(4) = 2.48, p = .648; goodness-of-fit index = 1; comparative fit index = 1; root-mean-square error of approximation = 0; standardized root-mean-square residual = 0.01. For MVPA change from baseline to postintervention, enjoyment (B = 24.48, p < .001) and social support (B = 30.48, p < .001) had a positive direct effect, whereas the intervention had a positive indirect effect through enjoyment and social support (B = 9.13, p < .001). Enjoyment (B = -13.83, p < .001) and social support (B = -17.22, p < .001) had a negative indirect effect on MVPA change from postintervention to follow-up. DISCUSSION: Enjoyment of PA and social support for PA may be important mediators of PA in young adolescent girls and warrant consideration when designing interventions.