Greenspace, stress, and health: how is epigenetics involved?

Most expositions of the association between green space and overall health and well-being focus on psychosocial mechanisms. However, discussions of the biological underpinnings of the exposure to green space and health implications are limited. In this paper, we highlight the role epigenetics plays in the manifestation or suppression of stress, in addition to some of the proposed epigenetic mechanisms through which green space mitigates stress. The Health: Epigenetics, Greenspace and Stress (HEGS) model is introduced to explicate this association, and suggestions for research to build the evidence base in this area are discussed.

Lessons (Not) Learned: Chicago Death Inequities during the 1918 Influenza and COVID-19 Pandemics.

During historical and contemporary crises in the U.S., Blacks and other marginalized groups experience an increased risk for adverse health, social, and economic outcomes. These outcomes are driven by structural factors, such as poverty, racial residential segregation, and racial discrimination. These factors affect communities' exposure to risk and ability to recover from disasters, such as pandemics. This study examines whether areas where descendants of enslaved Africans and other Blacks lived in Chicago were vulnerable to excess death during the 1918 influenza pandemic and whether these disparities persisted in the same areas during the COVID-19 pandemic. To examine disparities, demographic data and influenza and pneumonia deaths were digitized from historic weekly paper maps from the week ending on 5 October 1918 to the week ending on 16 November 1918. Census tracts were labeled predominantly Black or white if the population threshold for the group in a census tract was 40% or higher for only one group. Historic neighborhood boundaries were used to aggregate census tract data. The 1918 spatial distribution of influenza and pneumonia mortality rates and cases in Chicago was then compared to the spatial distribution of COVID-19 mortality rates and cases using publicly available datasets. The results show that during the 1918 pandemic, mortality rates in white, immigrant and Black neighborhoods near industrial areas were highest. Pneumonia mortality rates in both Black and immigrant white neighborhoods near industrial areas were approximately double the rates of neighborhoods with predominantly US-born whites. Pneumonia mortality in Black and immigrant white neighborhoods, far away from industrial areas, was also higher (40% more) than in US-born white neighborhoods. Around 100 years later, COVID-19 mortality was high in areas with high concentrations of Blacks based on zip code analysis, even though the proportion of the Black population with COVID was similar or lower than other racial and immigrant groups. These findings highlight the continued cost of racial disparities in American society in the form of avoidable high rates of Black death during pandemics.

Maternal Experiences with Discussing Complementary Feeding in Primary Care.

Complementary feeding practices promote healthy eating habits and food preferences later in life. Little is known about how US pediatricians communicate infant feeding practices to caregivers or how caregivers respond to this information. The purpose of this study is to explore mothers' experiences and perceptions of the complementary feeding recommendations they receive in primary care settings. English- and Spanish-speaking mothers of infants were recruited from Special Supplemental Nutrition for Women, Infants, and Children offices in Rhode Island, US, and snowball sampling. Semi-structured telephone interviews were conducted to investigate mothers' discussions with pediatricians about complementary feeding and their overall impressions of wellness visits. Thematic analysis was informed by the Fundamentals of Care theoretical framework. The mean age of the sample (n = 13) was 30.5 years and 62% self-identified as Latina. Four themes emerged from the analysis: (1) wellness visits are mostly positive experiences, (2) not all infant feeding recommendations are easy to follow, (3) alternative sources of infant feeding recommendations can be just as helpful, and (4) there is room for improvement at wellness visits. Improving the content, delivery, and cultural relevance of infant feeding recommendations in primary care settings with more specific and tailored information may promote adherence to evidence-based practices.

Impact of social environment on sexual behaviors of adolescent girls in 12 sub-Saharan African countries: a cross-sectional study.

BACKGROUND: Early sexual debut among adolescent girls may result in teenage pregnancy and sexually transmitted diseases. In sub-Saharan Africa (SSA), pregnancy among adolescent girls may adversely impact the continuation of their education, general health status, and birth outcomes. However, few cross-national studies have examined the role that the social environment plays in adolescent girls' sexual behaviors in SSA. In this study, we explored adolescent girls' social environment and the impact on their sexual behaviors.. METHODS: The country selection was based on availability of Global School-Based Student Health Survey (GSHS) national data (2003-2015). The total analytic sample was 22,067 adolescent girls from 12 countries in SSA. Descriptive statistics were generated to determine the characteristics of adolescent girls and independent samples t-test analysis were performed to determine whether there were differences between the social environment and age of sexual debut and sexual partners. Logistic regression models were used to determine the association between adolescent girls' social environment and sexual debut. RESULTS: The study results showed variations across the 12 countries. Almost one in five (19.9%) adolescent girls reported to have ever engaged in sexual intercourse. Their mean age of sexual debut was 13.21 (13.04-13.37) years and mean number of sexual partners was 2.19 (2.08-2.29). We found that adolescent girls who reported not being connected with their parents were more likely to debut sex (aOR = 1.32, 95% CI, 1.14-1.53, p < 0.000). Parental monitoring was significantly associated with sexual debut but after controlling for the confounding variables (age, class grade and drug use), the association was no longer significantly positively associated. Adolescent girls who felt supported by their peers had a significantly higher number of sexual partners than those who did not feel supported by their peers. CONCLUSION: The social environment of adolescent girls plays a very important role in sexual debut, age of sexual debut, and the number of sexual partners. Sexual health policies targeting adolescent girls are likely to achieve positive impacts if they focus on improving parental connectedness and peer support.

Adolescent girls in sub-Saharan Africa are at risk of dropping out of school when they get pregnant. There are also several health risks associated with adolescent pregnancies. This study explored factors in the adolescent girl's social environment which could impact their sexual behaviors. We examined data from adolescent girls in 12 sub-Saharan African Countries, namely, Kenya, Tanzania, Uganda, Ghana, Mauritania, Senegal, Swaziland, Zambia, Botswana, Namibia, Seychelles and Mozambique. After analyzing the data, we found that adolescent girls who reported not being close with their parents were more likely to debut sex. Adolescent girls who felt supported by their friends had a higher number of sexual partners. Thus, support from parents and peers play a vital role in the sexual behaviors of adolescent girls.

US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study.

Background: Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective: This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods: Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results: A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73%, and discussions about creating space for Black women decreased by just under 30%. Conclusions: The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts.

COVID-19, green space exposure, and mask mandates.

INTRODUCTION: Mask-wearing and social distancing are critical prevention measures that have been implemented to stem the spread of COVID-19. The degree to which these measures are adhered to in the US, however, may be influenced by access to outdoor resources such as green space, as well as mask mandates that may vary by state. PURPOSE: To examine the association between the presence or absence of statewide mask mandates and green space exposure with COVID-19 cumulative incidence in the US. METHODS: In October 2020, COVID-19 case data for each US county was downloaded from USA Facts, in addition to statewide mask mandates from a database maintained by the American Association of Retired Persons. The Normalized Difference Vegetation Index from the US Geological Survey (USGS), was used as a measure of greenspace, while the 2016 National Land Cover Database was used to assess tree canopy exposure as an alternative measure of greenspace. We performed generalized linear regression to evaluate associations with COVID-19 incidence, adjusting for potential confounders such as other environmental factors (i.e., air pollution and climate) and socio-economic factors derived from the CDC social vulnerability index. In addition, we also performed spatial regression analyses to account for spatial autocorrelation across counties. RESULTS: Counties with mandatory mask-wearing policies had a lower cumulative incidence of COVID-19 (B = -0.299, SE = 0.038). Among environmental factors, precipitation (B = 0.005, SE = 0.001) and PM 2.5 (B = 0.072, SE = 0.012) were associated with a higher incidence of COVID-19, while tree canopy (B = -0.501, SE = 0.129) was associated with a lower risk of COVID-19. COVID-19 incidence was higher in counties with socially vulnerable populations regarding socioeconomic status, minority status, and housing and transportation. CONCLUSION: Mandatory mask regulation, exposure to green space, and reduced exposure to air pollution may reduce COVID-19 incidence in the US. Additional public health policies should consider ways to mitigate environmental conditions that may contribute to the risk of COVID-19, especially for vulnerable populations.

COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries.

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

Disparities in the distribution of COVID-19 testing sites in black and Latino areas in new York City.

In New York City (NYC), there are disproportionately more cases and deaths from COVID-19 for Blacks and Latinos compared to Whites. Using data from the NYC coronavirus data repository and the 2018 American Community Survey 5-year census estimates, we examined the distribution of testing sites across NYC areas (zip code tabulation areas) by race in May 2020. ArcGIS was used to create majority race zip code-level maps showing the distribution of testing sites on May 1, 2020 and May 17, 2020 in NYC. t-tests were used to determine whether significant differences existed in the number of testing sites by the majority race of zip codes. Between May 1, 2020 and May 17, 2020, testing sites in majority Black areas increased by more than 240% from nine to 31, and more than 90% from 16 to 31 in majority Latino areas. Black (M = 1257.7) and Latino (M = 1662.3) areas had significantly more COVID-19 cases (p < 0.05) compared to White areas. Nonetheless, White (n = 70; 38.9%) areas had most of the 180 testing sites on May 17, 2020, compared to Black (n = 31;17.2%) and Latino (n = 31;17.2%) areas. Due to the socio-economic and underlying health conditions that may place Blacks and Latinos at high risk for COVID-19, it is imperative that access to testing is improved for vulnerable groups.

Do Spatial Boundaries Matter for Exploring the Impact of Community Green Spaces on Health?

Green space exposure is thought to have a positive influence on physical activity behavior and overall health. However, the literature remains equivocal, and green space measurement methods remain complicated. Using data from the Illinois Behavioral Risk Factor Surveillance System, this study examines the influence of green space on health-related factors, such as exercise, physical health, and mental health. Moreover, we explore the methods for measuring community green space via various spatial boundaries and green space resources. The results show that combining two contextually designated census boundaries and a measure of green space with seasonality were the best spatial conceptualizations for capturing community green space. Moreover, the findings showed a positive influence of green space exposure on health outcomes. These findings highlight the importance of considering geographic contexts of daily human behaviors and green space seasonality in providing a better understanding of the influence of community activity space on environmental exposure measurement. Further, this work contributes to community planning for encouraging health-promoting behaviors.

Greenspace exposure and sleep: A systematic review.

Green space is considered a critical environmental factor for sleep quality and quantity. However, no systematic review exploring this relationship exists. The purpose of this systematic review was to 1) explore research related to green space and sleep, and 2) examine the impact of green space exposure on sleep quality and quantity. Papers from eight electronic databases were eligible for inclusion if they met the following criteria: well-designed, any analysis exploring green space and sleep, provided sleep and green space measurement, published in peer-reviewed journals, and written in English. Thirteen eligible studies related to green space and sleep were selected after peer-review procedures. Cross-sectional studies (n = 7) used either a questionnaire or the combination of Geographic Information Systems and remote sensing images for green space measurement, while questionnaires were primarily used to measure both sleep quality and quantity. Intervention studies (n = 5) were categorized into three types: walking program, gardening, and working in a forest. Eleven out of thirteen studies concluded that green space exposure was associated with improvement in both sleep quality and quantity. The findings support the evidence of a positive association between green space exposures and sleep quality and quantity, and also suggest green exercise and therapeutic gardening as possible intervention methods to improve sleep outcomes.

Do Fruit and Vegetable Policies, Socio-Environmental Factors, and Physical Activity Influence Fruit and Vegetable Intake Among Adolescents?

PURPOSE: Several factors are known to influence the intake of fruits and vegetables (FV) among adolescents. However, few studies have examined the role that FV policies and associated factors (such as availability of food at home, parental support, and physical activity) play on consumption of FV, particularly among adolescents in low- and middle-income countries (LMICs). METHOD: Adolescent data (except for FV policy status) were obtained from the Global School-based Student Health Survey from 2004 to 2013. Information on FV policies was obtained from government ministries, World Health Organization databases, Scopus, and PubMed. Countries were designated as having the policy if the policy was issued at least a year before Global School-based Student Health Survey data collection (n = 13 LMICs). Countries without FV policies were based on the absence of a policy between 2004 and 2013 (n = 11 LMICs). The total analytic sample included 89,843 adolescents from 24 countries. RESULTS: Logistic regression models revealed a positive association between the presence of FV policy and the adequate consumption of FV (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI]: 1.74-2.40; p-value < .001). Parental supervision was positively associated with sufficient intake of FV (AOR = 1.62; 95% CI: 1.42-1.84; p-value < .001). Physical activity was also positively associated with adolescents consuming ≥5 servings of FV daily (AOR = 1.30; 95% CI: 1.13-1.50; p-value < .001). CONCLUSION: Adolescents' physical environment (presence of FV policies, unavailability of food), social environment (parental connectedness, supervision, and bonding), and physical activity behavior are all significant predictors of adolescents' intake of FV.

Sex and racial/ethnic differences in sleep quality and its relationship with body weight status among US college students.

Objective: To examine sex and racial/ethnic differences in sleep quality and the association between sleep quality and body weight status among US college students. Participants: A nationally representative sample (N = 324,767) of college students from 2011 to 2015. Methods: A secondary data analysis of cross-sectional data. Results: Women showed poorer sleep quality (nights per week getting enough sleep to feel rested) than men (4.00 versus 4.34 days; p < .001). In both men and women, compared with non-Hispanic whites, racial/ethnic minorities showed lower sleep quality (p < .001). Compared with normal weight participants, overweight participants had poorer sleep quality (p = .007) among men, and both overweight (p = .004) and obese participants (p < .001) had lower sleep quality among women. Conclusions: Understanding sex and racial/ethnic sleep differences and the association between sleep and body weight status is important for colleges to promote college students' healthy sleep.

Impact of Pokémon Go on Physical Activity: A Systematic Review and Meta-Analysis.

CONTEXT: Pokémon Go is a popular mobile augmented reality game that requires players to travel to different locations to capture virtual characters. This study systematically reviews and quantifies Pokémon Go in relation to physical activity engagement among players. EVIDENCE ACQUISITION: A keyword search was conducted in PubMed, Web of Science, Scopus, EBSCO, SPORTDiscus, PsycINFO, ScienceDirect, and Cochrane Library for articles published between July 2016 and October 2018. Meta-analysis was performed to estimate the pooled effect of playing Pokémon Go on physical activity outcome. EVIDENCE SYNTHESIS: From the keyword search, 17 studies (16 observational and 1 pre-post) were identified, with a total sample of 33,108 participants. A comparison between Pokémon Go players and nonplayers and between pre- and post-play time points revealed an increase in walking duration, distance walked, and number of steps/day. Pokémon Go players were also found to engage in less sedentary behavior. Playing Pokémon Go was associated with an increase in the number of steps per day by 1,446 steps (95% CI=953, 1,939; I2=81%). CONCLUSIONS: Playing Pokémon Go was associated with a statistically significant but clinically modest increase in the number of daily steps taken among game players. One challenge for future physical activity interventions using Pokémon Go is to retain active engagement once the initial novelty wears off. Additional studies with longer follow-up periods and experimental study design are needed to assess to what extent Pokémon Go and other augmented reality games can be used to promote physical activity at the population level for a sustained time period.

Changes to SNAP-authorized retailer stocking requirements and the supply of foods and beverages in low-income communities in seven U.S. states.

Low-income communities often lack access to supermarkets and healthy foods. Enhanced stocking requirements for staple foods for Supplemental Nutrition Assistance Program (SNAP)-authorized retailers may increase availability of healthy foods in smaller stores which are prevalent in low-income areas. This study aimed to evaluate the extent that small food stores located in low-income areas met the U.S. Department of Agriculture's 2016 final rule on SNAP-authorized retailer stocking requirements, which increased the minimum number of required staple food varieties from three to seven for each staple food category, required a depth of stock of three units of each variety, and increased the required number of categories with perishables from two to three. A multisite research project was conducted in 2017. Nine research teams located in seven U.S. states audited the availability of perishable and nonperishable staple foods and beverages in 351 small food stores in low-income areas. Analyses determined the extent to which stores met all or part of the stocking requirements and tested differences by store type. 30.2% of stores met all of the 2016 final rule requirements; 86.3% met the requirements for fruits and vegetables, whereas only 30.5% met requirements for dairy. 53.1% of non-chain small grocery stores met all requirements compared to 17.1% of convenience stores (p < .0001). Less than one half of the food stores audited met the U.S. Department of Agriculture's 2016 final rule that would expand SNAP-authorized retailer stocking requirements suggesting that, if implemented, the rule may generate increased offerings of staple foods in small stores in low-income areas.

Increase in Obesity Among Women of Reproductive Age in Zambia, 2002-2014.

Objective: To describe trends in obesity in Zambian women of reproductive age and to identify factors that may have contributed to changes in trends and nutrition outcomes. Materials and Methods: We obtained data on body mass index and individual factors of women from the Zambia Demographic and Health Survey for the period 2002 to 2014. From these data, we calculated descriptive statistics and examined the extent to which factors link to the odds of obesity over time. We also reviewed primary and secondary data sources, such as government documents, theses, and search engines to identify factors that may have contributed to trends and changes in nutrition outcomes. Results: The proportion of obesity doubled from 2002 (12.5%) to 2014 (22.3%). The odds were higher among educated, currently married and wealthy women, and it increased with age. Rural residence and working in agricultural-related jobs were linked to lower odds for obesity. This disparity varies by province. In addition, despite the presence of many nutrition policies and strategies, the increase in obesity occurred within the past two decades when urbanization and other factors (e.g., sedentary work, a proliferation of fast food restaurants, and advertisements) may have affected changes in nutrition outcomes for women. Conclusions: We identified increasing trends in obesity in women of reproductive age over time. The rapid urbanization and other factors that occurred in Zambia during this period are significant risk factors for obesity in Zambian women. The findings will be of interest to countries that are undergoing a nutrition transition.

Factors Associated with Parental Intent not to Circumcise Daughters in Enugu State of Nigeria: An Application of the Theory of Planned Behavior.

This study explored intention of parents not to circumcise daughters in Enugu State, Nigeria using theory of planned behavior (TPB) as a framework. A survey of 1345 parents was carried out using structured questionnaire with FGM question items based on TPB constructs of attitude, subjective norm (SN), perceived behavioral control (PBC), and intention. Intention was dichotomized into two categories and logistic regression analysis was performed to examine the association between the constructs of TPB while controlling for some socio-demographic factors. 70% of respondents did not intend circumcising daughters. Constructs of TPB associated significantly, at p < 0.0001, with intention not to perform FGM on daughters with PBC having the strongest association. Having a post-secondary education (OR = 3.94; CI = 2.73-5.67) and absence of history of FGM in family (OR = 3.39; CI = 2.62-4.39) are the socio-demographic variables most significantly associated with the intention not to circumcise daughters. Homer-Lemeshow goodness-of-fit statistics indicated logistic regressions model 1 was significant (p < 0.05) making TPB a good theoretical basis for study of FGM. Intervention activity should focus on improving attitude of parents and especially those with less than post-secondary education and those with cases of FGM in their household.

A comparative study of fruit and vegetable consumption and physical activity among adolescents in 49 Low-and-Middle-Income Countries.

Physical inactivity and low consumption of fruits and vegetables (FV) during adolescence may persist through adulthood, putting adolescents at risk of developing chronic diseases. Although studies from high-income countries have reported differences in FV consumption and physical activity (PA) between adolescent boys and girls, few exist from low-and-middle-income countries (LMICs). In this study, we examined patterns of FV consumption and PA among adolescent boys and girls in LMICs. Country selection was based on availability of Global School-Based Student Health Survey (GSHS) data from 2004 to 2013. The total analytic sample was 164,771 adolescents from 49 LMICs. Descriptive statistics were generated to determine adolescents meeting the World Health Organization (WHO) recommendations for FV and PA. A Rao-Scott adjusted chi-square statistic was computed to assess gender differences. Less than 30% of adolescents across all countries met the WHO guidelines for FV consumption or PA. Morocco (29.5%) and India (29.5%) however had the highest percentage of adolescents meeting recommendations for FV and PA, respectively. Adolescent boys were more active than girls, and this difference was more notable in the Middle East and North African region. Adolescents achieving the WHO recommendations for daily consumption of FV and PA were consistently low in all countries.

Best practices for using natural experiments to evaluate retail food and beverage policies and interventions.

Policy and programmatic change in the food retail setting, including excise taxes on beverages with added-caloric sweeteners, new supermarkets in food deserts, and voluntary corporate pledges, often require the use of natural experimental evaluation for impact evaluation when randomized controlled trials are not possible. Although natural experimental studies in the food retail setting provide important opportunities to test how nonrandomized interventions affect behavioral and health outcomes, researchers face several key challenges to maintaining strong internal and external validity when conducting these studies. Broadly, these challenges include 1) study design and analysis; 2) selection of participants, selection of measures, and obtainment of data; and 3) real-world considerations. This article addresses these challenges and different approaches to meeting them. Case studies are used to illustrate these approaches and to highlight advantages and disadvantages of each approach. If the trade-offs required to address these challenges are carefully considered, thoughtful natural experimental evaluations can minimize bias and provide critical information about the impacts of food retail interventions to a variety of stakeholders, including the affected population, policymakers, and food retailers.

Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review.

BACKGROUND: Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. OBJECTIVE: A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. METHODS: Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. RESULTS: An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). CONCLUSIONS: We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research.

Physical Activity, Sleep, and BMI Percentile in Rural and Urban Ugandan Youth.

BACKGROUND: Uganda is experiencing a dual burden of over- and undernutrition, with overweight prevalence increasing while underweight remains common. Potential weight-related factors, particularly physical activity, sleep, and rural/urban status, are not currently well understood or commonly assessed in Ugandan youth. OBJECTIVE: The purpose of this study was to pilot test a survey measuring weight-related factors in rural and urban Ugandan schoolchildren. METHODS: A cross-sectional survey measured sociodemographics, physical activity, sleep patterns, and dietary factors in 148 rural and urban schoolchildren aged 11-16 in central Uganda. Height and weight were objectively measured. Rural and urban youth were compared on these factors using χ2 and t tests. Regression was used to identify correlates of higher body mass index (BMI) percentile in the full sample and nonstunted youth. FINDINGS: Youth were on average 12.1 ± 1.1 years old; underweight (10%) was more common than overweight (1.4%). Self-reported sleep duration and subjective sleep quality did not differ by rural/urban residence. Rural children overall had higher BMI percentile and marginally higher stunting prevalence. In adjusted analyses in both the full and nonstunted samples, higher BMI percentile was related to living in a rural area, higher frequency of physical activity, and higher subjective sleep quality; it was negatively related to being active on weekends. In the full sample, higher BMI percentile was also related to female gender, whereas in nonstunted youth, higher BMI was related to age. BMI percentile was unrelated to sedentary time, performance of active chores and sports, and dietary factors. CONCLUSIONS: This study is one of the first to pilot test a survey assessing weight-related factors, particularly physical activity and sleep, in Ugandan schoolchildren. BMI percentile was related to several sociodemographic, sleep, and physical activity factors among primarily normal-weight school children in Uganda, providing a basis for understanding weight status in the context of the nutrition transition.