Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial.

BACKGROUND: The objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation. METHODS: A parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention. RESULTS: A total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention. CONCLUSION: The present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking. TRIAL REGISTRATION: This study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07.

Multi-level validation of the German physical activity self-efficacy scale in a sample of female sixth-graders.

BACKGROUND: The majority of children and adolescents are insufficiently physically active. Self-efficacy is considered one of the most important determinants of physical activity (PA). The purpose of this study was to validate the German version of the physical activity self-efficacy scale by means of a multi-level approach. Factorial validity, internal consistency and criterion validity were examined for the individual and the class level. METHODS: The final sample comprised 454 female sixth-graders of 33 classes. To examine the factorial validity of the translated 8-item scale, a multi-level confirmatory factor analysis was conducted with the lavaan package in R. Internal consistency was estimated with the alpha function of the psych package. Criterion validity was examined by correlating self-efficacy with moderate-to-vigorous physical activity (MVPA) assessed with accelerometers. RESULTS: In contrast to previous validation studies, a unidimensional structure of the scale was not supported. Instead, two highly correlated (rindividual = .87; rclass = .69) but distinct latent factors, representing PA self-efficacy and social support from family and friends, were differentiated on both the individual and class level. The best overall fit exhibited a multi-level 1 × 1-model, including only the six items measuring PA self-efficacy (χ2 = 32.10, CFI = .986, TLI = .976, RMSEA = .059, SRMR = .035). Internal consistencies for the complete 8-item scale and the 6-item scale were good on the individual level and excellent on the class level. For the two items measuring social support, Cronbach's alpha was low on the individual and excellent on the class level. Weak relations between self-efficacy and MVPA were found for the individual level, strong associations were found for the class level. CONCLUSIONS: The validation speaks for the use of the abridged 6-item scale, which allows for a unidimensional assessment of PA self-efficacy. Generally, the results support the relevance of a multi-level approach, which not only differentiates between self-efficacy on the individual level and on the class level but also between the respective implications regarding reliability and criterion validity on both levels. Thereby, this study offers a rigorously validated scale and further illustrates possible consequences of the usual neglect of group-level variance in scale validation.

A school-based intervention based on self-determination theory to promote girls' physical activity: study protocol of the CReActivity cluster randomised controlled trial.

BACKGROUND: Physical inactivity is deemed to be the fourth leading cause for premature death. Nevertheless, only a minority of children and adolescents in Germany fulfil the guideline of the World Health Organization of at least 60 min of moderate-to-vigorous physical activity per day. Children and adolescents with a lower socioeconomic background and especially girls are regarded as a high-risk group in terms of physical inactivity. Aim of this study is to examine how a theory-based physical education intervention programme supporting students' autonomy, competence and relatedness affects physical activity both during these lessons and in leisure time. Based on the self-determination theory and the social cognitive theory, the extent to which autonomy, competence, relatedness, social support and self-efficacy in girls mediate the effect of the intervention programme on their physical activity will be examined. Moreover, the potential moderating role of socioeconomic status, environmental factors, teacher characteristics and BMI will be tested. METHODS: CReActivity is a two-arm cluster randomised controlled trial with a follow-up period of three months after the end of the intervention programme. A total of 600 sixth grade girls in lower secondary schools in Bavaria, Germany will be proactively recruited. The intervention is carried out by the physical education teachers of the participating classes for five months. Primary outcome is the girls' physical activity measured by accelerometers and systematic observations. DISCUSSION: We expect to provide an intervention programme that can contribute to the increase of physical activity levels in girls and offer insights into the mechanisms of physical activity behaviour change. TRIAL REGISTRATION: German Clinical Trials Register DRKS00015723 (date of registration: 2018/10/22 retrospectively registered).

Environmental attitude and affective-motivational beliefs towards sustainability of secondary school children in Germany and their associations with gender, age, school type, socio-economic status and time spent in nature.

There are warnings that human actions will lead to irreversible environmental damage if they continue at their current pace and scale. With regard to individual aspects, a pro-environmental attitude and positive affective-motivational beliefs towards sustainability represent fundamentals for a more sustainable future. However, there is little data regarding these constructs and relevant explanatory factors, especially with regard to young people. We examined environmental attitude (two-dimensional: utilization and preservation) and affective-motivational beliefs towards sustainability with regard to gender, age, socio-economic status, school type and time spent in nature in 484 adolescents (11-14 years) living in German cities by means of univariate and multiple regression analyses. Mean values were high in preservation and affective-motivational beliefs towards sustainability, and relatively low in utilization. Female adolescents had higher values compared to male students in affective-motivational beliefs towards sustainability. Age did not play a substantial role. Although being strongly correlated with each other, school type and socio-economic status each exhibited positive associations to environmental attitude and affective-motivational beliefs towards sustainability. Furthermore, multiple regression analyses identified time spent in nature as a significant predictor of incremental value, suggesting a tentative recommendation to spend at least half an hour per week in nature in order to promote positive attitudes towards the environment and sustainability. In sum, special needs for topic-related education seem to exist for male students, students with lower formal level of education, students with a lower socio-economic status and students who spend little time in nature.

Subjective walkability perceived by children and adolescents living in urban environments: A study protocol for participatory methods and scale development in the WALKI-MUC project.

BACKGROUND: Youth's perceptions of a city or neighbourhood's walkability are important for determining the physical activity (PA) friendliness of their environment. Traditional objective measures of walkability fail to incorporate children and youth's (CY) subjective perceptions of places that they perceive as supportive for play and exercise. Internationally, the most promising subjective measure is the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) questionnaire. Yet, the NEWS-Y is not available for German-speaking adolescents. In the WALKI-MUC project, a combination of participatory research methods is used to identify CY's perceptions of PA-friendly places in Munich, Germany. Based on the findings, a German version of the NEWS-Y (NEWS-Y-G) for subjective walkability measurement is developed. METHODS AND DESIGN: CY aged six to 17 years from neighbourhoods with different objectively-measured walkability, take part in photovoice, walking interviews and mapping to gather their perceptions of PA-friendly places. The participatory study begins with an introductory workshop and concludes with a follow-up workshop, where characteristics of PA-friendly places are discussed in focus groups. In between these workshops, participants complete a photo mission with a walking interview, allowing for individual significance of PA-related places to be shared in a one-on-one setting with the researcher. The findings are used to adapt and translate the NEWS-Y for the German context. The newly developed NEWS-Y-G is then used to measure the subjective walkability perceived by a representative sample of adolescents in Munich. DISCUSSION: The WALKI-MUC project introduces a participatory methodology for researchers and urban planners to assess subjective walkability with CY. The combination of qualitative and quantitative walkability measurements is described in this study protocol. Findings on PA-friendly places contribute to environmental psychology and the development of the NEWS-Y-G adds a German-language instrument for subjective walkability measurement.

Physical activity through place attachment: Understanding perceptions of children and adolescents on urban places by using photovoice and walking interviews.

Public urban places and their environmental characteristics impact youth's physical activity (PA) through perceptions. The objective of this study was to use a qualitative participatory approach with children and adolescents to understand how their attachment to urban places perceived as PA-friendly or unfriendly is related to their PA behaviour. Ninety-three participants aged six to 17 from six neighbourhoods with varying objective walkability engaged in photovoice and walking interviews. Data were analysed by using the tripartite framework of place attachment (PPP model), which was adapted for application to PA behaviour and supplemented by photographs. Themes were identified for each (sub-)dimension of the PPP model with person, place and process factors influencing attachment. Further subdimensions (PA and other behaviours) and categories (travel mode, trip length and frequency of visits) were added to the PPP model. Urban design recommendations were derived by age and gender to promote PA through place attachment.

Changes in social interaction, social relatedness, and friendships in Education Outside the Classroom: A social network analysis.

Introduction: Social interaction is associated with many effects on the psychological level of children such as mental health, self-esteem, and executive functions. Education Outside the Classroom (EOtC) describes regular curricular classes/lessons outside the school building, often in natural green and blue environments. Applied as a long-term school concept, EOtC has the potential to enable and promote social interaction. However, empirical studies on this topic have been somewhat scant. Methods: One class in EOtC (N = 24) and one comparison class (N = 26) were examined in this study to explore those effects. Statistical Actor-Oriented Models and Exponential Random Graph Models were used to investigate whether there are differences between EOtC and comparison class regarding changes over time in social interaction parameters; whether a co-evolution between social interaction during lessons and breaks and attendant social relatedness and friendships exists; whether students of the same gender or place of residence interact particularly often (homophily). Results: Besides inconsistent changes in social interaction parameters, no co-evolutional associations between social interaction and social relatedness and friendships could be determined, but grouping was evident in EOtC. Both classes showed pronounced gender homophily, which in the case of EOtC class contributes to a fragmentation of the network over time. Discussion: The observed effects in EOtC could be due to previously observed tendencies of social exclusion as a result of a high degree of freedom of choices. It therefore seems essential that in future studies not only the quality of the study design and instruments should be included in the interpretation - rather, the underlying methodological-didactic concept should also be evaluated in detail. At least in Germany, it seems that there is still potential for developing holistic concepts with regards to EOtC in order to maximize the return on the primarily organizational investment of implementing EOtC in natural environments.

Motivation and Basic Psychological Needs Satisfaction in Active Travel to Different Destinations: A Cluster Analysis with Adolescents Living in Germany.

Active travel in adolescence contributes to improved health outcomes. Self-Determination Theory suggests that motivation and basic psychological needs influence travel behavior. Person-centered approaches can examine interrelationships of these constructs underlying travel behavior. The aim of this study was to investigate (i) which clusters can be identified in adolescents, (ii) whether clusters explain overall active travel behavior, (iii) whether clusters were associated with travel mode to various destinations or distance, and (iv) whether differences across clusters appear regarding sex/gender, age, and weight status. The sample included 517 (263 male, 254 female) adolescents from Germany, aged 11-15. Self-organizing maps analysis identified six clusters from nine input variables: intrinsic motivation, integrated regulation, identified regulation, introjected regulation, external regulation, amotivation, autonomy satisfaction, competence satisfaction, and relatedness satisfaction. The most beneficial cluster regarding active travel demonstrated highest basic psychological needs satisfaction and autonomous motivation with low controlled motivation and amotivation. The most vulnerable cluster was characterized by generally low levels of motivation except for external regulation and amotivation. Clusters were not associated with distance to school, friends/relatives, shopping facilities, or leisure facilities. The findings support the importance of high quality and high quantity of motivation for active travel in adolescents.

Do Active Commuters Feel More Competent and Vital? A Self-Organizing Maps Analysis in University Students.

University students represent a population that faces high risks regarding physical inactivity. Research suggests that a regular engagement in physical activity (PA) may be more likely established when it leads to the experience of subjective vitality. Subjective vitality, in turn, is more likely achieved through physical activities that individuals feel competent in, and that take place in natural outdoor environments. An activity that may fulfill these conditions is active commuting to and from university (ACU). To examine whether and in which form ACU can combine this promising pattern of aspects, a person-oriented analysis was conducted. The sample contained 484 university students (59.3% females). Leisure-time PA, ACU by walking, ACU by cycling, subjective vitality, PA-related competence and body mass index were included as input variables in a self-organizing maps analysis. For both female and male university students, the identified clusters indicated that students who intensively engaged in ACU did not exhibit subjective vitality levels above average. Consistently, they did not show elevated levels of PA-related competence, which suggests that ACU does not support the perception of their physical abilities. Considerations regarding urban university environments lacking sufficient natural elements finally add to the conclusion that engaging in ACU does not suffice to establish a vitality-supportive and thus sustainable PA behavior. Additionally, the identified clusters illustrate a large heterogeneity regarding the interaction between leisure-time PA, body mass index and subjective vitality.

The Effect of Teacher Autonomy Support on Leisure-Time Physical Activity via Cognitive Appraisals and Achievement Emotions: A Mediation Analysis Based on the Control-Value Theory.

Analyzing students' emotional experience in physical education (PE) is of crucial importance as it may fill an important gap in research examining the role of PE for students' leisure-time physical activity (PA). Based on the control-value theory of achievement emotions, the purpose of this study was to test the assumption that multi-dimensional autonomy support of the PE teacher may affect students' leisure-time PA via their appraisals of control and value and achievement emotions experienced in PE. Variance-based structural equation modelling was used to test the proposed model in a sample of 1030 students aged between 11 and 18 years (M = 13.4, SD = 1.48) stemming from schools with the lowest educational level among secondary schools in Germany. The results indicated that in particular cognitive autonomy support positively predicted students' self-efficacy and intrinsic value. Whereas appraisals of self-efficacy were negatively related to the experience of anxiety, intrinsic value was a major positive predictor of enjoyment. Enjoyment, in turn, was of substantial relevance for leisure-time PA. The findings offer a meaningful contribution in understanding students' emotional experiences and remind PE teachers of their opportunity to adopt an autonomy-supportive teaching style to positively influence the emotions of their students.

Accelerometer-Measured Physical Activity and Sedentary Behavior Levels and Patterns in Female Sixth Graders: The CReActivity Project.

Regular physical activity (PA) and low levels of sedentary behavior (SB) have positive health effects on young people. Adolescent girls of low socioeconomic background represent a high-risk group with regard to physical inactivity and SB. In this study, accelerometer-measured levels of PA and SB of female sixth graders attending lower secondary schools in Germany are presented, patterns of PA and SB throughout the day are described and differences between weekdays and weekend days are analyzed. Data of 425 students of the CReActivity project were analyzed. Sampling and processing of accelerometer data followed recent recommendations, which had not been applied to data of a German-speaking sample before. The WHO recommendation of daily 60 min moderate-to-vigorous PA was fulfilled by 90.4% of the girls on weekdays and by 57.4% on weekend days. The significant weekday-weekend differences were mainly associated with active commuting to and from school. Students engaged in SB for more than 8 h on weekdays and for over 7 h on weekend days. The results suggest a strong need for interventions increasing PA and reducing SB, especially during school hours and on weekends. Furthermore, a comparison with methods and results of previous studies highlights the need to follow recent criteria in accelerometer data sampling and processing to ensure an accurate and valid differentiation between PA-related risk groups and non-risk groups.

The German Multi-Dimensional Perceived Autonomy Support Scale for Physical Education: Adaption and Validation in a Sample of Lower Track Secondary School Students.

Teachers' autonomy support (AS) in physical education (PE) has positive effects on students' affective and behavioral outcomes in PE. Even though the existence of three different dimensions of AS, namely cognitive, organizational and procedural AS has been suggested in educational settings, there is a lack of multidimensional instruments for the assessment of autonomy-supportive teaching in PE. The aim of this study was to validate the German Multi-Dimensional Perceived Autonomy Support Scale for Physical Education (MD-PASS-PE). The sample comprised 1030 students of grades 6 through 10. Internal consistency was used to test the reliability of the assumed subscales. Factorial validity and measurement invariance across gender and age were examined by confirmatory factor analyses. Structural equation modeling was used to evaluate criterion validity. The subscales exhibited acceptable to good internal consistency. The assumed three-factor structure was confirmed within a bi-factor model including a general factor and three specific group factors. Results strongly supported measurement invariance across gender while tentatively suggesting measurement invariance across age. Criterion validity was supported as the MD-PASS-PE explained 15% and 14% of the variance in the constructs of self-efficacy and intrinsic value, respectively. The German MD-PASS-PE provides PE teachers with deeper insights into their autonomy-supportive teaching behavior, helping them to support their students' autonomy in a holistic way.

The German Basic Psychological Needs Satisfaction in Physical Education Scale: Adaption and Multilevel Validation in a Sample of Sixth-Grade Girls.

(1) Background: Self-determination theory (SDT) claims that need supportive behavior is related to the satisfaction of the basic psychological needs: autonomy, relatedness and competence. The student-teacher relationship is of special interest to understand mechanisms of physical activity behavior change in physical education (PE). (2) Methods: In this cross-sectional study, 481 girls answered a German version of the Basic Psychological Need Satisfaction (BPNS) in PE Scale. Contrary to previous studies, the psychometric properties of this scale were examined by multilevel confirmatory factor analysis. (3) Results: A model with three latent factors on both levels showed acceptable fit and all items showed significant factor loadings. Although one item was excluded due to psychometric reasons, the scale showed good internal consistencies; α = 0.85 at the individual level and α = 0.84 at the class level. Subscales' internal consistency at the individual levels was good, while at class level, the scores differed from poor to good. Small significant correlations of BPNS with moderate to vigorous physical activity support criterion validity. (4) Conclusion: The 11-item scale is a valid measurement tool to assess BPNS in PE and further application in the school setting would broaden the insights into the psychological impacts of SDT in PE.

Physical Activity-Related Profiles of Female Sixth-Graders Regarding Motivational Psychosocial Variables: A Cluster Analysis Within the CReActivity Project.

INTRODUCTION: Adolescents' physical activity (PA) behavior can be driven by several psychosocial determinants at the same time. Most analyses use a variable-based approach that examines relations between PA-related determinants and PA behavior on the between-person level. Using this approach, possible coexistences of different psychosocial determinants within one person cannot be examined. Therefore, by applying a person-oriented approach, this study examined (a) which profiles regarding PA-related psychosocial variables typically occur in female sixth-graders, (b) if these profiles deliver a self-consistent picture according to theoretical assumptions, and (c) if the profiles contribute to the explanation of PA. MATERIALS AND METHODS: The sample comprised 475 female sixth-graders. Seventeen PA-related variables were assessed: support for autonomy, competence and relatedness in PE as well as their satisfaction in PE and leisure-time; behavioral regulation of exercise (five subscales); self-efficacy and social support from friends and family (two subscales). Moderate-to-vigorous PA was measured using accelerometers. Data were analyzed using the self-organizing maps (SOM) analysis, a cluster analysis including an unsupervised algorithm for non-linear models. RESULTS: According to the respective level of psychosocial resources, a positive, a medium and a negative cluster were identified. This superordinate cluster solution represented a self-consistent picture that was in line with theoretical assumptions. The three-cluster solution contributed to the explanation of PA behavior, with the positive cluster accumulating an average of 6 min more moderate-to-vigorous PA per day than the medium cluster and 10 min more than the negative cluster. Additionally, SOM detected a subgroup within the positive cluster that benefited from a specific combination of intrinsic and external regulations with regard to PA. DISCUSSION: The results underline the relevance of the assessed psychosocial determinants of PA behavior in female sixth-graders. The results further indicate that the different psychosocial resources within a given person do not develop independently of one another, which supports the use of a person-oriented approach. In addition, the SOM analysis identified subgroups with specific characteristics, which would have remained undetected using variable-based approaches. Thus, this approach offers the possibility to reduce data complexity without overlooking subgroups with special demands that go beyond the superordinate cluster solution.

Effects of a Sports-Oriented Primary School on Students' Physical Literacy and Cognitive Performance.

As only a small group of children fulfil the guidelines for physical activity, interventions are necessary to promote active lifestyles. We examined the effects of a sports-oriented primary school (N = 79) in comparison to a regular primary school (N = 90) on students' physical literacy and cognitive performance. To evaluate the implementation of the sports-oriented school curriculum a process evaluation was conducted, in which the school curriculum was analysed and guideline-based interviews were carried out with the schoolteachers and the school director. To measure students' physical literacy and cognitive performance several tests were used. Small positive effects of the sports-oriented primary school on students' physical literacy were shown in standing long jump and attitudes towards physical activity. There were no differences between the groups regarding cognitive performance. This study provides the first insights on how a sports-oriented school can promote students' physical literacy in the future. The results are in line with previous research that shows that when children spend more time in physical education and overall physical activities at school, no negative consequences result for their cognitive performance. In future, long-term evaluations of the effects of sports-oriented schools are required to receive valid results on the effects on students.