The participation of Aboriginal and Torres Strait Islander parents in Australian trials of parenting programs for improving children's health: a scoping review.

OBJECTIVES: To assess the inclusion of Aboriginal and Torres Strait Islander parents in trials of parenting programs in Australia; the involvement of Indigenous fathers in such studies; and whether parenting programs are designed to be culturally appropriate for Aboriginal and Torres Strait Islander people. STUDY DESIGN: Scoping review of peer-reviewed journal publications that report quantitative outcomes for Australian randomised control trials of parenting programs in which the participants were parents or caregivers of children under 18 years of age, and with at least one outcome related to children's health, health behaviour, or wellbeing. DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus databases. DATA SYNTHESIS: Of 109 eligible publications, nine reported how many participants were Aboriginal or Torres Strait Islander people; three specified whether they were Aboriginal, Torres Strait Islander, or both. Two publications described specific interventions for Aboriginal and Torres Strait Islander children; both reported consultation with Indigenous people regarding program design. Of the 15 559 participating parents in all included publications, 93 were identified as Aboriginal or Torres Strait Islander people. No publications noted as study limitations the absence of consultation with Indigenous people or the low participation rate of Aboriginal and Torres Strait Islander families. CONCLUSIONS: The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants.

Implementation of health and wellbeing policies and programs for students: Views of Australian universities.

ISSUE ADDRESSED: Universities are a crucial setting to address and promote optimal mental health of young Australians. However, there is a lack of knowledge of universities' views of current implementation of health and wellbeing initiatives. Therefore, we examined the views of Australian universities on the implementation of health and wellbeing policies and programs within Australian universities. METHODS: An online survey of Australian universities asked respondents to rate their level of agreement with five statements pertaining to the implementation of health and wellbeing policies and programs for students within Australian universities using a 5-point Likert scale (strongly agree to strongly disagree). RESULTS: Eleven universities completed the survey (28.2% response rate). All respondents (n = 11) agreed that universities play a crucial role in supporting the health and wellbeing of their students and report access to sufficient expertise to do this. Approximately three-quarters (8/11) agreed that universities know what policies and programs to implement to support their students' health and wellbeing. There was less agreement that universities have sufficient resources (2/11 agree) or access to sufficient information about the health and wellbeing of their student population (3/11 agree) to support the implementation of health and wellbeing policies and programs. CONCLUSIONS: Australian universities demonstrated strong organisational commitment to supporting the health and wellbeing of their students but highlighted some key barriers to implementation. SO WHAT?: Findings from this preliminary research highlight potential barriers and facilitators to the implementation of health and wellbeing policies and programs in Australian universities, and potential foci for future research.

Behavioral and Cognitive Outcomes of an Online Weight Loss Program for Men With Low Mood: A Randomized Controlled Trial.

BACKGROUND: Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms. PURPOSE: To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood. METHODS: Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 ≥ 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d). RESULTS: At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up. CONCLUSIONS: This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).

Establishing Effectiveness of a Community-based, Physical Activity Program for Fathers and Daughters: A Randomized Controlled Trial.

BACKGROUND: The 'Dads And Daughters Exercising and Empowered' (DADEE) program significantly improved physical activity levels of fathers and their daughters in an efficacy trial. However, the effectiveness of interventions when delivered in real-world settings needs to be established. PURPOSE: To evaluate the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. METHODS: We conducted a two-arm RCT, (baseline and 3-months post-intervention assessments), in Newcastle, Australia. In 2016, 155 fathers (27-60 years) and 189 primary-school-aged daughters (4-12 years) (n = 344) were randomly allocated to the intervention (78 fathers, 95 daughters) or waitlist-control (77 fathers, 94 daughters) groups. Trained facilitators delivered the 9-week DADEE program (weekly sessions plus home-based tasks). Primary outcomes were fathers' and daughters' physical activity (steps/day). Secondary outcomes included screen-time, weight status, daughters' fundamental movement skill (FMS) proficiency, perceived sports competence, and fathers' parenting practices. Effects were assessed using linear mixed models. RESULTS: Primary outcome follow-up data were collected from 88% of fathers and 89% of daughters. Significant group-by-time differences in mean daily steps were found for fathers' (adjusted difference = +1,638; 95% CI: 833, 2,443, d = 0.7) and daughters' (adjusted difference = +1,023 steps/day; 95% CI: 259, 1,787; d = 0.4) physical activity. Significant effects were observed for daughters' screen-time, FMS, and some parenting practices. No significant effects were identified for weight status, or fathers'screen-time or self-reported MVPA. Program attendance, satisfaction and fidelity were very high. CONCLUSION: This study established the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Importantly, the findings were comparable to those of the efficacy RCT delivered by the research team. To maximize public health benefits, a larger-scale dissemination of the program appears warranted.Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12616001270404 Human Research Ethics Committee: H-2014-0330.

Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children.

BACKGROUND: Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels. METHODS: A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m2) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children's mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers' physical activity levels and parenting practices for physical activity and screen time behaviours, children's fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes. RESULTS: Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers' physical activity levels, children's FMS proficiency, and several parenting constructs. No effects were observed for both fathers' and children's accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity. CONCLUSION: Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers' physical activity levels, children's FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12619000105145 . Registered 24/01/2019.

Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review.

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-022-04017-7.

Engaging Fathers to Increase Physical Activity in Girls: The "Dads And Daughters Exercising and Empowered" (DADEE) Randomized Controlled Trial.

Background: Existing strategies to increase girls' physical activity levels have seen limited success. Fathers may influence their children's physical activity, but often spend more time with their sons and rarely participate in family-based programs. Purpose: To test a novel program designed to increase the physical activity levels of fathers and their daughters. Methods: In a two-arm RCT, 115 fathers (29-53 years) and 153 daughters (4-12 years) were randomized to (i) the "Dads And Daughters Exercising and Empowered" (DADEE) program, or (ii) a wait-list control. The 8-week program included weekly educational and practical sessions plus home tasks. Assessments were at baseline, 2 months (postintervention), and 9 months. The primary outcomes were father-daughter physical activity levels (pedometry). Secondary outcomes included screen-time, daughters' fundamental movement skill proficiency (FMS: perceived and objective), and fathers' physical activity parenting practices. Results: Primary outcome data were obtained from 88% of daughters and 90% of fathers at 9 months. Intention-to-treat analyses revealed favorable group-by-time effects for physical activity in daughters (p = .02, d = 0.4) and fathers (p < .001, d = 0.7) at postintervention, which were maintained at 9 months. At postintervention and follow-up, significant effects (p < .05) were also identified for daughters' FMS competence (objective: d = 1.1-1.2; perceived: d = 0.4-0.6), a range of fathers' physical activity parenting practices (d = 0.3-0.8), and screen-time for daughters (d = 0.5-0.8) and fathers (d = 0.4-0.6, postintervention only). Program satisfaction and attendance were very high. Conclusions: This study provided the first experimental evidence that efforts to increase physical activity behavior in preadolescent girls would benefit from a meaningful engagement of fathers. Clinical Trial information: Australian New Zealand Clinical Trials Registry: ACTRN12615000022561.

Effectiveness of mother and daughter interventions targeting physical activity, fitness, nutrition and adiposity: A systematic review.

BACKGROUND: Physical inactivity and poor dietary habits in women pose a clear public health burden. Mothers are generally the main female role model for daughters, therefore, targeting intergenerational females simultaneously may be a novel approach. However, the effectiveness of this approach to improve physical activity, fitness, nutrition and adiposity has not been systematically examined. OBJECTIVES: To assess the effectiveness of physical activity, fitness and nutrition interventions targeting mothers and their daughters. DATA SOURCES: PubMed, Psychinfo, EMBASE, Ovid Medline, SCOPUS, CINAHL, Sportdiscus and Informit were searched for English language studies (1980-2015). STUDY SELECTION: Randomized controlled trials (RCTS), non-randomized experimental trials and pre-post studies of physical activity, fitness, nutrition and adiposity interventions targeting mothers and daughters were eligible if they reported changes in physical activity, fitness, dietary intake or adiposity. DATA EXTRACTION: Data were extracted using a standardized template and checked by a second author. DATA SYNTHESIS: 3577 articles were screened and 14 unique studies (7 RCTs, 1 pseudo-randomized, 1 non-randomized, 5 pre-post) met the inclusion criteria. The majority of studies were conducted in the US (n=11) and most were limited by methodological concerns. Of the RCTs that targeted each outcome exclusively, ≤20%, ≤20% ≤21% and 0% were successful for improving physical activity, fitness, nutrition and adiposity respectively. CONCLUSIONS: Overall, evidence for the effectiveness of mother-daughter interventions to improve physical activity, fitness, nutrition and adiposity is inconclusive. The diversity of study designs, exposures and outcomes used, along with methodological weaknesses means that well-designed and reported RCTs are warranted.

Targeted Health Behavior Interventions Promoting Physical Activity: A Conceptual Model.

This article presents a conceptual model illustrating a targeted approach to the design and delivery of health behavior interventions that focus on physical activity promotion. We hypothesize that researchers who i) enhance the sociocultural relevance of their core intervention components and ii) recognize the unique contributions of both intervention design and delivery will experience greater intervention engagement and improved outcomes.

Behavioral mediators of weight loss in the SHED-IT community randomized controlled trial for overweight and obese men.

BACKGROUND: Little is known about which behavioral strategies are most important to target in weight loss interventions for men. PURPOSE: The aim of the current study was to identify behavioral mediators of weight loss in the male-only Self-Help, Exercise, and Diet using Information Technology (SHED-IT) community weight loss study. METHODS: A randomized controlled trial with 159 overweight/obese men [mean (SD) age = 47.5 (11.0) years; body mass index = 32.7 (3.5) kg/m(2)] assessed at baseline, 3 months (post-test) and 6 months (follow-up). RESULTS: In an intention-to-treat, multiple-mediator model, the significant intervention effect on weight at 6 months (-3.70 kg; p < 0.001) was mediated by increases in physical activity (steps/day) and decreases in takeaway meals (kJ/day) and portion size at 3 months. The largest mediation effect was for physical activity (-0.6 kg; 95 % confidence interval -1.4, -0.1). Overall, the targeted mediators accounted for 47.0 % of the intervention's effect on weight. CONCLUSION: Step counts, takeaway food consumption, and portion sizes may be key areas to target in future weight loss programs for men (ACTRN12610000699066).

A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men.

OBJECTIVES: To investigate the effectiveness of Smoking, Nutrition, Alcohol, Physical activity and Obesity (SNAPO) interventions in young men exclusively. The secondary aim was to evaluate the recruitment, retention and engagement strategies. METHODS: A search with no date restrictions was conducted across seven databases. Randomized controlled trials recruiting young men only (aged 18-35 years) into interventions targeting any SNAPO risk factors were included. RESULTS: Ten studies were included (two nutrition, six alcohol use, two targeting multiple SNAPO risk factors). Six studies (two nutrition, three alcohol use and one targeting multiple SNAPO risk factors) demonstrated significant positive short-term intervention effects, but impact was either not assessed beyond the intervention (n=3), had short-term follow-up (≤6 months) (n=2) or not sustained beyond six months (n=1). Overall, a high risk of bias was identified across studies. Only one study undertook a power calculation and recruited the required sample size. Adequate retention was achieved in three studies. Effectiveness of engagement strategies was not reported in any studies. CONCLUSIONS: Despite preliminary evidence of short-term effectiveness of SNAPO interventions in young men, few studies characterized by a high risk of bias were identified. High quality SNAPO interventions for young men are warranted.

Associations between program outcomes and adherence to Social Cognitive theory tasks: process evaluation of the SHED-IT community weight loss trial for men.

BACKGROUND: Despite rising international rates of obesity, men remain reluctant to participate in weight loss research. There is a lack of evidence to guide the development of effective weight loss interventions that engage men. The objective of this study was to provide a comprehensive process evaluation of the SHED-IT (Self-Help, Exercise and Diet using Information Technology) weight loss program for men, as delivered in the SHED-IT community weight loss trial, and to identify key components associated with success. METHODS: In an assessor-blinded randomised controlled trial, 159 overweight and obese men (BMI 25.0-40.0 kg/m2) were randomised to one of two gender-tailored weight loss interventions with no face-to-face contact, or a control group. The interventions were informed by Bandura's Social Cognitive Theory (SCT) with men encouraged to complete a Support Book containing SCT-based tasks including goal setting, reward setting, creation of social support strategies and self-monitoring of: i) weight, ii) physical activity, and iii) diet. At post-test, compliance with SCT tasks was examined and men also completed a process evaluation questionnaire. RESULTS: Both SHED-IT intervention groups demonstrated greater weight loss during the intervention compared to the control, with no difference between intervention groups. Most men engaged with the SCT tasks although compliance declined over time and utilisation of social support networks and reward selection was poor. In a multiple regression model, the number of goals set (ß [95% CI] = -0.3 [-0.6, -0.1], p = 0.01) and the number of weight records documented (ß [95% CI] = -0.2 [-0.4, -0.0], p = 0.03) independently predicted weight loss. The process evaluation indicated that men found the programs to be supportive, enjoyable and beneficial. CONCLUSIONS: This process evaluation provides valuable information to inform the development of obesity treatment strategies that engage men. Future studies with men should include a strong focus on self-monitoring and goal setting to enhance behaviour change and improve treatment effects. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000699066.

The 'Healthy Dads, Healthy Kids' community randomized controlled trial: a community-based healthy lifestyle program for fathers and their children.

OBJECTIVE: To evaluate the effectiveness of the 'Healthy Dads, Healthy Kids (HDHK)' program when delivered by trained facilitators in community settings. METHOD: A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age=40.3 [5.3] years; BMI=32.5 [3.8] kg/m(2)) and their primary school-aged children (n=132) from the Hunter Region, Australia. In 2010-2011, families were randomized to either: (i) HDHK intervention (n=48 fathers, n=72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors. RESULTS: Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P<.001, d=0.24), with HDHK fathers losing more weight (-3.3 kg; 95%CI, -4.3, -2.4) than control fathers (0.1 kg; 95%CI, -0.9,1.0). Significant treatment effects (P<.05) were also found for fathers' waist (d=0.41), BMI (d=0.26), resting heart rate (d=0.59), energy intake (d=0.49) and physical activity (d=0.46) and for children's physical activity (d=0.50) and adiposity (d=0.07). DISCUSSION: HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting.

Compliance to step count and vegetable serve recommendations mediates weight gain prevention in mid-age, premenopausal women. Findings of the 40-Something RCT.

The 40-Something RCT aimed to determine if a 12-month health professional-led intervention could modify diet and physical activity behaviour for obesity prevention, in 44-50 year old, non-obese (BMI = 18.5-29.9 kg/m(2)) premenopausal women. Women were monitored for an additional 12 months to determine if effects could be maintained. This paper aimed to explore dietary and physical activity behavioural mediators hypothesised to be causally associated with weight change. Fifty-four women were randomised to a Motivational Interviewing Intervention (MI) (n = 28; five health professional consultations) or a Self-Directed Intervention (n = 26; written advice). Compliance to 10 study recommendations was measured at three months by a four-day weighed food and physical activity record including pedometer-measured step counts, self-reported exercise minutes and sitting time. The 10 compliance scores were independently assessed in mediation models for 12- and 24-month weight change. The MI effect on step count was an increase of 0.99 points on the 10-point compliance scale (p ≤ 0.01). This MI effect on step count significantly mediated the 12 and 24 month effect on weight (12 months AB = -0.74, 95%CI = -1.95, -0.14; 24 months AB = -1.06, 95% CI = -2.56, -0.36), accounting for 37.23% and 53.79% of the effect, respectively. The MI effect on vegetable serves was an increase of 1.50 points on the compliance scale (p = 0.02). The MI effect on vegetable compliance significantly mediated the effect on weight at 24 months (AB = -0.54, 95% CI = -1.50, -0.04), accounting for 24.92% of the effect. The remaining eight dietary and physical activity compliance scores did not significantly mediate weight loss. Encouraging women to take 10,000 steps and eat five vegetable serves per day may be a promising strategy to achieve long-term weight control at mid-life.

The SHED-IT community trial: a randomized controlled trial of internet- and paper-based weight loss programs tailored for overweight and obese men.

BACKGROUND: There is limited evidence for effective obesity treatment programs that engage men. PURPOSE: This study evaluated the efficacy of two gender-tailored weight loss interventions for men, which required no face-to-face contact. METHODS: This was a three-arm, randomized controlled trial: (1) Resources (n = 54), gender-tailored weight loss materials (DVD, handbooks, pedometer, tape measure); (2) Online (n = 53), Resources materials plus study website and e-feedback; and (3) Wait-list control (n = 52). The interventions lasted 3 months and were grounded in Social Cognitive Theory. RESULTS: At 6 months, significantly greater weight loss was observed for the Online (-4.7 kg; 95 % CI -6.1, -3.2) and Resources (-3.7 kg; 95 % CI -4.9, -2.5) groups compared to the control (-0.5 kg; 95 % CI -1.4, 0.4). Additionally, both intervention groups significantly improved body mass index, percent body fat, waist circumference, blood pressure, physical activity, quality of life, alcohol risk, and portion size, compared to controls. CONCLUSIONS: Men achieved significant weight loss after receiving novel, minimal-contact, gender-tailored programs, which were designed for widespread dissemination.

Effects of a father-daughter physical activity intervention delivered by trained facilitators in the community setting on girls' social-emotional well-being: A randomized controlled trial.

This study evaluated the effect of the Dads And Daughters Exercising and Empowered (DADEE) program on daughters' social-emotional well-being when delivered by trained facilitators. Fathers (n = 158; Mage = 41.95 ± 5.32 years; 86% Australian born) and daughters (n = 193; Mage = 8.35 ± 1.85 years) from Newcastle, New South Wales, Australia, were randomized into (a) the DADEE intervention or (b) a wait-list control. At baseline and 3 months, fathers, daughters, and mothers completed validated scales of daughters' social-emotional well-being (main outcome of interest), daughters' self-esteem, and other family-related outcomes. Intervention daughters improved their social-emotional well-being from father and mother perspectives compared to the control group (d = 0.51-0.64). Intervention effects were observed for the father-daughter relationship, indicators of father involvement, fathering warmth, coparenting, and family-related well-being, but not daughters' self-reported self-esteem and family-related well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mechanisms of an eHealth program targeting depression in men with overweight or obesity: A randomised trial.

BACKGROUND: The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect. METHODS: The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS. RESULTS: Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness. LIMITATIONS: The study was a secondary analysis with power to detect moderate-to-large mediation effects only. CONCLUSION: To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.

The Severity of the Co-infection of Mycoplasma pneumoniae in COVID-19 Patients.

Background and objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 2019 (COVID-19) infection, with symptoms ranging from mild upper respiratory illness to multisystem organ failure, and even death. Since its discovery in December 2019, the SARS-CoV-2 virus has led to a global pandemic, rapidly spreading to countries around the world, with millions of reported deaths to date. As researchers around the world continue to analyze and interpret the data gathered regarding the novel virus, it is evident that its co-infection with various bacterial pathogens is associated with a worse overall prognosis. One such bacterial pathogen, Mycoplasma pneumoniae (M. pneumoniae), has been associated with an increase in inpatient mortality, length of hospital stay, and need for mechanical ventilation. The aim of this study was to evaluate the characteristics and outcomes of patients co-infected with SARS-CoV-2 and M. pneumoniae. We sought to determine if this co-infection led to increased incidence of ventilatory support, intensive care unit (ICU) stay, and mortality. Materials and Methods A multi-center retrospective study was conducted involving patients aged 18 years and older. We compared the incidence of in-hospital mortality, ICU stay, and mechanical ventilation support between COVID-19-positive patients with and without M. pneumoniae co-infection. Based on the collected data, a binary logistic regression model was implemented to assess the correlation between mortality and ventilatory support, while linear regression was used to study the length of stay (LOS) independent variable. Results A total of 1,208 patients with a positive SARS-CoV-2 test were identified. Among them, 604 (50%) had an M. pneumoniae co-infection. LOS (95% CI for the coefficient estimate [0.86, 1.05], p<0.001), need for mechanical ventilation (95% CI for the odds ratio [2.60, 6.02], p<0.001), and inpatient mortality (95% CI for the odds ratio [1.43, 2.97], p<0.001) among those co-infected were significantly higher compared to COVID-19 patients without concomitant M. pneumoniae infection. Conclusion COVID-19 with a concomitant M. pneumoniae infection was found to have worse outcomes and overall prognosis when compared to individuals with independent disease states. Based on retrospective data gathered from a large multicenter database, the rates of mortality, ventilatory support, and length of hospital stay were significantly worse in patients with a co-infection of SARS-CoV-2 and M. pneumoniae.

The 'Healthy Dads, Healthy Kids' community effectiveness trial: study protocol of a community-based healthy lifestyle program for fathers and their children.

BACKGROUND: The 'Healthy Dads, Healthy Kids' program was designed to help overweight fathers lose weight and positively influence the health behaviors of their children. The aim of the current study was to evaluate the previously established program in a community setting, in a large effectiveness trial. METHODS/DESIGN: The Healthy Dads, Healthy Kids community trial consists of three stages: (i) Stage 1 - program refinement and resource development (ii) Stage 2 - community randomized controlled trial (iii) Stage 3 - community effectiveness trial. The program will be evaluated in five Local Government Areas in the Hunter Valley Region of NSW, Australia. For the community randomized controlled trial, 50 overweight/obese men (aged 18-65 years) from one Local Government Area with a child aged between 5-12 years of age will be recruited. Families will be randomized to either the program or a 6-month wait-list control group. Fathers and their children will be assessed at baseline, post-intervention (3-months) and 6-months. Inclusion criteria are: body mass index 25-40 kg/m2; no participation in other weight loss programs during the study; pass a health-screening questionnaire; and access to a computer with Internet facilities. In the community trial, the program will be evaluated using a non-randomized, prospective design in five Local Government Areas. The exclusion criteria is body mass index < 25 kg/m2 or lack of doctor's approval. MEASURES will be collected at baseline, 3-, 6- and 12-months. The program involves fathers attending seven face-to-face group sessions (three with children) over 3-months. MEASURES: The primary outcome is fathers' weight. Secondary outcomes for both fathers and children include: waist circumference, blood pressure, resting heart rate, physical activity, sedentary behaviors and dietary intake. Father-only measures include portion size, alcohol consumption, parenting for physical activity and nutrition and parental engagement. Process evaluation will determine the fidelity, dose (delivered and received), reach, recruitment and context of the program. DISCUSSION: As a unique approach to reducing obesity prevalence in men and improving lifestyle behaviours in children, our findings will provide important evidence relating to the translation of Healthy Dads, Healthy Kids, which will enable it to be delivered on a larger scale. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000608066.