Effectiveness of a Digital Health Game Intervention on Early Adolescent Smoking Refusal Self-Efficacy.

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.

The Arctic Plant Aboveground Biomass Synthesis Dataset.

Plant biomass is a fundamental ecosystem attribute that is sensitive to rapid climatic changes occurring in the Arctic. Nevertheless, measuring plant biomass in the Arctic is logistically challenging and resource intensive. Lack of accessible field data hinders efforts to understand the amount, composition, distribution, and changes in plant biomass in these northern ecosystems. Here, we present The Arctic plant aboveground biomass synthesis dataset, which includes field measurements of lichen, bryophyte, herb, shrub, and/or tree aboveground biomass (g m-2) on 2,327 sample plots from 636 field sites in seven countries. We created the synthesis dataset by assembling and harmonizing 32 individual datasets. Aboveground biomass was primarily quantified by harvesting sample plots during mid- to late-summer, though tree and often tall shrub biomass were quantified using surveys and allometric models. Each biomass measurement is associated with metadata including sample date, location, method, data source, and other information. This unique dataset can be leveraged to monitor, map, and model plant biomass across the rapidly warming Arctic.

Actualization of evidence-based nursing in primary, specialized, and social care settings-A cross-sectional survey.

BACKGROUND: Basing practice on evidence is a widely acknowledged requirement for nursing, but shortcomings still exist. An increased understanding of the actualization of evidence-based nursing (EBN) across different nursing contexts is needed to develop better support for EBN and promote uniform high-quality nursing. AIMS: The aim of this study was to compare the actualization of EBN in different organizational contexts in Finland. METHODS: Data for this survey were collected in 2021. The actualization of EBN in primary, specialized, and social care organizations was evaluated with the Actualization of Evidence-Based Nursing instrument, nurses' version, which focuses on individual and organizational-level EBN support structures. Differences between (1) specialized and primary healthcare, and (2) different nursing practice settings were tested with Welch's two sample t-test, the Kruskal-Wallis rank sum test, and the Wilcoxon rank sum test. RESULTS: Based on nurse (n = 1020) evaluations, those working in specialized healthcare hold more positive attitudes toward EBN (p = .021) and evaluated their organization's methods for monitoring and evaluating nursing practices (p = .004) more positively than those working in primary healthcare. Regarding different nursing practice settings (n = 1241), the most positive results were observed within preventive healthcare where nurses evaluated their attitudes toward EBN, EBN competence, and personal evidence-based practices more positively compared to other nursing practice settings. The results were parallel regarding several organizational structures for EBN. Positive results were also observed within somatic units at university hospitals, and most negative results were within institutional care settings, health centers, and home care settings. LINKING EVIDENCE TO ACTION: There is a need for targeted support to strengthen EBN across different organizational contexts, with special attention to those contexts where nursing professionals with lower education levels work. Future research needs to focus on further analyzing the organizational differences and what can be learned, especially from preventive healthcare but also somatic units at university hospitals.

Systematic review of digital interventions to support refusal self-efficacy in child and adolescent health promotion.

Refusal self-efficacy protects against risky health behavior. Digital interventions have the potential to support self-efficacy due to the enactive experience provided by digital technologies. The aim of this systematic literature review was to evaluate the evidence of digital interventions to support refusal self-efficacy in child and adolescent health promotion. Following the Cochrane Collaboration guidelines, five electronic databases were searched from 2009 to 2020. The studies were assessed by two independent reviewers according to the eligibility criteria. Eligible studies were included in the review, assessed for risk of bias, synthesized narratively and assessed for evidence quality with the GRADE approach. Twenty-three studies, that examined 18 different interventions, were included in the review. The interventions included various digital elements as means to support the child and adolescent refusal self-efficacy (e.g. games, videos, feedback and activities for regulating feelings). The interventions improving refusal self-efficacy were more often used at home setting and addressed the four sources of self-efficacy with different digital elements regardless of intervention duration and intensity. Although the results on intervention effects varied and the evidence quality remained low, the overall evidence concerning these interventions was encouraging. Based on the subgroup analysis, the results were mainly encouraging among girls. When these interventions are implemented in health promotion, their benefits and weaknesses need to be considered comprehensively. The results provide information for designing and developing digital interventions to support child and adolescent refusal self-efficacy. Further research with larger sample sizes and more rigorous study designs is needed to strengthen the evidence of these interventions.

Refusal self-efficacy determines children's and adolescents' health behavior, for example when they are being offered cigarettes or alcohol and they face the challenge of refusing it. Since digital interventions are potential tools to support refusal self-efficacy, this review examined digital interventions to support refusal self-efficacy in child and adolescent health promotion. Twenty-three studies that examined such interventions were found. Most of the interventions that improved child and adolescent refusal self-efficacy were used in home settings and addressed all sources of self-efficacy regardless of intervention duration. Although the results varied, the interventions in general seemed to improve refusal self-efficacy, especially among girls. However, this study suggests that more high-quality research with more study participants is still needed to make stronger conclusions. Also, the benefits and weaknesses of digital interventions to support refusal self-efficacy need to be considered comprehensively before using them in child and adolescent health promotion.

Developing a Health Game to Prepare Preschool Children for Anesthesia: Formative Study Using a Child-Centered Approach.

BACKGROUND: Every year, millions of children undergo medical procedures that require anesthesia. Fear and anxiety are common among young children undergoing such procedures and can interfere with the child's recovery and well-being. Relaxation, distraction, and education are methods that can be used to prepare children and help them cope with fear and anxiety, and serious games may be a suitable medium for these purposes. User-centered design emphasizes the involvement of end users during the development and testing of products, but involving young, preschool children may be challenging. OBJECTIVE: One objective of this study was to describe the development and usability of a computer-based educational health game intended for preschool children to prepare them for upcoming anesthesia. A further objective was to describe the lessons learned from using a child-centered approach with the young target group. METHODS: A formative mixed methods child (user)-centered study design was used to develop and test the usability of the game. Preschool children (4-6 years old) informed the game design through playful workshops (n=26), and usability testing was conducted through game-playing and interviews (n=16). Data were collected in Iceland and Finland with video-recorded direct observation and interviews, as well as children's drawings, and analyzed with content analysis and descriptive statistics. RESULTS: The children shared their knowledge and ideas about hospitals, different emotions, and their preferences concerning game elements. Testing revealed the high usability of the game and provided important information that was used to modify the game before publishing and that will be used in its further development. CONCLUSIONS: Preschool children can inform game design through playful workshops about health-related subjects that they are not necessarily familiar with but that are relevant for them. The game's usability was improved with the participation of the target group, and the game is now ready for clinical testing.

Efetividade da versão portuguesa do Fume na literacia em saúde de adolescentes acerca do tabaco / Effectiveness of the Portuguese version of Fume in adolescents' health literacy about tobacco / Efectividad de la versión portuguesa de Fume en la alfabetización en salud de los adolescentes sobre el tabaco

Resumo Objetivo Avaliar a efetividade da versão traduzida para português europeu do mobile health game Fume (No Fume), no que diz respeito à literacia em saúde de adolescentes em contexto escolar sobre as questões relacionadas com o tabaco. Método Estudo quantitativo, quase-experimental, com avaliação pré-teste e pós-teste, com uma amostra por conveniência de 144 adolescentes, dividida por um grupo experimental e um grupo de controle, realizado em duas escolas públicas do 2º e 3º ciclo do ensino básico de uma cidade do distrito de Coimbra, região centro de Portugal. Resultados Verificou-se, nos adolescentes que utilizaram o No Fume (grupo experimental), uma evolução favorável, estatisticamente significativa, nas expetativas negativas sobre fumar (p = 0,033). Conclusão O No Fume revelou um efeito positivo nas expetativas negativas sobre fumar dos adolescentes. Deve investir-se no desenvolvimento do No Fume para maximizar o seu potencial de utilização pois, enquanto tecnologia educativa baseada na gamificação, poderá contribuir para o alargamento e disseminação de intervenções inovadoras promotoras da saúde mental dos adolescentes

Abstract Objective To evaluate the effectiveness of the version translated into European Portuguese of the Fume mobile health game (No Fume), with regard to the health literacy of adolescents in the school context on tobacco-related issues. Method A quantitative and quasi-experimental study, with pre-test and post-test evaluation, conducted with a convenience sample of 144 adolescents, divided into an experimental group and a control group, carried out in two public schools serving the 2nd and 3rd cycles of elementary education from a city in the district of Coimbra, central region of Portugal. Results Among the adolescents who used No Fume (experimental group), a statistically significant and favorable evolution was verified in the negative expectations about smoking (p = 0.033). Conclusion No Fume revealed a positive effect on the negative expectations about smoking among the adolescents. Investments should be made in developing No Fume in order to maximize its potential for use since, as an educational technology based on gamification, it may come to contribute to the expansion and dissemination of innovative interventions that promote adolescents' mental health.

Resumen Objectivo Evaluar la efectividad de la versión traducida al portugués europeo del mobile health game Fume (No Fume) en la alfabetización en salud de los adolescentes en un contexto escolar sobre temas relacionados con el tabaco. Método Estudio cuantitativo, cuasiexperimental, con evaluación pretest y postest, con una muestra por conveniencia de 144 adolescentes dividida en un grupo experimental y un grupo de control, realizado en dos escuelas públicas del segundo y tercer ciclo de educación básica de una ciudad en el distrito de Coímbra, región central de Portugal. Resultados Los adolescentes que utilizaron No Fume (grupo experimental), tuvieron una evolución favorable estadísticamente significativa en las expectativas negativas sobre fumar (p = 0,033). Conclusión No Fume reveló un efecto positivo sobre las expectativas negativas sobre fumar en los adolescentes. Se debe invertir en el desarrollo de No Fume para maximizar su potencial de uso porque, como tecnología educativa basada en la gamificación, puede contribuir a la expansión y difusión de intervenciones innovadoras que promuevan la salud mental de los adolescentes.

Instrumentos de avaliação da literacia em saúde acerca do tabaco: tradução e adaptação para português europeu / Instrumentos para evaluar la alfabetización en salud sobre el tabaco: traducción y adaptación al portugués europeo / Instruments for assessing tobacco-related health literacy: translation and adaptation to european portuguese

RESUMO Objetivo traduzir e adaptar culturalmente para português europeu os instrumentos de avaliação da literacia em saúde acerca do tabaco Attitudes Towards Tobacco Use, Tobacco-Use Motives e Motivation to Decline Tobacco Use in the Future, e Smoking Outcome Expectation Scale e Anti-Smoking Self-Efficacy Scale, e realizar validação preliminar Método tradução e adaptação transcultural de acordo com as recomendações do Institute for Work and Health e validação preliminar em 144 adolescentes de duas escolas públicas da região central de Portugal, em abril e maio de 2019 Resultados foram retirados itens relativos a snus, por não apresentarem relevância no contexto português. Assim, dois instrumentos passaram a ser constituídos apenas por um item. Os valores de alfa de Cronbach das versões em português europeu foram 0,799, 0,673, 0,905 e 0,890 Conclusão contribui para a existência de instrumentos de avaliação da literacia em saúde acerca do tabaco, adaptados para português europeu, para a população dos adolescentes

RESUMEN Objetivo traducir y adaptar culturalmente al portugués europeo los instrumentos de evaluación de la alfabetización en salud sobre el tabaco Attitudes Towards Tobacco Use, Tobacco-Use Motives y Motivation to Decline Tobacco Use in the Future, y Smoking Outcome Expectation Scale y Anti-Smoking Self-Efficacy Scale, y realizar una validación preliminar Método traducción y adaptación transcultural según las recomendaciones del Institute for Work and Health y validación preliminar en 144 adolescentes de dos escuelas públicas de la región central de Portugal, en abril y mayo de 2019 Resultados se eliminaron los artículos relacionados con la snus, ya que no eran relevantes en el contexto portugués. De este modo, dos instrumentos se componen de un solo ítem. Los valores del alfa de Cronbach de las versiones en portugués europeo fueron 0,799, 0,673, 0,905 y 0,890 Conclusión contribuye a la existencia de instrumentos de evaluación de la alfabetización en salud sobre el tabaco, adaptados al portugués europeo, para la población adolescente

ABSTRACT Objectives To translate and culturally adapt to European Portuguese the tobacco-related health literacy assessment instruments "Attitudes Towards Tobacco Use," "Tobacco-Use Motives," "Motivation to Decline Tobacco Use in the Future," "Smoking Outcome Expectation Scale," and "Anti-Smoking Self-Efficacy Scale"; and to conduct the preliminary validation of the translated versions Methodology Translation and cross-cultural adaptation in accordance with the Institute for Work & Health recommendations and preliminary validation study using a sample of 144 adolescents from two public schools in central Portugal in April and May 2019 Results Snus-related items were removed due to their lack of relevance in the Portuguese context. Thus, two instruments consisted of only one item each. The European Portuguese versions of the instruments presented Cronbach's alpha scores of 0.799, 0.673, 0.905, and 0.890 Conclusion The present study contributed to developing European Portuguese versions of instruments for assessing tobacco-related health literacy among adolescents

Finnish adolescents' self-efficacy in peer interactions: a critical incident study.

Peers play a significant role in influencing adolescent self-efficacy. Self-efficacy, in turn, has been considered to influence health behavior. The purpose of this qualitative descriptive study was to describe adolescents' perceptions about their self-efficacy in peer interactions to strengthen the theoretical understanding about the sources of self-efficacy during adolescence. The sample comprised of 155 adolescents (13 - 17 years) in three upper comprehensive schools within two Finnish cities. The data were collected using the critical incident technique with an open-ended questionnaire. Adolescents were asked to describe two situations: one in which they had, and another in which they had not been able to act according to their own choice in peer interactions. Adolescents' written descriptions were analyzed using inductive thematic analysis. The data suggests that adolescents' perceptions about their self-efficacy in peer interactions manifests itself as a dynamic process characterized by debating with oneself and reflecting on information relevant for judging personal abilities. Debating with oneself consisted of five themes which influenced the adolescents' self-efficacy in peer interactions: adolescents' self-identity, social atmosphere, adolescents' cognitive and emotional aspects as well as evaluating the consequences of the intended action. Adolescents' self-identity, which included self-confidence and morals, appeared to be the most solid theme, whereas social atmosphere varied according to the situation. Social atmosphere often diminished the adolescents' self-efficacy in peer interactions. Although the findings are partly consistent with previous literature, they also put more emphasis on adolescents' own active role in the formation of self-efficacy in the context of peer interactions.

Indirect effects of human-induced environmental change on offspring production mediated by behavioural responses.

Human-induced rapid environmental changes often cause behavioural alterations in animals. The consequences that these alterations in turn have for the viability of populations are, however, poorly known. We used a population of threespine sticklebacks Gasterosteus aculeatus in the Baltic Sea to investigate the consequences of behavioural responses to human-induced eutrophication for offspring production. The investigated population has been growing during the last decades, and one cause could be increased offspring production. We combined field-based surveys with laboratory-based experiments, and found that an enhanced growth of macroalgae relaxed agonistic interactions among males. This allowed more males to nest, improved hatching success, and increased the number of reproductive cycles that males completed. Thus, the behavioural responses were adaptive at the individual level and increased offspring production. However, a larger proportion of small males of low competitive ability reproduced in dense vegetation. As male size and dominance are heritable, this could influence the genetic composition of the offspring. Together with a higher number of offspring produced, this could influence natural selection and the rate of adaptation to the changing environment. Thus, behavioural responses to a rapid human-induced environmental change can influence offspring production, with potential consequences for population dynamics and evolutionary processes.