RESUMO
BACKGROUND: Physical activity (PA) may be an important fall prevention strategy. Current PA guidelines emphasize total PA dose, but daily patterning of PA is underappreciated. With aging, PA bouts become less frequent and shorter in duration (i.e.: more fragmented). PA fragmentation may be an indicator of fall risk, but the relationship is not well understood. This study examined daily PA accumulation and patterns with fall risk in older adults. METHODS: Participants (n=685, 54.3% female, 61.5% aged 70-79 years) from the National Health and Aging Trends Study (NHATS) with wrist-worn accelerometry PA data from Round 11 (baseline) and sample person interviews with fall data from Round 12 (follow-up) were included. PA variables were categorized into tertiles and incident falls were defined as ≥1 self-reported fall in the year following the PA assessment between baseline and follow-up. A modified Poisson approach was used to estimate the relative risk of both PA accumulation and fragmentation with falls. RESULTS: Overall, 40.0% reported an incident fall. After adjustment for sociodemographic and health characteristics, those in the highest tertile of total PA accumulation had lower fall risk (aRR=0.74, 95% CI: 0.57, 0.95) and those in the highest tertile of PA fragmentation had increased fall risk (aRR=1.33, 95% CI: 1.03, 1.73). Models were attenuated after adjustment for physical functioning. CONCLUSIONS: PA fragmentation may identify fall risk in older adults. Longitudinal studies are needed to disentangle the temporal sequencing of the complex relationship between PA and physical functioning across the life-course.
RESUMO
OBJECTIVE: The purpose of the study was to assess the attitudes and beliefs towards HPV vaccination among Ghanaian parents with unvaccinated adolescents using the Multi-Theory Model (MTM) of behavior change. Additionally, we used MTM constructs to predict the likelihood of parents allowing their adolescents to initiate and complete the recommended HPV vaccine series. METHODS: A 44-item validated survey was administered among parents with unvaccinated adolescents living in the Ashanti Region of Ghana. HPV vaccine initiation predictors were perceived beliefs and MTM constructs: participatory dialogue, behavioral confidence, and change in the physical environment. HPV vaccine completion predictors were emotional transformation, social environment, and practice for change. RESULTS: Multiple linear regression analyses showed that perceived beliefs (95% CI: 0.03 - 0.14), change in the physical environment (95% CI: 0.06 - 0.15), and behavioral confidence (95% CI: 0.00 - 0.07), were strongly associated with parents' likelihood of allowing their adolescents to initiate the HPV vaccine series (p<0.001). Together, perceived beliefs, behavioral confidence, and change in the physical environment accounted for 13.6% of the variance (R2 = 0.136). The emotional transformation (95% CI: 0.04 - 0.10), and social environment (95% CI: 0.25 - 0.35), predictors were both strongly associated with parents' likelihood of allowing their adolescent to complete the vaccine series (p<0.001). Together, emotional transformation and social environment accounted for 45.8% of the variance (R2 = .458). A sample of 380 parents with unvaccinated adolescents, between the ages of 35 - 60 years, participated in this study. Many of the participants were unaware of HPV (98.7%) and its related vaccinations (96.8%). CONCLUSION: Our findings underscore the need for comprehensive multi-level interventions to create HPV vaccination awareness among Ghanaian parents with unvaccinated adolescents.
