Telephone versus web panel National Survey for monitoring adoption of preventive behaviors to climate change in populations: a case study of Lyme disease in Québec, Canada.

BACKGROUND: To monitor the adoption of climate change adaptive behaviors in the population, public health authorities have to conduct national surveys, which can help them target vulnerable subpopulations. To ensure reliable estimates of the adoption of these preventive behaviors, many data collection methods are offered by polling firms. The aim of this study was to compare a telephone survey with a web survey on Lyme disease with regard to their representativeness. METHODS: The data comes from a cross-sectional study conducted in the Province of Québec (Canada). In total, 1003 people completed the questionnaire by telephone and 956 filled in a web questionnaire. We compared the data obtained from both survey modes with the census data in regard to various demographic characteristics. We then compared the data from both samples in terms of self-reported Lyme disease preventive behaviors and other theoretically associated constructs. We also assessed the measurement invariance (equivalence) of the index of Lyme disease preventive behaviors across the telephone and web samples. RESULTS: Findings showed that neither the telephone nor the web panel modes of data collection can be considered more representative of the target population. The results showed that the proportion of item non-responses was significantly higher with the web questionnaire (5.6%) than with the telephone survey (1.3%), and that the magnitude of the differences between the two survey modes was nil for 19 out of the 30 items related to Lyme disease, and small for 11 of them. Results from invariance analyses confirmed the measurement invariance of an index of adaptation to Lyme disease, as well as the mean invariance across both samples. CONCLUSIONS: Our results suggested that both samples provided similar estimates of the level of adaptation to Lyme disease preventive behaviors. In sum, the results of our study showed that neither survey mode was superior to the other. Thus, in studies where adaptation to climate change is monitored over time, using a web survey instead of a telephone survey could be more cost-effective, and researchers should consider doing so in future surveys on adaptation to climate. However, we recommend conducting a pretest study before deciding whether to use both survey modes or only one of them.

Terrain park feature compliance with Québec ski area safety recommendations.

OBJECTIVES: The primary objective of this paper is to examine terrain park (TP) feature compliance with recommendations from a ski area industry guide (are TP features compliant with the guide?) and determine factors that could be associated with TP feature compliance in Québec ski areas (do factors influence TP feature compliance?), Canada. These recommendations on the design, construction and maintenance are provided by the Québec Ski Areas Association Guide. METHODS: A group of two to four trained research assistants visited seven ski areas. They used an evaluation tool to assess the compliance of 59 TP features. The evaluation tool, originally developed to assess the quality of TP features based on the guide, was validated in a previous study. Compliance was calculated by the percentage of compliant measures within a given feature. The potential influence of four factors on compliance (size of the TP, size of the feature, snow conditions and type of feature) were examined using a mixed-effects logistic regression model. RESULTS: The average TP feature compliance percentage was 93% (95% CI 88% to 99%) for boxes, 91% (95% CI 89% to 94%) for rails and 89% (95% CI 86% to 92%) for jumps. The logistic regression showed that none of the four factors examined were associated with TP feature compliance with the guide. CONCLUSION: Our results suggest that TP features are highly compliant with the guide in Québec ski areas.

Monitoring the evolution of individuals' flood-related adaptive behaviors over time: two cross-sectional surveys conducted in the Province of Quebec, Canada.

Climate change is predicted to increase the frequency and intensity of floods in the province of Quebec, Canada. Therefore, in 2015, to better monitor the level of adaptation to flooding of Quebec residents living in or near a flood-prone area, the Quebec Observatory of Adaptation to Climate Change developed five indices of adaptation to flooding, according to the chronology of events. The present study was conducted 4 years later and is a follow-up to the 2015 one. Two independent samples of 1951 (2015) and 974 (2019) individuals completed a questionnaire on their adoption (or non-adoption) of flood adaptation behaviors, their perception of the mental and physical impacts of flooding, and their knowledge of the fact that they lived in a flood-prone area.The results of the study demonstrated the measurement invariance of the five indices across two different samples of people over time, ensuring that the differences (or absence of differences) observed in flood-related adaptive behaviors between 2015 and 2019 were real and not due to measurement errors. They also showed that, overall, Quebeckers' flood-related adaptive behaviors have not changed considerably since 2015, with adaptation scores being similar in 2019 for four of the five flood indices. Moreover, the results indicated an increase in self-reported physical and mental health issues related to past flooding events, as well as a larger proportion of people having consulted a health professional because of these problems. Thus, this study provides a better understanding of flood adaptation in Quebec over the past 4 years and confirms that the five adaptive behavior indices developed in 2015 are appropriate tools for monitoring changes in flood adaptation in the province. Finally, our results showed that little has changed in Quebeckers' adoption of adaptive behaviors, highlighting the need for awareness raising in order to limit the impacts that climate change will have on the population.

Development and validation of a behavioral index for adaptation to lyme disease.

BACKGROUND: Recent evidence suggests that climate change and other factors are leading to the emergence of Lyme disease in the province of Quebec, where it previously did not exist. As risk areas expand further north, the population can adopt specific preventive behaviors to limit chances of infection. The objectives of this study were to (1) create an index of Lyme disease prevention behaviors (LDPB), and (2) use the theory of planned behavior (TPB) to explain the decision-making process of people who choose to adopt LDPB. METHODS: A sample of 1959 adults living in a Lyme disease risk area completed a questionnaire by phone (n = 1003) or on the Web (n = 956). The questionnaire measured whether they did or did not adopt the LDPB proposed by public health officials. It also measured some TPB variables, including their attitude or perceived social norms regarding LDPB. RESULTS: Our findings led to the creation of a Lyme disease prevention index consisting of 10 behaviors, down from the 19 behaviors initially considered for inclusion in the index. Rates of adoption of each behavior varied tremendously, from 4.30 to 83.80%. All variables of the TPB model (attitude, social norms, and perceived control) were significantly associated with intention to adopt preventive behaviors. Intention itself was significantly associated with adoption of LDPB. Likewise, risk perception was positively correlated with the adoption of LDPB. CONCLUSIONS: This study led to the creation of a Lyme disease prevention index that can be used by public health agencies, researchers, and professionals to monitor the evolution over time of individuals' LDPB adoption rates. It also showed the usefulness of the TPB in understanding the adoption of LDPB and how intention to adopt such behaviors is formed.

Development and validation of five behavioral indices of flood adaptation.

BACKGROUND: In the current context of climate change, climate forecasts for the province of Quebec (Canada) are a lengthening of the thunderstorm season and an increase in episodes of intense precipitations. These changes in the distribution of precipitations could heighten the intensity or frequency of floods, a natural hazard that concerns 80% of Quebec's riverside municipalities. For the health and safety of the at-risk population, it is very important to make sure they have acquired necessary adaptive behaviors against flooding hazard. However, there has been no assessment of these flood adaptation behaviors to date. Thus, the aim of this study was to develop and validate five indices of adaptation to flooding. METHODS: A sample of 1951 adults completed a questionnaire by phone. The questionnaire, specifically developed for this study, measured whether they did or did not adopt the behaviors that are proposed by public health officials to protect themselves against flooding. RESULTS: The results of the item, confirmatory factor, and multiple correspondence analyses contributed to the development of five indices corresponding to the adaptation behaviors to adopt according to the chronology of events: (a) pre-alert preventive behaviors, (b) behaviors to carry out after the alert is issued, (c) behaviors to adopt during a flood not requiring evacuation, (d) behaviors to adopt during a flood requiring evacuation, and (e) post-flood behaviors. The results of this study also showed that people who perceive a risk of flooding in their home in the next 5 years tend to adopt more preventive behaviors and adaptation behaviors than those who perceive little or no risk at all. They also reveal that people who feel more adverse effects on their physical or mental health tend to adopt more adaptive behaviors than those who feel little or no adverse effects on their health. CONCLUSION: Across a series of psychometric analyses, the results showed that these flood adaptation indices could properly measure a vast range of adaptive behaviors according to the chronology of events. Therefore, researchers, public health agencies, and professionals can use them to monitor the evolution of individuals' adaptive behaviors during floods.

The needs of siblings of children with a life-threatening illness, part 2: Psychometric validation of the IBesFEMS.

OBJECTIVE: Life-threatening illnesses in children have a significant impact on the lives of their brothers and sisters. Consequently, special attention must be paid to the specific needs of these siblings to help them cope with their situations. To address this issue, we developed an inventory of the needs of the adolescent siblings of severely ill children, the Inventaire des Besoins de la Fratrie d'Enfants Malades Sévèrement (IBesFEMS) [Needs Inventory for Siblings of Critically Ill Children]. The present article describes a preliminary validation study of this new instrument. METHOD: In a prospective cohort study, the 48-item instrument was administered via a website or paper to 58 siblings. RESULTS: Our study revealed that the measure has an estimated internal consistency of 0.96 and a temporal stability intraclass correlation coefficient (ICC) of 0.86 (p < 0.01). Its convergence validity is also satisfactory. SIGNIFICANCE OF RESULTS: Our findings suggest that the IBesFEMS is highly relevant for pediatric palliative care clinicians and researchers. Future studies should investigate its factorial structure and predictive validities.

The needs of siblings of children with a life-threatening illness, part 1: Conceptualization and development of a measure.

OBJECTIVE: The presence of a child afflicted with a life-threatening illness is a difficult situation for the child's siblings, especially when their own needs are left unmet. The present article describes the first three phases of research involved in the conceptualization, development, and content validation of an initial version of the Inventaire des Besoins de la Fratrie d'Enfants Malades Sévèrement (IBesFEMS) [Needs Inventory for Siblings of Critically ill Children]. METHOD: The first phase of the development of this instrument was conducted using qualitative methodology (focus groups: 6 siblings, 8 parents). The second phase consisted of validating the content of a pool of items developed according to the needs identified in the first phase. Some 21 participants (3 psychometricians, 3 researchers, 9 clinicians, and 6 siblings) evaluated each item for relevance and clarity. Finally, during the third phase, the acceptability and administration procedures of the preliminary version of the instrument were assessed qualitatively by five siblings. RESULTS: The first phase led to production of a typology made up of 43 needs in 10 different environments. The second phase allowed for selection of the items that were clearest and most relevant, based on expert opinion. This procedure gave rise to a first version of the IBesFEMS, which consisted of 48 items. SIGNIFICANCE OF RESULTS: The IBesFEMS appears to be a promising tool for specifically assessing the needs of the adolescent siblings of seriously ill children.

A multilevel analysis to explain self-reported adverse health effects and adaptation to urban heat: a cross-sectional survey in the deprived areas of 9 Canadian cities.

BACKGROUND: This study identifies the characteristics and perceptions related to the individual, the dwelling and the neighbourhood of residence associated with the prevalence of self-reported adverse health impacts and an adaptation index when it is very hot and humid in summer in the most disadvantaged sectors of the nine most populous cities of Québec, Canada, in 2011. METHODS: The study uses a cross-sectional design and a stratified representative sample; 3485 people (individual-level) were interviewed in their residence. They lived in 1647 buildings (building-level) in 87 most materially and socially disadvantaged census dissemination areas (DA-level). Multilevel analysis was used to perform 3-level models nested one in the other to examine individual impacts as well as the adaptation index. RESULTS: For the prevalence of impacts, which is 46 %, the logistic model includes 13 individual-level indicators (including air conditioning and the adaptation index) and 1 building-level indicator. For the adaptation index, with values ranging from -3 to +3, the linear model has 10 individual-level indicators, 1 building-level indicator and 2 DA-level indicators. Of all these indicators, 9 were associated to the prevalence of impacts only and 8 to the adaptation index only. CONCLUSION: This 3-level analysis shows the differential importance of the characteristics of residents, buildings and their surroundings on self-reported adverse health impacts and on adaptation (other than air conditioning) under hot and humid summer conditions. It also identifies indicators specific to impacts or adaptation. People with negative health impacts from heat rely more on adaptation strategies while low physical activity and good dwelling/building insulation lead to lower adaptation. Better neighbourhood walkability favors adaptations other than air conditioning. Thus, adaptation to heat in these neighbourhoods seems reactive rather than preventive. These first multi-level insights pave the way for the development of a theoretical framework of the process from heat exposure to impacts and adaptation for research, surveillance and public health interventions at all relevant levels.

Evaluation of Sports Nutrition Knowledge and Recommendations Among High School Coaches.

The objectives of this study were to evaluate high school coaches' knowledge in sports nutrition and the nutritional practices they recommend to their athletes. Forty-seven high school coaches in "leanness" and "non-leanness" sports from the greater region of Quebec (women = 44.7%) completed a questionnaire on nutritional knowledge and practices. "Leanness sports" were defined as sports where leanness or/and low bodyweight were considered important (e.g., cheerleading, swimming and gymnastics), and "non-leanness sports" were defined as sports where these factors are less important (e.g., football). Participants obtained a total mean score of 68.4% for the nutrition knowledge part of the questionnaire. More specifically, less than 30% of the coaches could answer correctly some general nutrition questions regarding carbohydrates and lipids. No significant difference in nutrition knowledge was observed between coaches from "leanness" and "non-leanness" sports or between men and women. Respondents with a university education scored higher than the others (73.3% vs. 63.3%, p < .05). Coaches who participated in coaching certification also obtained better results than those without a coaching certification. The most popular source of information about nutrition used by coaches was the Internet at 55%. The two most popular nutrition practices that coaches recommended to improve athlete performance were hydration and consumption of protein-rich foods. Recommendation for nutritional supplements use was extremely rare and was suggested only by football coaches, a nonleanness sport. Findings from this study indicate that coaches need sports nutrition education and specific training.

Heat-related mortality prediction using low-frequency climate oscillation indices: Case studies of the cities of Montréal and Québec, Canada.

Heat-related mortality is an increasingly important public health burden that is expected to worsen with climate change. In addition to long-term trends, there are also interannual variations in heat-related mortality that are of interest for efficient planning of health services. Large-scale climate patterns have an important influence on summer weather and therefore constitute important tools to understand and predict the variations in heat-related mortality. Methods: In this article, we propose to model summer heat-related mortality using seven climate indices through a two-stage analysis using data covering the period 1981-2018 in two metropolitan areas of the province of Québec (Canada): Montréal and Québec. In the first stage, heat attributable fractions are estimated through a time series regression design and distributed lag nonlinear specification. We consider different definitions of heat. In the second stage, estimated attributable fractions are predicted using climate index curves through a functional linear regression model. Results: Results indicate that the Atlantic Multidecadal Oscillation is the best predictor of heat-related mortality in both Montréal and Québec and that it can predict up to 20% of the interannual variability. Conclusion: We found evidence that one climate index is predictive of summer heat-related mortality. More research is needed with longer time series and in different spatial contexts. The proposed analysis and the results may nonetheless help public health authorities plan for future mortality related to summer heat.

Predictors of the use of performance-enhancing substances by young athletes.

OBJECTIVES: To document the use of performance-enhancing substances (PES) by young athletes and to identify associated factors. DESIGN: Retrospective survey. SETTING: Self-reported anonymous questionnaire. PARTICIPANTS: Three thousand five hundred seventy-three athletes (mean age, 15.5 years) from Quebec provincial teams run by organizations recognized by the Government of Quebec. INTERVENTIONS: All subjects filled out a validated questionnaire on factors associated with the use of and the intention to use PES. MAIN OUTCOME MEASURES: The use of and intention to use PES. RESULTS: In the 12 months before filling out the questionnaire, 25.8% of respondents admitted having attempted to improve their athletic performance by using 1 or more of 15 substances that were entirely prohibited or restricted by the International Olympic Committee. Multiple regression analyses showed that behavioral intention (beta = 0.34) was the main predictor of athletes' use of PES. Attitude (beta = 0.09), subjective norm (beta = 0.13), perceived facilitating factors (beta = 0.40), perceived moral obligation (beta = -0.18), and pressure from the athlete's entourage to gain weight (beta = 0.10) were positively associated with athletes' behavioral intention to use PES. CONCLUSIONS: This study provides evidence that supports the predicting value of the theory of planned behavior. Results suggest that the athlete's psychosocial environment has a significant impact on the decision to use PES and support the need to integrate this factor into the development and implementation of prevention interventions.

Factors Leading Municipal Authorities to Implement Preventive Interventions for Lyme Disease.

The aim of this study is to document climate change adaptation interventions targeting Lyme disease at the municipal level in the province of Quebec (Canada). This exploratory study relies on the theory of planned behavior and certain constructs from the health belief model to identify the factors leading municipal authorities to implement preventive interventions for Lyme disease (PILD). Data were obtained from an online survey sent, during the summer of 2018, to municipal officers in 820 municipalities in Quebec, in all health regions where the population is at risk of contracting Lyme disease (response rate = 36%). The questionnaire was used to measure the implementation of PILD, the intention to implement these interventions, attitudes, perceived social pressure, perceived control (levers and barriers) over interventions, perceived effectiveness of preventive measures, risk, and perceived vulnerability. Results of structural equation analyses showed that attitudes were significantly associated with municipal authorities' intention to implement PILD, while the intention to implement PILD was a significant predictor of the implementation of PILD. Additional analyses showed that perceived barriers added a moderating effect in the intention-implementation relationship. The prediction of behaviors or practices that municipal authorities could implement to prevent Lyme disease will enable the evaluation over time of the evolution of Quebec municipalities' adaptation to Lyme disease. Moreover, the examination of the associations of specific psychosocial factors revealed important implications for the design of effective behavior-change interventions, which would allow health officials doing awareness work to create personalized interventions better suited to municipal officers and their specific contexts.

Determinants of coaches' intentions to provide different recommendations on sports nutrition to their athletes.

BACKGROUND: Coaches are considered as an important source of nutrition information by their athletes. However, their knowledge in this area is often insufficient for proper guidance and may lead to the dissemination of misinformation regarding sports nutrition. The aim of this study was to assess coaches' intentions as well as psychosocial determinants underlying their intentions to provide sports nutrition recommendations to their high school athletes. METHODS: Coaches (n = 47) completed a Web-based questionnaire based on the theory of planned behaviour, to assess their intentions to provide three different sports nutrition recommendations and their determinants. Multiple regression analyses were used to identify the variables that were most strongly related to the intentions. RESULTS: Forty-six, 44.7 and 91.9% of coaches had the intention to recommend a higher consumption of foods rich in carbohydrates, foods rich in proteins and an increase in hydration to their athletes, respectively. Subjective norm was the only significant determinant of coaches' intention to recommend a higher consumption of foods rich in carbohydrates (R2 = 53.7%, ß = 0.73 ± 0.12, P < 0.0001). Subjective norm and perceived behavioural control were significantly associated with coaches' intentions to recommend a higher consumption of foods rich in proteins (R2 = 25.9%, ß = 0.50 ± 0.16, P = 0.002 and R2 = 17.2%, ß = 0.39 ± 0.17, P = 0.01, respectively) and an increase in hydration (R2 = 26.8%, ß = 0.38 ± 0.13, P = 0.001 and R2 = 46.3%, ß = 0.58 ± 0.11, P < 0.0001, respectively). CONCLUSIONS: The results of this study suggest that subjective norm and perceived behavioural control represent important determinants of coaches' intentions to provide recommendations on sports nutrition. These findings should be considered in future interventions aimed at facilitating proper general sports nutrition recommendations provided by coaches to their athletes.

Use of residential wood heating in a context of climate change: a population survey in Québec (Canada).

BACKGROUND: Wood heating is recommended in several countries as a climate change (CC) adaptation measure, mainly to increase the autonomy of households during power outages due to extreme climatic events. The aim of this study was to examine various perceptions and individual characteristics associated with wood heating through a survey about CC adaptations. METHODS: A telephone survey (n = 2,545) of adults living in the southern part of the province of Québec (Canada) was conducted in the early fall season of 2005. The questionnaire used closed questions and measured the respondents' beliefs and current adaptations about CC. Calibration weighting was used to adjust the data analysis for the respondent's age and language under stratified sampling based on health regions. RESULTS: More than three out of four respondents had access to a single source of energy at home, which was mainly electricity; 22.2% combined two sources or more; 18.5% heated with wood occasionally or daily during the winter. The prevalence of wood heating was higher in the peripheral regions than in the more urban regions, where there was a higher proportion of respondents living in apartments. The prevalence was also higher with participants completely disagreeing (38.5%) with the eventual prohibition of wood heating when there is smog in winter, compared to respondents somewhat disagreeing (24.2%) or agreeing (somewhat: 17.5%; completely: 10.4%) with the adoption of this strategy. It appears that the perception of living in a region susceptible to winter smog, smog warnings in the media, or the belief in the human contribution to CC, did not influence significantly wood heating practices. CONCLUSION: Increased residential wood heating could very well become a maladaptation to climate change, given its known consequences on winter smog and respiratory health. It would thus be appropriate to implement a long-term national program on improved and controlled residential wood heating. This would constitute a "no-regrets" adaptation to climate change, while reducing air pollution and its associated health impacts.

Teacher structure as a predictor of students' perceived competence and autonomous motivation: The moderating role of differentiated instruction.

BACKGROUND: An important pedagogical practice is the provision of structure (Farkas & Grolnick, 2010, Motiv. Emot., 34, 266). According to self-determination theory (SDT; Deci & Ryan, 1985, Intrinsic motivation and self-determination in human behavior, Plenum, New York, NY), structure allows students to develop perceived competence in different school subjects, which in turn facilitates the development of autonomous motivation towards these subjects and limits the development of controlled motivation. AIMS: In this study, we test a mediated moderation model that posits that teacher structure has a stronger positive effect on students' autonomous motivation (and a negative effect on controlled motivation) in French class when differentiated instruction is used, and that this moderation effect is mediated by perceived competence. SAMPLE: To test this model, we used a sample of 27 elementary school teachers and 422 students from Quebec, a province of Canada. METHODS: Data for teachers and students were collected with self-report measures. The method used was a correlational one with a single measurement time. RESULTS: Results revealed that (1) the effect of teacher structure on students' autonomous motivation was positive only when differentiated instruction strategies were frequently used, and this moderated effect was partially mediated by perceived competence, and (2) teacher structure was negatively associated with students' controlled motivation only when differentiated instruction was provided infrequently, and this moderated effect was not explained by perceived competence. CONCLUSIONS: These findings are discussed in the light of the literature on SDT and on differentiated instruction.

Evaluation of a Theory-Based Intervention Aimed at Reducing Intention to Use Restrictive Dietary Behaviors Among Adolescent Female Athletes.

OBJECTIVE: To evaluate the effectiveness of a theory-based intervention to reduce the intention to use restrictive dietary behaviors for losing weight among adolescent female athletes involved in aesthetic sports. DESIGN: Cluster-randomized controlled trial. SETTING: Aesthetic sport teams of adolescent female athletes aged 12-17 years. PARTICIPANTS: Two teams (n = 37 athletes) in the intervention group and 3 teams (n = 33) in the comparison group. INTERVENTIONS: The 2 groups received nutrition education during 3 weekly 60-minute sessions. The intervention group was further exposed to a theory-based intervention targeting the specific determinant of intention to use restrictive dietary behaviors for losing weight, namely attitude. MAIN OUTCOME MEASURES: Difference over time between groups in intention to use restrictive dietary behaviors for losing weight and in nutrition knowledge. ANALYSIS: Mixed models for repeated measures. RESULTS: The theory-based intervention contributed to maintaining a low intention of using restrictive dietary behaviors for losing weight over time in the intervention group compared with the comparison group (P < .03). Nutrition knowledge score increased equally in both groups. CONCLUSION AND IMPLICATIONS: Complementing nutrition education with theory-based behavior change intervention may help maintain a low intention of using restrictive dietary behaviors for losing weight among female high school athletes involved in aesthetic sports.

Development and Validation of a Behavioural Index for Adaptation to High Summer Temperatures among Urban Dwellers.

One of the consequences of climate change is the growing number of extreme weather events, including heat waves, which have substantial impacts on the health of populations. From a public health standpoint, it is vital to ensure that people can adapt to high heat, particularly in cities where heat islands abound. Identifying indicators to include in a parsimonious index would help better differentiate individuals who adapt well to heat from those who do not adapt as well. This study aimed at developing and validating a summer heat adaptation index for residents of the 10 largest cities in the province of Québec, Canada. A sample of 2000 adults in 2015 and 1030 adults in 2016 completed a telephone questionnaire addressing their adoption (or non-adoption) of behaviours recommended by public health agencies to protect themselves during periods of high temperature, and their perceptions of how high summer heat affects their mental and physical health. Item analysis, confirmatory factor analysis, multiple correspondence analysis, measurement invariance analyses and criterion-validity analyses were used to develop a 12-behaviour heat adaptation index for distinguishing between individuals who adapt well to high temperatures and those who do not adapt as well. The results indicated that the measurement and the factor structure of the index were invariant (equivalent) across the two independent samples of participants who completed the questionnaire at different times one year apart, an important prerequisite for unambiguous interpretation of index scores across groups and over time. The results also showed that individuals who perceived more adverse effects on their physical or mental health adopted more preventive behaviours during periods of high temperatures and humidity conditions compared to those who felt lesser or no effects. This study thus presents support for the validity of the index that could be used in future studies to monitor preventive behaviours adoption during summer periods of high temperature.

Analyzing Exercise Behaviors during the College Years: Results from Latent Growth Curve Analysis.

UNLABELLED: The objective of this study is to analyze changes in the predictors of physical activity behavior among college students. The Theory of Planned Behavior served as its theoretical framework. METHODS: Among an initial sample of 417 college students, 195 participants completed a validated questionnaire measuring attitudes, subjective norms, perceived control, intentions and self-reported physical activity, at the beginning and end of each of 3 college semesters. Latent growth curve modeling analyses were conducted to examine the relationships between the trajectories of changes in PA, intentions, attitudes, subjective norms, and perceived control. RESULTS: Good fit indices supported the validity of the proposed longitudinal model (CFI > .97, RMSEA < .05). Changes in perceived control (γ = 0.57) were significantly linked with changes in intentions (p < .05). Perceived control (γ = 0.28) and intention growth (γ = 0.36) predicted behavior changes (p < .05). No gender differences were observed on attitudes, subjective norms and perceived control (p > .10). However, girls tend to have higher growth parameters on intentions and physical activity (p < .05). In summary, intentions and physical activity has significantly increased over 3 college semesters (growth parameters significant at p < .05). CONCLUSIONS: This study demonstrated that attitudes and perceived control are key determinants regarding the intentions of being active. On a longer term perspective, future physical activity interventions should focus on the enhancement of students' perceived control. Such educational context should help in promoting the adoption of an active lifestyle during college.

Evaluation of a Theory-Based Intervention Aimed at Improving Coaches' Recommendations on Sports Nutrition to Their Athletes.

BACKGROUND: Coaches are a major source of nutrition information and influence for young athletes. Yet, most coaches do not have training in nutrition to properly guide their athletes. OBJECTIVE: The aim of this study was to evaluate the effectiveness of an intervention aimed at improving the accuracy of coaches' recommendations on sports nutrition. DESIGN: This was a quasi-experimental study with a comparison group and an intervention group. Measurements were made at baseline, post-intervention, and after a 2-month follow-up period. Coaches' recommendations on sports nutrition during the follow-up period were recorded in a diary. PARTICIPANTS/SETTING: High school coaches from various sports (n=41) were randomly assigned to a comparison group or an intervention group. INTERVENTION: Both groups attended two 90-minute sessions of a theory-based intervention targeting determinants of coaches' intention to provide recommendations on sports nutrition. The intervention group further received an algorithm that summarizes sports nutrition guidelines to help promote decision making on sports nutrition recommendations. MAIN OUTCOME MEASURES: Nutrition knowledge and accuracy of coaches' recommendations on sports nutrition. STATISTICAL ANALYSIS PERFORMED: χ(2) analyses and t-tests were used to compare baseline characteristics; mixed and general linear model analyses were used to assess the change in response to the intervention and differences in behaviors, respectively. RESULTS: Coaches in the intervention vs comparison group provided more nutrition recommendations during the 2-month post-intervention period (mean number of recommendations per coach 25.7±22.0 vs 9.4±6.5, respectively; P=0.004) and recommendations had a greater accuracy (mean number of accurate recommendations per coach 22.4±19.9 [87.1%] vs 4.3±3.2 [46.1%], respectively; P<0.001). Knowledge was significantly increased post-intervention in both groups, but was maintained only in the intervention group during the 2-month follow-up (Pgroup*time=0.04). CONCLUSIONS: A theory-based intervention combined with a decision-making algorithm maintained coaches' sports nutrition knowledge level over time and helped them to provide more accurate recommendations on sports nutrition.

The Health Impacts of Climate Change: A Continuing Medical Education Needs Assessment Framework.

INTRODUCTION: As the health consequences of climate change (CC) will likely become more manifest in the future, family physicians have to be knowledgeable about these impacts and the ways in which they can affect their patients. The main aim of this study was to propose a competency framework and questionnaire used to conduct a needs analysis to identify and prioritize family physicians' real educational needs regarding the health impacts of CC. METHODS: A mixed method combining a qualitative interview and a quantitative online questionnaire was used (n = 24 physicians). The interview assessed key beliefs related to participating in an online continuing medical education (eCME) activity on the health impacts of climate change, and the perception of the key factors or conditions required to ensure the family physicians' satisfaction with this eCME activity. The questionnaire assessed the current and desired levels of competency on five general training themes: general knowledge about CC; heat-related illnesses; CC, extreme weather events and modification of vector-borne and zoonotic diseases; CC, extreme weather events and modification of water-borne diseases; and mental health impacts of natural disasters. RESULTS: Results revealed the need for improved medical education on climate change and health. Results also add to the literature by showing that a 3-hour eCME activity covering these topics would be useful and would allow family physicians to use this knowledge in their daily practice, notably through prevention and counseling. DISCUSSION: Introducing a CME needs assessment framework and a generic instrument that reflects family physicians' needs regarding the health impacts of CC has the added advantage of standardizing the assessment procedure.