bluuebunny/crossref_metadata_2025 huggingface dataset:
O.4.5-7 Inactive by force? Barriers and motivation to exercise in older adults during a pandemic
Authors: Szekeres Zsofia Eva , Agustín-Sierra Noelia , Zaidell Lisa , Mileva Katya , de Oliveira Rita
Published: September 2023

Purpose

The lockdown restrictions over the Covid-19 pandemic have accelerated the ongoing ‘physical inactivity pandemic’ and significantly affected physical and mental well-being in older adults (Eime et al., 2022; Pérez et al., 2021; Sjöberg et al., 2022, Peterson et al., 2021). This study aimed to elucidate the factors that limit or facilitate physical activity in inactive older adults. The main objectives were to identify: (1) the perceived barriers that influence motivation to exercise or physical activity; (2) physical activity patterns when living under lockdown restrictions; (3) how the restriction impacted the motivation and exercise behaviour in older adults.

Methods

Participants were 24 older adults (M = 74 years, SD = 5.0) either physically active or inactive before the pandemic. Semi-structured interviews and self-reported physical activity measures were taken during lockdown and followed up at eight weeks. Transcripts were analysed using thematic analysis.

Results

The three main themes were: sense of purpose for being physically active, routes for engagement, and inactive by force. The sense of purpose was found to be a key source of motivation to exercise influenced by both the belief in the importance of exercise and the affective valence participants assigned to it. Active participants valued exercise due to its health benefits and enjoyment. With the closing of exercise settings, they missed the social context that gave their exercising a purpose. However, both active and inactive participants found purpose in walking outdoors for exercise, as a response to lockdown.

Conclusions

Overall, we suggest that enjoyment and the maintenance of physical function should be targeted in all recommendations and interventions because these are the benefits of exercise most highly valued by older adults. Exercise recommendations and interventions at each socio-ecological level should be tailored specifically to older adults. Supporting older adults to find a valued activity that suits their needs and preferences should be the focus of these strategies. Inactive older adults should be intensively supported by their social and physical context to implement more physical activity in their lives. Our main recommendations include emphasising the importance and benefits of physical activity, supporting and enabling exercise for all ages and levels of mobility.
O.4.6-1 Examining the feasibility, acceptability, and effectiveness of a self-compassion workshop in physical education class for adolescent females
Authors: Coulbeck Vanessa Marie
Published: September 2023

Purpose

In adolescence, enrollment in Physical Education (PE) drastically drops in the transition from grade 9 to 10 – particularly for females who disengage at higher rates than males after completing provincial PE curricular requirements. This is problematic since engagement in PE has the potential to shape and guide young females’ perceptions of movement, their bodies, and coping with life’s difficulties through physical activity. Body image distress may be one reason to explain PE disengagement therefore, may warrant intervention. Self-compassion is an emotion regulation strategy that helps deal with body-related distress and may be an effective strategy to help females cope with these negative experiences in PE and PA beyond. This is the first pilot study to examine the feasibility, acceptability and effectiveness of a self-compassion psychoeducation intervention in PE.

Methods

A pragmatic one-group pre-test post-test design, with 1-month follow-up was used. The sample consisted of n = 52 students from 2 Canadian high school grade 9 grade 10 females PE classes. The intervention consisted of a 75 minute self-compassion workshop. Feasibility and acceptability were assessed using multiple data sources from a 75-minute focus group, and 1-month follow up survey data. Effectiveness was examined using change in scores on PE attitudes, PA attitudes, self-compassion, and body-image coping.

Results

There was overall feasibility evidence for the intervention, whereby, all available classes and teachers agreed to host the workshop. The majority of students completed the pre-survey 84.6% (44/52), workshop 71.5% (37/52), and focus group session 92.3% (48/52), and expressed interest in having follow-up workshops 60.7% (17/28). The intervention demonstrated acceptability, as indicated by students indicating high scores on workshop acceptability, ethical conduct, effectiveness, limited negative side effects, material being beneficial and presented in a useful way. Small improvements were shown for self-compassion (d = 0.0761), PE attitudes (d = 0.0761) and PA attitudes (d = 0.245) from pre-workshop to follow-up.

Conclusions

The knowledge gained from this pilot study may enhance capacity for delivery of scalable curriculum-informed physical education promotion strategies which may be broadly transferrable to physical activity programs.
O.4.6-6 Providing physical activity and sport opportunities in Active Schools: coordinators’ satisfaction with facilities and equipment
Authors: Valencia-Peris Alexandra , Peiró-Velert Carmen , Evangelio Carlos , Valenciano-Valcárcel Javier , Pérez-Gimeno Esther
Published: September 2023

Purpose

The premises and equipment available in schools are essential for developing programs that promote active lifestyles in schoolchildren. The aim of this study was to determine how satisfied coordinators of Active school programs were with their sports equipment and facilities and identify differences by type of school.

Methods

In the 2021/22 academic year, 580 schools were accredited as Active schools in the Valencian Community (Spain). A representative sample of 257 Active school coordinators (33.1% women; 90.7% Physical Education teachers; 83.7% state schools) participated. An ad-hoc questionnaire was designed and administered on-line. It consisted of 47 open and closed response questions concerning the actions carried out to promote physical activity and sport and the school coordinators’ degree of satisfaction. The anonymity of all the participants was guaranteed. Descriptive statistics and chi-square tests were conducted on SPSS Statistics v. 26.0 software.

Results

Active schools in the Valencian Community were equipped with the following facilities/spaces: sports fields or courts (55.6%), gym (55.5%), outdoor playing fields (41.4%), green spaces (10.9%), a football pitch (8.2%), skating rink (5.2%) and swimming-pool (0.8%). The Active school coordinators were quite satisfied with the school areas and playgrounds (65.3%) and sport equipment (75.1%) but dissatisfied with the gym or sports hall (60.7%), toilets and showers (59.5%), or with the equipment for students with functional diversity (66.1%). Significant differences by type of school emerged for school spaces and playgrounds (χ2(3)=11.480; p<.05), gym and sports hall (χ2(3)=10.829; p<.05) and equipment for students with functional diversity (χ2(3)=33.368; p<.05). Private schools were better represented in the maximum degree of satisfaction than state schools. The Active school coordinators suggested that improvements in outdoor premises (80.9%) and more and better equipment (74.7%) would contribute to increasing pupils' physical activity at school.

Conclusions

The degree of satisfaction of the Active schools coordinators was balanced regarding the school equipment and facilities, but lower in state schools than private schools. The authorities should provide state schools with more sports and open spaces, green areas and appropriate equipment to facilitate designing inclusive, effective and sustainable physical activity and sports promotion programs.

Funding

Grants AICO/2021/342 and Margarita Salas [MS2021].
O.5.1-2 Associations of active school transport and leisure-time physical activity with educational and school-related mental health outcomes among Finnish adolescents: a nationwide cross-sectional study
Authors: Jussila Juuso J , Pulakka Anna , Halonen Jaana I , Salo Paula , Allaouat Sara , Mikkonen Santtu , Lanki Timo
Published: September 2023

Purpose

Physically active pupils may be better and more resilient learners. However, it is unknown whether active school transport (walking or cycling to school) could affect educational and school-related mental health outcomes. We examined the associations of active school transport and leisure-time moderate-to-vigorous physical activity with perceived academic performance, self-reported competency in academic skills (concentration in classroom, writing, reading, and calculation), school burnout, and school enjoyment among Finnish adolescents.

Methods

We included 34103 eighth and ninth graders (mean age 15.4 years; 53% girls) from the nationwide School Health Promotion study cohort of 2015. We used logistic regression, adjusting for major sociodemographic, lifestyle, and physical activity covariates, to estimate the associations.

Results

We observed small but positive associations between active school transport and educational outcomes. For example, compared with non-active transport, 10-30 minutes of active school transport a day was associated with 30% higher odds of high perceived academic performance (OR 1.30, 95% CI 1.21-1.40) and 16% higher odds of high competency in reading (OR 1.16, 95% CI 1.07-1.26). Any dose of active school transport was also associated with higher school enjoyment, but no relationship with school burnout was observed. Compared with inactivity, higher doses of leisure-time physical activity were robustly associated with better educational outcomes. For example, the most physically active adolescents had 85% higher odds of high perceived academic performance (OR 1.85, 95% CI 1.65-2.08). Regarding competency in academic skills, the strongest association was observed for calculation (OR 1.57, 95% CI 1.39-1.77). Engaging in leisure-time physical activity, at any dose, was also associated with lower odds of school burnout, and higher odds of school enjoyment.

Conclusions

Compared with active school transport, engaging in leisure-time moderate-to-vigorous physical activity seems to be more strongly associated with high perceived academic performance, high competency in academic skills, and less school burnout among youth. Despite this, walking and cycling to school might lead to minor improvements in classroom performance and school enjoyment.

Funding Source

Juuso J. Jussila was supported by the Academy of Finland, Strategic Research Council (#336003).
O.5.1-4 Approaches to promote active transport against the background of societal and climate change – Results of a nationwide survey from Germany
Authors: Manz Kristin , Böttger Sarah Jane , Krug Susanne
Published: September 2023

Purpose

Active transport has various benefits, such as increasing physical activity levels and mitigating climate change. However, knowledge about common motives for active transport is limited, although it could be useful for designing effective public health strategies. In addition, the impact of currently observable increased remote working on active transport behaviour change are widely unknown. We aim to investigate (1) what motivates adults to walk or cycle to get to and from places, (2) differ health- and climate-related motives by sociodemographic factors (e.g., gender, age, education), and (3) whether an increase in remote working affects active transport behaviour.

Methods

We used data from a nationwide population-based study conducted from 11/2021 till 02/2022. Our sample compromised 10,448 participants (51.1 % women), and data used were self-reported. We performed multivariable regression analyses to investigate whether sociodemographic factors predict the selection of a motive for active transport and whether a change in remote working predicts a change in active transport behaviour.

Results

The most frequently chosen motives for active transport were “it is good for my health” (77.4 % of adults using active transport regularly) and “to be physically active” (75.7 %), followed by “it is good for the environment and climate” (54.8 %). The health-related motives were more often chosen by older adults, adults with a higher educational level and adults with a better health status. The motive to protect the environment and climate was more often chosen by women, adults with a higher educational level and adults with a better health status. A comparison between winter 2021/2022 and pre-pandemic times based on retrospective questions showed that an increase in remote working was associated with a reduction in active transport (relative risk ratio: 2.8) as well as an increase (relative risk ratio: 1.5; only significant in men).

Conclusions

Health- and climate-related motives should be addressed when promoting active transport. Additionally, compensatory strategies are necessary to prevent a decline in total physical activity level due increased remote working.

Support/Funding Source

The study was funded by the German Federal Ministry of Health.
O.5.1-11 Index for Promoting Sustainable, Healthy and Environment friendly Lifestyles and its association with metabolic syndrome: findings from a Swedish Population-Based Cohort Study
Authors: Singh Nisha , Bälter Katarina , Tillander Annika
Published: September 2023

Purpose

The purpose of this study was to investigate the association between sustainable and healthy lifestyle factors and the risk of metabolic syndrome, with a focus on promoting sustainable, healthy and environment friendly behaviours. By creating Index for Promoting Sustainable, Healthy and Environment friendly Lifestyles (IPSHEL), we aimed to assess the combined impact of various lifestyle factors on the development of metabolic syndrome.

Methods

A population-based cohort study was conducted in Sweden, involving a total of 5,364 participants. Lifestyle factors related to physical activity, food habits, tobacco use, alcohol, and sleep were assessed through questionnaires. To quantify the influence of these factors, an Index called IPSHEL was developed. Each lifestyle factor was graded and aggregated into an overall index score for each participant.

Results

The results showed a significant association between IPSHEL and the risk of metabolic syndrome. Individuals with the highest IPSHEL scores had reduced relative risk of developing metabolic syndrome compared to those with the lowest IPSHEL scores. Notable lifestyle factors strongly associated with metabolic syndrome included the intake of fast food and soda, portion sizes of meat and other protein-rich foods, intake of red and processed meat, consumption of cakes, candy, chocolate, ice-cream, chips, total sitting time, snuff use, and the climate impact from diet.

Conclusions

This study highlights the importance of adopting a sustainable and healthy lifestyle in reducing the risk of metabolic syndrome. The IPSHEL proved to be a valuable tool in assessing the combined impact of multiple lifestyle factors. These findings suggest the practical application of the index in public health contexts, serving as a useful tool for surveys, interventions, and evaluations targeting healthy behaviours. By promoting sustainable, healthy and environment friendly lifestyle choices, we can strive towards improved population health and the achievement of global development goals.
O.5.2-2 The relationship between moderate-vigorous physical activity and menopausal symptoms
Authors: Fitzsimons Claire , Reid Janis , Sivaramakrishnan Divya , Mutrie Nanette , Strain Tessa , Niven Ailsa
Published: September 2023

Purpose

There is growing evidence for the benefits of physical activity (PA) during the menopause lifestage (MLS), but limited understanding of women’s experiences of being PA at this time. This study aimed to understand how PA is related to menopausal symptoms during the MLS by: i) assessing the proportion of participants meeting the moderate-vigorous PA (MVPA) guidelines, and perceived PA changes during MLS; ii) assessing prevalence of menopausal symptoms; iii) examining participants’ perceptions of how menopausal symptoms impact PA; iv) investigating the relationship between experiencing symptoms and meeting PA recommendations.

Methods

Participants completed an online survey (Oct-Nov22, n = 655; average age 49.9 years; 56% peri-menopausal; 20% early-post menopause; 24% mid post-menopause) including questions related to meeting MVPA recommendations, experience of 14 menopausal symptoms, and perceptions of symptom impact on likelihood of PA engagement. Descriptive statistics were presented and Chi-squared tests used to examine associations between symptom experience and MVPA guideline compliance, with Bonferroni correction for multiple comparisons.

Results

Seventy-five percent of participants reported achieving MVPA guidelines (150 minutes/week). Fifty-seven percent reported PA levels had decreased during the current menopause life stage. Twelve out of 14 symptoms were experienced by > 50% participants, with changes in mood and brain fog most common (>80%). For 10 out of the 14 symptoms, >50% participants indicated a negative impact on likelihood to engage in PA, with changes to mood, difficulty sleeping (not due to night sweats), and muscle aches and joint pains most detrimental. Whilst not significant, for 10 of the 14 symptoms the proportion meeting the MVPA guidelines was lower amongst those who experienced the symptoms.

Conclusions

Participants had similar levels of MVPA to national norms, although the majority perceived their PA levels had declined. Participants experienced a range of symptoms which were perceived to negatively impact their PA levels, although not statistically evident. The MLS represents a time when being active can be difficult so it is important to find ways to better support women.

Support/Funding Source

This work was funded by SAMH, the Scottish Association for Mental Health.
O.5.3-2 Development of a framework for scaling up community-based health promotion: a best fit framework synthesis
Authors: Weber Philipp , Birkholz Leonie , Helsper Natalie , Dippon Lea , Kohler Simone , Pfeifer Klaus , Rütten Alfred , Semrau Jana
Published: September 2023

Purpose

Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion.

Methods

We followed the “best fit” framework synthesis approach and conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework.

Results

From 80 articles, 5 were included for data extraction. The analysis yielded 10 a priori defined key components: “innovation characteristics”; “clarify and coordinate roles and responsibilities”; “build up skills, knowledge, and capacity”; “mobilize and sustain resources”; “initiate and maintain regular communication”; “plan, conduct, and apply assessment, monitoring, and evaluation”; “develop political commitment and advocacy”; “build and foster collaboration”; “encourage participation and ownership”; and “plan and follow strategic approaches”. We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework.

Conclusion

The “best fit” framework synthesis approach provides science-based insights for developing successful scaling up processes in the field of physical activity-related health promotion. We further identified “encourage participation and ownership” as a crucial component regarding health equity. Moreover, practice-based evidence from different stakeholders at various levels will be needed to develop a practice and science-based concept to scaling up a community-based health promotion approach.

Funding Source

This research was funded by the Federal Centre of Health Education (BZgA) on behalf of and with funds from the statutory health insurances according to § 20a SGB V in the context of the GKV Alliance for Health.
O.5.3-3 Evaluation of the Sports Club for Health (SCforH) online learning tool among various stakeholders and end-users from 34 European countries
Authors: Matolić Tena , Jurakić Danijel
Published: September 2023

Purpose

The awareness of the Sports Club for Health (SCforH) guidelines was shown to be positively associated with a greater commitment to HEPA promotion in sports organisations. Because of the low implementation (<20%) of SCforH guidelines, we created their e-version, an interactive multilingual online learning course. The aim of this research was to determine the levels of potential stakeholders’ perceived quality of the course, to help improve the: i) content of new, similar courses, ii) effectiveness of their future dissemination, and iii) the rate of their success.

Methods

The sample included 910 participants: 26 HEPA policymakers, 15 HEPA promotors and researchers, 55 sports associations, and 219 sports club representatives, 70 academic staff, and 410 students in higher education or research institution in the field of sport, health, or physical activity, and 115 “other” participants, from 34 European countries. The participants provided their answers to the EDUCA-TOOL course evaluation questionnaire consisting of 12 course-quality assessment items categorised into 4 different subscales: Reaction, Learning, Behavioural intent, and Expected outcomes. The summary scores for all subscales (max = 25) and the total score (max = 100) were calculated.

Results

Overall reaction and learning mean were 21.11 and 19.63, ranging from 20.58 to 22.33 for reaction, and from 18.81 to 20.94 for learning among students, and HEPA promotors and researchers, respectively. The overall behavioural intent mean was 20.12, ranging from 19.29 in students to 21.68 in HEPA policymakers. The expected outcomes mean was 19.31, ranging from 18.39 in academic staff to 21.7 in HEPA promotors and researchers. Overall satisfaction with the course was relatively high – 80.43 mean, and in a range from 77.72 for students to 86.51 in HEPA promotors and researchers.

Conclusions

Innovative and engaging methods of disseminating the SCforH guidelines may aid their widespread adoption and understanding among various stakeholders in Europe. These findings can also be used to improve the content of new training courses for HEPA promotion.

Support/Funding Source

This work is supported by the Erasmus+ Program of the European Union as part of the project “Creating Mechanisms for Continuous Implementation of the Sports Club for Health Guidelines in the European Union” under Grant: 613434-EPP-1-2019-1-HR-SPO-SCP.
O.6.1-4 A whole school, systems-based approach to health enhancing physical activity (WSA HEPA)- challenges and lessons learnt from an ERASMUS+ Collaborative Partnership project
Authors: Crone Diane , Sellars Paul , Barkoukis Vasillis , Jaakkola Timo , Huhtiniemi Miko
Published: September 2023

Purpose

Health-enhancing physical activity (HEPA) is an ongoing concern for all countries and in particular for young people, who are the future adults in our society. Global physical inactivity levels remain static (Guthold et al., 2018) and as a consequence there is an international goal to reduce physical inactivity by 10% by 2025 and by 15% by 2030 (WHO, 2018). To support the achievement of physical activity goals, the World Health Organisation designed a Global Action Plan for Physical Activity (GAPPA) (WHO, 2018). Using the GAPPA, the aim of the WSA HEPA project was to co-produce resource materials that promote the GAPPA objectives and adopt a whole-systems approach to addressing HEPA in schools for young people. In summary, this presentation will present the WSA HEPA project, explain the material development and how to access them (here) and conclude with challenges and lessons learnt.

Description

The presentation will include (i) an overview of the project including the co-production approach to the material (module) development and EU wide mixed method needs analysis undertaken to inform their development; (ii) an explanation of the six modules and conclude with (iii) challenges and lessons learnt from the project.

Conclusion

Participants attending the presentation will gain an understanding of how a whole school, whole systems-based approach for health enhancing physical activity can be implemented. They will also have access to the resources to enable this from the project and be cognisant of the challenges and benefits to such an approach. They should have sufficient knowledge and access to resources to be able to implement this in their home countries.
O.6.2-6 Life skills development and transfer in community sports programs
Authors: Alarslan Güven , Harmsel-Nieuwenhuis Liselot ter , Verkooijen Kirsten , van Hilvoorde Ivo , Koelen Maria
Published: September 2023

Purpose

Participating in community sports programs can contribute to positive developmental outcomes, such as the development and transfer of life skills. However, studies specifically focusing on which life skills are developed and whether these skills are indeed transferred to other life domains among socially vulnerable adults, are still lacking. Therefore, the aim of this study was to investigate life skills development and transfer among socially vulnerable adults as a result of pariticpating in in community sports programs.

Methods

This study builds on a life-course approach. Data were collected through semi-structured interviews with a total of 13 program participants and three social sports coaches. Additionally, four focus group discussions were organized in which a total of four program coordinators, five social sports coaches and six social workers participated. By employing multiple methods and data sources, data triangulation was achieved. Data were analyzed using thematic analysis.

Results

We found that program participants developed cognitive, emotional, and social life skills. Examples of cognitive life skills were planning and time management, taking initiative, critical thinking, self-awareness, and self-direction. Examples of emotional life skills were coping skills, empathy, and staying mentally positive. Examples of social skills were expressing feelings, assertiveness, leadership, respect, and teamwork. Although the views of the program participants, their coaches and the results from the focus group discussions showed overlap, differences in which life skills were developed and/or transferred by program participants were also found. For example, the development and transfer of planning and time management was mentioned by several social sports coaches and during the focus group discussions, however, this was not always mentioned by the program participants.

Conclusions

Adults in a socially vulnerable position (can) develop cognitive, emotional and social life skills by participating in community sports programs. Moreover, the transfer of these life skills to other life domains like home and work was demonstrated. These findings are an important step towards better understanding the societal impact of community sports programs serving socially vulnerable adults.
O.6.2-7 “Virtual Surf Booth”: assessment of a novel tool and data collection process to measure the impact of a 6-week surf programme on wellbeing
Authors: Gerami Ariane , Foster Charlie , Murphy Joey
Published: September 2023

Purpose

Practicing physical activity in blue space (i.e. forms of natural and manmade surface water) is shown to be associated with an improvement in wellbeing. Surfing is a popular blue space activity with surf therapy increasingly used as a health intervention. However, the mechanisms through which surfing leads to an improvement in wellbeing remain unclear. One reason for this is the challenges with collecting data related to acute and chronic wellbeing outcomes. The purpose of this study was to evaluate the usability of an online digital tool to measure wellbeing outcomes, and the usefulness of the data collected.

Methods

Participants of a 6-week surf programme, delivered at The Wave Bristol, were invited to partake. Each participant was asked to complete the online digital tool on weeks 1, 2, 4 and 6. Qualitative (video recording and word association) and quantitative (Short Warwick-Edinburgh Mental Well-Being scale) responses were collected. Usability and acceptability of the tool were evaluated through focus groups with participants and engagement data. Descriptive analysis and paired samples t-tests were used to assess differences in wellbeing during the surf programme. A reflexive thematic analysis was used to assess video and word association responses.

Results

Participants (n = 15, 100% female, age=43.0±5 years) perceived the tool as easy to use due to the short completion time, range of tool functionalities, and useful because it provided time for reflection. Aspects such as increasing privacy when using the tool, accessibility of the tool, and incentivisation with completing the questions were seen as aspects that can increase future engagement. From a research perspective, the data collected allowed for the assessment of acute and chronic wellbeing, and demonstrated a positive relationship between surfing and wellbeing.

Conclusions

The study provides support that the tool can be a usable and useful process of collecting wellbeing data within surfing. Such a tool may allow us to understand the mechanisms through which surfing and other activities impact wellbeing. However this area of research is still new and more work needs to be done to assess the reliability and validity of the tool.

Funding Source

University of Bristol Grant Capture Fund.
O.6.3-1 Implementation and evaluation of the Walking In ScHools (WISH) Trial in adolescent girls: mixed-methods process evaluation of a clustered randomised control trial using RE-AIM
Authors: Carlin Angela , Doherty Leanne C , O'Kane S Maria , Jago Russell , McDermott Gary , Gallagher Alison M , Lahart Ian M , Faulkner Maria , Murphy Marie H
Published: September 2023

Purpose

The aim of the Walking In ScHools (WISH) Study was to investigate the effectiveness of a school-based, peer-led, walking intervention, delivered across the school year, at increasing adolescent girls (12-14 years) physical activity (PA) levels. The intervention was delivered in schools across Northern Ireland (n6) and the Republic of Ireland (n3). Older girls (15-18 years) were trained as Walk Leaders and led the pupils in 10–15-minute brisk walks, before school, during break and lunch recess.

Methods

A mixed methods process evaluation was undertaken, using the RE-AIM framework, to evaluate the WISH intervention. Attendance and fidelity of walks were monitored by Walk Leaders completing a check list at each walk. At baseline, end of intervention and follow-up, pupils completed questionnaires to assess self-efficacy for PA and walking, health-related quality of life and reasons for engaging in PA. Friendship networks were evaluated at baseline and end of intervention. Walk Leaders completed questionnaires before the training and at end of intervention to evaluate self-perception of PA and fitness, PA enjoyment and self-efficacy, and leadership skills. Semi-structured online interviews were conducted with Teachers (n9) and Walk Leaders (n19), to identify key elements affecting implementation. Focus groups (n9) were conducted with pupils who were low and high attenders at walks, to identify factors that affected intervention participation, motivation and enjoyment. Interviews and focus groups were audio-recorded and transcribed verbatim. Qualitative data was managed in NVivo and analysis was undertaken using thematic analysis. Quantitative analysis was undertaken using SPSS (IBM SPSS V23).

Results

A total of 589 pupils were recruited and 286 girls were allocated to the intervention cluster with 149 Walk Leaders trained. Over the duration of the study, 51 pupils and 4 Walk Leaders withdrew from the study. Most girls attended walks (n212; 74%), albeit, participation varied across schools, with number of walks attended, ranging from 2 to 80. Data analysis is ongoing and results will be finalised May 2023.

Conclusions

Early results from the process evaluation of this fully powered Intervention, indicate implementation of the intervention varied across schools. This process evaluation will provide insights into factors affecting implementation of school-based interventions.
How Alliances Shape Rivalries
Authors: Suhas Prashant Hosur
Published: September 2023

A small body of scholarship has identified asymmetric rivalries as a phenomenon where two unevenly matched states are engaged in drawn-out security competitions or rivalries. Despite pointing out that many rivalries persist between states with significant power disparity, their conflict dynamics remain an understudied topic. Questions such as: why weaker states initiate conflicts against stronger states within a strategic rivalry, and why do some asymmetric rivalries de-escalate while others do not, have not been sufficiently addressed. In this paper, I argue that alliances embolden weaker states to initiate conflicts but also manage to facilitate a greater degree of affinity with their rivals on global and regional issues. Weaker states in a rivalry pursue alliances to equip themselves to fight against stronger rivals. At the same time, allies are also likely to act as a restraint on their partner fearing being dragged into their partner’s conflicts thus contributing to rivalry de-escalation. These two factors lead to two different behaviors: a higher probability of conflict initiation by the weaker state on account of newfound support, and medium to long-term rivalry de-escalation, on account of the weaker state’s ally’s fears of chain-ganging and becoming embroiled in its partner’s conflicts.
Barriers to human papillomavirus vaccine uptake: role of state religiosity and healthcare professionals’ participation in a state vaccine program
Authors: Chandra Monalisa , Osaghae Ikponmwosa , Talluri Rajesh , Shete Sanjay
Published: September 2023

Background

Despite the known benefits of preventing human papillomavirus (HPV)–related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-level (state) and meso-level (organization) factors associated with HPV vaccine initiation and up-to-date.

Methods

Data from 2020 National Immunization Survey-Teen were used to study a sample of 20 163 US adolescents (aged 13-17 years). The data were collected from each teen’s parents or guardians and health-care professionals. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted.

Results

The prevalence of HPV vaccine initiation was 75.1% and of remaining up-to-date was 58.6%. At the macro level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity adjusted odds ratio [AOR] = 0.63, 95% confidence interval [CI] = 0.50 to 0.78; moderate religiosity AOR = 0.68, 95% CI = 0.55 to 0.85) and up-to-date (high religiosity AOR = 0.69, 95% CI = 0.56 to 0.85; moderate religiosity AOR = 0.74, 95% CI = 0.61 to 0.91) than states with low religiosity. At the meso level, when none of their healthcare professionals ordered vaccine from the state, teens had lower odds of initiation (AOR = 0.68, 95% CI = 0.53 to 0.87) and up-to-date (AOR = 0.76, 95% CI = 0.60 to 0.95) than teens whose healthcare professionals ordered vaccine from the state. In addition, race and ethnicity, age, mother’s education level, household income, well-child examination status, and doctor’s recommendation were significantly associated with HPV vaccine uptake.

Conclusion

A multiprong approach is needed to address religious and systemic barriers to HPV vaccination and expand healthcare professionals’ access and enrollment in state vaccine initiatives, such as the Vaccine for Children program.
Challenges of Plasmodium vivax and Plasmodium knowlesi co-infection
Authors: Charoenwisedsil Rachata , Asawapaithulsert Punyisa , Pisutsan Phimphan , Chotivanich Kesinee , Matsee Wasin
Published: September 2023

A Burmese man was diagnosed with severe Plasmodium vivax (P. vivax) malaria infection admitted to a hospital in Thailand. Interestingly, following RT-PCR analysis, infections with both P. vivax and Plasmodium knowlesi were identified, potentially contributing to severe manifestation. Co-infection risk, especially in severe P. vivax cases, warrants vigilant consideration.
Epidemiology and the Spread of HIV
Authors: Banach Laurel , Goodier Meagan , Bolduc Philip
Published: September 2023

This chapter discusses the global prevalence, as well as the geographic distribution, of human immunodeficiency syndrome (HIV)-1 and HIV-2 infections and updates on recent shared global initiatives. The demographic trends in HIV in the United States, especially regarding gender, sexuality, race, ethnicity, age, injection-drug use, socioeconomic status, and recent initiatives are reviewed. Special attention is paid to HIV among communities of color, as well as women, children, and adolescents. The role of HIV in men who have sex with men and the transgender community is reviewed in detail. The chapter also discusses the 95-95-95 initiative, which highlights both critical improvements and enduring deficits alike.
Origin, Evolution, and Spread of HIV1 & HIV2
Authors: Kirchner Jeffrey T.
Published: September 2023

All strains of HIV-1 and HIV-2 are genetic descendants of simian immunodeficiency viruses (SIVs). Initial cross-species transmission of the virus occurred from the butchering and eating of bush meat. This chapter reviews the origin of HIV and its entry into humans as well as the different strains and subtypes of HIV. A section of the chapter is dedicated to examining the spread of HIV throughout Africa and the rest of the world. The diversity of HIV is discussed in detail, along with treatments and vaccine developments. The chapter concludes with a brief discussion about the future of HIV regional and global genetic diversity. Genetic diversity of HIV, including recombination between subtypes, may continue to present challenges to the development of a globally effective vaccine.
HIV Care Coordination
Authors: Nelson Margret O.
Published: September 2023

Currently available antiretroviral therapies have higher efficacy and lower side-effect profiles and are associated with better adherence compared to antiretroviral therapy available in previous decades. This has led to prolonged survival of people living with HIV (PWH), approaching that of the general population. Coordination of care using a patient-centered interdisciplinary team model can be an effective strategy to increase engagement in care and reduce barriers, especially for complicated patients and/or those with few resources. This broad chapter describes the importance of an interdisciplinary team approach to the optimal management of PWH. The chapter covers interdisciplinary care coordination in care for PWH. The HIV continuum of care is discussed through to palliative and hospice care. Roles of the HIV patient care team are outlined in depth, along with information about quality improvement. The chapter also reviews the importance of clinical research and interpretation of clinical trial results. It concludes with a review of funding for HIV care.
HIV Drug Resistance
Authors: Chu Carolyn , Pollock Lealah , Shafer Robert W.
Published: September 2023

According to the Centers for Disease Control and Prevention (2022), approximately 35% of persons with diagnosed HIV infection in the United States do not have a suppressed viral load, underscoring ongoing gaps in HIV care—many of which were exacerbated with the COVID-19 pandemic. Updated US guidelines continue to incorporate specific antiretroviral recommendations after first- and second-line treatment failures, accounting for commonly observed resistance patterns that emerge across different treatment scenarios. Proviral DNA sequencing remains an area of high interest, given ongoing attention to regimen simplification and “switch” strategies, including the newly approved dual combination of long-acting injectable cabotegravir plus rilpivirine. For persons who acquire HIV in the setting of pre-exposure prophylaxis (PrEP) use (in particular long-acting injectable PrEP with cabotegravir), subsequent antiretroviral therapy (ART) treatment selection should take into account potential transmitted and/or acquired HIV drug resistance. HIV providers should have a solid understanding of HIV drug resistance, as it is one of the most common dilemmas in HIV medicine and can be encountered in multiple contexts including transmitted drug resistance, pretreatment drug resistance, and acquired drug resistance. Drug resistance testing is recommended under specific circumstances including at time of initial HIV diagnosis, and when PWH on therapy experience virologic failure. Although guidelines continue to recommend caution when interpreting results of peripheral blood mononuclear cells (PBMC) (proviral) DNA genotype testing, this information may be considered when optimizing/simplifying ART in people with viral suppression.
Substance Use in HIV Populations
Authors: Truong Thanh Thuy , David Elizabeth H.
Published: September 2023

The relationship between substance use and HIV infection is complex and encompasses all stages, including transmission, diagnosis, progression, and treatment. Substance use can increase risk for exposure to HIV via needle-sharing or impairing judgment linked to risky sexual behaviors. Among men who had sex with men (MSM), substance use was associated with an increased risk of HIV infection, particularly with binge drinking, crack/cocaine, methamphetamine, and inhalant use. In the 2018 Centers for Disease Control and Prevention report, MSM accounted for 66% of HIV diagnoses in the United States. HIV diagnoses attributed to injection drug use increased from 2014–2018, which was likely due to the increase in prescription opioid use and heroin. Among people living with HIV (PWH), substance use can lead to a poor prognosis and progression to acquired immune deficiency syndrome. Irregular follow-up with treatment, poor adherence to antiretroviral therapy, and risk of acquiring other sexually transmitted infections and hepatitis C through injection drug use increase morbidity and mortality. This chapter discusses issues, implications, diagnosis, and treatment of substance use disorders in PWH. The learner will be able to describe the bidirectional interactions between HIV and unhealthy substance use, recognize unhealthy substance use in PWH and provide an initial outline of possible approaches to the treatment of substance use disorders among people with HIV.
Opportunistic Infections
Authors: Armitige Lisa Y. , Vigil Karen J. , Dib Rita Wilson
Published: September 2023

This chapter aids the learner in recognizing and managing the most common opportunistic infections associated with people with HIV. The chapter describes the issues concerning starting antiretroviral therapy in the setting of an opportunistic infection. It summarizes the recommendations for starting ART in the setting of an opportunistic infection. Learners will be able to delineate the available test and treatment modalities to manage Mycoacterium tuberculosis, M. avium complex, and M. kansasii, and discuss the established and evolving science regarding diagnosis, treatment, and prophylaxis of opportunistic viral infections associated with HIV, including herpes simplex, Varicella zoster, Cytomeglovirus, human herpesvirus, and John Cunningham (JC) virus.
Malignancies in HIV
Authors: Clark Eva H. , Chiao Elizabeth Y.
Published: September 2023

This chapter discusses the role of virally mediated and non-virally mediated AIDS-associated and non-AIDS-associated malignancies. The learner will review the epidemiology and role of antiretroviral therapy on the impact of AIDS-defining malignancies. The chapter discusses the role of human herpes virus-8 in the development of Kaposi’s sarcoma, the role of Epstein–Barr virus in primary central nervous system lymphoma, and other HIV-associated lymphomas. It reviews and the role of human papillomavirus vaccination in virally mediated anogenital squamous cell cancer. Non-AIDS-defining malignancies including lung, prostate, oropharyngeal, liver, breast, and pancreatic caners are covered. Lastly, it emphasizes that antiretroviral initiation is of utmost importance for all AIDS-defining malignancies and non-AIDS-defining malignancies and summarizes the National Cancer Center Network Guidelines for HIV malignancies.
Psychiatric Illness and Treatment in HIV Populations
Authors: Vijayvargiya Richa , David Elizabeth H.
Published: September 2023

This chapter discusses the psychiatric concomitants of HIV illness and the role of psychiatric care in the overall treatment of persons living with HIV. The chapter reviewers the bidirectional causes of the close association between HIV infection and psychiatric illnesses and /symptoms. The learner will recognize symptoms that suggest the presence of a psychiatric component to the patient’s clinical presentation. Lastly, the chapter describes general principles of treatment and when specific interventions by mental health professionals are advised. This chapter has been updated to reflect terminology from the Diagnostic and statistical manual of mental disorders text revision (DSM-5 TR, American Psychiatric Association, 2022), and has been updated with relevant new citations. The section discussing the impact on people living with HIV from the COVID-19 pandemic has been updated with new statistics.
Cardiovascular Disease
Authors: Sell Jarrett K. , Nunez Jonathan J.
Published: September 2023

This chapter describes the pathophysiology of cardiovascular disease and myocardial infarction in persons with HIV and the association between HIV infection as it relates to an increased risk of cardiovascular disease, myocardial infarction, stroke, and peripheral artery disease. The learner will also understand the association between specific antiretroviral therapies and cardiovascular risk and myocardial infarction, and how to assess risk for cardiovascular disease using the AHA/ACC atherosclerotic cardiovascular disease (ASCVD) 10-year risk calculator. Lastly, the learner will become familiar with medical therapies including statins and non-statins and lifestyle interventions including diet, exercise, weight loss, and smoking cessation to lower the risk of cardiovascular disease and myocardial infarction in persons with HIV.
Immune Reconstitution Inflammatory Syndrome (IRIS)
Authors: Coppock Dagan
Published: September 2023

This chapter aids the learner in understating the epidemiology of immune reconstitution inflammatory syndrome (IRIS) and associated opportunistic infections. IRIS is the inflammatory response of a rapidly restored immunologic function after starting antiretroviral therapy for HIV that can cause clinical deterioration. Opportunistic and other infections, previously unrecognized or tolerated by a failing immune system, may suddenly become targets of an overzealous restored immune system that can cause patients to become clinically worse, despite an otherwise excellent response to antiretroviral therapy. The learner will also recognize timing considerations regarding opportunistic infection treatment and antiretroviral therapy initiation related to IRIS, as well as management approaches to IRIS based on presenting and underlying opportunistic infections.