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BackgroundPhysical activity decreases from childhood through adulthood. Among youth, teenagers (teens) achieve the lowest levels of physical activity, and high school age youth are particularly at risk of inactivity. Effective methods are needed to increase youth physical activity in a way that can be maintained through adulthood. Because teens text a great deal, text messages promoting walking, a low cost physical activity, may be an effective method for promoting sustainable physical activity. ObjectiveThe objective of our study was to determine the effect of pedometers, self selected step goals, and texts grounded in the self-determination theory (SDT) on physical activity among the teens. Methods“TXT Me!” was a 12 week intervention that texted 14-17 year olds to increase their daily physical activity by increasing the number of steps they take each day. The intervention was grounded in the SDT. Formative research with the teens helped construct the intervention and develop the texts. A total of 84 texts were developed (12 to set a step goal, and 72 promoting autonomy, competence, and relatedness). The pilot evaluation used a four group, randomized design (n=160). After baseline data collection, the participants were randomized to one of four conditions (no treatment control, pedometer only, pedometer + weekly prompts, pedometer + weekly prompts + SDT grounded texts). Data were collected at baseline and immediately upon completion of the study. The primary outcome was physical activity, measured by 7 days of accelerometry. Basic psychological needs, physical activity motivation, process evaluation, and program satisfaction data were also collected. ResultsTo our knowledge, this is one of the first studies to explore the use of stand alone, SDT grounded texts, supported by pedometers and prompts to set a self selected step goal, as a method for increasing physical activity among teens. ConclusionsThis pilot study will contribute valuable information regarding whether theoretically grounded text messages show promise as an effective method to increase physical activity among teens. Trial RegistrationClinicaltrials.gov NCT01482234; http://clinicaltrials.gov/ct2/show/NCT01482234 (Archived by WebCite at http://www.webcitation.org/6NYvRMOoq).

BackgroundYouths eat fewer fruits and vegetables than recommended. Effective methods are needed to increase and maintain their fruit and vegetable consumption. Goal setting has been an effective behavior change procedure among adults, but has had limited effectiveness among youths. Implementation intentions are specific plans to facilitate goal attainment. Redefining goal setting to include implementation intentions may be an effective way to increase effectiveness. Video games offer a controlled venue for conducting behavioral research and testing hypotheses to identify mechanisms of effect. ObjectiveThis report describes the protocol that guided the design and evaluation of Squire’s Quest! II, a video game aimed to increase child fruit and vegetable consumption. MethodsSquire’s Quest! II is a 10-episode videogame promoting fruit and vegetable consumption to 4th and 5th grade children (approximately 9-11 year old youths). A four group randomized design (n=400 parent/child dyads) was used to systematically test the effect of two types of implementation intentions (action, coping) on fruit and vegetable goal attainment and consumption of 4th and 5th graders. Data collection occurred at baseline, immediately post game-play, and 3 months later. Child was the unit of assignment. Three dietary recalls were collected at each data collection period by trained interviewers using the Nutrient Data System for Research (NDSR 2009). Psychosocial and process data were also collected. ResultsTo our knowledge, this is the first research to explore the effect of implementation intentions on child fruit and vegetable goal attainment and consumption. ConclusionsThis intervention will contribute valuable information regarding whether implementation intentions are effective with elementary age children. Trial RegistrationClinicalTrials.gov NCT01004094

Little is known about effective eHealth recruitment methods. This paper presents recruitment challenges associated with enrolling African-American girls aged 8-10 years in an eHealth obesity prevention program, their effect on the recruitment plan, and potential implications for eHealth research. Although the initial recruitment strategy was literature-informed, it failed to enroll the desired number of girls within a reasonable time period. Therefore, the recruitment strategy was reformulated to incorporate principles of social marketing and traditional marketing techniques. The resulting plan included both targeted, highly specific strategies (e.g., selected churches), and more broad-based approaches (e.g., media exposure, mass mailings, radio advertisements). The revised plan enabled recruitment goals to be attained. Media appeared to be particularly effective at reaching the intended audience. Future research should identify the most effective recruitment strategies for reaching potential eHealth audiences. (Contains 2 tables.)

Background: The International Healthcare Community has considered the ideal rate for caesarean section (CS) to be between 10% and 15%. Since then, caesarean section have become increasingly common in both developed and developing countries. Objectives: 1) To analyse frequency and indications for CS at tertiary care hospital. 2) To classify population in Robson's ten group classification system and evaluate indications within the groups. 3) To identify the measures to reduce CS rates by formulating the plans in each group. Materials and Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in Ahmedabad, India. All the women delivered from March 2018 to October 2018 in the labour ward were included and classified into 10 Robson's classes. Percentages were calculated for the overall CS rate, contribution made by each group to overall CS rate and percentage of CS in each group. Results: The total number of women delivered during study period were 4500, out of which CS deliveries were 2006. Overall, CS rate calculated was 44.5%. Conclusion: In the present study, repeat CS was the highest contributor to all caesarean sections performed. [ABSTRACT FROM AUTHOR]

Youth encounter physical activity barriers, often called problems. The purpose of problem solving is to generate solutions to overcome the barriers. Enhancing problem-solving ability may enable youth to be more physically active. Therefore, a method for reliably assessing physical activity problem-solving ability is needed. The purpose of this research was to report the development and initial validation of the physical activity problem-solving inventory for adolescents (PAPSIA). Qualitative and quantitative procedures were used. The social problem-solving inventory for adolescents guided the development of the PAPSIA scale. Youth (14- to 17-year-olds) were recruited using standard procedures, such as distributing flyers in the community and to organizations likely to be attended by adolescents. Cognitive interviews were conducted in person. Adolescents completed pen and paper versions of the questionnaire and/or scales assessing social desirability, self-reported physical activity, and physical activity self-efficacy. An expert panel review, cognitive interviews, and a pilot study (n = 129) established content validity. Construct, concurrent, and predictive validity were also established (n = 520 youth). PAPSIA is a promising measure for assessing youth physical activity problem-solving ability. Future research will assess its validity with objectively measured physical activity. [ABSTRACT FROM AUTHOR]

Background: Child fruit and vegetable intake is below recommended levels, increasing risk for chronic disease. Interventions to influence fruit and vegetable intake among youth have had mixed effects. Innovative, theory-driven interventions are needed. Goal setting, enhanced by implementation intentions (i.e., plans tightly connected to a behavioral goal), may offer a solution. Action plans state “how” a goal will be achieved, while coping plans identify a potential barrier and corresponding solution. The research reported here evaluated the short- and long-term effects of goal setting enhanced with implementation intentions on child fruit and vegetable intake in a 10-episode, theoretically-grounded serious videogame promoting fruit and vegetables. This is one of the first studies to test the efficacy of implementation intentions on the dietary intake of healthy children. Methods: A four-group randomized design with three data collection periods (baseline, immediate post-intervention, 3 months post-intervention) was employed. Groups varied on whether children created an implementation intention (none, action, coping, both) as part of goal setting. Participants were 4th and 5th grade children (~9-11 years old) and one parent. An a priori power analysis indicated this would provide >80% power to detect a small effect (Cohen's d = 0.17). Children played a 10-episode online videogame; parents received 10 electronic newsletters and access to a parent-only website. The primary outcome was child fruit and vegetable intake, assessed via three, dietitian-assisted telephone recalls at each data collection period. The primary analysis was conducted using a repeated measures analysis of covariance with a mixed model procedure. Secondary analyses examined intervention effects on fruit and vegetables separately. Results: Four hundred parent/child dyads were recruited. A significant group-by-time interaction for fruit and vegetable intake (p < 0.001) was found in only the Action group, which had significant increases in fruit and vegetable intake at post 1 (p < 0.0001) and post 2 (p < 0.0001). No other significant interactions were observed; however, there were significant time effects for fruit (p < 0.0001). Conclusions: Action intentions may be an important component of successful interventions to increase and maintain fruit and vegetable intake in pre-adolescent children. Videogames promoting healthy diets offer an effective vehicle for delivering behavior change interventions to children. Trial registration: ClinicalTrials.gov NCT01004094. [ABSTRACT FROM AUTHOR]

Background: Young African American girls have a high risk of obesity. Online behavior change programs promoting healthy diet and physical activity are convenient and may be effective for reducing disparities related to obesity. This report presents the protocol guiding the design and evaluation of a culturally and developmental appropriate online obesity prevention program for young African American girls. Methods/Design: The Butterfly Girls and the Quest for Founder's Rock is an 8-episode online program delivered as an animated, interactive comic. The program promotes healthy diet and physical activity and is specifically designed for 8-10 year old African American girls. Girls, parents, and community representatives provided formative feedback on cultural relevance and developmental appropriateness. A three-group (treatment, comparison, wait-list control) randomized design (n = 390 parent/child dyads) is employed, with child as the unit of assignment. Change in body mass index is the primary outcome; change in fruit and vegetable consumption, water, and physical activity are secondary outcomes. Data collection occurs at baseline, approximately 3 months after baseline (i.e., completion of the online program), and approximately three months later (i.e., maintenance assessment). Two dietary recalls are collected at each data collection period by trained interviewers using the Nutrient Data System for Research (NDSR 2012) system. Physical activity is objectively measured by seven days of accelerometry. Psychosocial and process data are also collected. Girls in the treatment and comparison groups will be interviewed at post 1 to obtain information on personal reactions to the program. Discussion: This research will develop and evaluate the efficacy of an online program for reducing obesity risk among girls at risk of obesity and related diseases. Online programs offer the potential for wide dissemination, thus reducing disparities related to obesity. [ABSTRACT FROM AUTHOR]