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- All Subjects: Health Sciences
- All Subjects: Digital Health
- Creators: Buman, Matthew P
- Creators: Gaesser, Glenn A
- Member of: Theses and Dissertations
- Member of: Barrett, The Honors College Thesis/Creative Project Collection
Description
Cardiovascular disease (CVD) is the number one cause of death in the United States and type 2 diabetes (T2D) and obesity lead to cardiovascular disease. Obese adults are more susceptible to CVD compared to their non-obese counterparts. Exercise training leads to large reductions in the risk of CVD and T2D. Recent evidence suggests high-intensity interval training (HIT) may yield similar or superior benefits in a shorter amount of time compared to traditional continuous exercise training. The purpose of this study was to compare the effects of HIT to continuous (CONT) exercise training for the improvement of endothelial function, glucose control, and visceral adipose tissue. Seventeen obese men (N=9) and women (N=8) were randomized to eight weeks of either HIT (N=9, age=34 years, BMI=37.6 kg/m2) or CONT (N=8, age=34 years, BMI=34.6 kg/m2) exercise 3 days/week for 8 weeks. Endothelial function was assessed via flow-mediated dilation (FMD), glucose control was assessed via continuous glucose monitoring (CGM), and visceral adipose tissue and body composition was measured with an iDXA. Incremental exercise testing was performed at baseline, 4 weeks, and 8 weeks. There were no changes in weight, fat mass, or visceral adipose tissue measured by the iDXA, but there was a significant reduction in body fat that did not differ by group (46±6.3 to 45.4±6.6%, P=0.025). HIT led to a significantly greater improvement in FMD compared to CONT exercise (HIT: 5.1 to 9.0%; CONT: 5.0 to 2.6%, P=0.006). Average 24-hour glucose was not improved over the whole group and there were no group x time interactions for CGM data (HIT: 103.9 to 98.2 mg/dl; CONT: 99.9 to 100.2 mg/dl, P>0.05). When statistical analysis included only the subjects who started with an average glucose at baseline > 100 mg/dl, there was a significant improvement in glucose control overall, but no group x time interaction (107.8 to 94.2 mg/dl, P=0.027). Eight weeks of HIT led to superior improvements in endothelial function and similar improvements in glucose control in obese subjects at risk for T2D and CVD. HIT was shown to have comparable or superior health benefits in this obese sample with a 36% lower total exercise time commitment.
ContributorsSawyer, Brandon J (Author) / Gaesser, Glenn A (Thesis advisor) / Shaibi, Gabriel (Committee member) / Lee, Chong (Committee member) / Swan, Pamela (Committee member) / Buman, Matthew (Committee member) / Arizona State University (Publisher)
Created2013
Description
The effects of aging on muscular efficiency are controversial. Proponents for increased efficiency suggest that age-related changes in muscle enhance efficiency in senescence. Exercise study results are mixed due to varying modalities, ages, and efficiency calculations. The present study attempted to address oxygen uptake, caloric expenditure, walking economy, and gross
et cycling efficiency in young (18-59 years old) and older (60-81 years old) adults (N=444). Walking was performed at three miles per hour by 86 young (mean = 29.60, standard deviation (SD) = 10.50 years old) and 121 older adults (mean = 66.80, SD = 4.50 years old). Cycling at 50 watts (60-70 revolutions per minute) was performed by 116 young (mean= 29.00, SD= 10.00 years old) and 121 older adults (m = 67.10 SD = 4.50 years old). Steady-state sub-maximal gross
et oxygen uptake and caloric expenditures from each activity and rest were analyzed. Net walking economy was represented by net caloric expenditure (kilocalories/kilogram/min). Cycling measures included percent gross
et cycling efficiency (kilo-calorie derived). Linear regressions were used to assess each measure as a function of age. Differences in age group means were assessed using independent t-tests for each modality (alpha = 0.05). No significant differences in mean oxygen uptake nor walking economy were found between young and older walkers (p>0.05). Older adults performing cycle ergometry demonstrated lower gross
et oxygen uptakes and lower gross caloric expenditures (p< 0.05).
et cycling efficiency in young (18-59 years old) and older (60-81 years old) adults (N=444). Walking was performed at three miles per hour by 86 young (mean = 29.60, standard deviation (SD) = 10.50 years old) and 121 older adults (mean = 66.80, SD = 4.50 years old). Cycling at 50 watts (60-70 revolutions per minute) was performed by 116 young (mean= 29.00, SD= 10.00 years old) and 121 older adults (m = 67.10 SD = 4.50 years old). Steady-state sub-maximal gross
et oxygen uptake and caloric expenditures from each activity and rest were analyzed. Net walking economy was represented by net caloric expenditure (kilocalories/kilogram/min). Cycling measures included percent gross
et cycling efficiency (kilo-calorie derived). Linear regressions were used to assess each measure as a function of age. Differences in age group means were assessed using independent t-tests for each modality (alpha = 0.05). No significant differences in mean oxygen uptake nor walking economy were found between young and older walkers (p>0.05). Older adults performing cycle ergometry demonstrated lower gross
et oxygen uptakes and lower gross caloric expenditures (p< 0.05).
ContributorsFlores, Michelle (Author) / Gaesser, Glenn A (Committee member) / Campbell, Kathryn D (Committee member) / Angadi, Siddhartha S (Committee member) / Arizona State University (Publisher)
Created2014
Description
Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population.
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
ContributorsFloegel, Theresa A (Author) / Buman, Matthew P (Thesis advisor) / Hooker, Steven (Committee member) / Dickinson, Jared (Committee member) / DerAnanian, Cheryl (Committee member) / McCarthy, Marianne (Committee member) / Arizona State University (Publisher)
Created2015
Description
Cardiovascular disease and diabetes are major health burdens. Diabetes is a primary risk factor of cardiovascular disease, and there is a strong link between obesity and risk of developing diabetes. With the prevalence of prediabetes highest among overweight/obese individuals, investigation into preventative strategies are needed. Aerobic exercise is a potent stimulus for both insulin and non-insulin dependent glucose uptake into the skeletal muscle. A single exercise session can improve insulin sensitivity within hours after exercise. The effects of intensity, type, and volume of exercise on glucose homeostasis have been studied extensively; however, controlling for muscle contraction frequency with a constant exercise intensity and workload has not been examined. The purpose of this study was to compare muscle contraction frequency during aerobic exercise by altering cycling cadence on insulin sensitivity and vascular health. Eleven obese males (age=28yr, BMI=35kg/m2) completed three conditions in random order: 1) control-no exercise; 2) 45-min cycling at 45 revolutions per minute (45RPM) at 65-75%VO2max; 3) 45-min cycling at 90RPM at 65-75%VO2max. Glucose control and insulin sensitivity were assessed with oral glucose tolerance tests (OGTT) 4 hours post-exercise. Vascular health was assessed via flow-mediated dilation (FMD) pre-exercise, 1-hr and 2-hr post exercise and ambulatory blood pressure was assessed pre-exercise, and continually every 15 min post-exercise. Linear mixed models were used to compare the mean differences in outcome variables. There were no significant differences found between control and both exercise conditions for all OGTT outcomes and no differences were found between control and exercise in FMD (all, p>0.05). Significant effects for exercise were found for both brachial and central blood pressure measures. Brachial systolic blood pressures were lower at 2- and 4-hr post-exercise by approximately -10 and -8mmHg, respectively (p<0.001 and p=0.004) versus control. Central systolic blood pressures were lower at 2-, 3-, and 4-hr post-exercise by approximately -8, -9 and -6mmHg, respectively (p<0.001, p=0.021 and p=0.004) versus control. In conclusion, aerobic exercise, regardless of muscle contraction frequency, were unable to effect glucose control and insulin sensitivity. Similarly, there was no effect on vascular function. However, there was a significant effect of aerobic exercise on reducing post-exercise blood pressure.
ContributorsJarrett, Catherine Lee (Author) / Gaesser, Glenn A (Thesis advisor) / Angadi, Siddhartha S (Committee member) / Dickinson, Jared M (Committee member) / Whisner, Corrie M (Committee member) / Todd, Michael W (Committee member) / Arizona State University (Publisher)
Created2017
Description
Many individual-level behavioral interventions improve health and well-being. However, most interventions exhibit considerable heterogeneity in response. Put differently, what might be effective on average might not be effective for specific individuals. From an individual’s perspective, many healthy behaviors exist that seem to have a positive impact. However, few existing tools support people in identifying interventions that work for them, personally.
One approach to support such personalization is via self-experimentation using single-case designs. ‘Hack Your Health’ is a tool that guides individuals through an 18-day self-experiment to test if an intervention they choose (e.g., meditation, gratitude journaling) improves their own psychological well-being (e.g., stress, happiness), whether it fits in their routine, and whether they enjoy it.
The purpose of this work was to conduct a formative evaluation of Hack Your Health to examine user burden, adherence, and to evaluate its usefulness in supporting decision-making about a health intervention. A mixed-methods approach was used, and two versions of the tool were tested via two waves of participants (Wave 1, N=20; Wave 2, N=8). Participants completed their self-experiments and provided feedback via follow-up surveys (n=26) and interviews (n=20).
Findings indicated that the tool had high usability and low burden overall. Average survey completion rate was 91%, and compliance to protocol was 72%. Overall, participants found the experience useful to test if their chosen intervention helped them. However, there were discrepancies between participants’ intuition about intervention effect and results from analyses. Participants often relied on intuition/lived experience over results for decision-making. This suggested that the usefulness of Hack Your Health in its current form might be through the structure, accountability, and means for self-reflection it provided rather than the specific experimental design/results. Additionally, situations where performing interventions within a rigorous/restrictive experimental set-up may not be appropriate (e.g., when goal is to assess intervention enjoyment) were uncovered. Plausible design implications include: longer experimental and phase durations, accounting for non-compliance, missingness, and proximal/acute effects, and exploring strategies to complement quantitative data with participants’ lived experiences with interventions to effectively support decision-making. Future work should explore ways to balance scientific rigor with participants’ needs for such decision-making.
One approach to support such personalization is via self-experimentation using single-case designs. ‘Hack Your Health’ is a tool that guides individuals through an 18-day self-experiment to test if an intervention they choose (e.g., meditation, gratitude journaling) improves their own psychological well-being (e.g., stress, happiness), whether it fits in their routine, and whether they enjoy it.
The purpose of this work was to conduct a formative evaluation of Hack Your Health to examine user burden, adherence, and to evaluate its usefulness in supporting decision-making about a health intervention. A mixed-methods approach was used, and two versions of the tool were tested via two waves of participants (Wave 1, N=20; Wave 2, N=8). Participants completed their self-experiments and provided feedback via follow-up surveys (n=26) and interviews (n=20).
Findings indicated that the tool had high usability and low burden overall. Average survey completion rate was 91%, and compliance to protocol was 72%. Overall, participants found the experience useful to test if their chosen intervention helped them. However, there were discrepancies between participants’ intuition about intervention effect and results from analyses. Participants often relied on intuition/lived experience over results for decision-making. This suggested that the usefulness of Hack Your Health in its current form might be through the structure, accountability, and means for self-reflection it provided rather than the specific experimental design/results. Additionally, situations where performing interventions within a rigorous/restrictive experimental set-up may not be appropriate (e.g., when goal is to assess intervention enjoyment) were uncovered. Plausible design implications include: longer experimental and phase durations, accounting for non-compliance, missingness, and proximal/acute effects, and exploring strategies to complement quantitative data with participants’ lived experiences with interventions to effectively support decision-making. Future work should explore ways to balance scientific rigor with participants’ needs for such decision-making.
ContributorsPhatak, Sayali Shekhar (Author) / Buman, Matthew P (Thesis advisor) / Hekler, Eric B. (Committee member) / Huberty, Jennifer L (Committee member) / Johnston, Erik W., 1977- (Committee member) / Swan, Pamela D (Committee member) / Arizona State University (Publisher)
Created2019
Description
The winter holiday period has been highlighted as a major risk period for weight gain due to excess caloric intake in the form of fat and sugar. Furthermore, diets high in fat and sugar have been implicated in the pathogenesis of diabetes and cardiovascular disease. Exercise aids in the prevention of weight/fat gain, and prevents deleterious changes in cardiometabolic function. The objective of this study was to examine the effects of a fat-sugar supplemented diet, with and without two different exercise training protocols, on body composition, glycemic control and other markers of cardiovascular disease in an at-risk population of overweight and obese males. Twenty-seven, healthy overweight/obese (BMI >25 kg/m2) males were fed 2 donuts per day, 6 days/week, for four weeks, while maintaining their current diet. In addition, all subjects were randomized to one of the following conditions: sedentary control, 1,000 kcal/week moderate-intensity continuous training (MICT) (50% of peak oxygen consumption), or 1,000 kcal/week high-intensity interval training (HIIT) (90-95% of peak heart rate). Supervised exercise training was performed 4 days/week on a cycle ergometer. Changes in body weight and composition, endothelial function, arterial stiffness, glycemic control, blood lipids and cardiorespiratory fitness (CRF) were assessed before and after the intervention. Body weight, lean mass and visceral fat increased significantly in HIIT (p<0.05) and were unchanged in MICT. There was a trend for a significant increase in body weight (p=0.07) and lean mass (p=0.11) in control. Glycemic control during the 2-h OGTT improved significantly in MICT and control, with no change in HIIT. Hepatic insulin resistance index (IRI) and 30-min insulin during the OGTT improved significantly after MICT and worsened following control (p=0.03), while HIIT was unchanged. CRF increased significantly in both HIIT and MICT, with no change in control (p<0.001). There were no significant changes in other markers of cardiovascular disease. The addition of a fat-sugar supplement (~14,500 kcal) over a 4-week period was not sufficient to induce deleterious changes in body composition and cardiometabolic health in overweight/obese young males. Exercise training did not afford overweight/obese males additional health benefits, with the exception of improvements in fitness and hepatic IRI.
ContributorsTucker, Wesley Jack (Author) / Gaesser, Glenn A (Thesis advisor) / Angadi, Siddhartha S (Committee member) / Whisner, Corrie M (Committee member) / Buman, Matthew P (Committee member) / Shaibi, Gabriel (Committee member) / Arizona State University (Publisher)
Created2016
Description
Having accurate measurements of sedentary behaviors is important to understand relationships between sedentary behaviors and health outcomes and to evaluate changes in interventions and health promotion programs designed to reduce sedentary behaviors. This dissertation included three projects that examined measurement properties of wearable monitors used to measure sedentary behaviors. Project one examined the validity of three monitors: the ActiGraph GT3X+, activPAL™, and SenseWear 2. None of the monitors were equivalent with the criterion measure of oxygen uptake to estimate the energy cost of sedentary and light-intensity activities. The ActivPAL™ had the best accuracy as compared with the other monitors. In project two, the accuracy of ActiGraph GT3X+and GENEActiv cut-points used to assess sedentary behavior were compared with direct observation during free-living conditions. New vector magnitude cut-points also were developed to classify time spent in sedentary- and stationary behaviors during free-living conditions. The cut-points tested had modest overall accuracy to classify sedentary time as compared to direct observation. New ActiGraph 1-minute vector cut-points increased overall accuracy for classifying sedentary time. Project 3 examined the accuracy of the sedentary sphere by testing various arm elevation- and movement-count configurations using GENEActiv and ActiGraph GT3X+ data obtained during free-living conditions. None of the configurations were equivalent to the criterion measure of direct observation. The best configuration of the GENEActiv was: worn on the dominant wrist at 15 degrees below the horizontal plane with a cut-point <489 for each 15-second interval. The best configuration for the ActiGraph was: worn on the non-dominant wrist at 5° below the horizontal plane with a cut-point of <489 counts for each 15-second interval. Collectively, these findings indicate that the wearable monitors and methods examined in this study are limited in their ability to assess sedentary behaviors and light intensity physical activity. Additional research is needed to further understand the scope and limitations of wearable monitors and methods used to assess sedentary behaviors and light intensity physical activity.
ContributorsFlorez Pregonero, Argemiro Alberto (Author) / Ainsworth, Barbara E (Thesis advisor) / Buman, Matthew P (Committee member) / Hooker, Steven P (Committee member) / Keller, Colleen S (Committee member) / Swan, Pamela (Committee member) / Arizona State University (Publisher)
Created2017
Description
Physical activity is critical for optimal health and has emerged as a viable option to improve sleep. Moderate- and vigorous-intensity physical activity comparisons to improve sleep in non-exercising adults with sleep problems is limited. The purpose was to determine the effects of moderate- or vigorous-intensity exercise on sleep outcomes and peripheral skin temperature compared to a no-exercise control. The exercise intensity preference also was determined.
Eleven women (46.9±7.0 years) not participating in regular exercise and self-reporting insomnia completed a graded maximal exercise test followed by a crossover trial of three randomly assigned conditions separated by a 1-week washout. Participants performed moderate-intensity [MIC, 30 minutes, 65-70% maximum heart rate (HRmax)] or high-intensity (HIT, 20 minutes, 1-minute bouts at 90-95% HRmax alternating with 1-minute active recovery) treadmill walking or a no-exercise control (NEC) on two consecutive weekdays 4-6 hours prior to typical bed time. A dual-function wrist-worn accelerometer/temperature monitor recorded movement and skin temperature from which sleep-onset latency (SOL), sleep maintenance, sleep efficiency, total sleep time (TST), and peripheral skin temperature changes were calculated. Participants self-reported sleep outcomes weekly, enjoyment of exercise the morning after HIT and MIC, and exercise intensity preference upon completing all conditions. Mixed models analysis of variance examined differences between and within conditions controlling for demographic characteristics and habitual physical activity.
HIT resulted in up to a 90-minute TST increase on night four (448 minutes, 95% CI 422.4-474.2) compared to nights one-three. MIC nights three (43.5 minutes, 95% CI 30.4-56.6) and four (42.1 minutes 95% CI 29.0-55.2) showed nearly a 30-minute SOL worsening compared to nights one-two. No other actigraphy-measured sleep parameters differenced within or between conditions. Self-reported sleep outcomes, peripheral skin temperature change, and exercise enjoyment between conditions were similar (p>0.05). More participants preferred lower (n=3) to higher (n=1) intensity activities.
Early evening high-intensity and moderate-intensity exercise had no effect on sleep outcomes compared to a control in non-exercising adults reporting sleep complaints. Sleep benefits from HIT may require exercise on successive days. Participants indicated partiality for lower intensity exercise. More information on timing and mode of physical activity to improve sleep in this population is warranted.
Eleven women (46.9±7.0 years) not participating in regular exercise and self-reporting insomnia completed a graded maximal exercise test followed by a crossover trial of three randomly assigned conditions separated by a 1-week washout. Participants performed moderate-intensity [MIC, 30 minutes, 65-70% maximum heart rate (HRmax)] or high-intensity (HIT, 20 minutes, 1-minute bouts at 90-95% HRmax alternating with 1-minute active recovery) treadmill walking or a no-exercise control (NEC) on two consecutive weekdays 4-6 hours prior to typical bed time. A dual-function wrist-worn accelerometer/temperature monitor recorded movement and skin temperature from which sleep-onset latency (SOL), sleep maintenance, sleep efficiency, total sleep time (TST), and peripheral skin temperature changes were calculated. Participants self-reported sleep outcomes weekly, enjoyment of exercise the morning after HIT and MIC, and exercise intensity preference upon completing all conditions. Mixed models analysis of variance examined differences between and within conditions controlling for demographic characteristics and habitual physical activity.
HIT resulted in up to a 90-minute TST increase on night four (448 minutes, 95% CI 422.4-474.2) compared to nights one-three. MIC nights three (43.5 minutes, 95% CI 30.4-56.6) and four (42.1 minutes 95% CI 29.0-55.2) showed nearly a 30-minute SOL worsening compared to nights one-two. No other actigraphy-measured sleep parameters differenced within or between conditions. Self-reported sleep outcomes, peripheral skin temperature change, and exercise enjoyment between conditions were similar (p>0.05). More participants preferred lower (n=3) to higher (n=1) intensity activities.
Early evening high-intensity and moderate-intensity exercise had no effect on sleep outcomes compared to a control in non-exercising adults reporting sleep complaints. Sleep benefits from HIT may require exercise on successive days. Participants indicated partiality for lower intensity exercise. More information on timing and mode of physical activity to improve sleep in this population is warranted.
ContributorsKurka, Jonathan M (Author) / Ainsworth, Barbara E (Thesis advisor) / Adams, Marc A (Committee member) / Angadi, Siddhartha (Committee member) / Buman, Matthew P (Committee member) / Youngstedt, Shawn D (Committee member) / Arizona State University (Publisher)
Created2016
Description
Purpose: This qualitative research aimed to create a developmentally and gender-appropriate game-based intervention to promote Human Papillomavirus (HPV) vaccination in adolescents. <br/>Background: Ranking as the most common sexually transmitted infection, about 80 million Americans are currently infected by HPV, and it continues to increase with an estimated 14 million new cases yearly. Certain types of HPV have been significantly associated with cervical, vaginal, and vulvar cancers in women; penile cancers in men; and oropharyngeal and anal cancers in both men and women. Despite HPV vaccination being one of the most effective methods in preventing HPV-associated cancers, vaccination rates remain suboptimal in adolescents. Game-based intervention, a novel medium that is popular with adolescents, has been shown to be effective in promoting health behaviors. <br/>Methods: Sample/Sampling. We used purposeful sampling to recruit eight adolescent-parent dyads (N = 16) which represented both sexes (4 boys, 4 girls) and different racial/ethnic groups (White, Black, Latino, Asian American) in the United States. The inclusion criteria for the dyads were: (1) a child aged 11-14 years and his/her parent, and (2) ability to speak, read, write, and understand English. Procedure. After eligible families consented to their participation, semi-structured interviews (each 60-90 minutes long) were conducted with each adolescent-parent dyad in a quiet and private room. Each dyad received $50 to acknowledge their time and effort. Measure. The interview questions consisted of two parts: (a) those related to game design, functioning, and feasibility of implementation; (b) those related to theoretical constructs of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Data analysis. The interviews were audio-recorded with permission and manually transcribed into textual data. Two researchers confirmed the verbatim transcription. We use pre-developed codes to identify each participant’s responses and organize data and develop themes based on the HBM and TPB constructs. After the analysis was completed, three researchers in the team reviewed the results and discussed the discrepancies until a consensus is reached.<br/>Results: The findings suggested that the most common motivating factors for adolescents’ HPV vaccination were its effectiveness, benefits, convenience, affordable cost, reminders via text, and recommendation by a health care provider. Regarding the content included in the HPV game, participants suggested including information about who and when should receive the vaccine, what is HPV and the vaccination, what are the consequences if infected, the side effects of the vaccine, and where to receive the vaccine. The preferred game design elements were: 15 minutes long, stories about fighting or action, option to choose characters/avatars, motivating factors (i.e., rewards such as allowing users to advance levels and receive coins when correctly answering questions), use of a portable electronic device (e.g., tablet) to deliver the education. Participants were open to multiplayer function which assists in a facilitated conversation about HPV and the HPV vaccine. Overall, the participants concluded enthusiasm for an interactive yet engaging game-based intervention to learn about the HPV vaccine with the goal to increase HPV vaccination in adolescents. <br/>Implications: Tailored educational games have the potential to decrease the stigma of HPV and HPV vaccination, increasing communication between the adolescent, parent, and healthcare provider, as well as increase the overall HPV vaccination rate.
ContributorsBeaman, Abigail Marie (Author) / Chen, Angela Chia-Chen (Thesis director) / Amresh, Ashish (Committee member) / Edson College of Nursing and Health Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
Description
The 24-hour day is spent engaging in activities that include light-physical activity (LPA), moderate-vigorous physical activity (MVPA), sedentary time (i.e., sitting/lying/reclining posture with energy expenditure <1.5 METs, while awake), and sleep. These behaviors are mutually exclusive and time spent in one behavior affects the time spent in another. The time among these 24-hour behaviors is also associated with cardiometabolic health outcomes, including adiposity. Assessing specific behavioral contexts and their relationship within the 24-hour day is underdeveloped, this includes recreational sedentary screen time (rSST). rSST is sedentary time with televisions, computers, smartphones, tablets, inactive video games, and its relationship with other 24-hour behaviors is underdeveloped. This dissertation works evaluates the relationship between rSST and 24-hour behaviors, and adiposity in adults. The first study reviewed the existing observational and experimental evidence for rSST and its relationship with 24-hour behaviors by conducting a scoping review. From the 75 experimental and observational studies included, the evidence supported an overall positive association between rSST and non-screen sedentary behavior, an overall negative association between rSST with physical activity, and overall positive and negative associations between rSST with various sleep variables. The second study assessed the daily associations between rSST and 24-hour behaviors and how associations are influenced by age, sex, chronotype, and week- or weekend days. The findings include significant negative associations at between- and within-person levels for rSST with non-screen sedentary time, standing, LPA, MVPA, and sleep that were differentially influenced by age, chronotype, and week- or weekend day. The third study examined reallocating time between rSST and 24-hour behaviors and the associations with adiposity (i.e., body mass index, body fat percentage, and waist circumference). The results showed significant associations of replacing non-screen sedentary time with MVPA for both body fat percentage and waist circumference; and no significant associations between rSST and 24-hour behaviors for body mass index. Overall, this dissertation work provides important insights into the relationships between rSST and 24-hour behaviors and their relation to adiposity. These findings can be used to inform future intervention development targeting multiple behavior changes and improving health outcomes.
ContributorsHasanaj, Kristina (Author) / Buman, Matthew P (Thesis advisor) / Petrov, Megan E (Thesis advisor) / Sears, Dorothy D (Committee member) / Yu, Fang (Committee member) / Keadle, Sarah K (Committee member) / Arizona State University (Publisher)
Created2023