Adolescents and young adults with asthma and allergies: Physical activity,self-efficacy,social support,and subsequent psychosocial outcomes

Objective: To examine the relationships between self-efficacy (SE) and social support (SS) for physical activity (PA), weekly moderate to vigorous PA (MVPA), and depression and anxiety in young adults (YAs) with asthma and allergies. Methods: Participants were 611 YAs (age M = 19.56 ± 3.28). YAs completed measures of SE for PA, SS for PA, depression, anxiety, and weekly MVPA. Results: The hypothesized model demonstrated close fit to the data and was not adversely affected by pruning non-significant paths, χ² (457, n = 611) = 1085.31, p < 0.01, RMSEA = 0.05, CFI = 0.95, NNFI = 0.95. The final model supported the hypothesized relationships between MVPA and exercise-related SE, as well as SS for exercise from friends. Interestingly, MVPA was negatively associated with SS from parents. SE for exercise significantly predicted SS from family and friends. SS from friends was a significant mediator of the relationship between SE and MVPA. The relationship between MVPA and anxiety and depression was unsubstantiated. Conclusions: In this population, exercise-related SE and SS from friends were associated with higher rates of MVPA. Techniques aimed at boosting exercise confidence and involving friends in exercise routines may increase MVPA in YAs with asthma and allergies.     

Lutein and zeaxanthin status and auditory thresholds in a sample of young healthy adults

Objectives: Dietary carotenoids lutein (L) and zeaxanthin (Z) have been linked to improved visual and cognitive function. These effects are thought to be mediated by the presence of these pigments in critical regions of the retina and brain. There, it has been postulated that L and Z mediate improved performance by enhancing neural efficiency. The auditory system also relies on efficient segregating of signals and noise and LZ are also found in the auditory cortex. The purpose of the present study was to investigate the influence of LZ status (as assessed by the measuring levels in retina) on auditory thresholds in young non-smokers (N = 32, M = 20.72 ± 3.28 years).

Design: LZ status was determined by measuring macular pigment (MP) optical density using a standardized psychophysical technique (customized heterochromatic flicker photometry). Auditory thresholds were assessed with puretone thresholds and puretone auditory thresholds in white noise.

Results: MP density was related to many, but not all, of the puretone thresholds we tested: 250 Hz (F(6,32) = 4.36, P < 0.01), 500 Hz (F(6,32) = 2.25, P < 0.05), 1000 Hz (F(6,32) = 3.22, P < 0.05), and 6000 Hz (F(6,32) = 2.56, P < 0.05).

Conclusion: The overall pattern of results is consistent with a role for L and Z in maintaining optimal auditory function.     

Consequences associated with the use of psychoactive substances among female adolescents placed in residential care: the role of sexual exploitation

ABSTRACT

Sexual exploitation is a major burden among female adolescents placed in residential care centers. Moreover, problematic psychoactive substance use is a concern because of its prevalence and various associated consequences. However, little is known about the consequences resulting specifically from the use of psychoactive substances among sexually exploited female adolescents. This study explored the association between sexual exploitation and the various consequences associated with substance use among adolescent female (15.3–17.1 years old) living in Quebec’s residential care centers during 2008–2009. To better understand this association, 83 sexually exploited female adolescents and 66 non-sexually exploited female adolescents responded to self-reported questionnaires. As expected, even controlling for age of onset and frequency of substance use, an ANCOVA showed that sexually exploited female adolescents experience more consequences associated with their use of psychoactive substances (F (4, 148) = 24.79, p <.001, d = 0.83). The associations between sexual exploitation and the consequences of psychoactive substance use were particularly strong for risk-taking (OR = 7.99; p <.001) and delinquency (OR = 4.27; p <.001). Such results highlight the importance of not dissociating the use of psychoactive substances from sexual exploitation when working with female adolescents in rehabilitation centers.     

Perceptions of Food Advertising and Association With Consumption of Energy-Dense Nutrient-Poor Foods Among Adolescents in the United States: Results From a National Survey

The advertising and marketing of energy-dense, nutrient-poor (EDNP) food and drink has been cited as one contributor to unhealthy eating behaviors in adolescents. The present study examines perceptions about and trust in food advertising and their association with consumption of EDNP foods and drinks among adolescents in the United States. Data (n = 1,384) come from the U.S. National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating Survey. One way ANOVAs were conducted to assess differences between population subgroups in advertising perceptions. Bivariate and multivariable linear regression models were used to examine the associations between perceptions toward and trust in food advertising and consumption of EDNP foods and drinks, controlling for sociodemographic factors. Results show that there are significant differences between racial/ethnic groups on advertising perceptions (F = 16.32, p = < .0001). As positive perceptions toward food advertising increase among adolescents, there is an associated increase in daily frequency of consumption of EDNP foods and drinks (β = 0.10, p < .01). Similarly, the more adolescents agreed that they trusted food advertising, the higher the reported daily frequency of EDNP food and drink consumption (β = 0.08, p = .01). Targeting perceptions about food advertising may be a worthy intervention strategy to reduce the impact of food marketing and the consumption of heavily advertised EDNP foods and drinks among adolescents.     

Effects of Program Exposure and Engagement With Tailored Prevention Communication on Sun Protection by Young Adolescents

Few family-based interventions to increase sun safe behavior among adolescents have been evaluated. The present study tested an intervention that included tailored and nontailored print communications delivered by mail to adolescents (age 11 to 15) and their parents who were also participating in an evaluation of an in-school intervention. The use of sunscreen, protective clothing, and avoidance of the sun were promoted, and family communication and environmental change strategies were fostered. Adolescents and their parents were pretested in May of 2002 and posttested from August to October. Adolescents (N = 599) were stratified on experimental condition in the in-school study (in-school intervention vs control) and randomly were assigned from within strata to receive (N = 288) or not receive (N = 311) the summer intervention materials. No statistically significant effects were found for adolescents between the randomized experimental conditions. Parents' had increased knowledge (F = 5.52, p < .05) and propensity to have their child wear sunglasses (F = 4.07, p < .05). Greater program exposure/engagement led to enhanced sun protection behavior (e.g., fewer sunburns) and psychosocial factors among adolescents and parents. Greater exposure/engagement led to improvements in family interaction and home environment (e.g., shade audit completed). Future research is needed on exposure/engagement with family-based health messaging and on family-based sun safety programs for adolescents.     

Anhedonia is associated with poor health status and more somatic and cognitive symptoms in patients with coronary artery disease

Purpose

The effectiveness of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD) is moderated by negative emotions and clinical factors, but no studies evaluated the role of positive emotions. This study examined whether anhedonia (i.e. the lack of positive affect) moderated the effectiveness of CR on health status and somatic and cognitive symptoms.

Methods

CAD patients (n = 368) filled out the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at the start of CR, and the Short-Form Health Survey (SF-36) and the Health Complaints Scale (HCS) at the start of CR and at 3 months to assess health status and somatic and cognitive symptoms, respectively.

Results

Adjusting for clinical and demographic factors, health status improved significantly during the follow-up (F(1,357) = 10.84, P = .001). Anhedonic patients reported poorer health status compared with non-anhedonic patients, with anhedonia exerting a stable effect over time (F(1,358) = 34.80, P < .001). Somatic and cognitive symptoms decreased over time (F(1,358) = 3.85, P = .05). Anhedonics experienced more benefits in terms of somatic and cognitive symptoms over time (F(1,358) = 13.00, P < .001).

Conclusion

Anhedonic patients reported poorer health status and higher levels of somatic and cognitive symptoms prior to and after CR. Somatic and cognitive symptoms differed as a function of anhedonia over time, but health status did not. Anhedonia might provide a new avenue for secondary prevention in CAD.     

Using Online Computer Tailoring to Promote Physical Activity: A Randomized Trial of Text,Video, and Combined Intervention Delivery Modes

Website-delivered interventions are increasingly used to deliver physical activity interventions, yet problems with engagement and retention result in reduced effectiveness. Hence, alternative modes of online intervention delivery need to be explored. Therefore, this study aimed to evaluate the acceptability and effectiveness of a computer-tailored physical activity intervention delivered on the Internet in 3 delivery modes: video, text, or both. Australian adults (N = 803), recruited through e-mail, were randomized into the three delivery modes and received personal physical activity advice. Intervention content was identical across groups. Repeated measures analyses of variance were used to compare the three groups regarding acceptability, website usability, and physical activity. Participants in the video group accepted the content of the physical activity advice significantly better (F = 5.59; p < .01), and spent significantly more time on the website (F = 21.19; p < .001) compared with the text and combination groups. Total physical activity improved significantly over time in all groups (F = 3.95; p < .01). Although the combination group increased physical activity the most, few significant differences between groups were observed. Providing video-tailored feedback has advantages over the conventional text-tailored interventions; however, this study revealed few behavioral differences. More studies, examining alternative delivery modes, that can overcome the limitations of the present study, are needed.     

Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind,randomized controlled trial

Objective

To evaluate the effect of 8-week moderate intensity aerobic (heart-rate reserve 40–60 %) exercise on neuropathy quality of life in type 2 diabetes.

Methods

A single blind, parallel-group, randomized controlled trial was carried out in a tertiary setting. People with type 2 diabetes were eligible for the study if they had clinical neuropathy which was defined by a minimum score of seven on the Michigan diabetic neuropathy score. Following which, the patients were randomly assigned to an 8-week program by a computer-generated random number tables to intervention or control group. Repeated measure analysis of variance was used for data analysis (p < 0.05 was considered significant).

Results

There were 47 participants in the control group and 40 participants in the study group after randomization but 37 from the control group and 29 from the intervention group completed the final analysis. The two groups had a significant difference, pre–post intervention in scores of pain (F = 7, p = 0.01), sensory symptoms (F = 4.60, p = 0.04), restricted activities of daily living (F = 4.97, p = 0.03), disruptions in social relationships (F = 5.43, p = 0.02), specific impact on quality of life (F = 9.28, p < 0.001) overall quality of life (F = 28.72, p < 0.001), and total score (F = 31.10, p < 0.001). Degrees of freedom for all the components were 1, 62.

Conclusion

Moderate intensity aerobic exercise is cornerstone in improving the quality of life of individuals with peripheral neuropathy in type 2 diabetes.     

Systematic viewing in radiology: seeing more,missing less?

To prevent radiologists from overlooking lesions, radiology textbooks recommend “systematic viewing,” a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = ?.10, p = .62, and coverage and performance, r = ?.06, p = .74. Experts were significantly more systematic than students F _2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = ?.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F _2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.     

A Theory-Based Newsletter Nutrition Education Program Reduces Nutritional Risk and Improves Dietary Intake for Congregate Meal Participants

At-risk older adults need community-based nutrition programs that improve nutritional status and practices. This 6-month study assessed the impact of the traditional Chef Charles (CC) program (Control) compared to a theory-based CC program (Treatment) on nutritional risk (NR), dietary intakes, self-efficacy (SE), food security (FS), and program satisfaction for congregate meal participants. Participants were mostly educated, single, “food secure” White females. NR change for the treatment group was significantly higher (P = 0.042) than the control group. No differences were noted for SE or FS change and program satisfaction between groups. The overall distribution classification levels of FS changed significantly (P &#60; .001) from pre to post. Over half (n = 46, 76.7%) reported making dietary changes and the majority (n = 52, 86.7%) rated CC as good to excellent. Results suggest the theory-based CC program (treatment) is more effective in reducing NR and dietary practices than the traditional CC program (control).     

Association between mobile phone use and depressed mood in Japanese adolescents: a cross-sectional study

Objectives

Mobile phones are commonly used by adolescents. The aim of this study was to clarify associations between duration of mobile phone use and psychological mood in high school students.

Methods

This cross-sectional study included 2,785 high school students in Niigata, Japan. A self-administered questionnaire was used to elicit information on sex, school year, hours of mobile phone use, psychological mood status, and possible confounders. Psychological mood outcomes were evaluated with the Mood Inventory, developed and validated in 1994, which includes five subcomponents with total scores ranging from 8 to 32 (higher score indicates stronger feeling): “Tension and excitement,” “Refreshing mood,” “Fatigue,” “Depressed mood,” and “Anxious mood.” Analysis of covariance with Bonferroni’s multiple comparison was used to compare mean values among quartiles of hours of mobile phone use.

Results

Among the respondents, mean mobile phone use per week was 24 (median 18) h. Long-duration mobile phone use was associated with female students, no participation in sports club activities, early mobile phone use, and fewer hours spent sleeping (all P < 0.001). Overall associations between hours of mobile phone use and total scores were significant for “Depressed mood” (P for trend = 0.005), “Tension and excitement” (P for trend <0.001), and “Fatigue” (P for trend < 0.001). Total scores for “Depressed mood,” “Tension and excitement,” and “Fatigue” of the fourth quartile (≥33 h/week) of mobile phone use were significantly higher than for other quartiles (all P < 0.05).

Conclusions

Increased duration of mobile phone use is associated with unfavorable psychological mood, in particular, a depressed mood. Decreasing mobile phone use may help maintain appropriate mental health in very long-duration users.     

Caffeine ingestion, affect and perceived exertion during prolonged cycling

Caffeine's metabolic and performance effects have been widely reported. However, caffeine's effects on affective states during prolonged exercise are unknown. Therefore, this was examined in the present study. Following an overnight fast and in a randomised, double-blind, counterbalanced design, twelve endurance trained male cyclists performed 90 min of exercise at 70% VO_{2 max} 1 h after ingesting 6 mg kg⁻¹BM of caffeine (CAF) or placebo (PLA). Dimensions of affect and perceived exertion were assessed at regular intervals. During exercise, pleasure ratings were better maintained (F_(3,38) = 4.99, P < 0.05) in the CAF trial compared to the PLA trial with significantly higher ratings at 15, 30 and 75 min (all P < 0.05). Perceived exertion increased (F_(3,28) = 19.86, P < 0.01) throughout exercise and values, overall, were significantly lower (F_(1,11) = 9.26, P < 0.05) in the CAF trial compared to the PLA trial. Perceived arousal was elevated during exercise but did not differ between trials. Overall, the results suggest that a moderate dose of CAF ingested 1 h prior to exercise maintains a more positive subjective experience during prolonged cycling. This observation may partially explain caffeine's ergogenic effects.     

Health Related Quality of Life in a Rural Area with Low Racial/Ethnic Density

The purpose of this study was to compare the self-reported quality of life of racial/ethnic minorities and Caucasians living in a rural, northern New York county, where 94% of the population is Caucasian. Participants completed a 79-item survey online and in-person assessing health status, health-related quality of life, perceptions of health information, and health care access/use. Frequencies, Chi-Square, and ANOVA were used to analyze the results. A total of 1,039 surveys were completed. Racial/ethnic minorities earned significantly less income, F (1, 1031) = 29.306, P = .000, relied more on public health insurance, X ² (7, 1033) = 47.827, P = .000, were significantly less likely to see a doctor because of the cost, F(1,990) = 17.042, P = .000, and reported using health-related services significantly less often when compared to Caucasians, F(1, 1032) = 17.051, P = .000. In terms of quality of life, while there were no significant differences in self-reported physical health, racial/ethnic minorities were more likely to feel sad/blue/depressed, F(1, 1031) = 7.193, P = .011 and worried/tense/anxious, F(1, 1031) = 5.550, P = .040. Findings from this study offer some initial evidence that, while perceived health status is generally good, rural racial/ethnic minorities residing in predominantly Caucasian rural areas may experience more mental health problems that are risk factors for chronic diseases. This coupled with lower use of health care services increases the need for culturally competent health programs and services for this population.     

Acute mood and cardiovascular responses to moderate intensity vinyasa yoga,static yin yoga and aerobic exercise in people with depression and/or anxiety disorders: A 5-arm randomised controlled trial

IntroductionDue to the multi-composite, mind-body features of yoga, it is of interest to determine what effect exercise plays as a component of modern yoga in providing psychological and physiological health benefits, and whether benefits are enhanced with a combination of components. Furthermore, although the effects of regular, long-term yoga practice are well documented, the acute effects have received less empirical investigation.MethodA within-subjects, repeated measures randomised controlled crossover trial with five conditions was conducted (trial registration: ACTRN12620000983909). Participants (N = 41, mean age = 32 years) with Depressive and/or Anxiety Disorders completed 1) yin yoga, 2) aerobic exercise, 3) vinyasa yoga, 4) stretching (sham) control and 5) no-intervention control. Acute changes in mood and cardiovascular tone were assessed.ResultsA significant main effect of condition on mood was observed (N = 38; F_4,127.193 = 7.507, p = <.001). Participants receiving yin, vinyasa, aerobic exercise and stretching achieved comparable improvements in mood symptoms compared to no-intervention control. Cardiovascular changes were observed for aerobic exercise and vinyasa yoga. No adverse events were reported.ConclusionsThe acute mood benefits of a single initial session of yoga are not significantly greater than those derived from other forms of movement. Moderate-intensity styles of yoga can provide a sufficient and equivalent acute cardiovascular exercise effect to that of traditional exercise options (i.e., cycling).     

Nutritional Status and Related Factors in Elderly Nursing Home Residents: Comparative Cross-Sectional Study in Migrants and Native Germans

Former guest workers in Germany who stayed on after retirement are now older than 70 years. Nursing homes (NH) are broadening their offer to meet specific requirements of this population. The nutritional status and related problems of the older ethnic minority group living in German NH has so far not been investigated. The aim of this study was, thus, to compare the nutritional situation of older migrants to that of native residents in two “multicultural” NH (cross-sectional study). All residents 65 years and older with a migration background were enrolled and compared to nonmigrants using frequency matching for age and gender. Nutritional status was assessed using body mass index (BMI; cut-off for undernourishment: BMI < 22 kg/m²) and calf circumference (CC; CC < 31 cm). Care staff completed a questionnaire on residents' health. Consecutive 3-day food records were evaluated to analyze the intake of energy, macro-, and micronutrients.

Participants were n = 23 migrants (76 ± 6 years, 52% female) and n = 37 nonmigrants (78 ± 7 years, 59% female). Undernourishment was more prevalent in migrants according to BMI (39 vs. 11%; P < 0.05) and CC (57 vs. 22%; P < 0.05). Main nutritional problems in both groups were “loss of appetite” (56 vs. 19%; P < 0.05) and “refusal to eat” (56 vs. 25%; P < 0.05). Energy intake was low (6.4 ± 1.4, 6.8 ± 1.6 MJ/d). More than 50% of participants fell below recommended values for vitamin C, B₁, B₆, D, folate, calcium, and iron; 61% of the migrants had a low vitamin B₁₂ intake. Migrant NH residents were more often undernourished than German NH residents.     

Physical activity and quality of life among university students: exploring self-efficacy,self-esteem,and affect as potential mediators

Purpose

Physical activity (PA) has been shown to enhance quality of life (QOL) in older adults. Findings from these studies indicate that the relationship between PA and QOL is indirect and likely mediated by variables such as physical self-esteem, exercise self-efficacy, and affect. As PA varies greatly by age, the purpose of the current study is to extend this area of research to young adults and explore the complex relationship between PA and QOL in this target population.

Methods

Data were collected via anonymous questionnaire from N = 590 undergraduate students. PA was assessed with the Godin Leisure Time Exercise Questionnaire, and QOL was assessed by the Satisfaction with Life Scale. Path analysis was used to test the relationship between PA and QOL, with mediators of exercise self-efficacy, physical self-esteem, and affect.

Results

The PA model (RMSEA = .03, CFI = .99) accounted for 25 % of the variance in QOL. PA had positive direct effects on exercise self-efficacy (β = .28, P < .001), physical self-esteem (β = .10, P < .001), positive affect (β = .10, P < .05), and negative affect (β = .08, P < .05). Physical self-esteem was found to be the most powerful mediating variable on QOL (β = .30, P < .001), followed by positive affect (β = .27, P < .001) and negative affect (β = .14, P < .001).

Conclusion

Physical self-esteem and, to a lesser extent, positive affect emerged as integral components in the link between PA and QOL. Findings suggest that health education programs designed to promote regular PA and increase physical self-esteem may be effective in improving QOL in young adults.     

Sex Differences in the Association of Perceived Ambiguity,Cancer Fatalism,and Health-Related Self-Efficacy with Fruit and Vegetable Consumption

Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < ?0.31, ps <.001, than women, bs < ?0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.     

An Experimental Test of the Two-Dimensional Theory of Cultural Sensitivity in Health Communication

Based on a theoretical framework describing culturally sensitive (CS) health communication, this experiment tested the relative contributions of surface structure and deep structure in the recall of oral health information from pamphlets varied in written message and images. Using a 2 × 2 factorial design, Spanish-speaking Mexican heritage mothers of children under six (n = 160) were randomly assigned to read one of four 12-page pamphlets containing the same oral health information in Spanish: (1) standard written message/standard images; (2) standard written message/CS images; (3) CS written message/standard images; and (4) CS written message/CS images. Participants completed a 22-item oral health knowledge questionnaire before and after reading the pamphlet. Controlling for the effects of pretest scores, acculturation, and educational level on information recall, findings showed significant positive main effects for CS images (F(1, 152) = 5.03, p = .026, partial ?² = .032) and CS written message (F(1, 152) = 5.21, p = .024, partial ?² = .033). There was no interaction. These results support the two dimensions of CS and their independent effects. They should be applicable to a variety of health communication channels. Further research is needed to investigate the causal mechanism behind the observed effects.     

Differential Programming Needs of College Students Preferring Web-Based Versus In-Person Physical Activity Programs

College students report several barriers to exercise, highlighting a need for university-based programs that address these challenges. In contrast to in-person interventions, several web-based programs have been developed to enhance program engagement by increasing ease of access and lowering the necessary level of commitment to participate. Unfortunately, web-based programs continue to struggle with engagement and less-than-ideal outcomes. One explanation for this discrepancy is that different intervention modalities may attract students with distinctive activity patterns, motivators, barriers, and program needs. However, no studies have formally evaluated intervention modality preference (e.g., web-based or in-person) among college students. The current study sought to examine the relationship between intervention modality preference and physical activity programming needs. Undergraduate students (n = 157) enrolled in psychology courses at an urban university were asked to complete an online survey regarding current activity patterns and physical activity program preferences. Participants preferring web-based physical activity programs exercised less (p = .05), were less confident in their abilities to exercise (p = .01), were less likely to endorse the maintenance stage of change (p < .01) and perceived more barriers to exercising (p < .01) than those who preferred in-person programming. Findings suggest that students preferring web-based programming may require programs that enhance self-efficacy by fostering goal-setting and problem-solving skills. A user-centered design approach may enhance the engagement (and therefore effectiveness) of physical activity promotion programs for college students.