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      Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol

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          Abstract

          Introduction

          The majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with the neighbourhood environment as a mediating pathway. How to develop and implement sustainable and effective interventions focused on adolescent health and well-being in urban vulnerable life situations is a key challenge. This paper describes the protocol of a Youth-centred Participatory Action (YoPA) project aiming to tailor, implement, and evaluate social and physical environmental interventions.

          Methods and analysis

          In diverse urban environments in Denmark, the Netherlands, Nigeria and South Africa, we will engage a dynamic group of 15–20 adolescents (12–19 years) growing up in vulnerable life situations and other key stakeholders (eg, policy makers, urban planners, community leaders) in local co-creation communities. Together with academic researchers and local stakeholders, adolescents will take a leading role in mapping the local system; tailoring; implementing and evaluating interventions during participatory meetings over the course of 3 years. YoPA applies a participatory mixed methods design guided by a novel Systems, User perspectives, Participatory co-creation process, Effects, Reach, Adoption, Implementation and Maintenance framework assessing: (i) the local systems, (ii) user perspectives, (iii) the participatory co-creation process, (iv) effects, (v) reach, (vi) adoption, (vii) implementation and (viii) maintenance of interventions. Through a realist evaluation, YoPA will explore why and how specific outcomes were reached (or not) in each setting (n=800–1000 adolescents in total).

          Ethics and dissemination

          This study received approval from the ethics committees in Denmark, the Netherlands, Nigeria and South Africa and will be disseminated via various collaborative dissemination activities targeting multiple audiences. We will obtain informed consent from all participants. We envision that our YoPA co-creation approach will serve as a guide for participation of adolescents in vulnerable life situations in implementation of health promotion and urban planning in Europe, Africa and globally.

          Trial registration number

          NCT06181162.

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          Most cited references98

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          World Health Organization 2020 guidelines on physical activity and sedentary behaviour

          Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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            Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.

            Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the eff ect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level. For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population. Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9-9·6) of type 2 diabetes, 10% (5·6-14·1) of breast cancer, and 10% (5·7-13·8) of colon cancer. Inactivity causes 9% (range 5·1-12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41-0·95) years. Physical inactivity has a major health eff ect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially. None.
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              Interrupted time series regression for the evaluation of public health interventions: a tutorial

              Abstract Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2024
                21 February 2024
                : 14
                : 2
                : e084657
                Affiliations
                [1 ] departmentPublic and Occupational Health , Ringgold_1209Amsterdam UMC Location VUmc , Amsterdam, The Netherlands
                [2 ] departmentHealth Behaviours and Chronic Diseases , Ringgold_1229Amsterdam Public Health Research Institute , Amsterdam, The Netherlands
                [3 ] departmentCollege of Health Solutions , Ringgold_7864Arizona State University , Phoenix, Arizona, USA
                [4 ] departmentDepartment of Physiotherapy , Ringgold_59199Redeemer's University , Ede, Nigeria
                [5 ] SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa
                [6 ] departmentCIDEFES , Ringgold_70887Universidade Lusófona , Lisboa, Portugal
                [7 ] CIFI2D, Universidade do Porto , Porto, Lisbon
                [8 ] departmentPrograma Nacional para a Promoção da Atividade Física , Ringgold_59032Direcção-Geral da Saúde , Lisboa, Portugal
                [9 ] departmentDepartment of Public Health , Ringgold_37463Institute of Tropical Medicine , Antwerpen, Belgium
                [10 ] departmentDepartment of Sports Science and Clinical Biomechanics , Ringgold_6174University of Southern Denmark , Odense, Denmark
                Author notes
                [Correspondence to ] Professor Mai J.M. Chinapaw; m.chinapaw@ 123456amsterdamumc.nl
                Author information
                http://orcid.org/0000-0001-6259-2441
                http://orcid.org/0000-0001-9878-3530
                http://orcid.org/0000-0002-3737-2911
                http://orcid.org/0000-0002-2885-437X
                http://orcid.org/0000-0001-6508-0599
                http://orcid.org/0000-0003-4734-0283
                http://orcid.org/0000-0003-2074-0359
                http://orcid.org/0000-0003-1407-613X
                http://orcid.org/0000-0002-6558-7610
                http://orcid.org/0000-0002-8764-5631
                Article
                bmjopen-2024-084657
                10.1136/bmjopen-2024-084657
                10882351
                38387985
                c5d5aa75-a228-4dbf-bb60-c5dc7eacf9ce
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 24 January 2024
                : 08 February 2024
                Funding
                Funded by: European Union;
                Award ID: 101095423
                Categories
                Public Health
                1506
                1724
                Protocol
                Custom metadata
                unlocked

                Medicine
                adolescents,community-based participatory research,behavior,health equity
                Medicine
                adolescents, community-based participatory research, behavior, health equity

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