abstract: Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. While physical activity can reduce CVD risk, most adults do not engage in adequate physical activity to maintain or improve health. Older adults are less likely to participate in physical activity and experience a greater burden of CVD compared to younger adults. Despite knowledge of motivators and barriers to physical activity, the challenge to reduce cardiovascular risk in the older adult population remains unmet. Older adults face unique and complex barriers to physical activity, including limited social contextual resources and behavioral change processes. Interventions to enhance wellness motivation have demonstrated potential in promoting health behavior change among older adults. The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health. Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2018

abstract: Unintentional falls among community dwelling older adults are a common, serious and potentially preventable public health problem. In the United States, the annual incidence of fall related injuries per 100,000 persons was 4,616 in 2001, rising to 5,252 in 2008. The annual incidence of fall related deaths per 100,000 persons was 29.3 in 2000, rising to 41.86 in 2006. Older adults are particularly vulnerable to falls as they age. Potential consequences include fractures, emergency room, hospital and nursing home admissions, dependence, confusion, immobilization, depression, and death. Significant modifiable fall risk factors include muscle weakness, gait problems, and balance problems. While researchers have demonstrated the positive effects of balance and leg-strengthening physical activities, the majority of older adults do not engage in them, and the rate of falls continues to increase. Older adults participate in regular physical activity and fitness activities less often than younger populations; disparities are greater among those who are poor and living in rural communities. While knowledge about causes, risk factors, and efficacious physical activity to prevent falls has grown exponentially in the last several decades, bridging the gap between research and practice continues to be a challenge. As a strategy to address the gap between research and practice, this feasibility study utilized a tested theory, the wellness motivation theory, to address motivation for behavioral change in combination with instruction for physical activities proven to reduce fall risk. The study sample included rural, community dwelling older adults at risk of falls. The study included an innovative mobile computer to measure physical activity behavior and to augment motivational content of the intervention. Specific aims of this feasibility study were to: (a) examine the acceptability, demand, and implementation of the wellness motivation intervention (WMI) as well as the technology augmenting the WMI; and (b) evaluate the efficacy of the WMI to influence awareness of social contextual resources, behavioral change processes, physical activity, and fall risk. The WMI delivered in combination with proven multicomponent balance and strength activities was feasible and effectively increased motivation for behavioral change (social support from friends, awareness of social contextual resources, behavioral change processes) and physical activity behavior, and decreased fall risk among rural, community-dwelling older adults at risk of falls in this study. This study is the first step in a program of research focusing on enhancing motivation for physical activity that reduces falls and frailty among older adults. / Dissertation/Thesis / Ph.D. Nursing and Healthcare Innovation 2012

Maintaining independence is a primary reason that many older drivers continue to drive. Safety, however, is a growing concern for all older drivers. Numerous studies have noted that many older drivers lack an awareness of their driving abilities and driving safety issues for older adults. Identifying the awareness level of older drivers from a theoretical standpoint is important. The current educational interventions for older drivers show promising results and suggest that educational programs can impact older driver knowledge, self-reported awareness, and behaviours. However, rarely have older drivers with cognitive deficits been included. This research study fills a gap in the current literature regarding the utility of a theoretically-based intervention program to increase older driver awareness, improve attitudes towards driving, and increase behaviours around older driver safety. The purpose of this research study was to develop, pilot, and examine the effectiveness of a novel, theoretically based, in-class education program entitled “Safety Awareness for Elderly Drivers” (SAFE) for older drivers both with and without cognitive impairment. The SAFE education program was based on five relevant models/theories: 1) Driving as an Everyday Competence, 2) Hierarchical Awareness Theory, 3) Toglia & Kirk’s Awareness Model, 4) Theory of Planned Behaviour, and 5) Transtheoretical Model. A convenience sample of 47 current older drivers aged 70 years or older currently contemplating changing their driving behaviours and their passengers were recruited and randomly assigned. Participants in the intervention group received the group education session, while those in the treatment as usual control group received a copy of the Insurance Board of British Columbia’s “Roadsense for Driver’s” handbook. We measured general knowledge, awareness of individual driving abilities, attitudes, intention to change driving behaviours, driving behaviours, and readiness to change before, immediately after the intervention (intervention group only), and at 2-month follow-up. Results indicated that the “Safety Awareness for Elderly Drivers” education program was well received by older drivers. The education program demonstrated immediate impacts, such as increased knowledge of older driver safety issues (general level awareness), increased individual awareness, and some changes in attitude and intentions toward changing driving behaviours. Older drivers with mild cognitive impairment showed similar benefits from the education program. However, the program did not appear to be more effective than the review of a drivers handbook available though ICBC in follow-up, with most follow-up measures being similar to baseline. Implications of this research and further research suggestions for older drivers are discussed.

En France, la question du tabagisme des jeunes demeure un défi majeur pour la santé publique. Si l'influence des pairs peut encourager l'usage du tabac, on constate que l'éducation par les pairs a aussi un potentiel bénéfique pour changer le comportement tabagique des adolescents. En outre, il a été démontré que la Théorie du comportement planifié (TCP) donnait la meilleure prédiction des intentions et du comportement dans plusieurs domaines de la santé. Cependant, la TCP est peu utilisée pour développer des interventions contre le tabac. Dans le programme de P2P, des lycéens professionnels volontaires ont conçu et réalisé leur propre intervention basée sur la TCP (avec l'aide d'éducateurs formés), visant à réduire le tabagisme de leurs camarades. Notre objectif était de mesurer l'impact de la première année de P2P sur une population particulièrement exposée de lycéens professionnels. L'hypothèse principale est que P2P évite l’augmentation de la prévalence du tabagisme quotidien au cours de l'année dans le groupe d'intervention comparativement au groupe de contrôle. / In France, the issue of youth smoking remains a major challenge for public health. If peer pressure may encourage smoking, the peer education also has a positive potential to change smoking behavior of adolescents. In addition, it was demonstrated that the theory of planned behavior (TPB) gave the best prediction of intentions and behaviors in many domains of health. However, the TPB is usually not used to develop interventions against tobacco. In the P2P program, voluntary professional school students have designed and built their own TPB-based intervention (with the help of trained educators), aimed at reducing smoking peers. Our goal was to measure the impact of one year of P2P on a population particularly vulnerable professional students. The main hypothesis is that P2P avoids the increasing of daily smoking during the year in the intervention group compared to the control group