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Adults with intellectual disability (ID) have a higher rate of falls than the general population, and changing health behaviors through exercise program could enhance health and reduce falls in this population. However, the feasibility study of fall prevention based on the theoretical framework for adults with ID has not been explored to date. This study examined the feasibility of a home-based exercise intervention for people with ID living in a residential setting. We provided an 8 week intervention consisting of a training workshop for support workers and sessions for adults with ID devoted to behavior reward, education about fall prevention and exercise, and exercise training. Adults with ID (n = 33) and support workers, including caregivers (n = 3), staff (n = 8), and one administrator, participated in this study. Adults with ID significantly improved physical performance, self-efficacy for activity, fall efficacy, and support from friends and support workers. There were no significant changes in free-living PA. There was no adverse event during the intervention, and the average adherence rate was sufficient. Adults with ID, support workers, and an administrator were satisfied with the program and had the intention to continue the program. The intervention was feasible and perhaps efficacious for adults with ID living in group-homes.

Nudging syftar till vilken aspekt som helst av valarkitektur som förändrar människors beteende på ett positivt vis utan att förbjuda några alternativ eller väsentligt ändra deras ekonomiska incitament. Marknadsföringsstrategin har blivit allt vanligare de senaste åren och förekommer bland företag men även samhället i stort. Syftet med denna studie är att öka förståelsen kring nudging och dess effekt på beteendeförändring hos konsumenter i Sverige och England samt att undersöka om nudging är en effektiv marknadsföringsstrategi inom livsmedelsbranschen. För att undersöka detta har en kvalitativ forskningsstrategi använts. Empirin har samlats in genom semistrukturerade intervjuer av både svenska och brittiska konsumenter men även med hjälp av ett antal experter inom marknadsföring, nudging samt näringspolitik. Teorierna som ligger till grund för denna studie är teorier inom nudging, konsumentbeteende, hälsosam kost och social practice theory. Analysen av teorin och empirin tillsammans visade på flera samband och mönster. Studien har bland annat identifierat att det finns en relativt låg medvetenhet kring nudging hos de brittiska konsumenterna och en ännu lägre kännedom hos de svenska konsumenterna. Däremot visade det sig vara en relativt hög samt förhållandevis jämn upplevd påverkan hos samtliga konsumenter. Majoriteten av alla tillfrågade konsumenter visade sig även vara positivt inställda till att livsmedelsbutiker aktivt försöker påverka konsumenternas köpbeteende och främja ett allt mer hälsosamt köpbeteende. Samtliga experter menade på att nudging är en effektiv marknadsföringsstrategi och anser att utfallet är gynnsamt för både konsumenter samt företagen. Studiens centrala slutsats är att det finns tre faktorer som påverkar konsumenters upplevda påverkan av nudging inom livsmedelsbutiker. Det visade sig först och främst finnas en koppling mellan låg medvetenhet kring nudging och hög upplevd påverkan hos konsumenter. Sedan visade det sig även finnas en koppling mellan i vilken utsträckning livsmedelsbutiker anpassar en hälsosam miljö i butiken och konsumenters upplevda påverkan av nudging. Slutligen visade studien även på en koppling mellan konsumenters inställning till att företag arbetar med nudging och konsumenters upplevda påverkan av nudging. / Nudging refers to any aspect of choice architecture that changes people's behavior in a positive way without forbidding any alternatives or significantly changing their economic incentives. This marketing strategy has become increasingly common in recent years and occurs among companies but also society at large. The purpose of this study is to increase understanding of nudging and its effect on behavioral change in consumers in Sweden and England and to investigate whether nudging is an effective marketing strategy in the food industry. To investigate this, a qualitative approach has been used. The empirical data has been collected through semi-structured interviews of both Swedish and British consumers but also with help of a number of experts in marketing, nudging and business policy. The theories on which this study is based on are theories in nudging, consumer behavior, healthy eating and social practice theory. The analysis of the theory and the empirical data together showed several connections and patterns. Among other things, the study has identified that there is a relatively low awareness of nudging among British consumers and an even lower awareness among Swedish consumers. On the other hand, there turned out to be a relatively high and relatively evenly perceived impact on all consumers. The majority of all consumers surveyed also turned out to be in favor of grocery stores actively trying to influence consumers shopping behavior and promote increasingly healthy shopping behavior. All experts believe that nudging is an effective marketing strategy and believe that the outcome is favorable for both consumers and companies. The central conclusion of the study is that there are three factors that affect consumers perceived impact of nudging in grocery stores. First and foremost, there is a connection between low awareness of nudging and high perceived impact among consumers. Secondly there is a connection between the extent to which grocery stores adapt a healthy environment in the store and consumers perceived impact of nudging. Finally, the study also showed a connection between consumers attitudes towards companies working with nudging and consumers' perceived impact of nudging.

Bakgrund: Hälso- och vårdpersonal har möjlighet att ordinera individualiserad träning(aktivitetsförskrivning) för att öka patienters fysiska aktivitetsnivå. Vid utebliven effekt kanolika tillägg (beteendestöd) testas för att öka följsamheten till behandling. Syfte: Sammanställa all forskning som undersökt effekten av beteendestöd som tillägg tillaktivitetsförskrivning och dess effekt på fysisk aktivitetsnivå jämfört med endastaktivitetsförskrivning. Metod: Systematisk översiktsstudie. Sökningar i medicinska databaserna Pubmed och Cinahl.7 studier inkluderades. Granskningsmallen PEDro användes för att bedöma de inkluderadestudiernas risk för snedvridningar och bedömningen av tillförlitligheten utvärderades med hjälpav “Bedömning tillförlitlighet systematisk översikt”. Resultat: Översiktsstudien visade att beteendestöd som tillägg till aktivitetsförskrivning hadeen signifikant effekt på fysisk aktivitetsnivå i en studie. I sex av sju studier kunde det intepåvisas effekt av beteendestödet. Samtliga artiklar bedömdes enligt PEDro vara av minstmåttlig kvalitet. Värdering av tillförlitlighet till resultaten var låg respektive måttlig, baserat påindelning i motiverande samtal respektive beteendeförändringstekniker. Konklusion: Beteendestöd som tillägg till aktivitetsförskrivning kan inte rekommenderas tillfysiskt inaktiva vuxna. Fler randomiserade studier behövs inom ämnet för utveckla kunskapeninom området. / Background: Healthcare professionals have the option of prescribing individualised exercise(activity prescription) to increase patients' physical activity levels. In the absence of an effect,various supplements (behavioural support) can be tested to increase adherence to treatment. Aim: Compile all research that has investigated the effect of behavioural support as an add-onto activity prescription and its effect on physical activity level compared to activity prescribingalone. Method: Systematic review. Searches in the medical databases Pubmed and Cinahl - 7 studieswere included. The PEDro review template was used to assess the risk of bias of the includedstudies, and the assessment of reliability was evaluated using the "Bedömning tillförlitlighetsystematisk översikt”. Results: The review study showed that behavioural support as an adjunct to activityprescription had a significant effect on physical activity level in one study. In a total of six outof seven studies, behavioral support did not show a significant effect on activity levels.According to PEDro, all articles were assessed to be of at least moderate quality. Evaluation ofthe reliability of the results was low and moderate, based on the division into motivationalinterviewing and behavior. Conclusion: Behavioural support in addition to activity prescription can not be recommended tophysically inactive adults. More randomized studies are needed in the subject to developknowledge in the field.

This study evaluated the efficacy of the Stages of Behavior Change (SBC) Model for use with Hong Kong Chinese. The SBC Model has demonstrated empirical support in a variety of health behaviors and across diverse populations. Further, the SBC has implications for the development of behavior change interventions. The SBC is composed of three components: stages of change, self-efficacy, and decisional balance. The stages of change are used to determine intention and time frames for behavior change. The SBC model applies Bandura's (1977) definition of self-efficacy and Janis and Manns’ (1968, 1977) conflict theory of decision making. The surveys used to measure these components have been validated and are predictive for condom acquisition. Survey data related to HIV/AIDS prevention (condom use) were collected from university students in Hong Kong and the United States. Comparisons were made across cultures (Hong Kong and the United States) and within the two cultural groups. Exploratory factor analyses using Principal Components Analysis revealed a single-factor model for self-efficacy and a 4-factor model for decisional balance (2 factors for advantages and 2 factors for disadvantages) concerning self (1) and others (we). Main effects for culture and staging were found for self-efficacy and the disadvantage component of decisional balance. Main effects for stage were found for advantages with a significant interaction. These data described an increase in self-efficacy across the stages of change for condom use and greater self-efficacy in HK then the US. The hypotheses for this study were supported with the exception of the advantages component of decisional balance within Hong Kong. Post hoc tests found no difference in self-efficacy in sexually active versus sexually non-active subjects in HK and the US and demonstrated differences in sexually active versus sexually non-active subjects in HK for advantages and disadvantages. Results offer support for using this model with Hong Kong Chinese as the data suggest more similarities than differences across two diverse cultures. These results have important implications for understanding behavior change mechanisms in diverse cultural groups and have significance for intervention planning in Hong Kong for AIDS risk reduction. / Ph. D.

Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire; 2) Review the current literature on the availability and effectiveness of mobile phone interventions targeting sugar-sweetened beverage (SSB) consumption; and 3) Use the updated BEVQ-15 to conduct the Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The Healthy Beverage Habits study was an online randomized controlled pilot trial with an 8-week intervention and a 4-week maintenance period delivered through Instagram. The materials were adapted from the in-person SIPsmartER SSB reduction intervention. Data analysis included RM-ANOVAs to test for differences in beverage intake between the Instagram intervention group and the E-mail control group. Results: For the Healthy Beverage Habits trial, no significant between group over time differences were found. However, the Instagram group demonstrated a significant reduction in total beverage kcal (mean difference±SE=-156±48; p=0.049), and increase in total HBI scores (mean difference±SE= 11.9±2.3; p=0.025) from baseline to the end of the maintenance period. No within group differences were demonstrated for the E-mail control group over the intervention or maintenance period. The study retention rate was 38%, with 39 participants initially enrolled and 15 participants completing all study visits through maintenance. Results for the validity and reproducibility of the updated BEVQ-15 and a review of the availability and effectiveness of mobile phone interventions targeting SSB consumption are presented. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions. / Doctor of Philosophy / Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire which estimates habitual average daily intake of 15 beverage categories as well as total sugar-sweetened beverages (SSB) and total beverages. 2) Review the current literature of the availability and effectiveness of mobile phone interventions targeting SSB consumption. 3) Use the updated BEVQ-15 to conduct The Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The updated BEVQ-15 was assessed for agreement between the BEVQ-15 and dietary recalls. Researchers compared beverage intake between two BEVQ-15 administrations. The Healthy Beverage Habits pilot study was an 8-week intervention with a 4-week maintenance period. Data analysis included testing for differences in beverage intake between the Instagram group and the E-mail group. Results: The updated BEVQ-15 demonstrated moderate agreement between the BEVQ-15 and dietary recalls for total SSB intake and total beverage intake. All beverage variables were significantly correlated. For the systematic review, 11 of the 17 studies (65%) were successful in reducing SSB consumption through mobile phone delivery. The successful studies used multiple types of technology. There were no significant differences for any beverage variable between the Instagram and E-mail groups over time. However, for within group changes, Instagram significantly reduced total beverage kcals and improved total HBI score, while the E-mail group did not demonstrate any significant changes. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits pilot trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions.

Since the federal budget for EFNEP is over $66 million, it is crucial to know the effectiveness of program attributes that may bolster its effectiveness. The aim of this study was to determine how effectiveness of Youth EFNEP programs in Virginia is affected by participant, instructional and curriculum attributes for youth enrolled in Healthy Weight for Healthy Kids (HWHK). An ordered probit model was employed to study how these attributes affect dependent variables: Whole Grain, Fruits, Colored Vegetables, MyPlate, and Breathe Hard behavioral scores. The model assessed the probability of a participant having an improved score or improved behavior. Participant Attributes Results: In general, the chosen variables for participant characteristics consistently reduced the probability of participants having an improved behavior score. Instructional Attributes Results: African Americans Program Assistants were consistently associated with negative marginal effects on positive behavioral scores with the exception of the positive Breathe Hard behavioral score. Other PA attributes were not consistently associated with any behavioral models but were heterogeneous in terms of their marginal effects on the positive behavioral scores. Curriculum Attributes results: The curriculum attributes had more positive marginal effects than negative marginal effects across all the five behavioral scores. Attributes that were consistently associated with having a positive marginal effect on behavioral scores were program duration, smart foods lesson, and lesson duration. Other HWHK lessons were not consistent in increasing or reducing the probability of an improved behavior. / Master of Science

The increasing prevalence of overweight and obesity suggests that current policies and interventions have been inadequate to counteract the driving forces. Young adults attending college gain weight at a faster rate than the general population, without evidence of compensatory weight loss. Therefore, college may be an important stage for the primary prevention of obesity. We sought to identify weight gain mediators in college underclassmen using the social cognitive model for health behavior change. Eligible students living on-campus to underwent assessments of height, weight, waist circumference, blood pressure, body composition, cardiorespiratory fitness, habitual physical activity and dietary intake, and psychosocial determinants of health behavior change. We conducted elicitation interviews and focus group discussions to identify themes related to the diet and physical activity habits, attitudes, social norms, and experiences of the target population. Results found that students were generally physically fit and enjoyed a variety of physical activities, yet spent considerable amounts of time in sedentary activity and had difficulty exercising regularly. Healthy eating perceptions were instilled by parents; however, families are much less influential in college, and students almost always eat with friends. Healthy eating and exercise habits were secondary to several other responsibilities. Skills in planning, goal setting, and self-monitoring are necessary to overcome the social and environmental forces contributing to weight gain. These results will be used to develop a social cognitive theory-based intervention to improve health behaviors, and consequently prevent weight gain in young adults attending college. / Master of Science

This study used the Health Belief Model to examine the effects of viewing valenced levels of consequences of sexual decision found in prime time television programs. When exposed to portrayals of negative consequences, participants had higher levels of perceived severity than those in the positive condition. After viewing positive portrayals, participants perceived an increased amount of benefits of behavior modification when compared to those who were exposed to the negative portrayals. In addition, multiple correlations were found between several individual-level variables that were tested for in the study and the HBM constructs. Theoretical implications and practical implications are discussed. / Master of Arts

Human disturbance is a significant threat to shorebirds in North America. Disturbance can result in direct mortality or have long-term impacts on the survival of shorebirds. Land managers employ a variety of management techniques to minimize anthropogenic impacts on shorebirds, but because the Atlantic Flyway is ecologically and recreationally diverse, management can vary among sites. This thesis used social science methods to understand the extent to which human disturbance is managed and how human disturbance is managed. Specifically, we surveyed land managers and biologists in the U.S. and Canada portions of the Atlantic Flyway to examine potential disturbances, types of activities that are restricted, when restrictions occur, the perceived effectiveness of management techniques, public compliance with restrictions, and resource needs of managers. With the findings from this research, agencies and organizations that manage shorebirds can assess where to invest time, effort, and resources to reduce disturbance. We also used a survey of dog walkers to ascertain the benefits and constraints to leashing dogs near shorebirds because dog walking is one of the top-rated potential disturbances to shorebirds. Additionally, we sought to understand the personal and social norms related to dog walking and evaluated if a community-based social marketing (CBSM) approach would be enhanced by the addition of norms. Using a CBSM approach, we provided insights on strategies to promote voluntarily leashing of dogs near shorebirds. Through this thesis, we aimed to bridge the needs of people and the needs of shorebirds, in an effort to produce effective conservation outcomes. / Master of Science / Shorebird populations have declined in the past four decades. Declines are due in part to human use of coastal areas, which can result in harm to shorebirds. To reduce human impacts on shorebirds and help land managers make decisions about management, this thesis used social science methods. Using a survey of managers, we found that management primarily occurs during the spring and summer and is less frequently during the fall and winter. Of the human activities that could disturb shorebirds, walking dogs off leash is the most commonly regulated. But people are also least commonly compliant with these regulations. Managers believe that the best ways to reduce disturbance to shorebirds included fencing, informal outreach, and signage. More staff and volunteers are also needed to help reduce disturbance. In a subsequent survey of dog walkers, we learned why people leash (or do not leash) dogs near shorebirds. We found that people leash to protect shorebirds, keep dogs safe, control dogs, and keep dogs from bothering people. People choose not to leash because leashing prevents dogs from exercising and socializing, and people believe dogs respond to commands. People who leash dogs generally believe others expect them to leash their dogs near shorebirds. Knowing why people leash or do not leash can help predict leashing behavior and encourage dog walkers to voluntarily leash dogs near shorebirds. This thesis considers the needs of people and the needs of shorebirds as way to achieve effective conservation solutions.