Paula Mayara Matos Fialho

Background: Childhood overweight and obesity are a growing global public health concern due to their long-term physical and mental health consequences. Digital public health interventions (DPHIs) can help promote healthy behaviors in children and adolescents, and gamification, which uses rewards, challenges, and social interaction, may further increase motivation and sustain engagement with these tools. Aim: This scoping review provides an overview of studies on digital public interventions that used gamification to prevent or reduce overweight and obesity in children and adolescents and assesses their reported effectiveness. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework, two reviewers independently searched OVID MEDLINE ^® and Web of Science for English or German studies from January 2005 until July 2025. Eligible studies targeted children and adolescents (< 18 years), examined the effects of gamification elements in interventions, and reported outcomes related to overweight/obesity. Data were extracted using a structured form and synthesized narratively. Results: Of 249 records, six studies met the inclusion criteria. The studies were conducted across six countries and reported differing study designs, durations, and technologies incorporated in health behavior change interventions. Most interventions (66%) used exercise-based games or apps promoting physical activity; others involved school-based gamified systems or integrated digital ecosystems combining education and behavior tracking. Common gamification elements included points, rewards, leaderboards, and team challenges. Most interventions improved physical activity and engagement, but only one study showed a sustained weight reduction. Motivation and adherence generally declined over time. Conclusions: DPHIs that used gamification can help promote health behaviors, particularly physical activity, in children and adolescents, but evidence for lasting weight reduction is limited. Future interventions should focus on personalization, social engagement, and strategies and evaluate whether these elements can support maintenance of long-term weight reductions.

Zusammenfassung: Hintergrund: Im Rahmen des Smart-City-Projekts „Gesundes Tal“ entwickelt die Stadt Wuppertal eine digitale Plattform zur Stärkung der individuellen Gesundheitskompetenz und eines niederschwelligen Zugangs zu gesundheitsfördernden Angeboten. Hier sollen gesundheitsrelevante Lebensstilfaktoren bei Bürger*innen der Stadt Wuppertal erfasst werden, um diesen passende Angebote zu vermitteln. Methode: Im Rahmen eines partizipativen, iterativen Prozesses wurde ein Vermittlungscoach (mit dem Namen „Rundum gesund“) mit Fragen aus validierten Fragebögen zu Ernährung, Bewegung, Schlaf, Wohlbefinden und soziales Umfeld entwickelt. Nationale und internationale Leitlinien sowie die Abgrenzung zum Medizinprodukt wurden berücksichtigt. Fragen wurden altersdifferenziert ausgewählt, z. T. in einfache Sprache verändert und in einem Komposit-Fragebogen zusammengeführt. Usability-Tests wurden mit unterschiedlichen Zielgruppen durchgeführt. Ergebnisse: Fragen für das Themenfeld Ernährung basieren auf Empfehlungen der Deutschne Gesellschaft für Ernährung (DGE), sie stammen aus den GEDA (Gesundheit in Deutschland aktuell) und DEGS (Studie zur Gesundheit Erwachsener in Deutschland) Studien des Robert Koch Instituts (RKI). Die Themenfelder Bewegung und Schlaf basieren auf Empfehlungen der Weltgesundheitsorganisation (WHO), Fragen stammen aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS-Studie). Im Themenfeld soziales Umfeld werden Erwachsene nach emotionaler sowie praktischer Unterstützung, Kinder und Jugendliche nach sozialer Unterstützung gefragt. Das Themenfeld mentale Gesundheit umfasst Fragen zum mentalen Zustand (SF-12) und Stresserleben, bei Kindern und Jugendlichen zu Mobbingerfahrungen (QBVQ). Ergebnisse der Tests führten zur verbesserten Personalisierung, Integration motivierender Elemente und einem stärkeren lokalen Bezug. Schlussfolgerung: Der entwickelte Vermittlungscoach erlaubt eine ressourcenorientierte Einschätzung gesundheitsförderungsbezogener Bedarfe und unterstützt die Navigation durch relevante, auf der Plattform abgebildete Angebote.

Introduction: Physical inactivity is a persistent public health challenge with 52% of German adults reporting physical activity (PA) levels below the recommendations of the World Health Organization. Interventions promoting PA are essential for reducing non-communicable diseases and associated economic burdens. This study evaluated the awareness and use of "10,000 Steps Duesseldorf," a community-based intervention promoting PA among city district residents. Methods: A controlled intervention study was conducted with 627 participants at baseline (376 intervention, 251 control) and 553 participants after one year (330 intervention, 223 control). The one-year intervention combined community events, digital tools, print materials, and social media outreach. A process evaluation assessed reach, adoption, implementation, and maintenance based on the RE-AIM framework. Results: By the end of the intervention, 500 participants had registered on the intervention website, logging nearly 100 million steps. Ten external organizations organized step count competitions and participants completed 20 challenges. Social media platforms attracted modest engagement. Awareness of intervention materials and events varied, with 62% of participants aware of events, but only 2% attending them. Organizational adoption of the intervention was very low. Overall, only 13% of contacted organizations responded to the survey, of these, only 27% reported that they were familiar with the intervention. Conclusion: The ‘10,000 Steps Duesseldorf’ intervention successfully engaged participants via digital intervention components, but faced challenges engaging organizations located in the intervention city districts. Future interventions might prioritize strategies for broader organizational engagement and enhanced community participation to foster long-term PA behavior changes.

Background: Despite approximately half of the German general population not meeting the physical activity (PA)-guidelines of the World Health Organization with further decreases noted during the pandemic, population-based intervention strategies to tackle this public health problem remain sparse. This study aimed to replicate the successfully delivered “10,000 Steps Ghent” intervention and research trial conducted in Belgium, two research questions were examined: (1) Do individuals located in the city that a complex PA intervention is implemented in (Duesseldorf) engage in more PA compared to individuals located in the control city (Wuppertal) after one year? (2) Is the proportion of those reaching 10,000 steps/day higher in the intervention than in the control city after the intervention? Methods: A nonrandomized controlled intervention trial was conducted among residents of two German cities. The 12-month intervention ‘10,000 Steps Duesseldorf’ was designed as a multicomponent intervention targeting different socioecological levels: at the intrapersonal level, a website allowed participants to self-monitor their steps; at the organizational level, workplaces and community groups were engaged through step count competitions; and at the community and policy levels, a city-wide media campaign to increase awareness regarding PA benefits was rolled out and street signage indicating walking routes were posted in different city district of Duesseldorf. To investigate intervention effects, PA was assessed via pedometers in two representative samples of adults aged 25–75 years from Duesseldorf (intervention) and Wuppertal (control). Measurements were taken at baseline (April 2021-March 2022) and again one year later (May–November 2023) and the same participants recorded their steps over a 7-day period at both time points. Baseline differences in socio-demographic and health-related variables between intervention and control were adjusted for in a propensity score model with matching weights. Results: 627 adults completed baseline and 553 the follow-up assessment (60% female, 60% intervention across both timepoints and cities). The results of the propensity score analyses revealed that intervention participants walked an average of 462 steps per day more (95% confidence interval: -146 to 1070) than controls at follow-up. However, the proportion of residents reaching 10,000 steps/day was comparable between intervention and control (Duesseldorf: 26.4%, Wuppertal: 25.6%) after the intervention (odds ratio 1.04, 95% confidence interval: 0.41 to 2.66). Conclusions: Although the increase in step count detected in our study was promising, further intervention efforts and accompanying research are needed to meet the minimally relevant intervention effect of 1000 steps that was set in the original Ghent study. Trial registration: German Clinical Trials Register DRKS00024873 (Date of registration: April 21st, 2021; URL: https://drks.de/search/de/trial/DRKS00024873 ).

Background: Student life offers many opportunities for personal development; however, this transitional phase often also poses challenges to mental health. Various factors associated with university life, such as academic stress and financial burdens, have been found to exacerbate psychological distress and contribute to increased alcohol and substance use among students. Our aim is to closely examine (i) components of available digital public health interventions (DPHIs), (ii) to evaluate their effectiveness for promoting well-being, health behaviors, and reducing symptoms of mental disorders among university students and (iii) to rate the quality of the evidence identified in this rapid review. Methods: We conducted a rapid review to capture the evidence on DPHIs for university students. We adhered to the methodological criteria recommended by the Cochrane Rapid Reviews Methods Group and PRISMA. The literature search was performed in Ovid MEDLINE to look for articles related to university students, mental well-being, mental health, and DPHIs published between June 2018 - June 2023. The selection was carried out in two steps: Screening of titles and abstracts and screening of full texts. Results: One thousand one hundred thirty-two articles were screened, of which 24 met the inclusion criteria for data extraction. (i) Of the intervention components in the included studies, 18 used web-based platforms, while six used smartphone applications. The interventions were aimed at improving mental health (68%), reducing substance use (28%), promoting physical activity (PA) (36%) and changing eating habits (16%). (ii) 42% of the included studies were able to demonstrate significant effects in the intended direction for mental health, 4% for substance use, 25% for PA and 8% for eating behavior. (iii) The quality assessment revealed that 58% of the studies were classified with ‘some concerns’, indicating moderate bias, while 29% were classified as ‘high risk’, suggesting considerable bias affecting the validity of the results. Conclusion: This rapid review comprehensively summarized intervention components of DPHIs. Further, the findings of this review provide significant insights into the effectiveness of DPHIs targeting mental well-being and health behaviors among university students. The studies included in the analysis demonstrate varying degrees of success across different domains, highlighting both the potential and limitations of DPHIs.

Substance use (SU) and physical activity (PA) among university students changed with the beginning of the COVID-19 pandemic. In this study, we examined factors associated with SU and PA and profiles of these health behaviours in university students in Germany 20 months into the pandemic. A cross-sectional study on student well-being during the COVID 19-pandemic was conducted in October/November 2021 at five German universities. 7203 students completed the web-based survey. Smoking, binge drinking, cannabis use, and moderate and vigorous PA served as outcomes. Twenty months into the pandemic, 17% of students reported smoking, 19% binge drinking and 6% cannabis use at least once during the last week. 13% reported low moderate and 35% low vigorous PA in the last week. Students perceiving studies to be more important than other activities showed lower odds for SU. Depressive symptoms were associated with a higher chance of smoking (OR 1.07; 95%-CI 1.06–1.09 per one unit on the CESD-8-scale) and cannabis use (1.07; 95%-CI 1.04–1.09), low moderate (1.09; 95%-CI 1.07–1.11) and low vigorous (1.06; 95%-CI 1.05–1.07) PA. The ‘health protective behaviour’-profile with high overall PA and low SU was the most common one found. Among other factors, perceiving studying to be less important than other activities and reporting depressive symptoms appear to play a role in reporting risky health behaviours. Prevention programmes should therefore be integrated in the university setting and address mental health issues and health behaviours simultaneously.

BACKGROUND Student life offers many opportunities for personal development; however, this transitional phase often also poses challenges to mental health. Various factors associated with university life, such as academic stress and financial burdens, have been found to exacerbate psycho-logical distress and contribute to increased alcohol and substance use among students. OBJECTIVE Our aim is to closely examine i) components of available digital public health interventions (DPHIs), ii) to evaluate their effectiveness for promoting well-being, health behaviors, and reducing symptoms of mental disorders among university students and iii) to rate the quality of the evidence identified in this rapid review. METHODS We conducted a rapid review to capture the evidence on DPHIs for university students. We adhered to the methodological criteria recommended by the Cochrane Rapid Reviews Meth-ods Group and PRISMA. The literature search was performed in Ovid MEDLINE to look for keywords related to university students, mental well-being, mental health, and DPHIs. Only articles published between June 2018 and June 2023, written in English, and reporting studies with a randomized controlled trial design or observational studies were considered. The selec-tion was carried out in two steps: 1) Screening of titles and abstracts by two independent re-viewers 2) Screening of full texts by three independent reviewers. RESULTS From the 1,134 initially found articles, 1,132 remained for screening after removing duplicates. Of these, 1,098 did not meet the inclusion criteria, leaving 24 articles for data extraction. The studies were conducted between 2018 and 2023 in ten countries. In 16% of the studies, inter-ventions were specifically implemented during the COVID-19 pandemic. All included studies used an experimental design, with 72% of the studies having two intervention arms, and one study having up to eight intervention arms. i) Of the intervention components in the included studies, 18 used web-based platforms, while six used smartphone apps. Interventions were aimed at improving mental health (68%), reducing substance use (28%), promoting physical activity (PA) (36%), and changing dietary and eating habits (16%). ii) 42% of the included studies were able to demonstrate significant effects in the desired direction for mental health, 4% for substance use, 25% for PA, and 8% for eating behavior. iii) The quality assessment revealed that 58% of studies were rated with "some concerns”, indicating moderate bias, while 29% were rated as “high risk”, suggesting considerable bias affecting outcome validity. CONCLUSIONS This rapid review comprehensively summarized intervention components of DPHIs. Further, the findings of this review provide significant insights into the effectiveness of DPHIs targeting mental well-being and health behaviors among university students. The studies included in the analysis demonstrate varying degrees of success across different domains, highlighting both the potential and limitations of DPHIs.

Estimar a prevalência de simultaneidade de atividade física insuficiente (AFI) e consumo excessivo de alimentos ultraprocessados (AUP), bem como verificar a associação entre AFI e hábitos alimentares (alimentos in natura/minimamente processados, ultraprocessados e marcadores de consumo alimentar) em adultos brasileiros. Estudo transversal com dados do inquérito telefônico Vigitel 2018. Foram estudados 51.064 adultos (≥20 anos). AFI abarcou três domínios: lazer, deslocamento, trabalho (<150 minutos/semana). Calcularam-se os escores de alimentos in natura/minimamente processados e AUP (número de subgrupos referidos/dia anterior); ≥5 AUP: consumo excessivo. Foram utilizadas questões sobre a frequência semanal e diária de consumo alimentar. Estimaram-se razões de prevalência (RP) com regressão de Poisson. A simultaneidade de AFI e consumo de AUP foi de 7,0% (IC 95%: 6,50 - 7,55), maior nas mulheres (RP = 1,26; IC 95%: 1,08 - 1,47), nos residentes do Sudeste (RP = 1,23; IC 95%: 1,00 - 1,51) e Sul (RP = 1,50; IC 95%: 1,22 - 1,84), e foi menor nos indivíduos com idade ≥40 anos (40-49: RP = 0,71; IC 95%: 0,56 - 0,88; 50 - 59: RP = 0,46; IC 95%: 0,36 - 0,58; ≥60: RP = 0,45; IC 95%: 0,36 - 0,56) e com plano de saúde (RP = 0,84; IC 95%: 0,72 - 0,99). A AFI associou-se ao menor consumo de alimentos in natura/minimamente processados e ao maior consumo de AUP. Observou-se menor consumo regular (≥5 dias/semana) de hortaliças cruas (RP = 0,82; IC 95%: 0,78 - 0,85), cozidas (RP = 0,88; IC 95%: 0,84 - 0,92), frutas (RP = 0,78; IC 95%: 0,75 - 0,82), suco (RP = 0,93; IC 95%: 0,89 - 0,97), e maior de refrigerante (≥3 dias/semana: RP = 1,17; IC 95%: 1,11 - 1,23) entre os indivíduos com AFI. Estes também apresentaram menor consumo de hortaliças cruas (2 vezes/dia: RP = 0,93; IC 95%: 0,88 - 0,98), frutas (2 vezes/dia: RP = 0,89; IC 95%: 0,85 - 0,94; ≥3 vezes/dia: RP = 0,84; IC 95%: 0,79 - 0,89) e suco (≥2 copos/dia: RP = 0,93; IC 95%: 0,89 - 0,98). Identificou-se associação entre AFI e hábitos alimentares inadequados, os subgrupos mais acometidos por ambos os comportamentos de risco, que devem ser priorizados em estratégias de promoção da saúde e prevenção de agravos.

Background: The World Health Organization recommends 150 minutes of moderate to vigorous physical activity (PA), which translates to approximately 7000 to 10,000 steps per day for adults. In Germany, less than half of the population in this age range meets this recommendation, highlighting the need for population-based intervention approaches for promoting daily PA. Objective: The complex community-based PA intervention “10,000 Steps Ghent,” which was originally developed in Belgium and was shown to be effective for PA promotion, has been adapted for implementation and evaluation in 2 German cities. The original Belgian study is currently being replicated, and we aim to examine the effectiveness of the adapted intervention among adults living in intervention city districts in Duesseldorf when compared with those living in control city districts in Wuppertal, over the course of 1 year. Methods: A controlled intervention trial examining the effects of an intervention addressing multiple levels (eg, individual level: website; organizational level: PA promotion in companies; community level: media campaigns and environmental changes) is being conducted. PA and various secondary outcomes will be assessed in 2 random samples of adults aged 25 to 75 years (n=399 in each city) at baseline and after 1 year. Results: Funding for this study was obtained in March 2020. Recruitment for this study and baseline data collection were conducted from May 2021 to March 2022 (as of March 2022, 626 participants were enrolled in the study). The intervention will be implemented in Duesseldorf for 1 year from April 2022 onward, and follow-up assessments will be conducted, starting in May 2023 (until September 2023). Data analysis will be performed in fall 2023, and the results will be published in spring 2024. Conclusions: To our knowledge, this is the first research project (currently underway in Germany) that is aimed at replicating the effects of a complex intervention for PA promotion that was previously shown to be effective in another European country. Trial Registration: German Clinical Trials Register DRKS00024873; https://tinyurl.com/4c9e8azh

Objectives The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16–24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours. Design Scoping review. Study selection Relevant literature was systematically searched following the methodological framework proposed by Arksey and O’Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered. Data extraction To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment). Results A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible. Conclusions This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited.