Intervention Planning for Adolescents and Sedentary Behaviour/Physical Activity in Australia

Part 1: Population, Health Behaviour, and Underlying Reasons for the Behaviour

Physical activity encompasses any bodily movement involving the rigorous use of skeletal muscles and a consequent increase in energy consumption above the basal level (Van, Paw, Twisk & Van, 2007). Physical activities include cycling, jogging, or active participation in sports like swimming or football. Sedentary behaviour is any behaviour characterized by the minimalistic expenditure of energy due to increased sitting, reclining or lying posture (Van et al., 2007). In the contemporary world, ordinary sedentary lifestyle activities involve the time spent viewing TVs, video gaming, using computers, driving or reading.

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According to research, there is an undeniable association between physical activity, sedentary lifestyles and the quality of health and general life among children and adolescents (Ortega, Ruiz, Castillo & Sjostrom, 2008). Regular physical exertions and minimal sedentary behaviour contribute to a high quality of life across all life stages. Concerning health, more movement and less sitting have a direct relationship with physical, as well as the psychological well-being. Also, even the overweight and obese persons who engage in physical activities have a lower mortality risk than people with normal weight and sedentary lifestyles (Ortega et al., 2008). Physical inactivity, in conjunction with sedentary behaviour, is associable with increased global mortality due to non-communicable diseases such as cardiovascular diseases and obesity. Thus, physical activities are recognized as significant factors in primordial and primary prevention strategies for non-communicable illnesses (Solar & Irwin, 2010). This is because these behaviours have a direct cause-effect relationship with the prevalence of chronic disease conditions, metabolic disorders and mental illnesses at all stages of life.

Systematic reviews and primary studies reveal that an estimated 50% of young Australians aged 12 to 21 lack a consistent, vigorous physical activity routine (Scully, Dixon, White & Beckmann, 2016). Physical inactivity is characterised by less than 300 minutes weekly, of moderate and vigorous involvement in physical activity (Scully et al., 2016). Notably, this trend is attributable to a repertoire of conditions. First, there is a general reduction in seriousness and time allocation for physical education in schools. Curriculum implementation in schools tends to favor excellence in other subjects over physical education. Second, technological advancement provides readily available inactive pursuits: video games, television programs, and computers. Such gadgets have resulted in diminishing interest in energy-sapping activities. Moreover, there is an observable increase in adults' preference for driving and use of lifts, which causes a lack of motivation among the youth to engage in physical activity. This availability of inactive options and a lack of social motivation has led most youths to embrace inactivity and sedentary behaviours. This is because they believe it is 'cool.' Finally, rapid real estate development takes up playing fields, thus limiting space for exercise. Additionally, the commercialisation of gyms and physical exercise facilities results in inaccessibility of these facilities for adolescents. Understanding the connection between physical activity and sedentary behaviour among adolescents is central to the formulation of intervention plans and delivery, as well as the wider health implications of these behaviours. This paper seeks to present for consideration, a systematic discussion on these health behaviours and the underlying reasons for the behaviours among adolescents. An exposition on the social norms approach framework used to plan the health intervention follows. Finally, there is the detailed explanation of the evidence-based intervention itself.

Part 2: Social Norms Approach Framework Used to Plan the Intervention

"Social Norms" is a theoretical framework envisaging an evidence-based strategy to deal with health issues that affect a particular population (Berkowitz, 2005). For instance, social norms interventions have registered unmatched success in addressing alcohol use and cigarette smoking, curbing driving under the influence, encouraging the use of seat belts and preventing sexual harassment among college and high school students. The framework seeks to understand how environmental and interpersonal influences influence the adoption of new behaviours (Nolan, Schultz, Cialdini, Goldstein & Griskevicius, 2008). Notably, there is the emphasis on understanding the impact of peer influence on personal decisions and individual behaviour. Consequently, the theoretical framework is highly applicable when handling issues among adolescents and the youth. This is because of the significance of peer influences and normative ideals among young social groups (Nolan et al., 2008). According to Berkowitz (2005), adolescents are more interested in conforming to the perceived norms (typical or standard perceptions in their group). As a result, the actual norms (factual information) tends to be ignored, thus creating a gap between perceptive and actual norms - the misconception. Such misconceptions constitute 'cool' behaviour in the group and necessitate the application of social norms theory.

This theoretical framework posits that adolescent behaviour is directed by misperceptions of the thoughts, opinion, and actions shared by peers. Thibaut (2017), suggests that the probability of an adolescent to involve themselves in risky behaviour is down to the maturational gap created by the reconstitution of their brain's socio-economic reward system, and the progressively gradual process of strengthening their neurocognitive system. Thus, as the cognitive control ability increases with biological maturation, teenagers grow into the capacity to coordinate cognition and to exercise self-regulation even in emotionally arousing situations (Thibaut, 2017). Late adolescence is characterised by a greater ability to resist peer pressure. However, early adolescence involves an uncontrolled response to peer-generated stimuli. Such stimuli sensitise the reward system to engage in risky behaviour since peers form the primary environmental influence in adolescence. For instance, a certain teenager confesses that "it is true, friends accept you more if you're, like, a conformist or something that unquestionably acts for the team. If there's a sign forbidding you from doing something and you disregard it in front of them, they all like that. However, it matters only if your friends are with you since there's no fun doing it when alone," (Maxwell, 2002). In short, there is a direct relationship between the appeal of risky behaviour among peers and their likelihood to engage in it. Moreover, dedicating efforts to correct the misconceptions is crucial to effecting behaviour change and influence the adoption of the desired behaviour (Maxwell, 2002). Notably, social approach is successful because adolescents possess the information, values, and processing efficiency to assess risky decisions.

In applying this framework, the intervention program involves portraying the dangers of physical inactivity and increasingly sedentary lifestyle. To achieve this, there is increased sensitisation about the health risks associated with the behaviors. Consequently, efforts are geared towards underestimation of the misconception, as a way of minimizing interest in it as a form of group identity.

Part 3: 'Let's Skip It' - A School-based Multilevel Intervention to Increase Physical Activity and Reduce Sedentary among Adolescents

The 'Let's Skip It' health intervention program is a theoretical framework and evidence-based interactive intervention for school-going adolescents. This program encompasses various elements to increase individual inherent motivation for physical activity and enhanced self-determination with regards to physical activity and sedentary lifestyles. Notably, self-driven desire and independence from group mentalities with regards to engaging in physical activity (PA) promotes efforts to initiate and maintain regular schedules for PA while reducing sedentary behaviour (SB). The intervention components were designed to appeal to the adolescents with significantly low levels of motivation, and low to medium involvement in PA. Notably, the general decline in engaging in physical exertions and increased sedentarism among adolescents is attributed to the lack of information aimed at countering the appeal of easily accessible inactive alternatives to PA as the 'cool' norm for this age group (Morton, Atkin, Corder, Suhrcke & Sluijs, 2016). The 'Let's Skip It' program primary objective is to improve the effectiveness and adherence to a school-based multi-level intervention, using minimalistic day-to-day activities. Thus, students are encouraged to 'skip' the lift, screen time, gaming time, bus or the video call in favor of physical movement and expenditure of calories. Moreover, other stakeholders are encouraged to 'skip' the large margins of profits in favor of promoting PA among adolescents in whichever way. The adoption of the program is based on the assumption that it is effective in providing a bottom-up impetus to make all PA sessions vigorous, especially among adolescents with minimalistic basal levels, as well as decreasing SB. This is because of the carefully chosen methods of delivering information, coupled with the innovative ways to facilitate the adolescents' involvement ensure effectiveness.

The 'Let's Skip It' initiative aims to achieve an increment in gross PA by applying different techniques. Firstly, there is the need for increasing low/moderate level PA to vigorous PA among those with little or no desire for PA. Second, there is the approach to encourage dropping of activities that promote sedentary behaviours. Finally, there is an emphasis on the efforts to adopt schedules that incorporate regular interruptions from SB periods in classrooms. The applicability of these components lies in the intensive preliminary collation of information regarding the specific characteristics and defining features or behaviours of adolescents. The initiative is designed for those reporting minimalistic involvement in intensively energy-consuming activities, due to lack of motivation or conviction.

The design process sought to enhance inclusivity by involving the youth who report low levels PA due to demotivation and peer involvement in other inactive leisure activities in the development of the program. This approach creates a greater appeal for Let's Skip It because the teenagers have a perceived sense of control and determination. Reneging some of the control to teenagers optimizes participation by minimising defiance to the detested thought-of control (Morton et al., 2016). In addition to inclusivity in designing, the program is delivered universally for all students. Universality helps to minimise the risks associated with generating a feeling that the program is discriminative or has a group-targeting mentality (Maxwell, 2002). Moreover, rolling out the program for all eradicate the risks associated with inequalities in accessing the intervention.

Additionally, the design enhances the adaptability of this initiative to the prevailing day-to-day activities among adolescents. Therefore, it fits seamlessly into the school curriculum. Moreover, the ability to incorporate them into the inactive pursuits, albeit with varying degree of involvement promotes acceptability.

The program involves various components aimed at ensu...