Background Lifestyle risk behaviours typically emerge during adolescence, track into adulthood, and commonly co-occur. Interventions targeting multiple risk behaviours in adolescents have the potential to efficiently improve health outcomes, yet further evidence is required to determine their effect. We reviewed the effectiveness of eHealth school-based interventions targeting multiple lifestyle risk behaviours. Methods In this systematic review and meta-analysis, we searched Ovid MEDLINE, Embase, PsycINFO, and the Cochrane Library databases between Jan 1, 2000, and March 14, 2019, with no language restrictions, for publications on school-based eHealth multiple health behaviour interventions in humans. We also screened the grey literature for unpublished data. Eligible studies were randomised controlled trials of eHealth (internet, computers, tablets, mobile technology, or tele-health) interventions targeting two or more of six behaviours of interest: alcohol use, smoking, diet, physical activity, sedentary behaviour, and sleep. Primary outcomes of interest were the prevention or reduction of unhealthy behaviours, or improvement in healthy behaviours of the six behaviours. Outcomes were summarised in a narrative synthesis and combined using random-effects meta-analysis. This systematic review is registered with PROSPERO, identifier CRD42017072163. Findings Of 10 571 identified records, 22 publications assessing 16 interventions were included, comprising 18 873 students, of whom on average 56•2% were female, with a mean age of 13•41 years (SD 1•52). eHealth schoolbased multiple health behaviour change interventions significantly increased fruit and vegetable intake (standard mean difference 0•11, 95% CI 0•03 to 0•19; p=0•007) and both accelerometer-measured (0•33, 0•05 to 0•61; p=0•02) and self-reported (0•14, 0•05 to 0•23; p=0•003) physical activity, and reduced screen time (-0•09,-0•17 to-0•01; p=0•03) immediately after the intervention; however, these effects were not sustained at follow-up when data were available. No effect was seen for alcohol or smoking, fat or sugar-sweetened beverage or snack consumption. No studies examined sleep or used mobile health interventions. The risk of bias in masking of final outcome assessors and selective outcome reporting was high or unclear across studies and overall we deemd the quality of evidence to be low to very low. Interpretation eHealth school-based interventions addressing multiple lifestyle risk behaviours can be effective in improving physical activity, screen time, and fruit and vegetable intake. However, effects were small and only evident immediately after the intervention. Further high quality, adolescent-informed research is needed to develop eHealth interventions that can modify multiple behaviours and sustain long-term effects.

Findings support the use of enjoyment and behavioral intentions as indicators of sport participation/dropout behavior and may aid the development of interventions aimed at preventing future dropout.

This study explored whether adolescent sports participants' perceptions of the social climate fall into distinct profiles, and whether these profiles are related to enjoyment and intention to continue. A Latent Profile Analysis using 313 Australian sports participants (M age = 13.03 years) revealed four distinct profiles: positive social climate (45.1%), diminished social climate (19.8%), positive coach relationship quality (19.8%), and positive friendship quality (15.3%). Individuals within the positive social climate and the positive coach relationship quality profiles reported relatively higher levels of enjoyment and intention to continue than individuals in the diminished social climate and the positive friendship quality profiles. Indirect path analyses found the social climate profiles were linked with intention to continue through enjoyment. Results highlight the value of investigating multiple dimensions of the social climate and suggest that the coach may be of particular importance in this age group. Findings have implications for understanding youth sports participation and preventing dropout.

1 AbstractThe purpose of this systematic review and meta-analysis was to gather, catalogue, assess and evaluate the available evidence examining implicit beliefs about ability in the sport, physical activity, and physical education contexts. A total of 43 studies were found, of which 39 were subjected to meta analyses. With only 7 experimental studies, the strength of evidence is moderate and the field would benefit from greater experimental work. Overall, incremental beliefs were moderately associated with a small group of theoretically-derived correlates, while entity beliefs were only weakly associated. The field would benefit from expanding these outcomes to include a wider range of pertinent outcomes. Researchers should focus their efforts on systematically exploring the most powerful ways of inducing adaptive implicit beliefs with the aim of providing solutions to significant problems such as preventing dropout from organised sports, improving academic grades in and beyond physical education, and increasing levels of physical activity.Key words: implicit beliefs, self-theories, motivation, incremental beliefs, entity beliefs 2 A Systematic Review and Meta-Analysis of Implicit Theory Research in Sport, Physical Activity, and Physical EducationImplicit beliefs about human traits and abilities over a wide variety of domains have consistently been shown to influence one's cognitions, affect, and behaviours (Burnette, O'Boyle, VanEpps, Pollack, & Finkel, 2013;Dweck, 1999;W. Li & Lee, 2004). Implicit beliefs are unconscious conceptions about the nature of human abilities and they exert a strong influence on motivational frameworks because they provide a schemata through which all achievement-related events are interpreted and responded to (Dweck & Leggett, 1988).There are two basic implicit beliefs: incremental beliefs and entity beliefs. Those who hold an incremental belief regard ability as a malleable and incremental quality that can be trained and developed, while those who hold an entity belief regard ability as a fixed or concrete entity (Dweck, 1999).Research across domains including sports, education, personality, and morality supports the adaptive benefits of incremental beliefs. Such benefits include higher rates of motivation, persistence and effort, a greater preference for learning and challenge, an ability to self-regulate behaviour, and an ability to generate strategies for improvement (Blackwell, Trzesniewski, & Dweck, 2007;Burnette et al., 2013;Chiu, Dweck, Tong, & Fu, 1997;Chiu, Hong, & Dweck, 1997;Dweck & Leggett, 1988;Gunderson et al., 2013;W. Li & Lee, 2004). Furthermore, implicit beliefs are particularly powerful predictors of adaptive or maladaptive responses following a failure or setback (Dweck & Leggett, 1988). As such, implicit beliefs may be important in sports and physical activity contexts where: failures and setback are numerous and occur often; the development of expertise requires effort and persistence over the course of many years; and the core goals of participation often rela...

IntroductionLifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease. These behaviours often emerge during adolescence and co-occur. School-based interventions have the potential to address risk factors prior to the onset of disease, yet few eHealth school-based interventions target multiple behaviours concurrently. This paper describes the protocol of the Health4Life Initiative, an eHealth school-based intervention that concurrently addresses the Big 6 risk behaviours among secondary school students.Methods and analysisA multisite cluster randomised controlled trial will be conducted among year 7 students (11–13 years old) from 72 Australian schools. Stratified block randomisation will be used to assign schools to either the Health4Life intervention or an active control (health education as usual). Health4Life consists of (1) six web-based cartoon modules and accompanying activities delivered during health education (once per week for 6 weeks), and a smartphone application (universal prevention), and (2) additional app content, for students engaging in two or more risk behaviours when they are in years 8 and 9 (selective prevention). Students will complete online self-report questionnaires at baseline, post intervention, and 12, 24 and 36 months after baseline. Primary outcomes are consumption of sugar-sweetened beverages, moderate-to-vigorous physical activity, sleep duration, sedentary recreational screen time and uptake of alcohol and tobacco use.Ethics and disseminationThis study has been approved by the University of Sydney (2018/882), NSW Department of Education (SERAP no. 2019006), University of Queensland (2019000037), Curtin University (HRE2019-0083) and relevant Catholic school committees. Results will be presented to schools and findings disseminated via peer-reviewed journals and scientific conferences. This will be the first evaluation of an eHealth intervention, spanning both universal and selective prevention, to simultaneously target six key lifestyle risk factors among adolescents.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000431123), 18 March 2019.