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Sapre M, Elaiho CR, Brar Prayaga R, Prayaga R, Constable J, Vangeepuram N. The Development of a Text Messaging Platform to Enhance a Youth Diabetes Prevention Program: Observational Process Study. JMIR Form Res 2024; 8:e45561. [PMID: 38809599 PMCID: PMC11170040 DOI: 10.2196/45561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. OBJECTIVE We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. METHODS The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. RESULTS Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: "interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective." CONCLUSIONS We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities.
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Affiliation(s)
- Manali Sapre
- New York University Langone, New York, NY, United States
| | - Cordelia R Elaiho
- Medical College of Wisconsin, Milwaukee, WI, United States
- Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Ram Prayaga
- mPulse Mobile, Los Angeles, CA, United States
| | - Jeremy Constable
- Community Action Board, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nita Vangeepuram
- Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Li Y, Xie H, Liu B, Elaiho C, Vangeepuram N. Sex Differences in Diet and Physical Activity Behaviors Among Racial/Ethnic Minority Adolescents with High Metabolic Risk. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01880-3. [PMID: 38135863 PMCID: PMC11213532 DOI: 10.1007/s40615-023-01880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Certain dietary and physical activity (PA) behaviors may differentially predispose male and female adolescents to obesity and diabetes; however, sex differences in dietary and PA behaviors and in factors that impact these behaviors (e.g., self-efficacy, social support) in this population remain unknown. Using data from a community-based adolescent diabetes prevention intervention conducted in East Harlem in New York City, we examined sex differences in baseline characteristics including clinical measurements, lifestyle behaviors, and behavioral determinants. Among 147 overweight/obese adolescents aged 13-19 years, 61.9% were girls, 69.7% were of Hispanic ethnicity, 24.8% were non-Hispanic Black, and 60.5% were diagnosed with prediabetes. Boys had higher metabolic risk scores than girls (3.8 vs. 3.3, p = 0.002) despite girls reporting more perceived barriers to healthy eating and PA. Boys reported doing more moderate to vigorous PA but also had more sedentary behaviors than girls. Boys reported higher self-efficacy and more peer support for PA. Girls reported more depressive symptoms and were more likely to compare their body images to those in magazines/social media. Overall, among a sample of urban adolescents with high metabolic risk, we found significant sex differences in many dietary and PA behaviors and related factors, which could be used to inform tailored strategies for weight management to reduce cardiometabolic risk among youth from similar high-risk populations.
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Affiliation(s)
- Yannan Li
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hui Xie
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Nita Vangeepuram
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Institute for Health Equity Research and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Islam S, Elaiho C, Arniella G, Rivera S, Vangeepuram N. A Pilot Study to Examine the Feasibility and Acceptability of a Virtual Adaptation of an In-Person Adolescent Diabetes Prevention Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912286. [PMID: 36231588 PMCID: PMC9564467 DOI: 10.3390/ijerph191912286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 05/24/2023]
Abstract
BACKGROUND Rates of prediabetes and type 2 diabetes are alarmingly high among racial/ethnic minority youth. The current study examines the virtual adaptation of an in-person peer-led youth diabetes prevention program. METHODS The initial phase involved the study team adapting workshop sessions from an in-person to a virtual format (Zoom). We conducted a 2-h feasibility pilot in December 2020 and implemented the full 12 session pilot program from June to September 2021 with 14 prediabetic adolescents recruited from our hospital-based general pediatric clinic. Weekly sessions were led by trained peer educators and focused on promoting healthy eating and physical activity using behavioral techniques (e.g., goal setting, brainstorming, and problem solving). RESULTS The virtual adaptation of our program was shown to be feasible and acceptable among our pilot participants. We were able to deliver the same workshop content and behavioral skills development as the in-person workshop using a variety of Zoom features. CONCLUSIONS Our peer-led youth diabetes prevention program was successfully adapted and implemented in a virtual format and was well accepted by at-risk youth. Future research is needed to examine the impact of virtual youth lifestyle interventions on behavioral and clinical outcomes such as weight and diabetes risk.
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Affiliation(s)
- Sumaiya Islam
- School of Medicine, City University of New York (CUNY), New York, NY 10031, USA
| | - Cordelia Elaiho
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Guedy Arniella
- Institute for Family Health, New York, NY 10035, USA
- Teen HEED Community Action Board, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sheydgi Rivera
- Teen HEED Community Action Board, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Mandoh M, Redfern J, Mihrshahi S, Cheng HL, Phongsavan P, Partridge SR. Shifting From Tokenism to Meaningful Adolescent Participation in Research for Obesity Prevention: A Systematic Scoping Review. Front Public Health 2022; 9:789535. [PMID: 35004591 PMCID: PMC8734426 DOI: 10.3389/fpubh.2021.789535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Traditionally, adolescent participation in research has been tokenistic. Adolescents are rarely afforded the opportunity to influence decision-making in research designed to prevent obesity. Engaging adolescents in meaningful decision-making may enhance research translation. This review aimed to analyze the current modes and nature of adolescent participation in obesity prevention research decision-making. Methods: A systematic scoping review was conducted using Arksey and O'Malley's six-stage framework. Six major databases were searched for peer-reviewed primary research studies with adolescent participation related to obesity, physical activity, and diet. Modes of adolescent participation were categorized based on the Lansdown-UNICEF conceptual framework for measuring outcomes of adolescent participation. The framework outlines three modes of meaningful participation: (i) consultative, which involves taking opinions and needs into consideration; (ii) collaborative, where adolescents are partners in the decision-making process; and (iii) adolescent-led participation where adolescents have the capacity to influence the process and outcomes. The degree of involvement in research cycles was classified based on the National Health and Medical Research Council consumer engagement framework. Five stages of the research cycle were determined: identify, design and develop, conduct, analyze and disseminate. Results: In total, 126 papers describing 71 unique studies were identified. Of these, 69% (49/71) took place in the USA, and 85% (52/61) were conducted in minority or underserved communities, while males were more likely to be under-represented. In 49% (35/71) of studies, participation was consultative and 9% (6/71) of studies involved an adolescent-led approach. Furthermore, 87% (62/71) of studies incorporated adolescent participation in one or more of the research cycle's formative phases, which involve eliciting views, opinions and idea generation. Only 11% of studies engaged adolescents in all five stages of the research cycle where adolescents could have more influence over the research process. Conclusion: Meaningful adolescent participation in the obesity prevention research cycle is limited. Empowering and mobilizing equal partnership with adolescents should be at the forefront of all adolescent-related obesity prevention research.
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Affiliation(s)
- Mariam Mandoh
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, The University of New South Wales, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Hoi Lun Cheng
- Sydney Medical School, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Academic Department of Adolescent Medicine, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephanie R Partridge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Pike JM, Moore CM, Yazel LG, Lynch DO, Haberlin-Pittz KM, Wiehe SE, Hannon TS. Diabetes Prevention in Adolescents: Co-design Study Using Human-Centered Design Methodologies. J Particip Med 2021; 13:e18245. [PMID: 33625364 PMCID: PMC7946580 DOI: 10.2196/18245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/28/2020] [Accepted: 01/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The rise in pediatric obesity and its accompanying condition, type 2 diabetes (T2D), is a serious public health concern. T2D in adolescents is associated with poor health outcomes and decreased life expectancy. Effective diabetes prevention strategies for high-risk adolescents and their families are urgently needed. OBJECTIVE The aim of this study was to co-design a diabetes prevention program for adolescents by using human-centered design methodologies. METHODS We partnered with at-risk adolescents, parents, and professionals with expertise in diabetes prevention or those working with adolescents to conduct a series of human-centered design research sessions to co-design a diabetes prevention intervention for youth and their families. In order to do so, we needed to (1) better understand environmental factors that inhibit/promote recommended lifestyle changes to decrease T2D risk, (2) elucidate desired program characteristics, and (3) explore improved activation in diabetes prevention programs. RESULTS Financial resources, limited access to healthy foods, safe places for physical activity, and competing priorities pose barriers to adopting lifestyle changes. Adolescents and their parents desire interactive, hands-on learning experiences that incorporate a sense of fun, play, and community in diabetes prevention programs. CONCLUSIONS The findings of this study highlight important insights of 3 specific stakeholder groups regarding diabetes prevention and lifestyle changes. The findings of this study demonstrate that, with appropriate methods and facilitation, adolescents, parents, and professionals can be empowered to co-design diabetes prevention programs.
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Affiliation(s)
- Julie M Pike
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney M Moore
- Research Jam, Indiana Clinical and Translational Sciences Institute Patient Engagement Core, Indiana University, Indianapolis, IN, United States
| | - Lisa G Yazel
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dustin O Lynch
- Research Jam, Indiana Clinical and Translational Sciences Institute Patient Engagement Core, Indiana University, Indianapolis, IN, United States
| | - Kathryn M Haberlin-Pittz
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sarah E Wiehe
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Research Jam, Indiana Clinical and Translational Sciences Institute Patient Engagement Core, Indiana University, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tamara S Hannon
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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Vangeepuram N, Angeles J, Lopez-Belin P, Arniella G, Horowitz CR. Youth Peer Led Lifestyle Modification Interventions: A Narrative Literature Review. EVALUATION AND PROGRAM PLANNING 2020; 83:101871. [PMID: 33032025 DOI: 10.1016/j.evalprogplan.2020.101871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/16/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
The prevalence of obesity remains high among school age children and continues to rise among adolescents in the United States. One strategy to address this challenge is to use peer rather than professional leaders to run weight management programs. Youth peer-led lifestyle interventions have become increasingly common over the last few decades, but there is a lack of review and synthesis of these programs. The purpose of this manuscript was to critically review and synthesize results and lessons learned from evaluated youth peer-led lifestyle modification and weight management programs. We searched the PubMed/MEDLINE database to identify articles published between March 2002 and December 2015. We identified 29 interventions including children from kindergarten to 12th grade from different settings and racial/ethnic and economic backgrounds. We first summarized descriptive information about the interventions and then compared outcomes based on intervention type, peer leader characteristics and training, and other related factors. Our review indicated that youth peer-led interventions of varying structure and content can result in positive changes in behavioral influences, diet, physical activity, body measures and other clinical outcomes. We used information from our analysis to formulate recommendations for design of future youth peer-led lifestyle interventions.
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Affiliation(s)
- Nita Vangeepuram
- Departments of Pediatrics and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1202A, New York, NY, 10029, United States.
| | - Jesenia Angeles
- Departments of Pediatrics and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY 10029, United States.
| | - Patricia Lopez-Belin
- TEEN HEED Community Action Board, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place Box 1077, New York, NY 10029, United States.
| | - Guedy Arniella
- Institute for Family Health, 1824 Madison Ave, New York, NY, 10035, United States.
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1077, New York, NY, 10029, United States.
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