The Association of Racism and Discrimination in Disparities of Hypertensive Disorders of Pregnancy in the United States: An Analysis of PRAMS Data

BACKGROUND

Hypertensive disorders of pregnancy are a leading cause of maternal mortality. Racial disparities in maternal outcomes such as maternal mortality in the United States (US) are well-documented, but the relationship of racism and/or discrimination with one's risk of developing a hypertension during pregnancy (HDP) is not well-studied.

METHODS

Data from 17 sites that asked questions regarding experiences with racism and/or discrimination during pregnancy via the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2020) was used. Logistic regression models were used compare the potential of stress induced HDP from perceived experiences of racism and/or discrimination versus the effect of systemic racism and/or discrimination (in healthcare settings and generally) on racial disparities in HDP diagnosis.

RESULTS

Among 9,907 live births, 18% of participants reported they were diagnosed with hypertension during pregnancy, with non-Hispanic Black individuals having the highest rate (21.8%). Regarding experiences of racism and/or discrimination, 76.4% of participants responded "yes", with all races/ethnicities studied here except non-Hispanic White individuals responding "yes" at rates higher than 89%. Perceived experiences of racism and/or discrimination did not statistically significantly affect one's odds of being diagnosed with HDP (OR = 0.94, CI: 0.74, 1.20). The disparity in odds of having hypertension during pregnancy between Non-Hispanic Black individuals and non-Hispanic White individuals was not statistically significant when perceived experiences of racism and/or discrimination were included in the model.

CONCLUSIONS

Experiences of racism and/or discrimination drive racial disparities in hypertensive disorders in pregnancy.

PUBLIC HEALTH IMPLICATIONS

It is vital to eliminate racist and discriminatory practices and behaviors to reduce maternal morbidity and mortality.

Improvements in stress among Latinas participating in a randomized controlled trial of technology-supported physical activity interventions

High levels of stress and inactivity likely contribute to chronic disease disparities among Latinas in the U.S. and call for intervention. To inform such efforts, the current study examined the relationships among changes (over time) in physical activity, stress, and related cardiometabolic biomarkers among sedentary (mostly) first generation Latinas. Data are taken from a randomized controlled trial (N = 199 Latinas) of two home-based physical activity interventions (Original vs. theory- and technology- Enhanced versions). Physical activity and perceived stress were assessed at baseline and 6 and 12 months. Blood draws occurred at baseline and 6 months in a random subsample (N = 153). The participants were underactive (<60/min week of moderate-to-vigorous physical activity) Mexican American (89%) women with moderate perceived stress scores (M = 21.49, SD = 8.55, range = 0-40) and excess weight (M BMI = 30.6) at baseline. Overall, participants reported decreases in stress after 6 months enroled in the physical activity programs. The odds of a reduction in perceived stress were 11% higher among Enhanced versus Original Intervention participants (OR = 1.11, 95% CI: 1.05-2.27). Those who met physical activity guidelines were significantly more likely to report reductions in perceived stress over 6 months (OR = 1.92, 95% CI: 1.08-4.16). Furthermore, those who reported reductions in perceived stress over 6 months reported significantly more moderate-to-vigorous physical activity at 12 months (+69 min/week, SE = 27.98, p = 0.01) compared to those who did not. Greater reductions in perceived stress over 6 months were associated with greater improvements in cardiometabolic biomarkers (HbA1c, triglycerides, p's < 0.05). These results support a bidirectional relationship between improvements in stress and physical activity among Latinas. Future implications include using physical activity to address stress management and health disparities in this community.

The Sleep Environment, Napping, and Sleep Outcomes among Urban Children With and Without Asthma

OBJECTIVES

Children with asthma living in U.S. urban neighborhoods experience increased risk for asthma morbidity and poor sleep outcomes. In addition to asthma, environmental factors (e.g. noise, uncomfortable temperature, light exposure) related to urban poverty may disturb children's sleep. This study examined the association between environmental factors and sleep outcomes among urban children with and without asthma, and whether napping underlies the environment-sleep link. Additionally, the study tested whether these associations differed by health status (i.e. asthma) or race/ethnicity.

METHOD

Participants included urban children aged 7-9 years with (N = 251) and without (N = 130) asthma from Latino, Black, or non-Latino White (NLW) background. Caregivers reported sleep environmental factors and naps. Sleep duration, efficiency, and nightly awakenings were assessed via actigraphy.

RESULTS

Regardless of health status, frequent exposure to noise and light was associated with poorer sleep outcomes only among Latino children. In the full sample with and without asthma, noise exposure during nighttime sleep was related to more frequent daytime naps, which were linked to shorter nighttime sleep duration.

CONCLUSIONS

Exposure to noise and light may play a particularly influential role in shaping urban children's sleep outcomes. Racial/ethnic differences and the potential mediating role of napping in this environment-sleep association may inform tailored interventions.

The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men

BACKGROUND

Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men.

OBJECTIVE

This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis.

METHODS

We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message-based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months.

RESULTS

The 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety.

CONCLUSIONS

The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/23690.

Testing an insurance-based monetary incentive program for exercise: RCT design and rationale

Participation in regular physical activity (PA) has numerous health benefits; however, as few as 10% of U.S. adults meet guidelines when device-based assessments of PA are used. The present paper presents the design and rationale for an RCT examining the efficacy of an exercise incentive program currently offered by at least three major US insurance companies, in which participants must attend a YMCA fitness facility at least 50 times within 6 months to receive an incentive. In a factorial design, incentive amount ($200, $100, $0) is crossed with a comparison of the standard gain-framed incentive program and a loss-framed incentive condition in which participants are told their membership fee is being held and will be returned or forfeited depending on their fitness facility attendance. Participants (N = 330) are randomized to gain-framed $100 incentive (n = 55), gain-framed $200 incentive (n = 55), loss-framed $100 incentive (n = 55), loss-framed $200 incentive (n = 55), or control (n = 110). Each participant is enrolled in the same condition for two consecutive 6-month periods for a total of 12 months per participant. The primary outcome is number of visits to the fitness facility over each 6-month period, verified by objective swipe-card data. Secondary outcomes include total moderate-to-vigorous PA (MVPA) over 7-day periods assessed at 3-month intervals through accelerometers (Actigraph wGT3x-BT) and self-report. Habit formation and anticipated regret are putative mediators and household income is a putative moderator of the incentive-based programs. A payer-perspective, within-trial cost-utility analysis will quantify the incremental costs per (a) quality-adjusted life year gained, (b) YMCA attendance, and (c) change in MVPA.

Subgroup Analyses of Girl2Girl, a Text Messaging-Based Teen Pregnancy Prevention Program for Sexual Minority Girls: Results from a National RCT

This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14-18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed "healthy lifestyle" topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a "latent" period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, (f2 = .12), sexual identity (f2 < .14), and sexual experience (f2 = .11) on rates of condom use and use of other contraception. Although there were no significant moderating effects on pregnancy, abstinence, or intentions to use condoms, use birth control, or be abstinent, (p's > .16), patterns of effects were in the same direction as for significant findings. For example, at 9-month post-intervention, among those who identified as bisexual, the incidence rate of protected sex events was 39% higher for intervention vs. control (IRR = 1.39, 95% CI: 1.06-2.70), adjusting for baseline rate of condom use and sexual experience. Similarly, at 12 months, among bisexual participants, intervention participants had a significantly higher IRR of condom-protected sexual events (IRR = 2.65, 95% CI: 1.31-5.34). There were also higher odds of uptake of birth control use other than condoms for intervention vs. control at 6- (OR = 1.10, 95% CI: 1.01-1.77), 9 m (OR = 1.11, 95% CI: 1.07-1.89), and 12-month (OR = 1.13, 95% CI: 1.07-1.78) follow-up. Girl2Girl appears to be particularly effective for older adolescents, bisexual girls, and those who have already had penile-vaginal sex. No one single approach is going to affect teen pregnancy. Instead, it is more likely that different intervention content and delivery methods will be more accessible and salient to some but not other youth. Understanding for whom the intervention works is just as important as understanding for whom the intervention does not, as this can inform opportunities for future intervention development.Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962.

Greater engagement in valued activities is associated with less barriers to quitting smoking among smokers with mobility impairments

BACKGROUND

Individuals with mobility impairments (MI; use equipment to ambulate) have a high prevalence of both smoking and depression. Behavioral activation (BA) purports that depressed mood is remediated through valued activity engagement and may facilitate smoking cessation in MI populations.

OBJECTIVE

We examined cross-sectional associations between activity engagement and variables important for smoking cessation among a high-risk group of smokers (people with MIs) and also describe a smoking cessation intervention based on BA, given the lack of studies on smokers with MIs.

METHODS

This study used data from a smoking cessation trial enrolling smokers with MIs (n = 263). We assessed valued activities, activity type, activity restriction due to MI, and replacement of restricted activities. Motivation and confidence to quit smoking, number of cigarettes per day, and mood were also assessed. Analysis was performed with generalized linear (or logistic) regression models adjusted for age and physical functioning using aggregated data at baseline.

RESULTS

Greater number and frequency of valued activities was associated with less smoking, depression, negative affect, and stress and higher positive affect and self-efficacy to quit. Activity restriction was associated with greater odds of major depression, and activity replacement with lower odds of major depression, lower stress, and higher positive affect and self-efficacy. Strength of associations varied by activity type.

CONCLUSIONS

Consistent with our theoretical model, BA activity constructs were associated with several mediators of smoking outcomes in the expected directions. Smokers engaging in valued activities have more favorable profiles for smoking cessation and mood management.

Family asthma management and physical activity among urban children

INTRODUCTION

Urban, low-income, and Black and Latino children with asthma experience higher morbidity and poorer outcomes compared to their suburban, higher-income, and non-Latino White counterparts. This risk is further compounded by higher rates of co-occurring overweight or obesity. Physical activity contributes to both asthma and overweight/obesity status, however, little is known about factors that may promote/limit physical activity among youth from low-income, urban, and racial/ethnic backgrounds. This study evaluates associations between asthma management behaviors and physical activity among a sample of racially/ethnically diverse youth with asthma of both healthy weight and overweight/obesity status.

METHOD

147 children with asthma (Mage = 8.3; 50% overweight/obese status, 58% Hispanic/Latino, and 26% Black) and their families completed the Family Asthma Management System Scale (FAMSS; McQuaid et al., 2005) between 2013 and 2015. Physical activity was measured with waist-worn accelerometers. Differences in FAMSS scores by physical activity levels and associations between FAMSS scores and physical activity for the total sample and by race/ethnicity and weight status were evaluated.

RESULTS

Children who met recommended physical activity guidelines had higher FAMSS "medication adherence", t(89) = -2.04, p < .05, and "collaboration with health care provider", t(89) = -2.09, p < .05. More optimal "environmental control" related to lower levels of physical activity (β = -.21, p < .05) while more optimal "medication adherence" was associated with higher levels of physical activity (β = .21, p < .05). Differences in these associations were identified by race/ethnicity, though not weight status.

CONCLUSIONS

Asthma management behaviors were associated with physical activity, with notable differences by race/ethnicity. Tailored interventions simultaneously addressing multiple health behaviors may be warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The moderating effects of alcohol use on the association between sexual orientation and HIV testing: results from the 2013-2018 National Health Interview Study

Routine screening and testing for HIV are recommended for all adolescents and adults. However, only one-third of the U.S. population has been tested for HIV. Women, sexual minorities, and people who use alcohol are more likely to be tested for HIV, but less is known about how alcohol use and sexual orientation impact the likelihood of HIV testing synergistically. Examining both alcohol use and sexual orientation is especially relevant, because sexual minorities are at increased risk for alcohol use, including heavy drinking. This study tested an alcohol x sexual orientation interaction effect on HIV testing through logistic regression modeling with a nationally representative sample. Results of the significant interaction identify demographic groups that are particularly at-risk for not being tested for HIV. These groups include lesbian women who currently use alcohol or previously used alcohol; bisexual men who have not used or previously used alcohol; and gay men who previously used alcohol. Although efforts to test all adolescents and adults are warranted, these findings highlight the importance of assessing alcohol and sexual orientation and augmenting testing efforts for highrisk groups.

Effect of Cognitive Behavioral Therapy for Insomnia on Alcohol Treatment Outcomes Among US Veterans: A Randomized Clinical Trial

Importance

Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established.

Objective

To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes.

Design, Setting, and Participants

For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 2019 and 2022. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Follow-up visits occurred posttreatment and at 6 weeks.

Interventions

Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Participants were asked to complete sleep diaries for 7 days at each assessment.

Main Outcomes and Measures

Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men; number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up.

Results

The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8); 61 (91%) were male and 6 (9%) female. The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: -3.70; 95% CI, -6.79 to -0.61) and follow-up (-3.34; 95% CI, -6.46 to -0.23) and greater improvements in sleep efficiency (posttreatment, 8.31; 95% CI, 1.35 to 15.26; follow-up, 18.03; 95% CI, 10.46 to 25.60). They also reported greater decreases in alcohol problems at follow-up (group × time interaction: -0.84; 95% CI, -1.66 to -0.02), and this effect was mediated by posttreatment change in insomnia severity. No group differences emerged for abstinence or heavy-drinking frequency.

Conclusions and Relevance

In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence.

Trial Registration

ClinicalTrials.gov Identifier: NCT03806491.

Exploring Factors Associated with Dietary Improvement Among Participants Who Completed a Randomized Controlled Trial for Physical Activity: Evidence of a Transfer Effect

BACKGROUND

This research aimed at understanding how changes in one behavior affect other behaviors, known as "transfer effect," could extend knowledge of shared constructs among compound health risk behaviors, and improve methods for promoting simultaneous behavior changes. The current study explored whether participants who completed a randomized controlled trial for physical activity (PA) improved their diet with no intervention in diet or nutrition.

METHODS

US adults (N = 283) were randomly assigned to 12 weeks of either exercise videogames, standard exercise, or an attention control. Secondary analyses were conducted to examine a possible transfer effect of the intervention on diet at end of intervention (EOT) and 6-month follow-up. Assessments of potential PA constructs (i.e., exercise enjoyment, self-efficacy) and demographics (e.g., age, gender) were conducted. PA, specifically moderate-to-vigorous levels of physical activity (MVPA), was measured using a self-report measure. Diet was measured using the Rate Your Plate dietary assessment.

RESULTS

Findings support that a randomization effect was associated with a higher likelihood of increasing MVPA (β = 30.00, 95% CI = 4.46, 64.46) and dietary improvement at EOT (β = 1.48, SE = .83, P = .01) and follow-up (β = 1.74, SE = .52, P = .02). At EOT, changes in diet were associated with higher PA enjoyment (β = 0.41, SE = 0.15, P = .01). This intervention effect on diet was moderated by gender, with women showing more dietary improvement than men (β =  - .78, SE = 13, P = .03). At 6 months, dietary improvement was associated with greater self-efficacy (β = .04, SE = .01, P = .01).

CONCLUSION

This study shows evidence of a transfer effect among two synergistic behaviors and expands understanding of factors that predict the occurrence of this type of behavior change.

Integrated smoking cessation and mood management following acute coronary syndrome: Protocol for the post-acute cardiac event smoking (PACES) trial

BACKGROUND

Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality.

METHOD/DESIGN

The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all-cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months.

DISCUSSION

Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03413423. Registered 29 January 2018. https://beta.

CLINICALTRIALS

gov/study/NCT03413423 .

The Impact of Police Response on Intimate Partner Violence Victims' Social, Emotional, and Physical Well-Being: Results From the National Crime Victimization Survey

This study examined whether police involvement in intimate partner violence (IPV) incidents is associated with victims' socio-emotional problems, and emotional and physical toll symptoms for 1 month or longer post-victimization. Data from the 2010-2019 National Crime Victimization Survey suggest that police investigational effort, later contact with the police, suffering severe injury during victimization, and repeated victimization were positively associated with experiencing socio-emotional problems. Later contact with police and severe injury were positively associated with both emotional and physical toll symptoms, while the female sex was positively associated with emotional toll symptoms. The arrest of the abuser was negatively associated with physical toll symptoms. Findings highlight the need for policies and practices in response to IPV that consider the diverse needs of survivors of partner abuse to help reduce IPV-related trauma.

One-Year Follow-up After a Pregnancy Prevention Intervention for LGB+ Teens: An RCT

BACKGROUND

Lesbian, gay, bisexual, and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence. Nonetheless, LGB+ inclusive pregnancy prevention programming is lacking.

METHODS

Between January 2017 and January 2018, 948, 14 to 18 year-old cisgender LGB+ girls were enrolled in a national randomized controlled trial. Girls were assigned either to Girl2Girl or an attention-matched control group. They were recruited via social media and enrolled over the telephone. The 5-month intervention consisted of a 7-week program (4-12 text messages sent daily) and a 1-week booster delivered 12 weeks later. Longitudinal models of protected sex events had a negative binomial distribution and a log link function. Longitudinal models examining use of birth control assumed a Bernoulli distribution of the outcome variable and a logit link function. Models adjusted for baseline rate of the outcome, age, and a time-varying indicator of sexual experience.

RESULTS

Girl2Girl participants had higher rates of protected penile-vaginal sex events over time compared with controls. Girl2Girl participants also were more likely than control participants to report use of birth control other than condoms. Models of abstinence and pregnancy rates did not suggest statistically significant group differences across time. However, effect sizes were in the small to medium range and point estimates favored Girl2Girl versus control in both cases.

CONCLUSIONS

Girl2Girl is associated with sustained pregnancy preventive behaviors for LGB+ girls through 12 months postintervention. Text messaging could be considered as a viable method to increase access to sexual health programming to adolescents nationally.

Impact of the COVID-19 pandemic for youth with a history of exposure to self-directed violence

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic created a sudden shift in the social lives of youth with important negative impacts on mental health. The current article aims to understand how the pandemic may have differentially impacted the mental health of adolescents and young adults with recent (1 year or less) and past (> 1 year) exposure to self-directed violence (SDV).

METHOD

Data were collected online from 990 youth and young adults, aged 13-23 years between November 27, 2020 and December 11, 2020.

RESULTS

Participants who had recently been exposed to SDV reported being more impacted by the pandemic and had poorer mental health indicators. Participants with past SDV exposure who engaged in a high number of prosocial activities (e.g., talking with friends) were less likely to report depressive symptoms (β = -.13, p = .01) than similarly engaged nonexposed participants; the same was true for recently exposed participants (β = -.14, p = .02).

CONCLUSIONS

Findings highlight that the effects of the COVID-19 pandemic on the mental health of young people are compounded by exposure to mental health concerns of people in their network. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mind Your Heart-II: Protocol for a behavioral randomized controlled trial of mindfulness training to promote self-care in patients with comorbid heart failure and cognitive impairment

BACKGROUND

Heart failure (HF) self-care is a robust predictor of prognosis in HF patients. Cognitive impairment is a common comorbidity in HF patients and constitutes a major challenge to HF self-care. Mindfulness training (MT) has been shown to improve cognitive function and interoception, two components essential to promoting effective HF self-care.

OBJECTIVES

The aims of the Mind Your Heart-II (MYH-II) study are to investigate the effects of MT on HF self-care via changes in cognitive function and interoception in patients with comorbid HF and cognitive impairment, and to study the process by which MT can improve cognitive function via vagal control. We hypothesize that MT will improve cognitive function, interoception, and vagal control, resulting in enhanced HF self-care, compared to control participants.

METHODS

MYH-II is a mechanistic parallel phase II behavioral randomized controlled trial. We will enroll 176 English or Spanish-speaking patients with comorbid chronic HF and mild cognitive impairment. Participants will be randomized to either: (1) 8-week phone-delivered MT + Enhanced Usual Care (EUC), or (2) EUC alone. Participants will complete baseline, end-of-treatment (3 months), and follow-up (9 months) assessments. The primary outcome is cognitive function (NIH Toolbox Fluid Cognition Composite Score). Additional key outcomes include: interoception (heartbeat tracking task, Multidimensional Assessment of Interoceptive Awareness), HF self-care (Self-Care of Heart Failure Index v7.2), and vagal control (high-frequency heart rate variability).

IMPLICATIONS

If study hypotheses are confirmed, phone-based MT may be a key tool for improving HF self-care, and possibly clinical outcomes, in HF patients with comorbid cognitive impairment.

Study Protocol for the Breathe Easier Trial: A Pilot RCT of a Dyad-Based, Multiple-Behavior Intervention for Improving Physical and Emotional Health in Survivors Facing Lung Cancer

BACKGROUND

Research targeting survivors of lung cancer has yet to adequately address the management of physical deconditioning and unresolved symptoms (dyspnea, fatigue). The objective of the Breathe Easier trial is to test the feasibility and preliminary effects of a theory-based, multiple-behavior intervention (physical activity, smoking reduction for current smokers, stress management) targeting survivors of localized non-small-cell lung cancer (NSCLC, stages I-III) and their supportive partners.

METHODS

This pilot RCT will enroll 30 dyads (60 participants). Each dyad will consist of one survivor and one partner (defined as a family member or friend) Dyads will be randomized to the Intervention Group (IG) or the Attention Control Group (AC). IG members will receive the 12-week, home-based intervention based on the individual and family self-management theory, which targets improvements in self-efficacy, social support, and self-regulation. Improvement in lifestyle behaviors is a proximal outcome. Improvements in physical and emotional health are distal outcomes. Breathe Easier (IG) includes educational content written in plain language as well as breathing exercises and meditations; SMART goal setting; daily text messaging; and weekly telephone calls with trained staff. The AC program includes relevant National Institutes of Health publications plus weekly telephone chats. Members who currently smoke will also receive an evidence-based smoking cessation resource.

DISCUSSION

Breathe Easier focuses on changes in multiple behaviors in dyads coping with a diagnosis of NSCLC (stages I-III) with the overall purpose of improving physical and emotional health. Findings will provide additional evidence of the feasibility and preliminary effects of this intervention.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05956782; This trial was registered retrospectively.

Evaluating the feasibility and efficacy of a home-based combined high intensity interval and moderate intensity training program for increasing physical activity among low-active adults: A randomized pilot trial

BACKGROUND

High intensity interval training (HIIT), which includes short bursts of high-intensity physical activity (PA) followed by recovery, can increase PA by addressing time barriers and improving PA enjoyment. The purpose of this pilot study was to examine the feasibility and preliminary efficacy of a home-based HIIT intervention on PA.

METHODS

Low active adults (n = 47) were randomly assigned to a home-based HIIT intervention or wait-list control lasting 12 weeks. Participants in the HIIT intervention received motivational phone sessions based on Self-Determination Theory and accessed a website that included workout instructions and videos demonstrating proper form.

RESULTS

The HIIT intervention appears feasible based on retention, recruitment, adherence to the counseling sessions, follow-up rates, and the consumer satisfaction survey. HIIT participants reported more minutes of vigorous intensity PA at six weeks relative to control (no differences at 12 weeks). HIIT participants reported higher levels of self-efficacy for PA, enjoyment of PA, outcome expectations related to PA, and positive engagement with PA than the control.

CONCLUSIONS

This study provides evidence for feasibility and possible efficacy of a home-based HIIT intervention for vigorous intensity PA; however, additional studies are needed with larger samples sizes to confirm efficacy of home-based HIIT interventions.

TRIAL REGISTRATION

Clinical Trials Number: NCT03479177.

Mind Your Heart: Exploring Feasibility, Acceptability, and Preliminary Effects of Phone-Delivered Mindfulness Training on Medication Adherence in Outpatients With Chronic Heart Failure

BACKGROUND

Mindfulness training (MT) may promote medication adherence in outpatients with heart failure.

OBJECTIVE

The aims of this study were to determine the feasibility and acceptability of MT (primary outcomes) and explore effects on medication adherence, functional capacity, cognitive function, depression, and mindfulness skills (secondary outcomes).

METHODS

In this pre/post-design study, participants received a 30-minute phone-delivered MT session weekly for 8 weeks.

RESULTS

We enrolled 33 outpatients (32% women; 69.7 White; mean age, 60.3 years). Retention was 100%, and session attendance was 91%. Overall, participants (97%) rated MT as enjoyable. Objectively assessed ( P < .05) adherence decreased post intervention, whereas improvements were noted in functional capacity ( P = .05), mindfulness ( P < .05), and cognitive function (reaching significance for Flanker scores).

CONCLUSIONS

Phone-delivered MT was feasible and acceptable. Whereas no improvements were noted in medication adherence and depression, cognitive function, functional capacity, and mindfulness levels increased post intervention, suggesting MT may have beneficial effects in outpatients with heart failure.

Physical Activity Among Urban Children with Asthma: Does Sleep Matter?

The present study examined associations between sleep and physical activity among a diverse sample of 97 urban children (ages 7-9) with persistent asthma. Differences in associations were evaluated by race/ethnicity and weight status. The extent to which sleep moderated the association between lung function and physical activity was also evaluated. Generalized linear models were utilized to examine associations. Findings indicated that, among the aggregate sample, more frequent nighttime awakenings were associated with less time spent engaging in moderate-to-vigorous physical activity (MVPA). Important differences in these associations were identified by both race/ethnicity and weight status. Better lung function was associated with, (a) higher levels of MVPA for children with better sleep efficiency and fewer nighttime awakenings, and (b) lower levels of MVPA for children with poorer sleep efficiency and more frequent nighttime awakenings. In short, sleep mattered with respect to children's physical activity levels in this sample.

Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program

BACKGROUND

App-based interventions provide a promising avenue for mitigating the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems' use of app features may be associated with changes in mental health outcomes (eg, anxiety and worry).

OBJECTIVE

This study was a secondary analysis of engagement data from a stage 1 randomized controlled trial testing the impact of the Unwinding Anxiety mobile app among adults with generalized anxiety disorder. The aims of this study were 2-fold: to investigate whether higher microengagement with the primary intervention feature (ie, educational modules) is associated with positive changes in mental health outcomes at 2 months (ie, anxiety, worry, interoceptive awareness, and emotional reactivity) and to investigate whether the use of adjunctive app features is also associated with changes in mental health outcomes.

METHODS

We analyzed the intervention group during the stage 1 trial of the Unwinding Anxiety mobile app. The total use of specific mobile app features and the use specific to each feature were calculated. We used multivariate linear models with a priori significance of α=.05 to investigate the impact of cumulative app use on anxiety, worry, interoceptive awareness, and emotional regulation at 2 months, controlling for baseline scores, age, and education level in all models. Significant relationships between system use metrics and baseline participant characteristics were assessed for differences in use groupings using between-group testing (ie, 2-tailed t tests for continuous data and chi-square analyses for categorical data).

RESULTS

The sample was primarily female (25/27, 93%), and the average age was 42.9 (SD 15.6) years. Educational module completion, the central intervention component, averaged 20.2 (SD 11.4) modules out of 32 for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (b=22.6; SE 8.32; P=.01; 95% CI 5.3-39.8) and an 11.6-point decrease in worry (b=-11.6; SE 4.12; P=.01; 95% CI -20.2 to -3.1). In addition, a single log unit change in the total number of meditations was associated with a 0.62-point reduction in the Generalized Anxiety Disorder-7 scale scores (b=0.62; SE 0.27; P=.005; 95% CI -1.2 to -0.6), whereas a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (Five Facet Mindfulness Questionnaire; b=0.5; SE 0.21; P=.03; 95% CI 0.1-0.9).

CONCLUSIONS

This study offers a clearer understanding of the impact of engagement with app features on broader engagement with the health outcomes of interest. This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based mobile apps.

Pasos Hacia La Salud II: study protocol for a randomized controlled trial of a theory- and technology-enhanced physical activity intervention for Latina women, compared to the original intervention

Background

Latinas are at increased risk for many lifestyle-related chronic diseases and are one of the least physically active populations in the US Innovative strategies are needed to help Latinas achieve the health benefits associated with physical activity (PA). This manuscript describes the study protocol of the Pasos Hacia La Salud II Study, which builds upon our previous research to test an enhanced individually-tailored, text-message and website-delivered, Spanish-language intervention (enhanced intervention), in comparison to the original web-based Pasos Hacia La Salud Intervention (original intervention).

Methods

Sedentary Latinas between the ages of 18–65 will be recruited and will complete an orientation and baseline assessments. Participants will be subsequently randomized to the original intervention, or the Enhanced Intervention, which has greater targeting of theoretical constructs such as self-efficacy, enjoyment, and social support, and which uses text messages and more dynamic and refined website features to encourage increased website use. Using a linear mixed effects regression model, we will simultaneously estimate the intervention effects on mean accelerometer-measured hours/week of moderate-to-vigorous PA (MVPA) at 6, 12, 18, and 24 months, with a subject-specific intercept (intent-to-treat sample). Change in self-reported MVPA, measured via the 7-day Physical Activity Recall, will be assessed as a secondary outcome using a similar model. We will investigate potential mediators of the intervention effect using a multiple mediation approach, and potential moderators by evaluating potential interactions. As an exploratory outcome, we will study the differences (among both study arms) in cost, in US dollars, per minute increases in weekly mean MVPA.

Discussion

The original Pasos PA intervention showed efficacy in helping Latinas increase PA; we expect the Enhanced Intervention to help a larger proportion of participants to increase and maintain their PA long term. This web- and text-based enhanced intervention could have great reach and dissemination potential, which could be capitalized on in the future to help to advance health equity. Adaptations made in response to the COVID-19 pandemic are also described in this manuscript.

Trial registration

Clinical Trial Number: NCT03491592. First posted April 9, 2018.

Increases in Muscle-Strengthening Activities Among Latinas in Seamos Saludables

BACKGROUND

Only 17% of Latinas meet national physical activity (PA) guidelines for both moderate-to-vigorous aerobic and muscle-strengthening PA. Additional health benefits are derived from the combination of aerobic and muscle-strengthening PA (vs. aerobic alone), yet there is paucity in research on muscle-strengthening activity in Latinas. The aim of this study was to examine changes in muscle-strengthening activity from baseline to 6 and 12 months in Seamos Saludables, a 12-month PA randomized controlled trial for Latinas.

METHODS

A secondary data analysis was conducted among 131 Latinas ages 18-65 years, who were randomized to either a PA Intervention or a Wellness Control. Self-reported muscle-strengthening exercise was measured at baseline, 6 months, and 12 months via adapted muscle-strengthening questions from the Behavioral Risk Factor Surveillance System.

RESULTS

There was a 16-minute/week difference in median minute/week of muscle-strengthening activity between Intervention and Wellness at 6 months (SE = 7.91, p = .04) and 45-minute/week difference at 12 months (SE = 25.80, p = .06) adjusting for baseline. Significantly more PA Intervention participants met muscle-strengthening guidelines of 2 or more days/week at 6 months versus Wellness Control participants (odds ratio [OR] = 4.29, 95% confidence interval [CI] = [1.03, 17.84]).

CONCLUSION

Results from the current study showed that Latinas engaged in muscle-strengthening activity in an intervention that emphasized primarily aerobic PA outcomes, suggesting they may be interested in engaging in muscle-strengthening activities. Future interventions targeting both aerobic and muscle-strengthening activity could achieve greater health improvements and help more Latinas reach the full national PA guidelines.ClinicalTrials.gov Identifier. NCT01583140.

0713 Longitudinal Sleep Position Patterns and Breathing Parameters in Pregnancy

Introduction

Supine sleep position during pregnancy has been linked to increased risk of stillbirth in retrospective studies. However, existing literature is largely cross-sectional and limited by recall bias and self-reporting of sleep position. This study aims to use objectively-measured sleep position to quantify sleep position change between trimesters and its influence on maternal respiratory health.

Methods

This study is a secondary analysis of data from a study investigating maternal sleep, among women with singleton pregnancies and overweight or obesity. Each participant underwent level III sleep apnea monitoring using Noxturnal T3 devices (Nox Medical, Georgia, US), in the first (0-12 weeks) and third (29-40 weeks) trimester of pregnancy. Using accelerometry, the software differentiated 5 positions including supine, right lateral, left lateral, prone, and upright. The studies were scored using AASM 2012 recommended criteria. The first non-upright position was recorded as going-to-bed position. The number of sleep position changes was calculated using only positions that lasted ≥30 seconds.

Results

A total of 126 women were included. Mean BMI was 34.00±5.14 and mean age was 30.46±5.40 years. Mean number of position changes was similar in early (14.19±7.82) vs. late (14.58±8.25) pregnancy. There was a significant correlation between sleep onset position and predominant sleep position in both early (p=0.001) and late (p&lt;0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. There was a significant change in sleep position between early and late pregnancy (p=0.04) with a reduction in supine sleep (51.6% to 30.2%) and an increase in left lateral sleep (24.6% to 37.3%). Only in the third trimester, there was a significant positive correlation between time spent supine and oxygen desaturation index (r=0.22, p=0.01), and a trend toward positive correlation with respiratory event index (r=0.15, p=0.08).

Conclusion

Going-to-bed position predicts predominant sleep position in less than half of women with overweight and obesity. Time spent supine in late pregnancy correlates with measures of sleep-disordered breathing. More prospective studies are needed to evaluate the potential for sleep position changes over time as a potentially modifiable risk factor for maternal and neonatal health outcomes.

Support (If Any)

R01HL130702, R01HD078515, SRA grant

A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes

Background

Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.

Methods

We plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.

Discussion

The Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.

Trial registration

ClinicalTrials.govNCT04190225. Registered on November 20, 2019

Randomized trial examining the effect of exercise and wellness interventions on preventing postpartum depression and perceived stress

BACKGROUND

Approximately 13-19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk.

METHODS

Participants (n = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care.

RESULTS

Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = - 1.00, SE = 0.46, p = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = - 2.00, SE = .98, p = .04) and exercise vs. wellness participants (b = - 2.20, SE = 1.11, p = .04).

CONCLUSIONS

The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care.

TRIAL REGISTRATION

Clinical Trials Number: NCT01883479 (06/21/2013).

Feasibility and Cost of Using Instagram to Recruit Adolescents to a Remote Intervention

PURPOSE

The purpose of this study was to describe the feasibility, cost-effectiveness, and generalizability of a strategy for recruiting adolescents into research studies through social media.

METHODS

We designed and tested six Instagram advertisements (ads) with a combination of Instagram campaign objectives (Traffic vs. Reach) and types of placement (Story vs. Feed). The goal was to obtain remote assent and screen for a larger remote behavioral intervention study. The eligibility criteria for screening were being aged 13-17 years, residing in the United States, and English-speaking. The eligibility for the larger study was past year cybervictimization and smartphone ownership. A target sample was 80 participants, randomly assigned to a control or intervention group and followed up for 16 weeks. Recruitment rates and cost-per-enrolled participant with different advertising strategies, demographics, and retention were examined using descriptive statistics.

RESULTS

The six ads were run over 907.5 hours, generating 1,069,747 impressions, 2,051 click-throughs, and 663 completed screening surveys. Of 493 eligible participants, 24.4% assented to participate, 69.4% completed enrollment, and 4.8% dropped/withdrew after randomization. Average advertising costs were $52/participant; the lowest-cost strategy (Traffic campaign + Feed ad placement) was $19/enrolled participant. The study sample was largely white (81.3%), non-Hispanic (87.5%), and female (77.5%) with an average age of 15.33 years. Nearly half of the participants were identified as lesbian, gay, or bisexual. More than 96% of participants were retained at the 16-week follow-up.

CONCLUSIONS

Instagram can be a feasible and cost-effective way to recruit adolescents for a remote study. This method may be ideal for recruiting hard-to-reach audiences.

A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial

BACKGROUND

Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth.

OBJECTIVE

This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying.

METHODS

From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant-led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models.

RESULTS

Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=-.66, SE 0.08, P=.04 at 8 weeks and β=-.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02).

CONCLUSIONS

This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216.

Exercise as a smoking cessation treatment for women: a randomized controlled trial

Cigarette smoking remains the leading behavioral risk factor for chronic disease and premature mortality. This RCT tested the efficacy of moderate intensity aerobic exercise as an adjunctive smoking cessation treatment among women. Participants (N = 105; age = 42.5, SD = 11.2) received brief smoking cessation counseling and 10 weeks of nicotine replacement therapy and were randomized to 12 weeks of moderate intensity exercise (Exercise; n = 53) or 12 weeks of health education (Control; n = 52). Longitudinal models, with Generalized Estimating Equations, showed no differences between Exercise and Control in cotinine-verified 7-day point prevalence abstinence (Wald = 1.96, p = 0.10) or continuous abstinence (Wald = 1.45, p = 0.23) at 12-weeks (post-treatment) or 6-, 9-, or 12-month follow-up, controlling for differences in baseline nicotine dependence. There was no effect of exercise on smoking cessation. The present study adds to the literature suggesting null effects of exercise as a smoking cessation adjunctive treatment despite promising findings in short-term laboratory based studies.

Physical activity, lung function, and sleep outcomes in urban children with asthma

OBJECTIVES

To examine (1) whether daily declines in physical activity (PA) level and/or in lung function (FEV1) predict an asthma exacerbation in a sample of urban children with asthma, and (2) the association between number of sleep awakenings and decline in daytime PA in this group.

METHODS

In this sample of urban children aged 7-9 years with persistent asthma (N = 147), objective methods assessing lung function via a handheld spirometer and moderate-to-vigorous physical activity (MVPA) via accelerometry were measured over a 4-week period during the fall and early winter of each year as part of a larger 5-year study.

RESULTS

In the entire sample, a significant association between PA and lung function was noted such that a greater decline in daily MVPA was associated with lower odds of exacerbation. Ethnic group differences showed that this association was also significant only among Latino children (odds ratio [OR] = 0.98; 95% confidence interval [CI]:0.97-0.99). A greater number of sleep awakenings were associated with greater declines in daily MVPA among Latinos only (p = .05).

CONCLUSIONS

Results suggest that declining MVPA may contribute to lower risk for an exacerbation. Reasons for declining MVPA need to be further explored in this group. Children with asthma may avoid or be fearful of engaging in PA or may face early symptoms which influence patterns of PA, and this may minimize risk for an exacerbation. Results also suggest reasons for night-time disruptions may need to be targeted in further research or interventions as they can contribute to PA avoidance in this high-risk group.

Feasibility and Acceptability of a Smoking Cessation Program for Individuals Released From an Urban, Pretrial Jail: A Pilot Randomized Clinical Trial

IMPORTANCE

Tobacco use prevalence among individuals involved in the criminal-legal system is 125% higher than that of the general population and leads to high levels of smoking-related morbidity and mortality.

OBJECTIVE

To examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated.

DESIGN, SETTING, AND PARTICIPANTS

This pilot randomized clinical trial was conducted from January 2019 to May 2020. Participants were recruited in a pretrial county jail in a large Midwestern US city and were followed up after release. Participants were incarcerated, smoked daily before incarceration, desired to stay quit or reduce cigarette smoking upon release, and expected to be released to the community within 90 days of enrollment. Data analysis was performed from June to October 2020.

INTERVENTIONS

Participants randomized to the counseling plus nicotine replacement therapy (NRT) group received 1 hour of smoking cessation counseling in jail, a supply of nicotine lozenges upon release, and up to 4 telephone counseling sessions after release. Those randomized to brief health education (BHE) received 30 minutes of general health education in jail.

MAIN OUTCOMES AND MEASURES

The primary clinical outcome was biologically verified 7-day point prevalence abstinence (PPA) at 3 weeks after release. Secondary clinical outcomes included 7-day PPA at 12 weeks, changes in number of cigarettes per day, and time to smoking lapse and relapse.

RESULTS

A total of 46 participants (42 men [91%]; mean [SD] age, 38.2 [9.1] years) were enrolled and remained eligible at release; 23 were randomized to the counseling plus NRT group and 23 were randomized to the BHE group. Recruitment, enrollment, and retention of participants was feasible and acceptable. There were no significant differences in smoking abstinence between groups as determined by 7-day PPA at 3 weeks (adjusted 7-day PPA, 11.9% for counseling plus NRT vs 10.6% for BHE; odds ratio, 1.13; 95% CI, 0.14-9.07) and at 12 weeks (adjusted 7-day PPA, 11.1% for counseling plus NRT vs 14.3% for BHE; odds ratio, 0.75; 95% CI, 0.09-6.11). Cigarettes per day for the counseling plus NRT group decreased more compared with the BHE group at both 3 weeks (difference [SE], -4.58 [1.58] cigarettes per day; 95% CI, -7.67 to -1.48 cigarettes per day; P = .007) and 12 weeks (difference [SE], -3.26 [1.58] cigarettes per day; 95% CI, -5.20 to -0.20 cigarettes per day; P = .04) after release.

CONCLUSIONS AND RELEVANCE

Initiation of counseling plus NRT during incarceration and continuing after release is feasible and acceptable to participants and may be associated with reduced cigarette use after release. However, additional supports are needed to increase engagement in telephone counseling after release. A larger clinical trial is warranted to determine the effectiveness of counseling plus NRT.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03799315.

C.A.R.E.S: A mobile health program for alcohol risk reduction in community college students

BACKGROUND

Compared to students at four-year residential colleges, Community College Students (CCS) are at greater risk for binge drinking and alcohol related risks, however few interventions have been developed specifically for the needs of CCS.

METHODS AND DESIGN

This study design tests the efficacy of a smartphone app (CARES) compared to an existing online alcohol education (AE) program. CCS (n = 250) will be recruited using a nationwide social media campaign and randomly assigned to either arm, stratified by sex and age (over/under 21). Eligibility screening, consent and assessments are conducted online and both interventions are accessible by smartphone. Assessments will be conducted at baseline, 4- and 8- weeks, end of treatment (12-weeks) and at 6-month follow-up. The primary outcomes are heavy episodic drinking (past 2 weeks), and alcohol related problems Confidence in refusing alcohol, use of protective behavioral strategies and expectations regarding alcohol use. Demographics including age, sex, race/ethnicity, marital and parental status and employment will be analyzed as potential covariates.

DISCUSSION

Community colleges serve approximately half of all US college students but frequently lack the resources to implement full-service alcohol prevention and education programs. The specific needs of CCS also differ from those of residential college students for whom most alcohol prevention programs have been developed. If proven efficacious, the CARES intervention may offer a scalable, easily disseminable program designed for the needs of community colleges and their students. ClinicalTrials.gov Registration: NCT03927482.

Daily Instrumental and Affective Attitudes About Exercise: An Ecological Momentary Assessment Study

BACKGROUND

Daily decisions to exercise may be influenced by day-to-day changes in affective attitudes (AA) and instrumental attitudes (IA) toward exercise. However, the within-day association between AA, IA, and exercise behavior has received little attention.

PURPOSE

To examine the effects of more temporally proximal (daily) AA and IA on daily exercise behavior beyond traditionally assessed distal (at the beginning of an exercise program) AA and IA.

METHODS

In the context of a 3-month exercise promotion program (N = 50), distal AA and IA were assessed at baseline. Ecological momentary assessment was used to assess proximal AA, IA, and exercise each day.

RESULTS

Between-subject differences in distal AA (OR = 1.28, p = .03) and distal IA (OR = 1.34, p = .01) were predictive of average likelihood of exercise each day over the 3-month period. Within-subject differences in proximal AA (OR = 1.19, p = .007), but not proximal IA (OR = 1.11, p = .18), predicted exercise each day beyond the between-subjects effects of distal AA and IA. Exploratory analysis revealed an interaction, such that the within-subjects impact of proximal AA on daily exercise was most evident among individuals who held more negative distal AA at baseline (OR = 0.80, p < .0001).

CONCLUSIONS

Attitude type (affective versus instrumental) and temporality (distal versus proximal) are important to consider in attempts to predict and understand exercise behavior. In addition to targeting change in distal attitudes, exercise interventions should target changes in daily AA to impact exercise later in the same day.

The Moderating Effects of Genetic Variations on Changes in Physical Activity Level and Cardiorespiratory Fitness in Response to a Life-Style Intervention: A Randomized Controlled Trial

OBJECTIVE

Prior studies identified single nucleotide polymorphisms (SNPs) associated with physical activity (PA) level in a natural environment and intervention study: rs978656-DNAPTP6, rs10887741-PAPSS2, rs7279064-C18orf2, and rs6265-BDNF. Using the four SNPs' polygenic score (PGS), we examined whether PGS moderates a life-style intervention's effect on changes in PA level and cardiorespiratory fitness (CRF).

METHODS

This is a secondary analysis of Look AHEAD, a multicenter randomized controlled trial designed to test the health benefits of a life-style intervention among 2675 participants with overweight/obesity and type 2 diabetes (ages, 45-76 years). Using linear mixed-effects models, level of PA (Paffenbarger PA questionnaire) and treadmill-assessed CRF were each regressed on four SNPs' PGS, study time (baseline, year 1, and year 4), intervention arm, and interactions between the three. Models adjusted for age, sex, body mass index, ancestry principal components (population stratification), and study sites, with Bonferroni corrections for multiple testing (α < .005). Effect modification by age was examined.

RESULTS

PGS was not predictive of change in CRF or PA level in response to intervention. In analyses without PGS by intervention by time, the relationships between PGS and PA phenotypes were modified by age (p interaction = .048 for CRF and .058 for PA), such that a 1-unit increase in PGS was associated with 24 kcal · wk-1 more in moderate-intensity PA and 0.004 MET higher CRF only among older groups (age >55 years for CRF, >60 years for PA level).

CONCLUSIONS

The effects of the intervention on PA and CRF were not moderated by the four SNPs. Future studies with extended SNP list should confirm the findings on effect modification by age.

Novel behavioral interventions to improve long-term weight loss: A randomized trial of acceptance and commitment therapy or self-regulation for weight loss maintenance

Maintenance of weight loss is hard to achieve, and novel interventions are needed to improve long-term outcomes. In this pilot randomized controlled trial, N = 188 participants received an online, 12-week weight loss intervention and N = 102 who lost ≥ 5% were then randomly assigned to a 1-day, 5-h workshop based on Acceptance and Commitment Therapy (ACT), Self-Regulation (SR), or no workshop (Control) with 3 months of limited email follow-up. Assessments were conducted at baseline, 3, 6, 12, 18, and 24 months. The primary outcome was percent weight change; secondary outcomes were weight-related experiential avoidance and health values-consistent behavior. ACT had greater overall weight loss (-7.18%, SE = 1.33) when compared to Control (-1.15%, SE = 1.50; p = .03). Post hoc analyses showed that ACT had significantly greater weight losses than Control (6.11%, β = -2.03, p = .048) among those with lower initial weight loss (5-7%), and significantly greater weight loss than SR (6.19%, β = -1.77, p = .05) among those with the highest initial weight losses (10% +). There is potential for continuing to develop ACT in a limited interventionist-contact format with modifications. This pilot study represents an innovative model for behavioral weight loss by reversing the typical treatment intensity model with the aim of providing interventionist support during a critical period after initial weight loss. REGISTRATION: Clinicaltrials.org #NCT02156752 https://www.clinicaltrials.gov/ct2/show/NCT02156752 .

Asthma and Physical Activity in Urban Children

OBJECTIVES 

Asthma and obesity disproportionately affect urban minority children. Avoidance of physical activity contributes to obesity, and urban children with asthma are at risk for lower levels of physical activity. We examined associations between lung function and moderate to vigorous physical activity (MVPA) and moderators of this association in a diverse sample of children with asthma.

METHODS 

Urban children (N = 142) ages 7-9 with persistent asthma and their caregivers completed a study of asthma and physical activity. Longitudinal mixed effects models examining daily-level asthma and physical activity evaluated the association between asthma and MVPA, and the moderating effect of weight, and cultural/contextual factors on this association.

RESULTS 

Average daily MVPA was below recommended guidelines. Differences in MVPA were found by racial/ethnic group (p = .04) and weight (p = .001). Poorer asthma status was associated with lower MVPA in Latino and Black participants (p's < .05), and in normal weight youth (p = .01). Body mass index (BMI) moderated the association between asthma and MVPA. Those with lower BMI had more optimal asthma status and higher MVPA levels, whereas associations attenuated for participants with higher BMI (p = .04). Caregivers' perceptions of neighborhood safety and fear of asthma were marginally associated with children's symptoms and MVPA: as perceptions of safety decreased and fear increased, associations between asthma and MVPA weakened (p's = .09 and .07, respectively).

CONCLUSIONS 

Suboptimal asthma status is associated with less MVPA in urban children. Weight status and cultural/contextual factors play a role in the association and are worthy targets for future research and intervention.

Abstract P645: Sex Differences in the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial

Introduction: Sex differences have been noted in stroke and estrogen is associated with decreased platelet aggregation. The purpose of this study was to assess sex differences in the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) study.

Methods: We performed a secondary analysis of the POINT study. Patients were analyzed by intention to treat group: 1) Males, standard (n=1351) aspirin; 2) Males, intervention (n=1335) clopidogrel+aspirin; 3) Females; standard (n=1098) aspirin; and 4) Females, intervention (n=1097) clopidogrel+aspirin. Groups were compared for baseline demographics via ANOVA followed by Mann Whitney U. A Cox Proportional Hazards Model was used to assess the primary safety and efficacy outcomes.

Results: Baseline characteristics were significantly different only for race (p<.001) with white race being most represented. The primary outcome occurred in 6.4% of standard males, 6.7% of standard females, 5.1% of intervention males, and 4.8% of intervention females (p=0.12). Cox models suggest that male intervention participants had lower hazard rate compared to male standard participants (HR=0.79, CI:0.58-1.09) and female intervention participants had a lower hazard compared to male standard (HR=0.76, CI: 0.54-1.07) but this was not statistically significant. Major hemorrhage occurred in 0.4% of standard males, 0.5% of standard females, 0.8% of intervention males, and 1.1% of intervention females (p=0.11). Female intervention subjects had a significantly higher hazard rate of major hemorrhage compared to standard males (HR=2.99, CI:1.06-8.52) with no other between group differences.

Conclusion: This study found that there were no significant sex differences in the reduction of recurrent vascular events in the POINT trial. The rate of major hemorrhage was higher in female intervention compared to male standard subjects, but there was no difference in rates between the female groups or the male intervention group. Future studies must provide a sample size with enough power to assess for sex differences to optimize care. Both males and females benefit from combination therapy but the risk of major hemorrhage must be considered.

Study protocol for a randomized controlled trial comparing two low-intensity weight loss maintenance interventions based on acceptance and commitment therapy or self-regulation

BACKGROUND

Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated.

METHODS

Adults (anticipated N = 480) with overweight or obesity will complete an initial 3-month online weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N = 288) will then be randomized to an ACT or SR weight loss maintenance intervention. Both interventions will entail four 2.5 h, face-to-face, group-based workshop sessions and 6 months of email contact. Assessments will be conducted at phase 1 baseline, phase 1 completion/pre-randomization, and 6, 12, 18, 24, and 30 months post-randomization. The primary outcome will be weight change for the period from randomization to 30 months. Potential process measures including ACT-based constructs (e.g., psychological acceptance, values-consistent behavior), self-weighing frequency, and motivation will be also be assessed, as will potential moderators (e.g., initial weight loss).

CONCLUSIONS

This study will compare the efficacy of two intervention approaches (ACT and SR) delivered in a scalable workshop format for long-term weight loss maintenance. Future research could examine efficacy and cost-effectiveness of these approaches in real world settings.

Patterns of Asthma Medication Use across the Transition to High School

OBJECTIVE

Adherence to asthma controller medications is suboptimal among adolescents. We evaluated predictors of adherence and longitudinal patterns of medication use between 8th and 10th grade among a sample of youth of diverse race/ethnicity.

METHODS

Eighth graders with asthma on controller medications (N = 62; 40.0% non-Latino white; 23.7% Black; 37.3% Latino; 37.3% female) completed measures of medication beliefs, responsibility for asthma management, and family cohesion. Objective methods tracked medication use longitudinally.

RESULTS

Adherence declined during the high school transition, from 48.0% in eighth grade to 34.1% in tenth grade (F = 5.35, p < .01). Males had lower adherence (b = -10.11, SE = 5.37, p = .02, f2 = 0.11), as did Latino youth (b = -12.21, SE = 8.23, p = .03, f2 = 0.12). Family cohesion was associated with higher adherence (b = 4.38, SE = 1.98, p = .04, f2 = 0.06). Latent class models (LCMs) suggested a three-class model of longitudinal adherence patterns. This included low, declining adherence (Class 1 = 29%; higher proportion male, p = .02), high, sustained adherence (Class 2 = 26%, high family cohesion, p = .05, higher proportion female, p = .02), and low, sustained adherence (Class 3 = 45%; higher proportion Latino, p = .05, higher proportion male, p = .02).

CONCLUSIONS

Asthma medication adherence declined between 8th and 10th grade. LCMs indicated some youth have stable patterns of adherence (high or low), whereas others demonstrate declines. Gender differences were observed, and family cohesion was associated with higher, sustained adherence. Interventions building on family resources and targeting the barriers adolescents face are necessary to improve asthma management during this vulnerable period.

A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial

Background

Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men.

Objective

To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables.

Methods

Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization.

Results

This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing.

Conclusions

We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial.

Trial Registration

Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570

International Registered Report Identifier (IRRID)

DERR1-10.2196/23690

Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: A Feasibility, Proof-of-Concept Study

OBJECTIVES

This study sought to explore feasibility, acceptability, and preliminary effects of aerobic training (AT), mindfulness training (MT), or both (MT + AT) on cognitive function in older individuals at risk of dementia.

METHOD

Participants were randomized to AT, MT, both, or usual care (UC). Z-scores of attention, verbal fluency, and episodic memory for non-demented adults (ZAVEN) were computed at baseline, end of treatment (EOT), and 6 months since baseline.

RESULTS

Of the 36 enrolled participants (12 M, 24 F, mean age = 70.1 years), 97% were retained in the study at 6 months. At EOT, MT had higher ZAVEN scores than UC (b = .43, P =.03) and AT (b = .26, P = .10), while no differences were seen with MT + AT. A similar pattern was observed at a 6 month follow-up (all P values = .10).

DISCUSSION

MT may improve cognitive function in older individuals at risk of dementia. These preliminary findings need to be confirmed in a fully powered RCT.

Tai Chi practice and change in exercise habits in survivors of acute coronary syndromes: Is mindfulness a possible mechanism?

BACKGROUND

Mechanisms by which mind-body practice may improve exercise behaviors in patients with coronary heart disease (CHD) are unknown.

PURPOSE

To identify predictors of exercise behaviors developed in response to a tai chi intervention.

METHODS

We conducted an exploratory analysis using data from a pilot study of tai chi for physically inactive patients with CHD. We used Latent Class Analysis to identify patterns of moderate to vigorous physical activity (MVPA) (accelerometry-assessed, average min/week) over the 9-month study period. Logistic regression was used to evaluate associations between MVPA patterns and changes in exercise self-efficacy (Self-efficacy for exercise scale), social support (Multidimensional Scale of Perceived Social Support), resilience (Brief Resilience Survey), and mindfulness (Five Facets of Mindfulness) at 6 months.

RESULTS

Data supported a 3-class model over time: 31% of participants were in class 1 (high and sustained MVPA, > 200 min/week), 21% were in class 2 (low and decreasing MVPA, < 100 > 50 min/week), and 48% in class 3 (low and stable MVPA, < 50 min/week). Higher mindfulness scores at 6 months were associated with a high and sustained MVPA pattern (b = 1.89, SE = 0.15, p = .01). Social support was inversely associated with low and decreasing MVPA (b = -0.72, SE = 0.34, p = .04). No associations were noted with the other factors.

CONCLUSIONS

Improvements in mindfulness were associated with a distinct high and sustained MVPA pattern. Although only hypothesis-generating, these findings suggest that improvements in mindfulness skills could be a mechanism for the possible effect of Tai Chi in the promotion of MVPA.

Telephone-Delivered Mindfulness Training to Promote Medication Adherence and Reduce Sexual Risk Behavior Among Persons Living with HIV: An Exploratory Clinical Trial

This study explored whether telephone-delivered mindfulness training (MT) to promote medication adherence and reduce sexual risk behavior was feasible for and acceptable to people living with HIV. Participants (N = 42; 50% female; M age = 47.5 years) were randomized to MT or health coaching (HC). Pre- and post-intervention, and at 3-month follow-up, we assessed adherence to ART, sexual risk behavior, and hypothesized mediators; we also conducted individual interviews to obtain qualitative data. Results showed that 55% of patients assigned to MT completed ≥ 50% of the training calls compared with 86% of HC patients (p < .05). Most patients reported satisfaction with their intervention (MT = 88%, HC = 87%). Patients in MT and HC reported improvements in medication adherence, mindfulness, and sexual risk reduction as well as reductions in anxiety, depressive symptoms, perceived stress, and impulsivity over time; however, no between-groups differences were observed.

Higher education associated with better national tetanus vaccination coverage: A population-based assessment

Vaccination coverage among United States (U.S.) adults for tetanus continues to be lower than the national goals. Education has demonstrated a positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study assessed the relationship between education and tetanus vaccination. Data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), a self-reported annual survey for non-institutionalized adults in the US from the Centers for Disease Control, was analyzed in 2019. The outcome was up-to-date tetanus vaccination if received within the last 10 years. Education was categorized into 1) grade 11 or less, 2) grade 12/GED, 3) college 1-3 years, and 4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design. In 2016, 59.9% of U.S. adults had up-to-date tetanus vaccination. Higher education level was associated with increased odds of up-to-date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% (CI: 1.26-1.35)]. Female sex, Black (non-Hispanic), unemployed, not being married, not having insurance or a personal health care provider, and above 45 years of age had lower odds of up-to-date tetanus vaccination. Targeted community specific vaccination education programs for those without tertiary education may help enhance the knowledge and thus the overall vaccination status in the U.S.

Smokers with children with asthma: Parental perceptions about prototype intervention messages focused on reducing child tobacco exposure and use

Formative research is needed to develop effective interventions that eliminate secondhand smoke exposure (SHSe) and prevent tobacco use (TU) among children with asthma. This online study included 300 parents who smoke and had a child with asthma (ages 10-14) and evaluated their perceptions about prototypes of parent-directed and child-directed feedback intervention messages focused on reducing child SHSe and future TU; correlates of perceptions were explored. Parents rated examples of parent-directed messages on motivation and helpfulness for eliminating SHSe and promoting conversations about TU and also rated child-directed messages on acceptability and helpfulness for promoting conversations about TU. Messages differed by level of personalization, theoretical background, or message content. Parents found all parent-directed messages similarly motivating and helpful and all child-directed messages similarly acceptable and helpful for reducing child tobacco exposure. Differences in perceptions about feedback emerged based on parent gender, parent readiness to quit, smoking ban status, and the presence of additional smokers in the home. Overall, parents rated parent-directed and child-directed feedback message prototypes positively, including established and novel types of feedback. Parent-child feedback interventions may hold promise for breaking the intergenerational transmission of smoking among families with a parent who smokes and a child with asthma.