Domains of Sedentary Behavior and Cognitive Function: The Health, Aging, and Body Composition Study, 1999/2000 to 2006/2007

BACKGROUND

This study examines the relationship between various domains of sedentary behavior and subsequent cognitive function to evaluate whether different sedentary activities have specific associations with future cognitive performance.

METHODS

Data were from 1 261 older adults participating in the Health, Aging, and Body Composition (Health ABC) Study between 1999/2000 and 2006/2007. Total sitting time (hours/day), reading time (hours/week), and TV time (≤27/≥28 h/wk) were self-reported at baseline and 3 years later. At follow-up, cognitive function was evaluated using the Teng Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST). Multivariable linear regression modeling examined the independent associations of baseline sedentary behaviors and 3-year change in those behaviors with cognitive function scores at follow-up, adjusting for important covariables.

RESULTS

Baseline total sitting time was positively associated with 3MS (β = 0.14 ± 0.07; p < .05) and DSST (β = 0.20 ± 0.10; p < .05) scores at follow-up, as was reading time (β = 0.09 ± 0.03; p < .05 for 3MS score and β = 0.14 ± 0.04; p < 0.01 for DSST score). Participants who increased their TV watching time over 3 years had a significantly lower 3MS score (β = -1.45 ± 0.71; p < .05) at follow-up, compared with those who maintained a low level of TV time (referent). These findings were independent of age, sex, race, education level, health status, depressive symptoms, and physical activity.

CONCLUSION

Some types of sedentary behavior may have benefits for cognitive function in older age, thus highlighting the importance of measuring different domains of sitting time.

Physical Activity, Stress, and Physically Active Stress Management Behaviors Among University Students With Overweight/Obesity

Student physical activity is associated with lower stress. Research gaps remain regarding the types of stress management behaviors students use and how these behaviors are associated with students' activity levels. This study examined associations between physical activity and stress management behaviors among students (18-35 years). Students with overweight/obesity (n = 405) attending universities in 2 urban locations enrolled in a randomized controlled trial to promote healthy weight and completed the following baseline measurements: perceived stress, stress management behaviors, accelerometer-measured physical activity, and demographic characteristics. Perceived stress did not differ by physical activity status or race. A greater proportion of students meeting moderate-to-vigorous physical activity guidelines used physically active stress management behaviors compared to those not meeting guidelines (74% vs 56%; P = .006), and students using physically active stress management had lower stress scores (13.1 vs 15.5; P = .003). Among Black and White students only (n = 306), a greater proportion of White students used physically active stress management behaviors compared to Black students (77% vs 62%, P = .013). Results indicate differences in stress management behaviors by student activity level and race. During times of high stress, colleges/universities might support students by promoting stress management and physical activity in tandem, and tailoring messages to student activity levels and demographic characteristics.

Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis

Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.

Sleep duration and chronotype of pregnant women in the United States: An online cross-sectional survey study

Sleep is an important behavior, and during pregnancy plays a critical role in promoting the health of both woman and child. Therefore, identifying and addressing sleep parameters during pregnancy, and associated disparities in maternal-child health outcomes, is a public health priority. This studied aimed to examine chronotype and sleep duration in pregnant women by sociodemographic factors. An online survey was distributed to currently pregnant women living in the greater Washington, DC, area of the United States from March to May of 2022. The survey included the ultra-short version of the Munich Chronotype Questionnaire (µMCTQ), which was used to calculate the mid-point of sleep time (MST; a measure of chronotype) and sleep duration, as well as demographic questions. Linear regression was used to assess differences in sleep outcomes by demographic factors. A sample of n = 142 currently pregnant women were eligible for analysis. In covariate adjusted models, sleep duration was longer among respondents ages 25-34 (09:52) compared with younger respondents ages 18-24 (08:59; p = 0.014), and shorter for those with a household income ≥ 100,000 United States dollars (USD) (07:42) compared with those with a household income < 50,000 USD (08:59; p = 0.001). No differences in mean mid-point of sleep were identified across demographic factors. Differences in sleep duration by age and household income were found among currently pregnant women. Future studies should investigate sleep parameters and other factors that may influence maternal-child health disparities.

Is the Risk Perception Attitude Framework Associated with the Accuracy of Self-Reported vs Actual Cardiometabolic Risk and Physical Activity in Young Adults with Overweight/Obesity?

We examined the accuracy of perceived vs actual cardiometabolic risk and physical activity within the Risk Perception Attitude Framework (RPA). We analyzed baseline data from 343 young adults (23.3 ± 4.4 years) participating in a weight management clinical trial. Cardiometabolic risk factors were measured according to standard clinical procedures. A cardiometabolic risk score was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded. Physical activity was determined by ActiGraph and self-report. Perceived risk and physical activity self-efficacy were assessed by validated measures. The Proactive cluster (low perceived risk/high self-efficacy) was most accurate regarding actual vs perceived risk awareness (54%), while the Responsive cluster (high perceived risk/high self-efficacy) was the least accurate (16%). All RPA clusters underestimated their actual physical activity, self-reporting less than half the moderate-to-vigorous physical activity that was captured via accelerometry. The RPA Framework can identify young adults unlikely to be aware of their cardiometabolic risk. Given the growing prevalence of metabolic syndrome, efforts early in adulthood to increase knowledge and awareness of cardiometabolic risk, and behaviors necessary to reduce that risk, can have substantial impact on future health.

Application of McGuire's Model to Weight Management Messages: Measuring Persuasion of Facebook Posts in the Healthy Body, Healthy U Trial for Young Adults Attending University in the United States

Digital communication is a common intervention channel for weight loss, yet little is known about the types of messages that are most effective. Using McGuire's Model of Communication and Persuasion as a framework, this study investigates the persuasiveness of Facebook messages posted as part of the weight loss intervention in the Healthy Body Healthy U (HBHU) study to determine what message characteristics prompt higher engagement on Facebook, and whether certain messages are more appealing to certain demographics. The first four weeks of HBHU Facebook posts (n = 32) were coded according to McGuire's Input Communication Factors. Facebook engagement scores [(Total Engaged Users/Total Reach) × 100] were calculated for each post to determine effectiveness. The most effective posts were diet-related discussions or interactive polls. Participants who engaged with the highest and lowest effect posts were in their mid-twenties and tended to be female. Those engaged with the highest effect posts had an average BMI of 32.34 kg/m², while those engaged with the lowest effect posts had an average BMI of 31.31 kg/m². The least effective posts were didactic lessons (i.e., diet- or reminder-based), or video-based informational posts (edutainment). Future interventions should balance didactic content and interactive engagement to achieve persuasive messaging.

Women's Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study

BACKGROUND

Since March 2020, the need to reduce patients' exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women.

OBJECTIVE

This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population.

METHODS

A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years.

RESULTS

In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049).

CONCLUSIONS

Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic.

Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity

This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m². For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.

Meeting Specific 24-Hour Movement Guidelines Is Associated With BMI Among University Students With Overweight/Obesity

Background: Approximately 40% of college/university students have overweight/obesity; physical activity and sleep play a role. To address these interrelated behaviors, Canada recently released 24-Hour Movement Guidelines. This study aimed to determine (1) the percent of students with overweight/obesity meeting Canadian 24-Hour Movement Guidelines, (2) whether health behaviors differ by demographics, and (3) whether meeting guidelines is associated with BMI. Methods: University students 18–35 years (n = 459) enrolled in a randomized controlled weight management trial completed 1 week of ActiGraph measured activity, self-reported sleep duration, researcher-measured height/weight, and demographics at baseline. ANOVA and t-tests determined differences in student demographics and BMI among those meeting vs not meeting each guideline. Results: Of the analytic sample (n = 403), 341 (84.6%) met the MVPA guideline, 284 (70.5%) met the LIPA guideline, 236 (58.6%) met the sleep guideline, 62 (15.4%) met the sedentary time guideline, and 34 (8.4%) met all guidelines. Students meeting MVPA (30.8±4.3 vs 32.5±4.5, P = .008) or sleep (30.7±4.4 vs 31.6±4.3, P = .04) guidelines had significantly lower BMIs compared to those not meeting each guideline. Percent of students meeting sleep ( P = .039) or all guidelines ( P = .012) differed by race/ethnicity. Conclusion: Meeting MVPA/sleep guidelines is associated with lower BMI; these behaviors are important targets for future weight management programs.

Associations Between College/University Physical Activity Requirements and Student Physical Activity

Background: Most U.S. college students do not meet physical activity guidelines. Physical activity requirements (PAR) are a proposed solution for increasing undergraduate physical activity. Purpose: To determine whether college/university PAR are associated with undergraduates' self-reported physical activity. Methods: Undergraduate students (N = 383,632) attending colleges and universities taking part in the American College Health Association-National College Health Assessment II survey (2015-2019) self-reported physical activity and demographics. Using websites and course catalogs, researchers coded schools to indicate binary PAR status. Bayesian Hierarchical Logistic Regression was used to determine the percentage of students meeting physical activity guidelines; interactions between PAR status and student characteristics (sex, BMI) were examined. Results: PAR status was positively associated with percent of students meeting physical activity guidelines (PAR: 43.3%, without: 40.5%; difference score 95% Highest Density Interval [HDI; 1.0, 4.5]). A greater percentage of students attending schools with PAR, versus without, met physical activity guidelines across all categories of sex and weight. However, the positive relationship between PAR status and physical activity was stronger among male students (PAR: 46.7%, without: 43.2%; 95% HDI [1.6, 5.4]) compared to female students (PAR: 39.9%, without: 37.9%; 95% HCI [0.2, 3.8]), and among students with underweight (PAR: 39.2%, without: 35.5%; 95% HDI [1.2, 6.3]) or obesity (PAR: 37.1%, without: 33.7%; 95% HDI [1.4, 5.3]) compared to normal weight (PAR: 49.3%, without: 47.4%; 95% HDI [0.1, 3.7]) or overweight (PAR: 47.5%, without: 45.5%; 95% HDI [0.1, 4.0]). Conclusions: PAR are associated with meeting physical activity guidelines, particularly among college/university students with underweight or obesity.

What moves young people? Applying the risk perception attitude framework to physical activity behavior and cardiometabolic risk

Cardiometabolic disease risk factors, including metabolic syndrome and physical inactivity, are prevalent among young adults. However, few young adults are aware of their risk status. The risk perception attitude (RPA) framework was used to categorize participants (n = 456) enrolled in a three-arm randomized controlled weight management trial by their baseline values of cardiometabolic risk perceptions and physical activity self-efficacy. Trial recruitment occurred at two universities from 2015 to 2018 and participants were randomly assigned to one of three weight management interventions: Tailored, Targeted, Control. Cross-sectional and longitudinal analyses were conducted to examine associations between RPA category (i.e., Responsive, Indifferent, Avoidant, Proactive) and physical activity behavior. At baseline, the Responsive group had the highest amount of physical activity (mean [95% CI]: 379.2 [332.6 to 425.8] min/week), the Indifferent group had the lowest (296.7 [261.98 to 331.32] min/week), and the Avoidant/Proactive groups showed intermediate values. Over 6 months, there was a significant interaction between RPA group and intervention arm on change in physical activity adjusted for age, sex, race/ethnicity, baseline body mass index, and baseline moderate-to-vigorous physical activity (p = .017). Among Tailored intervention participants only, the Proactive participants were the only group to have an increase in physical activity (19.97 min/week) and the Indifferent participants had the most significant decrease in physical activity (127.62 min/week). Results suggest the importance of early screening for young adults to help raise awareness of cardiometabolic risk and ultimately support them in health promotion efforts.

A qualitative investigation of the need for and feasibility of weight loss programs on university campuses

BACKGROUND

Despite the public health significance of overweight and obesity, weight management has remained a low priority for health-related programming on university campuses.

OBJECTIVE

Investigate the need for and feasibility of implementing university-based weight loss programs.

METHODS

The Practical, Robust Implementation and Sustainability Model (PRISM) was used as a framework. Semi-structured individual interviews were conducted with fifteen university staff and students from two large U.S. universities in the Northeast and Mid-Atlantic. Interviews aimed to assess readiness, preferences, characteristics, barriers and facilitators in each of the four adapted PRISM domains: (1) Organizational and Recipient (Student) Perspectives on the Intervention, (2) Recipient (Student) Characteristics, (3) Internal Environment (organizational characteristics and infrastructure), and (4) External Environment. Verbatim transcriptions were analyzed using inductive and deductive thematic analyses. Themes were extracted as outlined by Consensual Qualitative Research.

RESULTS

Participants supported university-based weight loss programs, but recognized barriers of resources, coordination across entities, and competing health issues taking priority for school programming. Campus built environment and students' busy schedules were identified as barriers to maintaining healthy weight and participation in weight loss programs. Recommendations included designing weight loss programming with a positive and holistic approach, minimizing weight-stigma, ensuring support from university leaders and students, and securing external funding.

CONCLUSIONS

The identified themes provide recommendations for universities looking to develop and implement weight loss programming.

Associations between college/university campus characteristics and student body mass index

Background

Campus environments are associated with undergraduate weight. However, few studies have examined campus type and geographic location in relation to student weight. This article aimed to identify college/university students with elevated BMIs by campus type and region.

Methods

Linear mixed effects regression models were fit to data from the American College Health Association-National College Health Assessment II. Analyses tested associations between campus type/region and student self-reported BMI.

Results

The sample included 404,987 students from 445 schools with mean BMI 24.9 ± 5.8. Across all school types/regions, BMI confidence intervals included overweight values. Two-year and public school students had higher BMIs compared to four-year and private school students, respectively. Students in the Midwest had higher BMIs compared to students in the Northeast. In the South only, Minority Serving Institution (MSI) students had higher BMIs compared to non-MSI students.

Conclusion

Healthy weight maintenance programs should be made available to undergraduate students.

Application of social marketing to recruitment for a digital weight management intervention for young adults

Recruiting young adults into weight loss interventions poses challenges that may be mitigated by the use of novel social marketing strategies. The purpose of this study is to describe how social marketing principles were applied to recruitment for a digitally delivered randomized controlled trial for weight management among young adults and report recruitment data and demographics on those who enrolled and did not enroll in the study. The marketing mix of the 7Ps (i.e., product, price, place, promotion, packaging, positioning, and people) was applied to intervention recruitment. Prior to enrollment, respondents completed a screening survey, which was examined to determine optimal strategies for study awareness and enrollment. Of the initial 5,731 who initiated a screener, 3,059 provided data on the source of where they heard about the study. Subsequently, 460 (12.5%) were enrolled in the study, 409 (51.3% non-White; 78.7% female; body mass index: 30.6 ± 4.3) provided data on recruitment source, with emails (72.5%), cited most often followed by flyers/posters (8.8%), "other" (6.7%), and multiple sources (6.6%). Although email remained the most frequently cited promotion source, Pearson's chi-squared tests revealed that, compared to those not enrolled in the study, those who enrolled were more likely to hear about the study via flyers/posters (enrolled = 14.4%; not enrolled = 7.9%; p < .001) and multiple sources (enrolled = 11.7%; not enrolled 5.85%; p < .01) and less likely to hear via email (enrolled = 62.1%; not enrolled = 74.2%; p < .01). This study applied social marketing principles to successfully recruit a large and diverse group of young adults. While email emerged as the most effective source of study awareness, multiple channels and a mix of marketing principles are recommended for recruiting in university settings.

Effect of tailoring on weight loss among young adults receiving digital interventions: an 18 month randomized controlled trial

Weight loss outcomes among young adults in technology-based programs have been equivocal. The purpose of this study was to deliver digital weight loss treatments to young adults and examine the 6, 12, and 18 month effects on weight loss. Young adults with overweight/obesity (N = 459; 23.3 ± 4.4 years) were recruited from two university sites and randomly assigned to receive through Facebook and text messaging either personalized (TAILORED; n = 150) or generic (TARGETED; n = 152) weight loss information, messages, and feedback or general healthy body content (e.g., body image, sleep; CONTROL; n = 157). The study was powered to detect a 2.1-kg difference at all time points with the primary outcome being 18 months. There was no overall effect of treatment group on 6, 12, or 18 month weight loss (ps = NS). However, at 6 months, those in TAILORED who were highly engaged (completing >66%) lost more weight compared to CONTROL (-2.32 kg [95% confidence intervals: -3.90, -0.74]; p = .004), with the trend continuing at 12 months. A significant baseline body mass index (BMI) by treatment group interaction (p = .004) was observed at 6 months. Among participants in the lowest baseline BMI category (25-27.5 kg/m2), those in TAILORED lost 2.27 kg (-3.86, -0.68) more, and those in TARGETED lost 1.72 kg (-3.16, -0.29) more than CONTROL after adjusting for covariates. Among participants with a BMI between 27.5 and 30 kg/m2, those in TAILORED lost 2.20 kg (-3.90, -0.51) more than participants in TARGETED. Results did not persist over time with no treatment interaction at 12 or 18 months. Initial body weight should be considered when recommending weight loss treatments for young adults. More intensive interventions or stepped care approaches may be needed for young adults with obesity.

Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system

PURPOSE

Robotic inguinal hernia repair (RHR) is an evolving technique but is comparatively expensive and has yet to show superior outcomes versus open (OHR) or laparoscopic (LHR) approaches. The utilization and clinical outcomes of RHR have not been reported within the veterans affairs (VA) system. This study analyzes trends in utilization and 30-day post-operative outcomes between OHR, LHR, and RHR in veterans.

METHODS

This is a retrospective review of patients that underwent inguinal herniorrhaphy using the Veterans Affairs Quality Improvement Program database. Multivariable analysis of outcomes was performed adjusting for pre-operative confounding covariates between OHR, LHR, and RHR. Trends in utilization, complication rates, and operative times were also reported.

RESULTS

From 2008-2019, 124,978 cases of inguinal herniorrhaphy were identified: 100,880 (80.7%) OHR, 18,035 (14.4%) LHR, and 6063 (4.9%) RHR. Compared to LHR, RHR was associated with 4.94 times higher odds of complications, 100 min longer mean operative time, and 1.5 days longer median length of stay (LOS). Compared to OHR, RHR was associated with 5.92 times higher odds of complications, 57 min longer mean operative time, and 1.1 days longer median LOS. Utilization of RHR and LHR significantly increased over time. RHR complication rates decreased over time (2008: 20.8% to 2019: 3.2%) along with mean operative times (2008: 4.9 h to 2019: 2.8 h; p < 0.05).

CONCLUSION

While this study demonstrated inferior outcomes after RHR, the temporal trends are encouraging. This may be due to increased surgeon experience with robotics. Further prospective data will elucidate the role of RHR as this technique increases.

Evaluating an Interactive Digital Intervention for College Weight Gain Prevention

OBJECTIVE

Pilot a digital interactive intervention for weight gain prevention among college students.

METHODS

One sample pre-post study reporting on initial usability and changes in theoretical constructs (ie, self-efficacy, behavioral capability, elaboration) and program acceptability. Twenty college freshmen (mean age, 18.25 ± 0.72 years) reviewed a digital program providing self-assessment and brief tailored feedback on 8 behaviors that relate to a healthy weight: physical activity, sedentary behavior, and consumption of sugary beverages, high fat snacks, breakfast, fried foods, fruits and vegetables, and pizza.

RESULTS

At posttest, improvements in self-efficacy were found for 5 behaviors (ie, physical activity, high fat snacks, breakfast, fried foods, fruits and vegetables); improvements in behavioral capability were found for 3 behaviors (ie, high fat snacks, fried foods, and fruits and vegetables). Acceptability benchmarks included: positive impression (60%), relevance (95%), and ease of comprehension (75%).

CONCLUSIONS AND IMPLICATIONS

This program demonstrates acceptability for a digital weight gain prevention intervention, with improvements in behavioral mediators of change. Suggestions to simplify messaging and allowing for user control may enhance acceptability and comprehension. There is a need for further testing with larger more diverse populations before broader implementation by universities to address student health.

Physical Activity and Cardiometabolic Risk Factor Clustering in Young Adults with Obesity

INTRODUCTION

There is a paucity of information on the clustering of cardiometabolic risk factors in young adults and how this clustering may vary based on whether or not they perform sufficient levels of physical activity.

METHODS

We analyzed baseline data from 346 young adults (23.3 ± 4.4 yr) participating in the Healthy Body Healthy U clinical trial from 2015 to 2018. Cardiometabolic risk factors were measured according to standard procedures and moderate- to vigorous-intensity physical activity (MVPA) was determined by accelerometry. A cardiometabolic clustering score (ranging from 0 to 5) was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded (0, no; 1, yes): abdominal circumference (>102 cm (men) or >88 cm (women)), hemoglobin A1c (≥5.7%), HDL cholesterol (<40 mg·dL (men) or <50 mg·dL (women)), systolic blood pressure (≥130 mm Hg), and diastolic blood pressure (≥85 mm Hg). Cardiometabolic dysregulation (CD) was defined as a cardiometabolic clustering score ≥3. Multiple logistic regression determined the independent association between level of MVPA and CD, while adjusting for sex, race/ethnicity, sedentary time, and smoking.

RESULTS

The prevalence of CD was 18% (22% in men, 17% in women). We observed a nonlinear graded association between MVPA and CD. Participants performing 150-300 min·wk of MVPA significantly lowered their odds of CD by 66% (odds ratio, 0.34; 95% confidence interval, 0.16-0.75), whereas those exceeding 300 min·wk lowered their odds by 61% (odds ratio, 0.39; 95% confidence interval, 0.18-0.86) compared with those performing <150 min·wk, independent of obesity and the other covariables.

CONCLUSION

Recommended levels of moderate-intensity physical activity is significantly associated with lower odds of CD and thus may prevent or diminish the need for expensive pharmaceutical treatment over the remainder of the life-span.

Young adult e-cigarette users: perceptions of stress, body image, and weight control

OBJECTIVE

With the rise in electronic cigarette (ENDS) use among US young adults, more research is needed on expectations for use and perceptions related to body image, weight control, and stress relief.

METHODS

College students (N = 230; modal age 21 years; 68% female) completed an online survey assessing cigarette smoking and ENDS, dieting and body image, perceptions about flavors, stress, weight gain prevention, and appetite regulation.

SAMPLE CHARACTERISTICS

Dual use (cigarette and ENDS) was reported by n = 69 (30.0%). Exclusive cigarette smoking was endorsed by n = 53 (23%) with exclusive ENDS use reported by n = 15 (6.5%). Ninety-three participants (40.5%) reported not using either product.

RESULTS

Among those using ENDS, < 33% reported using as a stress management tool, < 15% reported using ENDS to control appetite, and > 70% reported using cartridges that tasked like sweets. There was a positive correlation between dieting behaviors and body concern, suggesting those who reported higher use of ENDS for weight and appetite regulation also had higher pathological eating scores and concern over body shape and size.

CONCLUSION

Prevention and education related to weight, body image, and tobacco are needed to address misperceptions of tobacco products.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Formative work to design a digital learning self-assessment and feedback tool to prevent weight gain among college students

OBJECTIVE

While colleges have implemented brief, tailored interventions for health-risk areas such as alcohol prevention, theoretically-guided digital learning offerings for weight gain prevention have lagged behind in programming and implementation. Thus, the objective was to design and usability test a weight gain prevention digital learning platform for college students with modules targeting key nutrition and physical activity behaviors.

METHODS

Development occurred in iterative phases: formative research, descriptive normative data collection, prototype development, and usability testing. Formative research consisted of background work and survey administration to incoming and current freshmen. Prototype development was guided by theories of behavior change and cognitive processing, and consisted of brief assessment and feedback using written text, graphs, and videos. Iterative usability testing was conducted.

RESULTS

Current freshmen reported eating more quick order meals per week than incoming freshman, but fewer high-fat snacks and fewer sugary beverages. Current freshmen reported more sedentary time than incoming freshmen. Based on iterative testing results, eight behavioral targets were established: breakfast, high-fat snacks, fried foods, sugary beverages, fruit/vegetables, physical activity, pizza intake, and sedentary behavior. Initial usability testers indicated the modules were easy to understand, held their attention, and were somewhat novel. Analysis of qualitative feedback revealed themes related to content, layout, structure and suggested refinements to the modules.

CONCLUSIONS

A gap exists for evidence-based obesity prevention programs targeted to adolescents as they transition into adulthood. Brief, tailored digital learning interventions show promise towards addressing key behavioral nutrition and physical activity targets among students during the transition to college.

Physical Activity Promotion: Highlights from the 2018 Physical Activity Guidelines Advisory Committee Systematic Review

PURPOSE

This article describes effective interventions to promote regular physical activity and reduce sedentary behavior that were identified as part of the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.

METHODS

A comprehensive literature search was conducted of eligible systematic reviews, meta-analyses, and relevant governmental reports published between 2011 and 2016. For the physical activity promotion question, articles were first sorted by four social ecological levels of impact (i.e., individual, community, communication environment, and physical environment and policy levels) and then further sorted into more specific categories that emerged during the review process. For the sedentary behavior reduction question, the literature was sorted directly into emergent categories (i.e., youth, adult, and worksite interventions).

RESULTS

Effective physical activity promotion strategies were identified at each level of impact, including those based on behavior change theories and those occurring at different settings throughout the community. Effective interventions also included those delivered in person by trained staff or peer volunteers and through different information and communication technologies, such as by phone, Web or Internet, and computer-tailored print. A range of built environment features were associated with more transit-based and recreational physical activity in children and adults. Effective sedentary reduction interventions were found for youth and in the workplace.

CONCLUSIONS

A promising number of interventions with demonstrated effectiveness were identified. Future recommendations for research include investigating the most useful methods for disseminating them to real-world settings; incorporating more diverse population subgroups, including vulnerable and underrepresented subgroups; collecting cost data to inform cost-effectiveness comparisons; and testing strategies across different levels of impact to determine which combinations achieve the greatest effects on different modes of physical activity across the week.

Social Support for Breastfeeding in the Era of mHealth: A Content Analysis

BACKGROUND

Several barriers to successful breastfeeding exist, including a lack of support from peers or professionals. With the emergence of mobile health (mHealth) tools to provide additional breastfeeding support, a more thorough review of social support resources was needed. Research Aim: The aim of this study was to determine mHealth breastfeeding support resources and characterize the type of social support they provide.

METHODS

A content analysis of mHealth programs ( n = 65), including text messaging ( n = 12) and mobile applications ( n = 53), was conducted on the basis of searches of the iTunes and Google Play stores ( n = 50) and PubMed, the Cumulative Index of Nursing and Allied Health, and American Business Information/INFORM Complete Plus ( n = 15). Results were then dual-coded for key characteristics and types of support provided.

RESULTS

Thirty-eight apps (76%) were free to users, 14 (28%) were offered in a variety of languages, and 47 (94%) provided informational support. The mobile applications were targeted largely to postpartum women, focused on breastfeeding duration, and included troubleshooting information. Mobile applications often included media components ( n = 12 [24%]); few were tailored or personalized ( n = 5 [10%]) and interactive ( n = 15 [30%]). Text-messaging programs were available in a variety of countries ( n = 7 [58%]) and provided mostly informational support ( n = 5 [42%]), were pro-breastfeeding ( n = 12 [100%]), were targeted to both pregnant and postpartum women ( n = 6 [50%]), focused on both breastfeeding initiation and duration ( n = 9 [75%]), and had two-way interactivity ( n = 6 [50%]) and personalization ( n = 5 [42%]).

CONCLUSIONS

Although freely available mobile applications and text-messaging programs exist, with potential for wide reach, the majority provide only informational support. These programs would benefit from additional study of their usefulness.

Using social media to deliver weight loss programming to young adults: Design and rationale for the Healthy Body Healthy U (HBHU) trial

BACKGROUND

The transitional period from late adolescence to early adulthood is a vulnerable period for weight gain, with a twofold increase in overweight/obesity during this life transition. In the United States, approximately one-third of young adults have obesity and are at a high risk for weight gain.

PURPOSE

To describe the design and rationale of a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored randomized, controlled clinical trial, the Healthy Body Healthy U (HBHU) study, which compares the differential efficacy of three interventions on weight loss among young adults aged 18-35years.

METHODS

The intervention is delivered via Facebook and SMS Text Messaging (text messaging) and includes: 1) targeted content (Targeted); 2) tailored or personalized feedback (Tailored); or 3) contact control (Control). Recruitment is on-going at two campus sites, with the intervention delivery conducted by the parent site. A total of 450 students will be randomly-assigned to receive one of three programs for 18months. We hypothesize that: a) the Tailored group will lose significantly more weight at the 6, 12, 18month follow-ups compared with the Targeted group; and that b) both the Tailored and Targeted groups will have greater weight loss at the 6, 12, 18month follow-ups than the Control group. We also hypothesize that participants who achieve a 5% weight loss at 6 and 18months will have greater improvements in their cardiometabolic risk factors than those who do not achieve this target. We will examine intervention costs to inform implementation and sustainability other universities. Expected study completion date is 2019.

CONCLUSIONS

This project has significant public health impact, as the successful translation could reach as many as 20 million university students each year, and change the current standard of practice for promoting weight management within university campus communities. ClinicalTrial.gov: NCT02342912.

Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination

Despite the increased health risks of a sedentary lifestyle, only 49 % of American adults participate in physical activity (PA) at the recommended levels. In an effort to move the PA field forward, we briefly review three emerging areas of PA intervention research. First, new intervention research has focused on not only increasing PA but also on decreasing sedentary behavior. Researchers should utilize randomized controlled trials, common terminology, investigate which behaviors should replace sedentary behaviors, evaluate long-term outcomes, and focus across the lifespan. Second, technology has contributed to an increase in sedentary behavior but has also led to innovative PA interventions. PA technology research should focus on large randomized trials with evidence-based components, explore social networking and innovative apps, improve PA monitoring, consider the lifespan, and be grounded in theory. Finally, in an effort to maximize public health impact, dissemination efforts should address the RE-AIM model, health disparities, and intervention costs.

Breastfeeding Duration and Primary Reasons for Breastfeeding Cessation among Women with Postpartum Depressive Symptoms

BACKGROUND

Although postpartum depression is associated with lower breastfeeding initiation rates and shorter breastfeeding duration, the potential mechanisms through which this relationship functions are not well understood.

OBJECTIVE

This study examined the breastfeeding behaviors of women with postpartum depressive symptoms (PDS) to identify potential motivations for early breastfeeding cessation.

METHODS

An analysis of quantitative data from the Infant Feeding Practices Study II examined the relationship between PDS and breastfeeding behaviors, including breastfeeding duration and primary reasons for early breastfeeding cessation.

RESULTS

Of the women in the sample, 30.9% met criteria for mild PDS. Women with PDS had shorter overall (18.4 vs 21.8 weeks, P = .001) and exclusive breastfeeding duration (3.6 vs 4.7 weeks, P = .012) than women without PDS. A larger proportion of women with PDS stopped breastfeeding before 6 months (68.7% vs 57.2%, P < .001). After controlling for socioeconomic status, education, marital status, employment status, race/ethnicity, maternal age, parity, and breastfeeding intentions, presence of PDS significantly predicted higher odds of reporting "too many household duties" (OR = 1.90, P = .011) as a primary reason for breastfeeding cessation among women who stopped breastfeeding before 6 months. After controlling for these same covariates, women with PDS had, on average, 2.4 weeks shorter breastfeeding duration than women without PDS (P = .025).

CONCLUSION

There is a high prevalence of depressive symptoms among new mothers, and most do not breastfeed for recommended time periods. Increased PDS screening during prenatal and postpartum visits and promotion of lactation support services may better address the high rates of PDS and suboptimal breastfeeding behavior.

Examination of the Beck Depression Inventory-II Factor Structure Among Bariatric Surgery Candidates

BACKGROUND

The Beck Depression Inventory-II (BDI-II) is frequently used to evaluate bariatric patients in clinical and research settings; yet, there are limited data regarding the factor structure of the BDI-II with a bariatric surgery population.

METHODS

Exploratory factor analysis (EFA) using principal axis factoring with oblimin rotation was employed with data from 1228 consecutive presurgical bariatric candidates. Independent t tests were used to examine potential differences between sexes. Confirmatory factor analysis (CFA) was conducted with the next 383 consecutive presurgical patients to evaluate the proposed model based on EFA results.

RESULTS

EFA revealed three factors: negative perceptions, diminished vigor, and cognitive dysregulation, each with adequate internal consistency. Six BDI-II items did not load significantly on any of the three factors. CFA results largely supported the proposed model.

CONCLUSIONS

Results suggest that dimensions of depression for presurgical bariatric candidates vary from other populations and raise important caveats regarding the utility of the BDI-II in bariatric research.

Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control

BACKGROUND

Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas.

METHODS

Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs.

RESULTS

At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months.

CONCLUSIONS

While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population.

TRIAL REGISTRATION

NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.

The effect of insurance status on pre- and post-operative bariatric surgery outcomes

BACKGROUND

This study compared pre- and post-surgical data and outcomes among gastric bypass patients based on the type of insurance (Medicaid, Medicare, or private).

METHODS

Data were examined from 2553 consecutive RYGB patients at a rural ASMBS Center of Excellence.

RESULTS

Participants were primarily female (80.5 %), Caucasian (97.1 %), and middle-aged (45.9 years). Medicaid patients' BMI at consultation was significantly higher than the other two groups (p < 0.001). Time to surgery was significantly longer for Medicaid (13.2 %) and Medicare (7.1 %) patients compared with privately insured patients (p < 0.001). Pre-surgical weight loss and post-surgical percent of excess weight loss nadir did not differ among the groups. Type 2 diabetes remission rates were comparable across insurance groups.

CONCLUSIONS

Medicaid patients, although demographically different from their privately insured and Medicare counterparts, will benefit from surgery with comparable weight loss results and overall diabetes remission rates.

Internalized weight bias in weight-loss surgery patients: psychosocial correlates and weight loss outcomes

PURPOSE

In this study, we examined the relationship between pre-operative internalized weight bias and 12-month post-operative weight loss in adult bariatric surgery patients.

METHODS

Bariatric surgery patients (n=170) from one urban and one rural medical center completed an internalized weight bias measure (the weight bias internalization scale, WBIS) and a depression survey (Beck depression inventory-II, BDI-II) before surgery, and provided consent to access their medical records.

RESULTS

Participants (BMI=47.8 kg/m2, age=45.7 years) were mostly female (82.0 %), White (89.5 %), and underwent gastric bypass (83.6 %). The average WBIS score by item was 4.54 ± 1.3. Higher pre-operative WBIS scores were associated with diminished weight loss at 12 months after surgery (p=0.035). Pre-operative WBIS scores were positively associated with depressive symptoms (p<0.001).

CONCLUSION

Greater internalized weight bias was associated with more depressive symptoms before surgery and less weight loss 1 year after surgery.

Smoking and alcohol use in gastric bypass patients

Bariatric surgery may increase the risk of substance use. The purpose of this study was to prospectively assess smoking and alcohol use before and after bariatric surgery, identify characteristics associated with alcohol use and smoking, and examine substance use and weight loss. Participants (N = 155, mean = 50.1 ± 11.3 y and 45.7 ± 7.0 kg/m(2)) were Roux-en-Y gastric bypass (RYGB) patients that completed surveys on substance use preoperatively and postoperatively. Alcohol use decreased significantly from the preoperative (72.3%) to the postoperative (63.2%) period. As preoperative alcohol quantity rose, the odds of consuming any alcohol postoperatively increased six-fold. Higher BMI increased the odds of high alcohol consumption. Older age decreased the odds of alcohol use and smoking. Smoking status did not differ pre- (19.4%) to post- (14.8%) surgery. Alcohol use and smoking were not associated with weight loss. After weight-loss surgery, alcohol use declined but smoking rates did not significantly change. Younger patients were more likely to use alcohol and smoke postoperatively. Patients with a higher BMI or a history of substance use may be more likely to use alcohol postoperatively.

Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial

BACKGROUND

Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor.

METHODS

Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions.

RESULTS

Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12).

CONCLUSIONS

Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

Using avatars to model weight loss behaviors: participant attitudes and technology development

BACKGROUND

Virtual reality and other avatar-based technologies are potential methods for demonstrating and modeling weight loss behaviors. This study examined avatar-based technology as a tool for modeling weight loss behaviors.

METHODS

This study consisted of two phases: (1) an online survey to obtain feedback about using avatars for modeling weight loss behaviors and (2) technology development and usability testing to create an avatar-based technology program for modeling weight loss behaviors.

RESULTS

Results of phase 1 (n = 128) revealed that interest was high, with 88.3% stating that they would participate in a program that used an avatar to help practice weight loss skills in a virtual environment. In phase 2, avatars and modules to model weight loss skills were developed. Eight women were recruited to participate in a 4-week usability test, with 100% reporting they would recommend the program and that it influenced their diet/exercise behavior. Most women (87.5%) indicated that the virtual models were helpful. After 4 weeks, average weight loss was 1.6 kg (standard deviation = 1.7).

CONCLUSIONS

This investigation revealed a high level of interest in an avatar-based program, with formative work indicating promise. Given the high costs associated with in vivo exposure and practice, this study demonstrates the potential use of avatar-based technology as a tool for modeling weight loss behaviors.

Exercise advice by humans versus computers: maintenance effects at 18 months

OBJECTIVE

An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors.

METHODS

Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry.

RESULTS

The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months.

CONCLUSIONS

The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation.

Using Facebook and text messaging to deliver a weight loss program to college students

OBJECTIVE

Between 31 and 35% of the college-aged population is overweight or obese, yet few weight loss trials for this population have been conducted. This study examined the feasibility, acceptability, and initial efficacy of a technology-based 8-week weight loss intervention among college students.

DESIGN AND METHODS

Students (N = 52) were randomly assigned to one of the three arms: Facebook (n = 17); Facebook Plus text messaging and personalized feedback (n = 18); Waiting List control (n = 17), with assessments at 4 weeks and 8 weeks (post-treatment). Participants were 20.47 ± 2.19 years old, 86.45 ± 17.11 kg, with a body mass index of 31.36 ± 5.3 kg/m(2) . Participants were primarily female (86.5%), and the sample was racially diverse (57.7% Caucasian, 30.8% African American, 5.8% Hispanic, and 5.7% other races).

RESULTS

The primary outcome was weight loss after 8 weeks (post-treatment); 96.0% of the participants completed this assessment. At 8 weeks, the Facebook Plus group had significantly greater weight loss (-2.4 ± 2.5 kg) than the Facebook (-0.63 ± 2.4 kg) and Waiting List (-0.24 ± 2.6 kg) (both Ps < 0.05). Weight change at 8 weeks was not significantly different between the Facebook and Waiting List groups.

CONCLUSIONS

Results show preliminary efficacy and acceptability of the two active intervention arms (97.0% found the program helpful, 81.3% found the videos/handouts helpful, and 100% would recommend the program to others). Results indicate the potential for an innovative weight loss intervention that uses technology platforms (Facebook and text messaging) that are frequently used and already integrated into the cultural life of college students.

Examination of weight control practices in a non-clinical sample of college women

The current study examined healthy weight control practices among a sample of college women enrolled at an urban university (N=715; age=19.87±1.16; 77.2% Caucasian; 13.4% African American, 7.2% Asian, 2.2% other races). Participants completed measures as part of an on-line study about health habits, behaviors, and attitudes. Items from the Three Factor Eating Questionnaire were selected and evaluated with exploratory factor analysis to create a healthy weight control practices scale. Results revealed that college women, regardless of weight status, used a comparable number (four of eight) of practices. Examination of racial differences between Caucasian and African American women revealed that normal weight African American women used significantly fewer strategies than Caucasian women. Of note, greater use of healthy weight control practices was associated with higher cognitive restraint, drive for thinness, minutes of physical activity, and more frequent use of compensatory strategies. Higher scores on measures of binge and disinhibited eating, body dissatisfaction, negative affect, and depressive symptoms were associated with greater use of healthy weight control practices by underweight/normal weight but not by overweight/obese college women. Results suggest that among a sample of college females, a combination of healthy and potentially unhealthy weight control practices occurs. Implications of the findings suggest the need for effective weight management and eating disorder prevention programs for this critical developmental life stage. Such programs should be designed to help students learn how to appropriately use healthy weight control practices, as motivations for use may vary by weight status.

The impact of self-monitoring of blood glucose on a behavioral weight loss intervention for patients with type 2 diabetes

PURPOSE

The purpose of the study was to examine the association of self-monitoring of blood glucose (SMBG) to weight loss and A1C among participants in a behavioral weight loss intervention.

METHODS

Multivariate analyses were employed to evaluate the relationship between SMBG and changes in patient weight and A1C levels. Bootstrapping was used to determine whether there was an indirect effect of SMBG on weight loss through diet adherence and an indirect effect of SMBG on A1C through weight loss.

RESULTS

The relationship between increased SMBG and greater weight loss was mediated by better adherence to diet. The relationship of increased SMBG and greater reductions in A1C were mediated by greater weight loss.

CONCLUSIONS

Results of the study were consistent with the hypothesis that SMBG leads to an increased adherence to dietary recommendations. For patients who are taught to use their diet to lose weight, increased adherence to dietary recommendations is associated with increased weight loss and subsequently better glucose control. SMBG may be of value as an adjunctive intervention in behavioral programs for type 2 diabetes.

Mediators of physical activity behavior change: findings from a 12-month randomized controlled trial

OBJECTIVE

To examine putative mediators of a 12-month motivationally tailored physical activity (PA) promotion intervention.

DESIGN

We randomly assigned 239 healthy, underactive adults (moderate-vigorous physical activity <90 min/week; mean age = 47.5 years; 82% women) to receive (a) print-based feedback, (b) phone-based feedback, or (c) contact control.

PRIMARY OUTCOME

PA at baseline, 6, and 12 months, as measured by the 7-day physical activity recall interview. MEDIATORS: Four TransTheoretical Model constructs explicitly targeted by the intervention (i.e., self-efficacy, decisional balance, cognitive and behavioral processes of change), as well as four additional constructs linked to PA behavior change (i.e., social support, outcome expectancy, PA enjoyment, exercise-induced feelings).

RESULTS

Multivariate mediation analyses were used to analyze longitudinal PA outcomes. Changes in behavioral processes and one aspect of exercise-induced feelings (revitalization) satisfied both action theory (i.e., treatment effects on mediators) and conceptual theory (i.e., mediator effects on PA) tests at 6 and 12 months and emerged as statistically significant mediators of treatment effects on PA across delivery channels (ps <.014). Cognitive processes, self-efficacy, decisional balance, and social support for PA participation satisfied Action Theory tests at both 6 and 12 months, but failed conceptual theory tests. Delayed intervention effects were observed on other aspects of exercise-induced feelings, PA enjoyment, and outcome expectancies, but these variables failed mediation testing at 12 months.

CONCLUSION

Findings are consistent with previous research illustrating the importance of behavioral processes of change, but also indicate that affective response to PA may warrant more attention as a potential target of behavior change programs.

Does tailoring on additional theoretical constructs enhance the efficacy of a print-based physical activity promotion intervention?

OBJECTIVE

To enhance a previously efficacious individually tailored physical activity (PA) promotion intervention by adding theoretical constructs to the tailored feedback.

DESIGN

We randomly assigned 248 healthy, underactive (moderate to vigorous physical activity [MVPA] min/week < 90) adults (mean age = 48.8 years, SD = 10.0) to receive either (a) a theoretically tailored (based on 5 constructs from the transtheoretical model and social-cognitive theory [SCT]) print-based PA promotion intervention (print) or (b) the same theoretically tailored print-based PA promotion intervention plus enhanced tailoring addressing 5 additional SCT constructs (enhanced print).

MAIN OUTCOME MEASURE

The 7-day physical activity recall administered at baseline, Month 6, and Month 12, with outcomes operationalized as percentage achieving 150 min/week of MVPA.

RESULTS

When controlling for covariates, there was a nonsignificant trend in favor of the enhanced print condition reflecting 46% and 50% greater odds of achieving 150 min/week of MVPA at Month 6 and Month 12, respectively.

CONCLUSION

Enhanced tailoring based on additional theoretical constructs may result in marginal improvements in physical activity outcomes.

Effects of weight status and barriers on physical activity adoption among previously inactive women

This study examined self-reported physical activity (PA) barriers, and their effects on PA behavior change at 3 and 12 months among 280 previously inactive women enrolled in a PA promotion trial. Effect modification of baseline barriers by baseline weight status on PA behavior change was also examined. At baseline and month 12, obese women reported significantly greater PA barriers compared with normal and overweight women (P < 0.05). Individual barriers that were more likely to be elevated for obese vs. normal and overweight participants at baseline were feeling too overweight, feeling self-conscious, reporting minor aches and pains, and lack of self-discipline. Also, weight status moderated the effect of PA barriers on PA behavior change from baseline to month 3 (P < 0.05), but not to month 12 (P = 0.637), with obese participants reporting high barriers achieving 70 min/week fewer than those with low barriers (P < 0.05). Finally, the interaction between barriers (high vs. low) and weight status (obese vs. normal), shows PA barriers had a detrimental PA effect among obese participants that was 122.5 min/week (95% confidence interval (CI) = 15.7, 229.4; P < 0.05) lower than their effect on normal-weight participants. These results suggest that for obese women, PA barriers have quantifiable effects on PA behavior change. This study has implications for the design of future weight loss and PA interventions, suggesting that a comprehensive assessment of PA barriers is a prerequisite for appropriate tailoring of behavioral PA interventions.

Targeting body image schema for smoking cessation among college females: rationale, program description, and pilot study results

Smoking among young adults is a significant public health problem. Despite the negative health effects, many young women smoke for weight and body image reasons. Understanding the factors that prompt young women to initiate and continue smoking is important for designing smoking cessation interventions. The aim of the current article is to outline a potential pathway for smoking behavior among young women, specifically applying a cognitive bias framework previously used to describe disordered eating behaviors. This article provides the rationale for using two different treatments targeting body image schema among female smokers. The authors describe the development, feasibility, and acceptability of these two treatment approaches among a sample of female college smokers (N = 24). Preliminary pilot data are presented as well as the significance and implications for future clinical interventions.

Race, weight, and correlates of binge eating in female college students

This study examined the correlates of race, weight status, and binge eating among 715 female undergraduate students (77% Caucasian; 13% African American) enrolled at an urban university. Approximately 21.7% of Caucasians and 36.8% of African-Americans (AA) were overweight/obese. Higher BMI was associated with BED, and severity of binge eating symptoms. After removing participants who endorsed compensatory behaviors ≥ 1×/week from the analyses, 8.4% of the sample met criteria for BED (2.4% of the AA and 9.9% of the Caucasian students) and 44% reported severe binge eating symptoms. AA students were less likely to have BED than Caucasian students and reported less severe binge eating symptomatology. For Caucasian students, mood, cognitive restraint, drive for thinness, and BMI all contributed significant individual variance in binge eating severity. For African Americans, mood, body image dissatisfaction, and drive for thinness were found to be unique contributors. For those meeting criteria for BED, retrospectively recalled predictors of binge eating included negative affect (e.g., self-anger, worry, guilt), but not hunger. Behavioral triggers for binge behavior differed by race, as well, with African American students retrospectively reporting lower levels of anxiety prior to bingeing. Results from this study suggest that there are racial differences in binge eating behaviors. Future studies are needed to examine differences in eating practices among racial groups (e.g., grazing, large portions, high fat food preparation) that may contribute to early onset weight gain and obesity. The results suggest the importance of sensitive tailored weight and disordered eating interventions for college women from diverse backgrounds.

Behavioral and psychological factors associated with 12-month weight change in a physical activity trial

Examining behavioral and psychological factors relating to weight stability over a 1-year period is of public health importance. We conducted a physical activity (PA) intervention trial for women (N = 247; mean age = 47.5 ± 10.7; mean BMI = 28.6 ± 5.3) in which participants were assigned to one of three groups (two PA and one contact-control). By Month 12, participants achieved 140.4 ± 14.82 min of PA/week, with no group differences. Weight status change from baseline to Month 12 was categorized: no change (N = 154; 62.4%); increase (N = 34; 13.8%); decrease (N = 59; 23.9%). Discriminant function analyses indentified two statistically significant dimensions associated with weight change. Dimension 1 was positively weighted by mood (0.73) and self-efficacy (0.79); dimension 2 was positively weighted to change in physical activity (0.58) and fat consumption (0.55). Results provide further evidence for the importance of behavior in long-term weight maintenance, particularly physical activity and dietary fat. These findings also provide evidence for the importance of addressing psychosocial variables, in particular depressed mood and self-efficacy.

Accelerometer use in a physical activity intervention trial

This paper describes the application of best practice recommendations for using accelerometers in a physical activity (PA) intervention trial, and the concordance of different methods for measuring PA. A subsample (n = 63; 26%) of the 239 healthy, sedentary adults participating in a PA trial (mean age = 47.5; 82% women) wore the ActiGraph monitor at all 3 assessment time points. ActiGraph data were compared with self-report (i.e., PA weekly recall and monthly log) and fitness variables. Correlations between the PA recall and ActiGraph for moderate intensity activity ranged from 0.16-0.48 and from 0.28-0.42 for vigorous intensity activity. ActiGraph and fitness [estimated VO(2)(ml/kg/min)] had correlations of 0.15-0.45. The ActiGraph and weekly self-report were significantly correlated at all time points (correlations ranged from 0.23 to 0.44). In terms of detecting intervention effects, intervention groups recorded more minutes of at least moderate-intensity PA on the ActiGraph than the control group at 6 months (min = 46.47, 95% CI = 14.36-78.58), but not at 12 months. Limitations of the study include a small sample size and only 3 days of ActiGraph monitoring. To obtain optimal results with accelerometers in clinical trials, the authors recommend following best practice recommendations: detailed protocols for monitor use, calibration of monitors and validation of data quality, and use of validated equations for analysis. The ActiGraph has modest concordance with other assessment tools and is sensitive to change over time. However, until more information validating the use of accelerometry in clinical trials becomes available, properly administered self-report measures of PA should remain part of the assessment battery.

When, why and for whom there is a relationship between physical activity and menopause symptoms

OBJECTIVES

The relationship between enhanced physical activity and decreased menopause symptoms is equivocal. In this study we sought to better understand this relationship by examining the association of physical activity to different symptom domains and by examining mediating and moderating variables.

STUDY DESIGN

Women participating in a randomized control trial on physical activity were given a menopause symptom measure (MENQOL) at follow-up. Of the 280 women participating, 113 (mean age=52) reported having symptoms they attributed to menopause. Regression analyses were run to examine if change in physical activity predicted fewer symptoms. Exercise self-efficacy was examined as a mediator and depressive symptoms as a moderator.

RESULTS

An increase in physical activity from baseline was found to be related to reporting fewer total menopause symptoms (beta=-0.22, p=.02). When the total menopause symptoms score was examined by domain, increased physical activity was found to be related to reporting fewer general symptoms attributed to menopause (psychosocial (beta=-0.18, p=.05) and physical (beta=-0.23, p=.01)), but had no effect on specific symptoms of menopause (vasomotor and sexual). Exercise self-efficacy was found to mediate the relationship between increased physical activity and total, physical and psychosocial menopause symptoms. Finally, for individuals with high depressive symptoms, those who increased physical activity the most reported fewer sexual symptoms of menopause.

CONCLUSION

This study suggests that physical activity participation is associated with lower general symptom reporting as opposed to specifically impacting menopause symptoms. Further, exercise self-efficacy mediates the relationship between physical activity and general menopause symptoms, suggesting a psychological pathway.

Interventions to increase walking behavior

Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions. We identified 14 randomized controlled trials, which tested interventions specifically targeting and assessing walking behavior. Results show that among self-selected samples, intensive interventions can increase walking behavior relative to controls. Brief telephone prompts appear to be as effective as more substantial telephone counseling. Although more research is needed, individual studies support prescriptions to walk 5-7 versus 3-5 d.wk and at a moderate (vs vigorous) intensity pace, with no differences in total walking minutes when single or multiple daily walking bouts are prescribed. Mediated interventions delivering physical activity promotion materials through non-face-to-face channels may be ideal for delivering walking promotion interventions and have shown efficacy in promoting overall physical activity, especially when theory-based and individually tailored. Mass media campaigns targeting broader audiences, including those who may not intend to increase their physical activity, have been successful at increasing knowledge and awareness about physical activity but are often too diffuse to successfully impact individual behavior change. Incorporating individually tailored programs into broader mass media campaigns may be an important next step, and the Internet could be a useful vehicle.