Interventions intended to reduce the consumption of dietary sugars among those population groups demonstrating disproportionately greater and more frequent consumption of sugar-sweetened beverages ...and foods (SSBF) would benefit from intervention strategies that are tailored to population-specific barriers and facilitators. The objective of this study was to develop and evaluate the acceptability of photo-enhanced and theory-based health promotion messages that target the reduction in SSBF among adult residents of public housing developments, a population known for their high rates of chronic disease. Using the message development tool as a framework, we developed a series of 15 SSBF reduction messages, using an iterative process with community member input. We then evaluated the acceptability of the messages and compared three delivery mechanisms: print, text, and social media. We recruited participants who were residents of urban public housing developments, and who spoke either English or Spanish. A majority of participants identified as being of Hispanic ethnicity (73%). The message acceptability scoring did not appear to differ according to the assigned delivery mechanism, despite some imbalances in participants' characteristics across delivery mechanisms. The messages that targeted motivation were least likely to be accepted. In conclusion, our findings suggest that engaging members of the community at all phases of the development process was a feasible method to develop SSBF reduction messages with a high perceived acceptability.
Individuals with opioid use disorder (OUD) who smoke cigarettes have high tobacco-related comorbidities, lack of access to tobacco treatment, lack of inclusion in smoking cessation trials, and remain ...understudied in the mobile health field. The purpose of this study was to understand patients' with OUD perceptions of 1) text message programs to promote smoking cessation, 2) content and features to include in such a program, and 3) how message content should be framed.
From December 2018 to February 2019, we recruited 20 hospitalized individuals with a concurrent diagnosis of OUD and tobacco dependence at Boston Medical Center (BMC), the largest safety-net hospital in New England. We surveyed participants' cell phone use, their interest in a text message program to promote smoking cessation, and their reactions to and ratings of a series of 26 prototype texts. We then conducted open-ended interviews to elicit content and suggestions on how text message interventions can improve motivation to increase smoking cessation among individuals with OUD. The interviews also included open-ended inquiries exploring message ratings and message content, inquiries about preferences for message duration, frequency, and personalization.
Quantitative analysis of questionnaire data indicated that the majority of participants owned a cell phone (95%, 19/20). Most participants (60%, 12/20) reported that they would be interested or very interested in receiving text messages about smoking cessation. Text messages about the health benefits of quitting were rated the highest among various categories of text messages. Qualitative analysis showed that almost every participant felt that text messages would help motivate smoking cessation given the support it would provide.
This study demonstrates that individuals with OUD who smoke cigarettes perceive that a text message program designed to promote smoking cessation would motivate and support smoking cessation efforts. Our findings demonstrate that such a program is feasible as participants own cell phones, frequently send and receive text messages, and have unlimited text message plans. Findings from this study provide valuable insight into content and features to include when developing text message programs to address barriers to smoking cessation in individuals who have OUD and smoke cigarettes.
Sugar-sweetened beverage (SSB) consumption is an important behavior that can influence individuals' risk for diabetes, obesity, and other chronic diseases. Nonetheless, there is a lack of valid ...measures to assess SSB-related constructs. Reliable and valid measures can help evaluate the efficacy of interventions designed to curb SSB consumption. Our aim was to develop a valid and reliable instrument to measure constructs related to SSB consumption in English and Spanish.
A cross-sectional survey was conducted among a convenience sample of 150 adult residents of public housing developments in Boston, Massachusetts between July of 2016 and January of 2017. All households from two public housing developments were approached by study staff to solicit participation via door-to-door knocking and posted flyers. We developed questions to measure three SSB-related constructs informed by the Social Cognitive Theory: SSB knowledge, and self-efficacy and intention to act on SSB consumption. The questions were pilot tested in the population, and then administered in-person by bilingual study staff in either English or Spanish. Interviews were conducted most often in the participant's home and less frequently within a community space. Item normality was assessed with descriptive statistics. Difficulty of knowledge items was assessed with percent correct. Construct validity of self-efficacy items was assessed using confirmatory factor analysis (CFA). A model was considered a good fit if confirmatory factor index (CFI) > 0.95, root mean square error of approximation (RMSEA) < 0.05, and standardized root mean square residual (RMSR) < 0.05. Pearson correlations with consumption scores assessed criterion validity, and intraclass correlation coefficients (ICC) assessed test-retest reliability.
Of the eight knowledge items tested, only four items resulted in correct answers less than half of the time. CFA resulted in a 5-item scale with excellent fit indices (CFI = .99; RMSEA = .025: SRMR = .02) and Cronbach's (0.79), test-retest (ICC = 0.68), and significant correlation with intention and SSB consumption. Of the four intention items, one was significantly correlated with SSB consumption.
This study provides evidence for the validity of key constructs related to SSB consumption for use in adults, which could provide important theory-based markers for program evaluations of SSB-related interventions.
Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents ...are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments.
This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments.
Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable.
These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.
Abstract
Background
Physical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the ...intervention period. Interventions at both environmental and individual levels might facilitate durable change. This community-based study seeks to test a multilevel, multicomponent intervention to increase moderate intensity physical activity among people with low incomes living in U.S. public housing developments, over a 2 year period.
Methods
The study design is a prospective, cluster randomized controlled trial, with housing developments (
n=
12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual (E+I) intervention (3 developments), against an assessment only control group (3 developments). The environmental only intervention consists of community health workers leading walking groups and indoor activities, a walking advocacy program for residents, and provision of walking maps/signage. The individual only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is change in moderate intensity physical activity measured via an accelerometer-based device among an evaluation cohort (
n=
50 individuals at each of the 12 developments) from baseline to 24-month follow up. Mediation (e.g., neighborhood walkability, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to inform future implementation.
Discussion
We hypothesize participants living in developments in any of the three intervention groups (E only, I only, and E+I combined) will increase minutes of moderate intensity physical activity more than participants in control group developments. We expect delivery of an intervention package targeting environmental and social factors to become active, combined with the individual level intervention, will improve overall physical activity levels to recommended guidelines at the development level. If effective, this trial has the potential for implementation through other federal and state housing authorities.
Trial registration
Clinical Trails.gov PRS
Protocol Registration and Results System
,
NCT05147298
. Registered 28 November 2021.
Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited ...if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines.
The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes.
The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing-based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires.
Ten women participated; they had a mean age of 59 years (SD 6), 50% belonged to a racial or ethnic minority group, 50% had some college or less, and 40% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100% of participants completed all 4 calls with the counselor. Most (90%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change -3.38 SD 7.67), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 SD 2.82), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 SD 1694).
Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions.
We present the first high-quality catalog of early aftershocks of the three mainshocks of the 2016 central Italy Amatrice-Visso-Norcia normal faulting sequence. We located 10,574 manually picked ...aftershocks with a robust probabilistic, non-linear method achieving a significant improvement in the solution accuracy and magnitude completeness with respect to previous studies. Aftershock distribution and relocated mainshocks give insight into the complex architecture of major causative and subsidiary faults, thus providing crucial constraints on multi-segment rupture models. We document reactivation and kinematic inversion of a WNW-dipping listric structure, referable to the inherited Mts Sibillini Thrust (MST) that controlled segmentation of the causative normal faults. Spatial partitioning of aftershocks evidences that the MST lateral ramp had a dual control on rupture propagation, behaving as a barrier for the Amatrice and Visso mainshocks, and later as an asperity for the Norcia mainshock. We hypothesize that the Visso mainshock re-activated also the deep part of an optimally oriented preexisting thrust. Aftershock patterns reveal that the Amatrice Mw5.4 aftershock and the Norcia mainshock ruptured two distinct antithetic faults 3-4 km apart. Therefore, our results suggest to consider both the MST cross structure and the subsidiary antithetic fault in the finite-fault source modelling of the Norcia earthquake.
Parkinson disease (PD) is a debilitating and chronic neurodegenerative disease resulting in ambulation difficulties. Natural walking activity often declines early in disease progression despite the ...relative stability of motor impairments. In this study, we propose a paradigm shift with a "connected behavioral approach" that targets real-world walking using cognitive-behavioral training and mobile health (mHealth) technology.
The Walking and mHealth to Increase Participation in Parkinson Disease (WHIP-PD) study is a twelve-month, dual site, two-arm, randomized controlled trial recruiting 148 participants with early to mid-stage PD. Participants will be randomly assigned to connected behavioral or active control conditions. Both conditions will include a customized program of goal-oriented walking, walking-enhancing strengthening exercises, and eight in-person visits with a physical therapist. Participants in the connected behavioral condition also will (1) receive cognitive-behavioral training to promote self-efficacy for routine walking behavior and (2) use a mHealth software application to manage their program and communicate remotely with their physical therapist. Active control participants will receive no cognitive-behavioral training and manage their program on paper. Evaluations will occur at baseline, three-, six-, and twelve-months and include walking assessments, self-efficacy questionnaires, and seven days of activity monitoring. Primary outcomes will include the change between baseline and twelve months in overall amount of walking activity (mean number of steps per day) and amount of moderate intensity walking activity (mean number of minutes per day in which > 100 steps were accumulated). Secondary outcomes will include change in walking capacity as measured by the six-minute walk test and ten-meter walk test. We also will examine if self-efficacy mediates change in amount of walking activity and if change in amount of walking activity mediates change in walking capacity.
We expect this study to show the connected behavioral approach will be more effective than the active control condition in increasing the amount and intensity of real-world walking activity and improving walking capacity. Determining effective physical activity interventions for persons with PD is important for preserving mobility and essential for maintaining quality of life. Clinical trials registration NCT03517371, May 7, 2018.
ClinicalTrials.gov: NCT03517371. Date of registration: May 7, 2018. Protocol version: Original.
Rates of physical inactivity are high among Black women living in the United States with overweight or obesity, especially those living in the rural South. This study was conducted to determine if an ...efficacious weight gain prevention intervention increased moderate-vigorous physical activity (MVPA).
The Shape Program, a weight gain prevention intervention implemented in community health centers in rural North Carolina, was designed for socioeconomically disadvantaged Black women with overweight or obesity. MVPA was measured using accelerometers, and summarized into 1- and 10-min bouts. We employed analyses of covariance (ANCOVA) to assess the relationship between changes in MVPA over 12 months, calculated as a change score, and intervention assignment (intervention versus usual care).
Participants completing both baseline and 12-month accelerometer assessments (n = 121) had a mean age of 36.1 (SD = 5.43) years and a mean body mass index of 30.24 kg/m
(SD = 2.60). At baseline, 38% met the physical activity recommendation (150 min of MVPA/week) when assessed using 10-min bouts, and 76% met the recommendation when assessed using 1-min bouts. There were no significant differences in change in MVPA participation among participants randomized to the intervention from baseline to 12-months using 1-min bouts (adjusted intervention mean 95% CI: 20.50 -109.09 to 150.10 vs. adjusted usual care mean 95% CI: -80.04 -209.21 to 49.13, P = .29), or 10-min bouts (adjusted intervention mean 95% CI: 7.39 -83.57 to 98.35 vs. adjusted usual care mean 95% CI: -17.26 -107.93 to 73.40, P = .70).
Although prior research determined that the Shape intervention promoted weight gain prevention, MVPA did not increase significantly among intervention participants from baseline to 12 months. The classification of bouts had a marked effect on the prevalence estimates of those meeting physical activity recommendations. More research is needed to understand how to promote increased MVPA in weight gain prevention interventions.
This study is registered at www.clinicaltrials.gov database (No. NCT00938535. Retrospectively Registered 7/10/2009).
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