Herpreet Thind

The associations of perceived neighborhood disorder and physical activity with obesity among African American adolescents

BackgroundAccording to recent research studies, the built and socioeconomic contexts of neighborhoods are associated with African American adolescents’ participation in physical activity and obesity status. However, few research efforts have been devoted to understand how African American adolescents’ perceptions of their neighborhood environments may affect physical activity behaviors and obesity status. The objective of the current study was to use a perceived neighborhood disorder conceptual framework to examine whether physical activity mediated the relationship between perceived neighborhood disorder and obesity status among African American adolescents.MethodsThe data were obtained from a cross-sectional study that examined social and cultural barriers and facilitators of physical activity among African American adolescents. The study included a sample of 101 African American adolescents age 12 to 16 years and their parents who were recruited from the Birmingham, Alabama metropolitan area. The primary outcome measure was obesity status which was classified using the International Obesity Task Force cut off points. Moderate-to-vigorous physical activity was assessed via accelerometry. Perceived neighborhood disorder was assessed using the Perceived Neighborhood Disorder Scale. Mediation models were used to examine whether the relationship between neighborhood disorder and obesity status was mediated by physical activity.ResultsPerceived neighborhood disorder was significantly and positively related to obesity status and moderate-to-vigorous physical activity was inversely associated with obesity status. However, there was no evidence to support a significant mediating effect of moderate-to-vigorous physical activity on the relationship between neighborhood disorder and obesity status.ConclusionFuture studies should longitudinally assess perceived neighborhood disorder characteristics and childhood adiposity to examine the timing, extent, and the mechanisms by which perceived neighborhood disorder characteristics increase the risk of obesity.

Translating Behavioral Interventions Onto mHealth Platforms: Developing Text Message Interventions for Smoking and Alcohol.

The development of mHealth applications is often driven by the investigators and developers with relatively little input from the targeted population. User input is commonly limited to “like/dislike” post- intervention consumer satisfaction ratings or device or application specific user analytics such as usability. However, to produce successful mHealth applications with lasting effects on health behaviors it is crucial to obtain user input from the start of each project and throughout development. The aim of this tutorial is to illustrate how qualitative methods in an iterative process of development have been used in two separate behavior change interventions (targeting smoking and alcohol) delivered through mobile technologies (ie, text messaging). A series of focus groups were conducted to assist in translating a face-to-face smoking cessation intervention onto a text message (short message service, SMS) delivered format. Both focus groups and an advisory panel were used to shape the delivery and content of a text message delivered intervention for alcohol risk reduction. An in vivo method of constructing message content was used to develop text message content that was consistent with the notion of texting as “fingered speech”. Formative research conducted with the target population using a participatory framework led to important changes in our approach to intervention structure, content development, and delivery. Using qualitative methods and an iterative approach that blends consumer-driven and investigator-driven aims can produce paradigm-shifting, novel intervention applications that maximize the likelihood of use by the target audience and their potential impact on health behaviors.

Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis

Background Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations. Objective The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy. Methods Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined. Results The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet. Conclusions The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority.

Does Short Sleep Lead to Obesity Among Children and Adolescents? Current Understanding and Implications

Childhood obesity continues to be a major public health concern in the United States. This work reviews the current understanding of the relationship between sleep duration and obesity among children and adolescents. A systematic search was conducted for papers published between January 2000 and July 2013 using keywords: (sleep) and (overweight or obesity or obese or body mass index or BMI or adiposity or body fat or fat) and (children or child or youth or teen or pediatric or adolescent or paediatric or childhood or adolescence or boy or girl). Reference lists of relevant articles and reviews or meta-analysis articles were checked to identify additional studies. Only empirical work and longitudinal studies that focused on children and adolescents were included in this review. The search identified 22 longitudinal studies. The majority of the reviewed studies support the presence of an inverse relationship between sleep duration and obesity. However, in some studies the relationship was not significant in adjusted analyses. Differences as a function of age and gender were also noted. Despite more than a decade of research, the debate on the association between sleep duration and obesity continues. Further research with repeated assessments, valid objective measures, and better control of potential confounding variables is warranted.

Predictors of Moderate-to-Vigorous Physical Activity (MVPA) in African American Young Adolescents

BackgroundAfrican American adolescents residing in the South are at increased risk for obesity and physical inactivity, yet our understanding of potential influences is limited.PurposeUsing an ecological framework, this study explored multilevel predictors (individual, family, home, and neighborhood environment) of moderate-to-vigorous physical activity (MVPA) among 116 African American adolescents (ages 12–16).MethodsAdolescents and their parents completed self-report surveys for hypothesized predictors. Youth physical activity was measured using accelerometry.ResultsIn multiple regression models, decreased daily MVPA was associated with female sex (β = −24.27, p < 0.0001). Family social support (β = 1.07, p = 0.004) and adolescent self efficacy for PA (β = 6.89, p = 0.054) were positively associated with daily MVPA.ConclusionsAdolescent demographics along with family social support and self-efficacy influence younger African American adolescent physical activity. Further exploration of the complex interaction of multiple levels of influence is needed to develop appropriate interventions for this vulnerable group.

Mobile Phone Apps for Preventing Cancer Through Educational and Behavioral Interventions: State of the Art and Remaining Challenges

Background Rapid developments in technology have encouraged the use of mobile phones in smoking cessation, promoting healthy diet, nutrition, and physical activity, sun safety, and cancer screening. Although many apps relating to the prevention of cancer and other chronic diseases are available from major mobile phone platforms, relatively few have been tested in research studies to determine their efficacy. Objective In this paper, we discuss issues related to the development and testing of new apps for preventing cancer through smoking cessation, sun safety, and other healthy behaviors, including key methodologic issues and outstanding challenges. Methods An exploratory literature review was conducted using bibliographic searches in PubMed and CINAHL with relevant search terms (eg, smartphones, smoking cessation, cancer prevention, cancer screening, and carcinogens) to identify papers published in English through October 2015. Results Only 4 randomized controlled trials of the use of mobile phone apps for smoking cessation and 2 trials of apps for sun safety were identified, indicating that it is premature to conduct a systematic search and meta-analysis of the published literature on this topic. Conclusions Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of mobile phone apps. In developing new and refined apps for cancer prevention and control, both health literacy and eHealth literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, and sun safety. Mobile phone apps are likely to be a useful and low-cost intervention for preventing cancer through behavioral changes.

A text message intervention for alcohol risk reduction among community college students: TMAP

BACKGROUND Students at community colleges comprise nearly half of all U.S. college students and show higher risk of heavy drinking and related consequences compared to students at 4-year colleges, but no alcohol safety programs currently target this population. OBJECTIVE To examine the feasibility, acceptability, and preliminary efficacy of an alcohol risk-reduction program delivered through text messaging designed for community college (CC) students. METHODS Heavy drinking adult CC students (N=60) were enrolled and randomly assigned to the six-week active intervention (Text Message Alcohol Program: TMAP) or a control condition of general motivational (not alcohol related) text messages. TMAP text messages consisted of alcohol facts, strategies to limit alcohol use and related risks, and motivational messages. Assessments were conducted at baseline, week 6 (end of treatment) and week 12 (follow up). RESULTS Most participants (87%) completed all follow up assessments. Intervention messages received an average rating of 6.8 (SD=1.5) on a 10-point scale. At week six, TMAP participants were less likely than controls to report heavy drinking and negative alcohol consequences. The TMAP group also showed significant increases in self-efficacy to resist drinking in high risk situations between baseline and week six, with no such increase among controls. Results were maintained through the week 12 follow up. CONCLUSIONS The TMAP alcohol risk reduction program was feasible and highly acceptable indicated by high retention rates through the final follow up assessment and good ratings for the text message content. Reductions in multiple outcomes provide positive indications of intervention efficacy.

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥6 months postintervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: self-determination theory, theory of planned behavior, social cognitive theory, transtheoretical model, and social ecological model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.

Exercise videogames for physical activity and fitness: Design and rationale of the Wii Heart Fitness trial.

INTRODUCTION Despite numerous health benefits, less than half of American adults engage in regular physical activity. Exercise videogames (EVG) may be a practical and attractive alternative to traditional forms of exercise. However there is insufficient research to determine whether EVG play alone is sufficient to produce prolonged engagement in physical activity or improvements in cardiovascular fitness and overall health risk. The goal of the present study is to test the efficacy of exercise videogames to increase time spent in moderate to vigorous physical activity (MVPA) and to improve cardiovascular risk indices among adults. METHODS Wii Heart Fitness is a rigorous 3-arm randomized controlled trial with adults comparing three 12-week programs: (1) supervised EVGs, (2) supervised standard exercise, and (3) a control condition. Heart rate is monitored continuously throughout all exercise sessions. Assessments are conducted at baseline, end of intervention (week 12), 6 and 9 months. The primary outcome is time spent in MVPA physical activity. Secondary outcomes include changes in cardiovascular fitness, body composition, blood lipid profiles and maintenance of physical activity through six months post-treatment. Changes in cognitive and affective constructs derived from Self Determination and Social Cognitive Theories will be examined to explain the differential outcomes between the two active treatment conditions. CONCLUSION The Wii Heart Fitness study is designed to test whether regular participation in EVGs can be an adequate source of physical activity for adults. This study will produce new data on the effect of EVGs on cardiovascular fitness indices and prolonged engagement with physical activity.

The MOMS (Making Our Mothers Stronger) Project: A Culturally Tailored Parenting Intervention for Mothers Living with HIV in the Southern USA

The southeastern region of the United States has had the highest increase of new HIV/AIDS cases among all regions in the country and now has the highest incidence of HIV-positive women. The MOMS (Making Our Mothers Stronger) Project was a randomized, controlled behavioral trial that aimed to improve functioning of families affected by HIV by reducing childbearing stressors among HIV-positive mothers. Participants were randomly assigned to one of two intervention conditions: a Social Cognitive Theory (SCT)-based intervention (focused on reducing parenting stress) or an attention-control intervention (focused on reducing health-related stress). The parenting intervention focused on building four key skills: communicating clearly and effectively with their children, using positive and negative consequences with their children to effectively change child’s behavior, enjoying their children more by finding ways to build quality time together into their normal routine, and taking care of themselves so they can best care for their children. Post intervention, there was significant decline in parenting-related stress in both the intervention conditions. Implications and future directions based on study findings are discussed.