Molly E. Waring

Content analysis of Twitter chatter about indoor tanning

Twitter may be useful for learning about indoor tanning behavior and attitudes. The objective of this study was to analyze the content of tweets about indoor tanning to determine the extent to which tweets are posted by people who tan, and to characterize the topics of tweets. We extracted 4,691 unique tweets from Twitter using the terms tanning bed or tanning salon over 7 days in March 2016. We content analyzed a random selection of 1,000 tweets, double-coding 20% of tweets (κ = 0.74, 81% agreement). Most tweets (71%) were by tanners (n = 699 individuals) and included tweets expressing positive sentiment about tanning (57%), and reports of a negative tanning experience (17%), burning (15%), or sleeping in a tanning bed (9%). Four percent of tweets were by tanning salon employees. Tweets posted by people unlikely to be tanners (15%) included tweets mocking tanners (71%) and health warnings (29%). The term tanning bed had higher precision for identifying individuals who engage in indoor tanning than tanning salon; 77% versus 45% of tweets captured by these search terms were by individuals who engaged in indoor tanning, respectively. Extrapolating to the full data set of 4,691 tweets, findings suggest that an average of 468 individuals who engage in indoor tanning can be identified by their tweets per day. The majority of tweets were from tanners and included reports of especially risky habits (e.g., burning, falling asleep). Twitter provides opportunity to identify indoor tanners and examine conversations about indoor tanning.

Social Media and Obesity in Adults: a Review of Recent Research and Future Directions

Purpose of ReviewSocial media is widely used and has potential to connect adults with obesity with information and social support for weight loss and to deliver lifestyle interventions. The purpose of this review is to summarize recent observational and intervention research on social media and obesity.Recent FindingsOnline patient communities for weight loss abound but may include misinformation. Systematic reviews and meta-analyses suggest that social media-delivered lifestyle interventions modestly impact weight, yet how social media was used and participant engagement varies widely.SummaryThe rapidly changing social media landscape poses challenges for patients, clinicians, and researchers. Research is needed on how patients can establish supportive communities for weight loss and the role of clinicians in these communities. Emerging research on meaningful engagement in, and the efficacy and cost-effectiveness of, social media-delivered lifestyle interventions should provide insights into how to leverage social media to address the obesity epidemic.

Gendered Race Modification of the Association Between Chronic Stress and Depression Among Black and White U.S. Adults

Chronic stress stemming from social inequity has long been recognized as a risk factor for poor physical and psychological health, yet challenges remain in uncovering the mechanisms through which such exposures affect health outcomes and lead to racial and gender health disparities. Examination of sociocultural influences on group identity, coping, and the expression of stress may yield relevant insight into potential pathways of inequity’s effect on risk for chronic disease. The objective of this study was to examine the relationship between chronic stress as measured by allostatic load (AL) and depression by gendered race group. Using National Health and Nutrition Examination Survey 2005–2010 data, we included Black and White U.S. adults aged 18–64 years (n = 6,431). AL was calculated using 9 biomarkers; scores ≥4 indicated high risk. Depression was assessed using the Patient Health Questionnaire-9; scores ≥10 indicated likely clinical depression. Logistic models estimated odds of depression as a function of AL for each gendered race group adjusting for age and family poverty-to-income ratio. Effect modification was assessed by analysis of variance and relative excess risk due to the interaction. We observed modification on the multiplicative scale. High AL was more strongly associated with depression among White women and Black men than among Black women or White men. In conclusion, a potential manifestation of high chronic stress burden, depression, differs across gendered race groups. These disparities may be due to group-specific coping strategies that are shaped by unequal social contexts.

Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home

Objectives To examine the association between sugar‐sweetened beverage availability at home and sugar‐sweetened beverage consumption, and to evaluate whether this association was consistent across school and school neighborhood sugar‐sweetened beverage availability. Study design Secondary data analyses were performed from the 2014 cross‐sectional, Internet‐based Family Life, Activity, Sun, Health, and Eating (FLASHE) study of 1494 adolescents (age 12‐17 years). Ordinal logistic regression analyses were conducted to examine the association between sugar‐sweetened beverage availability in the home and adolescents frequency of sugar‐sweetened beverage consumption (nondaily, <1; daily, 1‐<2; daily, ≥2), adjusting for adolescent age, sex, race, and body mass index and parent marital status and housing insecurity. Stratified ordinal logistic regression analyses were used to examine the associations by school and school neighborhood sugar‐sweetened beverage availability. Results One‐third (32.6%) of adolescents were nondaily consumers of sugar‐sweetened beverages, 33.9% consumed 1‐<2 sugar‐sweetened beverages daily, and 33.5% consumed ≥2 sugar‐sweetened beverages daily. Almost one‐half (44.4%) reported that sugar‐sweetened beverages were often or always available in the home. Frequency of sugar‐sweetened beverage availability at home was associated with greater sugar‐sweetened beverage consumption (OR, 2.88; 95% CI, 2.86‐2.89 for rarely/sometimes available at home; OR. 5.62; 95% CI, 5.60‐5.64 for often/always available at home). Similar associations were found regardless of the availability of sugar‐sweetened beverages in the adolescents school or school neighborhood. Conclusions Sugar‐sweetened beverage availability in the home was associated with adolescent sugar‐sweetened beverage consumption, regardless of sugar‐sweetened beverage availability in other settings, and may be a key target for obesity prevention efforts.

Online health information seeking by adults hospitalized for acute coronary syndromes: Who looks for information, and who discusses it with healthcare providers?

OBJECTIVEnTo describe characteristics associated with online health information-seeking and discussing resulting information with healthcare providers among adults with acute coronary syndromes (ACS).nnnMETHODSnConsecutive patients hospitalized with ACS in 6 hospitals in Massachusetts and Georgia who reported Internet use in the past 4 weeks (online patients) were asked about online health information-seeking and whether they discussed information with healthcare providers. Participants reported demographic and psychosocial characteristics; clinical characteristics were abstracted from medical records. Logistic regression models estimated associations with information-seeking and provider communication.nnnRESULTSnOnline patients (Nu202f=u202f1142) were on average aged 58.8 (SD: 10.6) years, 30.3% female, and 82.8% non-Hispanic white; 56.7% reported online health information-seeking. Patients with higher education and difficulty accessing medical care were more likely to report information-seeking; patients hospitalized with myocardial infarction, and those with impaired health numeracy and limited social networks were less likely. Among information-seekers, 33.9% discussed information with healthcare providers. More education and more frequent online information-seeking were associated with provider discussions.nnnCONCLUSIONnOver half of online patients with ACS seek health information online, but only 1 in 3 of these discuss information with healthcare providers.nnnPRACTICE IMPLICATIONSnClinician awareness of patient information-seeking may enhance communication including referral to evidence-based online resources.

Barriers to Healthcare Access and Long-Term Survival After an Acute Coronary Syndrome

BackgroundBarriers to healthcare are common in the USA and may result in worse outcomes among hospital survivors of an acute coronary syndrome (ACS).ObjectiveTo examine the relationship between barriers to healthcare and 2-year mortality after hospital discharge for an ACS.DesignLongitudinal study.SettingSurvivors of an ACS hospitalization were recruited from 6 medical centers in central Massachusetts and Georgia in 2011–2013.PatientsStudy participants with a confirmed ACS reported whether they had a financial-related healthcare barrier, no usual source of care, or a transportation-related healthcare barrier around the time of hospital admission.InterventionsNone.MeasurementsCox regression analyses calculated adjusted hazard ratios (aHRs) for 2-year all-cause mortality for the three healthcare barriers while controlling for several demographic, clinical, and psychosocial characteristics.ResultsThe mean age of study participants (nu2009=u20092008) was 62xa0years, 33% were women, and 77% were non-Hispanic white. One third of patients reported a financial barrier, 17% lacked a usual source of care, and 12% had a transportation barrier. Five percent (nu2009=u2009100) died within 2xa0years after hospital discharge. Compared to patients without these barriers, those lacking a usual source of care and with barriers to transportation experienced significantly higher mortality (aHRs 1.40, 95% CI 1.30 to 1.51 and 1.46, 95% CI 1.13 to 1.89, respectively). Financial barriers were not associated with all-cause mortality (aHR 0.79, 95% CI 0.60 to 1.06).LimitationsObservational study with other unmeasured potentially confounding prognostic factors.ConclusionsAbsence of an established usual source of care and inconsistent transportation availability were associated with a higher risk for dying after an ACS. Patients with these barriers to follow-up care may benefit from more intensive follow-up and support.

Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study

Background Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. Objective This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. Methods Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. Results Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). Conclusions Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. Trial Registration ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2)

Does provider advice to increase physical activity differ by activity level among US adults with cardiovascular disease risk factors

BackgroundnRegular physical activity (PA) lowers the risk of cardiovascular disease (CVD), but few US adults meet PA guidelines. The United States Preventive Services Task Force (USPSTF) recommends primary care providers offer PA counselling for CVD prevention. We examined the association between adherence to PA guidelines and reported provider advice to increase PA among US adults with overweight/obesity and ≥1 additional CVD risk factor.nnnMethodsnCross-sectional data from the National Health and Nutrition Examination Survey (2011-2014) on PA and provider advice to increase PA were analysed for 4158 adults (≥20 years old) with overweight/obesity who reported ≥1 of hypertension, high cholesterol or impaired fasting glucose. Adherence to federal PA guidelines was determined using self-reported PA data from the Global Physical Activity Questionnaire. Meeting PA guidelines was defined as ≥150 minutes/week moderate intensity PA, ≥75 minutes/week vigorous intensity, or an equivalent combination. Participants self-reported provider advice to increase PA.nnnResultsnIn total, 57.7% of US adults with overweight/obesity and ≥1 additional CVD risk factor who did not meet PA guidelines reported provider advice to increase PA compared to 49.7% of adults who met PA guidelines. Adults who did not meet PA guidelines were more likely to report provider PA advice (aOR = 1.21; 95% CI = 1.00-1.47).nnnConclusionsnUS adults with CVD risk factors who do not meet PA guidelines are more likely to receive provider advice to increase PA, but only half receive such advice. Strategies to increase provider advice are needed to improve adherence to USPSTF guidelines among US adults with overweight/obesity and additional CVD risk factors.

Change in Cognitive Function in the Month After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transition, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education)

Background— Cognitive function is often impaired during hospitalization, but whether this impairment resolves or persists after discharge is unknown. Methods and Results— We enrolled (April 2011–May 2013) and interviewed during hospitalization and 1-month post-discharge 1521 nondemented acute coronary syndrome survivors enrolled in TRACE (Transitions, Risks and Actions in Coronary Events). Cognitive function was assessed using the Telephone Interview of Cognitive Status (range: 0–41) at both time points. Patients reported demographic and psychosocial characteristics and medical records were abstracted. Using the Telephone Interview of Cognitive Status cut point of ⩽28, we defined 4 groups of cognitive change based on cognitive status during hospitalization and 1 month later: consistently impaired, transiently impaired, newly impaired, and consistently nonimpaired. Characteristics associated with cognitive change categories were examined using multinomial logistic regression. Participants were 67% male, 84% non-Hispanic white, with mean age±SD 62±11 years; 16% (n=237) were cognitively impaired during hospitalization, and 11% (n=174) were impaired 1 month after discharge. Overall, 80% were consistently nonimpaired, 9% transiently impaired, 7% consistently impaired, and 4% newly impaired. Lower education level, minority status, low health literacy and numeracy, and higher severity of disease were independently associated with cognitive impairment during and after hospitalization. Male sex was associated with increased risk of cognitive impairment after hospital discharge. Conclusions— Cognitive function changes during the transition from hospital to home after acute coronary syndrome are less favorable for men and those with psychosocial vulnerability. Assessing cognitive status both in hospital and post-discharge is important for detecting patients who could benefit from tailored transitional care including early follow-up and booster discharge instructions.