Enhancing Parent-Child Communication and Promoting Physical Activity and Healthy Eating Through Mobile Technology: A Randomized Trial

Background Although rates of pediatric and adult obesity remain high in the U.S., finding scalable and engaging ways to disseminate obesity prevention and treatment for families has been challenging. The purpose of the Motivating Families with Interactive Technology (mFIT) study was to test the feasibility, acceptability, and effectiveness of two remotely-delivered family-based health promotion programs for improvements physical activity (PA), healthy eating, and parent-child communication and relationship quality. Methods Parent-child (child age 9-12 years) dyads enrolled in a 12-week mobile intervention to increase physical activity and healthy eating, which included weekly email newsletters and the use of pedometers. Dyads were randomly assigned to one of two family-based programs, one of which utilized a mobile website and program materials that emphasized the importance of family interactions for health behavior changes. At baseline and 12 weeks, height and weight were measured by research staff, and participants completed web-based questionnaires about their dietary intake, family dynamics (e.g., parent-child communication), and experiences in the study. Results Dyads (n=33) were randomized (parents: 43+/-6 years, 88% female, 70% white, BMI 31.1+/-8.3 kg/m2; children: 11+/-1 years, 64% female, 67% white, BMI 77.6+/-27.8 percentile) and 31 (93.9%) provided complete follow-up data. Overall, there were no significant between-group differences in PA or dietary outcomes, but families significantly increased their average daily steps and servings of fruit during the intervention (marginally significant decrease in sugar-sweetened beverages) and had excellent adherence to self-monitoring protocols. Family functioning indicators were all high at baseline and most did not change significantly over time; none of the family dynamics variables were significant predictors of changes in average daily steps. Almost all parents (97%) and children (86%) said that they would recommend the mFIT program to a friend. Conclusions Dyads in the present study had high scores on family functioning variables at baseline, from both parent and child perspectives. Further research is needed to develop domain-specific measures of family dynamics, as well as to test familybased research with samples of families with more diverse baseline scores on family dynamics variables. Overall, the mFIT program showed excellent feasibility and acceptability as a low-cost, remotely delivered family intervention for physical activity and healthy eating promotion, and could serve as a dissemination model for similar public health interventions

Iron–Nutrient Interactions within Phytoplankton

Iron limits photosynthetic activity in up to one third of the world’s oceans and in many fresh water environments. When studying the effects of Fe limitation on phytoplankton or their adaptation to low Fe environments, we must take into account the numerous cellular processes within which this micronutrient plays a central role. Due to its flexible redox chemistry, Fe is indispensable in enzymatic catalysis and electron transfer reactions and is therefore closely linked to the acquisition, assimilation and utilization of essential resources. Iron limitation will therefore influence a wide range of metabolic pathways within phytoplankton, most prominently photosynthesis. In this review we map out four well-studied interactions between Fe and essential resources: nitrogen, manganese, copper and light. Data was compiled from both field and laboratory studies to shed light on larger scale questions such as the connection between metabolic pathways and ambient iron levels and the biogeographical distribution of phytoplankton species

What Type of Engagement Predicts Success in a Facebook Weight Loss Group?

Studies of social media-delivered behavioral interventions generally reveal that engagement, as defined as total number of posts, is associated with better outcomes. Little is known about whether the type of engagement, volume of content posted, or timing of engagement matters. In the present study, we analyzed the content, volume, and timing of participant posts in a Facebook weight loss intervention. Content was analyzed via thematic analyses. Volume was defined as total characters posted. We explored types of posts and for each, how frequency and volume overall, and in first half and second half of intervention were related to weight loss at end of treatment. Findings revealed that reporting a healthy choice was the most common type of post. The frequency and volume of most types of posts except negative posts predicted weight loss, but those occurring in second half of intervention were more strongly related to weight loss

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). Danielle E Jake-Schoffman. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.06.2018

SoMe and Self Harm: The Use of Social Media in Depressed and Suicidal Youth

Increased access and use of social media on smartphones and tablets have changed interpersonal communication styles. Because of the ease of social media access and the ability to reach a large number of individuals, social media is an ever more important modality that connects individuals. Importantly, adolescents have adopted social media platforms to discuss issues related to mental health. There is little existing data regarding how adolescents who are depressed or suicidal use social media prior to treatment in the emergency department (ED) for medical care of their psychiatric illness. In this paper, we present formative evidence of social media behaviors in 29 adolescents seeking emergency care for depression or suicidal ideation. Participants were surveyed regarding social media use and motivations to post content regarding depression, death or dying. Among the participants who allowed the research team to view their social media accounts, 40% (n=6) posted content related to depression, death or dying, while 20% (n=3) wrote that they felt depressed and 13.3% (n=2) posted that they wanted to die. Qualitative discussions with participants provided description of reasons for posting content on social media about depression, death and dying, or reasons that individuals refrained from posting online. Despite methodological and technical challenges in research, social media may prove be valuable in detection and intervention of adolescents who are depressed and contemplating suicide

The history and future of digital health in the field of behavioral medicine.

Since its earliest days, the field of behavioral medicine has leveraged technology to increase the reach and effectiveness of its interventions. Here, we highlight key areas of opportunity and recommend next steps to further advance intervention development, evaluation, and commercialization with a focus on three technologies: mobile applications (apps), social media, and wearable devices. Ultimately, we argue that future of digital health behavioral science research lies in finding ways to advance more robust academic-industry partnerships. These include academics consciously working towards preparing and training the work force of the twenty first century for digital health, actively working towards advancing methods that can balance the needs for efficiency in industry with the desire for rigor and reproducibility in academia, and the need to advance common practices and procedures that support more ethical practices for promoting healthy behavior

Clinic Versus Online Social Network-Delivered Lifestyle Interventions: Protocol for the Get Social Noninferiority Randomized Controlled Trial

BACKGROUND: Online social networks may be a promising modality to deliver lifestyle interventions by reducing cost and burden. Although online social networks have been integrated as one component of multimodality lifestyle interventions, no randomized trials to date have compared a lifestyle intervention delivered entirely via online social network with a traditional clinic-delivered intervention. OBJECTIVE: This paper describes the design and methods of a noninferiority randomized controlled trial, testing (1) whether a lifestyle intervention delivered entirely through an online social network would produce weight loss that would not be appreciably worse than that induced by a traditional clinic-based lifestyle intervention among overweight and obese adults and (2) whether the former would do so at a lower cost. METHODS: Adults with body mass index (BMI) between 27 and 45 kg/m(2) (N=328) will be recruited from the communities in central Massachusetts. These overweight or obese adults will be randomized to two conditions: a lifestyle intervention delivered entirely via the online social network Twitter (Get Social condition) and an in-person group-based lifestyle intervention (Traditional condition) among overweight and obese adults. Measures will be obtained at baseline, 6 months, and 12 months after randomization. The primary noninferiority outcome is percentage weight loss at 12 months. Secondary noninferiority outcomes include dietary intake and moderate intensity physical activity at 12 months. Our secondary aim is to compare the conditions on cost. Exploratory outcomes include treatment retention, acceptability, and burden. Finally, we will explore predictors of weight loss in the online social network condition. RESULTS: The final wave of data collection is expected to conclude in June 2019. Data analysis will take place in the months following and is expected to be complete in September 2019. CONCLUSIONS: Findings will extend the literature by revealing whether delivering a lifestyle intervention via an online social network is an effective alternative to the traditional modality of clinic visits, given the former might be more scalable and feasible to implement in settings that cannot support clinic-based models. TRIAL REGISTRATION: ClinicalTrials.gov NCT02646618; https://clinicaltrials.gov/ct2/show/NCT02646618

Methods for Evaluating the Content, Usability, and Efficacy of Commercial Mobile Health Apps

Commercial mobile apps for health behavior change are flourishing in the marketplace, but little evidence exists to support their use. This paper summarizes methods for evaluating the content, usability, and efficacy of commercially available health apps. Content analyses can be used to compare app features with clinical guidelines, evidence-based protocols, and behavior change techniques. Usability testing can establish how well an app functions and serves its intended purpose for a target population. Observational studies can explore the association between use and clinical and behavioral outcomes. Finally, efficacy testing can establish whether a commercial app impacts an outcome of interest via a variety of study designs, including randomized trials, multiphase optimization studies, and N-of-1 studies. Evidence in all these forms would increase adoption of commercial apps in clinical practice, inform the development of the next generation of apps, and ultimately increase the impact of commercial apps. Boudreaux, Rajani S Sadasivam, Sean P Mullen, Jennifer L Carey, Rashelle B Hayes, Eric Y Ding, Gary G Bennett, Sherry L Pagoto. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 18.12.2017

Managing Stakeholders or the Environment? The Challenge of Relating Indicators in Practice

Many organizations present their environmental work in the form of annual reports and use the indicators in them for follow-up. However, internal communication and management is needed for environmental improvements. The indicators found in reports may be suitable for external communication, but are they also suitable internally and operationally? This article reviews the existing literature on environmental indicators. With the help of an operational approach, from organisation theory, and a life-cycle approach, indicators are analysed. The analysis shows that formulating indicators for internal management is not an easy task; available guidelines are of little help. It is concluded that the environment can be managed internally by relating indicators. Therefore, an additional set of indicators for internal management and a wider responsibility for the life cycle are recommended. The analysis and recommendations are illustrated with examples drawn from the field of property management