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Aims: Physical activity plays an important role in blood glucose management, yet most adults with elevated blood glucose do not engage in regular physical activity. Exercise videogames (EVGs) may be an attractive alternative for persons who have not found standard exercise modalities appealing.Methods: This sub-study within a larger trial examined the effects of 12 weeks of EVGs versus standard exercise (e.g., treadmill, cycling) and a control condition among individuals with elevated HbA1c (100% prediabetic). This study was conducted at a university research lab. Outcomes included HbA1c and weekly minutes of moderate to vigorous physical activity (MVPA) assessed using self-report and accelerometer.Other health risk indices (e.g., lipids) and psychosocial constructs shown to influence exercise participation (e.g., intrinsic motivation) were assessed.Results: Participants (n = 84), averaged age 51.4 years (range 20-79), 80% were female, and 77.4% were non-Hispanic. Baseline HbA1c ranged from 5.7% to 6.4% (39-49 mmol/mol). At week 12, EVG participants demonstrated an average 2% reduction in HbA1c compared to a 0.6% reduction in Standard and Control groups (p's = 0.04 and 0.03). EVG participants engaged in significantly more MVPA than Standard (+17 min/week) and Controls (+54 min/week) (p's < 0.05), had reduced LDL cholesterol (p = 0.05) and trends suggesting reduced body fat (p = 0.10). EVG participants reported higher exercise enjoyment and motivation compared to other participants.Conclusions: EVGs may be an attractive and effective tool to improve management of blood glucose that might contribute toward preventing the onset of type 2 diabetes among those with prediabetes. [ABSTRACT FROM AUTHOR]

Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs. This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants. This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion. [ABSTRACT FROM AUTHOR]

Introduction: Adults who engage in regular physical activity have lower rates of morbidity and mortality than those who do not. Exercise videogames may offer an attractive, sustainable alternative or supplement to traditional modes of exercise. This study compared exercise videogames with standard exercise modalities for improving uptake and maintenance of moderate to vigorous physical activity, and health risk indices.Study Design: A three-arm clinical RCT including 12 weeks of supervised laboratory-based moderate to vigorous physical activity followed by 6 months follow-up.Setting/participants: This study was conducted at a university affiliated hospital research lab. Healthy, sedentary adults were eligible.Interventions: This study compared a 12-week program of supervised exercise videogames versus standard exercise (e.g., treadmill) versus control. Data were collected from January 2012 to September 2017 and analyzed in 2018.Main Outcome Measures: The primary outcome was weekly minutes of moderate to vigorous physical activity at end of treatment, assessed at 3 and 6 months post-intervention by using self-report and accelerometer data. Health risk indices (e.g., HbA1c, lipids) were also assessed.Results: Participants (N=283) had an average age of 46.2 ±13.5 years; 79% were female. At end of treatment, those in the exercise videogame arm engaged in 30 minutes/week more moderate to vigorous physical activity compared with standard exercise and 85 more minutes/week than controls (all p<0.05). Exercise videogame participants had greater reductions in cholesterol, HbA1c, and body fat versus other groups. Reductions in cholesterol were twice as large in exercise videogame versus standard participants.Conclusions: Exercise videogames produced greater uptake and maintenance of moderate to vigorous physical activity compared with standard exercise and improvements in multiple health risk indices. Exercise videogames may promote sustainable physical activity with significant health benefits.Trial Registration: This study is registered at www.clinicaltrials.gov NCT03298919. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction Smokers trying to quit encounter many challenges including nicotine withdrawal symptoms, cigarette craving, increased stress and negative mood and concern regarding weight gain. These phenomena make it difficult to successfully quit smoking. Studies in non-smoking populations show that yoga reduces stress and negative mood and improves weight control. By increasing mindfulness we anticipate that yoga may also improve smokers' ability to cope with the negative symptoms associated with quitting. Yoga may also improve cognitive deliberation which is needed to make effective choices and avoid smoking in tempting situations. Methods/design The BreathEasy study is a rigorous, randomized controlled clinical trial examining the efficacy of Iyengar yoga as a complementary therapy to cognitive-behavioral therapy for smoking cessation. All participants are given an 8-week program of smoking cessation classes, and are randomized to either twice weekly yoga (Yoga) or twice-weekly health and wellness classes which serve as a control for contact and participant burden (CTL). Assessments are conducted at baseline, 8 weeks, 3, 6, and 12 months of follow-up. The primary outcome is prolonged abstinence using an intention-to-treat approach. Multiple internal and external audits using blind data collection are employed to ensure treatment fidelity and reliability of study results. To understand why yoga may be more effective than CTL, we will examine the mechanisms of action (i.e., mediators) underlying intervention efficacy. We will examine the maintenance of yoga practice and smoking status at each follow-up. Focus groups and interviews will be used to enrich our understanding of the relationship of yoga practice and smoking abstinence. Conclusions This study will provide a stringent test of the relative efficacy of yoga compared to a condition that controls for contact time and attention. The use of mixed methodology also provides the opportunity to validate existing knowledge about yoga and helps to explore new themes for future mindfulness and yoga research. [ABSTRACT FROM AUTHOR]

Adult smokers were recruited during routine health care visits at primary care clinics located in three urban hospitals and were given a brief intervention and nicotine replacement therapy. Analyses compared bicultural (BC: n=60) or less acculturated (LA: n=138) Latinos and non-Latino White (NL: n=417) participants. Both Latino groups were significantly different from NL subjects in smoking rate and nicotine dependence. However, BC and NL subjects differed significantly from LA subjects in perceived benefits of quitting, perceived risk from smoking, and negative affect smoking. LA subjects had higher cessation rates than either BC or NL groups. Regression analyses showed that nicotine dependence and confidence in quitting predicted cessation at month 6, and acculturation appeared to moderate the relationship between smoking cessation and both confidence in quitting and nicotine dependence. These results provide support for the viability of brief interventions for smoking provided through health care delivery systems. Results also suggest that characteristics previously shown to be predictive of successful cessation in mixed or non-Latino populations may not be equally predictive of cessation across members of diverse populations. [ABSTRACT FROM AUTHOR]

: ObjectiveOur objective is to describe the current state of treatment for NCCP, identify barriers to treatment and limitations of current approaches, and to recommend treatment strategies, which may address these challenges.: MethodsWe describe the underlying rationale for treating NCCP and review the current literature concerning NCCP treatments and other brief approaches to outpatient treatment for psychosomatic illness.: ResultsMost treatments for NCCP have been based on the Attribution Model. Although effective, these treatments are appropriate and acceptable to only a small minority of NCCP patients. The Biopsychosocial Model has been used to treat psychosomatic conditions in outpatient groups and may overcome or avoid many of the limitations inherent in current treatment strategies for NCCP.: ConclusionsWe recommend an intervention for NCCP that is brief, would be delivered in the emergency department setting (to take advantage of the Teachable Moment), and which is based on the Biopsychosocial Model. [Copyright &y& Elsevier]

A more positive affective valence during exercise is predictive of adherence to physical activity programs. This study examines the relationship between affective response during exercise and longer-term maintenance of physical activity among individuals using exercise video games (EVGs) and standard modalities of physical activity (i.e., walking, cycling). Healthy adults (mean age 45.4, SD = 14.5) were randomly assigned to a 12-week supervised, thrice weekly program of EVGs (n = 93) or Standard exercise (n = 96), and were assessed for affect immediately before, at the mid-point, and immediately after one exercise session per week. Participation in moderate-to-vigorous physical activity (MVPA) was conducted at end of treatment (EOT) and 6-month follow up. EVG participants reported more positive affective valence during exercise compared to Standard participants (b = 0.63, SE = 0.08, p <.001), and perceived less exertion (b = 0.52, SE = 0.36, p =.04) compared to Standard participants. For both groups, a more positive affective valence during exercise was significantly predictive of continued physical activity at 6-months (b = 6.64, SE = 2.50, p =.01). EVG participants also showed a significant chronic effect such that week-to-week there were improvements in affect prior to exercise and this effect was significantly associated with greater MPVA at EOT and follow-up (b = 21.96, SE = 10.10, p =.03 at EOT). Among Standard participants no significant chronic effect was seen over time. EVGs may provide an effective means of promoting more positive shifts in affective valence both during, and in anticipation of, physical activity that encourages longer-term participation. • Sedentary adults endorsed more positive affect during exercise video games than during standard exercise. • Greater positive affect during exercise predicted more physical activity 6 months after the end of the intervention. • Both groups exercised at the same intensity as measured by heart rate monitors. • Video game participants reported lower perceived exertion than those in standard exercise. • Exercise video games are a promising physical activity intervention for sedentary adults. [ABSTRACT FROM AUTHOR]

Latinas face an increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA. The researchers conducted a superiority randomized controlled trial (data collected 2018–2022, analyzed 2023). Participants were 195 Spanish-speaking Latinas ages 18–65 in the Providence, RI area. The original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features. Total weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months. Participants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs 70.18 [9.99]) and accelerometer-measured (66.21 [18.26] vs 60.27 [16.00]) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 [23.35] vs 81.44 [1.82]) and accelerometer-measured (63.76 [15.12] vs 54.86 [14.59]) MVPA at 24 months. Baseline PA moderated the intervention effect. This study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance. This study is registered at www.clinicaltrial.gov (NCT03491592). [ABSTRACT FROM AUTHOR]

Introduction Cardiac rehabilitation (CR) programs reduce overall and cardiovascular mortality in patients with a history of acute coronary events or revascularization procedures, but only 30% of patients enroll in CR and attrition rates reach up to 60%. Tai chi, a mind-body practice based on light/moderate aerobic exercise accompanied by meditative components could be a possible exercise option for patients who do not attend CR. Methods/design Sixty patients will be randomized to a “LITE” condition (one tai chi session twice weekly for 12 weeks) or to a “PLUS” condition (one tai chi session 3 times weekly for 12 weeks, followed by maintenance classes 1–2 times weekly for an additional 12 weeks). Measurements will be conducted at baseline, 3-, 6-, and 9 months after enrollment. The primary outcome is to determine the feasibility, acceptability and safety of each dose. Secondary outcomes include estimates of effect size of each dose on accelerometry-assessed physical activity; the proportion of patients meeting current recommendations for physical activity; and measures of fitness, quality of life, body weight, and sleep. In addition, we will collect exploratory information on possible mediators (exercise self-efficacy, perceived social support, resilience, mindfulness, and depression). Conclusions Findings from this pilot study will provide preliminary indications about the usefulness of tai chi as an exercise option for patients not attending traditional CR programs. Results will also shed light on the possible mechanisms by which tai chi practice may improve overall physical activity among patients with atherosclerotic coronary heart disease. [ABSTRACT FROM AUTHOR]

Abstract Youth exiting foster care represent a unique, at-risk population in that they receive supportive health services while under the umbrella of the foster care system, but access to care can drop precipitously upon release from foster custody. Traditional means of substance use treatment may not meet the needs of this vulnerable population. Mobile interventions, however, have demonstrated high acceptability and efficacy across a range of mental and physical health issues. The specific advantages to mobile interventions dovetail well with the barriers faced by youth exiting foster care. This study describes the feasibility, acceptability, and initial efficacy of iHeLP, a computer- and mobile phone-based intervention based in Motivational Interviewing for reducing substance use among youth exiting foster care (n = 33). Participants were randomly assigned to either iHeLP or a contact control, each of which lasted six months. Feasibility was evaluated through eligibility and enrollment rates at baseline, and retention and intervention reach rates 3, 6, 9, and 12 months later. Acceptability was measured through a 5-item satisfaction measure and exit interviews. The two groups were then compared on a monthly measure of substance use. Study enrollment, retention, response rate, engagement, and satisfaction were all very good. Participants receiving iHeLP reported higher percent days abstinent than the control group, with effect sizes ranging from 0.32 to 0.62. Technology-based interventions such as iHeLP may be attractive to this population and support efforts towards reductions in substance use. Highlights • Youth who have experienced foster care report high levels of substance use. • Traditional approaches to substance use service provision may not meet the unique needs of this population. • We developed a computer- and mobile phone-based intervention for reducing substance use among youth exiting foster care. • Feasibility, acceptability, and preliminary efficacy were strong. • Technology-based interventions may be an engaging alternative to reduce substance use among youth exiting foster care. [ABSTRACT FROM AUTHOR]

Background Despite reductions in cigarette smoking in the U.S., improvements in the efficacy of smoking cessation treatments are needed, as rates of sustained abstinence remain disappointingly low. Both low positive affect and high negative affect contribute to smoking relapse and constitute viable targets for smoking cessation interventions. Although some clinical trials have evaluated interventions to address depression as a smoking relapse risk factor, very few have focused on positive affect. Recently, we developed and conducted a preliminary clinical trial of a smoking cessation treatment that targets positive affect and cognitions by incorporating interventions rooted in positive psychology. The current randomized controlled trial will expand upon this preliminary trial to test whether this positive psychology-informed approach results in higher smoking cessation rates compared to a time-matched standard smoking cessation treatment control. Methods Three hundred and forty adult daily smokers will be randomly assigned to either positive psychotherapy for smoking cessation or standard behavioral smoking cessation counseling. Participants will meet weekly with a study counselor for 6 weeks and will receive transdermal nicotine patch and text messaging smoking cessation support. Additionally, text messaging in the positive psychotherapy condition will encourage engagement in positive psychology-specific strategies for boosting mood and staying smoke free. Smoking cessation outcomes will be measured at 12, 26, and 52 weeks following target quit date. Conclusion Results from this study will provide evidence on whether incorporating positive psychology interventions into smoking cessation treatment can improve smoking cessation outcomes relative to standard behavioral counseling with nicotine patch and text messaging. [ABSTRACT FROM AUTHOR]

Youth who are aging out of the foster care system face significant barriers to accessing substance use treatment. Mobile interventions have shown efficacy for several mental and physical health issues and may be helpful in overcoming barriers facing foster youth with substance use problems. A program (iHeLP) for substance use reduction was developed that used a computerized screening and brief intervention (SBI) followed by six months of dynamically-tailored text messages. The program was shown to focus groups of youth (N = 24) ages 18–19 who recently left foster care and had moderate to severe substance use risk. Focus group feedback was used to modify iHeLP prior to delivery in an open trial (N = 16). Both study phases included assessments of feasibility and acceptability; the open trial also included assessments of substance use outcomes at 3 and 6 months. Focus groups indicated a high level of acceptability for the proposed intervention components. Of those screened for the open trial, 43% were eligible and 74% of those eligible enrolled, indicating good feasibility. Retention through the final follow-up was 59%, and drop out was associated with involvement in the criminal justice system. Participant ratings for liking, ease of working with, interest in and respectfulness of the SBI were high. Satisfaction ratings for the texting component were also high. A computerized brief screening intervention for substance use risk reduction together with tailored text messaging is both feasible and highly acceptable among youth who have recently aged-out of foster care. [ABSTRACT FROM AUTHOR]

Introduction: Cigarette smoking is associated with many adverse health effects and is an important public health concern. Increased understanding of smokers' behavior is central to developing effective interventions. Cigarette scavenging, a behavior that involves smoking shared or previously used cigarettes has thus far only been shown to be prevalent among homeless or incarcerated populations. The current study examines whether cigarette scavenging is prevalent in a more general population of adult smokers enrolling in a smoking cessation clinical trial, and whether engagement in this behavior is associated with demographic or smoking-related psychosocial factors.Methods: Baseline data was obtained from adult smokers (N=227) enrolling in a randomized clinical trial for smoking cessation. Cigarette scavenging was assessed using three items: a) sharing a cigarette with a stranger; b) smoking a "found" cigarette and c) smoking a previously used cigarette "butt". Participants who endorsed engaging in at least one of these three behaviors were categorized as a scavenger.Results: Approximately 32% of participants endorsed at least one cigarette scavenging behavior. A multiple logistic regression analysis found that scavengers were more likely to be: men (p<0.001), of younger age at smoking onset (p=0.012), unemployed (p=0.003), more likely to have used marijuana in the past 30days (p=0.005), single or living alone (p=0.003), and to have experienced higher withdrawal symptoms during previous quit attempts (p=0.044) as compared to non-scavengers.Conclusions: Scavenging is common among adult smokers. Interventions that address cigarette scavenging behaviors may better meet the needs of this unique smoking subgroup. [ABSTRACT FROM AUTHOR]

Latent class modeling (LCM) offers a promising approach for examining correlates of heart rate (HR) patterns over multiple exercise sessions. This research examined biological and psychological variables associated with different patterns of HR response to physical activity (PA). In a three-arm randomized controlled trial (exercise video games vs. standard exercise vs. non-exercise control), HR was recorded during PA sessions over a 12-week period. LCM identified three patterns of HR during PA across 189 participants in active arms: 1) high HR across sessions with low variability within sessions, 2) linear increase in HR across sessions with low variability within sessions, and 3) high variability in HR across all sessions. Associations with biological (resting heart rate, blood pressure, BMI, age, cholesterol, triglycerides, HbA1c) and psychological (depression, motivations for PA, PA-induced feelings) predictors of latent class membership were iteratively tested. Psychological variables played as important a role in the final model as biological variables for predicting latent class membership. Few differences were found between LC1 and LC2, but LC3 differed from the other two groups in that participants were likelier to report that they feel revitalized after PA (vs. LC1 and LC2), to be less motivated for PA (vs. LC1), reported greater depression (vs. LC1 and LC2), and were younger (vs. LC1). These findings demonstrate the potential of LCM to identify biological and psychological factors associated with chronotropic responses to PA, and advance understanding of the role of psychological factors in chronotropic PA outcomes. • Latent class modeling found three patterns in heart rate during an exercise trial. • Baseline psychological variables were key predictors of these patterns. • Psychological covariates may be important to patterns of heart rate during exercise. • Results have implications for wearable fitness trackers. [ABSTRACT FROM AUTHOR]

Internet-based interventions show promise as an effective channel for promoting physical activity. However, a paucity of research has been conducted among underserved groups despite recent increases in Internet access and physical activity-related health disparities in these communities. Thus, the current randomized controlled trial will test the efficacy of an individually tailored, Internet-based physical activity intervention for Latinas. This program was culturally and linguistically adapted for the target population through extensive formative research. Two hundred eighteen sedentary Latinas were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. The Physical Activity Internet Intervention, based on Social Cognitive Theory and the Transtheoretical Model, utilizes a website with features including self-monitoring, goal setting, discussion forum, links to online resources, individually tailored and motivation-matched physical activity feedback reports, and exercise tip sheets. Participants receive regular emails over the first 6 months with a tapered dose during the second 6 months (maintenance phase) to alert them to new content on the website. The main outcome is differences in minutes/week of moderate to vigorous physical activity at six months as measured by the 7-Day Physical Activity Recall and accelerometer data. High reach, low cost, culturally relevant Internet-based interventions that encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health. [ABSTRACT FROM AUTHOR]

Background: Physical activity interventions designed for Latinas have shown short-term behavior change, but longer-term change and maintenance is rarely measured. Purpose: To assess physical activity change at 12 months, following 6-month tapered completion of an RCT of a physical activity intervention for Latinas. Methods: Two hundred sixty-six underactive (<60 minutes/week physical activity) Latinas were randomized to an individually tailored, culturally and linguistically adapted physical activity intervention, or a wellness contact control. Participants received the materials through the mail for 6 months, then received booster doses at 8, 10, and 12 months. Minutes per week of moderate to vigorous physical activity were measured by the 7-Day Physical Activity Recall interview at baseline and 6 and 12 months. Data were collected at Brown University between 2009 and 2013, and analyses were conducted in 2013. Results: At 12 months, increases in moderate to vigorous physical activity were significantly greater in the intervention than in the wellness group (mean difference=52 minutes/week, SE=9.38, p<0.01), with both groups showing slight increases in moderate to vigorous physical activity from 6 to 12 months. Intervention participants were also more likely to meet national moderate to vigorous physical activity guidelines (OR=3.14, p=0.01). Conclusions: The intervention was more effective than the wellness control at 12 months, and physical activity increases from baseline to 6 months were maintained, suggesting the intervention may lead to sustainable behavior change. [ABSTRACT FROM AUTHOR]

Background: Latinas in the U.S. are less physically active than non-Latino white women and also report higher levels of diabetes, obesity, and other conditions related to inactivity. Interventions are needed to address disparities in this high-risk group. Purpose: To evaluate the efficacy of a culturally adapted, Spanish-language, individually tailored, computer expert system–driven physical activity print-based intervention for adult Latinas. Design: RCT. Setting/participants: Participants were 266 inactive adult Latinas who participated between 2009 and 2012. Intervention: Participants were randomized to one of two treatment arms: a 6-month tailored physical activity intervention condition or wellness contact control. For both conditions, print materials were delivered by mail. Main outcome measures: The main outcome measure was change in weekly moderate-to-vigorous physical activity (MVPA) measured by the 7-Day Physical Activity Recall interview, which was administered at baseline and post-intervention (6 months). Participants also wore accelerometers for a week at baseline and follow-up. Analyses were conducted in 2013. Results: Increases in minutes/week of MVPA measured by the 7-Day PAR were significantly greater in the intervention group compared to the control group (mean difference=41.36, SE=7.93, p<0.01). This difference was corroborated by accelerometer readings (rho=0.44, p<0.01). Further, results indicate that intervention participants had greater increases in self-efficacy, cognitive processes, and behavioral processes at 3 months compared to control paricipants (p’s<0.05). Conclusions: The tailored Spanish-language intervention was effective in increasing MVPA among predominantly low-income, less-acculturated Latinas. Such print-based interventions are poised for widespread dissemination, and thus may help address health disparities. [Copyright &y& Elsevier]

Background: Vigorous-intensity exercise has been shown to aid in smoking cessation, especially among women. In a previous trial, cognitive behavioral therapy (CBT) for smoking cessation plus regular vigorous aerobic exercise enhanced cessation rates, improved exercise capacity, and reduced weight gain compared to CBT plus equal contact time. Purpose: This study examined the effectiveness of this program adapted for and implemented in the YMCAs. Design: An RCT comparing CBT + Exercise (Exercise) to CBT + Contact Control (Control). Setting/participants: Apparently healthy female smokers were recruited to four local YMCAs. Intervention: YMCA staff members were trained to lead the manualized CBT smoking-cessation intervention and a standardized YMCA exercise program. Main outcome measures: Seven-day point prevalence and continuous abstinence. Results: Participants (330 women, mean age=44 years) were randomized to the Exercise (n=166) or Control (n=164) group. Results revealed no differences in 7-day point prevalence (29.5% vs 29.9%) nor continuous abstinence (13.9% vs 14.0%) between the Exercise and Control groups, respectively, at end of treatment or at the 3-, 6-, and 12-month follow-up. An examination of the relationship between exercise dose and quit status at end of treatment revealed that over 12 weeks, the odds of being quit (7-day point prevalence) grew by 4.5% for each additional aerobic exercise session (OR=1.05, 95% CI=1.01, 1.08) and by 7.7% for each additional resistance training session (OR=1.08, 95% CI=1.02, 1.14). Analyses were conducted between August 19, 2010, and December 16, 2011. Conclusions: No differences were seen between groups in smoking outcomes. The association between greater exercise participation and higher odds of quitting within the exercise condition suggests that the lack of between-group differences might be a result of poor compliance with the exercise program. Trial registration: This study is registered at clinicaltrials.gov NCT01615380. [Copyright &y& Elsevier]

Abstract: Background: Physician counseling can help patients make substantial changes in diet and physical activity behaviors that can result in weight loss and a reduction in metabolic risk factors. Unfortunately, time constraints and a lack of training often make it difficult for physicians to provide effective counseling. The objective in this study was to test the effect of a computerized support tool to enhance brief physician-delivered health lifestyle counseling to patients with increased metabolic risk factors during two usual care visits. Design/setting/participants: This is a prospective controlled trial of a 12-month intervention conducted at two large community health centers serving mostly Hispanic patients. Participants (n=279) had a body mass index (calculated as kg/m2) ≥25 and at least two components of the metabolic syndrome. Intervention: In the intervention group, a computer program was used to help patients set tailored self-management goals for weight loss, nutrition, and physical activity. Goals were then reviewed and reinforced at clinic visits with participants'' physicians at baseline and again at 6 months. The control group received care as usual. Data were collected between July 2007 and August 2008. Main outcome measures: Change in body weight was the primary outcome. Secondary measures included changes in blood glucose, blood cholesterol, blood pressure, physical activity, and energy intake. Results: Significantly more patients in the intervention group lost ≥5% of their body weight at 12 months than controls (26.3% vs 8.5%; odds ratio=3.86; P<0.01). Loss of >5% of total body weight was associated with improvements in cardiovascular risk factors, including low-density lipoprotein cholesterol (−14.0 vs −4.1 mg/dL; P=0.04). Conclusions: A brief computer-based intervention designed to increase the dialogue between patients and clinicians about behavioral goals can lead to increased 12-month weight loss. [Copyright &y& Elsevier]

Background: In the U.S., Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention. Thus, the purpose of the current study was to culturally and linguistically adapt an empirically supported, individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program.Design: An RCT was conducted.Setting/participants: The sample included 93 overweight/obese (80%) Latinas with low income and acculturation.Intervention: Data were collected in 2007-2008 and analyzed by intent-to-treat in 2009. Participants were randomly assigned to either (1) a culturally and linguistically adapted physical activity intervention (Seamos Activas) or (2) a wellness contact control condition.Main Outcome Measures: Self-report physical activity, as measured pre- and post-intervention (6 months, 87% retention) by the 7-Day Physical Activity Recall.Results: Moderate-intensity (or greater) physical activity increased from an average of 16.56 minutes/week (SD=25.76) at baseline to 147.27 (SD=241.55) at 6 months in the intervention arm (n=45), and from 11.88 minutes/week (SD=21.99) to 96.79 (SD=118.49) in the wellness contact control arm (n=48). No between-group differences were seen in overall physical activity. Intervention participants reported significantly greater increases in cognitive (F[1, 91]=9.53, p=0.003) and behavioral processes of change (F[1, 91]=8.37, p=0.005) and available physical activity supplies and equipment at home (F[1, 91]=4.17, p=0.04) than control participants.Conclusions: Results supported the hypothesized feasibility, acceptability, and preliminary efficacy of individually tailored physical activity print interventions among Latinas. Although more research is needed to corroborate these findings, such high-reach, low-cost approaches have great potential to positively affect public health.Trial Registration: NCT00724165. [ABSTRACT FROM AUTHOR]

Abstract: Female Emergency Department (ED) patients were surveyed to determine their comprehension of the concept of emergency contraception (EC), to assess how often they had used EC in comparison to other forms of contraception, and to learn which patients want the ED to provide EC services. Most of the 761 respondents were aged < 35 years (62.1%), never married (42.9%), had been pregnant at least once (70.2%), had never had an abortion (76.1%), had never used EC (90.6%), and had sex with a man within the past month (70.7%). Respondents were 2.5 times more likely to have had an abortion than to have used EC; 85.3% could not correctly answer two questions that assessed comprehension of the concept of EC; 43.1% wanted the ED to offer EC, 55.6% to provide information about EC, and 52.6% to refer patients for EC. Younger patients, those who attended religious services infrequently, patients who had ever used EC, and those at risk of pregnancy were more likely to want the ED to provide EC services. [Copyright &y& Elsevier]

Abstract: Over two-thirds of Americans access the Internet and therefore, the Internet may be an important channel for reaching the large population of sedentary individuals. The purpose of this paper is to describe the methods for a randomized controlled trial examining the efficacy of an Internet-based physical activity intervention relative to a print intervention that has been shown to be effective in previous trials. Specifically, 249 sedentary participants were randomized to receive one of three interventions: 1) Internet-based motivationally-tailored individualized feedback (Tailored Internet); 2) print-based motivationally-tailored individualized feedback (Tailored Print); or 3) physical activity websites currently available to the public (Standard Internet). Participants completed the 7-Day Physical Activity Recall interview, wore an objective physical activity monitor (i.e., ActiGraph), and participated in a treadmill fitness test at baseline, 6, and 12 months. The sample consisted of mostly women (84.2%) and Caucasian individuals (76.4%) who reported exercising an average of 21 min per week at baseline. This is the first study that we are aware of, that has examined the efficacy of a tailored Internet-based physical activity intervention. This study will have implications for the dissemination of Internet-based physical activity interventions. [Copyright &y& Elsevier]

Abstract: Background: Project STRIDE is a 4-year randomized controlled trial comparing two computer-based expert system guided intervention delivery channels (phone vs. print) for physical activity adoption and short-term maintenance among previously sedentary adults. Methods: Sedentary adults (n =239) were randomized to one of the following (1) telephone-based, individualized motivationally-tailored feedback; (2) print-based, individualized motivationally-tailored feedback; (3) contact-control delayed treatment group (received intervention after 12 months as control). This paper: (1) outlines the study design, rationale, and participant sample; and (2) describes relationships between baseline variables to better understand their influence on the efficacy of the intervention. Results: Participants averaged 19.8±25.0 min of physical activity/week that was at least of moderate intensity, with no group differences. The average estimated VO2 at 85% of maximum heart rate was 25.6 ml/kg/min. Body fat was 34.1% for women and 23.2% for men and the BMI of the sample averaged 28.5 kg/m2. Conclusions: Project STRIDE examines non face-to-face approaches for promoting physical activity behavior. It has unique features including a direct comparison of an expert system guided intervention delivered via phone or print. Future analyses will examine the cost-effectiveness of the interventions and this will likely yield important information for policy-makers. [Copyright &y& Elsevier]

Abstract: Objectives: For female emergency department (ED) patients, we sought to assess the prevalence of contraceptive usage as well as the extent of contraceptive knowledge and to determine if demographic and sexual health history factors, comprehension of contraceptive methods and moral/religious opinions on contraception were associated with current usage of birth control pills (BCPs), prior usage of emergency contraception (EC) and frequency of condom usage. Methods: English-speaking female ED patients aged between 18 and 55 years at a northeastern United States urban ED were surveyed on their usage, comprehension and opinions regarding BCPs, EC and condoms. Results: Of the 539 respondents (64.6% were aged ≤35 years), most were White (63.1%), single (42.5%), Catholic (48.4%) and privately insured (55.3%). Among the 223 women at pregnancy risk [not currently pregnant, not using any form of nonsurgical birth control (except condoms) and with no prior tubal ligation or hysterectomy], about 25% were using BCPs, fewer than 10% had used EC and almost 40% never used condoms. Most women displayed good knowledge about BCPs and condoms but poor understanding about EC. In multivariate logistic regression analyses, current BCP usage among women at risk of pregnancy was associated with younger age [odds ratio (OR)=0.54; 95% confidence interval (CI)=0.37–0.79], private insurance (OR=2.52; 95% CI=1.30–4.86) and recent intercourse (OR=1.61; 95% CI=1.19–2.18). Among women at risk of pregnancy, those who had an abortion (OR=2.56; 95% CI=1.17–5.61) and those who displayed greater EC knowledge (OR=3.23; 95% CI=1.50–6.95) had greater odds of having used EC. Among all women, more frequent condom usage was associated with being younger (OR=0.57; 95% CI=0.46–0.70), having never been married (OR=0.44; 95% CI=0.28–0.68) and not having intercourse recently (OR=0.79; 95% CI=0.64–0.98). Conclusions: A high percentage of female ED patients (41.4%) were at risk of pregnancy. Demographic and sexual history factors can help identify women who might benefit from receiving referrals or education on contraceptive measures. [Copyright &y& Elsevier]

Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention. The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings. Participants (N = 199) are Latinas 18–65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change. Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities. [ABSTRACT FROM AUTHOR]