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BackgroundEffective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. ObjectiveThis randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. MethodsParents with a child aged

BackgroundExisting instruments that assess individuals’ relationships with mobile phones tend to focus on negative constructs such as addiction or dependence, and appear to assume that high mobile phone use reflects pathology. Mobile phones can be beneficial for health behavior change, disease management, work productivity, and social connections, so there is a need for an instrument that provides a more balanced assessment of the various aspects of individuals’ relationships with mobile phones. ObjectiveThe purpose of this research was to develop, revise, and validate the Mobile Phone Affinity Scale, a multi-scale instrument designed to assess key factors associated with mobile phone use. MethodsParticipants (N=1058, mean age 33) were recruited from Amazon Mechanical Turk between March and April of 2016 to complete a survey that assessed participants’ mobile phone attitudes and use, anxious and depressive symptoms, and resilience. ResultsConfirmatory factor analysis supported a 6-factor model. The final measure consisted of 24 items, with 4 items on each of 6 factors: Connectedness, Productivity, Empowerment, Anxious Attachment, Addiction, and Continuous Use. The subscales demonstrated strong internal consistency (Cronbach alpha range=0.76-0.88, mean 0.83), and high item factor loadings (range=0.57-0.87, mean 0.75). Tests for validity further demonstrated support for the individual subscales. ConclusionsMobile phone affinity may have an important impact in the development and effectiveness of mobile health interventions, and continued research is needed to assess its predictive ability in health behavior change interventions delivered via mobile phones.

BackgroundTobacco 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. ObjectiveThe 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. MethodsElectronic 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. ResultsThe 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

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.

BackgroundMobile technology offers the potential to deliver health-related interventions to individuals who would not otherwise present for in-person treatment. Text messaging (short message service, SMS), being the most ubiquitous form of mobile communication, is a promising method for reaching the most individuals. ObjectiveThe goal of the present study was to evaluate the feasibility and preliminary efficacy of a smoking cessation intervention program delivered through text messaging. MethodsAdult participants (N=60, age range 18-52 years) took part in a single individual smoking cessation counseling session, and were then randomly assigned to receive either daily non-smoking related text messages (control condition) or the TXT-2-Quit (TXT) intervention. TXT consisted of automated smoking cessation messages tailored to individual’s stage of smoking cessation, specialized messages provided on-demand based on user requests for additional support, and a peer-to-peer social support network. Generalized estimating equation analysis was used to assess the primary outcome (7-day point-prevalence abstinence) using a 2 (treatment groups)×3 (time points) repeated measures design across three time points: 8 weeks, 3 months, and 6 months. ResultsSmoking cessation results showed an overall significant group difference in 7-day point prevalence abstinence across all follow-up time points. Individuals given the TXT intervention, with higher odds of 7-day point prevalence abstinence for the TXT group compared to the Mojo group (OR=4.52, 95% CI=1.24, 16.53). However, individual comparisons at each time point did not show significant between-group differences, likely due to reduced statistical power. Intervention feasibility was greatly improved by switching from traditional face-to-face recruitment methods (4.7% yield) to an online/remote strategy (41.7% yield). ConclusionsAlthough this study was designed to develop and provide initial testing of the TXT-2-Quit system, these initial findings provide promising evidence that a text-based intervention can be successfully implemented with a diverse group of adult smokers. Trial RegistrationClinicalTrials.gov: NCT01166464; http://clinicaltrials.gov/ct2/show/NCT01166464 (Archived by WebCite at http://www.webcitation.org/6IOE8XdE0).

Background The Internet has great potential to provide assistance to millions of smokers who seek help with quitting smoking. Objective The goals of this study were to assess the content and the quality of smoking cessation treatments most likely to be encountered by smokers seeking treatment on the Internet and to examine differences in quality between current websites and those reviewed in 2004. Methods Internet searches for smoking cessation were designed to mimic the search patterns of most Internet users. PhD-level specialists in tobacco cessation treatments used standardized procedures to review the content of each website, assess the degree to which each site covered key components of evidence-based treatment as described in US national guidelines, determine the accuracy of information presented, and evaluate the use of website interactivity. Results of the current study were compared to results obtained in a prior review. Results Most websites retrieved in the search met exclusion criteria and were not included in the final analyses in both the current (74%, 65/88) and the prior study (77%, 156/202). In both studies, the majority of websites were excluded because they sold cessation-related products but did not provide treatment recommended by the Public Health Service guidelines. Of the 23 websites included in the current study, 26% (n = 6) provided only minimal coverage (brief mention) of key components of tobacco treatment. However, compared to the earlier study, websites included in the present study scored significantly higher in quality ratings in four areas: providing advice to quit (P = .05), practical counseling (P = .02), and enhancing motivation to quit smoking through personal relevance (P = .05) and risks (P < .001). Most Web-assisted tobacco intervention (WATI) sites (69%, 16/23) contained no inaccurate information. When observed, inaccuracies primarily occurred in content related to pharmacotherapy. The percentage of sites offering at least one interactive feature increased from 39% (18/46) in 2004 to 56% (13/23) in the present study. Despite this improvement, there was a notable underutilization of the interactive capabilities of the Internet to personalize treatment, to connect users with a virtual support system, and to provide follow-up treatment contacts. Conclusions While the quality of treatment offered in WATIs has improved since our previous review in 2004, there is substantial room for further improvement to ensure that smokers are offered high-quality, evidence-based treatments. It is not clear what degree of informational detail and interactivity is optimal for Web-based smoking cessation treatments. Additional research is needed to understand how to maximize the interactive capabilities of the Internet to produce and sustain population-based health behavior change.

Background: Few cessation studies have examined their recruitment methods to determine the most effective methods for enrollment and retention. Purpose: Data from a randomized controlled trial of yoga for smoking cessation was used to evaluate recruitment methods (e.g., radio, referral) and their relationship to enrollment, participant characteristics, and retention at end of treatment (EOT). Methods: Screening data from 1065 adults were analyzed for recruitment method, eligibility, randomization, and retention through EOT using Analysis of Variance and Chi-squared tests. Costs per enrolled participant were calculated. Results: Rates of participant accrual from screening through randomization differed by recruitment method (p < 0.05), although there were no differences in retention post-randomization. Among randomized participants, the majority were recruited via radio (44%) and the least number via newspaper (5%). There were differences in baseline psychosocial (i.e., nicotine dependence, readiness to quit) and demographic (i.e., age, employment) characteristics of randomized participants (n = 227, 55.5% women) across recruitment methods. Differences in costs between recruitment methods (p < 0.001) were noted. Discussion: Recruitment methods differed substantially in their cost and ability to attract individuals who would ultimately enroll. Translation to Health Education Practice: This investigation highlights the need to combine different recruitment methods to attract diverse individuals into cessation treatments. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars http://portal.shapeamerica.org/trn-Webinars

Objective: The purpose of this study was to gain insight about patterns of alcohol use and related consequences among heavy drinking community college students. Participants: About 26 community college students (Mean age 22.3 years, 46% men, 69% White) participated in this study between January and April 2013. Methods: Five qualitative focus group discussions were conducted during formative research preceding a text message intervention; participants were asked about common drinking behavior patterns among community college students, as well as how age and gender affect drinking. Sessions were audio-recorded and transcribed verbatim. Participants also completed a brief quantitative survey about their drinking behavior and its consequences. Results: Qualitative data identified several themes: (1) reasons for drinking; (2) drinking occasions; and (3) age- and experience-related differences in drinking, including patterns specific to community college students and women. Conclusion: Research is needed to develop innovative strategies to reduce alcohol harm in this understudied population.

Spanish-speaking Latinas have some of the lowest rates of meeting physical activity guidelines in the U.S. and are at high risk for many related chronic diseases. The purpose of the current study was to examine the maintenance of a culturally and individually-tailored Internet-based physical activity intervention for Spanish-speaking Latinas. Inactive Latinas (N  =  205) were randomly assigned to a 6-month Tailored Physical Activity Internet Intervention or a Wellness Contact Control Internet Group, with a 6-month follow-up. Maintenance was measured by assessing group differences in minutes per week of self-reported and accelerometer measured moderate to vigorous physical activity (MVPA) at 12 months after baseline and changes in MVPA between the end of the active intervention (month 6) and the end of the study (month 12). Potential moderators of the intervention were also examined. Data were collected between 2011 and 2014, and were analyzed in 2015 at the University of California, San Diego. The Intervention Group engaged in significantly more minutes of MVPA per week than the Control Group at the end of the maintenance period for both self-reported (mean diff. = 30.68, SE = 11.27, p = .007) and accelerometer measured (mean diff. = 11.47, SE = 3.19, p = .01) MVPA. There were no significant between- or within-group changes in MVPA from month 6 to 12. Greater intervention effects were seen for those with lower BMI (BMI × intervention = -6.67, SE = 2.88, p = .02) and lower perceived places to walk to in their neighborhood (access × intervention = -43.25, SE = 19.07, p = .02), with a trend for less family support (social support × intervention = -3.49, SE = 2.05, p = .08). Acculturation, health literacy, and physical activity related psychosocial variables were not significant moderators of the intervention effect during the maintenance period. Findings from the current study support the efficacy of an Internet-delivered individually tailored intervention for maintenance of MVPA gains over time.

Adolescents and young adults (young people) with HIV (YPWH) often struggle with treatment self-management. Many have symptoms due to HIV disease, medication side-effects, or comorbid conditions. Our study investigated the severity of HIV-related symptoms among YPWH aged 18–24 with detectable viral loads from an HIV clinic in Ghana (N = 60) and potential correlates of severity across a range of factors. Results indicated that YPWH currently experienced, on average, 13 symptoms (SD = 12.33). Six of the 10 most common symptoms were from two domains: fatigue and psychological. The most common symptoms were headaches (62%), weakness (53%), and fear/worries (52%). No differences were observed in number or severity of symptoms between youth based on HIV transmission status. Bivariate correlates of symptom severity were found with six that remained significant or approached significance in a multivariate model predicting severity: living with a parent/guardian, higher perceived access to HIV care, and higher treatment readiness were associated with lower severity while greater travel time to the HIV clinic, psychological distress, and more missed clinic appointments were associated with higher severity. Our findings suggest that interventions to address symptoms among YPWH should be multilevel and include strategies (e.g., telehealth, home care) to increase access to care. [ABSTRACT FROM AUTHOR]

BackgroundInternet access has grown markedly in Latinos during the past decade. However, there have been no Internet-based physical activity interventions designed for Latinos, despite large disparities in lifestyle-related conditions, such as obesity and diabetes, particularly in Latina women. The current study tested the efficacy of a 6-month culturally adapted, individually tailored, Spanish-language Internet-based physical activity intervention.MethodsInactive Latinas (N = 205) were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. Participants in both groups received emails on a tapered schedule over 6 months to alert them to new content on the website. The primary outcome was minutes/week of moderate to vigorous physical activity (MVPA) at 6 months as measured by the 7-Day Physical Activity Recall; activity was also measured by accelerometers. Data were collected between 2011 and 2014 and analyzed in 2015 at the University of California, San Diego.ResultsIncreases in minutes/week of MVPA were significantly greater in the Intervention Group compared to the Control Group (mean difference = 50.00, SE = 9.5, p

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 6months with a tapered dose during the second 6months (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.

Background: To increase physical activity among college students, new approaches are needed including the exploration of home-based exercise. However, research related to potential facilitators and barriers to exercising at home is limited. Purpose: The goal of this study was to develop a reliable and valid measure that can assess predictors of home exercise. Methods: A systematic approach was used to develop items for the new measure and to examine its psychometric properties. Principal component analysis (PCA) was used to investigate the internal structure of the measure. External validity and initial construct validity were examined using correlations of the new subscale measures with existing valid measures of exercise. Results: Two hundred thirty-two adults (65% women and 72% white) completed a cross-sectional survey. The final PCA solution resulted in a 28-item measure with 7 distinct subscales with individual item loadings ranging from 0.64 to 0.91. These subscales comprised 3 higher order scales of Barriers to Home Exercise, Benefits of Home Exercise, and Barriers to Public Exercise. All demonstrated good internal consistency and external validity. Discussion: The measure developed in this study delineates important predictors of home exercise. Translation to Health Education Practice: This measure can be used to develop tailored interventions to promote home-based exercise.

Despite high rates of cigarette use, little attention has been paid to screening and cessation services for youth in foster care. Study aims were to test the feasibility, acceptability, and preliminary efficacy of a technology-based smoking cessation intervention. Study enrollment, satisfaction, and engagement were high in the intervention arm, where readiness to change also significantly increased over time. Intervention and control participants significantly reduced cigarette use at 6-month follow-up, though groups did not differ. Technology-based interventions appear to be attractive and offer a potentially scalable link to health care that this vulnerable population may not otherwise seek. [ABSTRACT FROM AUTHOR]