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BackgroundFew weight loss interventions are evaluated for longer than a year, and even fewer employ social and mobile technologies commonly used among young adults. We assessed the efficacy of a 2 year, theory-based, weight loss intervention that was remotely and adaptively delivered via integrated user experiences with Facebook, mobile apps, text messaging, emails, a website, and technology-mediated communication with a health coach (the SMART intervention).MethodsIn this parallel-group, randomised, controlled trial, we enrolled overweight or obese college students (aged 18-35 years) from three universities in San Diego, CA, USA. Participants were randomly assigned (1:1) to receive either the intervention (SMART intervention group) or general information about health and wellness (control group). We used computer-based permuted-block randomisation with block sizes of four, stratified by sex, ethnicity, and college. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured weight in kg at 24 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. Objectively measured weight at 6, 12, and 18 months was included as a secondary outcome. The trial is registered with ClinicalTrials.gov, number NCT01200459.FindingsBetween May 18, 2011, and May 17, 2012, 404 individuals were randomly assigned to the intervention (n=202) or control (n=202). Participants' mean (SD) age was 22·7 (3·8) years. 284 (70%) participants were female and 125 (31%) were Hispanic. Mean (SD) body-mass index at baseline was 29·0 (2·8) kg/m(2). At 24 months, weight was assessed in 341 (84%) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity, and college, was not significantly different between the groups at 24 months (-0·79 kg [95% CI -2·02 to 0·43], p=0·204). However, weight was significantly less in the intervention group compared with the control group at 6 months (-1·33 kg [95% CI -2·36 to -0·30], p=0·011) and 12 months (-1·33 kg [-2·30 to -0·35], p=0·008), but not 18 months (-0·67 kg [95% CI -1·69 to 0·35], p=0·200). One serious adverse event in the intervention group (gallstones) could be attributable to rapid and excessive weight loss.InterpretationSocial and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss.FundingThe National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).

Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study's on-time recruitment that was within budget, 86% retention at 24 months, and a minimum of 57% engagement with the intervention over the 2-year RCT. Use of technology in combination with marketing practices may enable investigators to reach a larger and more diverse community of participants to take part in technology-based clinical trials, help maximize limited resources, and lead to more cost-effective and efficient clinical trial management of study participants as modes of communication evolve among the target population of participants.

ObjectivesTo explore the relationship between cognitive functioning and time spent at different intensities of physical activity (PA) in free-living older adults.DesignCross sectional analyses.SettingContinuing care retirement communities.ParticipantsOlder adults residing in seven continuing care retirement communities in San Diego County with an average age of 83; 70% were female, and 35% had a graduate-level education (N = 217).MeasurementsPA was measured objectively using hip worn accelerometers with data aggregated to the minute level. Three cut points were used to assess low light-intensity PA (LLPA), high light-intensity PA (HLPA), and moderate- to vigorous-intensity PA (MVPA). The Trail Making Test (TMT) Parts A and B were completed, and time for each test (seconds) and time for Part B minus time for Part A (seconds) were used as measures of cognitive function. Variables were log-transformed and entered into linear regression models adjusting for demographic factors (age, education, sex) and other PA intensity variables.ResultsLLPA was not related to any TMT test score. HLPA was significantly related to TMT A, B, and B minus A but only in unadjusted models. MVPA was related to TMT B and B minus A after adjusting for demographic variables.ConclusionThere may be a dose response between PA intensity and cognitive functioning in older adults. The stronger findings supporting a relationship between MVPA and cognitive functioning are consistent with previous observational and intervention studies.

Regular physical activity (PA) improves mental health and reduces the risk of a number of adverse health outcomes, including cardiovascular disease mortality, hypertension, colon cancer, and diabetes mellitus. Many studies with different strategies have been conducted to increase the level of PA for people of all ages. One of many strategies applied in intervention studies is the use of pedometers as a motivational tool. Pedometers are simple and inexpensive body-worn motion sensors that researchers and practitioners use to assess and motivate PA behaviors. Most of the pedometer-based intervention studies report an increase in PA by the intervention group, but the magnitude of this increase and the effect of other variables (e.g., age and sex of participants, intervention length) are not known. A meta-analysis of those intervention studies can provide more information about the magnitude of change and the effect of those variables. Thus, the purpose of this study was twofold. The first goal of this study was to use meta-analysis to determine the magnitude and direction of effects in pedometer-based interventions. The results showed that the use of pedometers has a moderate and positive effect on the increase of PA in intervention studies. The second goal was to determine if age and sex of participants, intervention length, and intervention strategy influence the effectiveness of the intervention. The cumulative evidence suggested that all the moderators influence the effect of pedometer-based PA interventions. (Contains 2 tables and 1 figure.)

The purpose of this systematic review was to (i) estimate the prevalence and dose of television (TV) viewing, video game playing and computer use, and (ii) assess age-related and (iii) secular trends in TV viewing among youth ([less than or equal] 18 yr). Ninety studies published in English language journals between 1949 and 2004 were included, presenting data from 539 independent samples (the unit of analysis). Results suggest contemporary youth watch on average 1.8-2.8 h of TV per day, depending on age and gender. Most (66%) are "low users" (less than 2 h day[-1]) of TV but 28% watch more than 4 h day[-1]. Boys and girls with access to video games spend approximately 60 and 23 min day[-1], respectively, using this technology. Computer use accounts for an additional 30 min day[-1]. Age-specific data suggest TV viewing decreases during adolescence, but those considered "high users" at young ages are likely to remain high users when older. For children with access to a television set, the number of hours spent viewing does not appear to have increased over the past 50 years.

Investigated ethnic and gender differences in frequency of use and healthfulness of bag lunches at school. Surveys of middle school students and their parents indicated that one-half of students brought bag lunches, with boys doing so more often than girls. There were ethnic differences in the use of seven foods and whether foods were regular or low fat. (SM)

Background: Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Methods: Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders. Results: Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant. Conclusion: Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches. [ABSTRACT FROM AUTHOR]

Abstract Background Identification of non-modifiable correlates of physical activity and sedentary behaviour in youth contributes to the development of effective targeted intervention strategies. The purpose of this research was to examine the relationships between family circumstances (e.g. socio-economic status, single vs. dual parent household, presence/absence of siblings) and leisure-time physical activity and sedentary behaviours in adolescents. Methods A total of 1171 adolescents (40% male; mean age 14.8 years) completed ecological momentary assessment diaries every 15 minutes for 3 weekdays outside of school hours and 1 weekend day. Analysed behaviours were sports/exercise, active travel, TV viewing, computer use, sedentary socialising (hanging-out, using the telephone, sitting and talking) and total sedentary behaviour. Linear regression was employed to estimate levels of association between individual family circumstance variables and each behaviour. Results Compared to girls from higher socioeconomic status (SES) groups, girls from low SES groups reported higher weekend TV viewing and higher weekday total sedentary behaviour. For boys, single parent status was associated with greater total sedentary behaviour compared to those from dual parent households. Boys and girls from low socio-economic neighbourhoods reported lower participation in sports/exercise compared to those living in higher socio-economic neighbourhoods. Conclusion Associations were not consistent across behaviours or between genders. Overall, findings indicate that boys from single parent households and girls from low socio-economic families may be at increased risk of high sedentary behaviour. Those living in low socioeconomic neighbourhoods may be at increased risk of reduced participation in sports and exercise.

The present study examined physical activity and sedentary behavior patterns of adolescents between 15.30h and 18.30h. The sample for this study is 1,484 (boys: n = 561; girls: n = 923). Boys and girls reported 21 and 19 min of physical activity and 24 and 26 min of homework respectively during this period. Technology-based sedentary behavior (TV viewing, computer and video game use) was significantly higher in boys than girls (boys = 50 mins; girls = 35 mins; p < .05). The most prevalent behaviors after school are technology-based sedentary behavior, homework and physical activity. During these hours, engagement in physical activity does not appear to displace time spent doing homework. [ABSTRACT FROM AUTHOR]

Examines the leisure time physical activity of a classroom teacher. Application of a correlation analysis for the investigation; Confirmation of the active teachers teaching physical education.

This study examined ethnic and gender differences in frequency of use and request/or low-Jilt or non fat foods in bag lunches, while controlling for socioeconomic status. Questionnaires were completed by 1,678 middle school students and their parents (72% response). Ethnic distribution included White (51%), Latino (17%), Asian (11%), Multi-ethnic (11%), and African American (8%). Forty-five percent of students (N = 712, 59% female) brought lunch to school a mean of 3.6 (SD = 1.5) days per week. Boys brought lunch more often (M = 3.8 days/week vs. 3.4, respectively), yet requested less low-fat foods than girls. Whites brought lunches with the most low/non-fat items. Ethnic differences also were found in the use of seven specific bag lunch foods and whether these items were regular or low-fat. Because of ethnic and gender differences, different strategies for reducing fat in bag lunches are needed for different groups. (J Sch Health. 1999;69(8):332-336), Numerous agencies, recognizing the need to improve the healthfulness of young people's diets, have developed guidelines and identified reducing dietary fat as a national nutrition priority. The Surgeon General,[1] American [...]