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A diet high in fruits and vegetables (F&Vs) is associated with decreased risk for cardiovascular disease, diabetes, and cancer. This study investigated the relationship between sociodemographic, health, and psychosocial factors and F&V consumption among overweight and obese U.S. veterans. Participants were recruited from two Veterans Affairs medical center sites in 2005. Two hundred eighty-nine participants completed a self-administered survey. Bivariate and multivariate linear regression models were built to examine the association between sociodemographic, health, and psychosocial variables and F&V consumption. Older age (B = 0.01; p < 0.001) and being Black (B = -0.18; p < 0.05) were related to increased F&V consumption. Reported tobacco use was inversely associated with F&V consumption (B = -0.30; p < 0.01). Greater self-efficacy (B = 0.07; p < 0.05), fewer perceived barriers (B = -0.14; p < 0.01), and correct knowledge of recommended daily F&V intake (B = 0.12; p <0.05) were related to eating more F&Vs. U.S. veterans disproportionately experience overweight and obese conditions. Age, race, tobacco use, and psychosocial factors should be considered carefully when developing dietary interventionsamong overweight ana obese U.S. veterans. [ABSTRACT FROM AUTHOR]

Background: Program engagement is positively associated with improved outcomes in mobile health (mHealth) interventions, but little is known about which factors may increase or decrease the likelihood of participants viewing program messages. This study examined the association between daily behavioral goal achievement and likelihood of reading daily messages, and if this relationship is moderated by baseline depressive symptoms in an mHealth weight loss intervention., Methods: Data come from a 12-week microrandomized pilot mHealth weight management trial that tested the effects of daily messages on behavioral goals among 52 young adults (78.8% female, 61.5% white, ages 21-35). Conditional growth curve modeling was used to regress message viewing indicators onto the number of daily behavioral goals that participants had not met at the time of message receipt, with testing for moderation by depressive symptoms and controlling for covariates clustered within participants over time., Results: For each additional goal not met at the time of message receipt, participants were 34.8% less likely to read any message sent ( p  < 0.0001), and this relationship did not appear to be related to depressive symptoms ( p  = 0.1)., Conclusions: Participants may tend to avoid reading program messages when they know they are not meeting goals in a program, possibly due to motivated information avoidance to prevent negative emotional reactions from anticipated negative feedback messages. Future interventions may want to consider ways to contact participants who may be struggling in programs and also avoiding viewing standard message pushes in order to reduce the risk of disengagement., Competing Interests: De-identified data from this specific analysis may be made available by request to the corresponding author. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Most health care providers in Lagos State, Nigeria are private and are not required to offer breastfeeding counseling to women. From May 2019-April 2020, Alive & Thrive implemented a multicomponent breastfeeding promotion intervention in private health facilities in Lagos that included training and support to implement the Baby-Friendly Hospital Initiative and provide breastfeeding counseling and support to pregnant women and lactating mothers in person and on WhatsApp. We conducted a mixed methods process evaluation in 10 intervention and 10 comparison private health facilities to examine the feasibility and acceptability of integrating the intervention into routine health services. We conducted in-depth interviews with 20 health facility owners/managers and providers, 179 structured observations of health providers during service provision to pregnant and lactating women and 179 exit interviews with pregnant and lactating women. The in-depth interviews were transcribed and analyzed thematically. The structured observations and exit interviews were summarized using descriptive and inferential statistics. The in-depth interviews indicated that almost all health facility owners/managers and providers at the intervention health facilities had generally positive experiences with the intervention. However, the health providers reported implementation barriers including increased workload, use of personal time for counseling on WhatsApp, and some mothers' lack of access to WhatsApp support groups. Observations suggested that more breastfeeding counseling occurred at intervention compared with comparison health facilities. Third trimester exit interviews showed that 86% of women in the intervention health facilities were very confident they could carry out the breastfeeding advice they received, compared to 47% in the comparison health facilities. Our research suggests that provision of breastfeeding counseling and support through private health facilities is feasible and acceptable, but service delivery challenges must be considered for successful scale-up., Competing Interests: i. “SB is employed by Alive & Thrive initiative. SB was involved in managing the evaluation of the intervention but was not involved in the design, data collection and analysis of the study. OA is employed by Equitable Health Access Initiative. OA was involved in the design and implementation of the intervention, but not in data collection or analysis for this study. OA’s affiliation with Equitable Health Access Initiative does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have no conflicts of interest.”, (Copyright: © 2024 Allotey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: This study explored whether sociodemographic and health-related characteristics moderated mHealth PA intervention effects on total and moderate-to-vigorous physical activity (MVPA) at 6 months, relative to a self-help condition among young adult cancer survivors (YACS)., Methods: We conducted exploratory secondary analyses of data from a randomized controlled trial among 280 YACS. All participants received digital tools; intervention participants also received lessons, adaptive goals, tailored feedback, text messages, and Facebook prompts. Potential moderators were assessed in baseline questionnaires. PA was measured at baseline and 6 months with accelerometers. Linear model repeated measures analyses examined within- and between-group PA changes stratified by levels of potential moderator variables., Results: Over 6 months, the intervention produced MVPA increases that were ≥ 30 min/week compared with the self-help among participants who were males (28.1 vs. -7.7, p = .0243), identified with racial/ethnic minority groups (35.2 vs. -8.0, p = .0006), had baseline BMI of 25-30 (25.4 vs. -7.2, p = .0034), or stage III/IV cancer diagnosis (26.0 vs. -6.8, p = .0041). Intervention participants who were ages 26-35, college graduates, married/living with a partner, had a solid tumor, or no baseline comorbidities had modest MVPA increases over 6 months compared to the self-help (ps = .0163-.0492). Baseline characteristics did not moderate intervention effects on total PA., Conclusions: The mHealth intervention was more effective than a self-help group at improving MVPA among subgroups of YACS defined by characteristics (sex, race, BMI, cancer stage) that may be useful for tailoring PA interventions., Implications for Cancer Survivors: These potential moderators can guide future optimization of PA interventions for YACS., Gov Identifier: NCT03569605., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Participation in physical activity (PA) during and after cancer treatment is safe and beneficial in the adolescent and young adult (AYA) cancer population. PA can positively impact health-related outcomes; however, participation remains low. This systematic review aims to describe PA intervention characteristics and outcomes in AYA survivors of cancer (AYASCa). This review followed Preferred Reporting Index for Systematic Reviews and Meta Analyses (PRISMA) guidelines and was registered with Prospero (CRD42022365661). PubMed, CINAHL, and Scopus databases were searched for randomized control trials (RCTs) and pre/post-test studies without a control group through December 31, 2022. Data included: participant demographics, PA intervention characteristics, and health-related outcomes. Studies were assessed using the National Institute of Health Critical Appraisal Tools, and findings were synthesized to identify common characteristics of PA interventions and outcomes. Twenty-three studies were included: 15 RCTs and 8 pre/post-test studies. Heterogeneity existed across design, sample demographics, intervention timing, and observed outcomes. The most common characteristics of PA interventions were supervision of PA, wearable device use, tailored/individualized PA prescriptions, and goal setting. PA interventions positively affected health-related outcomes, with 21 studies reporting statistically significant findings. Implementing personalized PA prescriptions, utilizing wearable devices, and incorporating goal setting as characteristics in PA interventions hold potential benefits for AYASCa, leading to improved outcomes. Still, additional research is needed to explore interventions that utilize these PA characteristics and determine which ones are most effective for AYASCa. By further investigating and identifying optimal PA characteristics, interventions can be better tailored to meet this population's specific needs and preferences, ultimately enhancing their overall well-being and recovery.

Purpose: Social media can facilitate peer support among young adults with cancer; however, information is needed about what social media are used, by whom, and how to inform resource and intervention recommendations. Methods: In December 2021, we conducted an online survey with 396 young adults with cancer, ages 18-39, with any diagnosis ages 15-39. Participants reported their social media use to connect with other young adults with cancer, including frequency of use, type of support, and affect (positive to negative) when using to connect with cancer peers. Results: Participants were on average 31 years old (SD = 5.2), with an average age of 27 at diagnosis (63.4% male, 62.1% non-Hispanic White). Almost all (97.5%) reported using social media to connect with other young adults with cancer. Many (48.0%) used three or more social media platforms for cancer support, including Facebook (44.4%), YouTube (43.6%), Instagram (43.4%), Snapchat (36.9%), and Twitter (36.9%). Daily use for cancer support was common (32.9%-60.9%) among those who used social media, particularly among those who were younger; are not transgender; live in urban areas; or had brain, gynecologic, or testicular cancers. Across social media platforms, young adults with cancer reported seeking and sharing emotional support (88.9%), informational support (84.1%), and making connections (81.3%). Conclusion: Young adults with cancer use social media to connect with cancer peers for support. Commonly used existing social media (e.g., Facebook, YouTube, Instagram) should be prioritized in interventions to reach young adults who desire more age-appropriate resources to improve their psychosocial health.

Purpose: The purpose of this study was to identify resource needs and preferences of young adult cancer survivors (YAs) during the transition from active treatment to survivorship care to inform tailored care tools to support YAs during this period. Methods: A mixed methods study following a sequential explanatory approach was conducted among YAs between the ages of 15 and 39. Online surveys were distributed to assess participant information and resource needs, and responses were further explored during virtual focus group and interview discussions. Frequencies and proportions were calculated to identify quantitative resource needs, and a descriptive qualitative approach was used to gather and analyze qualitative data. Results: Thirty-one participants completed the online surveys, and 27 participated in qualitative data collection. The top resource needs identified in the surveys and discussed in focus groups and interviews were (1) fear of recurrence, (2) sleep and fatigue, (3) anxiety, (4) nutrition, (5) physical activity, and (6) finances. Emergent themes identified during transcript analyses included the need for (1) tailored, customizable resources, (2) connection with other survivors, (3) tools to guide conversations about cancer, (4) clarity in what to expect during treatment and survivorship, and (5) consistent and equitable care in YA oncology. Conclusions: Participants identified six important information needs in addition to an overarching need for tailored support and equitable distribution of resources while transitioning into early survivorship. Thus, tailored interventions are needed to enhance the distribution of YA-centered resources, improve equity in YA cancer care, and connect YAs with peer survivors.

Purpose: This scoping review describes the assessment methodologies for physical activity (PA) and physical fitness assessments used in studies focusing on adolescents and young adults (AYAs) diagnosed with cancer., Methods: A search of the literature was conducted in PubMed, CINAHL, Web of Science, and Cochrane Library following the PRISMA-ScR statement. A total of 34 studies were included in this review., Results: PA was primarily assessed via self-reported questionnaires (30/34) either completed in-person (n = 17) or online (n = 13) at different time points and different stages along the cancer trajectory (i.e., from diagnosis onward). A total of 9 studies conducted a physical fitness assessment., Conclusions: PA and physical fitness measurements are key when trying to describe outcomes, assess for associations, track changes, measure intervention adherence, and test intervention efficacy and effectiveness. Considerable heterogeneity across studies was reported limiting the generation of formal recommendations or guidance for researchers, healthcare providers, and policy makers., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a physical activity (PA) intervention trial., Methods: YACS were categorized at baseline using the 5-item FRAIL scale: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and non-cancer comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models., Results: Among 280 YACS (82% female; mean (M) age = 33.4 ± 4.8 years, M=3.7 ± 2.4 years post-diagnosis), 11% frail, 17% prefrail; the most frequent criteria were fatigue (41%), resistance (38%), and ambulation (14%). Compared to BMI < 25, higher BMI was associated with increased likelihood of frailty (BMI 25-30, PR: 2.40, 95% CI: 1.38-4.17; BMI > 30, PR: 2.95, 95% CI: 1.71-5.08). Compared to 0, ≥ 30 min/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.39, 95% CI: 0.25-0.60). Most YACS (55%) reported ≥ 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Comorbidities were more common for women (59% vs. 37%) and current/former smokers (PR: 1.71, 95% CI: 1.29-2.28)., Conclusion: Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and older adults without cancer and may be an indicator of accelerated aging and increased risk for poor outcomes., Implications for Cancer Survivors: Assessment of frailty may help identify YACS at increased risk for adverse health outcomes., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Most physical activity (PA) interventions in young adult cancer survivors (YACS) have focused on short-term outcomes without evaluating longer-term outcomes and PA maintenance. This study examined the effects of an mHealth PA intervention at 12 months, after 6 months of tapered contacts, relative to a self-help group among 280 YACS., Methods: YACS participated in a 12-month randomized trial that compared self-help and intervention groups. All participants received an activity tracker, smart scale, individual videochat session, and access to a condition-specific Facebook group. Intervention participants also received lessons, tailored feedback, adaptive goal setting, text messages, and Facebook prompts for 6 months, followed by tapered contacts. Accelerometer-measured and self-reported PA (total [primary outcome], moderate-to-vigorous [MVPA], light, steps, sedentary behaviors) were collected at baseline, 6, and 12 months. Generalized estimating equation analyses evaluated group effects on outcomes from baseline to 12 months., Results: From baseline to 12 months, there were no between- or within-group differences in accelerometer-measured total PA min/week, while increases in self-reported total PA were greater in the intervention versus self-help group (mean difference = +55.8 min/week [95% CI, 6.0-105.6], p = 0.028). Over 12 months, both groups increased accelerometer-measured MVPA (intervention: +22.5 min/week [95% CI, 8.8-36.2] vs. self-help: +13.9 min/week [95% CI, 3.0-24.9]; p = 0.34), with no between-group differences. Both groups maintained accelerometer-measured and self-reported PA (total, MVPA) from 6 to 12 months. At 12 months, more intervention participants reported meeting national PA guidelines than self-help participants (47.9% vs. 33.1%, RR = 1.45, p = 0.02)., Conclusion: The intervention was not more effective than the self-help group at increasing accelerometer-measured total PA over 12 months. Both groups maintained PA from 6 to 12 months. Digital approaches have potential for promoting sustained PA participation in YACS, but additional research is needed to identify what strategies work for whom, and under what conditions., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Physical inactivity is common in young adult cancer survivors (YACS), but evidence regarding effects of physical activity (PA) interventions among YACS is limited. The IMproving Physical Activity after Cancer Treatment (IMPACT) trial evaluated a theory-based mobile PA intervention on total PA minutes/week (primary) and secondary outcomes (moderate-to-vigorous PA [MVPA], light PA, steps, sedentary behaviors) at 6 months in YACS., Methods: YACS (N = 280) were randomized to an intervention group or self-help group. All participants received digital tools (activity tracker, smart scale, access to arm-specific Facebook group) and an individual video chat session. Intervention participants also received a 6-month program with behavioral lessons, adaptive goal-setting, tailored feedback, tailored text messages, and Facebook prompts. PA was assessed via accelerometry and questionnaires at baseline and 6 months. Generalized estimating equation analyses tested between-group differences in changes over time., Results: Of 280 YACS, 251 (90%) completed the 6-month accelerometry measures. Accelerometer-measured total PA minutes/week changed from 1974.26 at baseline to 2024.34 at 6 months in the intervention (mean change, 55.14 [95% CI, -40.91 to 151.19]) and from 1814.93 to 1877.68 in the self-help group (40.94 [95% CI, -62.14 to 144.02]; between-group p = .84). Increases in MVPA were +24.67 minutes/week (95% CI, 14.77-34.57) in the intervention versus +11.41 minutes/week in the self-help (95% CI, 1.44-21.38; between-group p = .07)., Conclusion: Although the intervention did not result in significant differences in total PA, the increase in MVPA relative to the self-help group might be associated with important health benefits. Future research should examine moderators to identify for whom, and under what conditions, the intervention might be effective., Clinicaltrials: gov Identifier: NCT03569605., Plain Language Summary: Physical inactivity is common in young adult cancer survivors. However, few interventions have focused on helping young adult cancer survivors to get more physical activity. The IMproving Physical Activity after Cancer Treatment trial compared a mobile health physical activity intervention with a self-help group on total amount of physical activity at 6 months in a nationwide sample of young adult cancer survivors. Intervention participants did not improve their total amount of physical activity, but they did increase their moderate-to-vigorous intensity physical activity by twice as much as the self-help participants. This increase in activity may be associated with health benefits., (© 2022 American Cancer Society.)

Purpose: To identify physical activity (PA) barriers and facilitators among Black and African American (Black/AA) cancer survivors that should be considered in future PA intervention development for this population., Methods: A community advisory board (CAB) of Black/AA cancer survivors and patient advocates guided in-depth qualitative interviews (n = 19) that were completed via telephone using a semi-structured interview guide. Interviews were transcribed verbatim, and data were analyzed using directed content analysis to detail a report of PA barriers and facilitators during and after cancer treatment. The CAB reviewed and interpreted these barriers and facilitators to identify the final results., Results: Survivors (n = 19) of nine different types of cancer completed interviews. PA barriers during cancer treatments included physical and psychological suffering. PA barriers after cancer treatments included social and environmental constraints (e.g., lack of access needed for PA, safety concerns, and competing priorities). PA facilitators both during and after cancer treatments included family support, faith, and support from other survivors. PA facilitators during treatment also included feeling better after doing PA, setting realistic and flexible goals, and gaining a sense of control of one's health by striving for PA goals., Conclusions: To increase PA among Black/AA cancer survivors, PA interventions are needed that address structural barriers, include the role of faith, leverage family support, highlight the psychological benefits of PA, and use goal setting., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Although parents with cancer report that talking with their children about cancer and dying is distressing, accessible support is rare. We assessed the feasibility, acceptability, and preliminary effects of Families Addressing Cancer Together (FACT), a web-based, tailored psychosocial intervention to help parents talk about their cancer with their children., Methods: This pilot study used a pre-posttest design. Eligible participants were parents with new or metastatic solid tumors who had minor (ages 3-18) children. Participants who completed baseline assessments received online access to FACT. We assessed feasibility through enrollment and retention rates and reasons for study refusal. Acceptability was evaluated by satisfaction ratings. We examined participants' selection of intervention content and preliminary effects on communication self-efficacy and other psychosocial outcomes (depression and anxiety symptoms, health-related quality of life, family functioning) at 2- and 12-week post-intervention., Results: Of 68 parents we approached, 53 (78%) agreed to participate. Forty-six parents completed baseline assessments and received the FACT intervention. Of the 46 participants, 35 (76%) completed 2-week assessments, and 25 (54%) completed 12-week assessments. Parents reported that FACT was helpful (90%), relevant (95%), and easy to understand (100%). Parents' psychosocial outcomes did not significantly improve post-intervention, but parents endorsed less worry about talking with their child (46% vs. 37%) and reductions in the number of communication concerns (3.4 to 1.8)., Conclusion: The FACT intervention was feasible, acceptable, and has potential to address communication concerns of parents with cancer. A randomized trial is needed to test its efficacy in improving psychological and parenting outcomes., Trial Registration: This study was IRB-approved and registered with clinicaltrials.gov (NCT04342871)., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Subjective Benign Paroxysmal Positional Vertigo (S-BPPV) is an atypical form of BPPV, its treatment is not well characterized and is not well known among otolaryngologists. The main aim of this study was to estimate the short-term efficacy of Epley maneuver as treatment for S-BPPV. This was a prospective study in a secondary care center. We included patients with unilateral S-BPPV demonstrated by negative nystagmus on Dix-Hallpike Maneuver (DHM) but with unilateral vestibular symptoms (dizziness or vertigo). Epley maneuver to the affected side was performed. Patients underwent Dizziness Handicap Inventory (DHI) and at 1-week follow-up, DHI and DHM were repeated. Outcome measures were resolution of symptoms during DHM and improvement of DHI scores. Patients were divided into resolved and unresolved groups according to the absence or presence of symptoms during the 1 week DHM. Wilcoxon-Mann-Whitney and Kruskal-Wallis tests were used, quantitative values were reported as mean and standard deviation. The results included thirteen participants, 12 females and 1 male, mean age 53.31 years (SD ± 15.71). Right ear was involved in 46.15% and left in 53.84%. A total of 46.15% patients (n = 6) had resolution of symptoms. DHI initial score for the resolved group was 34.66 ± 22 and for the unresolved group was 39.71 ± 19.61 ( p  = 0.568). At 1-week evaluation scores were 19.66 ± 25.05 for the resolved group and 30.28 ± 21.42 for the unresolved group ( p  = 0.252). DHI improvement was 15.00 ± 23.21 and 9.42 ± 10.17 for each group, respectively ( p  = 0.943). We concluded the Epley maneuver is an effective short-term treatment for S-BPPV. Half of the patients would need further diagnostic tests., Competing Interests: Conflict of interestThere are no conflicts of interest., (© Association of Otolaryngologists of India 2021.)

Background: Young adult cancer survivors experience frailty and decreased muscle mass at rates equivalent to much older noncancer populations, which indicate accelerated aging. Although frailty and low muscle mass can be identified in survivors, their implications for health-related quality of life are not well understood., Methods: Through a cross-sectional analysis of young adult cancer survivors, frailty was assessed with the Fried frailty phenotype and skeletal muscle mass in relation to functional and quality of life outcomes measured by the Medical Outcomes Survey Short-Form 36 (SF-36). z tests compared survivors with US population means, and multivariable linear regression models estimated mean SF-36 scores by frailty and muscle mass with adjustments made for comorbidities, sex, and time from treatment., Results: Sixty survivors (median age, 21 years; range, 18-29) participated in the study. Twenty-five (42%) had low muscle mass, and 25 were either frail or prefrail. Compared with US population means, survivors reported worse health and functional impairments across SF-36 domains that were more common among survivors with (pre)frailty or low muscle mass. In multivariable linear modeling, (pre)frail survivors (vs nonfrail) exhibited lower mean scores for general health (-9.1; P = .05), physical function (-14.9; P < .01), and overall physical health (-5.6; P = .02) independent of comorbid conditions., Conclusions: Measures of frailty and skeletal muscle mass identify subgroups of young adult cancer survivors with significantly impaired health, functional status, and quality of life independent of medical comorbidities. Identifying survivors with frailty or low muscle mass may provide opportunities for interventions to prevent functional and health declines or to reverse this process., Lay Summary: Young adult cancer survivors age more quickly than peers without cancer, which is evidenced by a syndrome of decreased resilience known as frailty. The relationship between frailty (and one of its common components, decreased muscle mass) and quality of life among young adult cancer survivors was examined. Measuring decreased muscle mass and frailty identifies young survivors with poor quality of life, including worse general health, fatigue, physical function, and overall physical health, compared with nonfrail survivors. Interventions to address components of frailty (low muscle mass and weakness) may improve function and quality of life among young adult cancer survivors., (© 2022 American Cancer Society.)

Background: Evidence about the effects of mothers' decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers' decision-making autonomy and the practice of complementary feeding., Objectives: This study examined the moderation effect of fathers' complementary feeding support on the association of mothers' decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers' and fathers' perspectives of mothers' autonomy and fathers' complementary feeding support., Methods: Data were from cross-sectional surveys of 495 cohabiting parents of children aged 6-23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents., Results: The moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents' perspectives of mothers' autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents' perspectives of fathers' complementary feeding support., Conclusions: In Nigeria, high levels of fathers' complementary feeding support strengthen the association of mothers' decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Purpose: Few studies have recruited young adult cancer survivors (YACS) from around the USA into remotely-delivered behavioral clinical trials. This study describes recruitment strategies used in the IMproving Physical Activity after Cancer Treatment (IMPACT) study, a 12-month randomized controlled trial of a mobile physical activity intervention for YACS., Methods: We conducted formative work to guide development of recruitment messages and used a variety of methods and channels to recruit posttreatment YACS (diagnosed ages 18-39, participating in < 150 min/week of moderate-to-vigorous intensity activity). We used targeted social media advertisements, direct mailings, clinical referrals, and phone calls to potentially eligible individuals identified through local tumor registries. We also asked community organizations to share study information and advertized at a national conference for YACS., Results: The final sample of 280 participants (23% identified as racial/ethnic minority individuals, 18% male, mean 33.4 ± 4.8 years) was recruited over a 14-month period. About 38% of those who completed initial screening online (n = 684) or via telephone (n = 63) were randomized. The top recruitment approach was unpaid social media, primarily via Facebook posts by organizations/friends (45%), while direct mail yielded 40.7% of participants. Other social media (paid advertisements, Twitter), email, clinic referrals, and conference advertisements each yielded 3% or fewer participants. The most cost-effective methods per participant recruited were unpaid social media posts and direct mailings., Conclusions: The IMPACT trial successfully met enrollment goals using a national strategy to recruit physically inactive YACS. Our approaches can inform recruitment planning for other remotely-delivered intervention trials enrolling YACS., Trial Registration: ClinicalTrials.gov NCT03569605 . Registered on 26 June 2018., (© 2022. The Author(s).)

Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision-making, intra-household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through father engagement. This study describes household gender roles among A&T participants and how they influence maternal and paternal involvement in complementary feeding. We conducted 16 focus group discussions with mothers and fathers of children aged 6-23 months in urban and rural administrative wards and analysed them using qualitative thematic analysis methods. Most mothers and fathers have traditional roles with fathers as 'providers' and 'supervisors' and mothers as 'caregivers'. Traditional normative roles of fathers limit their involvement in 'hands-on' activities, which support feeding and caring for children. Less traditional normative roles, whereby some mothers contributed to the provision of resources and some fathers contributed to caregiving, were also described by some participants and were more salient in the urban wards. In the rural wards, more fathers expressed resistance to fathers playing less traditional roles. Fathers who participated in caregiving tasks reported respect from their children, strong family relationships and had healthy home environments. Our research findings point to the need for more context-specific approaches that address prevalent gender normative roles in complementary feeding in a variety of settings., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Objective: This study tested the efficacy of a lower-burden, simplified dietary self-monitoring approach compared with a standard calorie monitoring approach for self-monitoring adherence and weight loss in a mobile-delivered behavioral weight loss intervention., Methods: Participants (n = 72) with overweight or obesity who had children 2 to 12 years of age living in the home were randomly assigned to a group that used simplified dietary self-monitoring of high-calorie foods (Simplified) or a group that tracked calories (Standard). Both groups received a wireless scale, Fitbit trackers, and a 6-month intervention delivered via a smartphone application with lessons, text messages, and weekly personalized feedback messages., Results: Percentage weight loss at 6 months was 5.7% (95% CI: -8.3% to -3.2%) in the Standard group and 4.0% (95% CI: -5.7% to -2.3%) in the Simplified group, which was not significantly different. Similar proportions reached 5% weight loss at 6 months (43.2% in Standard and 42.9% in Simplified). There were no differences in number of dietary tracking days or change in average daily caloric intake between groups., Conclusions: Two mobile-delivered weight loss interventions produced clinically meaningful levels of weight loss at 6 months, with no differences in dietary tracking adherence or dietary intake. The results suggest that simplified monitoring of high-calorie foods could be a promising alternative to calorie monitoring., (© 2022 The Obesity Society (TOS).)

Purpose: Social isolation is a prominent challenge for many young adults with cancer. Despite desires for peer-to-peer connections through technology, little is known about how young adults initiate or use social media for support over time., Methods: We interviewed young adults with cancer (n = 45; age 18-39, in or post cancer treatment) to explore their initiation of social media for support, changes in use over time, and types of connections sought., Results: Young adults with cancer learn about online support through individual personal recommendations, advocacy organizations, or searching on Google or social media. Most were reluctant to use social media support initially because of feeling overwhelmed-from diagnoses, abundance of online information, or demands of participation-and joined when informational and emotional needs arose. Many wished they had joined earlier. Some participants use social media to make close connections while others simply want to "see" others' shared experiences or crowdsource information., Conclusion: Young adults with cancer often haphazardly find online support from personal recommendations or Internet searches. Desires for social media connections are not one-size-fits-all; there are important audience segmentations for the degree and type of peer support., Implications for Cancer Survivors: Better promotion of online social support options and benefits-early in one's cancer timeline and systematically through healthcare providers, cancer organizations, or family and friends-could improve access to helpful peer-to-peer support., (© 2021 John Wiley & Sons Ltd.)

Background: Web-based social support can address social isolation and unmet support needs among young adults with cancer (aged 18-39 years). Given that 94% of young adults own and use smartphones, social media can offer personalized, accessible social support among peers with cancer., Objective: This study aims to examine the specific benefits, downsides, and topics of social support via social media among young adults with cancer., Methods: We conducted semistructured interviews with young adults with cancer, aged between 18 and 39 years, who were receiving treatment or had completed treatment for cancer., Results: Most participants (N=45) used general audience platforms (eg, Facebook groups), and some cancer-specific social media (eg, Caring Bridge), to discuss relevant lived experiences for medical information (managing side effects and treatment uncertainty) and navigating life with cancer (parenting and financial issues). Participants valued socializing with other young adults with cancer, making connections outside their personal networks, and being able to validate their emotional and mental health experiences without time and physical constraints. However, using social media for peer support can be an emotional burden, especially when others post disheartening or harassing content, and can heighten privacy concerns, especially when navigating cancer-related stigma., Conclusions: Social media allows young adults to connect with peers to share and feel validated about their treatment and life concerns. However, barriers exist for receiving support from social media; these could be reduced through content moderation and developing more customizable, potentially cancer-specific social media apps and platforms to enhance one's ability to find peers and manage groups., (©Allison J Lazard, Meredith K Reffner Collins, Ashley Hedrick, Tushar Varma, Brad Love, Carmina G Valle, Erik Brooks, Catherine Benedict. Originally published in JMIR Cancer (https://cancer.jmir.org), 02.09.2021.)

Introduction: Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS., Purpose: To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS., Methods: A total of 280 physically inactive YACS (diagnosed at ages 18-39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures., Conclusions: IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Self-monitoring is critical for weight management, but little is known about lapses in the use of digital self-monitoring. The objectives of this study were to examine whether lapses in self-weighing and wearing activity trackers are associated with weight and activity outcomes and to identify objective predictors of lapses., Methods: Participants (N = 160, BMI = 25.5 ± 3.3 kg/m 2 , 33.1 ± 4.6 years old) were drawn from a sample of young adults in the Study of Novel Approaches to Prevention-Extension (SNAP-E) weight gain prevention trial. Analyses evaluated associations between weighing and tracker lapses and changes in weight and steps/day during the first 90 days after receiving a smart scale and activity tracker., Results: On average, participants self-weighed 49.6% of days and wore activity trackers 75.2% of days. Every 1-day increase in a weighing lapse was associated with a 0.06-lb gain. Lapses in tracker wear were not associated with changes in steps/day or weight between wear days. Weight gain predicted a higher likelihood of starting a lapse in weighing and tracker wear, whereas lower steps predicted a higher likelihood of a tracker lapse., Conclusions: Weight gain may discourage adherence to self-monitoring. Future research could examine just-in-time supports to anticipate and reduce the frequency or length of self-monitoring lapses., (© 2021 The Obesity Society.)

Background: It has been widely communicated that individuals with underlying health conditions are at higher risk of severe disease due to COVID-19 than healthy peers. As social distancing measures continue during the COVID-19 pandemic, experts encourage individuals with underlying conditions to engage in telehealth appointments to maintain continuity of care while minimizing risk exposure. To date, however, little information has been provided regarding telehealth uptake among this high-risk population., Objective: The aim of this study is to describe the telehealth use, resource needs, and information sources of individuals with chronic conditions during the COVID-19 pandemic. Secondary objectives include exploring differences in telehealth use by sociodemographic characteristics., Methods: Data for this study were collected through an electronic survey distributed between May 12-14, 2020, to members of 26 online health communities for individuals with chronic disease. Descriptive statistics were run to explore telehealth use, support needs, and information sources, and z tests were run to assess differences in sociodemographic factors and information and support needs among those who did and did not use telehealth services., Results: Among the 2210 respondents, 1073 (49%) reported engaging in telehealth in the past 4 months. Higher proportions of women engaged in telehealth than men (890/1781, 50% vs 181/424, 43%; P=.007), and a higher proportion of those earning household incomes of more than US $100,000 engaged in telehealth than those earning less than US $30,000 (195/370, 53% vs 241/530 45%; P=.003). Although 59% (133/244) of those younger than 40 years and 54% (263/486) of those aged 40-55 years used telehealth, aging populations were less likely to do so, with only 45% (677/1500) of individuals 56 years or older reporting telehealth use (P<.001 and P=.001, respectively). Patients with cystic fibrosis, lupus, and ankylosing spondylitis recorded the highest proportions of individuals using telehealth when compared to those with other diagnoses. Of the 2210 participants, 1333 (60%) participants either looked up information about the virus online or planned to in the future, and when asked what information or support would be most helpful right now, over half (1151/2210, 52%) responded "understanding how COVID-19 affects people with my health condition.", Conclusions: Nearly half of the study sample reported participating in telehealth in the past 4 months. Future efforts to engage individuals with underlying medical conditions in telehealth should focus on outreach to men, members of lower-income households, and aging populations. These results may help inform and refine future health communications to further engage this at-risk population in telehealth as the pandemic continues., (©Lindsey Nicole Horrell, Sara Hayes, Leslie Beth Herbert, Katie MacTurk, Lauren Lawhon, Carmina G Valle, Amrita Bhowmick. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.02.2021.)

Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS., Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months., Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data., Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m 2 , SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active., Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management., (©Julianne M Power, Deborah F Tate, Carmina G Valle. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 08.06.2020.)

Background: Chronic otitis media (COM) questionnaire 12 (COMQ-12) is a specific-disease tool that evaluates COM patients. Objective: To validate COMQ-12 in the Mexican Spanish language (COMQ-12-Mx). Materials and methods: Mexican Spanish-speaking healthy volunteers and COM patients who attended a Secondary Care Center from May 2019 to October 2019. The COMQ-12 in Mexican Spanish was obtained by translation and back translation from an English-Spanish translator. All participants completed the COMQ-12-Mx questionnaire. COM patients were included regardless of their COM status. Control group completed the questionnaire twice. Participants were categorized into three groups: group 1 (COM), group 2 (volunteers first test) and group 3 (volunteers retest). Cronbach's alpha was used for internal consistency, Spearman's rank correlation coefficient was used for test-retest reliability and Mann-Whitney U test compared groups. Results: We included 78 Mexican Spanish-speaking participants (COM n  = 37, healthy volunteers n  = 41), 51 females and 27 males, mean age was 39.67 years (SD ± 18.32). Group 1 COMQ-12-Mx score was 22.108 ± 11.79, group 2 score was 3.561 ± 4.399 ( p  ≤ .001) and group 3 score was 3.683 ± 4.435. Cronbach's alpha was 0.828 and test-retest reliability achieved a 0.928 outcome. Conclusions: COMQ-12-Mx is a valid and reliable tool to evaluate quality life in Mexican Spanish-speaking patients with COM.

Purpose of Review: Participation in cardiac rehabilitation is associated with improved quality of life and physical functioning and may be an effective strategy to assist in the recovery from cancer. We conducted a scoping review to identify studies that enrolled cancer survivors into cardiac rehabilitation programs., Recent Findings: We identified nine studies that included 662 cancer survivors. Five studies integrated cancer survivors and cardiac patients into the same sessions, three studies developed cancer-only rehabilitation sessions, and one study did not report details on the rehabilitation sessions. On average, more than 60% of enrolled cancer survivors completed the rehabilitation programs and many health and psychosocial outcomes improved after rehabilitation., Summary: Cardiac rehabilitation appears to be acceptable and favorably impacts many health and psychosocial outcomes among cancer survivors. Future research should consider randomized controlled trial study designs, enrolling diverse survivor populations, and using a set of core physical function and psychosocial outcomes., Competing Interests: Conflict of Interest The authors report no conflicts of interest.

Background: With growing numbers of adults turning to the internet to get answers for health-related questions, online communities provide platforms with participatory networks to deliver health information and social support. However, to optimize the benefits of these online communities, these platforms must market effectively to attract new members and promote community growth., Objective: The aim of this study was to assess the engagement results of Facebook advertisements designed to increase membership in the LungCancer.net online community., Methods: In the fall of 2017, a series of 5 weeklong Facebook advertisement campaigns were launched targeting adults over the age of 18 years with an interest in lung cancer to increase opt ins to the LungCancer.net community (ie, the number of people who provided their email to join the site)., Results: The advertisements released during this campaign had a sum reach of 91,835 people, and 863 new members opted into the LungCancer.net community by providing their email address. Females aged 55 to 64 years were the largest population reached by the campaign (31,401/91,835; 34.29%), whereas females aged 65 and older were the largest population who opted into the LungCancer.net community (307/863; 35.57%). A total of US $1742 was invested in the Facebook campaigns, and 863 people opted into LungCancer.net, resulting in a cost of US $2.02 per new member., Conclusions: This research demonstrates the feasibility of using Facebook advertising to promote and grow online health communities. More research is needed to compare the effectiveness of various advertising approaches. Public health professionals should consider Facebook campaigns to effectively connect intended audiences to health information and support., (©Lindsey N Horrell, Allison J Lazard, Amrita Bhowmick, Sara Hayes, Susan Mees, Carmina G Valle. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.11.2019.)

Objective: With a steadily increasing number of Latino/a cancer survivors, there is a need for supportive care programs for this underserved survivor subgroup., Methods: In this study, the authors culturally adapted an evidence-based survivorship program, Cancer Transitions: Moving Beyond Treatment (CT) for this population. Guided by Barrera and Castro's heuristic model for cultural adaptation of interventions, we conducted five focus groups (FG) among Latino/a cancer survivors (n = 54) in several US sites to inform the preliminary adaptation of program materials. We conducted four additional FGs (n = 38) to obtain feedback on adapted materials., Results: Common themes from initial FGs were related to program delivery and logistics, and general recommendations for CT modification. Program adaptations addressed information needs, including health care system navigation, employment concerns, and sexuality. Other adaptations included an emphasis on family, spirituality, culturally appropriate translation and features, and role plays. Participants in the second round of FGs confirmed adaptations incorporated earlier findings and suggested additional refinements., Conclusion: This project helps guide the cultural adaptation of survivorship programs for Latino/a cancer survivors., (© 2019 John Wiley & Sons, Ltd.)

Introduction: Daily self-weighing (DSW) and daily activity tracking (DAT) are useful strategies for preventing weight gain among African American breast cancer survivors. However, self-monitoring behaviors vary over time, increasing risk of weight gain. This study explored the association of nonadherence to DSW and DAT with corresponding weight fluctuations among African American breast cancer survivors., Methods: Using data from a 6-month randomized controlled trial, we conducted a secondary data analysis among women randomized into a DSW group (n = 13) and a DSW+DAT group (n = 11). DSW and DAT were captured from wireless scale and activity tracker data. Nonadherence to DSW was defined as one or more days without a weight measurement, and nonadherence to DAT was defined as one or more days without activity tracking. Generalized estimating equations were used to examine weight fluctuations in relation to nonadherence to DSW and DAT. Data analysis occurred from September 2016-April 2017., Results: Over the 6-month study period, women provided 119.2 ± 46.0 weight measurements and 121.9 ± 53.2 days of physical activity tracking. Nonadherence to DSW was associated with weight fluctuations. For every 1-day increase in nonadherence to DSW, weight increased by 0.031 kg (95% CI: 0.012, 0.050; p<0.01). Additionally, during periods of DSW and DAT weight decreased by 0.028 kg (95% CI: -0.042, -0.014; p<0.001) and 0.017 kg (95% CI: -0.030; -0.004) respectively., Conclusions: Our findings suggest that nonadherence to DSW was associated with weight gain among breast cancer survivors. Weight loss was enhanced during periods of DSW and DAT., Competing Interests: The authors have declared that no competing interests exist.

Background: Health risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback., Objective: The goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions., Methods: We conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up., Results: For the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions., Conclusions: Findings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors., (©Carmina G Valle, Tara L Queen, Barbara A Martin, Kurt M Ribisl, Deborah K Mayer, Deborah F Tate. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.03.2018.)

Few studies have examined how young adult cancer survivors use online social media. The objective of this study was to characterize Facebook engagement by young adult cancer survivors in the context of a physical activity (PA) intervention program. Young adult cancer survivors participated in one of two Facebook groups as part of a 12-week randomized trial of a PA intervention (FITNET) compared to a self-help comparison (SC) condition. A moderator actively prompted group discussions in the FITNET Facebook group, while social interaction was unprompted in the SC group. We examined factors related to engagement, differences in engagement by group format and types of Facebook posts, and the relationship between Facebook engagement and PA outcomes. There were no group differences in the number of Facebook comments posted over 12 weeks (FITNET, 153 vs. SC, 188 p = 0.85) or the proportion of participants that reported engaging within Facebook group discussions at least 1-2 days/week. The proportion of participants that made any posts decreased over time in both groups. SC participants were more likely than FITNET participants to agree that group discussions caused them to become physically active (p = 0.040) and that group members were supportive (p = 0.028). Participant-initiated posts elicited significantly more comments and likes than moderator-initiated posts. Responses posted on Facebook were significantly associated with light PA at 12 weeks (β = 11.77, t(85) = 1.996, p = 0.049) across groups. Engagement within Facebook groups was variable and may be associated with PA among young adult cancer survivors. Future research should explore how to promote sustained engagement in online social networks. ClinicalTrials.gov identifier: NCT01349153.

Background: Few randomized studies have examined differential effects of group size in behavioral weight control, especially in hybrid programs that include Internet treatment approaches., Methods: Randomized controlled trial (n = 195) comparing a 4 month hybrid internet weight loss program coupled with monthly face to face groups of 100 persons (Large Group, LG; 1 group) or to the same approach with monthly groups of 20 persons (Small Group, SG; 4 groups). Repeated-measures mixed-model analysis with age and race as covariates were used to estimate primary (weight) and secondary outcomes, and to test group differences in change over time., Results: The sample was 46.3 years old ±10.4, 90.3% female, and 51.9% non-white, with BMI 37.9 ± 8.4 kg/m 2 . Participants in the LG were more likely to return for the 4-month assessment visit than those in the SG (p = 0.04). Participants randomized to both the LG and SG conditions experienced significant WL over time (no between group difference: -4.1 kg and -3.7 kg, respectively) and weight loss was positively associated with attendance at monthly meetings and logins to the website. Satisfaction with the program was high and similar in both groups (94.4% reported that they were "satisfied" or "very satisfied")., Conclusions: Using a hybrid approach of in-person and online weight loss interventions may be an effective way to reach larger and more diverse populations. Delivering the face to face component of the intervention in groups larger than those traditionally delivered (20-25 people) could increase the cost-effectiveness of group-based behavioral weight loss interventions., Clinical Trials Registration Number: NCT01615471 . Registered June 6, 2012. Registered retrospectively.

Purpose: This study evaluated the feasibility and preliminary efficacy of two 6-month, self-regulation interventions that focused on daily self-weighing (DSW) and used objective monitoring and tailored feedback about weight (±activity), to prevent weight gain among African American breast cancer survivors., Methods: Participants (n = 35) were randomized to an intervention + activity monitoring (INT+), intervention (INT), or control (CON) group. Interventions included a wireless scale (±activity tracker) that transmitted objective data to a mobile app/website, emailed lessons, and tailored feedback based on objective weight (±activity data). Participants completed in-person and online assessments at baseline, 3 months, and 6 months., Results: Ninety-four percent of participants completed assessments at 3 months, and 97 % at 6 months. Median (IQR) weight change after 6 months was -0.9 % (-4.4-0.1) in the INT+ (p = 0.075; p = 0.067 vs. CON) and -0.2 % (-4.2-1.3) in the INT groups (p = 0.463; p = 0.357 vs. CON), versus a 0.2 % (-0.7-1.7) gain in the CON group. The proportion of INT+, INT, and CON participants that were at or below baseline weight was 72.7, 53.8, and 45.5 %, respectively (effect sizes d = 0.64, d = 0.18). Most INT+ participants weighed and wore trackers ≥5 days/week (INT+, 81.9 % vs. INT, 38.5 % vs. CON, 0 %; p < 0.0005; INT+, 72.7 %). Both intervention groups perceived DSW as positive, and 100 % would recommend the program to other breast cancer survivors., Conclusion: An intervention focused on DSW as a self-monitoring strategy shows promise for preventing weight gain in breast cancer survivors., Implications for Cancer Survivors: Daily self-monitoring of weight and activity may be a feasible and accessible approach to promote weight gain prevention in breast cancer survivors., Clinical Trial Registration: ClinicalTrials.gov, NCT02030353., Competing Interests: The authors declare that they have no conflict of interest.

Teacher satisfaction can be reflected in the success of higher education institutions to provide meaningful learning to their students. This study analyzed the professional satisfaction of nutrition teachers at a federal institution of higher education by identifying the factors that generated satisfaction and dissatisfaction for them and also the feelings that they envisioned for themselves at the end of their careers. This is a descriptive and exploratory study with a qualitative approach. A questionnaire and semi-structured interviews were performed. The results showed that 72.7% of the teachers were satisfied with their profession. In relation to satisfaction were considered: the fulfillment of a vocation; research and extension activities; the development and recognition of students and society; learning; autonomy; flexibility; and relationships with students. In relation to dissatisfaction were considered: overloading due to work, administration, bureaucratic duties and assistance; lack of interest and respect from students; relationships with colleagues and managers; devaluation in the role of teaching; large classes and poor physical infrastructure. The respondents expressed a positive attitude and had no desire to leave their profession. Further studies are required regarding factors leading to satisfaction and dissatisfaction for teachers, in order to contribute to their productivity and well-being.

Background: Overweight and obesity rates in children and adolescents are concerning, particularly among girls. Social support from friends has been associated with healthier eating and higher levels of physical activity, yet little is known about the relationship between social support and weight loss among adolescents. This aim of this study was to prospectively examine the relationship between baseline social support from friends and family, changes in social support, and weight loss., Methods: Sixty-five adolescent girls completed a one-year weight loss intervention trial. Data were collected at baseline, 6 months, and 12 months., Results: At baseline, family support was higher compared to friend support; however, lower friend support at baseline and increases in friend support from baseline to 6 months and 12 months were associated with weight loss. When controlling for other predictors of weight loss, change in friend support for healthy eating was predictive of weight loss at 12 months., Conclusions: These findings suggest that weight loss interventions for adolescent females might consider including strategies to elicit or to create and promote social support for healthy eating from peers. Future studies are needed to test this relationship.

Purpose: This study examined the effects of a physical activity (PA) intervention for young adult cancer survivors on changes in self-efficacy, social support, and self-monitoring and determined whether changes in these social cognitive theory constructs mediated the relationship between the intervention and changes in PA., Methods: A 12-week randomized trial compared a Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA to a Facebook-based self-help comparison group. Young adult cancer survivors (N=86, aged 21-39) were randomly assigned to one of the two groups. Self-report measures of PA and psychosocial variables were collected at baseline and after 12 weeks., Results: The FITNET group reported lower self-efficacy for sticking to exercise (mean change=-0.38; 95% CI: -0.62 to -0.12; p=0.025) and social support from friends on social networking websites (mean change=-0.47; 95% CI: -1.45 to 0.65; p=0.039) relative to the self-help comparison group over time. Changes in social support from friends on social networking websites partially mediated the intervention effects on moderate-to-vigorous PA (mean indirect effect=-22.4; 95% CI: -62.0 to -2.8) in the unexpected direction. Across both groups, social support from friends and self-monitoring were positively associated with changes in moderate-to-vigorous PA., Conclusion: The proposed mediators did not explain the positive effects of the FITNET intervention on mild PA. The lack of significant improvements in psychosocial constructs among FITNET participants may partly explain why the intervention did not increase moderate-to-vigorous PA relative to the self-help comparison group. Future PA interventions with young adult cancer survivors should examine targeting social support from friends and self-monitoring.

Many young adults are insufficiently active to achieve the health benefits of regular physical activity. Using signal detection analysis of data from the 2007 Health Information National Trends Survey, the authors examined distinct subgroups of 18-39 year-old adults who vary in their likelihood of not meeting physical activity recommendations. We randomly split the sample and conducted signal detection analysis on the exploratory half to identify subgroups and interactions among sociodemographic and health communication variables that predicted engaging in less than 150 minutes per week of moderate-intensity physical activity (low physical activity). We compared rates of low physical activity among subgroups with similarly defined subgroups in the validation sample. Overall, 62% of participants did not meet physical activity recommendations. Among 8 subgroups identified, low physical activity rates ranged from 31% to 90%. Predictors of low physical activity were general health, body mass index (BMI), perceived cancer risk, health-related Internet use, and trust in information sources. The least active subgroup (90% low physical activity) included young adults in poor to good health with a BMI of 30.8 or more (obese). The most active subgroup (31% low physical activity) comprised those in very good to excellent health, who used a website to help with diet, weight, or physical activity, and had little to no trust in health information on television. Findings suggest potential intervention communication channels and can inform targeted physical activity interventions for young adults.

IN BRIEF The majority of patients with type 2 diabetes are not active at recommended levels, and many do not have access to behavior change programs to support lifestyle change. Thus, tools and programs designed to promote the adoption and maintenance of physical activity using technology may be helpful. This article reviews the evidence regarding the use of technology tools such as the Internet, mobile applications, social media, and video games and provides suggestions for evaluating the potential benefit of such tools for behavior change.

Purpose: Over half of young adult cancer survivors do not meet physical activity (PA) guidelines. PA interventions can enhance health and quality of life among young adult cancer survivors. However, few exercise interventions have been designed and tested in this population. This study evaluated the feasibility and preliminary efficacy of a 12-week, Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA compared with a Facebook-based self-help comparison (SC) condition., Methods: Young adult cancer survivors (n = 86) were randomly assigned to the FITNET or SC group. All participants were asked to complete self-administered online questionnaires at baseline and after 12 weeks., Results: Seventy-seven percent of participants completed postintervention assessments, and most participants reported using intervention components as intended. Participants in both groups would recommend the program to other young adult cancer survivors (FITNET, 46.9 vs. SC, 61.8 %; p = 0.225). Over 12 weeks, both groups increased self-reported weekly minutes of moderate-to-vigorous PA (FITNET, 67 min/week (p = 0.009) vs. SC, 46 min/week (p = 0.045)), with no significant difference between groups. Increases in light PA were 135 min/week greater in the FITNET group relative to the SC group (p = 0.032), and the FITNET group reported significant weight loss over time (-2.1 kg, p = 0.004; p = 0.083 between groups)., Conclusion: Facebook-based intervention approaches demonstrated potential for increasing PA in young adult cancer survivors., Implications for Cancer Survivors: Social networking sites may be a feasible way for young adult cancer survivors to receive health information and support to promote PA and healthy behaviors.

Objective: To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve results similar to those of earlier efficacy and effectiveness trials., Design: Prospective group randomized trial., Setting: Churches with predominantly African American membership., Participants: A total of 1,033 members from the 15 churches completed baseline surveys. Of these participants, 562 (54.4%) completed the follow-up survey 6 months later., Intervention: Church-based nutrition program for African Americans that included pastoral involvement, educational activities, church environmental changes, and peer counseling., Main Outcome Measure: Daily fruit and vegetable (FV) intake was assessed at pre- and posttest., Analysis: Mixed-effects linear models., Results: At posttest, there was no statistically significant difference in daily servings of FVs between the early intervention group participants compared to control group participants (4.7 vs 4.4, P = .38). Process evaluation suggested that added resources such as technical assistance could improve program implementation., Conclusions and Implications: The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials, primarily because of a lack of program implementation. Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level., (Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care., Methods: Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits., Results: Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions., Conclusions: The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care., Implications for Cancer Survivors: Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.

Objective: Body & Soul, an evidence-based nutrition program for African Americans churches, is currently being disseminated nationally and free of charge by the National Cancer Institute. For dissemination feasibility, the peer counseling training is done via DVD rather than by live trainers. We describe implementation and process evaluation of the peer counseling component under real world conditions., Methods: The study sample included 11 churches (6 early intervention, 5 delayed intervention) in 6 states. Data sources included training observations, post-training debriefing sessions, coordinator interviews, and church participant surveys. Survey data analysis examined associations between exposure to peer counseling and change in dietary intake. Qualitative data were analyzed using the constant comparative method., Results: Eight of 11 churches initiated the peer counseling program. Recall of talking with a peer counselor was associated with significantly (p<.02) greater fruit and vegetable intake. Data indicate sub-optimal program execution after peer counselor training., Conclusion: Inconsistent implementation of the peer counseling intervention is likely to dilute program effectiveness in changing nutrition behaviors., Practice Implications: Disseminating evidence-based programs may require added resources, training, quality control, and technical assistance for improving program uptake. Similar to earlier research phases, systematic efforts at the dissemination phase are needed for program success., ((c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Background: Obesity is a significant problem among US veterans. Diets high in fruits and vegetables (FV) can lower obesity risk. Health communication interventions are promising strategies for promoting healthy eating. We evaluated whether an enhanced intervention with tailored newsletters and motivational interviewing calls would be more effective than the Veterans Affairs (VA) weight management program, MOVE!, at increasing FV intake among overweight/obese veterans., Methods: Using a quasi-experimental design, 195 veterans at two clinics participated at baseline and 6-month follow-up from 2005 to 2006. Measures included daily FV intake and information processing of the intervention. The control group (MOVE!) received educational information, group sessions, and standard phone calls about weight. The intervention included MOVE! components plus tailored newsletters and motivational interviewing calls., Results: The intervention group reported a statistically significant increase in FV servings compared to control (1.7 vs. 1.2; p ≤ 0.05). Veterans who read more of the tailored newsletters (β=0.15, p=0.01) and perceived the messages as important (β=0.12, p<0.01) and applicable to their lives (β=0.12, p<0.01) ate more FV than those who did not. However, receiving MI calls and information processing regarding the calls were not associated with FV intake., Conclusion: A tailored intervention can impact short term FV intake for obesity prevention., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Few studies have examined how patients understand and use genomic test results when deciding about treatment. This study examined how women receive and incorporate results of Oncotype DX, a genomic test that offers recurrence risk estimates, into decisions about adjuvant treatment for early stage breast cancer., Methods: Participants in the cross-sectional study were 77 women with early stage, estrogen receptor-positive breast cancer with 0 to 3 positive lymph nodes who received Oncotype DX between 2004 and 2009. Mailed surveys, supplemented by medical chart review, assessed how women received and understood recurrence risk information based on the test., Results: The most common test results were low (50%, 34 of 68) or intermediate (37%, 25 of 68) breast cancer recurrence risk. Most women accurately recalled their recurrence risk based on the test (71%) and felt they understood much of what they were told about it (67%). Approximately 25% of women recalled experiencing test-related distress. Women's perceived recurrence risk was associated with their actual genomic-based recurrence risks, having had a previous cancer diagnosis, and worry about recurrence. Women with high recurrence risk typically had chemotherapy (78%, 7 of 9), whereas only 2 with a low recurrence risk did (7%, 2 of 30)., Conclusions: This is among the first studies to describe patients' experiences with genomic testing for recurrence risk. Although many women understood discussions about their genomic test results, a third reported not fully understanding these discussions, suggesting a need to aid and improve risk communication and treatment decision making., ((c) 2010 American Cancer Society.)

The activation of cAMP-dependent protein kinase regulates the physiological activity of AMPA-type glutamate receptors. In this study, phosphorylation of the AMPA receptor subunit GluR1 at Ser(845) was increased in neostriatal slices by activation of D1-type dopamine receptors and by inhibitors of protein phosphatase 1/protein phosphatase 2A. In contrast, Ser(831), a residue which, when phosphorylated by protein kinase C or calcium/calmodulin-dependent kinase II, increases AMPA receptor channel conductance, was unaffected by either D1 or D2 receptor agonists in neostriatal slices. The phosphorylation of Ser(845), but not Ser(831), was strongly increased in neostriatum in vivo in response to the psychostimulants cocaine and methamphetamine. The effects of dopamine and psychostimulants on the phosphorylation of GluR1 were attenuated in dopamine and cAMP-regulated phosphoprotein M(r) 32 kDa (DARPP-32) knock-out mice. These results identify DARPP-32 and AMPA-type glutamate receptors as likely essential cellular effectors for psychostimulant actions.