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Background: Cardiovascular disease continues to cause significant morbidity, mortality, and impaired quality of life, with unrealized health gains from the underuse of available evidence. The Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) aims to advance the science of acute coronary syndromes by examining the determinants and outcomes of the quality of transition from hospital to community and by quantifying the impact of potentially modifiable characteristics associated with decreased quality of life, rehospitalization, and mortality.Methods and Results: TRACE-CORE comprises a longitudinal multiracial cohort of patients hospitalized with acute coronary syndromes, 2 research projects, and development of a nucleus of early stage investigators. We are currently enrolling 2500 adults hospitalized for acute coronary syndromes at 6 hospitals in the northeastern and southeastern United States. We will follow these patients for 24 months after hospitalization through medical record abstraction and 5 patient interviews focusing on quality of life, cardiac events, rehospitalizations, mortality, and medical, behavioral, and psychosocial characteristics. The Transitions Project studies determinants of and disparities in outcomes of the quality of patients' transition from hospital to community. Focusing on potentially modifiable factors, the Action Scores Project will develop and validate action scores to predict recurrent cardiac events, death, and quality of life, describe longitudinal variation in these scores, and develop a dashboard for patient and provider action on the basis of these scores.Conclusions: In TRACE-CORE, sound methodologic principles of observational studies converge with outcomes and effectiveness research approaches. We expect that our data, research infrastructure, and research projects will inform the development of novel secondary prevention approaches and underpin the careers of cardiovascular outcomes researchers. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were to examine the magnitude of, and 20-year trends in, age differences in short-term outcomes among men and women hospitalized with acute myocardial infarction (AMI) in central Massachusetts.Methods: The study population consisted of 5907 male and 4406 female residents of the Worcester, MA, metropolitan area hospitalized at all greater Worcester medical centers with AMI between 1986 and 2005.Results: Overall, among both men and women, older patients were significantly more likely to have developed atrial fibrillation, heart failure, and to have died during hospitalization and within 30 days after admission compared with patients aged <65 years. Among men, age differences in the risk of developing atrial fibrillation have widened over the past 2 decades, while differences in the risk of developing cardiogenic shock have narrowed for men 75 years and older as compared with those aged <65 years. Among women, age differences in the risk of developing these major complications of AMI have not changed significantly over time. Age differences in short-term mortality have remained relatively unchanged over the past 20 years in both sexes, although individuals of all ages have experienced decreases in short-term death rates over this period.Conclusions: Elderly men and women are more likely to experience adverse short-term outcomes after AMI, and age differences in short-term mortality rates have remained relatively unchanged in both sexes over the past 20 years. More targeted treatment approaches during hospitalization for AMI and thereafter are needed for older patients to improve their prognosis. [ABSTRACT FROM AUTHOR]

Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home., Objective: This study aims to evaluate the virtual coach-guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes., Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group., Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03)., Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain-chronic pain acceptance-after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes., Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132., International Registered Report Identifier (irrid): RR2-10.2196/45887., (©Erin D Reilly, Megan M Kelly, Hannah L Grigorian, Molly E Waring, Karen S Quigley, Timothy P Hogan, Alicia A Heapy, Charles E Drebing, Matias Volonte, Ummul-Kiram Kathawalla, Hannah E Robins, Katarina Bernice, Timothy Bickmore. Originally published in JMIR Formative Research (https://formative.jmir.org), 08.11.2024.)

Objective: To examine awareness, information-seeking, and use of MyPlate among US adults with young children., Design: Secondary analysis of cross-sectional data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES)., Participants: US adults aged 18-45 years with children ≤5 years., Variables Measured: Adults reported sociodemographic characteristics and whether they had heard of MyPlate, looked online for MyPlate information, or tried to follow the MyPlate plan., Analysis: Logistic regression models estimated MyPlate awareness, information-seeking, and use by sociodemographic characteristics. Analyses were weighted to represent adults with young children nationally., Results: Twenty-nine percent of US adults with young children were aware of MyPlate. MyPlate awareness was lower among men, racial/ethnic minorities, adults with less education, adults who speak a language other than English, and SNAP/WIC recipients. Among those who knew of MyPlate, 39% sought MyPlate information online, and 33% had tried to use the MyPlate plan. Men were less likely to look online for or follow the MyPlate plan than women. Mexican-American adults and WIC recipients were more likely to have tried to follow the MyPlate plan., Conclusions: MyPlate is an underutilized resource among families with young children. Efforts are needed to disseminate and encourage the use of MyPlate, particularly among marginalized groups., (Copyright © 2024 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

The majority of Black women with hypertension in the United States have smartphones or tablets and use social media, and many use wearable activity trackers and health or wellness apps, digital tools that can be used to support lifestyle changes and medication adherence., (©Jolaade Kalinowski, Sandesh Bhusal, Sherry L Pagoto, Robert Newton Jr, Molly E Waring. Originally published in JMIR Cardio (https://cardio.jmir.org), 09.09.2024.)

This study utilized Facebook and Instagram as communication channels for disseminating evidence-based food and nutrition information to low-income adults. From February 2021 to October 2022, 442 identical posts were shared across both platforms for audience reach and engagement. Posts were categorized in two ways: hedonic and three levels of utilitarian (informative, convenience, utility), based on widely applied social media uses and effects theory (Uses and Gratifications Perspective); and food/nutrition topics (dietary guidance, mealtime behaviors, recipes, food resource management, health behaviors, and community building). From predominantly image-based posts (82.6%), reach and engagement for Instagram (136,621 versus 6096, respectively) outperformed Facebook (83,275 versus 1276, respectively). Analysis of covariance of rank-order reach and engagement metrics (likes, replies, shares) showed Facebook engagement was consistent across hedonic and utilitarian categories while Instagram showed highest reach and engagement for utilitarian posts, especially those emphasizing food affordability. Facebook and Instagram differed in which food/nutrition topics achieved maximal reach and engagement. Fifteen posts were randomly selected for qualitative analysis to identify features reflecting engagement levels. Low-engagement posts featured low-color-contrast or less-appealing images, especially on Instagram. This study offers insights for practitioners and researchers aiming to use social media to promote healthy food and nutrition.

Purpose: Adults with subjective cognitive decline (SCD), the self-reported concern of reduced cognitive function, are recommended to do physical activity for its brain health benefits. US adults aged ≥45 with SCD are less likely to meet the American College of Sports Medicine (ACSM) aerobic activity recommendations. Their engagement in muscle-strengthening activities is unknown. We aimed to identify if US adults aged ≥45 with SCD are less likely to do twice-weekly muscle-strengthening activities compared to those without SCD., Design: Secondary analysis of the 2019 Behavioral Risk Factor Surveillance System (BRFSS) data., Sample: 114 164 respondents, representing approximately 59 million US adults aged ≥45., Measures: SCD was indicated if the respondent reported confusion or memory loss during the past 12 months (yes/no). Respondents reported the frequency of muscle-strengthening activities, which we categorized as meeting the ACSM's recommendations (2+ times per week) or not (<2 times per week)., Analysis: Crude and adjusted logistic regression models controlling for variables associated with SCD and muscle-strengthening activities. The models used sample weights to represent US adults in the included 31 states and Washington D.C., Results: US adults aged ≥45 with SCD were less likely to do twice-weekly muscle-strengthening activities than those without SCD (28.6% [SE: .8%] vs 33.5% [SE: .3%], adjusted OR, .9; 95% CI: .9-1.0)., Conclusion: Primary care providers should encourage middle-aged and older patients to engage in muscle-strengthening and aerobic activities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To examine sources and perceived credibility of child nutrition information by maternal health literacy., Methods: US mothers of children (0-12 years) who used social media regularly (N = 340) completed an online survey. Health literacy was assessed using the Newest Vital Sign. Child nutrition information sources and perceived credibility of sources were compared by health literacy using logistic and quantile regression models., Results: Seventeen percent of mothers had limited health literacy. Compared to mothers with adequate health literacy, those with limited health literacy were more likely to get child nutrition information from siblings, extended family, dietitians, doctors, nurse practitioners, or physician assistants, and government agencies, and less likely to get information from Facebook. Mothers with limited health literacy rated information from parents, friends, Facebook, and Instagram as more credible than mothers with adequate health literacy. While perceived credibility of information from doctors, nurse practitioners, or physician assistants was high overall, mothers with limited health literacy perceived information from these health care providers as less credible., Conclusions: Sources of child nutrition information and perceived credibility differ by maternal health literacy., Practice Implications: Pediatric providers are encouraged to refer parents to engaging resources that provide evidence-based child nutrition information., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention., Methods: English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed., Results: Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences., Conclusions: Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-23-43/coif). All authors report that this project was supported by Faculty/Research Seed Grant from the Institute for Collaboration on Health, Intervention, and Policy (InCHIP) at the University of Connecticut (PI: M.E.W.). Additional support for this manuscript was provided by National Institute of Health (NIH) grants K23HL136657 (PI: D.A.) and K24HL124366 (PI: S.L.P.). M.E.W. is currently a Co-Investigator on a University of Connecticut Clinical Research and Innovation Seed Program (CRISP) related to a lifestyle intervention for pregnant persons with gestational diabetes mellitus; this grant did not provide support for the work reported in this manuscript. S.L.P. has received consulting fees from WW International for being a scientific advisor. The authors have no other conflicts of interest to declare., (2024 mHealth. All rights reserved.)

Background: Indoor tanning is a preventable risk factor for skin cancer. Statewide shutdowns during the COVID-19 pandemic resulted in temporary closures of tanning businesses. Little is known about how tanners reacted to losing access to tanning businesses., Objective: This study aimed to analyze Twitter (subsequently rebranded as X) chatter about indoor tanning during the statewide pandemic shutdowns., Methods: We collected tweets from March 15 to April 30, 2020, and performed a directed content analysis of a random sample of 20% (1165/5811) of tweets from each week. The 2 coders independently rated themes (κ=0.67-1.0; 94%-100% agreement)., Results: About half (589/1165, 50.6%) of tweets were by people unlikely to indoor tan, and most of these mocked tanners or the act of tanning (562/589, 94.9%). A total of 34% (402/1165) of tweets were posted by users likely to indoor tan, and most of these (260/402, 64.7%) mentioned missing tanning beds, often citing appearance- or mood-related reasons or withdrawal. Some tweets by tanners expressed a desire to purchase or use home tanning beds (90/402, 22%), while only 3.9% (16/402) mentioned tanning alternatives (eg, self-tanner). Very few tweets (29/1165, 2.5%) were public health messages about the dangers of indoor tanning., Conclusions: Findings revealed that during statewide shutdowns, half of the tweets about indoor tanning were mocking tanning bed users and the tanned look, while about one-third were indoor tanners reacting to their inability to access tanning beds. Future work is needed to understand emerging trends in tanning post pandemic., (©Laurie Groshon, Molly E Waring, Aaron J Blashill, Kristen Dean, Sanaya Bankwalla, Lindsay Palmer, Sherry Pagoto. Originally published in JMIR Dermatology (http://derma.jmir.org), 04.03.2024.)

Objective: We examined undergraduates' concerns about returning to campus and online learning from home., Participants: Undergraduates majoring in STEM (Science, Technology, Engineering, and Mathematics) at US universities/colleges., Methods: Participants completed an online survey in July 2020. We content-analyzed responses to open-ended questions about concerns about fall 2020., Results: Students ( N =  64) were 52% women, 47% low socioeconomic status (SES), and 27% non-Hispanic white. Concerns about returning to campus included student noncompliance with university COVID-19 prevention guidelines (28%), infection risk (28%), poor instructional quality (26%), inadequate university plans for preventing/handling outbreaks (25%), negative impacts on social interactions (11%), and transportation/commuting (11%). Concerns about learning from home included difficulty focusing on schoolwork (58%), lack of hands-on/experiential learning (24%), negative impacts on social interactions (19%), family/home environment (15%), concerns that online learning wastes time/money (10%), and inadequate technology/Internet access (5%)., Conclusions: Universities should address student concerns and provide resources to overcome barriers to effective learning.

Previous studies have linked food consumption outside the home and fast food to poor diet quality and living within a food swamp to an increased likelihood of obesity. A growing amount of research has linked food marketing to food choice. Still, limited information is available on how this dynamic may work within fast food establishments and if the marketing strategies used may vary by neighborhood food swamp status. Utilizing the Environment Assessment (EAT) Tool, we examined the within-store marketing environment of fast food restaurants to understand the factors potentially influencing food choice. A cross-sectional study design surveyed fast food outlets (n = 170) for unhealthy advertisements. Each fast-food outlet was assigned an FSI score based on its geographic location and proximity to unhealthy outlets. Outlets were assessed for associations between food swamp status and unhealthy advertisements. Poisson Regression was performed to assess the relationship between unhealthy advertisements and FSI score. Low FSI had a mean unhealthy advertisement score of 36.79 (11.06). Moderate and High FSI had mean unhealthy advertisement scores of 33.03 (14.67) and 31.71 (12.63), respectively. The number of unhealthy advertisements did not differ by food swamp categories (Moderate FSI IRR: 0.90, 95% CI: 0.74-1.09; High FSI IRR: 0.86, 95% CI: 0.73-1.01 vs. low FSI). Differences in marketing environments by food swamp status were not observed. Future research should examine other factors of the food swamp environment and additional factors such as television or social media to understand its association with food choice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Inc.)

Purpose: Few studies have examined the relationship between poor atrial fibrillation-related quality of life (AFQoL) and a battery of geriatric factors. The objective of this study is to describe factors associated with poor AFQoL in older adults with atrial fibrillation (AF) with a focus on sociodemographic and clinical factors and a battery of geriatric factors., Methods: Cross-sectional analysis of a prospective cohort study of participants aged 65+ with high stroke risk and AF. AFQoL was measured using the validated Atrial Fibrillation Effect on Quality of Life (score 0-100) and categorized as poor (<80) or good (80-100). Chi-square and t -tests evaluated differences in factors across poor AFQoL and significant characteristics ( P  < 0.05) were entered into a logistic regression model to identify variables related to poor AFQoL., Results: Of 1244 participants (mean age 75.5), 42% reported poor AFQoL. Falls in the past 6 months, pre/frail and frailty, depression, anxiety, social isolation, vision impairment, oral anticoagulant therapy, rhythm control, chronic obstructive pulmonary disease and polypharmacy were associated with higher odds of poor AFQoL. Marriage and college education were associated with a lower odds of poor AFQoL., Conclusions: More than 4 out of 10 older adults with AF reported poor AFQoL. Geriatric factors associated with higher odds of reporting poor AFQoL include recent falls, frailty, depression, anxiety, social isolation and vision impairment. Findings from this study may help clinicians screen for patients with poor AFQoL who could benefit from tailored management to ensure the delivery of patient-centered care and improved well being among older adults with AF., (Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Background: Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase., Objective: This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes., Methods: Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up., Results: Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m 2 . Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months., Conclusions: Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy., Trial Registration: ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736., (©Molly E Waring, Sherry L Pagoto, Tiffany A Moore Simas, Loneke T Blackman Carr, Madison L Eamiello, Brooke A Libby, Lauren R Rudin, Grace E Heersping. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 27.04.2023.)

Vaccine hesitancy can impact maternal and child vaccination rates. We examined factors associated with mothers' hesitancy to receive a COVID-19 vaccine using data from an online survey conducted from mid-February to mid-March 2021. Among unvaccinated participants (N = 203), 28% reported that they would probably not or definitely not get a COVID-19 vaccine. Mothers with high school/GED/trade/technical education (38% hesitant, aOR = 4.0, 95% CI: 1.2-13.2), Associate's degree (43%, aOR = 6.8, 95% CI: 2.4-19.5), and Bachelor's degree (30%, aOR = 3.1, 95% CI: 1.1-8.4) were more likely to report vaccine hesitancy compared to mothers with a graduate degree (19%). Non-Hispanic Black mothers (40% hesitant, aOR = 2.8, 95% CI: 1.0-7.6) were more likely to be vaccine hesitant compared to non-Hispanic white mothers (19%). Mothers with low pandemic-related anxiety were more likely to report vaccine hesitancy than mothers with high pandemic-related anxiety (56% vs 23% hesitant; aOR = 4.8, 95% CI: 1.7-14.1). Research is needed to understand informational, emotional, and attitudinal factors contributing to COVID-19 vaccine hesitancy among mothers to develop and test effective public health messaging to increase vaccination rates., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In behavioral weight loss interventions, participants are asked to set weekly goals to support long-term habits that lead to weight loss. Although participants are asked to set and accomplish weekly goals, we do not know how often they do this and whether doing so is associated with weight loss. Web-based weight loss interventions allow for the analysis of participant engagement data, including how participants articulate their goals and accomplishments., Objective: Using engagement data from a web-based weight loss intervention, we examined whether participants articulating their goals and accomplishments in measurable and repeating terms were associated with greater weight loss., Methods: Adults with overweight or obesity received a 12-week Facebook-delivered weight loss intervention based on the Diabetes Prevention Program Lifestyle Intervention. Participants replied to conversation threads that queried about their goals and accomplishments. Two independent coders classified participants' posts that articulated goals or accomplishments as measurable or repeating. Crude and age-adjusted linear regression models were used to examine the relationship between the frequency of post type and percent weight loss., Results: Participants (N=53; n=48, 91% female; n=48, 91% non-Hispanic White) were on average 46.2 (SD 10.5) years old with a mean BMI of 32.4 (SD 4.8) kg/m 2 . Over 12 weeks, participants shared a median of 4 (IQR 1-8) posts that reported goals and 10 (IQR 4-24) posts that reported accomplishments. Most participants shared ≥1 post with a goal (n=43, 81%) and ≥1 post with an accomplishment (n=47, 89%). Each post reporting a goal was associated with 0.2% greater weight loss (95% CI -0.3% to 0.0%). Sharing ≥1 post with a repeating goal was associated with an average of 2.2% greater weight loss (95% CI -3.9% to -0.4%). Each post with a repeating goal was associated with an average of 0.5% greater weight loss (95% CI -1.0% to 0.0%). Sharing ≥1 post with measurable and repeating goals was associated with an average of 1.9% greater weight loss (95% CI -3.7% to -0.2%). Sharing each post with an accomplishment was associated with an average of 0.1% greater weight loss (95% CI -0.1% to 0.0%). Every post with an accomplishment that was repeating was associated with an average of 0.2% greater weight loss (95% CI -0.3% to 0.0%). Sharing other types of goals and accomplishments was not associated with weight loss., Conclusions: In a web-based weight loss intervention, stating goals in repeating or both measurable and repeating terms was associated with greater weight loss, but simply stating them in measurable terms was not. For accomplishments, only those articulated in repeating terms were associated with greater weight loss. Posts about one-time goals and accomplishments represent an opportunity to encourage planning for future behaviors. Future research should examine if stating goals and accomplishments in repeating terms signals habit formation., (©Danielle E Jake-Schoffman, Molly E Waring, Joseph DiVito, Jared M Goetz, Cindy Pan, Sherry L Pagoto. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 16.03.2023.)

Background: In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning., Objective: The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20)., Methods: This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system., Results: This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023., Conclusions: The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning., Trial Registration: ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132., International Registered Report Identifier (irrid): DERR1-10.2196/45887., (©Erin D Reilly, Ummul-Kiram Kathawalla, Hannah E Robins, Alicia A Heapy, Timothy P Hogan, Molly E Waring, Karen S Quigley, Charles E Drebing, Timothy Bickmore, Matias Volonte, Megan M Kelly. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.03.2023.)

Background: Excessive gestational weight gain is associated with negative maternal and infant health outcomes. Digital health approaches may help overcome barriers to participating in lifestyle interventions requiring in-person visits. The purpose of this study was to develop and examine the feasibility of a web-based gestational weight gain intervention., Methods: Intervention development included feedback and input from pregnant women. We conducted a 12-week one-arm pilot study during which participants engaged in an online discussion board with coaches and other pregnant women, tracked their weight gain with an interactive graph, and accessed a list of online resources for pregnancy health. Feasibility outcomes were recruitment, retention, engagement and sustained participation, intervention acceptability, and website usability. Gestational weight gain was an exploratory outcome., Results: Participants (n=12) were on average 16.8 [standard deviation (SD): 2.0] weeks gestation with average pre-pregnancy body mass index of 30.5 (SD: 4.8) kg/m 2 . Participant retention was 92% (n=11). Participants logged into the website a median of 21 times [interquartile range (IQR), 8-37; range, 2-98] over 12 weeks, and 58% (n=7) logged into the website during the last week of the intervention. All participants said they would be very likely or likely to participate again, and 100% said they would be very likely or likely to recommend the intervention to a pregnant friend. In post-intervention interviews, 64% (n=7) explicitly said that the website was easy to use, but 100% (n=11) mentioned usability issues. When asked their preferred intervention platform, 18% (n=2) somewhat or strongly preferred a private website, 18% (n=2) had no preference, and 64% (n=7) somewhat or strongly preferred Facebook. Seventy percent (n=7) had excessive gestational weight gain, 10% (n=1) inadequate gestational weight gain, and 20% (n=2) gained within recommended ranges., Conclusions: Additional development work is needed before moving to efficacy testing. Most notably, usability issues with the investigator-developed website and participant preference suggest a switch to a commercial social media platform., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-22-49/coif). All authors report that this project was supported by the University of Massachusetts Center for Clinical and Translational Science through NIH grants KL2TR000160 and 5UL1RR031982. Partial support for website development provided by Veterans Affairs grant VA QUERI EHQ 10-190. Additional support provided by NIH grants U01HL105268, R25CA172009, and K24HL124366. MEW has also received a University of Connecticut InCHIP Faculty/Researcher Seed grant related to gestational weight gain; this grant did not provide support for the work reported in this manuscript. SLP received consulting fees from Fitbit and WW International. The authors have no other conflicts of interest to declare., (2023 mHealth. All rights reserved.)

Many parents and pregnant women in the US use social media to access health-related information. Estimates of current use of different platforms among these populations are needed. We used data from a 2021 Pew Research Center survey to describe use of commercial social media platforms by US parents and US women aged 18 to 39 years. Most US parents and women of childbearing age use YouTube, Facebook, and Instagram, with most engaging daily. Understanding social media use patterns can help public health professionals, health care systems, and researchers reach selected populations with evidence-based health information and health promotion programs.

Background: Preventive health care provides opportunity for preventive screenings and health promotion. Mothers of young children may disproportionately experience barriers to preventive care during the COVID-19 pandemic., Methods: We examined delaying and skipping preventive health care during the first year of the COVID-19 pandemic among mothers and described reasons for delaying or skipping care. Mothers of children aged 0-12 years from the United States completed an online survey in February/March 2021 and reported receipt of preventive care during the COVID-19 pandemic, reasons for delaying or skipping care, demographics, and experiences with COVID-19., Results: Participants (N = 306) were on average 35.9 (SD: 6.2) years old, racially/ethnically diverse, and 74.8% had at least a Bachelor's degree. From March 2020 to March 2021, 16.0% delayed and 20.6% skipped their physical examination, and 20.9% had not planned on receiving a physical examination. The most common reasons for delaying and skipping care were COVID-19 infection concerns, perception that delaying care would not negatively impact health, provider rescheduling, time, and childcare., Conclusions: Primary care teams may need to re-engage mothers who skipped preventive care during the pandemic, including addressing concerns about COVID-19 infection., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Current guidelines encourage regular physical activity (PA) to gain cardiovascular health benefit. However, little is known about whether older adults with atrial fibrillation (AF) who engage in the guideline-recommended level of PA are less likely to experience clinically relevant outcomes. We did a retrospective study based on the data from Systemic Assessment of Geriatric Elements in AF (SAGE-AF) prospective cohort study. The study population consisted of older participants with AF (≥65 years) and a congestive heart failure, hypertension, age, diabetes, stroke vascular disease, age 65 to 75 and sex(CHA 2 DS 2 -VASc) score ≥2. PA was quantified by self-reported Minnesota Leisure Time PA questionnaire. Competing risk models were used to examine the association between PA level and clinical outcomes over 2 years while controlling for several potentially confounding variables. A total of 1,244 participants (average age 76 years; 51% men; 85% non-Hispanic White) were studied. A total of 50.5% of participants engaged in regular PA. Meeting the recommended level of PA was associated with lower mortality over 2 years (adjusted hazard ratio 0.60, 95% confidence interval 0.38 to 0.95) but was not associated with rates of stroke or major bleeding. In conclusion, older adults with AF who engaged in guideline-recommended PA are more likely to survive in the long term. Healthcare providers should promote and encourage engagement in PA and tailor interventions to address barriers of engagement., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Melanoma is the second most common cancer in young adults. Social media may be a means to conduct interventions to increase sun safety in young adults., Purpose: We conducted a randomized proof-of-concept pilot trial to evaluate the feasibility and acceptability of a dissonance-based social media intervention designed to promote sun safety in young adult tanners., Methods: Young adult tanners (N = 66) were randomized into two 4-week interventions in which participants were incentivized to create content for a social media campaign on healthy skin or healthy lifestyle. Feasibility outcomes included retention, participation, acceptability, and contamination. We also examined the impact of participation on motivation to engage in the target health behaviors and outdoor tanning intentions., Results: Retention was 100%. Most Healthy Skin (88%) and Healthy Lifestyle participants (91%) created ≥1 post. Acceptability was high with 94% and 97% of participants in Healthy Skin and Healthy Lifestyle conditions, respectively, agreeing they would recommend the campaign to a friend. At 4 weeks, Healthy Skin participants reported greater declines in motivation to tan indoors (p = .0017) and outdoors (p = .0003), and greater increases in motivation to wear sunscreen (p = .0009) and protective clothing (p = .0342). Healthy Skin participants reported greater declines in intentions to tan outdoors in the next year (p = .0286)., Conclusions: A dissonance-based, social media sun safety intervention was feasible and acceptable. Future research should examine the efficacy and longer-term effects of this intervention in young adults at elevated risk for skin cancer., Trial Registration: Clinicaltrials.gov NCT03834974 https://clinicaltrials.gov/ct2/show/NCT03834974., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In 2009, the Institute of Medicine provided provisional guidelines for gestational weight gain (GWG) in twin gestations, citing limited research. We examined GWG by pre-pregnancy body mass index in a retrospective cohort of twin births uncomplicated by infant mortality, preterm birth, or low birth weight from Massachusetts in 2006-2017 (N = 273). Median (inter-quartile range [IQR]) GWG was 20.4 kg (IQR: 17.2-25.9 kg) for women who were normal weight pre-pregnancy, 21.3 kg (IQR: 17.2-25.9 kg) for women with overweight pre-pregnancy, and 13.6 kg (IQR: 8.6-20.9 kg) for women with obesity pre-pregnancy. Findings can inform the next generation of GWG recommendations for twin pregnancies., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Lifestyle interventions can facilitate healthy gestational weight gain but attending in-person meetings can be challenging. High rates of use and the popularity of pregnancy content suggests Instagram as a possible platform for delivering gestational weight gain interventions. We assessed the logistics and acceptability of creating a private Instagram group and to obtain feedback on intervention posts. We conducted a 2-week study with pregnant women with pre-pregnancy overweight or obesity who use Instagram daily. Participants created a private Instagram account and followed other participants and a moderator who shared twice-daily posts about physical activity and healthy eating during pregnancy. Participants provided feedback through a follow-up survey and focus group/interviews. Engagement data was abstracted from Instagram. Participants (N = 11) were on average 26.3 (SD: 7.4) weeks gestation and 54% had obesity pre-pregnancy. All participants followed the moderator's account, 73% followed all other participants, participants engaged with 100% of study posts, 82% felt comfortable sharing in the group, and 73% would participate in a similar group if pregnant in the future. While participants felt the posts were visually attractive and included helpful information, they wanted more personalized content and felt reluctant to post photos they felt were not "Instagram worthy." Moderators should foster an environment in which participants feel comfortable posting unedited, authentic photos of their lives, perhaps by sharing personal photos that are relatable and represent their own imperfect lives. Results will inform further development and testing of an Instagram-delivered gestational weight gain intervention., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Behavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes., Objective: In this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization., Methods: We conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m 2 . The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ≥5% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups., Results: Randomized participants (68/80, 85% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m 2 . We enrolled an additional 54 participants (50/54, 93% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88% and 98% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ≥5% was achieved by 30% (12/40) of the participants randomized to the open enrollment condition and 18% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics., Conclusions: Open enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial., Trial Registration: ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680., (©Sherry L Pagoto, Matthew W Schroeder, Ran Xu, Molly E Waring, Laurie Groshon, Jared M Goetz, Christie Idiong, Haley Troy, Joseph DiVito, Richard Bannor. Originally published in JMIR Formative Research (https://formative.jmir.org), 06.05.2022.)

Background: Little is known about online health information-seeking behavior among older adults with atrial fibrillation (AF) and its association with self-reported outcomes., Objective: To examine patient characteristics associated with online health information seeking and the association between information seeking and low AF-related quality of life and high perceived efficacy in patient-physician interaction., Methods: We used data from the SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study, which includes older participants aged ≥65 years with AF and a CHA 2 DS 2 -VASc risk score ≥2. To assess online health information seeking, participants who reported using the Internet were asked at baseline if they used the Internet to search for advice or information about their health in the past 4 weeks (not at all vs at least once). Atrial Fibrillation Effect on Quality of Life and Perceived Efficacy in Patient-Physician Interactions questionnaires were used to examine AF-related quality of life (QOL) and patient-reported confidence in physicians. Logistic regression models were used to examine demographic and clinical factors associated with online health information seeking and associations between information seeking and low AF-related QOL (AFEQT <80) and high perceived efficacy for patient-physician interactions (PEPPI ≥45)., Results: A total of 874 online participants (mean age 74.5 years, 51% male, 91% non-Hispanic White) were studied. Approximately 60% of participants sought health information online. Participants aged 74 years or older and those on anticoagulation were less likely, while those with a college degree were more likely, to seek online health information after adjusting for potential confounders. Participants who sought health information online, compared to those who did not, were significantly more likely to have a low AF-related QOL, but less likely to self-report confidence in patient-physician interaction (aOR = 1.56, 95% CI: 1.15-2.13; aOR = 0.68, 95% CI: 0.49-0.93, respectively)., Conclusion: Clinicians should consider barriers to patient-physician interaction in older adults who seek health information online, encourage shared decision-making, and provide patients with a list of online resources for AF in addition to disease education plans to help patients manage their health., (© 2022 Heart Rhythm Society.)

Objective: To examine temporal associations between participation in a community-based intervention targeting sugary drink intake and sleep outcomes among children., Methods: Data are from an ethnically diverse sample of 100 children aged 9-12 years from 2 Massachusetts Boys and Girls Club (BGC) sites who participated in a pilot-site randomized trial (usual BGC programming plus H 2 GO! intervention vs usual BGC programming). Secondary outcomes of the trial (sleep duration and adequate sleep duration [≥ 9 h/night] were assessed via a self-report survey at baseline, 2 months, and 6 months. Generalized linear and logistic regression models estimated intervention effects associated with outcomes., Results: The intervention was associated with increased sleep duration (β = 0.74; 95% confidence interval, 0.03-1.45) and higher odds of adequate sleep (odds ratio, 2.47; 95% confidence interval, 1.06-5.74) at 2 months. Sleep did not differ by treatment condition at 6 months., Conclusions and Implications: This community-based sugary drink intake intervention may be a potential avenue to improve child sleep outcomes in the short term., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: High blood pressure is the most common chronic condition among US veterans. Blood pressure control is essential to preventing and managing cardiovascular diseases. While depressive symptoms are a known risk factor for uncontrolled blood pressure and veterans experience high rates of depressive symptoms, no research has examined the relationship between depressive symptoms and blood pressure control among US veterans., Objective: We examined whether moderately severe-to-severe depressive symptoms, compared to none-to-minimal, are associated with higher risk of uncontrolled blood pressure among US veterans., Design: We analyzed a population-based sample of veterans from the National Health and Nutrition Examination Survey (2013-2016). Logistic regression models were adjusted for marital status, age, and body mass index. All analyses were weighted; results are generalizable to US veterans., Participants: A sample of 864 veterans was analyzed, representing approximately 18.8 million US veterans., Main Measures: Depressive symptoms were assessed by the Patient Health Questionnaire-9. Uncontrolled blood pressure was defined as average systolic blood pressure ≥ 130 and/or diastolic blood pressure ≥ 80., Key Results: For depressive symptoms, 78.2% (SE = 1.6) of US veterans had none-to-minimal, 18.2% (SE = 1.2) had mild-to-moderate, and 3.5% (SE = 0.8) had moderately severe-to-severe. Forty-three percent (SE = 3.0) of US veterans had uncontrolled blood pressure. Moderately severe-to-severe depressive symptoms, compared to none-to-minimal, were associated with lower risk for uncontrolled blood pressure (aOR = .28, 95% CI [.09, .85]). Mild-to-moderate depressive symptoms were not associated with blood pressure control (aOR = .98, 95% CI [.59, 1.65])., Conclusions: US veterans with moderately severe-to-severe depressive symptoms were less likely to have uncontrolled blood pressure than veterans with none-to-minimal symptoms. Future research should examine factors unique to veterans that may explain findings opposite of the hypothesized relationship between depressive symptoms and blood pressure control., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Introduction: Suboptimal and differential participant engagement in randomized trials-including retention at primary outcome assessments and attendance at intervention sessions-undermines rigor, internal validity, and trial conclusions., Methods: First, this study describes Methods-Motivational Interviewing approach and strategies for implementation. This approach engages potential participants before randomization through interactive, prerequisite orientation sessions that illustrate the scientific rationale behind trial methods in accessible language and use motivational interviewing to diffuse ambivalence about participation. Then, this study examines the potential improvements in retention (proportion of participants assessed at follow-up visits) and attendance (e.g., mean percentage of intervention sessions attended, percentage of participants who attended 0 sessions) in 3 randomized weight-management trials that quickly added prerequisite orientations to their protocols following early signs of suboptimal or differential participant engagement (Supporting Health by Integrating Nutrition and Exercise [2009-2013, n=194]; Get Social [2016-2020, n=217]; GestationaL Weight Gain and Optimal Wellness [2014-2018, n=389]). Using a pre-post analytical design, adjusted estimates from regression models controlling for condition and assessment timepoint (analyses from 2020) are reported., Results: After adding prerequisite orientations, all 3 trials attained higher participant engagement. Retention at assessments was 11.4% and 17.3% higher (Get Social and Supporting Health by Integrating Nutrition and Exercise, respectively). Mean percentage of attendance at intervention sessions was 8.8% higher (GestationaL Weight Gain and Optimal Wellness), and 10.1% fewer participants attended 0 intervention sessions (Get Social). Descriptively, all the remaining retention and attendance outcomes were consistently higher but were nonsignificant. Across the trials, adding prerequisite orientations did not impact the proportion of eligible participants enrolled or the baseline demographics., Conclusions: The Methods-Motivational Interviewing approach shows promise for increasing the rigor of randomized trials and is readily adaptable to in-person, webinar, and conference call formats., Trial Registration: All 3 trials are registered at www.clinicaltrials.gov (Supporting Health by Integrating Nutrition and Exercise: NCT00960414; Get Social: NCT02646618; and GestationaL Weight Gain and Optimal Wellness: NCT02130232)., (Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Exercise in pregnancy favorably affects maternal and fetal outcomes, yet only 50% of women receive exercise guidance during prenatal care and 15% are told to stop exercising. Reasons for clinician reluctance to recommend exercise include safety concerns and ambiguity of recommendations. To better inform clinicians, this systematic review assembled a consensus exercise prescription (ExRx) for healthy pregnant women framed by the Frequency, Intensity, Time, and Type (FITT) principle. Methods: In April 2021, PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane databases were searched. Reports were eligible if: (1) targeted healthy pregnant women, (2) framed the ExRx by the FITT, and (3) published by a professional society from 2000 to 2021 in English. The Appraisal of Guidelines for Research and Evaluation II tool assessed risk of bias. Results: Twelve reports of poor to good quality were included. Nine societies conducted systematic reviews, but only three provided a detailed, transparent description of the review conducted. Although the FITT varied, the most common was most days of the week, moderate intensity, 30 minutes/session to accumulate 150 minutes/week, and aerobic, resistance, and flexibility exercise with three societies advising neuromotor exercise. All professional societies specified activities to avoid and eight societies included contraindications to exercise. Conclusions: This systematic review produced a consensus ExRx for healthy pregnant women to better inform clinicians about advising their patients to exercise during pregnancy. Future research is needed to determine the upper limits of exercise while pregnant and provide better informed guidance relating to safety concerns for women who are pregnant., Competing Interests: No competing financial interests exist., (© Lauren R. Rudin et al., 2021; Published by Mary Ann Liebert, Inc.)

Objective: To examine sugar-sweetened beverage (SSB) consumption, sleep duration, and quality during pregnancy., Methods: Pregnant women completed 3 24-hour dietary recalls and the Pittsburgh Sleep Quality Index. Logistic regression models estimated odds of short sleep duration (< 7 h/night) and poor sleep quality (Pittsburgh Sleep Quality Index score > 5) by SSB consumption (servings/d averaged across 3 days)., Results: Participants (n = 108) were a median age of 30 years old (interquartile range [IQR], 26-33) and at 23.9 weeks gestation (IQR, 18.9-30.6). Participants consumed a median of 0.4 servings of SSBs per day on average (IQR, 0-1.1; range, 0-4.6). Fifty-two percent reported poor quality sleep and 38% short sleep. Each additional serving of SSB was associated with higher odds of short sleep (adjusted odds ratio, 1.6; 95% confidence interval, 1.1-2.5) and poor sleep quality (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.6)., Conclusions and Implications: SSB consumption may be a modifiable risk factor for short/poor sleep during pregnancy. Longitudinal research is needed to explore the interplay between SSB consumption and sleep., (Copyright © 2021 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objectives: We examined undergraduate STEM students' experiences during Spring 2020 when universities switched to remote instruction due to the COVID-19 pandemic. Specifically, we sought to understand actions by universities and instructors that students found effective or ineffective, as well as instructor behaviors that conveyed a sense of caring or not caring about their students' success., Methods: In July 2020 we conducted 16 focus groups with STEM undergraduate students enrolled in US colleges and universities (N = 59). Focus groups were stratified by gender, race/ethnicity, and socioeconomic status. Content analyses were performed using a data-driven inductive approach., Results: Participants (N = 59; 51% female) were racially/ethnically diverse (76% race/ethnicity other than non-Hispanic white) and from 32 colleges and universities. The most common effective instructor strategies mentioned included hybrid instruction (35%) and use of multiple tools for learning and student engagement (27%). The most common ineffective strategies mentioned were increasing the course workload or difficulty level (18%) and use of pre-recorded lectures (15%). The most common behaviors cited as making students feel the instructor cared about their success were exhibiting leniency and/or flexibility regarding course policies or assessments (29%) and being responsive and accessible to students (25%). The most common behaviors cited as conveying the instructors did not care included poor communication skills (28%) and increasing the difficulty of the course (15%). University actions students found helpful included flexible policies (41%) and moving key services online (e.g., tutoring, counseling; 24%). Students felt universities should have created policies for faculty and departments to increase consistency (26%) and ensured communication strategies were honest, prompt, and transparent (23%)., Conclusions: To be prepared for future emergencies, universities should devise evidence-based policies for remote operations and all instructors should be trained in best practices for remote instruction. Research is needed to identify and ameliorate negative impacts of the pandemic on STEM education., Competing Interests: The authors have declared that no competing interests exist.

Background: Over a third of preadolescent children with overweight or obesity. The American Academy of Pediatrics (AAP) recommends pediatric providers help families make changes in eating and activity to improve body mass index (BMI). However, implementation is challenging given limited time and referral sources, and family burden to access in-person weight management programs., Purpose: To describe the design of a National Heart Blood and Lung Institute sponsored cluster randomized controlled pediatric-based trial evaluating the effectiveness of the Fitline pediatric practice-based referral program to reduce BMI and improve diet and physical activity in children with overweight or obesity. Comparison will be made between brief provider intervention plus referral to (1) eight weekly nutritionist-delivered coaching calls with workbook to help families make AAP-recommended lifestyle changes (Fitline-Coaching), vs. (2) the same workbook in eight mailings without coaching (Fitline-Workbook)., Methods: Twenty practices are pair-matched and randomized to one of the two conditions; 494 parents and their children ages 8-12 with a BMI of ≥85th percentile are being recruited. The primary outcome is child BMI; secondary outcomes are child's diet and physical activity at baseline and 6- and 12-months post-baseline. Cost-effectiveness of the two interventions also will be examined., Conclusion: This is the first randomized controlled trial to examine use of a centrally located telephonic coaching service to support families of children with overweight and obesity in making AAP-recommended lifestyle changes. If effective, the Fitline program will provide an innovative model for widespread dissemination, setting new standards for weight management care in pediatric practice., Trial Registration: The ClinicalTrials.gov registration number is NCT03143660., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: This study assessed interest in digital dietary support among adults with kidney failure receiving hemodialysis., Methods: We recruited English-speaking adults with kidney failure receiving hemodialysis 2+ times per week online and in dialysis clinics to complete a brief survey. Participants were asked if they were interested in participating in an online patient community with access to a registered dietitian (RD) (not at all, slightly, somewhat, very, or extremely interested). Participants who reported owning a smartphone or tablet computer were asked about their interest in communicating with an RD about their kidney diet using a secure app (not at all, slightly, somewhat, very, or extremely interested)., Results: Participants (N = 100) were on average 53.5 (standard deviation: 16.0) years old, 48% were female, and 69% non-Hispanic white. The majority (83%) went online daily in the past 4 weeks, 80% reported having a Facebook account, and 70% looked online for information about kidney failure in the past 4 weeks. Forty-six percent were very/extremely interested in participating in an online patient community with access to an RD (18%-66% across subgroups). Of the 83% of patients who owned a tablet and/or smartphone, 39% were very/extremely interested in using an app to communicate with an RD about their kidney diet (21%-58% across subgroups)., Conclusions: In this relatively young and tech-connected sample of patients with kidney failure, many were interested in digital dietary support from an RD. Future research is needed to examine what patients desire in an online patient community and how digital support can complement and enhance support provided by RDs. RDs working with patients receiving hemodialysis may want to refer patients to evidence-based online resources and explore connecting with patients via social media or mobile app., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common., Objective: This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program., Methods: We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups., Results: A total of 75% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97% (31/32) retained in the Slip Buddy condition and 94% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8% (SD 31.3%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5%, SD 28.4% of days), and participants who recorded slips (30/32, 94%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9%). Slips most often occurred at home (297/538, 55.2%), while working (153/538, 28.4%), while socializing (130/538, 24.2%), or during screen time (123/538, 22.9%). The conditions did not differ in participants' ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ≥5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants., Conclusions: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring., Trial Registration: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171., (©Sherry Pagoto, Bengisu Tulu, Molly E Waring, Jared Goetz, Jessica Bibeau, Joseph Divito, Laurie Groshon, Matthew Schroeder. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 01.04.2021.)

Background: Management of AF requires patient engagement in disease management which requires adequate knowledge about AF., Objective: To identify the patient characteristics associated with low AF knowledge among older adults with AF., Methods: The SAGE-AF cohort enrolled adults aged ≥65 diagnosed with AF in 2016-2018. Patient characteristics associated with low AF knowledge (<6/8 JAKQ items correct) were examined using multivariable adjusted logistic regression models., Results: Participants (N = 950) were on average 74 years old (SD: 6.7), 50 % female, and 87 % non-Hispanic white. The average JAKQ score was 68.7 (SD: 17.1), and 78 % had low AF knowledge. Participants aged ≥ 75 (OR: 1.55, 95 % CI: 1.03, 2.33), without a college degree (OR: 0.46, 95 % CI: 0.32, 0.65), cognitively impaired (OR: 1.72, 95 % CI: 1.15, 2.58), with a history of anxiety (OR: 1.76, 95 % CI: 1.09, 2.83), myocardial infarction (OR: 1.82, 95 % CI: 1.08, 3.07), and heart failure (OR: 1.84, 95 % CI: 1.16, 2.91) were more likely to have low AF knowledge., Practice Implications: Characteristics available in the electronic medical record may identify patients at risk for low AF knowledge. Formal assessment of AF knowledge may identify areas of weakness and allow for targeted education., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background/objectives: Oral anticoagulation (OAC) is challenging in older patients with nonvalvular atrial fibrillation (NVAF) who are often frail and have cognitive impairment. We examined the characteristics of older NVAF patients associated with higher odds of physical and cognitive impairments. We also examined if these high-risk patients have different OAC prescribing patterns and their satisfaction with treatment because it may impact optimal management of their NVAF., Methods: The patients in the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF study cohort 2016-2018) had NVAF, were aged 65 and older, and eligible for the receipt of OAC. Measures included frailty (Fried Frailty scale), cognitive impairment (Montreal Cognitive Assessment Battery), OAC prescribing and type (direct oral anticoagulant [DOAC] or vitamin K antagonist [VKA]), depressive symptoms (Patient Health Questionnaire-9), bleeding, stroke risk, and treatment benefit (Anti-Clot Treatment Scale)., Results: Patients (n = 1,244) were 49% female, aged 76 (standard deviation = 7) years. A total of 14% were frail, and 42% had cognitive impairment. Frailty and cognitive impairment co-occurred in 9%. Odds of having both impairments versus none were higher with depression (odds ratio [OR] = 4.62; 95% confidence interval [CI] = 2.59-8.26), older age (OR = 1.56; 95% CI = 1.29-1.88), lower education (OR = 3.81; 95%CI = 2.13-6.81), race/ethnicity other than non-Hispanic White (OR = 7.94; 95% CI = 4.34-14.55), bleeding risk (OR = 1.43; 95% CI = 1.12-1.81), and stroke risk (OR = 1.35; 95% CI = 1.13-1.62). OAC prescribing was not associated with CI and frailty status. Among patients taking OACs (85%), those with both impairments were more likely to take DOAC than VKA (OR = 1.69; 95% CI = 1.01-2.80). Having both impairments (OR = 1.87; 95% CI = 1.08-3.27) or cognitive impairment (OR = 1.56; 95% CI = 1.09-2.24) was associated with higher odds of reporting lower treatment benefit., Conclusion: In a large cohort of older NVAF patients, half were frail or cognitively impaired, and 9% had both impairments. We highlight the characteristics of patients who may benefit from cognitive and physical function screenings to maximize treatment and enhance prognosis. Finally, the co-occurrence of impairment was associated with low perceived benefit of treatment that may impede optimal management., (© 2020 The American Geriatrics Society.)

Background: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden., Methods: Patients with AF age ≥65 years with a CHA 2 DS 2 VASC risk score ≥ 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used., Results: Participants (N = 1244, 49 % female) were on average 76 ± 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26)., Conclusions: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive., Objectives: Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity., Methods: Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities ( n  = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1-3 ( n  = 795), 4 ( n  = 713), and ≥5 ( n  = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome., Results: Approximately 15% (15.4%, n  = 332) of the WHI-DM 24HR cohort reported incident diabetes at follow-up. Cox proportional hazards regression tested associations of eating occasions with T2D adjusted for neighborhood socioeconomic status, BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index-2005, 24HR energy intake, and WHI-DM arm. Compared with women reporting 1-3 meals/d, those consuming 4 meals/d had a T2D HR = 1.38 (95% CI: 1.03, 1.84) without further increases in risk for ≥5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1-3 meals/d were stronger in women with BMI <30.0 kg/m 2 (HR = 1.55; 95% CI: 1.00, 2.39) and women aged ≥60 (HR = 1.61; 95% CI: 1.11, 2.33)., Conclusions: Four meals per day compared with 1-3 meals/d was associated with increased risk of T2D in postmenopausal women, but no dose-response effect was observed for additional eating occasions. Further studies are needed to understand eating occasions in relation to T2D risk., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Background: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population., Objective: The objective of our study was to describe online health information-seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not., Methods: The study population included 72,806 women aged 65 years and older enrolled in the Women's Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs., Results: Of the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% [38,481/42,887] vs 87% [26,017/29,919]), earned a higher income (over $US 50,000: 55% [23,410/42,887] vs 33% [9991/29,919]), achieved a higher educational level (more than high school: 87% [37,493/42,887] vs 75% [22,377/29,919]), and were more likely to live with a partner (52% [22,457/42,887] vs 36% [10,759/29,919]) (all P<.001). Women with Alzheimer disease were least likely to report online health information-seeking compared to those without the disease (OR 0.41, 95% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95% CI 1.00-1.19), were most likely to use the internet for health information., Conclusions: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital health resources., (©Mina S Sedrak, Enrique Soto-Perez-De-Celis, Rebecca A Nelson, Jennifer Liu, Molly E Waring, Dorothy S Lane, Electra D Paskett, Rowan T Chlebowski. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.04.2020.)

Objectives: Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing., Design: Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study., Setting: Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018., Participants: Participants with AF age 65 years or older, CHA 2 DS 2 -VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244)., Measurements: A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record., Results: A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51-1.09; frail OR = .69; 95% CI = .35-1.36; social isolation OR = .90; 95% CI = .52-1.54; depression OR = .79; 95% CI = .49-1.27; visual impairment OR = .98; 95% CI = .65-1.48; and hearing impairment OR = 1.05; 95% CI = .71-1.54)., Conclusion: Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147-154, 2019., (© 2019 The American Geriatrics Society.)

Research has revealed both the benefits and harms of social media use, but the public has very little guidance on how best to use social media to maximize the benefits to their health and well-being while minimizing the potential harms. Given that social media is intricately embedded in our lives, and we now have an entire generation of social media natives, the time has come for a public health research agenda to guide not only the public's use of social media but also the design of social media platforms in ways that improve health and well-being. In this viewpoint we propose such a public health agenda for social media research that is framed around three broad questions: (1) How much social media use is unhealthy and what individual and contextual factors shape that relationship; (2) What are ways social media can be used to improve physical and mental well-being; and (3) How does health (mis)information spread, how does it shape attitudes, beliefs and behavior, and what policies or public health strategies are effective in disseminating legitimate health information while curbing the spread of health misinformation? We also discuss four key challenges that impede progress on this research agenda: negative sentiment about social media among the public and scientific community, a poorly regulated research landscape, poor access to social media data, and the lack of a cohesive academic field. Social media has revolutionized modern communication in ways that bring us closer to a global society, but we currently stand at an inflection point. A public health agenda for social media research will serve as a compass to guide us toward social media becoming a powerful tool for the public good., (©Sherry L. Pagoto, Molly E Waring, Ran Xu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.12.2019.)

Background: Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs., Objective: The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity., Methods: Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome., Results: Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time., Conclusions: Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups., International Registered Report Identifier (irrid): DERR1-10.2196/15530., (©Molly E E. Waring, Brooke A Libby, Tiffany A Moore Simas, Madison L Bracken, Jessica L Bibeau, Valeria Herrera, Justin Wang, Sherry L Pagoto. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 28.11.2019.)