Showing papers in "Translational behavioral medicine in 2016"
TL;DR: The purpose of this paper is to define products and a preliminary process for efficiently and adaptively creating and curating a knowledge base for behavior change for real-world implementation and to target three products: the smallest, meaningful, self-contained, and repurposable behavior change modules of an intervention.
Abstract: Evidence-based practice is important for behavioral interventions but there is debate on how best to support real-world behavior change. The purpose of this paper is to define products and a preliminary process for efficiently and adaptively creating and curating a knowledge base for behavior change for real-world implementation. We look to evidence-based practice suggestions and draw parallels to software development. We argue to target three products: (1) the smallest, meaningful, self-contained, and repurposable behavior change modules of an intervention; (2) “computational models” that define the interaction between modules, individuals, and context; and (3) “personalization” algorithms, which are decision rules for intervention adaptation. The “agile science” process includes a generation phase whereby contender operational definitions and constructs of the three products are created and assessed for feasibility and an evaluation phase, whereby effect size estimates/casual inferences are created. The process emphasizes early-and-often sharing. If correct, agile science could enable a more robust knowledge base for behavior change.
156 citations
TL;DR: Five to 10 % weight losses produced improvements in cardiovascular risk factors, but greater weight losses were associated with even greater improvement, and those who lost >10 % improved on all risk factors and to a significantly greater degree than those losing less.
Abstract: Little is known about the cardiovascular effects of modest weight loss. To determine whether weight losses limited to 5–10 % are sufficient to produce cardiovascular health benefits, data from 401 overweight and obese adults who enrolled in a behavioral weight loss program from 2003 to 2011 were analyzed. Primary outcomes were changes in fasting glucose, triglycerides, and cholesterol. Patients who lost 5–10 % showed significant reductions in triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol. Patients who lost >10 % experienced significantly greater improvements in triglycerides, total cholesterol, and LDL cholesterol than patients losing less. For higher-risk patients, those who lost 5–10 % significantly reduced fasting glucose, triglycerides, and total cholesterol; those who lost >10 % improved on all risk factors (except HDL cholesterol) and to a significantly greater degree than those losing less. Five to 10 % weight losses produced improvements in cardiovascular risk factors, but greater weight losses were associated with even greater improvement.
82 citations
TL;DR: A broad-span, six-stage translational prevention model is presented, extending from the basic sciences—taking a multi-level systems approach, including the neurobiological sciences—through to globalization, and what resources and changes in research perspectives are needed to move along this translational spectrum.
Abstract: A broad-span, six-stage translational prevention model is presented, extending from the basic sciences-taking a multi-level systems approach, including the neurobiological sciences-through to globalization. The application of a very wide perspective of translation research from basic scientific discovery to international policy change promises to elicit sustainable, population-level reductions in behavioral health disorders. To illustrate the conceptualization and actualization of a program of translational prevention research, we walk through each stage of research to practice and policy using an exemplar, callous-unemotional (CU) traits. Basic science has identified neurobiological, psychophysiological, behavioral, contextual, and experiential differences in this subgroup, and yet, these findings have not been applied to the development of more targeted intervention. As a result, there are currently no programs considered especially effective for CU traits, likely because they do not specifically target underlying mechanisms. To prevent/reduce the prevalence of conduct disorder, it is critical that we transfer existing knowledge to subsequent translational stages, including intervention development, implementation, and scaling. And eventually, once resulting programs have been rigorously evaluated, replicated, and adapted across cultural, ethnic, and gender groups, there is potential to institutionalize them as well as call attention to the special needs of this population. In this paper, we begin to consider what resources and changes in research perspectives are needed to move along this translational spectrum.
77 citations
TL;DR: Findings support strategies proposed in the Kelly et al. (2013) ethical framework, which emphasizes procedures to improve informed consent, protect privacy, manage data, and respect bystander rights when using a wearable camera.
Abstract: Researchers utilize mobile imaging, pervasive sensing, social media, and location tracking (MISST) technologies to observe and intervene with participants in their natural environment. The use of MISST methods and tools introduces unique ethical issues due to the type and quantity of data, and produces raising new challenges around informed consent, risk assessment, and data management. Since MISST methods are relatively new in behavioral research, there is little documented evidence to guide institutional review board (IRB) risk assessment and inform appropriate risk management strategies. This study was conducted to contribute the participant perspectives when considering ethical and responsible practices. Participants (n = 82) enrolled in an observational study where they wore several MISST devices for 1 week completed an exit survey. Survey items focused on the following: 1—device comfort, 2—informed consent, 3—privacy protections, and 4—bystander engagement. The informed consent process reflected participant actual experience. Device comfort and privacy were raised as concerns to both the participants and bystanders. While the majority of the participants reported a positive experience, it is important to note that the participants were volunteers who were not mandated to wear tracking devices and that persons who are mandated may not have a similar response. Findings support strategies proposed in the Kelly et al. (2013) ethical framework, which emphasizes procedures to improve informed consent, protect privacy, manage data, and respect bystander rights when using a wearable camera.
66 citations
TL;DR: Questions to be considered when combining data across studies are described, based on discussions in an NIH-sponsored workshop on pooling issues across studies in consortia, and several statistical methodologies are described.
Abstract: Combining and analyzing data from heterogeneous randomized controlled trials of complex multiple-component intervention studies, or discussing them in a systematic review, is not straightforward. The present article describes certain issues to be considered when combining data across studies, based on discussions in an NIH-sponsored workshop on pooling issues across studies in consortia (see Belle et al. in Psychol Aging, 18(3):396–405, 2003). Several statistical methodologies are described and their advantages and limitations are explored. Whether weighting the different studies data differently, or via employing random effects, one must recognize that different pooling methodologies may yield different results. Pooling can be used for comprehensive exploratory analyses of data from RCTs and should not be viewed as replacing the standard analysis plan for each study. Pooling may help to identify intervention components that may be more effective especially for subsets of participants with certain behavioral characteristics. Pooling, when supported by statistical tests, can allow exploratory investigation of potential hypotheses and for the design of future interventions.
62 citations
TL;DR: Opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques across multiple interventions addressing obesity and capture dose received at the technique level are considered.
Abstract: Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.
59 citations
TL;DR: It is found that it is possible to identify potentially effective BCTs, and engagement and ease-of-use features in smoking cessation apps with fair to high inter-rater reliability.
Abstract: The aim of this study was to assess whether or not behaviour change techniques (BCTs) as well as engagement and ease-of-use features used in smartphone applications (apps) to aid smoking cessation can be identified reliably. Apps were coded for presence of potentially effective BCTs, and engagement and ease-of-use features. Inter-rater reliability for this coding was assessed. Inter-rater agreement for identifying presence of potentially effective BCTs ranged from 66.8 to 95.1 % with ‘prevalence and bias adjusted kappas’ (PABAK) ranging from 0.35 to 0.90 (p 50 % for rewarding abstinence. The average proportions of specified engagement and ease-of-use features included in the apps were 69 and 83 %, respectively. The study found that it is possible to identify potentially effective BCTs, and engagement and ease-of-use features in smoking cessation apps with fair to high inter-rater reliability.
59 citations
TL;DR: It is hypothesized that changes in DNA methylation as well as other epigenetic markers could generate stable phenotypes, and might provide an objective tool for assessing effects of early adverse experience on individual risks aswell as providing objective measures of progress of an intervention.
Abstract: The emerging field of behavioral epigenetics is producing a growing body of evidence that early life experience and social exposure can alter the way by which genes are marked with DNA methylation. We hypothesize that changes in DNA methylation as well as other epigenetic markers could generate stable phenotypes. Early life adversity appears to result in altered DNA methylation of genes in the brain and peripheral tissues, and these changes are associated with adverse phenotypic changes. Although the data are still sparse, early epigenetic studies have provided a proof of principle that experiences and the environment leave marks on genes, and thus suggest molecular and physical mechanisms for the epidemiological concept of gene-environment interaction. The main attraction of DNA methylation for type I (TI) translational prevention science is the fact that, different from genetic changes that are inherited from our ancestors, DNA methylation is potentially preventable and reversible and, therefore, there is a prospect of epigenetically targeted interventions. In addition, DNA methylation markers might provide an objective tool for assessing effects of early adverse experience on individual risks as well as providing objective measures of progress of an intervention. In spite of this great potential promise of the emerging field of social and translational epigenetics, many practical challenges remain that must be addressed before behavioral epigenetics could become translational epigenetics.
53 citations
TL;DR: The positive impact on the secondary outcome (days in hospital) among COPD patients, but not in CHF, may suggest that E-Coach may be more beneficial among patients with COPD.
Abstract: Care transitions from the hospital to home remain a vulnerable time for many patients, especially for those with heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Despite regular use in chronic disease management, it remains unclear how technology can best support patients during their transition from the hospital. We sought to evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community and mortality. Using a pragmatic randomized trial, we enrolled patients (511 enrolled, 478 analyzed) hospitalized with CHF/COPD to “E-Coach,” an intervention with condition-specific customization and in-hospital and post-discharge support by a care transition nurse (CTN), interactive voice response post-discharge calls, and CTN follow-up versus usual post-discharge care (UC). The primary outcome was 30-day rehospitalization. Secondary outcomes included (1) rehospitalization and death and (2) days in the hospital and out of the community. E-Coach and UC groups were similar at baseline except for gender imbalance (p = 0.02). After adjustment for gender, our primary outcome, 30-day rehospitalization rates did not differ between the E-Coach and UC groups (15.0 vs. 16.3 %, adjusted hazard ratio [95 % confidence interval]: 0.94 [0.60, 1.49]). However, in the COPD subgroup, E-Coach was associated with significantly fewer days in the hospital (0.5 vs. 1.6, p = 0.03). E-Coach, an IVR-augmented care transition intervention did not reduce rehospitalization. The positive impact on our secondary outcome (days in hospital) among COPD patients, but not in CHF, may suggest that E-Coach may be more beneficial among patients with COPD.
52 citations
TL;DR: This paper describes the development of a dynamical system model of SCT using fluid analogies and control systems principles drawn from engineering and generates precise and testable quantitative predictions for future intensive longitudinal research.
Abstract: Social cognitive theory (SCT) is among the most influential theories of behavior change and has been used as the conceptual basis of health behavior interventions for smoking cessation, weight management, and other health behaviors. SCT and other behavior theories were developed primarily to explain differences between individuals, but explanatory theories of within-person behavioral variability are increasingly needed as new technologies allow for intensive longitudinal measures and interventions adapted from these inputs. These within-person explanatory theoretical applications can be modeled as dynamical systems. SCT constructs, such as reciprocal determinism, are inherently dynamical in nature, but SCT has not been modeled as a dynamical system. This paper describes the development of a dynamical system model of SCT using fluid analogies and control systems principles drawn from engineering. Simulations of this model were performed to assess if the model performed as predicted based on theory and empirical studies of SCT. This initial model generates precise and testable quantitative predictions for future intensive longitudinal research. Dynamic modeling approaches provide a rigorous method for advancing health behavior theory development and refinement and for guiding the development of more potent and efficient interventions.
47 citations
TL;DR: Adolescents with persistent asthma reported that self-check quizzes, reminders, and charting features increased their ability to self-observe and self-judge their asthma, which helped them feel more confident they could manage their asthma independently and keep their asthma well-controlled.
Abstract: Asthma apps often lack strong theoretical underpinnings. We describe how specific features of asthma apps influenced adolescents’ self-observation, self-judgment, and self-reactions, which are key constructs of Self-Regulation Theory (SRT). Adolescents (ages 12–16) with persistent asthma (n = 20) used two asthma self-management apps over a 1-week period. During semi-structured interviews, participants identified their asthma goals and the app features that best promoted self-observation, self-judgment, and fostered positive self-reactions. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically using MAXQDA. Adolescents’ goals were to reduce the impact of asthma on their lives. Adolescents reported that self-check quizzes, reminders, and charting features increased their ability to self-observe and self-judge their asthma, which, in turn, helped them feel more confident they could manage their asthma independently and keep their asthma well-controlled. Asthma apps can positively influence adolescents’ self-management behaviors via increased self-observation, self-judgment, and increased self-efficacy.
TL;DR: The development of a smartphone app to help pregnant women stop smoking was guided by frameworks for developing complex interventions, including the Medical Research Council (MRC), Multiphase Optimization Strategy (MOST) and Behaviour Change Wheel (BCW).
Abstract: Pregnant smokers may benefit from digital smoking cessation interventions, but few have been designed for this population. The aim was to transparently report the development of a smartphone app designed to aid smoking cessation during pregnancy. The development of a smartphone app ('SmokeFree Baby') to help pregnant women stop smoking was guided by frameworks for developing complex interventions, including the Medical Research Council (MRC), Multiphase Optimization Strategy (MOST) and Behaviour Change Wheel (BCW). Two integrative behaviour change theories provided the theoretical base. Evidence from the scientific literature and behaviour change techniques (BCTs) from the BCT Taxonomy v1 informed the intervention content. The app was developed around five core modules, each with a distinct intervention target (identity change, stress management, health information, promoting use of face-to-face support and behavioural substitution) and available in a 'control' or 'full' version. SmokeFree Baby has been developed as part of a multiphase intervention optimization to identify the optimum combination of intervention components to include in smartphone apps to help pregnant smokers stop smoking.
TL;DR: The findings support the use of an intensive assessment protocol to study real-time relationships between biopsychosocial variables and health behaviors and the feasibility and acceptability of a novel, intensive EMA method utilizing two objective sensors and a mobile application.
Abstract: Intervention development can be accelerated by using wearable sensors and ecological momentary assessment (EMA) to study how behaviors change within a person. The purpose of this study was to determine the feasibility and acceptability of a novel, intensive EMA method for assessing physiology, behavior, and psychosocial variables utilizing two objective sensors and a mobile application (app). Adolescents (n = 20) enrolled in a 20-day EMA protocol. Participants wore a physiological monitor and an accelerometer that measured sleep and physical activity and completed four surveys per day on an app. Participants provided approximately 81 % of the expected survey data. Participants were compliant to the wrist-worn accelerometer (75.3 %), which is a feasible measurement of physical activity/sleep (74.1 % complete data). The data capture (47.8 %) and compliance (70.28 %) with the physiological monitor were lower than other study variables. The findings support the use of an intensive assessment protocol to study real-time relationships between biopsychosocial variables and health behaviors.
TL;DR: An 8-week multiphase optimization strategy design study was used to test the initial efficacy of the sleep, sedentary, and exercise components of the BeWell24 smartphone application.
Abstract: Lifestyle behaviors across the 24-h spectrum (i.e., sleep, sedentary, and active behaviors) drive metabolic risk. We describe the development and process evaluation of BeWell24, a multicomponent smartphone application (or “app”) that targets behavior change in these interdependent behaviors. A community-embedded iterative design framework was used to develop the app. An 8-week multiphase optimization strategy design study was used to test the initial efficacy of the sleep, sedentary, and exercise components of the app. Process evaluation outcomes included objectively measured app usage statistics (e.g., minutes of usage, self-monitoring patterns), user experience interviews, and satisfaction ratings. Participants (N = 26) logged approximately 60 % of their sleep, sedentary, and exercise behaviors, which took 3–4 min/day to complete. Usage of the sleep and sedentary components peaked at week 2 and remained high throughout the intervention. Exercise component use was low. User experiences were mixed, and overall satisfaction was modest.
TL;DR: A translational prevention framework of mindfulness and its effects is proposed that integrates neuroscience and prevention research and postulates underlying brain regulatory mechanisms that explain the impact of mindfulness on psychological outcomes via self-regulation mechanisms linked to underlying brain systems.
Abstract: Mindfulness meditation research mainly focuses on psychological outcomes such as behavioral, cognitive, and emotional functioning. However, the neuroscience literature on mindfulness meditation has grown in recent years. This paper provides an overview of relevant neuroscience and psychological research on the effects of mindfulness meditation. We propose a translational prevention framework of mindfulness and its effects. Drawing upon the principles of prevention science, this framework integrates neuroscience and prevention research and postulates underlying brain regulatory mechanisms that explain the impact of mindfulness on psychological outcomes via self-regulation mechanisms linked to underlying brain systems. We conclude by discussing potential clinical and practice implications of this model and directions for future research.
TL;DR: This work devised ways to address each intervention target, including selecting interactive features and behaviour change techniques, and provided a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target.
Abstract: Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target.
TL;DR: Regression analysis indicated that worksite type, decreased diastolic blood pressure, increased physical activity, and more internalized locus of weight control were significantly associated with 3-month weight loss.
Abstract: A previously translated Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was adapted for delivery as a worksite-based intervention, called PILI@Work, to address obesity disparities in Native Hawaiians/Pacific Islanders. This study examined the effectiveness of PILI@Work and factors associated with weight loss at post-intervention. Overweight/obese employees of 15 Native Hawaiian-serving organizations received the 3-month component of PILI@Work. Assessments included weight, systolic/diastolic blood pressure, physical activity and functioning, fat intake, locus of weight control, social support, and self-efficacy. Weight, systolic/diastolic blood pressure, physical functioning, physical activity frequency, fat intake, family support, and eating self-efficacy improved from pre- to post-intervention. Regression analysis indicated that worksite type, decreased diastolic blood pressure, increased physical activity, and more internalized locus of weight control were significantly associated with 3-month weight loss. PILI@Work initiated weight loss in Native Hawaiians/Pacific Islanders. DPP-LI translated to worksite settings and tailored for specific populations can be effective for addressing obesity.
TL;DR: Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness, as well as the prevalence of preventable diseases including cardiovascular disease and diabetes.
Abstract: Adults with serious mental illness die more than 10 years earlier than the average American. Premature mortality is due to the high prevalence of preventable diseases including cardiovascular disease and diabetes. Poor lifestyle behaviors including lack of exercise and physical inactivity contribute to the epidemic levels of obesity, diabetes, and cardiovascular disease observed among adults with serious mental illness. Not surprisingly, people with serious mental illness are among the most costly consumers of health services due to increased visits for poorly managed mental and physical health. Recent studies have demonstrated that exercise interventions based on community mental health settings can significantly improve physical and mental health in people with serious mental illness. However, current funding regulations limit the ability of community mental health settings to offer exercise programming services to people with serious mental illness. Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness.
TL;DR: Challenges and approaches to evaluation are discussed that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies.
Abstract: Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3–T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.
TL;DR: This framework guides integration of cultural and diversity considerations at each phase with emphasis on the importance and value of “citizen scientists” being research partners to promote ecological validity.
Abstract: Concepts of culture and diversity are necessary considerations in the scientific application of theory generation and developmental processes of preventive interventions; yet, culture and/or diversity are often overlooked until later stages (e.g., adaptation [T3] and dissemination [T4]) of the translational science process. Here, we present a conceptual framework focused on the seamless incorporation of culture and diversity throughout the various stages of the translational science process (T1-T5). Informed by a community-engaged research approach, this framework guides integration of cultural and diversity considerations at each phase with emphasis on the importance and value of "citizen scientists" being research partners to promote ecological validity. The integrated partnership covers the first phase of intervention development through final phases that ultimately facilitate more global, universal translation of changes in attitudes, norms, and systems. Our comprehensive model for incorporating culture and diversity into translational research provides a basis for further discussion and translational science development.
Virginia Commonwealth University1, University of Colorado Denver2, University of Maryland, College Park3, Leidos4, University of Texas Health Science Center at Houston5, Carilion Clinic6, Texas A&M University7, University of California, Los Angeles8, Northwestern University9, University of Vermont10, University of North Carolina at Chapel Hill11
TL;DR: Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns, and patient-centered health risk assessments improve screening and goal setting.
Abstract: Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p < 0.001), set goals for six risks (range of differences 3.8-16.6 %, p < 0.01), and improve five risks (range of differences 5.4-13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746.
PARC1
TL;DR: A computational predictive model (ACT-R-DStress) is presented and fit to individual daily adherence in 28-day mHealth exercise programs, which refines the psychological construct of self-efficacy.
Abstract: Mobile health (mHealth) applications provide an excellent opportunity for collecting rich, fine-grained data necessary for understanding and predicting day-to-day health behavior change dynamics. A computational predictive model (ACT-R-DStress) is presented and fit to individual daily adherence in 28-day mHealth exercise programs. The ACT-R-DStress model refines the psychological construct of self-efficacy. To explain and predict the dynamics of self-efficacy and predict individual performance of targeted behaviors, the self-efficacy construct is implemented as a theory-based neurocognitive simulation of the interaction of behavioral goals, memories of past experiences, and behavioral performance.
TL;DR: Tanning salons actively use social media as a strategy for maintaining relationships with customers and offer pricing deals that promote loyalty and high-frequency tanning.
Abstract: There is no research investigating indoor tanning advertising on social media. We assessed the use of social media to promote indoor tanning. We subscribed to social media platforms in six US cities and content-analyzed promotional messages received. We captured 662 messages on Twitter and Facebook, through salon emails, and in daily deal coupons. Salon postings were most frequent on Twitter and Facebook, with an average of 2–3 postings per week. National chains posted more frequently than local businesses. Forty percent of messages were devoid of tanning content and included photos, jokes, or popular references. Thirty percent mentioned price reductions, and 28 % referenced an upcoming holiday. Sunless tanning (17 %) was promoted more often than ultraviolet tanning (9 %). Tanning salons actively use social media as a strategy for maintaining relationships with customers and offer pricing deals that promote loyalty and high-frequency tanning.
TL;DR: Each measurement system described is described and considerations in the design and interpretation of studies that employ one or more of these systems are highlighted, and future directions for continued implementation ofThese systems in clinical practice, population-based research, observational studies, and clinical trials are summarized.
Abstract: There is rapidly growing interest in the capture of person-centered outcomes in clinical and population-based research and in healthcare delivery settings. Stakeholders (e.g., patients, clinicians, payers, regulators, researchers) increasingly agree that person-centered outcome measurement can accelerate the development of new knowledge, improve the efficiency and quality of care, and may also contribute to clinician or health system performance metrics and regulatory review of new therapies [1–3]. These outcomes may be incorporated into both observational studies and clinical trials, and provide salient endpoints in trials of preventive or disease-modifying treatments, as well as behavioral or psychosocial interventions. Over the past decade, the National Institutes of Health (NIH) has invested in the development and evaluation of several measurement systems that are now available for research and clinical use. These include the Patient Reported Outcomes Measurement Information System® (PROMIS®) [4], the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox®) [5], the Quality of Life Outcomes in Neurological Disorders (Neuro-QoL) [6], Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) [7], and the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) [8]. In this paper, we (i) describe each system; (ii) highlight considerations in the design and interpretation of studies that employ one or more of these systems; and (iii) summarize future directions for continued implementation of these systems in clinical practice, population-based research, observational studies, and clinical trials.
TL;DR: Findings suggest that research investments as small as seed funding are effective for scientific productivity and professional growth of novice investigators and production of research with new initiatives and innovations.
Abstract: There is a demand for providing evidence on the effectiveness of research investments on the promotion of novice researchers’ scientific productivity and production of research with new initiatives and innovations. We used a mixed method approach to evaluate the funding effect of the New Investigator Fund (NIF) by comparing scientific productivity between award recipients and non-recipients. We reviewed NIF grant applications submitted from 2004 to 2013. Scientific productivity was assessed by confirming the publication of the NIF-submitted application. Online databases were searched, independently and in duplicate, to locate the publications. Applicants’ perceptions and experiences were collected through a short survey and categorized into specified themes. Multivariable logistic regression was performed. Odds ratios (OR) with 95 % confidence intervals (CI) are reported. Of 296 applicants, 163 (55 %) were awarded. Gender, affiliation, and field of expertise did not affect funding decisions. More physicians with graduate education (32.0 %) and applicants with a doctorate degree (21.5 %) were awarded than applicants without postgraduate education (9.8 %). Basic science research (28.8 %), randomized controlled trials (24.5 %), and feasibility/pilot trials (13.3 %) were awarded more than observational designs (p < 0.001). Adjusting for applicants and application factors, awardees published the NIF application threefold more than non-awardees (OR = 3.4, 95 %, CI = 1.9, 5.9). The survey response rate was 90.5 %, and only 58 % commented on their perceptions, successes, and challenges of the submission process. These findings suggest that research investments as small as seed funding are effective for scientific productivity and professional growth of novice investigators and production of research with new initiatives and innovations. Further efforts are recommended to enhance the support of small grant funding programs.
TL;DR: Daily SMBG increased after one MI session, and further increased when incentives were added, but significantly more for so for older participants, and only returned to baseline levels for younger NS participants.
Abstract: Non-adherence with self-monitoring blood glucose (SMBG) among teenagers with type 1 diabetes can be a problem. The purpose of this study was to investigate the feasibility, acceptability, and preliminary efficacy of using Internet-based incentives to improve adherence with SMBG in non-adherent teenagers. Participants were randomly assigned to contingent (CS; N = 23), where they had to meet web camera-verified SMBG goals to earn incentives, or non-contingent (NS) groups (N = 18), where they earned incentives independent of adherence. Brief motivational interviewing (MI) was given prior to the intervention. Attrition was 15 % in the CS group. Participants and parents endorsed the intervention on all intervention dimensions. Daily SMBG increased after one MI session, and further increased when incentives were added, but significantly more for so for older participants. SMBG declined slowly over time, but only returned to baseline levels for younger NS participants. Internet-based incentive interventions are feasible, acceptable, and show promise for improving adherence with SMBG.
TL;DR: In the choice condition, in-home treatment was the preferred modality, and across conditions, families were less likely to be retained in group and clinic modalities.
Abstract: Incorporating participant preferences into intervention decision-making may optimize health outcomes by improving participant engagement. We describe the rationale for a preference-based approach to the personalization of community-based interventions. Compensating for the limitations of traditional randomized controlled trials (RCTs) and partially randomized preference trials (PRPTs), we employed a doubly randomized preference trial in the present study. Families (N = 129) presenting to community mental health clinics for child conduct problems were randomized to choice or no-choice conditions. Within each condition, parents were again randomized, or offered choices between home- and clinic-based, individual and group versions of a parent training program or services-as-usual. Participants were assessed at baseline, and treatment retention data were gathered. Families assigned to the choice condition were significantly less likely to drop out of treatment than those in the no-choice condition. In the choice condition, in-home treatment was the preferred modality, and across conditions, families were less likely to be retained in group and clinic modalities. Research on preferences may boost participant engagement and inform shared decision-making.
TL;DR: This study examines patterns of social media use and HIT engagement in the U.S.A. using data from the 2013 Health Information National Trends Survey to systematically examine the use and relationships across multiple types of health-related online media.
Abstract: Little is known about the association between Internet/social media use and health information technology (HIT) engagement. This study examines patterns of social media use and HIT engagement in the U.S.A. using data from the 2013 Health Information National Trends Survey (N = 3,164). Specifically, predictors of two HIT activities (i.e., communicating with a healthcare provider using the Internet or email and tracking personal health information electronically) are examined. Persons who were females, higher education, non-Hispanic others, having a regular healthcare provider, and ages 35–44 were more likely to participate in HIT activities. After controlling for sociodemographics and health correlates, social media use was significantly associated with HIT engagement. To our knowledge, this is one of the first studies to systematically examine the use and relationships across multiple types of health-related online media.
TL;DR: Current strategies used by NIH to support transdisciplinary translational behavioral (TDTB) research are discussed, successful efforts are summarized, and challenges encountered in conducting such work are highlighted.
Abstract: The translation of basic behavioral science discoveries into practical strategies represents a promising approach to developing more effective preventive interventions to improve health. Since translational research inevitably involves making use of diverse perspectives from multiple disciplines, it is best conducted as a transdisciplinary enterprise. In this paper, we discuss current strategies used by NIH to support transdisciplinary translational behavioral (TDTB) research, summarize successful efforts, and highlight challenges encountered in conducting such work (ranging from conceptual to organizational to methodological). Using examples from NIH-funded projects we illustrate the potential benefits of, and barriers to, pursuing this type of research and discuss next steps and potential future directions for NIH-supported TDTB research.
TL;DR: Twitter data provides unique insight into tanning behaviors and injuries not captured through traditional public health surveillance.
Abstract: Few surveillance tools exist for monitoring tanning bed injuries. Twitter data were examined to identify and describe reports of tanning bed-caused burns. Tweets sent in 2013 containing keywords for tanning bed use and burning were content analyzed to determine whether a burn caused by a tanning bed was described, and additional data on tanning behavior and burn characteristics were extracted. After content assessment, 15,178 (64 %) tweets were found to describe a tanning bed-caused burn. Sites most reportedly burnt were buttocks (n = 3117), face/head (n = 1020), and chest/breast (n = 546). Alarmingly, 200 burns to the eyes/eyelids were mentioned. A total of 456 tweets described burning >1 time from a tanning bed. A total of 211 tweets mentioned falling asleep inside the tanning bed. In 2013, over 15,000 tweets reported tanning bed-caused burns. Twitter data provides unique insight into tanning behaviors and injuries not captured through traditional public health surveillance.