Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study.

BACKGROUND: With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. OBJECTIVE: We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. METHODS: We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. RESULTS: Of the 55 students in the intervention group, 27 (49%) students in cohort 2 and 25 (45%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. CONCLUSIONS: Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation.

Perceived Risk of Cardiovascular Disease and Health Behaviors in Black College Students.

For college students, the transition from adolescence to young adulthood can be a time of increased stress and negative health behaviors, such as poor diet and physical inactivity, that may lead to cardiovascular disease (CVD), the primary cause of death in the United States. Blacks are disproportionately prone to CVD. Perception of disease risk is a critical predictor of engagement in healthy lifestyle activities intended to reduce CVD development. This project examined the relationship between perceived risk of CVD and health behaviors in Black HBCU students aged 18-25 years. All participants (n = 14) perceived that they were not at risk for heart disease within the next 10 years. Almost half (n = 6, 42.86%) had moderately high CVD risk scores, and three (21.43%) were at high risk for developing CVD. Scores on the subscales for dread risk, risk, and unknown risk were 28.29, 37.67, and 43.86, respectively. Total scores for perceived risk of heart disease ranged from 20 to 80. The Spearman's correlation between these Black college students' perceived dread risk and health responsibility was positive and moderately correlated (rs = 0.62, p = 0.019). A negative and moderate correlation was demonstrated between unknown perceived risk and health responsibility (rs = -0.54, p = 0.046). Thus, higher risk perception is correlated with greater health responsibility, while low risk perception is correlated with less health responsibility. Barriers to healthy lifestyle behaviors identified by the sample included lack of time and sleep, physical inactivity, cost, convenience of unhealthy foods, and low perception of developing CVD. A major implication is the benefit of implementing interventions to modify risk perception and college-specific barriers that increase CVD risk.

The Use of Text Messaging to Promote Physical Activity in African-American College Students: A Feasibility Study.

BACKGROUND: African-American college students are less likely to meet recommended physical activity guidelines to promote health, and are at risk of overweight, obesity, and elevated blood pressure. Text messaging is an emerging international technology shown to engage college students, promote physical activity, and reduce health risks. PURPOSE: To determine the feasibility of using text messaging to promote physical activity among African-American college students enrolled in a unique course focusing on lifestyle behaviors for a healthy heart. SAMPLE: A purposive sample of 11 (n=4 male, n=7 female) African-American college students aged 18-25 years with cell phones capable of receiving messages was used in this study. METHODS: A three-week text-message protocol was piloted using web-based software to evaluate feasibility with post-hoc grouping of participants into responders and non responders. Descriptive statistics and Mann-Whitney U-tests were used to analyze group differences. RESULTS: There was an attrition rate of nearly 91%. Observed engagement was 50% among responders with compliance at 44.44%. Observed engagement and compliance rates were less than 2% among nonresponders. There were no statistically significant differences in underlying variable distributions between groups. Of practical importance, it was noted that prior to texting responder means were higher for walking physical activity, and lower for body mass index, while nonresponders had higher means for vigorous physical activity. CONCLUSION: The literature review indicated that text messaging is a cost-effective technology that can be incorporated into health education courses on HBCU campuses, but this project suggested semester timing is pivotal to feasibility. Implications largely address tailoring text messages to maintain engagement and evaluating the effect of text messages on physical activity level, body mass index, and blood pressure.

Examining the Relationship between Mindfulness, Perceived Stress, and Blood Pressure in African-American College Students.

College students are prone to stress, making them vulnerable to cardiovascular disease (CVD). Harmful health behaviors, such as tobacco or alcohol use, further predispose students to hypertension (HTN). African-Americans (AA) experience increased blood pressure reactivity, and weathering, due to race-related stressors. This interplay makes AA college students good targets for strategies to prevent stress and HTN disease risk. This project examined the relationship between mindfulness, perceived stress and blood pressure among a group of AA college students enrolled in an HBCU healthy heart course. Participants' systolic and diastolic blood pressure averaged 122 mmHg and 76 mmHg, respectively. The Spearman correlation revealed a negative strong relationship between mindfulness and perceived stress (rs = -0.61, p = 0.004). The coefficient of determination indicated that 37% of the variance in mindfulness was explained by perceived stress. College health practitioners should consider integrating mindfulness into course activities and expanding its treatment modality.