Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis.

Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.

Knowledge about the cost-effectiveness of weight loss programs for university students is needed to inform administrator decision-making regarding whether to provide such programming. This study examined the cost-effectiveness of two digitally-delivered weight loss interventions (i.e., TAILORED and TARGETED) designed for university students. The TAILORED intervention included information tailored to the individual, while the TARGETED intervention included only generic weight loss information. At 6 months, the average cost per kilogram of weight loss was $107.82 for TAILORED participants and $179.29 for TARGETED participants. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention.

A qualitative investigation of the need for and feasibility of weight loss programs on university campuses.

BACKGROUND: Despite the public health significance of overweight and obesity, weight management has remained a low priority for health-related programming on university campuses. OBJECTIVE: Investigate the need for and feasibility of implementing university-based weight loss programs. METHODS: The Practical, Robust Implementation and Sustainability Model (PRISM) was used as a framework. Semi-structured individual interviews were conducted with fifteen university staff and students from two large U.S. universities in the Northeast and Mid-Atlantic. Interviews aimed to assess readiness, preferences, characteristics, barriers and facilitators in each of the four adapted PRISM domains: (1) Organizational and Recipient (Student) Perspectives on the Intervention, (2) Recipient (Student) Characteristics, (3) Internal Environment (organizational characteristics and infrastructure), and (4) External Environment. Verbatim transcriptions were analyzed using inductive and deductive thematic analyses. Themes were extracted as outlined by Consensual Qualitative Research. RESULTS: Participants supported university-based weight loss programs, but recognized barriers of resources, coordination across entities, and competing health issues taking priority for school programming. Campus built environment and students' busy schedules were identified as barriers to maintaining healthy weight and participation in weight loss programs. Recommendations included designing weight loss programming with a positive and holistic approach, minimizing weight-stigma, ensuring support from university leaders and students, and securing external funding. CONCLUSIONS: The identified themes provide recommendations for universities looking to develop and implement weight loss programming.

Body Image Quality of Life Related to Light Physical Activity and Sedentary Behavior among Young Adults with Overweight/Obesity.

Sedentary behaviors, low levels of physical activity (PA), and low body image quality of life have been identified during college years and associated with poor health outcomes. Public health efforts have recently focused on decreasing sedentary time by increasing light physical activity, both of which have been associated with body image quality of life, though mainly through self-report. In this cross-sectional study, we examined objective actigraphy and survey data from 404 of 459 young adults with overweight and obesity (mean age 23.3 ± 4.4 years, 78.4% female, 55.4% white). PA was measured using an accelerometer worn during waking hours for >10 h/day for four days. Body image quality of life was assessed using the Body Image Quality of Life Inventory Scale. Body image was positively correlated with light PA (r = 0.15) and inversely correlated with BMI (Pearson's r = -0.20) and sedentary time (r = -0.10), but not moderate PA, vigorous PA, or MVPA. Light PA and sedentary time were significantly inversely correlated (r = -0.38). When controlling for covariates, higher body image quality of life was significantly associated with higher levels of light PA (ß = 0.39; p < 0.01) and lower sedentary time (ß = -0.39; p = 0.02). Participants with lower body image quality of life enrolled in weight loss interventions may benefit from prescriptions of light PA in conjunction with decreasing sedentary behaviors.

Community health worker-delivered weight management intervention among public housing residents: A feasibility study.

Community health worker-led interventions may be an optimal approach to promote behavior change among populations with low incomes due to the community health workers' unique insights into participants' social and environmental contexts and potential ability to deliver interventions widely. The objective was to determine the feasibility (implementation, acceptability, preliminary efficacy) of a weight management intervention for adults living in public housing developments. In 2016-2018, in Boston Massachusetts, we conducted a 3-month, two-group randomized trial comparing participants who received a tailored feedback report (control group) to participants who received the same report plus behavioral counseling. Community health workers provided up to 12 motivational interviewing-based counseling sessions in English or Spanish for diet and physical activity behaviors using a website designed to guide standardized content delivery. 102 participants enrolled; 8 (7.8%) were lost at 3-month follow up. Mean age was 46.5 (SD = 11.9) years; the majority were women (88%), Hispanic (67%), with ≤ high school degree (62%). For implementation, among intervention group participants (n = 50), 5 completed 0 sessions and 45 completed a mean of 4.6 (SD = 3.1) sessions. For acceptability, most indicated they would be very likely (79%) to participate again. For preliminary efficacy, adjusted linear regression models showed mean changes in weight (-0.94 kg, p = 0.31), moderate-to-vigorous physical activity (+11.7 min/day, p = 0.14), and fruit/vegetable intake (+2.30 servings/day, p < 0.0001) in the intervention vs. control group. Findings indicate a low-income public housing population was reached through a community health worker-led intervention with sufficient implementation and acceptability and promising beneficial changes in weight, nutrition, and physical activity outcomes.

Effect of tailoring on weight loss among young adults receiving digital interventions: an 18 month randomized controlled trial.

Weight loss outcomes among young adults in technology-based programs have been equivocal. The purpose of this study was to deliver digital weight loss treatments to young adults and examine the 6, 12, and 18 month effects on weight loss. Young adults with overweight/obesity (N = 459; 23.3 ± 4.4 years) were recruited from two university sites and randomly assigned to receive through Facebook and text messaging either personalized (TAILORED; n = 150) or generic (TARGETED; n = 152) weight loss information, messages, and feedback or general healthy body content (e.g., body image, sleep; CONTROL; n = 157). The study was powered to detect a 2.1-kg difference at all time points with the primary outcome being 18 months. There was no overall effect of treatment group on 6, 12, or 18 month weight loss (ps = NS). However, at 6 months, those in TAILORED who were highly engaged (completing >66%) lost more weight compared to CONTROL (-2.32 kg [95% confidence intervals: -3.90, -0.74]; p = .004), with the trend continuing at 12 months. A significant baseline body mass index (BMI) by treatment group interaction (p = .004) was observed at 6 months. Among participants in the lowest baseline BMI category (25-27.5 kg/m2), those in TAILORED lost 2.27 kg (-3.86, -0.68) more, and those in TARGETED lost 1.72 kg (-3.16, -0.29) more than CONTROL after adjusting for covariates. Among participants with a BMI between 27.5 and 30 kg/m2, those in TAILORED lost 2.20 kg (-3.90, -0.51) more than participants in TARGETED. Results did not persist over time with no treatment interaction at 12 or 18 months. Initial body weight should be considered when recommending weight loss treatments for young adults. More intensive interventions or stepped care approaches may be needed for young adults with obesity.

Examination of Food Insecurity, Socio-Demographic, Psychosocial, and Physical Factors among Residents in Public Housing.

Objectives: Understanding associations between psychosocial and physical factors among those who experience food insecurity could help design effective food insecurity programs for improved cardiovascular health among low-income populations. We examined differences in psychosocial and physical factors between those who were food secure compared with food insecure among public housing residents. Methods: Data were from the baseline survey of a randomized controlled trial of a weight management intervention in Boston, Massachusetts from 2016-2017. Food insecurity and psychosocial and physical factors, including perceived stress, personal problems, social support, and physical symptoms, were measured via interviewer-administered screeners. Results: Mean age of the sample (N=102) was 46.5 years (SD=11.9). The majority were Hispanic (67%), female (88%), with ≤high school degree (62%). Nearly half were food insecure (48%). For psychosocial variables, those who were food insecure had higher ratings of perceived stress (adjusted mean difference 3.39, 95% CI:2.00,4.79), a higher number of personal problems (adjusted mean difference 1.85, 95% CI: 1.19, 2.51), and lower social support (adjusted mean difference -0.70, 95% CI:-1.30,-0.11) compared with those who were food secure. For physical variables, those who were food insecure had higher odds of reporting negative physical symptoms (aOR 4.92, 95% CI:1.84,13.16). Conclusion: Among this sample of public housing residents, food insecurity was associated with higher stress, more personal problems, higher experiences of physical symptoms, and lower social support.

Application of social marketing to recruitment for a digital weight management intervention for young adults.

Recruiting young adults into weight loss interventions poses challenges that may be mitigated by the use of novel social marketing strategies. The purpose of this study is to describe how social marketing principles were applied to recruitment for a digitally delivered randomized controlled trial for weight management among young adults and report recruitment data and demographics on those who enrolled and did not enroll in the study. The marketing mix of the 7Ps (i.e., product, price, place, promotion, packaging, positioning, and people) was applied to intervention recruitment. Prior to enrollment, respondents completed a screening survey, which was examined to determine optimal strategies for study awareness and enrollment. Of the initial 5,731 who initiated a screener, 3,059 provided data on the source of where they heard about the study. Subsequently, 460 (12.5%) were enrolled in the study, 409 (51.3% non-White; 78.7% female; body mass index: 30.6 ± 4.3) provided data on recruitment source, with emails (72.5%), cited most often followed by flyers/posters (8.8%), "other" (6.7%), and multiple sources (6.6%). Although email remained the most frequently cited promotion source, Pearson's chi-squared tests revealed that, compared to those not enrolled in the study, those who enrolled were more likely to hear about the study via flyers/posters (enrolled = 14.4%; not enrolled = 7.9%; p < .001) and multiple sources (enrolled = 11.7%; not enrolled 5.85%; p < .01) and less likely to hear via email (enrolled = 62.1%; not enrolled = 74.2%; p < .01). This study applied social marketing principles to successfully recruit a large and diverse group of young adults. While email emerged as the most effective source of study awareness, multiple channels and a mix of marketing principles are recommended for recruiting in university settings.

Physical Activity and Enjoyment in Parent-Child Dyads During Shared Physical Activity.

Purpose: The purpose of this study was to compare objectively-measured physical activity (PA) and enjoyment of five shared PAs in parent-child dyads. Method: Thirty-one parent-child dyads (mean±SD; age, parents: 38.0 ± 6.6 years, children: 5.9 ± 1.7 years) completed separate PA sessions, which included five standardized PAs (brisk walking, jumping games, dancing, body-weight exercises, and tag games) in random order for each dyad. Parent and child moderate-to-vigorous PA (MVPA) and accelerometer counts per minute (CPM) were measured using Actigraph GT9X activity monitors. The Visual Analog Scale was used to assess enjoyment of children and parents. Repeated measures ANOVAs and paired t-tests determined differences in PA within and between children and parents for the activities, respectively. Friedman Tests with post hoc Wilcoxon signed-rank tests determined significant differences in enjoyment across the activities for children and parents and Wilcoxon signed-rank tests compared enjoyment between children and parents for each PA. Results: Jumping games resulted in the highest proportion of time spent in MVPA and highest overall CPM for children and parents (p < .05). Compared to parents, children spent proportionally more time in MVPA during jumping games, body-weight exercises, and tag games (all, p < .05). Tag games were the most enjoyable PA for children and parents (p < .05). Children enjoyed body-weight exercises more than parents (p < .05). Conclusions: Future indoor PA programs and research interventions that include parent-child dyads should consider implementing jumping games, body-weight exercises, and tag games during shared PA, which resulted in higher MVPA and enjoyment by both children and parents when compared to walking and dancing.

Physical Activity and Cardiometabolic Risk Factor Clustering in Young Adults with Obesity.

INTRODUCTION: There is a paucity of information on the clustering of cardiometabolic risk factors in young adults and how this clustering may vary based on whether or not they perform sufficient levels of physical activity. METHODS: We analyzed baseline data from 346 young adults (23.3 ± 4.4 yr) participating in the Healthy Body Healthy U clinical trial from 2015 to 2018. Cardiometabolic risk factors were measured according to standard procedures and moderate- to vigorous-intensity physical activity (MVPA) was determined by accelerometry. A cardiometabolic clustering score (ranging from 0 to 5) was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded (0, no; 1, yes): abdominal circumference (>102 cm (men) or >88 cm (women)), hemoglobin A1c (≥5.7%), HDL cholesterol (<40 mg·dL (men) or <50 mg·dL (women)), systolic blood pressure (≥130 mm Hg), and diastolic blood pressure (≥85 mm Hg). Cardiometabolic dysregulation (CD) was defined as a cardiometabolic clustering score ≥3. Multiple logistic regression determined the independent association between level of MVPA and CD, while adjusting for sex, race/ethnicity, sedentary time, and smoking. RESULTS: The prevalence of CD was 18% (22% in men, 17% in women). We observed a nonlinear graded association between MVPA and CD. Participants performing 150-300 min·wk of MVPA significantly lowered their odds of CD by 66% (odds ratio, 0.34; 95% confidence interval, 0.16-0.75), whereas those exceeding 300 min·wk lowered their odds by 61% (odds ratio, 0.39; 95% confidence interval, 0.18-0.86) compared with those performing <150 min·wk, independent of obesity and the other covariables. CONCLUSION: Recommended levels of moderate-intensity physical activity is significantly associated with lower odds of CD and thus may prevent or diminish the need for expensive pharmaceutical treatment over the remainder of the life-span.

Identifying Barriers and Facilitators to Nutrition and Physical Activity among Public Housing Residents Using Photovoice.

BACKGROUND: Weight management is a national health priority for health disparity-facing populations. There is a paucity of literature examining perceptions of diet and physical activity behaviors for weight management among public housing residents. Photovoice is a qualitative technique in which participants take photographs to document and discuss personal, social, and environmental factors around a particular topic. OBJECTIVES: To use photovoice to identify facilitators and barriers to weight management, including diet and physical activity behaviors, among urban public housing residents. METHODS: Four 2-hour sessions were held in each of four housing developments (16 total sessions). Participants were given three photo missions to take photographs of the meaning of health, facilitators, and barriers. Participants then discussed and wrote narratives of their most meaningful photographs. RESULTS: The majority of participants (n = 28) were obese (60%), female (82%), and African American or Black (71%) residents. Qualitative analysis of the transcripts revealed multiple facilitators and barriers that influenced weight management at the individual (e.g., self-control), interpersonal (e.g., peer influence), and community (e.g., access) levels. Additional themes that were specific to the housing development level included built environment at the development, feelings of community support, the development tenant/resident task force, and living conditions. CONCLUSIONS: Findings revealed multiple facilitators and barriers to healthy eating, physical activity, and weight management among public housing residents with additional factors influencing health within the housing development. Photovoice was a feasible method to engage community members in discussions and may be useful to inform multilevel interventions.

Functional Resistance Training and Affective Response in Female College-Age Students.

INTRODUCTION: Although resistance training (RT) can lead to acute improvements in psychological, physiological and psychosocial outcomes, prevalence rates remain low in college-age females likely due to perceived barriers. This study compared the effects of an acute bout of both a functional RT (FRT) and traditional RT (TRT) session on affect, state anxiety enjoyment and physiological measures. METHODS: Females (n = 34, mean age = 27 ± 4.5 yr) not currently meeting American College of Sports Medicine RT guidelines completed four sessions (2 FRT, 2 TRT) within 4 wk in a randomized crossover design. Session 1 familiarized participants to the RT exercises. Session 2 consisted of 2 × 10 moderate intensity repetitions. Outcome measures included affect and state anxiety (preexercise, postexercise, and 15 min postexercise); enjoyment (post), and manipulation measures of session RPE and HR). RESULTS: Between-condition comparisons indicate change scores in state anxiety pre- to post-15 (P = 0.028) and enjoyment levels post- (P = 0.02) were significantly greater in FRT than TRT. Within-condition analyses revealed pre- to post-15 changes in affect were positive and greater in FRT (d = 0.79) than TRT (d = 0.53, P = 0.47), and greater in decreases in state anxiety (FRT, d = -0.58; TRT, d = -0.37, P = 0.028). Mean session RPE was not significantly different between conditions (FRT 6 ± 1.2 units; TRT 6.3 ± 1.1 units; P = 0.11), though average percent of age-predicted maximum HR (FRT 68.7 ± 7.6; TRT 57.1 ± 8.4) was significantly different (P < 0.01). CONCLUSIONS: Findings suggest that compared with TRT, FRT is associated with higher acute positive psychological states, higher levels of enjoyment, and greater energy expenditure. Future studies are recommended to examine additional measures of affect and in-task timepoints to determine how these responses relate to maintenance and adherence, thereby potentially increasing the proportion of college females meeting American College of Sports Medicine RT and moderate-to-vigorous physical activity guidelines.

Tailored communications for obesity prevention in pediatric primary care: a feasibility study.

Recommendations for the prevention of childhood obesity encourage providers to counsel parents and their children on healthy diet and activity behaviors. This study evaluated the feasibility of a theory-based, tailored communication intervention for obesity prevention (Team Up for Health) delivered during a well-child visit. A two-armed randomized controlled trial was used. Parents of children aged 4-10 years were recruited from a list of patients due for a well-child visit at a pediatric primary care clinic. Parents were randomized to either the 'immediate' condition (parent and pediatrician received the tailored report at the well-child visit) or the 'delayed' condition (parent received the report at the end of the study). Self-report measures assessed physical activity, fruits, vegetables, television time, sugary drinks, and 100% fruit juice. Parents completed assessments at baseline, <48 h and 4-week follow-up. Providers were interviewed at the end of the study. Independent t-tests were used to examine between group differences. Seven areas of feasibility were evaluated: Recruitment, randomization, measurement, retention, acceptability, implementation and demand. Results showed high rates of measurement (85%) and acceptability (89%) and implementation (80%) of the intervention. In conclusion, Team Up for Health was feasible; however, a larger study is needed to evaluate its efficacy.

Using social media to deliver weight loss programming to young adults: Design and rationale for the Healthy Body Healthy U (HBHU) trial.

BACKGROUND: The transitional period from late adolescence to early adulthood is a vulnerable period for weight gain, with a twofold increase in overweight/obesity during this life transition. In the United States, approximately one-third of young adults have obesity and are at a high risk for weight gain. PURPOSE: To describe the design and rationale of a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored randomized, controlled clinical trial, the Healthy Body Healthy U (HBHU) study, which compares the differential efficacy of three interventions on weight loss among young adults aged 18-35years. METHODS: The intervention is delivered via Facebook and SMS Text Messaging (text messaging) and includes: 1) targeted content (Targeted); 2) tailored or personalized feedback (Tailored); or 3) contact control (Control). Recruitment is on-going at two campus sites, with the intervention delivery conducted by the parent site. A total of 450 students will be randomly-assigned to receive one of three programs for 18months. We hypothesize that: a) the Tailored group will lose significantly more weight at the 6, 12, 18month follow-ups compared with the Targeted group; and that b) both the Tailored and Targeted groups will have greater weight loss at the 6, 12, 18month follow-ups than the Control group. We also hypothesize that participants who achieve a 5% weight loss at 6 and 18months will have greater improvements in their cardiometabolic risk factors than those who do not achieve this target. We will examine intervention costs to inform implementation and sustainability other universities. Expected study completion date is 2019. CONCLUSIONS: This project has significant public health impact, as the successful translation could reach as many as 20 million university students each year, and change the current standard of practice for promoting weight management within university campus communities. ClinicalTrial.gov: NCT02342912.

Results of a Nutrition and Physical Activity Peer Counseling Intervention among Nontraditional College Students.

UNLABELLED: Health promotion efforts targeting nontraditional college students (older, part-time enrollment, and working) may be an optimal way to reach large populations that potentially face health disparities. A randomized trial was undertaken to examine the feasibility of a nutrition and physical activity behavioral intervention among nontraditional undergraduate college students at a large urban public university. Over 8 weeks, participants received either (1) a brief tailored feedback report plus three motivational interviewing-based calls from trained peer counselors (intervention; n = 40) or (2) the report only (control; n = 20). Participants mean age was 32 years (SD = 10), 58 % were female, 47 % were racial/ethnic minorities, and 25 % reported receiving public health insurance. Most (78 %) intervention group participants completed at least two of three peer counseling calls. At follow-up, those in the intervention vs. control group self-reported beneficial, but non-statistically significant changes in fruits and vegetables (+0.7 servings/day), sugary drinks (-6.2 oz/day), and fast food visits (-0.2 visits/week). For physical activity, there was a non-statistically significant decrease in moderate-vigorous physical activity (107.2 min/week) in the intervention vs. CONTROL GROUP: Overall satisfaction with the program was high, although there were recommendations made for improving the structure and number of calls. Findings indicate that the intervention was feasible with promising effects on nutrition behaviors and the need to better target physical activity behaviors. Future work entails implementation in a larger sample with objectively measured behaviors.

Validation of 5 stage-of-change measures for parental support of healthy eating and activity.

OBJECTIVE: To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d of fruits and vegetables (FV), (2) limiting television (TV) to 2 h/d, (3) helping children achieve 1 h/d physical activity (PA), (4) limiting sugary drinks (SD) to 1 serving/wk, and (5) limiting fruit juice (FJ) to 4-6 oz/d. DESIGN: Cross-sectional instrument development study. Construct validity was evaluated by examining whether parental self-efficacy, parental readiness ladder (ladder), and child's behavioral levels (eg, FV consumption) exhibited a theoretically consistent pattern across the SOC. SETTING/PARTICIPANTS: Convenience sample (n = 283) of parents of children aged 4-10 years. MEASURES: Survey assessed SOC, ladder, and child's behavioral level score for each topic (FV, TV, PA, SD, and FJ), and parental self-efficacy for measure except TV. ANALYSIS: Analysis of variance with Tukey-Kramer post hoc tests examined whether variables differed by SOC. RESULTS: Percentages of parents in the pre-action SOC were 34% (PA), 39% (FV), 42% (SD), 45% (TV), and 63% (FJ). Parental self-efficacy, ladder, and child's behavioral level differed significantly by SOC for each topic area (P < .001). Maintenance SOC was significantly higher than pre-action SOC. CONCLUSIONS AND IMPLICATIONS: Measured variables exhibited a theoretically consistent pattern across SOC, suggesting construct validity and potential usefulness for obesity prevention efforts.

The challenges of translating an efficacious smoking cessation program, Commit to Quit, to the community setting of YMCAs.

Commit to Quit (CTQ), a program that utilized vigorous intensity exercise as an adjunct to a cognitive-behavioral smoking cessation program, was shown to be effective for female smokers (Marcus et al., Prev Med 26(4):586-597, 1997; Marcus et al., Arch Intern Med 159(11):1229-1234, 1999). Adapting effective programs, such as CTQ, to community settings could lead to a large public health impact as the program could substantially increase its reach. This case study chronicles the steps taken by researchers to translate CTQ from the medical to the community setting of YMCAs (CTQY). Use of aspects of Diffusion Theory [3] such as identifying a champion of the program and attending to the characteristics of an innovation to enhance program adoption are discussed. Details regarding attending to the tensions between internal and external validity as the program was adapted to the community setting are also outlined. The challenges of conducting community trials are discussed.

Time availability and preference for e-health communication channels for nutrition and physical activity.

The aim of this study was to examine the relationship between time availability and preference for computer-based (e-health) communication channels when receiving nutrition and physical activity information, two key behaviors related to cancer prevention. Students from a large, diverse, urban university (n = 397) completed a web-based survey indicating their usage patterns and preferences for multiple eHealth channels. Bivariate analyses were performed based on a measure of time availability, comprised of working status (25 h/week or more, 1-24 h/week, or not working) and enrollment status (full-time or part-time). Most e-health channels were broadly used by students and did not differ according to time availability. Those with the most amount of time available preferred receiving nutrition and physical activity information via social networking more frequently compared to those with the least amount of time available (60 versus 43%, P ≤ 0.05). Our study suggests that time availability may be another important factor to consider when planning cancer prevention programs.

Factors across home, work, and school domains influence nutrition and physical activity behaviors of nontraditional college students.

Nontraditional college students (older, part-time, and/or working) have less healthful nutrition and physical activity behaviors compared to traditional students, yet few health promotion efforts focus on nontraditional students. The purpose of this study was to use qualitative methods to explore factors affecting nutrition and physical activity behaviors of nontraditional students. Fourteen semi-structured individual interviews were conducted with nontraditional undergraduate students attending a large university. The sample had a median age of 25 (range, 21-64), 57% were men, 43% were racial/ethnic minorities, and 57% were employed (mean 22 hours/week). Data were coded using a systematic team-based approach. Consistent themes (mentioned by 4+ students) were identified and categorized into three domains: home, work, and school. Home (themes: neighborhood characteristics, family, partners), work (theme: work environment), and school (themes: cafeteria, vending machines) factors consistently influenced positive nutrition behaviors. Similarly, home (themes: neighborhood including safety, friends from home, partner,), work (theme: work environment), and school (themes: not having a car, campus structure, campus gym, friends at school) factors consistently influenced positive physical activity. Financial resources and perceptions of autonomy had influence across domains. Results indicate consistent influences on nutrition and physical activity behaviors across home, work, and school domains for nontraditional college students. Study findings suggest possible, and sometimes unconventional, intervention strategies to promote healthful eating and physical activity. For example, when cafeteria meal plans are not offered and financial constraints limit eating at the cafeteria, encouraging healthful choices from vending machines could be preferable to not eating at all.

YMCA commit to quit: randomized trial outcomes.

BACKGROUND: Vigorous-intensity exercise has been shown to aid in smoking cessation, especially among women. In a previous trial, cognitive behavioral therapy (CBT) for smoking cessation plus regular vigorous aerobic exercise enhanced cessation rates, improved exercise capacity, and reduced weight gain compared to CBT plus equal contact time. PURPOSE: This study examined the effectiveness of this program adapted for and implemented in the YMCAs. DESIGN: An RCT comparing CBT + Exercise (Exercise) to CBT + Contact Control (Control). SETTING/PARTICIPANTS: Apparently healthy female smokers were recruited to four local YMCAs. INTERVENTION: YMCA staff members were trained to lead the manualized CBT smoking-cessation intervention and a standardized YMCA exercise program. MAIN OUTCOME MEASURES: Seven-day point prevalence and continuous abstinence. RESULTS: Participants (330 women, mean age=44 years) were randomized to the Exercise (n=166) or Control (n=164) group. Results revealed no differences in 7-day point prevalence (29.5% vs 29.9%) nor continuous abstinence (13.9% vs 14.0%) between the Exercise and Control groups, respectively, at end of treatment or at the 3-, 6-, and 12-month follow-up. An examination of the relationship between exercise dose and quit status at end of treatment revealed that over 12 weeks, the odds of being quit (7-day point prevalence) grew by 4.5% for each additional aerobic exercise session (OR=1.05, 95% CI=1.01, 1.08) and by 7.7% for each additional resistance training session (OR=1.08, 95% CI=1.02, 1.14). Analyses were conducted between August 19, 2010, and December 16, 2011. CONCLUSIONS: No differences were seen between groups in smoking outcomes. The association between greater exercise participation and higher odds of quitting within the exercise condition suggests that the lack of between-group differences might be a result of poor compliance with the exercise program. TRIAL REGISTRATION: This study is registered at clinicaltrials.govNCT01615380.

Acute effects of moderate intensity aerobic exercise on affective withdrawal symptoms and cravings among women smokers.

A growing number of laboratory studies have shown that acute bouts of aerobic exercise favorably impact affect and cravings among smokers. However, randomized trials have generally shown exercise to have no favorable effect on smoking cessation or withdrawal symptoms during quit attempts. The purpose of the present study was to explore this apparent contradiction by assessing acute changes in affect and cravings immediately prior to and following each exercise and contact control session during an eight-week smoking cessation trial. Sixty previously low-active, healthy, female smokers were randomized to an eight-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either three sessions/week of moderate intensity aerobic exercise or contact control. Findings revealed a favorable impact of exercise on acute changes in positive activated affect (i.e., energy), negative deactivated affect (i.e., tiredness), and cigarette cravings relative to contact control. However, effects dissipated from session to session. Results suggest that aerobic exercise has potential as a smoking cessation treatment, but that it must be engaged in frequently and consistently over time in order to derive benefits. Thus, it is not surprising that previous randomized controlled trials-in which adherence to exercise programs has generally been poor-have been unsuccessful in showing effects of aerobic exercise on smoking cessation outcomes.