A Comprehensive Digital Program for Smoking Cessation: Assessing Feasibility in a Single-Group Cohort Study.

BACKGROUND: Cigarette smoking remains the leading cause of preventable death and disease worldwide. Evidence-based approaches are available, but few people access them. Although digital solutions offer great promise for population reach, few multicomponent programs exist. Pivot is a comprehensive digital solution combining a Food and Drug Administration-cleared carbon monoxide (CO) breath sensor; cigarette logging; a 6-phase, app-delivered smoking cessation program based on the US Clinical Practice Guidelines; and dedicated human coaching via text-based chat. OBJECTIVE: The purpose of this study was to assess program engagement, changes in attitudes toward smoking, self-reported changes in smoking behavior, and program acceptability for the initial phase of Pivot: Explore. METHODS: A total of 48 participants enrolled, and 41 completed the study. About half the participants (54%, 22/41) were men, and the mean age was 43 years. Most (85%, 35/41) were daily smokers and smoked an average of 12 cigarettes per day. Explore includes CO breath sensing, logging cigarettes in-app, learning via in-app activities, and dedicated human coaching through a text messaging interface. Participants completed surveys at baseline and exit assessing attitudes toward quitting including readiness, perceived difficulty, and confidence in quit success. At exit, participants also completed a survey of changes in smoking behavior and ratings of program acceptability. RESULTS: More than 80% of participants (34-39 of 41) took ≥1 CO breath sample each day, and more than 55% (23-27 of 41) took ≥5 samples each day. More than 65% of participants (27-34 of 41) logged ≥1 cigarette using the in-app logging feature each day. All 9 in-app activities had completion rates ≥80% (33-40 of 41). Response to coach-initiated outreach was also high, with all contacts receiving ≥73% (30-39 of 41) response. In matched pair analyses, significant positive changes in mean attitudes toward quitting (scale 1-10) were evident from baseline (T1) to study exit (T2), including increased readiness to quit (T1 mean=6.1, T2 mean=7.4, P=.005), lower perceived difficulty (T1 mean=3.7, T2 mean=5.6, P=.001), and greater expectations of success (T1 mean=4.5, T2 mean=6.5, P<.001). At exit, 78% (32/41) of participants reported decreasing the number of cigarettes smoked per day during the study. Participants rated program quality and satisfaction very high (mean ≥8 for all items). CONCLUSIONS: These results support the feasibility and acceptability of the initial 9-day phase of Pivot: Explore. Participants had high levels of engagement with sensing, logging, learning, and coaching. Attitudes toward quitting improved significantly, and the majority of users indicated decreasing smoking behavior. Explore was designed to raise smoker awareness and motivation. Additional research is underway to assess how users progress through the full Pivot smoking cessation program and determine the program's effectiveness for achieving sustained cessation.

Promoting weight loss methods in parenting magazines: Implications for women.

Weight gain before and after pregnancy is important for women's health. The purpose of this study was to assess articles and advertisements related to weight loss in three widely read parenting magazines, "Parenting School Years," "Parenting Early Years," and "Parenting," which have an estimated combined readership of approximately 24 million (mainly women readers). Almost a quarter (23.7%, n = 32) of the 135 magazine issues over a four year period included at least one feature article on weight loss. A variety of topics were covered in the featured articles, with the most frequent topics being on losing weight to please yourself (25.2%), healthy ways to lose weight (21.1%), and how to keep the weight off (14.7%). Less than half (45.9%) of the articles displayed author credentials, such as their degree, qualifications, or expertise. A fifth (20.0%, n = 27) of the magazines included at least one prominent advertisement for weight loss products. Almost half (46.9%) of the weight loss advertisements were for weight loss programs followed by weight loss food products (25.0%), weight loss aids (21.9%), and only 6.2% of the advertisements for weight loss were on fitness. Parenting magazines should advocate for healthy weight loss, including lifestyle changes for sustained health.

An Evaluation of the Effectiveness of School-Based Breastfeeding Education.

School-based interventions aimed at modifying the knowledge, attitudes, social norms, and intended future practice regarding breastfeeding may be an effective way of improving breastfeeding rates. A systematic review of relevant literature was conducted to identify scientifically rigorous studies on school-based interventions and promotion activities that focus on breastfeeding. Of the 1990 citations reviewed, only 6 empirical articles on school-based interventions to promote breastfeeding were found and these interventions vary greatly in terms of format, duration, outcome measures, and significance of the results. Overall, these studies demonstrated positive effects on perceptions and attitudes toward breastfeeding and increased behavioral intention of breastfeeding later in life. School-based breastfeeding promotion programs hold promise for increasing knowledge of breastfeeding and support for breastfeeding, promoting positive attitudes, creating a culture where breastfeeding is the norm, and increasing future intentions to breastfeed.

Use of the Internet and mobile-based "apps" for sex-seeking among men who have sex with men in New York City.

The Internet continues to be a popular venue for men who have sex with men (MSM) to seek sexual partners. Increased sexual risk behavior has been linked to MSM who use the Internet to seek partners. However, there has been little research on how new mobile-based social networking applications ("apps") may affect sex-seeking and sexual risk behaviors of MSM. One hundred twenty-six MSM in New York City were recruited to complete an online survey on the use of the Internet and other technology for sex-seeking. The authors collected data on variables of interest including sexual sensation seeking, gay identity affirmation, internalized homophobia, Internet/app use, and sexual behavior with men met via the Internet and mobile apps. Results indicated that men who use both the Internet and mobile apps to seek partners were younger and reported higher incomes (p<.05) than men who used the Internet only. There were no significant differences between the groups with regard to race, sexual sensation seeking, gay identity affirmation, or internalized homophobia, indicating that the use of mobile-based apps for sex-seeking may be simply an example of evolving technologies. These findings may provide insight for the feasibility and planning of effective mobile app-based HIV/STI programs for MSM.

On the positive relation between received social support and negative affect: a test of the triage and self-esteem threat models in women with breast cancer.

OBJECTIVE: There is a seemingly paradoxical positive relation between received social support and psychological distress in cancer patients. This study evaluates two models that explain this positive relation: (a) the triage model, which argues that more distressed people receive more support and (b) the self-esteem threat model, which argues that receiving support increases distress by undermining self-esteem. METHODS: Longitudinal survey data were collected from 71 women treated for breast cancer at 3- (T1) and 18-months (T2) post-diagnosis. RESULTS: Analyses did not disconfirm either model. Consistent with the triage model, there was a marginally significant (p=0.052) positive relation between T1 negative affect and T2 received support, controlling for T1-received support. Consistent with the self-esteem threat model, a significant positive relation between T1 received support and T2 negative affect, controlling for T1 negative affect, appeared to be mediated by T2 self-esteem. CONCLUSIONS: These findings suggest that people with cancer who are most distressed may receive the most social support, but the conveyance of support can have negative consequences for self-esteem and affect.