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    8 1 2012 Rapid Presentation 3 CreatingBehaviorChange

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    SteveEpstein
    This document discusses several presentations and studies related to using mobile health (mHealth) technologies to create behavior change. It describes an electronic button device that can automatically collect various health data like photos, location, and activity levels. A study is discussed that used the device to examine weight gain in college freshman. It also summarizes presentations on using mHealth for smoking cessation through incentives, parenting influences on childhood obesity, and improving self-monitoring and support for behavior change like diet and exercise.

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    8 1 2012 Rapid Presentation 3 CreatingBehaviorChange

    Uploaded by

    SteveEpstein
    40 views38 pages
    This document discusses several presentations and studies related to using mobile health (mHealth) technologies to create behavior change. It describes an electronic button device that can automatically collect various health data like photos, location, and activity levels. A study is discussed that used the device to examine weight gain in college freshman. It also summarizes presentations on using mHealth for smoking cessation through incentives, parenting influences on childhood obesity, and improving self-monitoring and support for behavior change like diet and exercise.

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    This document discusses several presentations and studies related to using mobile health (mHealth) technologies to create behavior change. It describes an electronic button device that can automatically collect various health data like photos, location, and activity levels. A study is discussed that used the device to examine weight gain in college freshman. It also summarizes presentations on using mHealth for smoking cessation through incentives, parenting influences on childhood obesity, and improving self-monitoring and support for behavior change like diet and exercise.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views38 pages

    8 1 2012 Rapid Presentation 3 CreatingBehaviorChange

    Uploaded by

    SteveEpstein
    This document discusses several presentations and studies related to using mobile health (mHealth) technologies to create behavior change. It describes an electronic button device that can automatically collect various health data like photos, location, and activity levels. A study is discussed that used the device to examine weight gain in college freshman. It also summarizes presentations on using mHealth for smoking cessation through incentives, parenting influences on childhood obesity, and improving self-monitoring and support for behavior change like diet and exercise.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    of 38

    RAPID PRESENTATION 3: Creating Behavior Change

    Willa Doswell, PhD, University of Pittsburgh Teresia OConnor, MD, Baylor College of Medicine Erin McClure, PhD, Johns Hopkins University Brie Turner-McGrievy, PhD, University of South Carolina Rajani Sadasivam, PhD, University of Massachusetts Medical School

    Using the eButton in Studies Monitoring Obesity


    Dr. Willa Doswell Associate Professor University of Pittsburgh School of Nursing

    The eButton
    It is a fully functional wearable computer with sophisticated electronic sensors to collect visual, location, motion, orientation, acoustic and/or physiological data (e.g., ECG) automatically. It is as smart as an iPhone but can be naturally worn. Since it is unattended and always on, the device has many important applications, such as monitoring diet or physical activity.

    The eButton

    Fig. 1 Our prototype eButton.

    How it Works
    This small and lightweight eButton has an array of sensors to perform a variety of measurements, including a GPS, one or two cameras, a 3-axial accelerometer, a 3-axial gyroscope, a temperature sensor, a audio sensor, and an indoor/outdoor sensor. The cameras take pictures either manually or automatically at selected rates. The acquired pictures contain foods and beverages consumed during the day, sedentary and physical activities performed, and social interactions with people. The GPS sensor records geographical information of the wearer providing information such as outdoor activity locations.

    Freshman-15 Study Revisited


    The problem is obesity which has been handled thru classes, public health campaigns, weight reduction programs. Study Objective: Investigate the changes in body weight, BMI, body composition and fat distribution among college freshmen women during their 1st year of college. Study Objective: Investigate the changes in body weight, BMI, body composition and fat distribution among college freshmen women during their 1st year of college.

    Research Questions
    What is the % weight gain in college freshman from baseline semester to month 4 and month 8? What is the food intake of students at baseline, month 4 and month 8? What psychosocial variables affect intake at baseline, month 4 and month 8? What are the ethnic differences What is relationship of stress (3 levels) to weight gain/food intake?

    More Specific Aims


    Examine acceptability, and functionality of the eButton in the study of eating habits and weight gain Refine the development of the eButton device for its use in the study of eating habits and weight gain in young adults. Conduct laboratory tests to assess device accuracy. Modify device design and software to improve performance during the project according to received feedback.

    IRB Questions
    How to preserve confidentiality and privacy in the real world of eating, working, learning. How to prevent wear and tear on clothing the eButton is affixed to. Is the gain worth the problems the device may cause? Can it be used in children?

    Feasibility of a mHealth child obesity 'app' targeting parents


    Teresia OConnor, MD, MPH
    Pediatrics Assistant Professor of Pediatrics USDA/ARS Childrens Nutrition Research Center Academic General Pediatrics Baylor College of Medicine

    Problem: Childhood Obesity


    1/3 US children overweight or obese (NHANES data) Childhood overweight tripled in 25 years (NHANES data) Overweight Children Overweight Adults (Whitaker 1997, Magarey 2003) Medical expenditures of obesity related conditions: $147 billion (Health Affairs 2009) Parents are an important influence on children's behaviors and therefore their weight status.
    - Parenting styles child obesity (Rhee 2006, Brotman 2012) - Parenting practices child behaviors (Fisher 2002, OConnor 2010, Davison 2003)

    Pediatrics

    Historical Obesity Interventions


    School, childcare and community interventions with no-tominimal effects Systematic Review of primary care interventions (Sargent 2010)
    - Obesity treatment initiated by pediatricians offers promise of improving childrens weight status - Only 1/17 primary care interventions targeted parenting

    USPSTF: Evidence for moderate to high intensity interventions (25 contact hours over 6 months) for children 6 years old. (Barton 2010)

    Pediatrics

    Helping HAND Pilot Study


    First line obesity intervention for primary care 5-8 year old children with 85% BMI > 99% Monthly visits for 6-months Delivered by Health Plan health promotion specialists using patient-centered counseling Parent & child self-selected behaviors to target, set goals and plans, and monitored Recruited 40 families randomized 20 % attrition; positive feedback; change in some child and parenting behaviors
    (OConnor , C:CHD 2011)

    Pediatrics

    Parent and neighborhood influences on Hispanic preschool childrens PA


    QStarz BT1000X GPS data loggers Actigraph GT3X accelerometer
    Variables
    Neighborhood type (n, %) High crime, High traffic (orange) High crime, low traffic (green) Low crime, high traffic (pink) Low crime, low traffic (blue) (NIH NICHD-1R21-HD060925) Pediatrics

    Whole Sample (n= 240)


    67 (28%) 22 (9%) 75 (31%) 76 (32%)

    Sub-sample wore Monitors (n=84)


    22 (26%) 5 (6%) 31 (37%) 26 (31%)

    How will mHealth Help?


    Propose to develop Helping HAND into a mobile Health app for Smartphones
    - Allows increased accessibility of program and increased contact with families - Build in behavior change tools: behavior assessment, goal setting, implementation plans, monitoring, and feedback - Remote counseling by Health Advisor via phone - Has potential to include additional features in future: GPS specific feedback for PA venues, healthy stores Accelerometer based assessment with feedback Similation games for behavior training (KIDDIO)
    Pediatrics

    Smoking cessation: Incentives for behavior change


    Erin A. McClure Medical University of South Carolina
    2012 NIH mHealth Summer Training Institute

    What is the problem?


    Smoking is the leading cause of preventable death in the United States Annual health care expenditures related to smoking are approximately $96 billion Smoking disproportionately affects ethnic minorities, socioeconomically marginalized, and vulnerable populations
    (Centers for Disease Control, 2008)

    How has the problem been addressed?


    Psychosocial education, motivational interviewing and enhancement, pharmacotherapy Incentives to promote abstinence
    Delivered contingently on biologically-verified confirmation of abstinence

    Highly effective in promoting abstinence from smoking, but also (Higgins & Silverman, 2007)
    Abstinence from other substances of abuse Medication compliance Exercise, weight loss, nutrition

    How has the problem been addressed?


    Implementation and adoption has been slow Problems:
    Costly (incentives and biological testing) Frequent samples required Immediacy of test results and incentive delivery

    Some mHealth solutions.


    Reducing clinic visits
    Assessments and self-report measures via voice or text

    Frequent monitoring
    Remote physiological monitoring Inertial sensors to detect smoking movements

    Immediacy of reinforcer
    Delivered or alerted via text or voice

    Some mHealth solutions.


    Beyond incentive-based interventions
    Motivational support upon request at times of high need Assessments of real-time craving, lapse, and relapse (Ecological Momentary Assessment, mobile apps) GPS-enabled devices to indicate highrisk areas

    mHealth and Obesity Brie Turner-McGrievy, PhD, MS, RD Assistant Professor University of South Carolina Arnold School of Public Health Department of Health Promotion, Education, and Behavior

    Public Health Issue/Problem


    Obesity and prevention/treatment/management of chronic diseases
    Through diet and physical activity

    Obesity Treatment
    Behavioral weight loss treatment

    How my research is addressing the issue


    Self-monitoring using mHealth

    Behavioral counseling delivered via podcast Group support via social networks

    How mHealth can help


    Improve accuracy Lower burden (time, memory, etc.) Lower cost Increase reach Lengthen time of support

    Whats next: mHealth and Obesity


    Tapping into location-based services and GPS Learning from behaviors recorded on mobile devices and tailoring based on those Predicting who engages in social networks and why Customizing interventions based on personal preference (one size doesnt have to fit all!)

    Get to Know Me

    Rajani S. Sadasivam, Ph.D.


    Div. of Health Informatics and Implementation Science Dept. of Quantitative Health Sciences Univ . of Massachusetts Medical School [email protected]

    Smoking cessation challenges

    How to increase demand for and use of proven cessation treatments (NIH State-of-the-Science conference on tobacco use )
    How to make existing treatments more attractive?

    Current WATIs are effective, but

    Expert-to-patient interventions have a natural limit


    Peer-to-peer, collective intelligence, gaming, mHealth

    Share2Quit - Peer to Peer referrals


    Products exclusively marketed by peer referrals
    Farmville has over 80 million users on Facebook

    Can peer referrals be used to market health interventions?


    Facebook referral Email referral

    Collective intelligence for computer tailoring

    Amazon, Netflix Products like these, People like you Computer tailoring Messages like these, Smokers like you

    CraveOut: mHealth gaming platform

    A fun way to distract from cravings and reinforce benefits of quitting


    Available on iTunes (Total downloads: 1067 as of 7/24/12)

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