Effects of Engagement with a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial.

In a social media campaign aimed at reducing mothers' permissiveness for indoor tanning (IT) by their teenage daughters, a secondary analysis of campaign engagement effects on IT outcomes was performed. Mothers (n = 869) with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial with follow-up at 12 months (end of intervention) and 18 months (6 months after intervention) post-randomization. Daughters' (n = 469) baseline and follow-up responses were analyzed too. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control). Engagement was measured by extracting reactions (e.g., like, sad, etc.) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters' IT immediately at the conclusion of the campaign (permit IT: -0.39, p < .05; facilitate IT: -0.29, p < .05) and 6 months after intervention (permit IT: -0.32, p < .05; facilitate IT: -0.31, p < .05) than mothers who did not engage with posts. Engagement with posts was essential to the success of a social media campaign for preventing IT by minors by reducing mothers' permissiveness.

Health and education concerns about returning to campus and online learning during the COVID-19 pandemic among US undergraduate STEM majors.

OBJECTIVE: We examined undergraduates' concerns about returning to campus and online learning from home. PARTICIPANTS: Undergraduates majoring in STEM (Science, Technology, Engineering, and Mathematics) at US universities/colleges. METHODS: Participants completed an online survey in July 2020. We content-analyzed responses to open-ended questions about concerns about fall 2020. RESULTS: Students (N = 64) were 52% women, 47% low socioeconomic status (SES), and 27% non-Hispanic white. Concerns about returning to campus included student noncompliance with university COVID-19 prevention guidelines (28%), infection risk (28%), poor instructional quality (26%), inadequate university plans for preventing/handling outbreaks (25%), negative impacts on social interactions (11%), and transportation/commuting (11%). Concerns about learning from home included difficulty focusing on schoolwork (58%), lack of hands-on/experiential learning (24%), negative impacts on social interactions (19%), family/home environment (15%), concerns that online learning wastes time/money (10%), and inadequate technology/Internet access (5%). CONCLUSIONS: Universities should address student concerns and provide resources to overcome barriers to effective learning.

Persisting Effects of a Social Media Campaign to Prevent Indoor Tanning: A Randomized Trial.

BACKGROUND: A social media campaign for mothers aimed at reducing indoor tanning (IT) by adolescent daughters reduced mothers' permissiveness toward IT in an immediate posttest. Whether the effects persisted at 6 months after the campaign remains to be determined. METHODS: Mothers (N = 869) of daughters ages 14-17 in 34 states without bans on IT by minors were enrolled in a randomized trial. All mothers received an adolescent health campaign over 12 months with posts on preventing IT (intervention) or prescription drug misuse (control). Mothers completed a follow-up at 18 months post-randomization measuring IT permissiveness, attitudes, intentions, communication, and behavior, and support for state bans. Daughters (n = 469; 54.0%) just completed baseline and follow-up surveys. RESULTS: Structural equation modeling showed that intervention-group mothers were less permissive of IT by daughters [unstandardized coefficient, -0.17; 95% confidence interval (CI), -0.31 to -0.03], had greater self-efficacy to refuse daughter's IT requests (0.17; 95% CI, 0.06-0.29) and lower IT intentions themselves (-0.18; 95% CI, -0.35 to -0.01), and were more supportive of bans on IT by minors (0.23; 95% CI, 0.02-0.43) than control-group mothers. Intervention-group daughters expressed less positive IT attitudes than controls (-0.16; 95% CI, 0.31 to -0.01). CONCLUSIONS: The social media campaign may have had a persisting effect of convincing mothers to withhold permission for daughters to indoor tan for 6 months after its conclusion. Reduced IT intentions and increased support for bans on IT by minors also persisted among mothers. IMPACT: Social media may increase support among mothers to place more restrictions on IT by minors.

A 2.5-Year Weight Management Program Using Noom Health: Protocol for a Randomized Controlled Trial.

BACKGROUND: Overweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs. OBJECTIVE: This weight loss trial will aim to examine the efficacy of the Noom weight loss program in comparison to a digital control after a 6-month intervention phase and a 24-month maintenance phase, with assessments continuing for 2 years beyond the intervention (to 30 months-after the baseline). The secondary outcomes include quality of life, psychosocial functioning, sleep quality, physical activity, diet, and health status. This trial will also examine the severity of obesity-related functional impairment, weight loss history, and demographic moderators, along with adherence and self-efficacy as mediators of the outcome. METHODS: A total of 600 participants were randomized in a parallel-group, controlled trial to either Noom Healthy Weight Program (intervention) or Noom Healthy Weight Control (control) for a 6-month intervention. Both intervention and control groups include diet and exercise recommendations, educational content, daily logging capabilities, and daily weigh-in entries. The Noom Healthy Weight Program also includes a coach support for weight loss. Remote follow-up assessments of eating, physical activity, psychosocial factors, app use data, and weight will be conducted at 1, 4, 6, 12, 18, 24, and 30 months after baseline. Weight is measured at each follow-up point during a Zoom call using the participants' scales. RESULTS: Enrollment began in March 2021 and the 6-month intervention phase ended in March 2022. Data collection for the final assessment will be completed in March 2024. CONCLUSIONS: This study tests commercially available digital lifestyle interventions for individuals with overweight and obesity seeking weight loss support. Data obtained from the study will evaluate whether the Noom Healthy Weight Control Program can help individuals overcome weight loss, achieve long-term maintenance, adhere to lifestyle changes, and feature use barriers that are present in other traditional weight loss treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT04797169; https://clinicaltrials.gov/ct2/show/NCT04797169. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37541.

Human Papillomavirus Vaccination and Social Media: Results in a Trial With Mothers of Daughters Aged 14-17.

Introduction: Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake. Secondary analysis in a randomized trial of a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination was undertaken with the aims of (a) determining whether the pre-post-change occurred in self-reports of the mothers on HPV vaccination of their adolescent daughters; (b) describing the comments and reactions to vaccine posts; (c) exploring the relationship of campaign engagement of the mothers assessed by their comments and reactions to posts to change in the self-reports of the mothers of HPV vaccination. Materials and Methods: Mothers of daughters aged 14-17 were recruited from 34 states of the US (n = 869). A social media campaign was delivered in two Facebook private groups that differed in that 16% of posts in one were focused on indoor tanning (IT) and 16% in the other, on prescription drug misuse, assigned by randomization. In both groups, posts promoted HPV vaccination (n = 38 posts; no randomization) and vaccination for other disease (e.g., influenza, n = 49). HPV and other vaccination posts covered the need for a vaccine, the number of adolescents vaccinated, how vaccines are decreasing the infection rates, and stories of positive benefits of being vaccinated or harms from not vaccinating. Guided by social cognitive theory and diffusion of innovations theory, posts were intended to increase knowledge, perceived risk, response efficacy (i.e., a relative advantage over not vaccinated daughters), and norms for vaccination. Some vaccination posts linked to stories to capitalize on identification effects in narratives, as explained in transportation theory. All mothers received the posts on vaccination (i.e., there was no randomization). Mothers completed surveys at baseline and 12- and 18-month follow-up to assess HPV vaccine uptake by self-report measures. Reactions (such as sad, angry) and comments to each HPV-related post were counted and coded. Results: Initiation of HPV vaccination (1 dose) was reported by 63.4% of mothers at baseline, 71.3% at 12-month posttest (pre/post p < 0.001), and 73.3% at 18-month posttest (pre/post p < 0.001). Completion of HPV vaccination (two or three doses) was conveyed by 50.2% of mothers at baseline, 62.5% at 12-month posttest (pre/post p < 0.001), and 65.9% at 18-month posttest (pre/post p < 0.001). For posts on HPV vaccines, 8.1% of mothers reacted (n = 162 total), and 68.4% of posts received a reaction (63.2% like; 13.2% love, 7.9% sad). In addition, 7.6% of mothers commented (n = 122; 51 unfavorable, 68 favorable, 1 neutral), and 50.0% of these posts received a comment. There were no differences in pre-post change in vaccine status by the count of reactions or comments to HPV vaccine posts (Ps > 0.05). Baseline vaccination was associated with the valence of comments to HPV vaccine posts (7.2% of mothers whose daughters had completed the HPV series at baseline made a favorable comment but 7.6% of mothers whose daughters were unvaccinated made an unfavorable comment). Conclusion: Effective strategies are needed in social media to promote HPV vaccines and counter misinformation about and resistance to them. Mothers whose daughters complete the HPV vaccine course might be recruited as influencers on HPV vaccines, as they may be predisposed to talk favorably about the vaccine. Comments from mothers who have not been vaccinated should be monitored to ensure that they do not spread vaccine-critical misinformation. Study limitations included lack of randomization and control group, relatively small number of messages on HPV vaccines, long measurement intervals, inability to measure views of vaccination posts, reduced generalizability related to ethnicity and social media use, and use of self-reported vaccine status. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02835807.

Slip Buddy App for Weight Management: Randomized Feasibility Trial of a Dietary Lapse Tracking App.

BACKGROUND: Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. OBJECTIVE: This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. METHODS: We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups. RESULTS: A total of 75% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97% (31/32) retained in the Slip Buddy condition and 94% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8% (SD 31.3%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5%, SD 28.4% of days), and participants who recorded slips (30/32, 94%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9%). Slips most often occurred at home (297/538, 55.2%), while working (153/538, 28.4%), while socializing (130/538, 24.2%), or during screen time (123/538, 22.9%). The conditions did not differ in participants' ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ≥5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants. CONCLUSIONS: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. TRIAL REGISTRATION: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171.

Results of a social media campaign to prevent indoor tanning by teens: A randomized controlled trial.

Indoor tanning (IT) increases risk of developing skin cancer. A social media campaign to reduce mother's permissiveness toward their teenage daughters IT was evaluated. Mothers (N = 869) of daughters aged 14-17 in 34 states without bans on IT by minors were enrolled in a randomized trial with assessments at baseline and 12-months follow-up in 2017-19. A year-long adolescent health campaign was delivered to all mothers. The intervention group received posts on preventing IT and the control group, posts about preventing prescription drug misuse. Daughters (n = 469; 54.0%) completed the assessments at baseline and 12 months. At 12-month follow-up, intervention-group mothers were less permissive of IT by daughters (unadjusted means = 1.70 [95% CI: 1.59, 1.80] v. 1.85 [1.73, 1.97] [5-point Likert scale], b = -0.152), reported more communication about avoiding IT with daughters (4.09 [3.84, 4.35] v. 3.42 [3.16, 3.68] [sum of 7 yes/no items], b = 0.213), and had lower intentions to indoor tan (1.41 [1.28, 1.55] v. 1.60 [1.43, 1.76] [7-point likelihood scale], b = -0.221) than control-group mothers. Daughters confirmed intervention-group mothers communicated about IT (3.81 [3.49, 4.14] v. 3.20 [2.87, 3.53] [sum of 7 yes/no items], b = 0.237) and shared IT posts (unadjusted percentages = 52.4% v. 36.4%, b = 0.438) more than control-group mothers. No differences were found in IT behavior, self-efficacy to refuse permission, and negative attitudes toward IT. A social media campaign may be an effective strategy to convince mothers to withhold permission for IT, which may help increase the effectiveness of state laws designed to reduce IT by minors by requiring parental permission.

Methods-Motivational Interviewing Approach for Enhanced Retention and Attendance.

INTRODUCTION: Suboptimal and differential participant engagement in randomized trials-including retention at primary outcome assessments and attendance at intervention sessions-undermines rigor, internal validity, and trial conclusions. METHODS: First, this study describes Methods-Motivational Interviewing approach and strategies for implementation. This approach engages potential participants before randomization through interactive, prerequisite orientation sessions that illustrate the scientific rationale behind trial methods in accessible language and use motivational interviewing to diffuse ambivalence about participation. Then, this study examines the potential improvements in retention (proportion of participants assessed at follow-up visits) and attendance (e.g., mean percentage of intervention sessions attended, percentage of participants who attended 0 sessions) in 3 randomized weight-management trials that quickly added prerequisite orientations to their protocols following early signs of suboptimal or differential participant engagement (Supporting Health by Integrating Nutrition and Exercise [2009-2013, n=194]; Get Social [2016-2020, n=217]; GestationaL Weight Gain and Optimal Wellness [2014-2018, n=389]). Using a pre-post analytical design, adjusted estimates from regression models controlling for condition and assessment timepoint (analyses from 2020) are reported. RESULTS: After adding prerequisite orientations, all 3 trials attained higher participant engagement. Retention at assessments was 11.4% and 17.3% higher (Get Social and Supporting Health by Integrating Nutrition and Exercise, respectively). Mean percentage of attendance at intervention sessions was 8.8% higher (GestationaL Weight Gain and Optimal Wellness), and 10.1% fewer participants attended 0 intervention sessions (Get Social). Descriptively, all the remaining retention and attendance outcomes were consistently higher but were nonsignificant. Across the trials, adding prerequisite orientations did not impact the proportion of eligible participants enrolled or the baseline demographics. CONCLUSIONS: The Methods-Motivational Interviewing approach shows promise for increasing the rigor of randomized trials and is readily adaptable to in-person, webinar, and conference call formats. TRIAL REGISTRATION: All 3 trials are registered at www.clinicaltrials.gov (Supporting Health by Integrating Nutrition and Exercise: NCT00960414; Get Social: NCT02646618; and GestationaL Weight Gain and Optimal Wellness: NCT02130232).

Insights on HPV vaccination in the United States from mothers' comments on Facebook posts in a randomized trial.

In the United States, parents' health beliefs affect HPV vaccination decisions for children. Our team acquired insights into mothers' health beliefs from their reactions and comments to posts on HPV vaccination in a social media adolescent health campaign in a randomized trial (n = 881 mothers; 63.1% reported daughters had 1+ doses of the HPV vaccine) evaluating communication intended to reduce daughters' indoor tanning. A total of 10 HPV vaccination messages in didactic (n = 7) and narrative (n = 3) formats were posted on vaccination need, uptake, and effectiveness and stories of young women who died from cervical cancer and a mother's decision to vaccinate her daughters. These posts received 28 reactions (like, love, and sad buttons; mean = 2.8 per post) and 80 comments (mean = 8.0 per post). More comments were favorable (n = 43) than unfavorable (n = 34). Data was not collected on views for posts. The most common favorable comment reported that daughters were vaccinated (n = 31). Unfavorable comments cited safety concerns, lack of physician support, distrust of pro-vaccine sources, and increased sexual activity of daughters. Mothers posting unfavorable (18.2%) as opposed to favorable (78.6%) comments or not commenting (64.0%) were less likely to have had their daughters vaccinated (chi-square = 22.27, p < 0.001). Favorable comments often did not state reasons for vaccinating. Concerns about lack of vaccine safety remain a barrier. Mothers may express distrust in pro-vaccine sources to reduce discomfort with not vaccinating daughters to reduce their risk for HPV infection. Many mothers who remained silent had vaccinated daughters, which suggests they did not resisit HPV vaccination.

Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial.

BACKGROUND: Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs. OBJECTIVE: The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity. METHODS: Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome. RESULTS: Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time. CONCLUSIONS: Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15530.