Effect of Media Use on Adolescent Body Weight.

INTRODUCTION: Adolescents spend a substantial amount of time consuming media, including watching television, playing video games, and using electronic devices to access the internet. We examined the relationship between prolonged media use on screen devices and its potential association with obesity through several mechanisms. METHODS: We used data from 659,288 eighth and eleventh grade students who participated in the 2015-2016 School Physical Activity and Nutrition (SPAN) survey in Texas to examine the associations between hours of media use per day and 3 behaviors related to obesity: timing of last food intake, unhealthy eating behavior, and sleep hours. Also, mediation analyses were conducted to examine the pathways between hours of media use and body mass index (BMI). RESULTS: Compared with adolescents who used media 2 hours or less per day, those who used media 6 hours or more had higher odds of nighttime eating (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.76-5.66) and inadequate sleep (OR, 1.57; 95% CI, 1.05-2.36) and a higher coefficient for Unhealthy Eating Index score (3.87; 95% CI, 1.3-6.37). Mediation analysis demonstrated that for males sleep hours and timing of last food intake mediated the pathway between hours of media use and BMI. For females, unhealthy eating behavior mediated this pathway. CONCLUSION: Adolescents who used electronic media 6 or more hours at night had higher odds of unhealthy eating behavior and inadequate sleep hours than those with 2 hours' use or less. Attention to behaviors associated with adolescents' prolonged media use is needed to reduce risk of obesity.

Promoting Influenza Vaccination Among an ACA Health Plan Subscriber Population: A Randomized Trial.

PURPOSE: To assess the effectiveness of an intervention to promote influenza vaccination among members of an Affordable Care Act (ACA) insurance plan. DESIGN: Randomized controlled trial. SETTING: Messages were delivered by a community-based, nonprofit health insurance provider to its members in Central Texas. PARTICIPANTS: Adult subscribers for whom either a phone number or an e-mail address was available (n = 25 649). INTERVENTION: Participants were randomly assigned to be sent (1) no messages, (2) messages encouraging influenza vaccination via e-mails and texts, and (3) messages encouraging influenza vaccination through e-mails, texts, and postal mail. Messages were sent between September 12, 2017 and November 17, 2017. MEASURES: Influenza vaccination was determined using medical and pharmacy claims. ANALYSIS: Rate differences and 95% confidence intervals between each exposure condition were calculated for the overall population and by subgroups. RESULTS: The vaccination rate by December 31, 2017 was 16.9%. Those sent both electronic messages and postal mail were significantly more likely to be vaccinated than those who were not sent messages (rate difference: 2.5%; 95% confidence interval [CI]: 1.4-3.6) and those who were sent electronic messages only (rate difference: 1.6%; 95% CI: 0.5-2.8). CONCLUSION: A combination of messages delivered via text, e-mail, and postal mail generated a modest but significant positive effect on influenza vaccine rates in an ACA plan population. The postal mail component was essential for achieving this effect.

Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients.

BACKGROUND: The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed. OBJECTIVE: This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers. METHODS: Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change. RESULTS: After the mobile app use, mean KS increased from 27(3) to 31(3) ( P<0.0001). Proportion of patients who felt they "cannot quit smoking" reduced from 36% (20/55) to 18% (10/55) ( P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level ( P<0.02), employment status ( P<0.05), and high app acceptance ( P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future. CONCLUSIONS: Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted.