Impact of social connectedness on weight loss outcomes in an online program.

Obesity is linked to many negative health consequences. While online behavioral weight loss programs (BWL) are an effective treatment for obesity, weight losses are modest. Social connectedness has been found to improve weight loss outcomes and previous findings suggests that it may be especially important for people of color. The present study investigated the impact of social connectedness (structural connectedness, or network size; relationship quality, and functional connectedness, or social support) on weight loss outcomes in an online BWL program and whether Black race or Hispanic ethnicity moderates the relationship between social connectedness and weight loss. Participants (N = 387) enrolled in a 16-week online BWL program and completed measures of social connectedness before treatment and had their weight measured. Individuals with less structural connectedness (smaller social networks) had greater weight losses. Further, higher levels of functional connectedness (affectionate support, positive support, and relationship quality) mediated the relationship between smaller network size and better weight loss outcomes. Black race / Hispanic ethnicity did not moderate the relationship between social connectedness and weight loss. These findings suggest that the quality of one's relationships, not the size of one's social network, is important for weight loss. Future studies may examine whether online BWL programs that build relationship quality and affectionate and positive support in participants' existing social networks improve overall weight loss outcomes.

Effect of an mHealth intervention on physical activity outcomes among young adult cancer survivors: The IMPACT randomized controlled trial.

BACKGROUND: Physical inactivity is common in young adult cancer survivors (YACS), but evidence regarding effects of physical activity (PA) interventions among YACS is limited. The IMproving Physical Activity after Cancer Treatment (IMPACT) trial evaluated a theory-based mobile PA intervention on total PA minutes/week (primary) and secondary outcomes (moderate-to-vigorous PA [MVPA], light PA, steps, sedentary behaviors) at 6 months in YACS. METHODS: YACS (N = 280) were randomized to an intervention group or self-help group. All participants received digital tools (activity tracker, smart scale, access to arm-specific Facebook group) and an individual video chat session. Intervention participants also received a 6-month program with behavioral lessons, adaptive goal-setting, tailored feedback, tailored text messages, and Facebook prompts. PA was assessed via accelerometry and questionnaires at baseline and 6 months. Generalized estimating equation analyses tested between-group differences in changes over time. RESULTS: Of 280 YACS, 251 (90%) completed the 6-month accelerometry measures. Accelerometer-measured total PA minutes/week changed from 1974.26 at baseline to 2024.34 at 6 months in the intervention (mean change, 55.14 [95% CI, -40.91 to 151.19]) and from 1814.93 to 1877.68 in the self-help group (40.94 [95% CI, -62.14 to 144.02]; between-group p = .84). Increases in MVPA were +24.67 minutes/week (95% CI, 14.77-34.57) in the intervention versus +11.41 minutes/week in the self-help (95% CI, 1.44-21.38; between-group p = .07). CONCLUSION: Although the intervention did not result in significant differences in total PA, the increase in MVPA relative to the self-help group might be associated with important health benefits. Future research should examine moderators to identify for whom, and under what conditions, the intervention might be effective. CLINICALTRIALS: gov Identifier: NCT03569605. PLAIN LANGUAGE SUMMARY: Physical inactivity is common in young adult cancer survivors. However, few interventions have focused on helping young adult cancer survivors to get more physical activity. The IMproving Physical Activity after Cancer Treatment trial compared a mobile health physical activity intervention with a self-help group on total amount of physical activity at 6 months in a nationwide sample of young adult cancer survivors. Intervention participants did not improve their total amount of physical activity, but they did increase their moderate-to-vigorous intensity physical activity by twice as much as the self-help participants. This increase in activity may be associated with health benefits.

Development and Implementation of a Pilot Transition Preparation Intervention for Young Adults With Type 1 Diabetes in an Integrated Healthcare Setting.

OBJECTIVE: To evaluate the feasibility, acceptability, and preliminary efficacy of a multisystem transition preparation intervention, SHIFT, for young adults (YAs) with type 1 diabetes (T1D). METHODS: A single-arm, clinic-based pilot was conducted with 25 YAs with T1D (M age = 18.9 ± 1.0 years; 80% female), their parents (n = 25), and their providers (n = 10). Young adults and parents participated in a 6-month intervention designed to enhance transition readiness and independent diabetes management. Providers viewed a video module highlighting their role preparing YAs for transition and received individualized reports of YA's goals and transition readiness. Intervention feasibility (i.e., recruitment, retention, and engagement) and acceptability (e.g., program satisfaction) were assessed. Assessments of transition readiness, diabetes engagement, hemoglobin A1c (HbA1c), and related psychosocial variables were conducted at baseline, post-intervention (6 m), and follow-up (9 m). Paired t-tests examined 0-6 m and 0-9 m changes in study constructs. RESULTS: SHIFT was feasible, evidenced by recruitment (100% of sample recruited in 4 m), retention (100% at 6 m), and YA session attendance (100%). Program satisfaction was high for YAs, parents, and providers (9.12 ± 1.40, 8.79 ± 1.56, 8.20 ± 1.30, respectively, [out of 10]). Significant improvements (with effect sizes ranging from small to medium) were observed in parent and YA-reported transition readiness at 6 and 9 m (ps<.05) and diabetes engagement at 9 m (ps<.05). Although based on limited data due to COVID-19-related disruptions, a potential reduction in HbA1c was also observed. CONCLUSION: Findings support the feasibility, acceptability, and preliminary efficacy of SHIFT (although limited by the single arm design and homogeneous sample), and suggest a larger randomized controlled trial is warranted.

The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial.

BACKGROUND: There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents' inclusion in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment. METHODS: Participants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up. DISCUSSION: Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment. TRIAL REGISTRATION: Clinicaltrials.gov NCT03851796. Registered: February 22, 2019.

Eating to cope: Advancing our understanding of the effects of exposure to racial discrimination on maladaptive eating behaviors.

OBJECTIVE: Racial discrimination is a stressor for young Black women that leads to poor health outcomes, including maladaptive eating. This study presents findings on racial discrimination and maladaptive eating behaviors (overeating, LOC eating) using ecological momentary assessment (EMA). METHODS: Black emerging adult women (N = 27) with overweight or obesity participated in a 14-day EMA study examining exposure to racial discrimination, eating behaviors, and racial identity. Frequencies and chi-square tests were used to characterize the type of racial discrimination experienced and frequency of overeating. Mixed effect ordinal logistic regression models were used to assess the relation between racial discrimination and maladaptive eating. Moderation analysis was conducted by creating interaction terms for discrimination and racial identity variables. RESULTS: 81.5% of participants reported experiencing racial discrimination. Young Black women reporting exposure to racial discrimination were more likely to endorse higher levels of both overeating and LOC eating compared to times when discrimination was not experienced (p < .0001). Racial identity moderated the link between racial discrimination and maladaptive eating (overeating, LOC) such that reporting greater levels of private regard buffered the deleterious effect of racial discrimination. Higher levels of public regard exacerbated the association between racial discrimination and both overeating, and LOC. Higher centrality worsened the relation between racial discrimination and LOC. CONCLUSION: Young Black women might use maladaptive eating to cope with exposure to racial discrimination, which underscores the importance of examining the link between racism and disordered eating, particularly among Black women submerged in a society that continuously exposes them to racial discrimination. PUBLIC SIGNIFICANCE: Emerging adult Black women are exposed to racial discrimination daily. In theory, exposure to racial discrimination could contribute to overeating and loss of control eating in this population. Using ecological momentary assessment, to capture experiences and eating behaviors in the moment they occur, this project quantified the magnitude of racial discrimination and how it was associated with maladaptive eating behaviors. Further, it examined ways in which racial identity was linked to this association.

Persistent, High Levels of Social Jetlag Predict Poor Weight Outcomes in a Weight Gain Prevention Study for Young adults.

INTRODUCTION: Social jetlag (SJL), the discrepancy in sleep timing between weekdays and weekends, is associated with higher BMI and cardiometabolic risk and is common in young adults. We examined whether chronic SJL impacts weight gain in young adults participating in a weight gain prevention trial. METHODS: Young adults (n = 599, age 18-35; BMI: 21.0-30.9 kg/m2) completed assessments at 0, 4, 12, and 24 months. Multilevel mixed growth models were used to examine (1) associations between demographics and longitudinal SJL and (2) longitudinal SJL as a predictor of weight change and cardiometabolic outcomes. SJL was assessed as a continuous and clinically-significant dichotomous (< vs. ≥2 h) variable. RESULTS: 38% of participants had clinically-significant SJL at ≥ 1 timepoints (Baseline M ± SD = 1.3±0.89). Younger (b=-0.05, p < 0.001), female (b = 0.18, p = 0.037) and Black (compared to White, b = 0.23, p = 0.045) participants were more likely to have greater SJL. Individuals with high SJL (≥ 2 h; between-person effect) were more likely to have greater weight gain over 2 years (b = 0.05, p = 0.028). High SJL did not affect the rate of change in waist circumference or cardiometabolic markers over time. CONCLUSIONS: High SJL is associated with greater weight gain over time. Reducing SJL may positively impact weight status in young adults.

Pilot randomized clinical trial targeting anxiety sensitivity: effects on physical activity.

Anxiety sensitivity (AS)-the tendency to interpret anxiety as an aversive state-is associated with low rates of physical activity. Previous interventions targeting AS via exercise-based interoceptive exposure have not assessed physical activity as an outcome and are limited by brief follow-up periods. This study replicated and extended previous work by including a 6-week follow-up and assessing physical activity. Participants were 44 sedentary young adults with elevated AS randomized to intervention (six 20-minute sessions of moderate-intensity walking) or assessment-only control. Assessments of AS and physical activity were conducted at baseline and weeks 2 (post-treatment), 4, and 8. Between-group change in AS and physical activity over time was assessed using hierarchical linear modeling. The intervention condition demonstrated a marginally significant reduction in AS compared to control at week 4, which eroded by week 8. There were no significant between-group differences for change in physical activity. Findings indicate that a brief intervention might not be sufficient to produce lasting changes in AS or related exercise avoidance without additional treatment. Intervention effects were weaker than previous reports, which may be due to the greater racial/ethnic diversity of the current sample. Future research should objectively measure physical activity and explore individual variability in response.ClinicalTrials.gov identifier: NCT03128437.

Impact of income and perceived stress on engagement and weight loss outcomes in an online behavioral weight loss program.

Lower income is associated with greater stress, and stress has been shown to undermine treatment engagement and weight loss outcomes in face-to-face interventions. The present study examined whether lower income predicts treatment engagement and weight loss outcomes during an online behavioral weight loss (BWL) intervention. A total of N = 260 participants (79.2% female; 50.7 ± 11.9 years of age; 60.3% non-Hispanic White) were enrolled into an online BWL program and had their income, stress, program engagement, and weight measured. Results showed that stress fully mediated the effect of income on engagement in the online program. Further, lower income predicted poorer weight loss outcomes, and this effect was partially mediated by perceived stress. This is the first study to demonstrate that lower income is associated with poorer engagement and weight loss outcomes in an online weight loss program, underscoring the need for systems-level stress reduction programs and individual level stress management tools, particularly for individuals with lower income.

Conducting a Community "Street Survey" to Inform an Obesity Intervention: The WE Project.

Using a community-based participatory research approach, a citywide survey was conducted to explore perceptions of obesity and interventions to reduce obesity within an African American urban community. More than 1300 surveys were collected within 3 months; 92.9% of respondents agreed or strongly agreed that obesity was an important health issue in the community and the majority indicated that family-based interventions were the preferred pathway for improving physical activity (86.0%) and nutrition (85.2%). Engaging community members in survey development and implementation was an effective approach to build local research capacity and establish a shared agenda of reaching a diverse sample of community residents.

Using the Health Belief Model to Analyze Instagram Posts about Zika for Public Health Communications.

We analyzed Instagram posts about Zika by using the Health Belief Model. We found a high presence of threat messages, yet little engagement with these posts. Public health professionals should focus on posting messages to increase self-efficacy and benefits of protective behavior, especially when a vaccine becomes available.

Dietary outcomes within the study of novel approaches to weight gain prevention (SNAP) randomized controlled trial.

BACKGROUND: Young adults (YA) are at high-risk for unhealthy dietary behaviors and weight gain. The Study of Novel Approaches to Weight Gain Prevention (SNAP) Trial demonstrated that two self-regulation approaches were effective in reducing weight gain over 2 years compared with control. The goal of this analysis was to examine effects of intervention on dietary outcomes and the association of diet changes with weight change. METHODS: Participants were 599 YA, age 18-35 years, BMI 21.0-30.0 kg/m2 (27.4 ± 4.4 years; 25.4 ± 2.6 kg/m2; 22% men; 73% non-Hispanic White), who were recruited in Providence, RI and Chapel Hill, NC and randomized to self-regulation with Small Changes (SC), self-regulation with Large Changes (LC) or Control (C). SC and LC emphasized frequent self-weighing to cue behavior changes (small daily changes vs. periodic large changes) and targeted high-risk dietary behaviors. Diet and weight were assessed at baseline, 4 months and 2 years. RESULTS: LC and SC had greater decreases in energy intake than C at 4 months but not 2 years. LC had the greatest changes in percent calories from fat at 4 months, but differences were attenuated at 2 years. No differences in diet quality were observed. Across conditions, increased total energy consumption, fast food, meals away from home, and binge drinking, and decreased dietary quality and breakfast consumption were all associated with weight gain at 2 years. CONCLUSIONS: This study suggests the need to strengthen interventions to produce longer term changes in dietary intake and helps to identify specific behaviors associated with weight gain over time in young adults. TRIAL REGISTRATION: Clinicaltrials.gov # NCT01183689 , registered August 18, 2010.

Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes.

OBJECTIVE: Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]). METHODS: Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month. RESULTS: Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes self-management mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020). CONCLUSION: Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population.

The relationship between body mass index, binge eating disorder and suicidality.

BACKGROUND: While restrictive and compensatory eating disorders (e.g. anorexia and bulimia) are associated with elevated risk of suicide, less is known about binge eating disorder (BED). There is suggestive evidence of a U-shaped relationship between body mass index (BMI) and completed suicide, but fewer studies on suicidal ideation or attempts. This study examined the association between BED, BMI, and suicidality, and assessed whether these relationships varied by gender. METHODS: Data come from the Collaborative Psychiatric Epidemiologic Surveys (N = 14,497). Binge episodes and BED were assessed using the Composite International Diagnostic Inventory (CIDI). BMI was calculated from self-reported height and weight. Suicidal ideation/attempts were assessed using the CIDI. Weighted logistic regression was used to assess the association between binging/BED, BMI and suicidality. Interaction terms were used to assess whether the relationship between BMI and suicidality was moderated by binging/BED, and whether the relationships between binging/BED and BMI differed by gender. RESULTS: One-third of adults with BED had a history of suicidality, compared to 19% of those without. Both binging (OR: 1.95, 95% CI: 1.50-2.53) and BED (OR: 2.01, 95% CI: 1.41-2.86) were associated with suicidality in fully-adjusted models. BMI was associated with suicidality in a curvilinear manner, and this relationship was exacerbated by binging/BED (ORBinge eating x BMI: 1.04, 95% CI: 1.01-1.09, p < 0.05). The relationship between BMI and suicidality did not differ by gender (ORgender x BMI: 1.00, p < 0.770). However, the relationship between binge eating and suicidality was stronger for women relative to men (ORgender X binge: 1.87, p < 0.012). CONCLUSIONS: Binge eating, even below the threshold for BED, is associated with suicidality. BMI is associated with suicidality in a curvilinear manner, and the BMI-suicidality relationship is potentiated by binge eating/BED. Findings support the thoughtful integration of psychiatric care into weight loss programs for adults with a history of binging behavior.

The Transition into Young Adulthood: a Critical Period for Weight Control.

PURPOSE OF REVIEW: Emerging adulthood (age 18-25) represents a critical period for weight control: rate of weight gain is greatest during these years and the prevalence of overweight and obesity is estimated to be at least 40% among emerging adults. Unique behavioral, psychosocial, and cognitive risk factors among this population must be specifically addressed within weight management programs. We review extant treatment approaches, including lessons learned from the nascent literature specifically targeting this population. Lastly, we provide suggestions to inform future work in this area. RECENT FINDINGS: The EARLY consortium comprises seven clinical trials targeting weight control in young adults age 18-35. Though these studies encompass a broader age range, two of the trials enrolled large numbers of 18-25-year-olds. Results from these trials and other recent pilot trials provide a foundation for next steps with respect to developing weight management interventions for emerging adults. The design of targeted weight control approaches for emerging and young adults has contributed to improved outcomes for this high-risk population. However, suboptimal engagement and variability in response pose challenges. Identifying and intervening on individual-level behavioral and psychological variables may enhance the effects of these adapted treatments.

Acceptability of a Self-Guided Lifestyle Intervention Among Young Men: Mixed Methods Analysis of Pilot Findings.

BACKGROUND: Young men are vastly underrepresented in lifestyle interventions, suggesting a need to develop appealing yet effective interventions for this population. OBJECTIVE: This study aimed to determine the acceptability of a self-guided lifestyle intervention designed specifically for young men (age: 18-35 years old). METHODS: Semistructured interviews and surveys were completed by 14 men following completion of a remotely delivered, 12-week lifestyle intervention. The intervention included 1 virtual group session, digital tools, access to self-paced web- and mobile-based content, and 12 weekly health risk text messages. We quantitatively and qualitatively examined young men's experiences with the intervention components of a remotely delivered, self-guided lifestyle intervention targeting weight loss. Data were integrated using convergent mixed methods analysis. RESULTS: Men were a mean age of 29.9 (SD 4.9) years with a mean BMI of 31.0 (SD 4.5) kg/m2. The self-guided aspect was not acceptable, and a majority preferred more check-ins. Participants expressed a desire for a social aspect in future lifestyle interventions. All men found the focus on health risks appealing. A majority of men found the study-issued, Bluetooth-enabled scale acceptable. CONCLUSIONS: Acceptability of the self-guided lifestyle intervention was perceived as suboptimal by young men. The findings highlight the need to add intervention components that sustain motivation and provide additional social support for young men. TRIAL REGISTRATION: ClinicalTrials.gov NCT04267263; https://www.clinicaltrials.gov/study/NCT04267263.

Study design and rationale for TEENS+REACH: Evaluating ripple effects of a family-based lifestyle intervention to untreated family members.

Background: Understanding the effects of family-based lifestyle intervention beyond the treated adolescent is important, given that obesity is a familial disease and there are likely bidirectional relations between an adolescent's treatment success and broader household changes. However, it is unknown if recommended household-wide changes are adopted or if untreated family members experience weight-related benefits. Methods: TEENS + REACH leverages our ongoing randomized clinical trial of TEENS+, a family-based lifestyle intervention for adolescents with obesity, to determine: 1) if household-wide changes to the shared home environment are implemented, 2) if ripple effects to untreated family members are observed, and 3) whether these changes are predictive of adolescents' weight management success. TEENS + REACH will expand trial assessments to include comprehensive assessments of the shared home feeding, weight, and physical activity environment of the target adolescents. Specifically, we will enroll untreated children (8-17yrs) and caregivers living in the same household as the target parent/adolescent dyad (N = 60 families). At 0, 2, 4 (primary endpoint), and 8-months, the target parent/adolescent dyad and other untreated children and caregivers in the home will complete anthropometric assessments. Discussion: Results will determine the familial reach of TEENS+ and reveal potential mediators of treatment response, which can inform future efforts to optimize family-based lifestyle interventions. Trial registration: TEENS + REACH was retrospectively registered in Clinicaltrials.gov March 22, 2023 (NCT05780970) as an observational study ancillary to the TEENS + clinical trial, registered February 22, 2019 (NCT03851796).

Association of poverty-income ratio with cardiovascular disease and mortality in cancer survivors in the United States.

BACKGROUND: Lower income is associated with high incident cardiovascular disease (CVD) and mortality. CVD is an important cause of morbidity and mortality in cancer survivors. However, there is limited research on the association between income, CVD, and mortality in this population. METHODS: This study utilized nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey evaluating the health and nutritional status of the US population. Our study included NHANES participants aged ≥20 years from 2003-2014, who self-reported a history of cancer. We evaluated the association between income level, prevalence of CVD, and all-cause mortality. All-cause mortality data was obtained through public use mortality files. Income level was assessed by poverty-income ratio (PIR) that was calculated by dividing family (or individual) income by poverty guideline. We used multivariable-adjusted Cox proportional hazard models through a backward elimination method to evaluate associations between PIR, CVD, and all-cause mortality in cancer survivors. RESULTS: This cohort included 2,464 cancer survivors with a mean age of 62 (42% male) years. Compared with individuals with a higher PIR tertiles, those in the lowest PIR tertile had a higher rate of pre-existing CVD and post-acquired CVD. In participants with post-acquired CVD, the lowest PIR tertile had over two-fold increased risk mortality (Hazard Ratio (HR) = 2.17; 95% CI: 1.27-3.71) when compared to the highest PIR tertile. Additionally, we found that PIR was as strong a predictor of mortality in cancer survivors as CVD. In patients with no CVD, the lowest PIR tertile continued to have almost a two-fold increased risk of mortality (HR = 1.72; 95% CI: 1.69-4.35) when compared to a reference of the highest PIR tertile. CONCLUSIONS: In this large national study of cancer survivors, low PIR is associated with a higher prevalence of CVD. Low PIR is also associated with an increased risk of mortality in cancer survivors, showing a comparable impact to that of pre-existing and post-acquired CVD. Urgent public health resources are needed to further study and improve screening and access to care in this high-risk population.

Examining sociodemographic and health-related characteristics as moderators of an mHealth intervention on physical activity outcomes in young adult cancer survivors.

PURPOSE: This study explored whether sociodemographic and health-related characteristics moderated mHealth PA intervention effects on total and moderate-to-vigorous physical activity (MVPA) at 6 months, relative to a self-help condition among young adult cancer survivors (YACS). METHODS: We conducted exploratory secondary analyses of data from a randomized controlled trial among 280 YACS. All participants received digital tools; intervention participants also received lessons, adaptive goals, tailored feedback, text messages, and Facebook prompts. Potential moderators were assessed in baseline questionnaires. PA was measured at baseline and 6 months with accelerometers. Linear model repeated measures analyses examined within- and between-group PA changes stratified by levels of potential moderator variables. RESULTS: Over 6 months, the intervention produced MVPA increases that were ≥ 30 min/week compared with the self-help among participants who were males (28.1 vs. -7.7, p = .0243), identified with racial/ethnic minority groups (35.2 vs. -8.0, p = .0006), had baseline BMI of 25-30 (25.4 vs. -7.2, p = .0034), or stage III/IV cancer diagnosis (26.0 vs. -6.8, p = .0041). Intervention participants who were ages 26-35, college graduates, married/living with a partner, had a solid tumor, or no baseline comorbidities had modest MVPA increases over 6 months compared to the self-help (ps = .0163-.0492). Baseline characteristics did not moderate intervention effects on total PA. CONCLUSIONS: The mHealth intervention was more effective than a self-help group at improving MVPA among subgroups of YACS defined by characteristics (sex, race, BMI, cancer stage) that may be useful for tailoring PA interventions. IMPLICATIONS FOR CANCER SURVIVORS: These potential moderators can guide future optimization of PA interventions for YACS. GOV IDENTIFIER: NCT03569605.

Analysis of F2-isoprostanes in plasma of pregnant women by HPLC-MS/MS using a column packed with core-shell particles.

Plasma F2-isoprostanes (F2-isoPs) are reliable biomarkers of oxidative stress. Several possible F2-isoPs are generated by the oxidation of arachidonic acid esterified in phospholipids. The separation of these isomers represents a technical challenge for rapid and selective determination. We have developed a HPLC-MS/MS method for the simultaneous determination of seven plasma F2-isoPs, namely 8-iso-15(R)-prostaglandin F2α (PGF2α), 8-iso-PGF2α, 15(R)-PGF2α, iPF2α-IV, iPF2α-VI, 5-iPF2α-VI, and (±)5-8,12-iso-iPF2α-VI. We have validated this method in plasma of pregnant women, a mild physiological oxidative stress known to increase F2-isoPs. Thus, plasma samples of women collected at the third trimester of pregnancy (n = 20) were subjected to alkaline hydrolysis followed by liquid-liquid extraction in order to extract total F2-isoPs. The F2-isoPs were separated within 16.5 min using a column packed with core-shell particles. The class VI isomers were the most abundant, accounting for 65% of the total level of all quantified F2-isoPs in plasma of pregnant women (P < 0.05). The 15(R)-PGF2α was the most abundant of the class III isomers quantified. This method allowed fast and selective separation of seven isomers from three different classes of F2-isoP regioisomers.

Weight gain prevention in young adults: design of the study of novel approaches to weight gain prevention (SNAP) randomized controlled trial.

BACKGROUND: Weight gain during young adulthood is common and is associated with increased cardiovascular risk. Preventing this weight gain from occurring may be critical to improving long-term health. Few studies have focused on weight gain prevention, and these studies have had limited success. SNAP (Study of Novel Approaches to Weight Gain Prevention) is an NIH-funded randomized clinical trial examining the efficacy of two novel self-regulation approaches to weight gain prevention in young adults compared to a minimal treatment control. The interventions focus on either small, consistent changes in eating and exercise behaviors, or larger, periodic changes to buffer against expected weight gains. METHODS/DESIGN: SNAP targets recruitment of six hundred young adults (18-35 years) with a body mass index between 21.0-30.0 kg/m2, who will be randomly assigned with equal probability to: (1) minimal intervention control; (2) self-regulation with Small Changes; or (3) self-regulation with Large Changes. Both interventions receive 8 weekly face-to-face group sessions, followed by 2 monthly sessions, with two 4-week refresher courses in each of subsequent years. Participants are instructed to report weight via web at least monthly thereafter, and receive monthly email feedback. Participants in Small Changes are taught to make small daily changes (~100 calorie changes) in how much or what they eat and to accumulate 2000 additional steps per day. Participants in Large Changes are taught to create a weight loss buffer of 5-10 pounds once per year to protect against anticipated weight gains. Both groups are encouraged to self-weigh daily and taught a self-regulation color zone system that specifies action depending on weight gain prevention success. Individualized treatment contact is offered to participants who report weight gains. Participants are assessed at baseline, 4 months, and then annually. The primary outcome is weight gain over an average of 3 years of follow-up; secondary outcomes include diet and physical activity behaviors, psychosocial measures, and cardiovascular disease risk factors. DISCUSSION: SNAP is unique in its focus on weight gain prevention in young adulthood. The trial will provide important information about whether either or both of these novel interventions are effective in preventing weight gain. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01183689.