Interest in an Instagram-delivered gestational weight gain intervention among pregnant women with pre-pregnancy overweight or obesity.

Background: Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention. Methods: English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed. Results: Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences. Conclusions: Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention.

A Content Analysis of Indoor Tanning Twitter Chatter During COVID-19 Shutdowns: Cross-Sectional Qualitative Study.

BACKGROUND: Indoor tanning is a preventable risk factor for skin cancer. Statewide shutdowns during the COVID-19 pandemic resulted in temporary closures of tanning businesses. Little is known about how tanners reacted to losing access to tanning businesses. OBJECTIVE: This study aimed to analyze Twitter (subsequently rebranded as X) chatter about indoor tanning during the statewide pandemic shutdowns. METHODS: We collected tweets from March 15 to April 30, 2020, and performed a directed content analysis of a random sample of 20% (1165/5811) of tweets from each week. The 2 coders independently rated themes (κ=0.67-1.0; 94%-100% agreement). RESULTS: About half (589/1165, 50.6%) of tweets were by people unlikely to indoor tan, and most of these mocked tanners or the act of tanning (562/589, 94.9%). A total of 34% (402/1165) of tweets were posted by users likely to indoor tan, and most of these (260/402, 64.7%) mentioned missing tanning beds, often citing appearance- or mood-related reasons or withdrawal. Some tweets by tanners expressed a desire to purchase or use home tanning beds (90/402, 22%), while only 3.9% (16/402) mentioned tanning alternatives (eg, self-tanner). Very few tweets (29/1165, 2.5%) were public health messages about the dangers of indoor tanning. CONCLUSIONS: Findings revealed that during statewide shutdowns, half of the tweets about indoor tanning were mocking tanning bed users and the tanned look, while about one-third were indoor tanners reacting to their inability to access tanning beds. Future work is needed to understand emerging trends in tanning post pandemic.

Sources and perceived credibility of child nutrition information in relation to maternal health literacy.

OBJECTIVE: To examine sources and perceived credibility of child nutrition information by maternal health literacy. METHODS: US mothers of children (0-12 years) who used social media regularly (N = 340) completed an online survey. Health literacy was assessed using the Newest Vital Sign. Child nutrition information sources and perceived credibility of sources were compared by health literacy using logistic and quantile regression models. RESULTS: Seventeen percent of mothers had limited health literacy. Compared to mothers with adequate health literacy, those with limited health literacy were more likely to get child nutrition information from siblings, extended family, dietitians, doctors, nurse practitioners, or physician assistants, and government agencies, and less likely to get information from Facebook. Mothers with limited health literacy rated information from parents, friends, Facebook, and Instagram as more credible than mothers with adequate health literacy. While perceived credibility of information from doctors, nurse practitioners, or physician assistants was high overall, mothers with limited health literacy perceived information from these health care providers as less credible. CONCLUSIONS: Sources of child nutrition information and perceived credibility differ by maternal health literacy. PRACTICE IMPLICATIONS: Pediatric providers are encouraged to refer parents to engaging resources that provide evidence-based child nutrition information.

Association Between Subjective Cognitive Decline and Twice-Weekly Muscle-Strengthening Activities in Middle-Aged and Older US Adults: An Analysis of the 2019 Behavioral Risk Factor Surveillance System.

PURPOSE: Adults with subjective cognitive decline (SCD), the self-reported concern of reduced cognitive function, are recommended to do physical activity for its brain health benefits. US adults aged ≥45 with SCD are less likely to meet the American College of Sports Medicine (ACSM) aerobic activity recommendations. Their engagement in muscle-strengthening activities is unknown. We aimed to identify if US adults aged ≥45 with SCD are less likely to do twice-weekly muscle-strengthening activities compared to those without SCD. DESIGN: Secondary analysis of the 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. SAMPLE: 114 164 respondents, representing approximately 59 million US adults aged ≥45. MEASURES: SCD was indicated if the respondent reported confusion or memory loss during the past 12 months (yes/no). Respondents reported the frequency of muscle-strengthening activities, which we categorized as meeting the ACSM's recommendations (2+ times per week) or not (<2 times per week). ANALYSIS: Crude and adjusted logistic regression models controlling for variables associated with SCD and muscle-strengthening activities. The models used sample weights to represent US adults in the included 31 states and Washington D.C. RESULTS: US adults aged ≥45 with SCD were less likely to do twice-weekly muscle-strengthening activities than those without SCD (28.6% [SE: .8%] vs 33.5% [SE: .3%], adjusted OR, .9; 95% CI: .9-1.0). CONCLUSION: Primary care providers should encourage middle-aged and older patients to engage in muscle-strengthening and aerobic activities.

Within-store fast food marketing: The association between food swamps and unhealthy advertisement.

Previous studies have linked food consumption outside the home and fast food to poor diet quality and living within a food swamp to an increased likelihood of obesity. A growing amount of research has linked food marketing to food choice. Still, limited information is available on how this dynamic may work within fast food establishments and if the marketing strategies used may vary by neighborhood food swamp status. Utilizing the Environment Assessment (EAT) Tool, we examined the within-store marketing environment of fast food restaurants to understand the factors potentially influencing food choice. A cross-sectional study design surveyed fast food outlets (n = 170) for unhealthy advertisements. Each fast-food outlet was assigned an FSI score based on its geographic location and proximity to unhealthy outlets. Outlets were assessed for associations between food swamp status and unhealthy advertisements. Poisson Regression was performed to assess the relationship between unhealthy advertisements and FSI score. Low FSI had a mean unhealthy advertisement score of 36.79 (11.06). Moderate and High FSI had mean unhealthy advertisement scores of 33.03 (14.67) and 31.71 (12.63), respectively. The number of unhealthy advertisements did not differ by food swamp categories (Moderate FSI IRR: 0.90, 95% CI: 0.74-1.09; High FSI IRR: 0.86, 95% CI: 0.73-1.01 vs. low FSI). Differences in marketing environments by food swamp status were not observed. Future research should examine other factors of the food swamp environment and additional factors such as television or social media to understand its association with food choice.

Characteristics associated with poor atrial fibrillation-related quality of life in adults with atrial fibrillation.

PURPOSE: Few studies have examined the relationship between poor atrial fibrillation-related quality of life (AFQoL) and a battery of geriatric factors. The objective of this study is to describe factors associated with poor AFQoL in older adults with atrial fibrillation (AF) with a focus on sociodemographic and clinical factors and a battery of geriatric factors. METHODS: Cross-sectional analysis of a prospective cohort study of participants aged 65+ with high stroke risk and AF. AFQoL was measured using the validated Atrial Fibrillation Effect on Quality of Life (score 0-100) and categorized as poor (<80) or good (80-100). Chi-square and t -tests evaluated differences in factors across poor AFQoL and significant characteristics ( P  < 0.05) were entered into a logistic regression model to identify variables related to poor AFQoL. RESULTS: Of 1244 participants (mean age 75.5), 42% reported poor AFQoL. Falls in the past 6 months, pre/frail and frailty, depression, anxiety, social isolation, vision impairment, oral anticoagulant therapy, rhythm control, chronic obstructive pulmonary disease and polypharmacy were associated with higher odds of poor AFQoL. Marriage and college education were associated with a lower odds of poor AFQoL. CONCLUSIONS: More than 4 out of 10 older adults with AF reported poor AFQoL. Geriatric factors associated with higher odds of reporting poor AFQoL include recent falls, frailty, depression, anxiety, social isolation and vision impairment. Findings from this study may help clinicians screen for patients with poor AFQoL who could benefit from tailored management to ensure the delivery of patient-centered care and improved well being among older adults with AF.

Delivering a Postpartum Weight Loss Intervention via Facebook or In-Person Groups: Results From a Randomized Pilot Feasibility Trial.

BACKGROUND: Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase. OBJECTIVE: This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes. METHODS: Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up. RESULTS: Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months. CONCLUSIONS: Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736.

Development and feasibility of a web-based gestational weight gain intervention for women with pre-pregnancy overweight or obesity.

Background: Excessive gestational weight gain is associated with negative maternal and infant health outcomes. Digital health approaches may help overcome barriers to participating in lifestyle interventions requiring in-person visits. The purpose of this study was to develop and examine the feasibility of a web-based gestational weight gain intervention. Methods: Intervention development included feedback and input from pregnant women. We conducted a 12-week one-arm pilot study during which participants engaged in an online discussion board with coaches and other pregnant women, tracked their weight gain with an interactive graph, and accessed a list of online resources for pregnancy health. Feasibility outcomes were recruitment, retention, engagement and sustained participation, intervention acceptability, and website usability. Gestational weight gain was an exploratory outcome. Results: Participants (n=12) were on average 16.8 [standard deviation (SD): 2.0] weeks gestation with average pre-pregnancy body mass index of 30.5 (SD: 4.8) kg/m2. Participant retention was 92% (n=11). Participants logged into the website a median of 21 times [interquartile range (IQR), 8-37; range, 2-98] over 12 weeks, and 58% (n=7) logged into the website during the last week of the intervention. All participants said they would be very likely or likely to participate again, and 100% said they would be very likely or likely to recommend the intervention to a pregnant friend. In post-intervention interviews, 64% (n=7) explicitly said that the website was easy to use, but 100% (n=11) mentioned usability issues. When asked their preferred intervention platform, 18% (n=2) somewhat or strongly preferred a private website, 18% (n=2) had no preference, and 64% (n=7) somewhat or strongly preferred Facebook. Seventy percent (n=7) had excessive gestational weight gain, 10% (n=1) inadequate gestational weight gain, and 20% (n=2) gained within recommended ranges. Conclusions: Additional development work is needed before moving to efficacy testing. Most notably, usability issues with the investigator-developed website and participant preference suggest a switch to a commercial social media platform.

An Online Acceptance and Mindfulness Intervention for Chronic Pain in Veterans: Development and Protocol for a Pilot Feasibility Randomized Controlled Trial.

BACKGROUND: In the veteran community, chronic pain is particularly prevalent and often debilitating. Until recently, veterans with chronic pain were offered primarily pharmacological intervention options, which rarely suffice and can also have negative health consequences. To better address chronic pain in veterans, the Veterans Health Administration has invested in novel, nonpharmacological behavior interventions that target both pain management and chronic pain-related functional issues. One approach, acceptance and commitment therapy (ACT) for chronic pain, is supported by decades of efficacy evidence for improving pain outcomes; however, ACT can be difficult to obtain owing to issues such as a lack of trained therapists or veterans having difficulty committing to the time and resources needed for the full clinician-led ACT protocol. Given the strong ACT evidence base combined with access limitations, we set out to develop and evaluate Veteran ACT for Chronic Pain (VACT-CP), an online program guided by an embodied conversational agent to improve pain management and functioning. OBJECTIVE: The aims of this study are to develop, iteratively refine, and then conduct a pilot feasibility randomized controlled trial (RCT) of a VACT-CP group (n=20) versus a waitlist and treatment-as-usual control group (n=20). METHODS: This research project includes 3 phases. In phase 1, our research team consulted with pain and virtual care experts, developed the preliminary VACT-CP online program, and conducted interviews with providers to obtain their feedback on the intervention. In phase 2, we incorporated feedback from phase 1 into the VACT-CP program and completed initial usability testing with veterans with chronic pain. In phase 3, we are conducting a small pilot feasibility RCT, with the primary outcome being assessment of usability of the VACT-CP system. RESULTS: This study is currently in phase 3; recruitment for the RCT began in April 2022 and is expected to continue through April 2023. Data collection is expected to be completed by October 2023, with full data analysis completed by late 2023. CONCLUSIONS: The findings from this research project will provide information on the usability of the VACT-CP intervention, as well as secondary outcomes related to treatment satisfaction, pain outcomes (pain-related daily functioning and pain severity), ACT processes (pain acceptance, behavioral avoidance, and valued living), and mental and physical functioning. TRIAL REGISTRATION: ClinicalTrials.gov NCT03655132; https://clinicaltrials.gov/ct2/show/NCT03655132. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45887.

The Relationship Between How Participants Articulate Their Goals and Accomplishments and Weight Loss Outcomes: Secondary Analysis of a Pilot of a Web-Based Weight Loss Intervention.

BACKGROUND: In behavioral weight loss interventions, participants are asked to set weekly goals to support long-term habits that lead to weight loss. Although participants are asked to set and accomplish weekly goals, we do not know how often they do this and whether doing so is associated with weight loss. Web-based weight loss interventions allow for the analysis of participant engagement data, including how participants articulate their goals and accomplishments. OBJECTIVE: Using engagement data from a web-based weight loss intervention, we examined whether participants articulating their goals and accomplishments in measurable and repeating terms were associated with greater weight loss. METHODS: Adults with overweight or obesity received a 12-week Facebook-delivered weight loss intervention based on the Diabetes Prevention Program Lifestyle Intervention. Participants replied to conversation threads that queried about their goals and accomplishments. Two independent coders classified participants' posts that articulated goals or accomplishments as measurable or repeating. Crude and age-adjusted linear regression models were used to examine the relationship between the frequency of post type and percent weight loss. RESULTS: Participants (N=53; n=48, 91% female; n=48, 91% non-Hispanic White) were on average 46.2 (SD 10.5) years old with a mean BMI of 32.4 (SD 4.8) kg/m2. Over 12 weeks, participants shared a median of 4 (IQR 1-8) posts that reported goals and 10 (IQR 4-24) posts that reported accomplishments. Most participants shared ≥1 post with a goal (n=43, 81%) and ≥1 post with an accomplishment (n=47, 89%). Each post reporting a goal was associated with 0.2% greater weight loss (95% CI -0.3% to 0.0%). Sharing ≥1 post with a repeating goal was associated with an average of 2.2% greater weight loss (95% CI -3.9% to -0.4%). Each post with a repeating goal was associated with an average of 0.5% greater weight loss (95% CI -1.0% to 0.0%). Sharing ≥1 post with measurable and repeating goals was associated with an average of 1.9% greater weight loss (95% CI -3.7% to -0.2%). Sharing each post with an accomplishment was associated with an average of 0.1% greater weight loss (95% CI -0.1% to 0.0%). Every post with an accomplishment that was repeating was associated with an average of 0.2% greater weight loss (95% CI -0.3% to 0.0%). Sharing other types of goals and accomplishments was not associated with weight loss. CONCLUSIONS: In a web-based weight loss intervention, stating goals in repeating or both measurable and repeating terms was associated with greater weight loss, but simply stating them in measurable terms was not. For accomplishments, only those articulated in repeating terms were associated with greater weight loss. Posts about one-time goals and accomplishments represent an opportunity to encourage planning for future behaviors. Future research should examine if stating goals and accomplishments in repeating terms signals habit formation.

Social Media Use Among Parents and Women of Childbearing Age in the US.

Many parents and pregnant women in the US use social media to access health-related information. Estimates of current use of different platforms among these populations are needed. We used data from a 2021 Pew Research Center survey to describe use of commercial social media platforms by US parents and US women aged 18 to 39 years. Most US parents and women of childbearing age use YouTube, Facebook, and Instagram, with most engaging daily. Understanding social media use patterns can help public health professionals, health care systems, and researchers reach selected populations with evidence-based health information and health promotion programs.

Reasons mothers of young children delayed or skipped preventive health care during the first year of the COVID-19 pandemic.

BACKGROUND: Preventive health care provides opportunity for preventive screenings and health promotion. Mothers of young children may disproportionately experience barriers to preventive care during the COVID-19 pandemic. METHODS: We examined delaying and skipping preventive health care during the first year of the COVID-19 pandemic among mothers and described reasons for delaying or skipping care. Mothers of children aged 0-12 years from the United States completed an online survey in February/March 2021 and reported receipt of preventive care during the COVID-19 pandemic, reasons for delaying or skipping care, demographics, and experiences with COVID-19. RESULTS: Participants (N = 306) were on average 35.9 (SD: 6.2) years old, racially/ethnically diverse, and 74.8% had at least a Bachelor's degree. From March 2020 to March 2021, 16.0% delayed and 20.6% skipped their physical examination, and 20.9% had not planned on receiving a physical examination. The most common reasons for delaying and skipping care were COVID-19 infection concerns, perception that delaying care would not negatively impact health, provider rescheduling, time, and childcare. CONCLUSIONS: Primary care teams may need to re-engage mothers who skipped preventive care during the pandemic, including addressing concerns about COVID-19 infection.

Mothers of young children may experience barriers to receiving preventive health care during the COVID-19 pandemic. Continued delay or skipping of these services may negatively impact mothers' health and decreases opportunity for intervention. We conducted an online survey of mothers of children 0­12 years old who live in the United States. We asked mothers whether they had delayed or skipped their routine physical examination during the first year of the COVID-19 pandemic, and if so, reasons they delayed or skipped care. From March 2020 to March 2021, 16% of mothers delayed their physical examination, 21% skipped their physical examination appointment, and 21% had not planned on receiving a physical examination. The most common reasons for delaying and skipping care were COVID-19 infection concerns, perception that delaying care would not negatively impact health, provider rescheduling, time, and childcare. Primary care teams may need to re-engage mothers who skipped preventive care during the pandemic, including addressing concerns about COVID-19 infection.

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.

Factors associated with mothers' hesitancy to receive a COVID-19 vaccine.

Vaccine hesitancy can impact maternal and child vaccination rates. We examined factors associated with mothers' hesitancy to receive a COVID-19 vaccine using data from an online survey conducted from mid-February to mid-March 2021. Among unvaccinated participants (N = 203), 28% reported that they would probably not or definitely not get a COVID-19 vaccine. Mothers with high school/GED/trade/technical education (38% hesitant, aOR = 4.0, 95% CI: 1.2-13.2), Associate's degree (43%, aOR = 6.8, 95% CI: 2.4-19.5), and Bachelor's degree (30%, aOR = 3.1, 95% CI: 1.1-8.4) were more likely to report vaccine hesitancy compared to mothers with a graduate degree (19%). Non-Hispanic Black mothers (40% hesitant, aOR = 2.8, 95% CI: 1.0-7.6) were more likely to be vaccine hesitant compared to non-Hispanic white mothers (19%). Mothers with low pandemic-related anxiety were more likely to report vaccine hesitancy than mothers with high pandemic-related anxiety (56% vs 23% hesitant; aOR = 4.8, 95% CI: 1.7-14.1). Research is needed to understand informational, emotional, and attitudinal factors contributing to COVID-19 vaccine hesitancy among mothers to develop and test effective public health messaging to increase vaccination rates.

Medication cost-reducing behaviors in older adults with atrial fibrillation: The SAGE-AF study.

BACKGROUND: As patient prices for many medications have risen steeply in the United States, patients may engage in cost-reducing behaviors (CRBs) such as asking for generic medications or purchasing medication from the Internet. OBJECTIVE: The objective of this study is to describe patterns of CRB, cost-related medication nonadherence, and spending less on basic needs to afford medications among older adults with atrial fibrillation (AF) and examine participant characteristics associated with CRB. METHODS: Data were from a prospective cohort study of older adults at least 65 years with AF and a high stroke risk (CHA2DS2VASc ≥ 2). CRB, cost-related medication nonadherence, and spending less on basic needs to afford medications were evaluated using validated measures. Chi-square and t tests were used to evaluate differences in characteristics across CRB, and statistically significant characteristics (P < 0.05) were entered into a multivariable logistic regression to examine factors associated with CRB. RESULTS: Among participants (N = 1224; mean age 76 years; 49% female), 69% reported engaging in CRB, 4% reported cost-related medication nonadherence, and 6% reported spending less on basic needs. Participants who were cognitively impaired (adjusted odds ratio 0.69 [95% CI 0.52-0.91]) and those who did not identify as non-Hispanic white (0.66 [0.46-0.95]) were less likely to engage in CRB. Participants who were married (1.88 [1.30-2.72]), had a household income of $20,000-$49,999 (1.52 [1.02-2.27]), had Medicare insurance (1.38 [1.04-1.83]), and had 4-6 comorbidities (1.43 [1.01-2.01]) had significantly higher odds of engaging in CRB. CONCLUSION: Although CRBs were common among older adults with AF, few reported cost-related medication nonadherence and spending less on basic needs. Patients with cognitive impairment may benefit from pharmacist intervention to provide support in CRB and patient assistance programs.

Usefulness of Self-Reported Physical Activity and Clinical Outcomes in Older Patients With Atrial Fibrillation.

Current guidelines encourage regular physical activity (PA) to gain cardiovascular health benefit. However, little is known about whether older adults with atrial fibrillation (AF) who engage in the guideline-recommended level of PA are less likely to experience clinically relevant outcomes. We did a retrospective study based on the data from Systemic Assessment of Geriatric Elements in AF (SAGE-AF) prospective cohort study. The study population consisted of older participants with AF (≥65 years) and a congestive heart failure, hypertension, age, diabetes, stroke vascular disease, age 65 to 75 and sex(CHA2DS2-VASc) score ≥2. PA was quantified by self-reported Minnesota Leisure Time PA questionnaire. Competing risk models were used to examine the association between PA level and clinical outcomes over 2 years while controlling for several potentially confounding variables. A total of 1,244 participants (average age 76 years; 51% men; 85% non-Hispanic White) were studied. A total of 50.5% of participants engaged in regular PA. Meeting the recommended level of PA was associated with lower mortality over 2 years (adjusted hazard ratio 0.60, 95% confidence interval 0.38 to 0.95) but was not associated with rates of stroke or major bleeding. In conclusion, older adults with AF who engaged in guideline-recommended PA are more likely to survive in the long term. Healthcare providers should promote and encourage engagement in PA and tailor interventions to address barriers of engagement.

Online health information seeking, low atrial fibrillation-related quality of life, and high perceived efficacy in patient-physician interactions in older adults with atrial fibrillation.

Background: Little is known about online health information-seeking behavior among older adults with atrial fibrillation (AF) and its association with self-reported outcomes. Objective: To examine patient characteristics associated with online health information seeking and the association between information seeking and low AF-related quality of life and high perceived efficacy in patient-physician interaction. Methods: We used data from the SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study, which includes older participants aged ≥65 years with AF and a CHA2DS2-VASc risk score ≥2. To assess online health information seeking, participants who reported using the Internet were asked at baseline if they used the Internet to search for advice or information about their health in the past 4 weeks (not at all vs at least once). Atrial Fibrillation Effect on Quality of Life and Perceived Efficacy in Patient-Physician Interactions questionnaires were used to examine AF-related quality of life (QOL) and patient-reported confidence in physicians. Logistic regression models were used to examine demographic and clinical factors associated with online health information seeking and associations between information seeking and low AF-related QOL (AFEQT <80) and high perceived efficacy for patient-physician interactions (PEPPI ≥45). Results: A total of 874 online participants (mean age 74.5 years, 51% male, 91% non-Hispanic White) were studied. Approximately 60% of participants sought health information online. Participants aged 74 years or older and those on anticoagulation were less likely, while those with a college degree were more likely, to seek online health information after adjusting for potential confounders. Participants who sought health information online, compared to those who did not, were significantly more likely to have a low AF-related QOL, but less likely to self-report confidence in patient-physician interaction (aOR = 1.56, 95% CI: 1.15-2.13; aOR = 0.68, 95% CI: 0.49-0.93, respectively). Conclusion: Clinicians should consider barriers to patient-physician interaction in older adults who seek health information online, encourage shared decision-making, and provide patients with a list of online resources for AF in addition to disease education plans to help patients manage their health.

A Facebook-Delivered Weight Loss Intervention Using Open Enrollment: Randomized Pilot Feasibility Trial.

BACKGROUND: Behavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes. OBJECTIVE: In this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization. METHODS: We conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m2. The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ≥5% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups. RESULTS: Randomized participants (68/80, 85% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m2. We enrolled an additional 54 participants (50/54, 93% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88% and 98% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ≥5% was achieved by 30% (12/40) of the participants randomized to the open enrollment condition and 18% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics. CONCLUSIONS: Open enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680.

Gestational weight gain in uncomplicated twin pregnancies by pre-pregnancy body mass index.

In 2009, the Institute of Medicine provided provisional guidelines for gestational weight gain (GWG) in twin gestations, citing limited research. We examined GWG by pre-pregnancy body mass index in a retrospective cohort of twin births uncomplicated by infant mortality, preterm birth, or low birth weight from Massachusetts in 2006-2017 (N = 273). Median (inter-quartile range [IQR]) GWG was 20.4 kg (IQR: 17.2-25.9 kg) for women who were normal weight pre-pregnancy, 21.3 kg (IQR: 17.2-25.9 kg) for women with overweight pre-pregnancy, and 13.6 kg (IQR: 8.6-20.9 kg) for women with obesity pre-pregnancy. Findings can inform the next generation of GWG recommendations for twin pregnancies.