How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunities.

With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. Each of these design methods requires a deliberate effort by practitioners to infuse health equity into the approach. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors. We conclude with a call for shared rigor around designing digital health tools that deliver equitable outcomes for members of underserved populations.

Vaping Behavior and Intention to Quit among Undergraduate Students in a Hispanic-Serving University.

The surge in electronic nicotine delivery systems (ENDS) usage, particularly among young adults, poses significant public health concerns. This study aimed to identify predictors of e-cigarette use, quit attempts, and frequency among undergraduate students in a Hispanic-serving university in Texas. A cross-sectional study was conducted between August 1 and October 26, 2023, recruiting undergraduate students through the Sona system, an online experiment management platform. Participants completed an online survey that covered demographics, educational status, vaping status, initiation age, reasons for first and current e-cigarette use, frequency of past usage, intentions to quit, and quit attempt frequency. Statistical analysis included descriptive statistics, multinomial logistic regression, and multivariable linear regression. Among 316 participants, 33.9% reported current e-cigarette use. Junior and senior students, as well as prior tobacco users, were more likely to be current vapers. Prior vaping experience was more prevalent among Hispanic individuals and those with a history of tobacco use. Notably, 74.3% of current users attempted to quit in the past year, with a higher frequency of quit attempts among females, Hispanic students, and those with vaping acquaintances. However, the vaping behavior and quit attempt patterns were similar across other categories. This study highlights how various factors influence e-cigarette use among college students. It suggests that prevention and quitting programs should consider the specific needs of different groups. Future studies will continue to look at different student groups to find the most effective ways to help them quit vaping.

Validation of the Sexual Discounting Task for Use in Adolescents.

The Sexual Discounting Task (SDT) was developed to evaluate the effects of delay on decision making as it relates to sexual risk-taking behaviors. Though previously validated with other populations, including urban emerging adults, the current study sought to validate the SDT with adolescents. A sample of adolescents (N = 155; 61% female) between ages 14 and 21 (Mage = 19.5 years) was recruited to complete the SDT (involving choices between immediate unprotected sex and delayed sex with a condom with hypothetical sexual partners) and the Delay Discounting Task (a delay discounting task for money outcomes). Additionally, they completed several self-report measures assessing demographics, sexual behavior, and sexual history. If the condom was readily available, respondents were more likely to use a condom for partners who were judged "most likely to have an STI" and for those that participants were "least likely to have sex with." Moreover, when a condom was not immediately available, greater self-reported sexual risk-taking was related to greater sexual discounting (i.e., greater effects of delay on decreasing condom use). Furthermore, sexual discounting was greater among partners deemed more desirable and those judged "least likely to have an STI." Differences in sexual discounting were significant after controlling for immediately available condom use. Findings from the current study suggest that the SDT is clinically meaningful for adolescents and is sensitive to factors that influence real-world decisions to use condoms. Future treatment and prevention should consider delay discounting as an important variable affecting sexual risk behavior.

Comparisons of Explicit Weight Bias Across Common Clinical Specialties of US Resident Physicians.

BACKGROUND: Patients with high body weight are persistently stigmatized in medical settings, with studies demonstrating that providers endorse negative stereotypes of, and have lower regard for, higher-weight patients. Very little is known about how this weight bias varies across specialties. OBJECTIVE: The purpose of this study is to examine how explicit weight bias varies between resident providers among sixteen of the largest residency specialties in the USA. The identification of these differences will guide the prioritization and targeting of interventions. DESIGN: The current study utilized cross-sectional, observational data. PARTICIPANTS: Forty-nine allopathic medical schools were recruited to participate in this national, longitudinal study. The current study utilized data from 3267 trainees in Year 2 of Residency among those who specialized in one of the most common sixteen residency programs in 2016. MAIN MEASURES: Participants reported demographic information and residency specialties and completed three sets of measures pertaining to explicit weight bias. KEY RESULTS: A significant minority (13-48%) of residents reported slight-to-strong agreement with each anti-fat statement. There was a significant relationship between residency specialty and anti-fat blame (F(15, 3189 = 12.87, p < .001), η2 = .06), anti-fat dislike (F(15, 3189 = 7.01, p < .001), η2 = .03), and attitudes towards obese patients (F(15, 3208 = 17.78, p < .001), η2 = .08). Primary care residents (e.g., family medicine, pediatrics) consistently reported lower levels of weight bias than those in specialty programs (e.g., orthopedic surgery, anesthesiology). CONCLUSIONS: This study is the first to report on weight bias in a large, heterogeneous sample of US resident physicians. Problematic levels of weight bias were found in all specialties, with residents in specialty programs generally reporting more bias than those in primary care residencies. Future research should examine which factors contribute to these differences to guide intervention.

Iron Deficiency in Attention-Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Internalizing and Externalizing Disorders, and Movement Disorders.

This article reviews the role of iron in brain development and function, with a focus on the association between iron deficiency (ID) and neuropsychiatric conditions. First, we describe how ID is defined and diagnosed. Second, the role of iron in brain development and function is summarized. Third, we review current findings implicating ID in a number of neuropsychiatric conditions in children and adolescents, including attention deficit hyperactivity disorder and other disruptive behavior disorders, depressive and anxiety disorders, autism spectrum disorder, movement disorders, and other situations relevant to mental health providers. Last, we discuss the impact of psychotropic medication on iron homeostasis.

A mixed-method analysis of counterfactual thinking, negative event themes, and the transtheoretical model in a community sample of smokers.

The transtheoretical model has been used as a model of behavior change for tobacco users. However, it does not account for perceptions of past behavior that may provide additional guidance toward smoking cessation. No studies have examined associations between the transtheoretical model, content themes of smoking experiences, and counterfactual thoughts (i.e. "If only. . .then. . ."). Mturk participants (N = 178; 47.8% female) completed measures of smoking attitudes, behavior, and stage and processes of change use. Participants described a past negative smoking event and an event-related counterfactual thought-listing task. Participants in the precontemplation stage endorsed fewer processes of change. Also, participants in the action stage reported significantly more counterfactuals about cravings (e.g. If only I could have controlled my urge to smoke. . .) inferring that they may be identifying cravings or urges as relevant barriers toward smoking cessation. Identifying these self-relevant thoughts may provide additional ways to address and overcome barriers toward achieving long-term smoking cessation.

Using a counterfactual-based intervention to change eating intentions: Results from Hispanic and non-Hispanic undergraduate and community samples.

Finding ways to improve eating behavior has become a major focus of interventions designed to improve health outcomes. Counterfactual thinking (i.e., mental simulations of how a past outcome could have been different) is a cognitive strategy that has been shown to improve behavior regulation and could be a promising intervention to improve eating behavior. The purpose of the current research was to examine the effect of a counterfactual-based intervention to shift contemplation to change eating behavior, motivation towards eating healthier, and intentions to engage in healthier eating behaviors. Participants in both studies were randomly assigned to either a counterfactual-based intervention or a control condition. In Study 1, those in the counterfactual-based intervention condition reported an increase in readiness to change their eating behavior, higher extrinsic motivation towards eating healthy, and higher intentions to eat healthy compared to those in the control condition. Within the counterfactual condition, individuals who self-identified as Hispanic had higher intentions to use their counterfactual strategies than those who identified as non-Hispanic. Study 2 found similar results using a more diverse community sample. Those in the counterfactual-based intervention condition reported an increase in readiness to change, intentions to eat healthy, and intentions to use their counterfactual strategies, with this effect being stronger for self-identified Hispanic participants. These studies provide initial evidence for the use of a counterfactual-based intervention to improve eating behavior in diverse populations.

Group differences in binge eating, impulsivity, and intuitive and mindful eating among intermittent fasters and non-fasters.

Intermittent fasting (IF) is an increasingly popular diet involving short-term fasting and/or caloric restriction. While published research highlights physiological effects (e.g., weight, body fat) of IF, hardly any research has examined its associations with psychological factors. This study aimed to investigate the relationship between IF and binge eating, impulsivity, intuitive eating, and mindful eating. An undergraduate sample (N = 298) was recruited through a large southwestern university psychology subject pool. The sample was divided into three groups based on IF status: Current IF (n = 70), Past IF (n = 48), and No IF (n = 182). Current IF was negatively associated with lack of perseverance (e.g., "I generally like to see things through to the end"; p < .01) and intuitive eating (p < .05), varying by subscale, compared to the other groups. Notably, Past-IF, but not Current IF, participants were more likely to binge eat than individuals who reported never fasting (p = .03). These findings add credence to the rapidly developing area of research suggesting IF is associated with increased disordered eating behaviors. Notably, the findings from this study are limited due to the lack of diversity sample, such that generalizations can only be made toward White, middle-to-high income, college students. Future longitudinal studies are needed to test the directionality of these relationships.

From if-then to here and now: Using personalized counterfactuals from past negative experiences to reduce future alcohol consequences.

College students are at an increased risk for problematic alcohol use. To address this health concern, several interventions have used protective behavioral strategies (PBS). However, interventions promoting PBS remain underdeveloped and underutilized. Counterfactual thinking is a type of postmortem cognitive strategy that highlights causal links between a behavior and a negative outcome. Recent research demonstrates the effectiveness of applying counterfactuals for increasing PBS use intentions. The present study examines the effect of a brief counterfactual-based intervention for increasing PBS use and decreasing adverse alcohol outcomes. Undergraduate students (n = 73) completed an online multiweek (baseline and five weekly follow-ups) intervention. At baseline, participants completed demographics, PBS use, and alcohol use and consequences. They were then randomly assigned to one of three conditions: a control (negative event only), sham (negative event with detailed description), or counterfactual (If only … then …) condition. At weekly follow-up sessions, participants completed PBS use and alcohol use and consequences from the previous week. The counterfactual condition was presented with their counterfactuals generated at baseline. Relative to the active control, the counterfactual condition reported greater use of PBS across the five-week follow-ups. This in turn resulted in decreases in alcohol consumed and alcohol-related consequences. This study highlights the effectiveness of counterfactual thinking as a relevant harm-reduction strategy for alcohol-related outcomes in college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relations Between Adolescent Sensation Seeking and Risky Sexual Behaviors Across Sex, Race, and Age: A Meta-Analysis.

Sensation seeking (SS)-the seeking of novel and intense sensations or experiences and the willingness to take risks for the sake of such experiences-has been shown to be related to various risky sexual behaviors (RSBs) in areas such as multiple sexual partners, condom use, and sexual initiation. The aims of the current meta-analysis were to examine (1) how SS relates to specific RSBs in adolescents and (2) how the overall relationship between SS and RSB differs across sex, race, and age. Overall, a total of 40 studies met the inclusion criteria for our meta-analysis examining the relationship between SS and RSB, contributing 102 effect sizes. RSB variables included unprotected sex; multiple sexual partners; hazardous sexual activity; sexual initiation; virginity status; and history of sexually transmitted disease (STD) diagnosis. Moderating effects of sex, race, and age were also examined. The overall mean effect size of the correlational relationship between adolescent SS and RSB was statistically significant, as were the mean effect sizes of the relationships between SS and RSB subgroups, except for history of STD diagnosis. Race and age did not significantly moderate the overall relationship between SS and RSB; however, results indicated that SS and RSB relations were stronger in females compared to males. Our findings suggest that adolescents with elevations in SS tendencies tend to engage in more RSBs compared to their peers with lower levels of SS, increasing their risk of unplanned pregnancy and STD acquisition.

Positive Urgency, Drinking Preoccupation, and Alcohol Problems in College Students.

OBJECTIVE: Individuals high in positive urgency (i.e., impulsiveness stemming from high positive mood) may be more preoccupied with alcohol-related cognitions. Our aim was to examine how positive urgency, drinking preoccupation, and consumption patterns concurrently influence the endorsement of alcohol-related problems. METHOD: We sampled 756 students enrolled in a large, public U.S. university, who completed a cross-sectional survey online. Their mean age was 19.6 (SD = 1.72), 71.3% identified as female, and participants largely identified as Caucasian (65.5%) and Hispanic/Latinx (22.1%). Self-report measurements of trait positive urgency and drinking preoccupation and retrospective data of alcohol use and alcohol-related problems were collected. A series of linear regressions tested for a hypothesized indirect effect between variables. RESULTS: We discovered an indirect effect in the relationship between positive urgency and alcohol-related problems via drinking preoccupation. A significant conditional effect showed that this relationship was influenced by past 30-day alcohol consumption, with the effect gaining strength as consumption days increased. CONCLUSIONS: Students with high positive urgency may be more engrossed with alcohol-related drinking cognitions, leading to negative consequences as their alcohol consumption increases. This potential association can inform tailored intervention plans for college student alcohol control, such as successfully managing intense positive moods and alcohol-related cognitions and triggers.

A Systematic Review of Patient-Perceived Barriers and Facilitators to the Adoption and Use of Remote Health Technology to Manage Diabetes and Cardiovascular Disease among Disproportionately Affected Populations.

As noncontact health interventions have become critical during the Covid-19 pandemic, our study aimed to systematically review the published literature for barriers and facilitators influencing the adoption and use of remote health intervention and technology, as perceived by adult patients with diabetes or cardiovascular diseases (CVD) belonging to groups that are socially/economically marginalized and/or medically under-resourced. We searched Medline, Embase, CINAHL, and PsychINFO for peer-reviewed articles published from 2010 to 2018. We employed content analysis to analyze qualitative patient feedback from the included studies. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 42 studies met the inclusion criteria. The design of the remote health technology used was the most frequently mentioned facilitator and barrier to remote health technology adoption and use. Our results should draw the attention of technology developers to the usability and feasibility of remote technology among populations that are socially/economically marginalized and/or medically under-resourced.

Ethnicity, age, and education influence perceptions of vegetable healthiness and macronutrient content.

Objective: To assess perceptions of nutritional content and health value of popular vegetables. Design: Cross-sectional online survey. Participants: A total of 760 adults participated in the study. Main Outcome Measures: Likert scale ratings of healthy, calories, carbohydrates, protein, and fiber, for (i) avocado, (ii) romaine lettuce, (iii) white potato, (iv) white onion, and (v) red tomato. Analysis: ANOVAs for continuous variables and Chi-square for categorical variables. Outcomes for nutritional content were compared using separate one-way ANOVAs with ethnicity (Hispanic/Latino vs. non-Hispanic); education (college degree/no college degree); age (18-34, 35-50, 51-70, 70 + ); and diabetes status (with or without diabetes) as the grouping variables. Results: Significant ethnicity effects were found for avocado, lettuce, potato, onion, and tomato. Education level effects were found for avocado, lettuce, potato, and tomato. Age level effects were found for avocado, lettuce, potato, and tomato. Conclusions and Implications: Participant perceptions of the macronutrient content of common vegetables and fruits largely coincided with the US Department of Agriculture values. However, stratifying by ethnicity, age, and education revealed significant differences in both macronutrient perceptions and perceived healthiness. There were no consistent, significant results for interactions of ethnicity by education, nor ethnicity by age. These results suggest that dietary interventions may need to be adjusted based on participant sociodemographic characteristics linked to the perceptions of nutritional value and healthiness.

Development and Validation of a Validity Scale for Use with the UPPS-P and Short UPPS-P Impulsive Behavior Scales.

Two of the most widely used self-report measures of impulsivity are the UPPS-P Impulsive Behavior Scale and its shortened version, the SUPPS-P, which currently are limited by their inability to detect careless and/or random responding. The present study develops and cross-validates an inconsistency scale for use with the UPPS-P and SUPPS-P in order to accurately screen for data quality and better detect invalid responding. A total of 443 participants were recruited from Amazon's MTurk online data collection service to serve as the derivation sample and 231 undergraduates were recruited to serve as the cross-validation sample. The inconsistency scale demonstrated good classification accuracy in differentiating between genuine and random protocols and moderated the relationships between the UPPS-P/SUPPS-P and a criterion measure of impulsivity, the Barratt Impulsiveness Scale-11 (BIS-11). Thus, the inconsistency scale shows promise as an indicator of variable response inconsistency for use with both the UPPS-P and SUPPS-P in community and undergraduate research samples.

The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review.

BACKGROUND: Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. OBJECTIVE: This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). METHODS: A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. RESULTS: Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. CONCLUSIONS: Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching.

Problematic Mobile Phone and Smartphone Use Scales: A Systematic Review.

The popularity of smartphones is undeniable in nearly all facets of society. Despite the many benefits attributed to the technology, concern has grown over the potential for excessive smartphone use to become problematic in nature. Due to the growing concerns surrounding the recognized and unrecognized implications of smartphone use, great efforts have been made through research to evaluate, label and identify problematic smartphone use mostly through the development and administration of scales assessing the behavior. This study examines 78 existing validated scales that have been developed over the past 13 years to measure, identify or characterize excessive or problematic smartphone use by evaluating their theoretical foundations and their psychometric properties. Our review determined that, despite an abundance of self-report scales examining the construct, many published scales lack sufficient internal consistency and test-retest reliability. Additionally, there is a lack of research supporting the theoretical foundation of many of the scales evaluated. Future research is needed to better characterize problematic smartphone use so that assessment tools can be more efficiently developed to evaluate the behavior in order to avoid the excessive publication of seemingly redundant assessment tools.

Does mindfulness reduce the effects of risk factors for problematic smartphone use? Comparing frequency of use versus self-reported addiction.

BACKGROUND: There is growing concern regarding problematic smartphone overuse. Practiced mindfulness, the state of being aware of the present moment, may protect against problematic smartphone use by reducing the strength of risk factors. PURPOSE: We hypothesized that trait mindfulness can reduce the impact of risk factors on a) objective smartphone use and b) subjective problematic smartphone use. METHODS: Our sample (n = 135, Mage = 19.15, 68% female) consisted of college students from a large university. Participants completed self-report measures of boredom proneness, impulsivity, technology-related anxiety (nomophobia), trait mindfulness, smartphone use frequency, and problematic use. RESULTS: Higher mindfulness was significantly associated with lower boredom proneness, impulsivity, and problematic use (F = 12.12, p < .01). Hierarchical regression revealed that the positive relationships between nomophobia, and problematic use decreased as mindfulness levels increased. A similar protective effect was observed for boredom proneness, although the effect dissipated as impulsivity rose. A second regression revealed no significant predictors of weekly smartphone use. CONCLUSIONS: Effects of nomophobia and boredom proneness on problematic smartphone use diminish with increased mindfulness, but impulsivity may interfere with this. Risk and protective factors for 'addiction' appear unrelated to smartphone use frequency. Future research should examine benefits of mindfulness-based interventions in promoting emotional and cognitive self-regulation, focusing on those who use smartphones in dysfunctional ways.

Sensation seeking, sexual orientation, and drug abuse symptoms in a community sample of emerging adults.

Increased use of drugs is associated with a number of factors including high sensation seeking and sexual minority status (through group-specific minority stress). We sought to examine how personality traits like sensation seeking may influence drug abuse among sexual minority individuals. Participants were 217 emerging adults (Mage = 20.23, SD = 0.85) recruited from Amazon Mechanical Turk (MTurk). Of these participants, 67.7% identified as heterosexual, 9.7% as gay or lesbian, 21.2% as bisexual, and 1.4% indicated other sexual orientations. Sensation seeking and drug abuse were self-reported using the Brief Sensation Seeking Scale and the Drug Abuse Screening Test, respectively. A preliminary multiple analysis of variance indicated no significant mean differences for these variables as a function of sex or sexual orientation. Next, sexual minority status, Brief Sensation Seeking Scale scores, sex and their interactions were entered into a linear regression predicting Drug Abuse Screening Test scores. Results revealed a significant moderation, such that the positive relationship between Brief Sensation Seeking Scale total scores and Drug Abuse Screening Test total scores was stronger for sexual minorities (ß = 0.14, P = 0.00) compared to heterosexuals (ß = 0.04, P = 0.04), controlling for sex. These results demonstrate, while sensation seeking and sexual minority status may selectively indicate risk for drug use, sexual minorities high in sensation seeking may be at especially high risk for problems related to drug abuse. More research examining the addiction etiology of sexual minority individuals would inform targeted interventions for this population.