Physical Activity, Stress, and Physically Active Stress Management Behaviors Among University Students With Overweight/Obesity.

Student physical activity is associated with lower stress. Research gaps remain regarding the types of stress management behaviors students use and how these behaviors are associated with students' activity levels. This study examined associations between physical activity and stress management behaviors among students (18-35 years). Students with overweight/obesity (n = 405) attending universities in 2 urban locations enrolled in a randomized controlled trial to promote healthy weight and completed the following baseline measurements: perceived stress, stress management behaviors, accelerometer-measured physical activity, and demographic characteristics. Perceived stress did not differ by physical activity status or race. A greater proportion of students meeting moderate-to-vigorous physical activity guidelines used physically active stress management behaviors compared to those not meeting guidelines (74% vs 56%; P = .006), and students using physically active stress management had lower stress scores (13.1 vs 15.5; P = .003). Among Black and White students only (n = 306), a greater proportion of White students used physically active stress management behaviors compared to Black students (77% vs 62%, P = .013). Results indicate differences in stress management behaviors by student activity level and race. During times of high stress, colleges/universities might support students by promoting stress management and physical activity in tandem, and tailoring messages to student activity levels and demographic characteristics.

Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis.

Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.

Knowledge about the cost-effectiveness of weight loss programs for university students is needed to inform administrator decision-making regarding whether to provide such programming. This study examined the cost-effectiveness of two digitally-delivered weight loss interventions (i.e., TAILORED and TARGETED) designed for university students. The TAILORED intervention included information tailored to the individual, while the TARGETED intervention included only generic weight loss information. At 6 months, the average cost per kilogram of weight loss was $107.82 for TAILORED participants and $179.29 for TARGETED participants. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention.

Sleep duration and chronotype of pregnant women in the United States: An online cross-sectional survey study.

Sleep is an important behavior, and during pregnancy plays a critical role in promoting the health of both woman and child. Therefore, identifying and addressing sleep parameters during pregnancy, and associated disparities in maternal-child health outcomes, is a public health priority. This studied aimed to examine chronotype and sleep duration in pregnant women by sociodemographic factors. An online survey was distributed to currently pregnant women living in the greater Washington, DC, area of the United States from March to May of 2022. The survey included the ultra-short version of the Munich Chronotype Questionnaire (µMCTQ), which was used to calculate the mid-point of sleep time (MST; a measure of chronotype) and sleep duration, as well as demographic questions. Linear regression was used to assess differences in sleep outcomes by demographic factors. A sample of n = 142 currently pregnant women were eligible for analysis. In covariate adjusted models, sleep duration was longer among respondents ages 25-34 (09:52) compared with younger respondents ages 18-24 (08:59; p = 0.014), and shorter for those with a household income ≥ 100,000 United States dollars (USD) (07:42) compared with those with a household income < 50,000 USD (08:59; p = 0.001). No differences in mean mid-point of sleep were identified across demographic factors. Differences in sleep duration by age and household income were found among currently pregnant women. Future studies should investigate sleep parameters and other factors that may influence maternal-child health disparities.

Domains of Sedentary Behavior and Cognitive Function: The Health, Aging, and Body Composition Study, 1999/2000 to 2006/2007.

BACKGROUND: This study examines the relationship between various domains of sedentary behavior and subsequent cognitive function to evaluate whether different sedentary activities have specific associations with future cognitive performance. METHODS: Data were from 1 261 older adults participating in the Health, Aging, and Body Composition (Health ABC) Study between 1999/2000 and 2006/2007. Total sitting time (hours/day), reading time (hours/week), and TV time (≤27/≥28 h/wk) were self-reported at baseline and 3 years later. At follow-up, cognitive function was evaluated using the Teng Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST). Multivariable linear regression modeling examined the independent associations of baseline sedentary behaviors and 3-year change in those behaviors with cognitive function scores at follow-up, adjusting for important covariables. RESULTS: Baseline total sitting time was positively associated with 3MS (ß = 0.14 ± 0.07; p < .05) and DSST (ß = 0.20 ± 0.10; p < .05) scores at follow-up, as was reading time (ß = 0.09 ± 0.03; p < .05 for 3MS score and ß = 0.14 ± 0.04; p < 0.01 for DSST score). Participants who increased their TV watching time over 3 years had a significantly lower 3MS score (ß = -1.45 ± 0.71; p < .05) at follow-up, compared with those who maintained a low level of TV time (referent). These findings were independent of age, sex, race, education level, health status, depressive symptoms, and physical activity. CONCLUSION: Some types of sedentary behavior may have benefits for cognitive function in older age, thus highlighting the importance of measuring different domains of sitting time.

Associations Between College/University Physical Activity Requirements and Student Physical Activity.

Background: Most U.S. college students do not meet physical activity guidelines. Physical activity requirements (PAR) are a proposed solution for increasing undergraduate physical activity. Purpose: To determine whether college/university PAR are associated with undergraduates' self-reported physical activity. Methods: Undergraduate students (N = 383,632) attending colleges and universities taking part in the American College Health Association-National College Health Assessment II survey (2015-2019) self-reported physical activity and demographics. Using websites and course catalogs, researchers coded schools to indicate binary PAR status. Bayesian Hierarchical Logistic Regression was used to determine the percentage of students meeting physical activity guidelines; interactions between PAR status and student characteristics (sex, BMI) were examined. Results: PAR status was positively associated with percent of students meeting physical activity guidelines (PAR: 43.3%, without: 40.5%; difference score 95% Highest Density Interval [HDI; 1.0, 4.5]). A greater percentage of students attending schools with PAR, versus without, met physical activity guidelines across all categories of sex and weight. However, the positive relationship between PAR status and physical activity was stronger among male students (PAR: 46.7%, without: 43.2%; 95% HDI [1.6, 5.4]) compared to female students (PAR: 39.9%, without: 37.9%; 95% HCI [0.2, 3.8]), and among students with underweight (PAR: 39.2%, without: 35.5%; 95% HDI [1.2, 6.3]) or obesity (PAR: 37.1%, without: 33.7%; 95% HDI [1.4, 5.3]) compared to normal weight (PAR: 49.3%, without: 47.4%; 95% HDI [0.1, 3.7]) or overweight (PAR: 47.5%, without: 45.5%; 95% HDI [0.1, 4.0]). Conclusions: PAR are associated with meeting physical activity guidelines, particularly among college/university students with underweight or obesity.

Application of McGuire's Model to Weight Management Messages: Measuring Persuasion of Facebook Posts in the Healthy Body, Healthy U Trial for Young Adults Attending University in the United States.

Digital communication is a common intervention channel for weight loss, yet little is known about the types of messages that are most effective. Using McGuire's Model of Communication and Persuasion as a framework, this study investigates the persuasiveness of Facebook messages posted as part of the weight loss intervention in the Healthy Body Healthy U (HBHU) study to determine what message characteristics prompt higher engagement on Facebook, and whether certain messages are more appealing to certain demographics. The first four weeks of HBHU Facebook posts (n = 32) were coded according to McGuire's Input Communication Factors. Facebook engagement scores [(Total Engaged Users/Total Reach) × 100] were calculated for each post to determine effectiveness. The most effective posts were diet-related discussions or interactive polls. Participants who engaged with the highest and lowest effect posts were in their mid-twenties and tended to be female. Those engaged with the highest effect posts had an average BMI of 32.34 kg/m2, while those engaged with the lowest effect posts had an average BMI of 31.31 kg/m2. The least effective posts were didactic lessons (i.e., diet- or reminder-based), or video-based informational posts (edutainment). Future interventions should balance didactic content and interactive engagement to achieve persuasive messaging.

Women's Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Since March 2020, the need to reduce patients' exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. OBJECTIVE: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. METHODS: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. RESULTS: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). CONCLUSIONS: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic.

Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity.

This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m2. For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.

What moves young people? Applying the risk perception attitude framework to physical activity behavior and cardiometabolic risk.

Cardiometabolic disease risk factors, including metabolic syndrome and physical inactivity, are prevalent among young adults. However, few young adults are aware of their risk status. The risk perception attitude (RPA) framework was used to categorize participants (n = 456) enrolled in a three-arm randomized controlled weight management trial by their baseline values of cardiometabolic risk perceptions and physical activity self-efficacy. Trial recruitment occurred at two universities from 2015 to 2018 and participants were randomly assigned to one of three weight management interventions: Tailored, Targeted, Control. Cross-sectional and longitudinal analyses were conducted to examine associations between RPA category (i.e., Responsive, Indifferent, Avoidant, Proactive) and physical activity behavior. At baseline, the Responsive group had the highest amount of physical activity (mean [95% CI]: 379.2 [332.6 to 425.8] min/week), the Indifferent group had the lowest (296.7 [261.98 to 331.32] min/week), and the Avoidant/Proactive groups showed intermediate values. Over 6 months, there was a significant interaction between RPA group and intervention arm on change in physical activity adjusted for age, sex, race/ethnicity, baseline body mass index, and baseline moderate-to-vigorous physical activity (p = .017). Among Tailored intervention participants only, the Proactive participants were the only group to have an increase in physical activity (19.97 min/week) and the Indifferent participants had the most significant decrease in physical activity (127.62 min/week). Results suggest the importance of early screening for young adults to help raise awareness of cardiometabolic risk and ultimately support them in health promotion efforts.

Associations between college/university campus characteristics and student body mass index.

BACKGROUND: Campus environments are associated with undergraduate weight. However, few studies have examined campus type and geographic location in relation to student weight. This article aimed to identify college/university students with elevated BMIs by campus type and region. METHODS: Linear mixed effects regression models were fit to data from the American College Health Association-National College Health Assessment II. Analyses tested associations between campus type/region and student self-reported BMI. RESULTS: The sample included 404,987 students from 445 schools with mean BMI 24.9 ± 5.8. Across all school types/regions, BMI confidence intervals included overweight values. Two-year and public school students had higher BMIs compared to four-year and private school students, respectively. Students in the Midwest had higher BMIs compared to students in the Northeast. In the South only, Minority Serving Institution (MSI) students had higher BMIs compared to non-MSI students. CONCLUSION: Healthy weight maintenance programs should be made available to undergraduate students.

A qualitative investigation of the need for and feasibility of weight loss programs on university campuses.

BACKGROUND: Despite the public health significance of overweight and obesity, weight management has remained a low priority for health-related programming on university campuses. OBJECTIVE: Investigate the need for and feasibility of implementing university-based weight loss programs. METHODS: The Practical, Robust Implementation and Sustainability Model (PRISM) was used as a framework. Semi-structured individual interviews were conducted with fifteen university staff and students from two large U.S. universities in the Northeast and Mid-Atlantic. Interviews aimed to assess readiness, preferences, characteristics, barriers and facilitators in each of the four adapted PRISM domains: (1) Organizational and Recipient (Student) Perspectives on the Intervention, (2) Recipient (Student) Characteristics, (3) Internal Environment (organizational characteristics and infrastructure), and (4) External Environment. Verbatim transcriptions were analyzed using inductive and deductive thematic analyses. Themes were extracted as outlined by Consensual Qualitative Research. RESULTS: Participants supported university-based weight loss programs, but recognized barriers of resources, coordination across entities, and competing health issues taking priority for school programming. Campus built environment and students' busy schedules were identified as barriers to maintaining healthy weight and participation in weight loss programs. Recommendations included designing weight loss programming with a positive and holistic approach, minimizing weight-stigma, ensuring support from university leaders and students, and securing external funding. CONCLUSIONS: The identified themes provide recommendations for universities looking to develop and implement weight loss programming.

Body Image Quality of Life Related to Light Physical Activity and Sedentary Behavior among Young Adults with Overweight/Obesity.

Sedentary behaviors, low levels of physical activity (PA), and low body image quality of life have been identified during college years and associated with poor health outcomes. Public health efforts have recently focused on decreasing sedentary time by increasing light physical activity, both of which have been associated with body image quality of life, though mainly through self-report. In this cross-sectional study, we examined objective actigraphy and survey data from 404 of 459 young adults with overweight and obesity (mean age 23.3 ± 4.4 years, 78.4% female, 55.4% white). PA was measured using an accelerometer worn during waking hours for >10 h/day for four days. Body image quality of life was assessed using the Body Image Quality of Life Inventory Scale. Body image was positively correlated with light PA (r = 0.15) and inversely correlated with BMI (Pearson's r = -0.20) and sedentary time (r = -0.10), but not moderate PA, vigorous PA, or MVPA. Light PA and sedentary time were significantly inversely correlated (r = -0.38). When controlling for covariates, higher body image quality of life was significantly associated with higher levels of light PA (ß = 0.39; p < 0.01) and lower sedentary time (ß = -0.39; p = 0.02). Participants with lower body image quality of life enrolled in weight loss interventions may benefit from prescriptions of light PA in conjunction with decreasing sedentary behaviors.

Feasibility of a Digital Intervention to Promote Healthy Weight Management among Postpartum African American/Black Women.

The study aim was to implement and evaluate the feasibility of a culturally informed ("BeFAB") app for African American/Black women to address postpartum weight. Women (n = 136; mean age = 27.8 ± 5.4; mean BMI = 32.5 ± 4.3) were recruited from postpartum units, and randomly assigned to receive BeFAB (n = 65) or usual care (n = 71) for 12 weeks. App content included didactic lessons delivered via a virtual coach, app-based messages, goal setting and tracking, and edutainment videos. Feasibility outcomes included recruitment, retention and engagement, and self-reported acceptability. Behavioral (i.e., diet, physical activity), psychosocial (i.e., stress, coping, support, self-efficacy) and weight outcomes were also examined. Recruitment goals were met, but attrition was high, with 56% retention at 12 weeks. Approximately half of participants accessed the app and set a goal ≥one time, but <10% reported achieving a nutrition or activity goal. Among study completers, ≥60% found the app content at least somewhat helpful. Within-group changes for BeFAB among completers were found for increased moderate-to-vigorous physical activity and decreased fruit/vegetable intake and weight. Findings indicate initial feasibility of recruiting postpartum women to participate in a digital healthy body weight program but limited use, reflecting low acceptability and challenges in engagement and retention. Future research is needed on strategies to engage and retain participants in postpartum interventions.

Effect of tailoring on weight loss among young adults receiving digital interventions: an 18 month randomized controlled trial.

Weight loss outcomes among young adults in technology-based programs have been equivocal. The purpose of this study was to deliver digital weight loss treatments to young adults and examine the 6, 12, and 18 month effects on weight loss. Young adults with overweight/obesity (N = 459; 23.3 ± 4.4 years) were recruited from two university sites and randomly assigned to receive through Facebook and text messaging either personalized (TAILORED; n = 150) or generic (TARGETED; n = 152) weight loss information, messages, and feedback or general healthy body content (e.g., body image, sleep; CONTROL; n = 157). The study was powered to detect a 2.1-kg difference at all time points with the primary outcome being 18 months. There was no overall effect of treatment group on 6, 12, or 18 month weight loss (ps = NS). However, at 6 months, those in TAILORED who were highly engaged (completing >66%) lost more weight compared to CONTROL (-2.32 kg [95% confidence intervals: -3.90, -0.74]; p = .004), with the trend continuing at 12 months. A significant baseline body mass index (BMI) by treatment group interaction (p = .004) was observed at 6 months. Among participants in the lowest baseline BMI category (25-27.5 kg/m2), those in TAILORED lost 2.27 kg (-3.86, -0.68) more, and those in TARGETED lost 1.72 kg (-3.16, -0.29) more than CONTROL after adjusting for covariates. Among participants with a BMI between 27.5 and 30 kg/m2, those in TAILORED lost 2.20 kg (-3.90, -0.51) more than participants in TARGETED. Results did not persist over time with no treatment interaction at 12 or 18 months. Initial body weight should be considered when recommending weight loss treatments for young adults. More intensive interventions or stepped care approaches may be needed for young adults with obesity.

Application of social marketing to recruitment for a digital weight management intervention for young adults.

Recruiting young adults into weight loss interventions poses challenges that may be mitigated by the use of novel social marketing strategies. The purpose of this study is to describe how social marketing principles were applied to recruitment for a digitally delivered randomized controlled trial for weight management among young adults and report recruitment data and demographics on those who enrolled and did not enroll in the study. The marketing mix of the 7Ps (i.e., product, price, place, promotion, packaging, positioning, and people) was applied to intervention recruitment. Prior to enrollment, respondents completed a screening survey, which was examined to determine optimal strategies for study awareness and enrollment. Of the initial 5,731 who initiated a screener, 3,059 provided data on the source of where they heard about the study. Subsequently, 460 (12.5%) were enrolled in the study, 409 (51.3% non-White; 78.7% female; body mass index: 30.6 ± 4.3) provided data on recruitment source, with emails (72.5%), cited most often followed by flyers/posters (8.8%), "other" (6.7%), and multiple sources (6.6%). Although email remained the most frequently cited promotion source, Pearson's chi-squared tests revealed that, compared to those not enrolled in the study, those who enrolled were more likely to hear about the study via flyers/posters (enrolled = 14.4%; not enrolled = 7.9%; p < .001) and multiple sources (enrolled = 11.7%; not enrolled 5.85%; p < .01) and less likely to hear via email (enrolled = 62.1%; not enrolled = 74.2%; p < .01). This study applied social marketing principles to successfully recruit a large and diverse group of young adults. While email emerged as the most effective source of study awareness, multiple channels and a mix of marketing principles are recommended for recruiting in university settings.

Evaluating an Interactive Digital Intervention for College Weight Gain Prevention.

OBJECTIVE: Pilot a digital interactive intervention for weight gain prevention among college students. METHODS: One sample pre-post study reporting on initial usability and changes in theoretical constructs (ie, self-efficacy, behavioral capability, elaboration) and program acceptability. Twenty college freshmen (mean age, 18.25 ± 0.72 years) reviewed a digital program providing self-assessment and brief tailored feedback on 8 behaviors that relate to a healthy weight: physical activity, sedentary behavior, and consumption of sugary beverages, high fat snacks, breakfast, fried foods, fruits and vegetables, and pizza. RESULTS: At posttest, improvements in self-efficacy were found for 5 behaviors (ie, physical activity, high fat snacks, breakfast, fried foods, fruits and vegetables); improvements in behavioral capability were found for 3 behaviors (ie, high fat snacks, fried foods, and fruits and vegetables). Acceptability benchmarks included: positive impression (60%), relevance (95%), and ease of comprehension (75%). CONCLUSIONS AND IMPLICATIONS: This program demonstrates acceptability for a digital weight gain prevention intervention, with improvements in behavioral mediators of change. Suggestions to simplify messaging and allowing for user control may enhance acceptability and comprehension. There is a need for further testing with larger more diverse populations before broader implementation by universities to address student health.

Formative work to design a digital learning self-assessment and feedback tool to prevent weight gain among college students.

OBJECTIVE: While colleges have implemented brief, tailored interventions for health-risk areas such as alcohol prevention, theoretically-guided digital learning offerings for weight gain prevention have lagged behind in programming and implementation. Thus, the objective was to design and usability test a weight gain prevention digital learning platform for college students with modules targeting key nutrition and physical activity behaviors. METHODS: Development occurred in iterative phases: formative research, descriptive normative data collection, prototype development, and usability testing. Formative research consisted of background work and survey administration to incoming and current freshmen. Prototype development was guided by theories of behavior change and cognitive processing, and consisted of brief assessment and feedback using written text, graphs, and videos. Iterative usability testing was conducted. RESULTS: Current freshmen reported eating more quick order meals per week than incoming freshman, but fewer high-fat snacks and fewer sugary beverages. Current freshmen reported more sedentary time than incoming freshmen. Based on iterative testing results, eight behavioral targets were established: breakfast, high-fat snacks, fried foods, sugary beverages, fruit/vegetables, physical activity, pizza intake, and sedentary behavior. Initial usability testers indicated the modules were easy to understand, held their attention, and were somewhat novel. Analysis of qualitative feedback revealed themes related to content, layout, structure and suggested refinements to the modules. CONCLUSIONS: A gap exists for evidence-based obesity prevention programs targeted to adolescents as they transition into adulthood. Brief, tailored digital learning interventions show promise towards addressing key behavioral nutrition and physical activity targets among students during the transition to college.

Young adult e-cigarette users: perceptions of stress, body image, and weight control.

OBJECTIVE: With the rise in electronic cigarette (ENDS) use among US young adults, more research is needed on expectations for use and perceptions related to body image, weight control, and stress relief. METHODS: College students (N = 230; modal age 21 years; 68% female) completed an online survey assessing cigarette smoking and ENDS, dieting and body image, perceptions about flavors, stress, weight gain prevention, and appetite regulation. SAMPLE CHARACTERISTICS: Dual use (cigarette and ENDS) was reported by n = 69 (30.0%). Exclusive cigarette smoking was endorsed by n = 53 (23%) with exclusive ENDS use reported by n = 15 (6.5%). Ninety-three participants (40.5%) reported not using either product. RESULTS: Among those using ENDS, < 33% reported using as a stress management tool, < 15% reported using ENDS to control appetite, and > 70% reported using cartridges that tasked like sweets. There was a positive correlation between dieting behaviors and body concern, suggesting those who reported higher use of ENDS for weight and appetite regulation also had higher pathological eating scores and concern over body shape and size. CONCLUSION: Prevention and education related to weight, body image, and tobacco are needed to address misperceptions of tobacco products. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Physical Activity and Cardiometabolic Risk Factor Clustering in Young Adults with Obesity.

INTRODUCTION: There is a paucity of information on the clustering of cardiometabolic risk factors in young adults and how this clustering may vary based on whether or not they perform sufficient levels of physical activity. METHODS: We analyzed baseline data from 346 young adults (23.3 ± 4.4 yr) participating in the Healthy Body Healthy U clinical trial from 2015 to 2018. Cardiometabolic risk factors were measured according to standard procedures and moderate- to vigorous-intensity physical activity (MVPA) was determined by accelerometry. A cardiometabolic clustering score (ranging from 0 to 5) was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded (0, no; 1, yes): abdominal circumference (>102 cm (men) or >88 cm (women)), hemoglobin A1c (≥5.7%), HDL cholesterol (<40 mg·dL (men) or <50 mg·dL (women)), systolic blood pressure (≥130 mm Hg), and diastolic blood pressure (≥85 mm Hg). Cardiometabolic dysregulation (CD) was defined as a cardiometabolic clustering score ≥3. Multiple logistic regression determined the independent association between level of MVPA and CD, while adjusting for sex, race/ethnicity, sedentary time, and smoking. RESULTS: The prevalence of CD was 18% (22% in men, 17% in women). We observed a nonlinear graded association between MVPA and CD. Participants performing 150-300 min·wk of MVPA significantly lowered their odds of CD by 66% (odds ratio, 0.34; 95% confidence interval, 0.16-0.75), whereas those exceeding 300 min·wk lowered their odds by 61% (odds ratio, 0.39; 95% confidence interval, 0.18-0.86) compared with those performing <150 min·wk, independent of obesity and the other covariables. CONCLUSION: Recommended levels of moderate-intensity physical activity is significantly associated with lower odds of CD and thus may prevent or diminish the need for expensive pharmaceutical treatment over the remainder of the life-span.

Physical Activity Promotion: Highlights from the 2018 Physical Activity Guidelines Advisory Committee Systematic Review.

PURPOSE: This article describes effective interventions to promote regular physical activity and reduce sedentary behavior that were identified as part of the 2018 Physical Activity Guidelines Advisory Committee Scientific Report. METHODS: A comprehensive literature search was conducted of eligible systematic reviews, meta-analyses, and relevant governmental reports published between 2011 and 2016. For the physical activity promotion question, articles were first sorted by four social ecological levels of impact (i.e., individual, community, communication environment, and physical environment and policy levels) and then further sorted into more specific categories that emerged during the review process. For the sedentary behavior reduction question, the literature was sorted directly into emergent categories (i.e., youth, adult, and worksite interventions). RESULTS: Effective physical activity promotion strategies were identified at each level of impact, including those based on behavior change theories and those occurring at different settings throughout the community. Effective interventions also included those delivered in person by trained staff or peer volunteers and through different information and communication technologies, such as by phone, Web or Internet, and computer-tailored print. A range of built environment features were associated with more transit-based and recreational physical activity in children and adults. Effective sedentary reduction interventions were found for youth and in the workplace. CONCLUSIONS: A promising number of interventions with demonstrated effectiveness were identified. Future recommendations for research include investigating the most useful methods for disseminating them to real-world settings; incorporating more diverse population subgroups, including vulnerable and underrepresented subgroups; collecting cost data to inform cost-effectiveness comparisons; and testing strategies across different levels of impact to determine which combinations achieve the greatest effects on different modes of physical activity across the week.