Engaging adolescents in research: Home self-collection of biological samples and health questionnaires.

Adolescent health research with biomarker data collection is limited due to difficulties in recruiting and engaging this age group. Thus, successful recruitment, engagement, and retention of adolescents in translational research are necessary to elucidate factors influencing mental and physical health conditions, uncover novel biomarkers, and expand prevention and treatment options. This paper describes strategies for effective recruitment and retention of adolescents in a research study, using a project examining depressive symptoms and the microbiome to illustrate these approaches. This cross-sectional study collected electronic self-reported survey data and self-collected biospecimens (stool and salivary samples) from adolescents 13-19 years old. All but two participants completed the questionnaires, with few missing responses. 94% provided at least one salivary sample and 89% supplied a stool sample. Participants were able to adhere to the study instructions. Using a participant-centered approach, our study successfully recruited and engaged the targeted 90 participants in self-collection of electronic survey data and biospecimens. Successful strategies of recruitment and retention included: 1) on-site clinic recruitment by research team, 2) active involvement of parents as appropriate, 3) use of electronic surveys and self-collection of biospecimens to foster control and ease of participation while addressing privacy concerns, 4) noninvasive collection of data on biospecimen, 5) frequent texting to communicate with participants, 6) flexibility in the pickup and transferring of biospecimens to accommodate adolescent schedules, 7) developmentally appropriate research, 8) participant reimbursement, and 9) sensitivity toward discussing stool sample materials. As a result of these strategies, adolescent participation in the research proved feasible.

Trait anxiety increases the attentional cost of walking in young adults: A cross-sectional study.

BACKGROUND: Anxiety is a prevalent mental health disorder, with debilitating symptoms causing avoidance and decreased quality of life. Balance impairments during standing and walking are common in anxiety. However, understanding of gait control mechanisms in people with trait anxiety, particularly when walking requires increased attention (dual-task), is still limited. This work examined the attentional cost of walking in people with varying levels of trait anxiety. Since people with anxiety are often prone to Space and Motion Discomfort (SMD), this work also evaluated the potential role of SMD in the attentional cost of walking. METHODS: Fifty-six participants, aged 18-51, classified as anxious and non-anxious, were asked to walk under single- and two dual-task conditions (cognitive: counting backwards; visuomotor: texting on a mobile phone). Task performance (walking, counting and texting) was measured. Prefrontal cortex (PFC) activation was recorded using functional near infrared spectroscopy (fNIRS) for a subset of participants (n = 29). RESULTS: Anxious individuals walked slower under dual-task conditions, with smaller increases in PFC activation from single to dual-task conditions in the cognitive task. Dual-task walking was unrelated to SMD. LIMITATIONS: sample size was limited, particularly for fNIRS data. CONCLUSIONS: To the best of our knowledge, this study is the first to identify anxiety-related deficits in attentional gait control in the general population, including during the everyday task of texting on a mobile phone. Since decrements in dual-task walking are linked to poor health outcomes, results from this work may have functional implications for people with anxiety.

Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial.

Objectives: We tested an adapted version of an effective U.S.-based peer-texting intervention to promote Quitline use and smoking cessation among rural participants in Vietnam. Methods: We conducted a two-arm randomized trial with participants recruited at four rural community centers. The intervention included peer messages sent for six months that promoted Quitline use and smoking cessation. Additionally, biweekly two-way text messages assessed participants' interest in Quitline referral and current smoking status. Comparison participants received only the bi-weekly text message assessment of their current smoking status. At six months, we assessed Quitline use and smoking cessation. Smoking cessation was assessed using the 7-day point prevalence question and verified with a carbon monoxide breath monitor (<=6 ppm). Results: Among 750 participants, the intervention had higher Quitline verified use (18%, 95% CI 0.14, 0.22) than comparison (1%, 95% CI .2, 2, p < 0.0001). Carbon-monoxide-verified smoking cessation did not differ between the two groups. However, intervention (28.3%, 95% CI) and comparison (28.1%, 95% CI) participants had substantial rates of carbon monoxide cessation at 6 months (both 28%). Conclusion: Our study highlighted the promise of texting interventions to extend tobacco control efforts in Vietnam.

Enrollment and use of a peer counselor mHealth texting program to support breastfeeding in low-income people: A pilot study in the District of Columbia.

OBJECTIVE: To describe the characteristics of postpartum people who did and did not enroll in a breastfeeding peer-counselor mobile health (mHealth) texting program as well as the issues raised through 2-way texting with peer counselors. DESIGN: Pilot intervention study involving two Special Supplemental Nutrition Programs for Women Infants and Children (WIC) sites in the District of Columbia over 1 year. SAMPLE: WIC recipients. MEASUREMENTS: Descriptive statistics, comparison of recipients who enrolled or not and qualitative content analysis of text messages. INTERVENTION: A breastfeeding peer counselor texting program entitled BfedDC involving routine 1-way programmed messages and 2-way texting capacity for recipients to engage with peer counselors. RESULTS: Among our sample (n = 1642), nearly 90% initiated breastfeeding. A total of 18.5% (n = 304) enrolled in the BfedDC texting program, of whom 19.7% (n = 60) utilized the 2-way texting feature. Message content covered seven content themes and included inquiries about expressing human milk, breastfeeding difficulties, breastfeeding frequency and duration, appointments and more. CONCLUSIONS: Although enrollment was relatively low in BfedDC, benefits included 1-way supportive texts for breastfeeding and the ability to 2-way text with peer counselors. This program aligns with the Surgeon General's Call to Action to Support Breastfeeding and promotes breastfeeding equity in low-income people.

HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let's Text!): Pilot Feasibility and Acceptability Study.

BACKGROUND: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants' texts. OBJECTIVE: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system's impact on adolescents' group CBT engagement and, ultimately, depression outcomes. METHODS: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. RESULTS: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. CONCLUSIONS: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants' qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research.

"It's okay because I'm just driving": an exploration of self-reported mobile phone use among Mexican drivers.

Introduction: Technological advancements have the potential to enhance people's quality of life, but their misuse can have a detrimental impact on safety. A notable example is the escalating issue of distracted driving resulting from the use of mobile phones behind the wheel, leading to severe crashes and injuries. Despite these concerns, both drivers' usage patterns and their risk-related associations remain scarcely documented in Mexico. Therefore, this descriptive study aimed to examine the mobile phone usage of Mexican drivers, its relationships to risk awareness and near-miss/crash involvement, and the self-reported underlying reasons for this behavior. Methods: This cross-sectional study utilized a sample of 1,353 licensed Mexican drivers who took part in a nationwide series of interviews regarding their onboard phone use settings. Results: A significant percentage of drivers (96.8%) recognize using a mobile phone while driving as high-risk behavior. However, only 7.4% reported completely avoiding its use while driving, with 22.4% identified as high-frequency users. Frequency was also found positively associated with the self-reported rate of near-misses and crashes. Furthermore, qualitative data analysis highlights the emergence of a 'sense of urgency' to attend to phone-related tasks in response to daily demands and life dynamics, offering a potential explanation for this behavior. Conclusion: The results of this study suggest common patterns of onboard mobile use among Mexican drivers concerning driving situations and associated risks. This underscores the need for increased efforts to discourage onboard phone use in the country.

Associations of Depression/Anxiety with Technology Use, Discontinued Use, and Nonuse in Older Adults.

OBJECTIVES: To examine correlates of the changes in technology use among older adults and the associations of depression/anxiety symptoms with technology use changes. METHODS: We used the 2019-2021 U.S. National Health and Aging Trends Study (N = 3,063; age 70+). We fitted multinomial logistic regression models to examine: (1) correlates of never use and discontinued use versus use of email/texting and the internet during the 3-year study period; and (2) associations of past-month depression/anxiety symptoms in 2021 with use and discontinued use versus never use of email/texting and social network site (SNS). RESULTS: The findings show age, socioeconomic, and health barriers to technology use. Email/texting and SNS use in 2021, compared to never use in all 3 years, was associated with a lower likelihood of moderate/severe depression/anxiety symptoms in 2021 (RRR = 0.54, 95% CI = 0.37-0.81 for email/texting use; RRR = 0.56, 95% CI = 0.33-0.97 for SNS use). Video calls with family/friends were not associated with depression/anxiety symptoms. CONCLUSIONS: The findings expand the existing knowledge base regarding potential impact of technology use on mental health beyond the early months of the COVID-19 pandemic. CLINICAL IMPLICATIONS: More concerted efforts are warranted to help older adults' technology uptake and continued use and to promote mental health benefits of technology use.

Teletherapy Used to Breakdown Access Barriers.

The studies presented in this literature review reveal the numerous ways that teletherapy can be used to treat patients with mental health issues. The literature includes six research articles from published scientific journals that span from 2005 to 2020. The three types of telehealth therapy reviewed include mobile telehealth, telephone, and video technology. The six research articles focus on the ways that telehealth can reach communities of lower socioeconomic status (SES) and those suffering from access barriers. The benefits of teletherapy include cost savings, time efficiency, easier access, and a reduction in recidivism. Challenges include access barriers, financial difficulties, anxiety, and fear of stigmatization. Limitations of the studies presented include a lack of accessibility to internet and technology, privacy issues, and insurance coverage. Overall, results show that teletherapy provides an affordable, accessible alternative to traditional in-person mental health therapy, especially in reaching lower SES groups, Veterans, and patients with access restrictions.

Exploring the Behaviour Change Wheel and the Theoretical Domains Framework in interventions for mobile phone driver distraction: A scoping review.

Mobile phone use while driving remains a significant traffic safety concern. Although numerous interventions have been developed to address it, there is a gap in the synthesis of relevant information through a comprehensive behaviour change lens. This scoping review uses the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to examine the literature to (a) identify behavioural constructs targeted in interventions for mobile phone use while driving, (b) determine if the intervention success varied by sociodemographic group (e.g., age, gender, driving experience), and (c) map interventions to TDF domains to highlight areas for future research. Following the PRISMA extension for scoping reviews, we searched seven databases and identified 5,202 articles. After screening, 50 articles detailing 56 studies met the following inclusion criteria: (a) intervention studies, (b) providing details on methods and results, (c) written in English, and (d) targeting any driver behaviour related to mobile phone use while driving with a bottom-up approach, using not regulation or law enforcement, but individuals' psychological processes, such as cognitive, behavioural, and emotional. Findings show that most interventions targeted young drivers and were typically effective. Except for a few studies, the effectiveness of interventions targeting different sociodemographic groups either remained untested or revealed nonsignificant differences. This finding points to a gap in the literature, indicating a need for further investigation into the efficacy of interventions for different groups, and for tailoring and testing them accordingly. The interventions also often targeted multiple TDF domains, complicating the interpretation of the relative efficacy of specific domains. Most frequently targeted domains included beliefs and consequences, emotions, knowledge, social influence, social/professional role and identity, and behavioural regulation. Physical skills and optimism domains were not targeted in any intervention. Further, almost all interventions addressed deliberate engagement in mobile phone distractions, while the automatic and fast processes involved in such behaviours were often overlooked. Mobile phone distractions are in part habitual behaviours, yet the existing mitigation efforts mostly assumed intentional engagement. More focus on the habitual nature of mobile phone distractions is needed.

Ergonomic evaluation of upper extremities muscle activity pattern during 60-min smartphone texting.

BACKGROUND: Smartphone usage has increased rapidly in the last decade due to rapid technological advancements. This extensive usage of smartphones led to physiological problems and musculoskeletal disorders (MSD) due to inappropriate postures. OBJECTIVE: Past studies have reported the effects/discomfort of smartphone usage for short periods, ranging from 3-20 min, which does not represent the current era of smartphone dependency (approximately 7-hr/day). METHODS: This study was performed on fifty-four participants aged 20-28 with 1-hr smartphone texting in a sitting posture. Flexion angles, both sides (dominant and non-dominant) muscle activity (maximum voluntary contraction %) at sternocleidomastoid (SCM), upper-trapezius (TRP), extensor digitorum (EDM) and abductor pollicis brevis (APB) muscles, and subjective discomfort were analyzed. RESULTS: After 1-hr smartphone texting, the muscle activity at eight upper extremities: SCM (24.80%), TRP (29.45%), EDM (14.44%) and APB (19.87%) significantly (p < 0.001) increased by 1.5-1.9 times with 27.4±3.18° and 82.94±7.03° head and lower-arm flexion angles, respectively. The mechanical loads on the cervical spine increased by 4.6 times, and subjective discomfort by 3 times. CONCLUSION: Maintaining the same posture for a long duration causes postural stress, muscular imbalances, and discomfort, leading to MSD with increased cervical intervertebral disc pressure.

Mad or mad-mad: conveying subtle emotion with face emoji.

Introduction: To compensate for the lack of pragmatic information available when communicating via text message, texters make frequent use of texting-specific cues, or textisms, to convey meaning that would otherwise be apparent in spoken conversation. Here, we explore how one such cue, face emoji, can impact the interpretation of text messages. METHODS: In Experiment 1, we paired neutral text messages with valenced face emoji to determine whether the emoji can alter the meaning of the text. In Experiment 2, we paired valenced text messages with valenced face emoji to determine whether the emoji can modulate the valence of the text. RESULTS: In Experiment 1, we found that texts paired with positive emoji were rated more positively than texts paired with negative emoji. Furthermore, texts paired with stronger-valenced emoji were rated as less neutral compared to texts paired with milder-valenced emoji. In Experiment 2, we found that slightly positive texts paired with strong positive emoji were rated somewhat similarly to the same texts paired with mild positive emoji; however, slightly negative texts paired with strong negative emoji were rated much more negatively than the same texts paired with mild negative emoji. DISCUSSION: These results indicate that the presence of face emoji, particularly negative face emoji, can alter the interpretation of text messages, allowing texters to communicate nuanced meaning and subtle emotion.

'I understood the texting process well'. Participant perspectives on usability and acceptability of SMS-based telehealth follow-up after voluntary medical male circumcision in South Africa.

Background: Voluntary medical male circumcision (MC) is a biomedical HIV prevention method that requires post-operative follow-up for healing confirmation. Recent research found that a two-way texting (2wT) app providing SMS-based telehealth for MC patients was safe and reduced provider workload. We evaluated 2wT usability among MC clients in South Africa assigned the 2wT intervention within a larger randomized controlled trial (RCT) of 2wT safety and workload. Methods: This quantitative usability study is within an RCT where 547 men used 2wT to interact with an MC provider via SMS. The sub-study involved the first 100 men assigned to 2wT who completed a usability survey 14 days after surgery. Acceptability was assessed through 2wT response rates of the 547 men. Regression models analyzed associations between age, wage, location, potential adverse events (AEs), and 2wT responses. Results: Men assigned to 2wT found it safe, comfortable, and convenient, reporting time and cost savings. High response rates (88%) to daily messages indicated acceptability. Age, wage, and location didn't affect text responses or potential AEs. Conclusion: 2wT for post-MC follow-up was highly usable and acceptable, suggesting its viability as an alternative to in-person visits. It enhanced confidence in wound self-management. This SMS-based telehealth can enhance MC care quality and be adapted to similar contexts for independent healing support, particularly for men.

Impact of mobile phone use on accidental falls risk in young adult pedestrians.

Background: Mobile phone use is known to be a distraction to pedestrians, increasing their likelihood of crossing into oncoming traffic or colliding with other people. However, the effect of using a mobile phone to text while walking on gait stability and accidental falls in young adults remains inconclusive. This study uses a 70 cm low friction slip hazard and the threat of hazard to investigate the effects of texting while walking on gait stability, the ability to recover balance after a slip hazard and accidental falls. Methods: Fifty healthy young adults performed six walking tasks, and one seated texting task in random order. The walks were conducted over a 10-m walkway. Four progressive hazard levels were used: 1) Seated; 2) Normal Walk (walking across the walkway with no threat of a slip); 3) Threat (walking with the threat of a slip); and 4) Slip (walking with an actual 70 cm slip hazard). The three walking conditions were repeated twice with and without the mobile phone texting dual-task. Gait kinematics and trunk posture were recorded using wearable sensors attached to the head, trunk, pelvis and feet. Study outcomes were analyzed using repeated measures analysis of variance with significance set to P≤.05. Results: Mobile phone use significantly impaired postural balance recovery when slipping, as demonstrated by increased trunk sway. Mobile phone use negatively impacted gait stability as demonstrated by increased step time variability and decreased harmonic ratios. Increased hazard levels also led to reduced texting accuracy. Conclusions: Using a mobile phone to text while walking may compete with locomotor tasks, threat assessment and postural balance control mechanisms, which leads to an increased risk of accidental falls in young adults. Pedestrians should therefore be discouraged through new educational and technology-based initiatives (for example a "texting lock" on detection of walking) from texting while walking on roadside footpaths and other environments where substantial hazards to safety exist.

Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project.

BACKGROUND: Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela-a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression. OBJECTIVE: This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening. METHODS: A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela. RESULTS: The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients' understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT. CONCLUSIONS: The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT.

A hierarchical cluster analysis of young drivers based on their perceived risk and frequency of texting while driving.

INTRODUCTION: The present study attempted to provide a proof-of-concept of usefulness of cluster analysis for identifying distinct and practically meaningful subgroups of drivers who differed in their perceived risk and frequency of texting while driving (TWD). METHOD: Using a hierarchical cluster analysis, which involves sequential steps in which individual cases are merged together one at a time based on their similarities, the study first attempted to identify distinct subgroups of drivers who differed in their perceived risk and frequency of TWD. To further evaluate the meaningfulness of the subgroups identified, the subgroups were compared in terms of levels of trait impulsivity and impulsive decision making for each gender. RESULTS: The study identified the following three distinct subgroups: (a) drivers who perceive TWD as risky but frequently engage in TWD; (b) drivers who perceive TWD as risky and infrequently engage in TWD; and (c) drivers who perceive TWD as not so risky and frequently engage in TWD. The subgroup of male, but not female, drivers who perceive TWD as risky but frequently engage in TWD showed significantly higher levels of trait impulsivity, but not impulsive decision making, than the other two subgroups. DISCUSSION: This is the first demonstration that drivers who frequently engage in TWD can be categorized into two distinct subgroups that differ in terms of the perceived risk of TWD. PRACTICAL APPLICATIONS: For drivers who perceived TWD as risky yet frequently engage in TWD, the present study suggests that different intervention strategies may be needed for each gender.

Increasing Social Communication by Teaching Texting to Autistic Children.

Objectives: In the present study, we increased the social communication of four autistic children by teaching texting conversation skills on smart phones. Methods: A multiple baseline design across two dyads was used to assess the texting conversation intervention, with additional generalization probes taken across texting partners and FaceTime® sessions. One-month maintenance probes were also assessed. Results: All four participants increased their conversational texting, and their conversation content was novel. Generalization across texting partners occurred, and skills were maintained. Appropriate verbal content spoken during FaceTime® probes was also observed. Conclusions: Results are discussed in terms of the potential benefits of teaching autistic children social communication through text.

Expanding the Evidence on the Safety and Efficiency of 2-Way Text Messaging-Based Telehealth for Voluntary Medical Male Circumcision Follow-up Compared With In-Person Reviews: Randomized Controlled Trial in Rural and Urban South Africa.

BACKGROUND: There is a dearth of high-quality evidence from digital health interventions in routine program settings in low- and middle-income countries. We previously conducted a randomized controlled trial (RCT) in Zimbabwe, demonstrating that 2-way texting (2wT) was safe and effective for follow-up after adult voluntary medical male circumcision (VMMC). OBJECTIVE: To demonstrate the replicability of 2wT, we conducted a larger RCT in both urban and rural VMMC settings in South Africa to determine whether 2wT improves adverse event (AE) ascertainment and, therefore, the quality of follow-up after VMMC while reducing health care workers' workload. METHODS: A prospective, unblinded, noninferiority RCT was conducted among adult participants who underwent VMMC with cell phones randomized in a 1:1 ratio between 2wT and control (routine care) in North West and Gauteng provinces. The 2wT participants responded to a daily SMS text message with in-person follow-up only if desired or an AE was suspected. The control group was requested to make in-person visits on postoperative days 2 and 7 as per national VMMC guidelines. All participants were asked to return on postoperative day 14 for study-specific review. Safety (cumulative AEs ≤day 14 visit) and workload (number of in-person follow-up visits) were compared. Differences in cumulative AEs were calculated between groups. Noninferiority was prespecified with a margin of -0.25%. The Manning score method was used to calculate 95% CIs. RESULTS: The study was conducted between June 7, 2021, and February 21, 2022. In total, 1084 men were enrolled (2wT: n=547, 50.5%, control: n=537, 49.5%), with near-equal proportions of rural and urban participants. Cumulative AEs were identified in 2.3% (95% CI 1.3-4.1) of 2wT participants and 1.0% (95% CI 0.4-2.3) of control participants, demonstrating noninferiority (1-sided 95% CI -0.09 to ∞). Among the 2wT participants, 11 AEs (9 moderate and 2 severe) were identified, compared with 5 AEs (all moderate) among the control participants-a nonsignificant difference in AE rates (P=.13). The 2wT participants attended 0.22 visits, and the control participants attended 1.34 visits-a significant reduction in follow-up visit workload (P<.001). The 2wT approach reduced unnecessary postoperative visits by 84.8%. Daily response rates ranged from 86% on day 3 to 74% on day 13. Among the 2wT participants, 94% (514/547) responded to ≥1 daily SMS text messages over 13 days. CONCLUSIONS: Across rural and urban contexts in South Africa, 2wT was noninferior to routine in-person visits for AE ascertainment, demonstrating 2wT safety. The 2wT approach also significantly reduced the follow-up visit workload, improving efficiency. These results strongly suggest that 2wT provides quality VMMC follow-up and should be adopted at scale. Adaptation of the 2wT telehealth approach to other acute follow-up care contexts could extend these gains beyond VMMC. TRIAL REGISTRATION: ClinicalTrials.gov NCT04327271; https://www.clinicaltrials.gov/ct2/show/NCT04327271.

Short-term impacts of all-driver handheld cellphone bans on high-schoolers' texting while driving: quasi-experimental analyses of Illinois and Georgia.

Teen drivers are more likely than their older counterparts to engage in distracted driving. Many states prohibit cellphone use for teen drivers, but only prohibit texting for all drivers. Evidence that these laws have been effective is mixed. We hypothesize that recent policy changes in Georgia and Illinois from teen cellphone bans with all-driver texting bans to all-driver handheld phone bans yielded short-term reductions in teen texting while driving. We analyzed Youth Risk Behavior Surveys in Georgia, Illinois, and control states North Carolina and Michigan. We estimated the reduction in texting while driving associated with policy changes via difference-in-differences models. In Illinois, 45.4 % of high school drivers texted while driving in 2013. After a 2014 policy change to an all-driver handheld ban, the percentage decreased in 2015 to 41.8 %, and decreased further in 2017 to 37.7 %. The adjusted DID estimate comparing Illinois to Michigan from 2013 to 2017 was -8.3 % (95 % CI: -15.5 % 1.1 %; p-value = 0.025). In Georgia, the percentage decreased from 37.5 % before the law to 30.8 % after, and the adjusted DID estimate comparing Georgia to North Carolina was -10.8 % (95 % CI: -19.0 %, -2.5 %; p-value = 0.011) than in North Carolina. Results support all-driver handheld phone bans to improve traffic safety for high school drivers.

Effect of receiving mobile text messages on cortisol concentrations in students at the University of the Free State.

Background: Texting has become central to social life, with adverse effects on physiological functioning. Research into the impact of texting on cortisol secretion is limited. Aim: Thus study aimed to determine how receiving mobile text messages affected salivary cortisol concentrations and investigate the moderating effects of stress, anxiety and depression on cortisol secretion. Setting: Undergraduate physiology students attending physiology lectures at the Faculty of Health Sciences, University of the Free State, 2016. Methods: An experimental, crossover, quantitative design was used. Participants were involved over two consecutive days, receiving mobile text messages (intervention) on one day and acting as their own control on the other. Self-reported data on stress, anxiety, depression and subjective experience of the study, and saliva samples were collected. Text frequency and wording (neutral, positive, negative) were varied among participants. Results: Forty-eight students participated in the study. Salivary cortisol concentrations did not differ significantly between the intervention and control days. High anxiety levels were associated with increased cortisol concentrations. No associations with cortisol concentrations were documented in low to moderate anxiety, stress, depression or how participants experienced the intervention. There were no significant differences between text frequency, text emotion and change in cortisol concentrations on the intervention day. Conclusion: Receiving mobile text messages did not elicit a significant cortisol response in participants. Contribution: Findings added to the body of knowledge about the effect of texting on student learning by measuring salivary cortisol concentrations in a lecture setting, with investigation into the moderating effects of stress, anxiety, depression and participants' subjective experience.