A long and resilient life: the role of coping strategies and variability in their use in lifespan among women.

OBJECTIVES: Associations of stress-related coping strategies with lifespan among the general population are understudied. Coping strategies are characterized as being either adaptive or maladaptive, but it is unknown the degree to which variability in tailoring their implementation to different contexts may influence lifespan. METHOD: Women (N = 54,353; Mage = 47) completed a validated coping inventory and reported covariate information in 2001. Eight individual coping strategies (e.g., Acceptance, Denial) were considered separately. Using a standard deviation-based algorithm, participants were also classified as having lower, moderate, or greater variability in their use of these strategies. Deaths were ascertained until 2019. Accelerated failure time models estimated percent changes and 95% confidence intervals (CI) in predicted lifespan associated with coping predictors. RESULTS: In multivariable models, most adaptive and maladaptive strategies were associated with longer and shorter lifespans, respectively (e.g., per 1-SD increase: Active Coping = 4.09%, 95%CI = 1.83%, 6.41%; Behavioral Disengagement = -6.56%, 95%CI = -8.37%, -4.72%). Moderate and greater (versus lower) variability levels were similarly and significantly related to 8-10% longer lifespans. Associations were similar across age, racial/ethnic, residential income, and marital status subgroups. CONCLUSIONS: Findings confirm the adaptive and maladaptive nature of specific coping strategies, and further suggest benefits from both moderate and greater variability in their use for lifespan among women.

Branched chain amino acids harbor distinct and often opposing effects on health and disease.

BACKGROUND: The branched chain amino acids (BCAA) leucine, isoleucine, and valine are essential nutrients that have been associated with diabetes, cancers, and cardiovascular diseases. Observational studies suggest that BCAAs exert homogeneous phenotypic effects, but these findings are inconsistent with results from experimental human and animal studies. METHODS: Hypothesizing that inconsistencies between observational and experimental BCAA studies reflect bias from shared lifestyle and genetic factors in observational studies, we used data from the UK Biobank and applied multivariable Mendelian randomization causal inference methods designed to address these biases. RESULTS: In n = 97,469 participants of European ancestry (mean age = 56.7 years; 54.1% female), we estimate distinct and often opposing total causal effects for each BCAA. For example, of the 117 phenotypes with evidence of a statistically significant total causal effect for at least one BCAA, almost half (44%, n = 52) are associated with only one BCAA. These 52 associations include total causal effects of valine on diabetic eye disease [odds ratio = 1.51, 95% confidence interval (CI) = 1.31, 1.76], valine on albuminuria (odds ratio = 1.14, 95% CI = 1.08, 1.20), and isoleucine on angina (odds ratio = 1.17, 95% CI = 1.31, 1.76). CONCLUSIONS: Our results suggest that the observational literature provides a flawed picture of BCAA phenotypic effects that is inconsistent with experimental studies and could mislead efforts developing novel therapeutics. More broadly, these findings motivate the development and application of causal inference approaches that enable 'omics studies conducted in observational settings to account for the biasing effects of shared genetic and lifestyle factors.

The three branched chain amino acids (BCAAs) leucine, isoleucine, and valine are important building blocks of muscle proteins that are obtained from the diet. Many studies in human populations have examined whether BCAAs affect health and disease. These human studies report results that are inconsistent with results from highly controlled animal studies. Because interest in the therapeutic targeting of BCAAs is growing, we wanted to better understand these discrepancies. Briefly, we used data from a large database that captured many diseases (e.g., cardiovascular disease, cancers, and respiratory disease) and new statistical methods. Our results showed that discrepancies between human studies and animal studies may reflect errors in the ways human studies were designed and conducted. As a result, these human studies may provide a flawed picture of BCAA effects that could mislead efforts developing novel therapeutics.

Social integration and risk of mortality among African-Americans: the Jackson heart study.

OBJECTIVE: Evidence suggests that greater social integration is related to lower mortality rates. However, studies among African-Americans are limited. We examined whether higher social integration was associated with lower mortality in 5306 African-Americans from the Jackson Heart Study, who completed the Berkman-Syme Social Network Index in 2000-2004 and were followed until 2018. METHODS: We estimated hazard ratios (HR) of mortality by categories of the Social Network Index (i.e., high social isolation, moderate social isolation [reference group], moderate social integration, high social integration) using Cox proportional hazard models. Covariates included baseline sociodemographics, depressive symptoms, health conditions, and health behaviors. RESULTS: Compared with moderate isolation, moderate integration was associated with an 11% lower mortality rate (HR = 0.89, 95% confidence interval [CI] 0.77, 1.03), and high integration was associated with a 25% lower mortality rate (HR = 0.75, 95% CI 0.64, 0.87), controlling for sociodemographics and depressive symptoms; compared with moderate isolation, high isolation was related to a 34% higher mortality rate (HR = 1.34, 95% CI 1.00, 1.79). Further adjustment of potential mediators (health conditions and health behaviors) only slightly attenuated HRs (e.g., HRmoderate integration = 0.90, 95% CI 0.78, 1.05; HRhigh integration = 0.77, 95% CI 0.66, 0.89). CONCLUSION: Social integration may be a psychosocial health asset with future work needed to identify biobehavioral processes underlying observed associations with mortality among African-Americans.

Affective response to physical activity as a deep phenotype in a non-randomized pilot study.

Large-scale genomic studies are beginning to identify genetic predictors of physical activity (PA). For those genetically predisposed to engage in low PA, a behavioral intervention may target a malleable factor that mediates genetic predisposition to low PA (i.e., intermediate phenotype) to mitigate the genetic influences. In a non-randomized exercise promotion pilot study, we test the feasibility of examining affective response to PA (how one feels during PA) as an intermediate phenotype between genetic variation and PA adherence. We hypothesized that three single nucleotide polymorphisms (SNPs; rs8044769 and rs3751812 in FTO; rs6265 in BDNF), identified from a prior systematic review, would be predictive of affective response to PA, and that affective response to PA would mediate the SNP-PA link. Forty five healthy, low-active adults received a 12-week print-based PA promotion program. Baseline affective response to PA was assessed using the Feeling Scale, a single-item measure of affective valence. Moderate to vigorous PA (MVPA) was assessed using accelerometers pre- and post-intervention. We examined the three SNPs in a weighted genetic score. Age, sex, body mass index, race, and neighborhood walkability were potential covariates. Affective response to PA and MVPA at follow-up (minutes/day over 4-7 days) were regressed on variation in SNPs, controlling for covariates. One unit increase in genetic score was associated with a 0.14 higher mean Feeling Scale, though was not statistically significant (p = 0.13). Among individual SNPs, having an additional FTO rs8044769 C allele was associated with a mean Feeling Scale score of 0.53 units higher (p = 0.015), which was statistically significant after applying the corrected p-value of 0.016. The genetic score or individual SNPs were not predictive of MVPA 12 weeks later, thereby mediation analyses were not performed. The preliminary findings demonstrate the promise of the intermediate phenotype approach.

Linking Individual-Level Facebook Posts With Psychological and Health Data in an Epidemiological Cohort: Feasibility Study.

BACKGROUND: Psychological factors (eg, depression) and related biological and behavioral responses are associated with numerous physical health outcomes. Most research in this area relies on self-reported assessments of psychological factors, which are difficult to scale because they may be expensive and time-consuming. Investigators are increasingly interested in using social media as a novel and convenient platform for obtaining information rapidly in large populations. OBJECTIVE: We evaluated the feasibility of obtaining Facebook data from a large ongoing cohort study of midlife and older women, which may be used to assess psychological functioning efficiently with low cost. METHODS: This study was conducted with participants in the Nurses' Health Study II (NHSII), which was initiated in 1989 with biennial follow-ups. Facebook does not share data readily; therefore, we developed procedures to enable women to download and transfer their Facebook data to cohort servers (for linkage with other study data they have provided). Since privacy is a critical concern when collecting individual-level data, we partnered with a third-party software developer, Digi.me, to enable participants to obtain their own Facebook data and to send it securely to our research team. In 2020, we invited a subset of the 18,519 NHSII participants (aged 56-73 years) via email to participate. Women were selected if they reported on the 2017-2018 questionnaire that they regularly posted on Facebook and were still active cohort participants. We included an exit survey for those who chose not to participate in order to gauge the reasons for nonparticipation. RESULTS: We invited 309 women to participate. Few women signed the consent form (n=52), and only 3 used the Digi.me app to download and transfer their Facebook data. This low participation rate was observed despite modifying our protocol between waves of recruitment, including by (1) excluding active health care workers, who might be less available to participate due to the pandemic, (2) developing a Frequently Asked Questions factsheet to provide more information regarding the protocol, and (3) simplifying the instructions for using the Digi.me app. On our exit survey, the reasons most commonly reported for not participating were concerns regarding data privacy and hesitation sharing personal Facebook posts. The low participation rate suggests that obtaining individual-level Facebook data in a cohort of middle-aged and older women may be challenging. CONCLUSIONS: In this cohort of midlife and older women who were actively participating for over three decades, we were largely unable to obtain permission to access individual-level data from participants' Facebook accounts. Despite working with a third-party developer to customize an app to implement safeguards for privacy, data privacy remained a key concern in these women. Future studies aiming to leverage individual-level social media data should explore alternate populations or means of sharing social media data.

Optimism and Longevity Among Japanese Older Adults.

Background: Optimism has been linked to better physical health across various outcomes, including greater longevity. However, most evidence is from Western populations, leaving it unclear whether these relationships may generalize to other cultural backgrounds. Using secondary data analysis, we evaluated the associations of optimism among older Japanese adults. Methods: Data were from a nationwide cohort study of Japanese older adults aged ≥65 years (Japan Gerontological Evaluation Study; n = 10,472). In 2010, optimism and relevant covariates (i.e., sociodemographic factors, physical health conditions, depressive symptoms, and health behaviors) were self-reported. Optimism was measured using the Japanese version of the Life Orientation Test-Revised (LOT-R). Lifespan was determined using mortality information from the public long-term care insurance database through 2017 (7-year follow-up). Accelerated failure time models examined optimism (quintiles or standardized continuous scores) in relation to percent differences in lifespan. Potential effect modification by gender, income, and education was also investigated. Results: Overall, 733 individuals (7%) died during the follow-up period. Neither continuous nor categorical levels of optimism were associated with lifespan after progressive adjustment for covariates (e.g., in fully-adjusted models: percent differences in lifespan per 1-SD increase in continuous optimism scores= -1.2%, 95%CI: -3.4, 1.1 higher versus lower optimism quintiles= -4.1%, 95%CI: -11.2, 3.6). The association between optimism and lifespan was null across all sociodemographic strata as well. Conclusion: Contrary to the existing evidence from Western populations, optimism was unrelated to longevity among Japanese older adults. The association between optimism, as evaluated by the LOT-R, and longevity may differ across cultural contexts.

Optimism and risk of mortality among African-Americans: The Jackson heart study.

Optimism is associated with reduced mortality risk among Whites, but evidence for this relationship is limited among African-Americans, whose life expectancy is shorter than Whites. This study examined the association between optimism and mortality rate in African-Americans. Data were from African-American women (n = 2652) and men (n = 1444) in the United States from the Jackson Heart Study. Optimism was measured using the Life Orientation Test-Revised at the baseline period (2000-2004), and mortality data were obtained until 2018. Using Cox proportional hazards models, we estimated hazard ratios (HRs) of mortality by optimism level, controlling for sociodemographic factors, depressive symptoms, health conditions, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex, age, income, and education. Higher optimism was related to lower mortality rates (HR = 0.85, 95% confidence interval [CI] = 0.74, 0.99), controlling for sociodemographic factors and depressive symptoms. After further adjusting for health conditions and health behaviors, associations were slightly attenuated (HR = 0.89; 95%CI = 0.77, 1.02). Stronger associations between optimism and mortality were observed in men, among those with higher income or education, and with age ≤ 55 (all p's for interaction terms <0.06). In summary, optimism was associated with lower mortality rates among African-Americans in the Jackson Heart Study. Effect modification by sociodemographic factors should be further explored in additional research considering optimism and mortality in diverse populations. Positive factors, such as optimism, may provide important health assets that can complement ongoing public health efforts to reduce health disparities, which have traditionally focused primarily on risk factors.

Daily Instrumental and Affective Attitudes About Exercise: An Ecological Momentary Assessment Study.

BACKGROUND: Daily decisions to exercise may be influenced by day-to-day changes in affective attitudes (AA) and instrumental attitudes (IA) toward exercise. However, the within-day association between AA, IA, and exercise behavior has received little attention. PURPOSE: To examine the effects of more temporally proximal (daily) AA and IA on daily exercise behavior beyond traditionally assessed distal (at the beginning of an exercise program) AA and IA. METHODS: In the context of a 3-month exercise promotion program (N = 50), distal AA and IA were assessed at baseline. Ecological momentary assessment was used to assess proximal AA, IA, and exercise each day. RESULTS: Between-subject differences in distal AA (OR = 1.28, p = .03) and distal IA (OR = 1.34, p = .01) were predictive of average likelihood of exercise each day over the 3-month period. Within-subject differences in proximal AA (OR = 1.19, p = .007), but not proximal IA (OR = 1.11, p = .18), predicted exercise each day beyond the between-subjects effects of distal AA and IA. Exploratory analysis revealed an interaction, such that the within-subjects impact of proximal AA on daily exercise was most evident among individuals who held more negative distal AA at baseline (OR = 0.80, p < .0001). CONCLUSIONS: Attitude type (affective versus instrumental) and temporality (distal versus proximal) are important to consider in attempts to predict and understand exercise behavior. In addition to targeting change in distal attitudes, exercise interventions should target changes in daily AA to impact exercise later in the same day.

The Moderating Effects of Genetic Variations on Changes in Physical Activity Level and Cardiorespiratory Fitness in Response to a Life-Style Intervention: A Randomized Controlled Trial.

OBJECTIVE: Prior studies identified single nucleotide polymorphisms (SNPs) associated with physical activity (PA) level in a natural environment and intervention study: rs978656-DNAPTP6, rs10887741-PAPSS2, rs7279064-C18orf2, and rs6265-BDNF. Using the four SNPs' polygenic score (PGS), we examined whether PGS moderates a life-style intervention's effect on changes in PA level and cardiorespiratory fitness (CRF). METHODS: This is a secondary analysis of Look AHEAD, a multicenter randomized controlled trial designed to test the health benefits of a life-style intervention among 2675 participants with overweight/obesity and type 2 diabetes (ages, 45-76 years). Using linear mixed-effects models, level of PA (Paffenbarger PA questionnaire) and treadmill-assessed CRF were each regressed on four SNPs' PGS, study time (baseline, year 1, and year 4), intervention arm, and interactions between the three. Models adjusted for age, sex, body mass index, ancestry principal components (population stratification), and study sites, with Bonferroni corrections for multiple testing (α < .005). Effect modification by age was examined. RESULTS: PGS was not predictive of change in CRF or PA level in response to intervention. In analyses without PGS by intervention by time, the relationships between PGS and PA phenotypes were modified by age (p interaction = .048 for CRF and .058 for PA), such that a 1-unit increase in PGS was associated with 24 kcal · wk-1 more in moderate-intensity PA and 0.004 MET higher CRF only among older groups (age >55 years for CRF, >60 years for PA level). CONCLUSIONS: The effects of the intervention on PA and CRF were not moderated by the four SNPs. Future studies with extended SNP list should confirm the findings on effect modification by age.

Psychological Stress, Smoking, and Hazardous Drinking Behaviors among South Korean Adults: Findings from the Korean National Health and Nutrition Examination Survey.

INTRODUCTION: There is growing attention to mental health as a contributor to behavioral health in South Korea. We investigated the prevalence of psychological stress and its associations with cigarette smoking and drinking behaviors among a nationally representative sample of South Korean adults. METHODS: Using data from 14,855 adults aged ≥19 years who participated in the 2013 to 2016 Korea National Health and Nutrition Examination Survey (KNHANES), we performed weighted logistic regression to examine the associations between stress and three binary outcome variables: cigarette smoking, heavy episodic drinking and frequent drinking. RESULTS: 27.2% of participants reported high stress. Controlling for sociodemographic covariates, high stress was associated with 1.54 times the odds (p<0.001) of being a smoker, 1.25 times the odds (p<0.001) of being a heavy episodic drinker, and 1.23 times the odds (p<0.001) of being a frequent drinker. There was evidence of effect modification by gender and occupation, such that the effects of stress on these behaviors were particularly stronger among women and pink-collar (service industry) workers (compared to men and white-collar workers). CONCLUSIONS: Future policies that aim to address smoking and drinking behaviors in South Korea should consider stress reduction and coping strategies, especially among women and pink-collar workers.

Optimism and telomere length among African American adults in the Jackson Heart Study.

BACKGROUND: Optimism is linked with greater longevity in both White and African American populations. Optimism may enhance longevity by slowing cellular aging, for which leukocyte telomere shortening is a biomarker. However, limited studies have examined the association of optimism with leukocyte telomere length among African Americans. METHODS: Data are from 723 men and 1244 women participating in the Jackson Heart Study (age = 21-93 years). We used multivariable linear regression models to conduct cross-sectional analyses examining whether higher optimism was associated with longer mean absolute leukocyte telomere length (assayed with Southern blot analysis). Models adjusted for sociodemographic characteristics, depressive symptomatology, health conditions, and health behavior-related factors. We also considered potential effect modification by key factors. RESULTS: In the age-adjusted model, optimism, measured as a continuous variable, was not associated with leukocyte telomere length (ß = 0.01, 95%CI: -0.02, 0.04). This association remained null in the fully-adjusted model (ß = 0.02, 95%CI: -0.02, 0.05) and was also null when considering optimism as a binary measure (higher vs. lower optimism). We found no evidence of effect modification by sex, age, body mass index, income, or chronic conditions. CONCLUSIONS: Optimism was not associated with leukocyte telomere length among African American adults. Future studies should investigate alternate biological and behavioral mechanisms that may explain the optimism-health association.

Affective response to physical activity as an intermediate phenotype.

Over the past seventy years, biomedical and epidemiological research has shown that regular physical activity (PA) is critical for physical and mental health. Despite this knowledge, physical inactivity is the fourth leading risk factor for global mortality, accounting for 9% (5.3 million) of premature deaths annually. We suggest this mismatch between knowing about the risks of PA and engaging in regular PA can be reconciled by focusing less on expected health benefits of PA and more on how people feel during PA. Specifically, in this position paper, we argue that affective response (feeling good versus bad) to PA is an intermediate phenotype that can explain significant variance in PA behavior and is, in turn, a function of genetic variability. In making this argument, we first review empirical evidence showing that affective response to PA predicts future physical activity behavior. Second, we systematically review research on single nucleotide morphisms (SNPs) that are associated with affective response to PA. Investigating affective response to PA as an intermediate phenotype will allow future researchers to move beyond asking "What SNPs are associated with PA?", and begin asking "How do these SNPs influence PA?", thus ultimately optimizing the translation of knowledge gained from genomic data to intervention development.

Cumulative Social Risk and Cardiovascular Disease Among Adults in South Korea: A Cross-Sectional Analysis of a Nationally Representative Sample.

INTRODUCTION: The Framingham risk score (FRS) is widely used to predict cardiovascular disease (CVD), but it neglects to account for social risk factors. Our study examined whether use of a cumulative social risk score in addition to the FRS improves prediction of CVD among South Korean adults. METHODS: We used nationally representative data on 19,147 adults aged 19 or older from the Korea National Health and Nutrition Examination Survey 2013-2016. We computed a cumulative social risk score (range, 0-3) based on 3 social risk factors: low household income, low level of education, and single-living status. CVD outcomes were stroke, myocardial infarction, and angina. Weighted logistic regression examined the associations between cumulative social risk, FRS, and CVD. McFadden pseudo-R2 and area under receiver operating characteristic curve (AUC) assessed model performance. We conducted mediation analyses to quantify the association between cumulative social risk score and CVD outcomes that is not mediated by the FRS. RESULTS: A unit increase in social risk was associated with 89.4% higher risk of stroke diagnosis, controlling for the FRS (P < .001). The FRS explained 8.0% of stroke diagnosis (R2) with fair discrimination (AUC = 0.728), and adding the cumulative social risk score enhanced R2 and AUC by 2.4% and 0.039. In the association between cumulative social risk and stroke, the proportion not mediated by the FRS was 65% (P < .001). We observed similar trends in myocardial infarction and angina, such that an increase in social risk was associated with increased relative risk of disease and improved disease diagnosis, and a large proportion of the association was not mediated by the FRS. CONCLUSION: Controlling for the FRS, cumulative social risks predicted stroke, myocardial infarction, and angina among adults in South Korea. Future research is needed to examine non-FRS mediators between cumulative social risk and CVD.

Age Moderates the Effect of Self-Paced Exercise on Exercise Adherence among Overweight Adults.

Objective: The present study tested the hypothesis that the effect of self-paced exercise on adherence to exercise programs is more pronounced with increasing age. Method: Fifty-nine low-active overweight adults (18-65 years) were encouraged to walk 30 to 60 min/day and randomized to either self-paced (n = 30) or prescribed moderate-intensity (n = 29) conditions. Results: The effect of study condition was moderated by age (main effect: b = 6.14, SE = 2.54, p = .02; Condition × Age: b = -11.55, SE = 3.77, p < .01), such that among participants >50 years, those in the self-paced condition exercised 6 more min/day than participants in the prescribed moderate-intensity condition (p = .02), whereas among participants <50 years, those in the self-paced condition exercised 5.4 fewer min/day compared with those in the moderate-intensity condition (p = .05). Affective response to physical activity did not mediate the moderating effect of age. Discussion: As age increases, adults may be more likely to adhere to self-paced versus prescribed moderate-intensity exercise.

Affective response as a mediator of the association between the physical and social environment and physical activity behavior.

Perceptions of the physical and social environment have been shown to be predictive of physical activity (PA) behavior. However, the mechanisms of this association have not been examined. Affective response to PA was examined as a putative mediator of the association between perceptions of the PA environment and subsequent PA behavior. As part of a PA promotion study, 59 low-active overweight or obese but otherwise healthy adults completed real-time assessments of the perceived physical and social PA environment, affective response to PA, and PA behavior over a 6-month period. As hypothesized, decreased latency to and greater duration of subsequent PA was predicted by engaging in PA with a partner (b = 17.24, SE = .45, p < .01), engaging in PA outdoors versus indoors (b = 3.70, SE = 0.67, p < .01), and perceived pleasantness of the physical (b = 0.59, SE = .17, p < .01) and social settings (b = 0.68, SE = .16, p < .01). Affective response to PA (a shift toward feeling good versus bad during PA) mediated the association between engaging in PA with a partner (a path: 0.53(.11), p < .01, b path: 0.42(.12), p < .01, ab path: 0.22(.08), 95% CI .09-.41) and perceived pleasantness of the physical (a path: .38(.02), p < .01; b path: .65(.23), p = .01; ab path: .25(.09), 95% CI .08-.43) and social setting (a path: .35(.02), p < .01; b path: .57(.23), p = .01; ab path: .20(.08), 95% CI .03-.37) and PA behavior, but not the association between engaging in PA outdoors versus indoors and PA behavior. These findings suggest that perceived environmental variables may have their effects on PA through the process of psychological hedonism.

Small sustainable monetary donation-based incentives to promote physical activity: A randomized controlled trial.

OBJECTIVE: To pilot test two low-cost and thus financially sustainable incentive programs to promote physical activity (PA) among low-active adults in a community setting. METHOD: In a three-arm randomized controlled trial the effects of small monetary incentives (cash incentives $1/day; n = 25) were compared to charitable donations (donation $1/day; n = 25) and a control group (n = 25) on PA behavior over the course of 12 months in insufficiently active, otherwise healthy adults. Incentives were based on attendance at a local YMCA. Electronic swipe card data from the YMCA was the primary outcome, with self-reported minutes of PA as a secondary outcome. RESULTS: Quantile regression models showed promising effects of treatment allocation on the primary outcome (attendance) adjusted for age and employment. There was a difference between cash incentives and control conditions such that median attendance in the cash incentives condition was 19.24 visits more over 12 months (b = 19.24; SE = 8.26, 95% CI [2.75, 35.72]). There was a similar though only marginally significant trend for the donation condition showing that participants in the donation condition made 11.88 additional visits to the YMCA over 12 months relative to the control condition (b = 11.88, SE = 8.41,95% CI [-0.91, 28.67]). There was a significant correlation between objectively verified YMCA attendance and self-reported moderate-to-vigorous PA at the YMCA (ρ = 0.587) over 12 months. CONCLUSIONS: These promising findings provide early support for small monetary incentives and charitable donations for promoting PA in community settings. Further research on the efficacy of using financially sustainable incentive programs, including charitable donations, for PA through community organizations (e.g., YMCAs) seems warranted. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Health Research Using Facebook to Identify and Recruit Pregnant Women Who Use Electronic Cigarettes: Internet-Based Nonrandomized Pilot Study.

BACKGROUND: Participant recruitment is often a challenge, particularly enrolling individuals with relatively rare characteristics. The wide reach of social media may provide a mechanism to overcome these challenges. OBJECTIVE: This paper aimed to provide information to researchers who seek to recruit participants from rare populations using social media for studies with demanding protocols. We aimed to describe a pilot study protocol that identified and enrolled pregnant women (second or third trimester) who were exclusive users of electronic cigarettes (e-cigarettes). We have described the recruitment methods, time, and cost; examined advertisement types that were more or less successful; discussed participant retention and relationship management; and described the process of collecting biological data. METHODS: In an open-access, nonrandomized pilot study, we placed Facebook advertisements that were selectively targeting women who were likely to be pregnant and interested in e-cigarettes or vaping. The advertisements invited individuals to complete a fully automated eligibility screener based on Qualtrics. Eligible participants were asked to (1) complete a Web-based survey that collected detailed information on the use of e-cigarettes, including the exact type of device and electronic liquid, (2) report the frequency and intensity of e-cigarette use for 3 months before pregnancy and during each trimester, and (3) provide a saliva specimen for a nicotine biomarker assay. We collected a photograph of each participant's e-cigarette device, 8 weeks after the mother's due date, to allow corroboration of the self-report and the baby's birth weight and gestational age from the participant's physician. RESULTS: Participants were recruited between August 19 and October 26, 2017. We enrolled 20 participants in 2 months at a cost of US $3421.28. Baseline data were collected for all 20 participants. Of the 20 women enrolled, 16 provided a saliva sample, 4 provided a photo of the e-cigarette device, and 10 provided physician contact information. Of the 10 physicians contacted by mail, 6 responded with information on the participants and their babies. CONCLUSIONS: Study findings suggest that Facebook's targeting criteria should focus on e-cigarette users to maximize advertisement exposure of potentially eligible women. In addition, saliva sample collection was feasible among pregnant women (second or third trimester) who were exclusive e-cigarette users, but obtaining photographs and physician reports was problematic and called for further refinement. These lessons are likely useful to others who are seeking to use social media to recruit participants from rare populations into studies with demanding protocols.

Age moderates the effect of socioeconomic status on physical activity level among south Korean adults: cross-sectional analysis of nationally representative sample.

BACKGROUND: In a nationally representative sample of South Korean adults, we investigated the association between socioeconomic status (SES) and physical activity level, and whether this association varied by age group. METHODS: We used data from 5065 subjects aged ≥19 years who participated in the 6th Korea National Health and Nutrition Examination Survey. Weighted logistic regression examined the SES-physical activity association. Using the International Physical Activity Questionnaire short form, physical activity level was categorized into two groups: meeting the guideline (≥150 min/week of moderate intensity physical activity) and not meeting the guideline. Annual household income quartile (first quartile = highest income) and education (elementary, middle school, high school, and college graduates) were used as SES indicators. Sociodemographic covariates included in the adjusted models were marital status, town type (rural/urban), dwelling type, perceived health, federal allowance support (yes/no), and working- and sleeping-hours. RESULTS: In unadjusted models, low income and low education were both associated with significantly lower odds of meeting the physical activity guideline. The income-physical activity association was moderated by age group in both unadjusted and adjusted models. Specifically, among those age < 45 years, those in the third quartile group had 41% higher odds (p < 0.01) of meeting the physical activity guideline compared with the first quartile group, after adjusting for covariates. In contrast, among those age ≥ 45 years, those in the third quartile group had 16% lower odds (p < 0.01) of meeting the physical activity guideline compared with the first quartile group, after adjusting for covariates. Furthermore, the education-physical activity association was moderated by age but only in the adjusted model. Specifically, among those age < 45 years, high school graduates had a 21% higher odds of meeting the physical activity guideline compared with college graduates (p = 0.08). In contrast, among those age ≥ 45 years, high school graduates had a 23% lower odds of meeting the physical activity guideline compared with college graduates (p = 0.01). CONCLUSION: Future policies that aim to address SES-related health disparities in physical activity among adults in South Korea should consider the different patterns of physical activity in accordance with SES and age.

Small sustainable monetary incentives versus charitable donations to promote exercise: Rationale, design, and baseline data from a randomized pilot study.

Regular physical activity (PA) enhances weight-loss and reduces risk of chronic disease. However, as few as 10% of U.S. adults engage in regular PA. Incentive programs to promote PA have shown some promise, but have typically used incentives that are too large to sustain over time and have not demonstrated habit formation or been tested in community settings. This report presents the rationale and design of a randomized pilot study testing the feasibility and preliminary efficacy of small monetary incentives for PA (n=25) versus charitable donations in the same amount (n=25) versus control (n=25) over 12months among 75 low-active but otherwise healthy adults at a local YMCA. Incentives are based on YMCA attendance, which is verified by electronic swipe card data and is the primary study outcome, with self-reported minutes/week of PA assessed as a secondary outcome. Incentives are intentionally small enough-$1/session, maximum of $5/week-such that they could be indefinitely sustained by community organizations, privately-owned health clubs, healthcare organizations, or employers (e.g., employer fitness facilities). Costs of the incentive program for the sponsoring organization may be partially offset by increases in membership resulting from the appeal of the program. Moreover, if efficacious, the charitable donation incentive program may have the added benefit of building social capital for the sponsoring organization and potentially serving as a tax write-off, thus further offsetting the cost of the incentives. Findings will also have implications for the use of financially sustainable community-based incentive programs for other health-related behaviors (e.g., weight loss, smoking).

The Exercise-Affect-Adherence Pathway: An Evolutionary Perspective.

The low rates of regular exercise and overall physical activity (PA) in the general population represent a significant public health challenge. Previous research suggests that, for many people, exercise leads to a negative affective response and, in turn, reduced likelihood of future exercise. The purpose of this paper is to examine this exercise-affect-adherence relationship from an evolutionary perspective. Specifically, we argue that low rates of physical exercise in the general population are a function of the evolved human tendency to avoid unnecessary physical exertion. This innate tendency evolved because it allowed our evolutionary ancestors to conserve energy for physical activities that had immediate adaptive utility such as pursuing prey, escaping predators, and engaging in social and reproductive behaviors. The commonly observed negative affective response to exercise is an evolved proximate psychological mechanism through which humans avoid unnecessary energy expenditure. The fact that the human tendencies toward negative affective response to and avoidance of unnecessary physical activities are innate does not mean that they are unchangeable. Indeed, it is only because of human-engineered changes in our environmental conditions (i.e., it is no longer necessary for us to work for our food) that our predisposition to avoid unnecessary physical exertion has become a liability. Thus, it is well within our capabilities to reengineer our environments to once again make PA necessary or, at least, to serve an immediate functional purpose. We propose a two-pronged approach to PA promotion based on this evolutionary functional perspective: first, to promote exercise and other physical activities that are perceived to have an immediate purpose, and second, to instill greater perceived purpose for a wider range of physical activities. We posit that these strategies are more likely to result in more positive (or less negative) affective responses to exercise, better adherence to exercise programs, and higher rates of overall PA.