Momentary intentions and perceived behavioral control are within-person predictors of sedentary leisure time: preliminary findings from an ecological momentary assessment study in adolescents.

Previous studies among adolescents conceptualize behavioral cognitions [e.g., intentions and perceived behavioral control (PBC)] as stable trait-like factors despite evidence suggesting they vary momentarily. We examined whether intentions and PBC momentarily relate to subsequent sedentary time during non-school periods. Healthy adolescents (N = 15, ages 11-15) reported their intentions and PBC regarding sedentary leisure behaviors via ecological momentary assessment (EMA) up to seven times/day for 14 days. Sedentary time in the two hours following each EMA prompt was measured by ActivPAL accelerometers. When participants reported greater sedentary intentions (within-person ß = 1.1, 95% CI 0.2, 2.1, p = 0.0213) and sedentary PBC (within-person ß = 1.7, 95% CI 0.6, 2.8, p = 0.0029), they accumulated greater sedentary time. This demonstrates that sedentary intentions and PBC are acutely associated with sedentary time among adolescents. Our findings highlight the potential for implementing just-in-time activity interventions among adolescents during at-risk periods within the day, characterized by deviations from one's usual intentions and PBC levels.

Associations Between Social Network Characteristics and Loneliness During Pregnancy in a Sample of Predominantly African American, Largely Publicly-Insured Women.

OBJECTIVES: Most research evaluating relationships between social network attributes and loneliness have focused on older adult and adolescent networks. The present study examines the relationships between social network size (number of relationships), social network density (whether named relationships are connected to one another) and maternal loneliness during pregnancy. METHODS: Eligible women were enrolled at the time of their dating ultrasound (between 8 and 12 weeks of gestation). Interested women provided written consent and completed demographic, social network and loneliness measures. Participants completed the same surveys in their third trimester. Mixed-regression models, adjusted for age, race, ethnicity, and insurance type, were used to assess the relationship between social network size, network density, and loneliness. RESULTS: A total of 94 pregnant women (mean age = 23.77, 70.2% Black, 87.2% public insurance) completed baseline study measures, and 60 participants completed both assessment time points. Completers and non-completers did not differ on key characteristics. Social network density, but not social network size, predicted maternal loneliness ([Formula: see text]= - 1.27, 95% CI - 2.53, - 0.01, p = 0.0489) in the first and third trimester. CONCLUSIONS: These findings indicate that pregnant women's social network density may be more intimately related to feelings of loneliness than the objective number of relationships. This knowledge can begin to inform the design of supportive approaches to improve women's health.

Evaluating environmental and inhibitory control strategies to improve outcomes in a widely available weight loss program.

BACKGROUND: Although many people try to lose weight, a large proportion of individuals do not achieve clinically significant weight loss. Nonresponse and relapse rates in lifestyle interventions are largely explained by challenges in avoiding or resisting temptation in the context of omnipresent food access. Innovative enhancement strategies are needed to help individuals manage temptation in evidence-based lifestyle interventions. METHODS: This prospective, four-parallel-arm, randomized controlled trial tests the efficacy of two weight management enhancement strategies on weight and dietary outcomes among individuals with overweight or obesity: (1) an environmental control strategy combining modification of the home food environment and grocery delivery (AVOID) and (2) an impulse control strategy involving daily, gamified inhibitory control training (RESIST). Women and men (n = 500) with overweight or obesity (Body Mass Index between 25 and 40.0 kg/m2) will be enrolled in a 12-month commercial weight-loss program (WW, formerly Weight Watchers©) and randomly assigned to one of four conditions: (1) WW alone, (2) WW + AVOID, (3) WW + RESIST, or (4) WW + AVOID + RESIST. Anthropometric, dietary, cognitive, and household food environment assessments will be conducted in English or Spanish at enrollment and at 6- and 12-month follow-up. DISCUSSION: This research addresses the pragmatic question of how to best optimize behavior change: Should we modify the choice environment, strengthen individuals' self-regulation, or both, to maximize behavior change? This work can inform the development of enhancement strategies to promote adherence to lifestyle recommendations and other impulse control challenges.

Supplementing a widely available weight loss program with gamified inhibitory control training: A randomized pilot study.

Background: Increasing evidence suggests that targeting self-regulatory processes may improve obesity treatment outcomes. Incorporating gamification principles in inhibitory control training may promote sustained training adherence and resulting benefits. This pilot study evaluated the preliminary efficacy of supplementing an evidence-based weight management program (WW) with sustained gamified inhibitory control training (PolyRules!) on change in Body Mass Index (BMI) among adults with overweight/obesity. Methods: 30 adults with overweight/obesity (M age 49.9 ± 12.4, 86.7% female; 23.3% Hispanic, mean BMI 35.3 ± 6.3) were randomly assigned to receive WW with or without PolyRules! for 12 weeks. The primary outcome was change in BMI from baseline to post-intervention across study arms. Implementation and process indicators were captured to inform larger trials. Results: Average change in BMI was -0.9 in the WW arm and -1.2 in the WW + PolyRules! arm (Cohen's d = 0.26). In the WW + PolyRules! arm, increased training was associated with greater decreases in BMI (r = -0.506, p = 0.0454). WW + PolyRules! participants completed an average of 60.4% sessions and reported positive experiences. There was no difference in frequency of food (d = -0.02) and weight tracking (d = -0.19) between arms. Conclusions: Studies in larger samples should evaluate training-related effects on weight. Supplementing WW with gamified inhibitory training appears feasible, with no detrimental effect on engagement.

How useful are body mass index and history of diabetes in COVID-19 risk stratification?

OBJECTIVE: This study examines the value of risk stratification by documented diagnosis of diabetes and objectively measured height and weight (BMI) in COVID-19 severity and mortality in a large sample of patients in an urban hospital located in Southern California. METHODS: Data from a retrospective cohort study of COVID-19 patients treated at Cedars-Sinai Medical Center between March 8, 2020, and January 25, 2021, was analyzed. Sociodemographic characteristics and pre-existing conditions were extracted from electronic medical records. Univariable and multivariable logistic regression models identified associated risk factors, and a regression causal mediation analysis examined the role of diabetes in the association between obesity and illness severity. All analyses were stratified by age (<65 and ≥65). RESULTS: Among individuals <65yo, diabetes accounted for 19-30% of the associations between obesity and COVID-19 illness severity. Among patients ≥65yo, having a BMI <18.5 was a risk factor for mortality regardless of diabetes history. CONCLUSION: Our findings have clinical implications in documenting which patients may be at elevated risk for adverse outcomes. More in-depth prospective studies are needed to capture how glycemic regulation may influence prognosis.

Interstitial glucose and subsequent affective and physical feeling states: A pilot study combining continuous glucose monitoring and ecological momentary assessment in adolescents.

OBJECTIVE: Circulating glucose may relate to affective and physical feeling states reflective of emotional disorder symptoms. No prior studies have investigated within-day associations between glucose and subsequent affective and physical feeling states (positive affect, negative affect, and fatigue) as they occur naturally among healthy adolescents; this pilot study assessed these associations by combining data collected from ecological momentary assessment (EMA) and continuous glucose monitors (CGM). METHODS: Participants (N = 15, mean age = 13.1[±1.0] years, 66.7% female, 40.0% Hispanic, 66.7% healthy weight) wore a CGM for 7-14 days. Simultaneously, participants reported on their current positive affect, negative affect, and fatigue randomly during specified windows up to 7 times daily via EMA. CGM-measured mean interstitial glucose was calculated during the time windows (mean minutes = 122.5[±47.3]) leading up to each EMA prompt. Multilevel models assessed within-subject (WS) associations between mean interstitial glucose since the previous EMA prompt and EMA-reported affective and physical feeling states at the current prompt. RESULTS: Participants provided 532 interstitial glucose-matched EMA reports of affective and physical feeling states. During intervals when interstitial glucose was higher than one's usual, higher positive affect (WS ß = 0.01, p < .0001, f2 = 0.02) and lower fatigue (WS ß = -0.01, p < .0001, f2 = 0.09) were subsequently reported. Interstitial glucose was unrelated to negative affect (WS ß = -0.002, p = .10, f2 = 0.01). Associations were weakened, but remained significant following further adjustment for time of day. CONCLUSIONS: Though effect sizes were small, within-person variations in interstitial glucose may relate to subsequent affective and physical feeling states among healthy youth. Investigations using similar methodologies in larger, more diverse samples are warranted.