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"Resnicow, Kenneth"
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Self-affirmation alters the brain’s response to health messages and subsequent behavior change
Health communications can be an effective way to increase positive health behaviors and decrease negative health behaviors; however, those at highest risk are often most defensive and least open to such messages. For example, increasing physical activity among sedentary individuals affects a wide range of important mental and physical health outcomes, but has proven a challenging task. Affirming core values (i.e., self-affirmation) before message exposure is a psychological technique that can increase the effectiveness of a wide range of interventions in health and other domains; however, the neural mechanisms of affirmation’s effects have not been studied. We used functional magnetic resonance imaging (fMRI) to examine neural processes associated with affirmation effects during exposure to potentially threatening health messages. We focused on an a priori defined region of interest (ROI) in ventromedial prefrontal cortex (VMPFC), a brain region selected for its association with self-related processing and positive valuation. Consistent with our hypotheses, those in the self-affirmation condition produced more activity in VMPFC during exposure to health messages and went on to increase their objectively measured activity levels more. These findings suggest that affirmation of core values may exert its effects by allowing at-risk individuals to see the self-relevance and value in otherwise-threatening messages.
Journal Article
Engagement With Tailored Physical Activity Content: Secondary Findings From the Families Improving Together for Weight Loss Randomized Controlled Trial
Web-based tailored interventions offer rich opportunities for improved access to and personalization of behavioral interventions. However, despite the promise of this approach, the engagement and underrepresentation of minority groups remain major issues.
This study evaluated whether engagement (log-in status and log-in duration) with different types of tailored behavioral content from the Families Improving Together for weight loss web-based intervention was associated with changes in moderate to vigorous physical activity (MVPA) among African American families with overweight or obesity.
Parent-adolescent dyads were randomized to a web-based tailored intervention or web-based health education comparison program. The web-based intervention (N=119) was completed by parents and targeted 6 weight-related behaviors to support their adolescent children's weight loss goals (session contents included energy balance, fast food, fruits and vegetables, physical activity [PA], sedentary behavior, and sweetened beverages). MVPA was measured using accelerometers at baseline and after the intervention.
Using a hierarchical approach, the log-in status and duration for each web-based session were used to evaluate the additive effects of engagement with different types of tailored behavioral content on MVPA after the web-based intervention. Among parents, logging in to the PA session was not associated with greater MVPA (B=-12.561, 95% CI -18.759 to -6.367), but MVPA increased with greater log-in duration for the PA (B=0.008, 95% CI 0.004-0.012) and sedentary behavior (B= 0.008, 95% CI 0.004-0.012) sessions. These results suggest that parents who logged in to the PA session had lower MVPA, but MVPA increased with greater log-in duration for the PA and sedentary behavior sessions. These associations remained even after accounting for engagement with other content sessions. However, these engagement effects did not translate to the adolescents.
The results of this study highlight the need to disentangle the impact of engagement with different tailored content to improve the efficacy of tailored web-based interventions, especially for promoting PA in African American families.
ClinicalTrials.gov NCT01796067; https://clinicaltrials.gov/ct2/show/NCT01796067.
Journal Article
Intervention to increase physical activity and healthy eating among under-represented adolescents: GOAL trial protocol
IntroductionTo reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition recommendations is important. To address the problem, a 16-week intervention called Guys/Girls Opt for Activities for Life (GOAL) was designed. The purpose of this randomised controlled trial is to evaluate any effect of the intervention, compared with a control condition, on improving: (1) adolescents’ % body fat (primary outcome), moderate-to-vigorous PA (MVPA), diet quality and cardiorespiratory fitness from 0 to 4 months; (2) body mass index (BMI), overweight/obesity percentage and quality of life from 0 to 4 months and to 13 months; and (3) perceived social support, self-efficacy and motivation from 0 to 4 months with evaluation of any mediating effect on adolescent PA and diet quality. An exploratory aim is to evaluate any effect of the intervention, compared with the control, on improving parents’/guardians’ home environment, MVPA and diet quality from 0 to 4 months; and BMI from 0 to 4 months and to 13 months.Methods and analysisAdolescents (fifth to eighth grade) in 14 schools located in underserved urban communities are randomly assigned to the intervention or usual school offerings. One parent per adolescent is enrolled (882 dyads total). Cohort 1 includes four schools (2022–2023). Cohorts 2 and 3 include 5 schools in 2023–2024 and 2024–2025, respectively. The 16-week intervention has three components: (1) after-school GOAL club for adolescents to engage in PA and healthy eating/cooking activities; (2) three parent–adolescent meetings to empower parents to assist adolescents; and (3) GOAL social networking website for parents to share how they helped their adolescent.Ethics and disseminationThe Michigan State University Biomedical Institutional Review Board provided ethical approval for the study. Findings will be shared via the trial registration database, peer-reviewed publications, conferences and community-oriented strategies.Trial registration numberNCT04213014.
Journal Article
Demographic differences in and correlates of perceived body image discrepancy among urban adolescent girls: a cross-sectional study
Background
Understanding factors related to girls’ body image discrepancy, which is the difference between self-perceived current or actual and ideal body size, is important for addressing body-related issues and preventing adverse sequelae. Two aims were to: 1) examine demographic differences in body image discrepancy; and 2) determine the association of body image discrepancy with weight status, percent body fat, physical activity, sedentary behavior, and cardiovascular (CV) fitness among young adolescent girls.
Methods
The cross-sectional study included a secondary analysis of baseline data from a group randomized controlled trial including 1519 5th–8th grade girls in 24 U.S. schools. Girls completed physical activity and sedentary behavior surveys. To indicate perceived current/actual and ideal body image, girls selected from nine body figures the one that represented how they look now and another showing how they want to look. Girls wore accelerometers measuring physical activity. Height, weight, and percent body fat were assessed. The Progressive Aerobic CV Endurance Run was used to estimate CV fitness. Independent t-test, one- and two-way ANOVA, correlational analyses, and hierarchical linear regressions were performed.
Results
The majority (67.5%;
n
= 1023) chose a smaller ideal than current/actual figure. White girls had higher body image discrepancy than Black girls (
p
= .035). Body image discrepancy increased with increasing weight status (F
3,1506
= 171.32,
p
< .001). Moderate-to-vigorous physical activity (MVPA) and vigorous physical activity were negatively correlated with body image discrepancy (
r
= −.10,
p
< .001;
r
= −.14,
p
< .001, respectively), but correlations were not significant after adjusting for race and body mass index (BMI), respectively. Body image discrepancy was moderately correlated with CV fitness (
r
= −.55,
p
< .001). After adjusting for demographics, percent body fat, but not CV fitness or MVPA, influenced body image discrepancy. Girls with higher percent body fat had higher body image discrepancy (
p
< .001).
Conclusion
This study provided important information to guide interventions for promoting a positive body image among girls.
Trial registration
ClinicalTrials.gov Identifier
NCT01503333
, registration date: January 4, 2012.
Journal Article
A Randomized Clinical Trial Evaluating Online Interventions to Improve Fruit and Vegetable Consumption
Objectives. We assessed change in fruit and vegetable intake in a population-based sample, comparing an online untailored program (arm 1) with a tailored behavioral intervention (arm 2) and with a tailored behavioral intervention plus motivational interviewing–based counseling via e-mail (arm 3). Methods. We conducted a randomized controlled intervention trial, enrolling members aged 21 to 65 years from 5 health plans in Seattle, Washington; Denver, Colorado; Minneapolis, Minnesota; Detroit, Michigan; and Atlanta, Georgia. Participants reported fruit and vegetable intake at baseline and at 3, 6, and 12 months. We assessed mean change in fruit and vegetable servings per day at 12 months after baseline, using a validated self-report fruit and vegetable food frequency questionnaire. Results. Of 2540 trial participants, 80% were followed up at 12 months. Overall baseline mean fruit and vegetable intake was 4.4 servings per day. Average servings increased by more than 2 servings across all study arms (P < .001), with the greatest increase (+2.8 servings) among participants of arm 3 (P = .05, compared with control). Overall program satisfaction was high. Conclusions. This online nutritional intervention was well received, convenient, easy to disseminate, and associated with sustained dietary change. Such programs have promise as population-based dietary interventions.
Journal Article
Food insecurity impacts neuroblastoma pathogenesis in murine xenograft tumor models
A recent landmark study by the National Cancer Institute’s Children’s Oncology Group identified an independent association between childhood poverty and increased mortality rates in children with neuroblastoma, beyond known biological, access, or treatment variables. Neuroblastoma, a prevalent extracranial nervous system tumor in children, is influenced by both biological and environmental factors. Recent studies suggest a direct link between poverty and poorer cancer survival outcomes, yet the biological mechanisms underlying this influence remain poorly understood. We hypothesize that socioeconomic stressors like food insecurity significantly impact neuroblastoma progression. To investigate this, we developed a murine model that simulates socioeconomic challenges by varying chow accessibility to mimic food insecurity. Our results demonstrate that food insecurity significantly accelerates neuroblastoma tumor growth and metastatic spread compared to controls. This exacerbation of tumor burden in food-insecure mice underscores the potential influence of socioeconomic stressors on cancer dynamics and challenges the traditional focus on genetic and biological factors alone. Our findings highlight the crucial role of socioeconomic factors in tumor biology and advocate for a more holistic approach that integrates socioeconomics and social determinants into therapeutic strategies.
Mechanistic modeling of food insecurity reveals how chronic social stress accelerates neuroblastoma progression through tumor-intrinsic and microenvironmental changes in stress signaling.
Journal Article
Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design
Background
About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients.
Methods
Glaucoma patients taking ≥ 1 medication will be pre-screened by telephone survey for adherence to their medication(s). Those who self-report poor adherence will be enrolled in a 3-month monitoring period to measure medication adherence using electronic medication monitors. Participants who are non-adherent (take
Journal Article
44190 Comparing the Accuracy of Different Tools in Identifying Glaucoma Medication Non-adherence
ABSTRACT IMPACT: Medication non-adherence is a widespread problem in glaucoma care, and this abstract shows that a free and easy to implement tool can be used to accurately screen and identify patients who are not adherent to their glaucoma medication. OBJECTIVES/GOALS: To compare the accuracy of pharmacy refill data and five measures of self-reported adherence in identifying patients with poor electronically monitored glaucoma medication adherence. METHODS/STUDY POPULATION: Glaucoma patients (age ≥40, poor self-reported adherence, and ≥1 medication) recruited at the University of Michigan completed five surveys of adherence and 3-months of electronically monitored medication adherence; pharmacy refill data were obtained. Electronically monitored adherence was summarized monthly as percent of doses taken on time. Median monthly adherence ≤80% was considered non-adherent. Pharmacy refill data were reported as the proportion of days covered. The accuracy of the measures in predicting ≤80% adherence was assessed with receiver operating characteristic curves such as estimation of area under the curve (AUC), sensitivity, specificity, and accuracy. RESULTS/ANTICIPATED RESULTS: 95 patients completed electronic monitoring with a median monthly adherence of 74% (±21%); 53 patients (56%) were non-adherent. Pharmacy refill adherence was not significantly correlated with electronically monitored medication adherence (r=0.12, p=0.2). A single-item adherence question (‘Over the past month, what percentage of your drops do you think you took correctly?’) had the largest correlation with electronically monitored adherence (r=0.47, p<0.0001), the largest AUC for predicting non-adherence (AUC= 0.76, [95% Confidence Interval = 0.66, 0.87]), best accuracy (71%, [61, 82]), and good sensitivity (84%, [73, 96]). DISCUSSION/SIGNIFICANCE OF FINDINGS: A free, single-item screening question ('Over the past month, what percentage of your drops do you think you took correctly?') offers an easy-to-implement tool for identifying glaucoma patients with poor medication adherence in clinical practice.
Journal Article
Development of a multicomponent implementation strategy to reduce upper gastrointestinal bleeding risk in patients using warfarin and antiplatelet therapy, and protocol for a pragmatic multilevel randomized factorial pilot implementation trial
Background
The concomitant use of anticoagulant and antiplatelet medications increases the risk of upper gastrointestinal (GI) bleeding. Two underused evidence-based practices (EBPs) can reduce the risk: de-prescribe unnecessary antiplatelet therapy or initiate a proton pump inhibitor. We describe the development of a multicomponent intervention to increase use of these EBPs in patients treated with warfarin and followed by an anticoagulation monitoring service (AMS), and the design of a pilot pragmatic implementation trial.
Methods
A participatory planning group iteratively used Implementation Mapping and the Multiphase Optimization Strategy to develop implementation strategies and plan the trial. Informed by qualitative interviews with patients and clinicians, we drew on several implementation science theories, as well as self-determination theory, to design interventions. For patients, we developed an activation guide to help patients discuss the EBPs with their clinicians. For clinicians, we developed two electronic health record (EHR)-based interventions: (1) clinician notification (CN) consists of a templated message that identifies a patient as high risk, summarizes the EBPs, and links to a guidance statement on appropriate use of antiplatelet therapy. (2) Clinician notification with nurse facilitation (CN+NF) consists of a similar notification message but includes additional measures by nursing staff to support appropriate and timely decision-making: the nurse performs a chart review to identify any history of vascular disease, embeds indication-specific guidance on antiplatelet therapy in the message, and offers to assist with medication order entry and patient education. We will conduct a pilot factorial cluster- and individual-level randomized controlled trial with a primary objective of evaluating feasibility. Twelve clinicians will be randomized to receive either CN or CN+NF for all their patients managed by the AMS while 50 patients will be individually randomized to receive either the activation guide or usual care. We will explore implementation outcomes using patient and clinician interviews along with EHR review.
Discussion
This pilot study will prepare us to conduct a larger optimization study to identify the most potent and resource conscious multicomponent implementation strategy to help AMSs increase the use of best practices for upper GI bleeding risk reduction.
Trial registration
ClinicalTrials.gov
NCT05085405
. Registered on October 19, 2021—retrospectively registered.
Journal Article
Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes
BACKGROUND:Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non–health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN.
METHODS:Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN.
RESULTS:Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05–1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5–1.67), and food insecurity (PR=1.30; 95% CI, 1.2–1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2–0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN.
CONCLUSIONS:Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
Journal Article