Publications by authors named "Carmina G Valle"

25 Publications

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Initiation and changes in use of social media for peer support among young adult cancer patients and survivors.

Psychooncology 2021 Jun 24. Epub 2021 Jun 24.

Stanford University School of Medicine, Stanford, California, USA.

Purpose: Social isolation is a prominent challenge for many young adults with cancer. Despite desires for peer-to-peer connections through technology, little is known about how young adults initiate or use social media for support over time.

Methods: We interviewed young adults with cancer (n = 45; age 18-39, in or post cancer treatment) to explore their initiation of social media for support, changes in use over time, and types of connections sought.

Results: Young adults with cancer learn about online support through individual personal recommendations, advocacy organizations, or searching on Google or social media. Most were reluctant to use social media support initially because of feeling overwhelmed-from diagnoses, abundance of online information, or demands of participation-and joined when informational and emotional needs arose. Many wished they had joined earlier. Some participants use social media to make close connections while others simply want to "see" others' shared experiences or crowdsource information.

Conclusion: Young adults with cancer often haphazardly find online support from personal recommendations or Internet searches. Desires for social media connections are not one-size-fits-all; there are important audience segmentations for the degree and type of peer support.

Implications For Cancer Survivors: Better promotion of online social support options and benefits-early in one's cancer timeline and systematically through healthcare providers, cancer organizations, or family and friends-could improve access to helpful peer-to-peer support.
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http://dx.doi.org/10.1002/pon.5758DOI Listing
June 2021

Predictors and Outcomes of Digital Weighing and Activity Tracking Lapses Among Young Adults During Weight Gain Prevention.

Obesity (Silver Spring) 2021 04;29(4):698-705

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objectives: Self-monitoring is critical for weight management, but little is known about lapses in the use of digital self-monitoring. The objectives of this study were to examine whether lapses in self-weighing and wearing activity trackers are associated with weight and activity outcomes and to identify objective predictors of lapses.

Methods: Participants (N = 160, BMI = 25.5 ± 3.3 kg/m , 33.1 ± 4.6 years old) were drawn from a sample of young adults in the Study of Novel Approaches to Prevention-Extension (SNAP-E) weight gain prevention trial. Analyses evaluated associations between weighing and tracker lapses and changes in weight and steps/day during the first 90 days after receiving a smart scale and activity tracker.

Results: On average, participants self-weighed 49.6% of days and wore activity trackers 75.2% of days. Every 1-day increase in a weighing lapse was associated with a 0.06-lb gain. Lapses in tracker wear were not associated with changes in steps/day or weight between wear days. Weight gain predicted a higher likelihood of starting a lapse in weighing and tracker wear, whereas lower steps predicted a higher likelihood of a tracker lapse.

Conclusions: Weight gain may discourage adherence to self-monitoring. Future research could examine just-in-time supports to anticipate and reduce the frequency or length of self-monitoring lapses.
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http://dx.doi.org/10.1002/oby.23123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995618PMC
April 2021

Telemedicine Use and Health-Related Concerns of Patients With Chronic Conditions During COVID-19: Survey of Members of Online Health Communities.

J Med Internet Res 2021 02 18;23(2):e23795. Epub 2021 Feb 18.

Health Union, LLC, Philadelphia, PA, United States.

Background: It has been widely communicated that individuals with underlying health conditions are at higher risk of severe disease due to COVID-19 than healthy peers. As social distancing measures continue during the COVID-19 pandemic, experts encourage individuals with underlying conditions to engage in telehealth appointments to maintain continuity of care while minimizing risk exposure. To date, however, little information has been provided regarding telehealth uptake among this high-risk population.

Objective: The aim of this study is to describe the telehealth use, resource needs, and information sources of individuals with chronic conditions during the COVID-19 pandemic. Secondary objectives include exploring differences in telehealth use by sociodemographic characteristics.

Methods: Data for this study were collected through an electronic survey distributed between May 12-14, 2020, to members of 26 online health communities for individuals with chronic disease. Descriptive statistics were run to explore telehealth use, support needs, and information sources, and z tests were run to assess differences in sociodemographic factors and information and support needs among those who did and did not use telehealth services.

Results: Among the 2210 respondents, 1073 (49%) reported engaging in telehealth in the past 4 months. Higher proportions of women engaged in telehealth than men (890/1781, 50% vs 181/424, 43%; P=.007), and a higher proportion of those earning household incomes of more than US $100,000 engaged in telehealth than those earning less than US $30,000 (195/370, 53% vs 241/530 45%; P=.003). Although 59% (133/244) of those younger than 40 years and 54% (263/486) of those aged 40-55 years used telehealth, aging populations were less likely to do so, with only 45% (677/1500) of individuals 56 years or older reporting telehealth use (P<.001 and P=.001, respectively). Patients with cystic fibrosis, lupus, and ankylosing spondylitis recorded the highest proportions of individuals using telehealth when compared to those with other diagnoses. Of the 2210 participants, 1333 (60%) participants either looked up information about the virus online or planned to in the future, and when asked what information or support would be most helpful right now, over half (1151/2210, 52%) responded "understanding how COVID-19 affects people with my health condition."

Conclusions: Nearly half of the study sample reported participating in telehealth in the past 4 months. Future efforts to engage individuals with underlying medical conditions in telehealth should focus on outreach to men, members of lower-income households, and aging populations. These results may help inform and refine future health communications to further engage this at-risk population in telehealth as the pandemic continues.
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http://dx.doi.org/10.2196/23795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894395PMC
February 2021

Promoting physical activity in young adult cancer survivors using mHealth and adaptive tailored feedback strategies: Design of the Improving Physical Activity after Cancer Treatment (IMPACT) randomized controlled trial.

Contemp Clin Trials 2021 04 27;103:106293. Epub 2021 Jan 27.

Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Introduction: Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS.

Purpose: To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS.

Methods: A total of 280 physically inactive YACS (diagnosed at ages 18-39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures.

Conclusions: IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.
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http://dx.doi.org/10.1016/j.cct.2021.106293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089056PMC
April 2021

Optimizing Behavioral Interventions for Obesity Using an Engineering-Inspired Approach.

Obesity (Silver Spring) 2020 09 7;28(9):1574. Epub 2020 Aug 7.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

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http://dx.doi.org/10.1002/oby.22957DOI Listing
September 2020

Cardiac Rehabilitation Programs for Cancer Survivors: A Scoping Review.

Curr Epidemiol Rep 2020 Jun 8;7(2):89-103. Epub 2020 May 8.

Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC.

Purpose Of Review: Participation in cardiac rehabilitation is associated with improved quality of life and physical functioning and may be an effective strategy to assist in the recovery from cancer. We conducted a scoping review to identify studies that enrolled cancer survivors into cardiac rehabilitation programs.

Recent Findings: We identified nine studies that included 662 cancer survivors. Five studies integrated cancer survivors and cardiac patients into the same sessions, three studies developed cancer-only rehabilitation sessions, and one study did not report details on the rehabilitation sessions. On average, more than 60% of enrolled cancer survivors completed the rehabilitation programs and many health and psychosocial outcomes improved after rehabilitation.

Summary: Cardiac rehabilitation appears to be acceptable and favorably impacts many health and psychosocial outcomes among cancer survivors. Future research should consider randomized controlled trial study designs, enrolling diverse survivor populations, and using a set of core physical function and psychosocial outcomes.
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http://dx.doi.org/10.1007/s40471-020-00235-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311091PMC
June 2020

Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study.

JMIR Mhealth Uhealth 2020 06 8;8(6):e16059. Epub 2020 Jun 8.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS.

Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months.

Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data.

Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active.

Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management.
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http://dx.doi.org/10.2196/16059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308909PMC
June 2020

Attracting Users to Online Health Communities: Analysis of LungCancer.net's Facebook Advertisement Campaign Data.

J Med Internet Res 2019 11 4;21(11):e14421. Epub 2019 Nov 4.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: With growing numbers of adults turning to the internet to get answers for health-related questions, online communities provide platforms with participatory networks to deliver health information and social support. However, to optimize the benefits of these online communities, these platforms must market effectively to attract new members and promote community growth.

Objective: The aim of this study was to assess the engagement results of Facebook advertisements designed to increase membership in the LungCancer.net online community.

Methods: In the fall of 2017, a series of 5 weeklong Facebook advertisement campaigns were launched targeting adults over the age of 18 years with an interest in lung cancer to increase opt ins to the LungCancer.net community (ie, the number of people who provided their email to join the site).

Results: The advertisements released during this campaign had a sum reach of 91,835 people, and 863 new members opted into the LungCancer.net community by providing their email address. Females aged 55 to 64 years were the largest population reached by the campaign (31,401/91,835; 34.29%), whereas females aged 65 and older were the largest population who opted into the LungCancer.net community (307/863; 35.57%). A total of US $1742 was invested in the Facebook campaigns, and 863 people opted into LungCancer.net, resulting in a cost of US $2.02 per new member.

Conclusions: This research demonstrates the feasibility of using Facebook advertising to promote and grow online health communities. More research is needed to compare the effectiveness of various advertising approaches. Public health professionals should consider Facebook campaigns to effectively connect intended audiences to health information and support.
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http://dx.doi.org/10.2196/14421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861997PMC
November 2019

¿Ahora qué?: Cultural Adaptation of a Cancer Survivorship Intervention for Latino/a Cancer Survivors.

Psychooncology 2019 09 16;28(9):1854-1861. Epub 2019 Jul 16.

Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Objective: With a steadily increasing number of Latino/a cancer survivors, there is a need for supportive care programs for this underserved survivor subgroup.

Methods: In this study, the authors culturally adapted an evidence-based survivorship program, Cancer Transitions: Moving Beyond Treatment (CT) for this population. Guided by Barrera and Castro's heuristic model for cultural adaptation of interventions, we conducted five focus groups (FG) among Latino/a cancer survivors (n = 54) in several US sites to inform the preliminary adaptation of program materials. We conducted four additional FGs (n = 38) to obtain feedback on adapted materials.

Results: Common themes from initial FGs were related to program delivery and logistics, and general recommendations for CT modification. Program adaptations addressed information needs, including health care system navigation, employment concerns, and sexuality. Other adaptations included an emphasis on family, spirituality, culturally appropriate translation and features, and role plays. Participants in the second round of FGs confirmed adaptations incorporated earlier findings and suggested additional refinements.

Conclusion: This project helps guide the cultural adaptation of survivorship programs for Latino/a cancer survivors.
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http://dx.doi.org/10.1002/pon.5164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028358PMC
September 2019

Nonadherence to daily self-weighing and activity tracking is associated with weight fluctuations among African American breast cancer survivors.

PLoS One 2018 26;13(6):e0199751. Epub 2018 Jun 26.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America.

Introduction: Daily self-weighing (DSW) and daily activity tracking (DAT) are useful strategies for preventing weight gain among African American breast cancer survivors. However, self-monitoring behaviors vary over time, increasing risk of weight gain. This study explored the association of nonadherence to DSW and DAT with corresponding weight fluctuations among African American breast cancer survivors.

Methods: Using data from a 6-month randomized controlled trial, we conducted a secondary data analysis among women randomized into a DSW group (n = 13) and a DSW+DAT group (n = 11). DSW and DAT were captured from wireless scale and activity tracker data. Nonadherence to DSW was defined as one or more days without a weight measurement, and nonadherence to DAT was defined as one or more days without activity tracking. Generalized estimating equations were used to examine weight fluctuations in relation to nonadherence to DSW and DAT. Data analysis occurred from September 2016-April 2017.

Results: Over the 6-month study period, women provided 119.2 ± 46.0 weight measurements and 121.9 ± 53.2 days of physical activity tracking. Nonadherence to DSW was associated with weight fluctuations. For every 1-day increase in nonadherence to DSW, weight increased by 0.031 kg (95% CI: 0.012, 0.050; p<0.01). Additionally, during periods of DSW and DAT weight decreased by 0.028 kg (95% CI: -0.042, -0.014; p<0.001) and 0.017 kg (95% CI: -0.030; -0.004) respectively.

Conclusions: Our findings suggest that nonadherence to DSW was associated with weight gain among breast cancer survivors. Weight loss was enhanced during periods of DSW and DAT.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199751PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019092PMC
December 2018

Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification.

J Med Internet Res 2018 03 1;20(3):e63. Epub 2018 Mar 1.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: Health risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback.

Objective: The goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions.

Methods: We conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up.

Results: For the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions.

Conclusions: Findings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors.
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http://dx.doi.org/10.2196/jmir.7613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856933PMC
March 2018

Randomized trial comparing group size of periodic in-person sessions in a remotely delivered weight loss intervention.

Int J Behav Nutr Phys Act 2017 10 23;14(1):144. Epub 2017 Oct 23.

Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7294, USA.

Background: Few randomized studies have examined differential effects of group size in behavioral weight control, especially in hybrid programs that include Internet treatment approaches.

Methods: Randomized controlled trial (n = 195) comparing a 4 month hybrid internet weight loss program coupled with monthly face to face groups of 100 persons (Large Group, LG; 1 group) or to the same approach with monthly groups of 20 persons (Small Group, SG; 4 groups). Repeated-measures mixed-model analysis with age and race as covariates were used to estimate primary (weight) and secondary outcomes, and to test group differences in change over time.

Results: The sample was 46.3 years old ±10.4, 90.3% female, and 51.9% non-white, with BMI 37.9 ± 8.4 kg/m. Participants in the LG were more likely to return for the 4-month assessment visit than those in the SG (p = 0.04). Participants randomized to both the LG and SG conditions experienced significant WL over time (no between group difference: -4.1 kg and -3.7 kg, respectively) and weight loss was positively associated with attendance at monthly meetings and logins to the website. Satisfaction with the program was high and similar in both groups (94.4% reported that they were "satisfied" or "very satisfied").

Conclusions: Using a hybrid approach of in-person and online weight loss interventions may be an effective way to reach larger and more diverse populations. Delivering the face to face component of the intervention in groups larger than those traditionally delivered (20-25 people) could increase the cost-effectiveness of group-based behavioral weight loss interventions.

Clinical Trials Registration Number: NCT01615471 . Registered June 6, 2012. Registered retrospectively.
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http://dx.doi.org/10.1186/s12966-017-0599-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654056PMC
October 2017

Engagement of young adult cancer survivors within a Facebook-based physical activity intervention.

Transl Behav Med 2017 12;7(4):667-679

Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Few studies have examined how young adult cancer survivors use online social media. The objective of this study was to characterize Facebook engagement by young adult cancer survivors in the context of a physical activity (PA) intervention program. Young adult cancer survivors participated in one of two Facebook groups as part of a 12-week randomized trial of a PA intervention (FITNET) compared to a self-help comparison (SC) condition. A moderator actively prompted group discussions in the FITNET Facebook group, while social interaction was unprompted in the SC group. We examined factors related to engagement, differences in engagement by group format and types of Facebook posts, and the relationship between Facebook engagement and PA outcomes. There were no group differences in the number of Facebook comments posted over 12 weeks (FITNET, 153 vs. SC, 188 p = 0.85) or the proportion of participants that reported engaging within Facebook group discussions at least 1-2 days/week. The proportion of participants that made any posts decreased over time in both groups. SC participants were more likely than FITNET participants to agree that group discussions caused them to become physically active (p = 0.040) and that group members were supportive (p = 0.028). Participant-initiated posts elicited significantly more comments and likes than moderator-initiated posts. Responses posted on Facebook were significantly associated with light PA at 12 weeks (β = 11.77, t(85) = 1.996, p = 0.049) across groups. Engagement within Facebook groups was variable and may be associated with PA among young adult cancer survivors. Future research should explore how to promote sustained engagement in online social networks. ClinicalTrials.gov identifier: NCT01349153.
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http://dx.doi.org/10.1007/s13142-017-0483-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684071PMC
December 2017

Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study.

J Cancer Surviv 2017 02 8;11(1):133-148. Epub 2016 Sep 8.

Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Purpose: This study evaluated the feasibility and preliminary efficacy of two 6-month, self-regulation interventions that focused on daily self-weighing (DSW) and used objective monitoring and tailored feedback about weight (±activity), to prevent weight gain among African American breast cancer survivors.

Methods: Participants (n = 35) were randomized to an intervention + activity monitoring (INT+), intervention (INT), or control (CON) group. Interventions included a wireless scale (±activity tracker) that transmitted objective data to a mobile app/website, emailed lessons, and tailored feedback based on objective weight (±activity data). Participants completed in-person and online assessments at baseline, 3 months, and 6 months.

Results: Ninety-four percent of participants completed assessments at 3 months, and 97 % at 6 months. Median (IQR) weight change after 6 months was -0.9 % (-4.4-0.1) in the INT+ (p = 0.075; p = 0.067 vs. CON) and -0.2 % (-4.2-1.3) in the INT groups (p = 0.463; p = 0.357 vs. CON), versus a 0.2 % (-0.7-1.7) gain in the CON group. The proportion of INT+, INT, and CON participants that were at or below baseline weight was 72.7, 53.8, and 45.5 %, respectively (effect sizes d = 0.64, d = 0.18). Most INT+ participants weighed and wore trackers ≥5 days/week (INT+, 81.9 % vs. INT, 38.5 % vs. CON, 0 %; p < 0.0005; INT+, 72.7 %). Both intervention groups perceived DSW as positive, and 100 % would recommend the program to other breast cancer survivors.

Conclusion: An intervention focused on DSW as a self-monitoring strategy shows promise for preventing weight gain in breast cancer survivors.

Implications For Cancer Survivors: Daily self-monitoring of weight and activity may be a feasible and accessible approach to promote weight gain prevention in breast cancer survivors.

Clinical Trial Registration: ClinicalTrials.gov, NCT02030353.
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http://dx.doi.org/10.1007/s11764-016-0571-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269496PMC
February 2017

Friend and Family Support for Weight Loss in Adolescent Females.

Child Obes 2016 Feb 19;12(1):44-51. Epub 2015 Nov 19.

3 Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina , Chapel Hill, NC.

Background: Overweight and obesity rates in children and adolescents are concerning, particularly among girls. Social support from friends has been associated with healthier eating and higher levels of physical activity, yet little is known about the relationship between social support and weight loss among adolescents. This aim of this study was to prospectively examine the relationship between baseline social support from friends and family, changes in social support, and weight loss.

Methods: Sixty-five adolescent girls completed a one-year weight loss intervention trial. Data were collected at baseline, 6 months, and 12 months.

Results: At baseline, family support was higher compared to friend support; however, lower friend support at baseline and increases in friend support from baseline to 6 months and 12 months were associated with weight loss. When controlling for other predictors of weight loss, change in friend support for healthy eating was predictive of weight loss at 12 months.

Conclusions: These findings suggest that weight loss interventions for adolescent females might consider including strategies to elicit or to create and promote social support for healthy eating from peers. Future studies are needed to test this relationship.
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http://dx.doi.org/10.1089/chi.2015.0044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913115PMC
February 2016

Exploring Mediators of Physical Activity in Young Adult Cancer Survivors: Evidence from a Randomized Trial of a Facebook-Based Physical Activity Intervention.

J Adolesc Young Adult Oncol 2015 Mar;4(1):26-33

Department of Biostatistics, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.

Purpose: This study examined the effects of a physical activity (PA) intervention for young adult cancer survivors on changes in self-efficacy, social support, and self-monitoring and determined whether changes in these social cognitive theory constructs mediated the relationship between the intervention and changes in PA.

Methods: A 12-week randomized trial compared a Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA to a Facebook-based self-help comparison group. Young adult cancer survivors (N=86, aged 21-39) were randomly assigned to one of the two groups. Self-report measures of PA and psychosocial variables were collected at baseline and after 12 weeks.

Results: The FITNET group reported lower self-efficacy for sticking to exercise (mean change=-0.38; 95% CI: -0.62 to -0.12; p=0.025) and social support from friends on social networking websites (mean change=-0.47; 95% CI: -1.45 to 0.65; p=0.039) relative to the self-help comparison group over time. Changes in social support from friends on social networking websites partially mediated the intervention effects on moderate-to-vigorous PA (mean indirect effect=-22.4; 95% CI: -62.0 to -2.8) in the unexpected direction. Across both groups, social support from friends and self-monitoring were positively associated with changes in moderate-to-vigorous PA.

Conclusion: The proposed mediators did not explain the positive effects of the FITNET intervention on mild PA. The lack of significant improvements in psychosocial constructs among FITNET participants may partly explain why the intervention did not increase moderate-to-vigorous PA relative to the self-help comparison group. Future PA interventions with young adult cancer survivors should examine targeting social support from friends and self-monitoring.
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http://dx.doi.org/10.1089/jayao.2014.0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365511PMC
March 2015

High-tech tools for exercise motivation: use and role of technologies such as the internet, mobile applications, social media, and video games.

Diabetes Spectr 2015 Jan;28(1):45-54

Cancer Health Disparities Training Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CHapel Hill, NC.

IN BRIEF The majority of patients with type 2 diabetes are not active at recommended levels, and many do not have access to behavior change programs to support lifestyle change. Thus, tools and programs designed to promote the adoption and maintenance of physical activity using technology may be helpful. This article reviews the evidence regarding the use of technology tools such as the Internet, mobile applications, social media, and video games and provides suggestions for evaluating the potential benefit of such tools for behavior change.
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http://dx.doi.org/10.2337/diaspect.28.1.45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334081PMC
January 2015

Physical activity in young adults: a signal detection analysis of Health Information National Trends Survey (HINTS) 2007 data.

J Health Commun 2015 6;20(2):134-46. Epub 2014 Nov 6.

a Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.

Many young adults are insufficiently active to achieve the health benefits of regular physical activity. Using signal detection analysis of data from the 2007 Health Information National Trends Survey, the authors examined distinct subgroups of 18-39 year-old adults who vary in their likelihood of not meeting physical activity recommendations. We randomly split the sample and conducted signal detection analysis on the exploratory half to identify subgroups and interactions among sociodemographic and health communication variables that predicted engaging in less than 150 minutes per week of moderate-intensity physical activity (low physical activity). We compared rates of low physical activity among subgroups with similarly defined subgroups in the validation sample. Overall, 62% of participants did not meet physical activity recommendations. Among 8 subgroups identified, low physical activity rates ranged from 31% to 90%. Predictors of low physical activity were general health, body mass index (BMI), perceived cancer risk, health-related Internet use, and trust in information sources. The least active subgroup (90% low physical activity) included young adults in poor to good health with a BMI of 30.8 or more (obese). The most active subgroup (31% low physical activity) comprised those in very good to excellent health, who used a website to help with diet, weight, or physical activity, and had little to no trust in health information on television. Findings suggest potential intervention communication channels and can inform targeted physical activity interventions for young adults.
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http://dx.doi.org/10.1080/10810730.2014.917745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852744PMC
May 2015

A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors.

J Cancer Surviv 2013 Sep 27;7(3):355-68. Epub 2013 Mar 27.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC 27599, USA.

Purpose: Over half of young adult cancer survivors do not meet physical activity (PA) guidelines. PA interventions can enhance health and quality of life among young adult cancer survivors. However, few exercise interventions have been designed and tested in this population. This study evaluated the feasibility and preliminary efficacy of a 12-week, Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA compared with a Facebook-based self-help comparison (SC) condition.

Methods: Young adult cancer survivors (n = 86) were randomly assigned to the FITNET or SC group. All participants were asked to complete self-administered online questionnaires at baseline and after 12 weeks.

Results: Seventy-seven percent of participants completed postintervention assessments, and most participants reported using intervention components as intended. Participants in both groups would recommend the program to other young adult cancer survivors (FITNET, 46.9 vs. SC, 61.8 %; p = 0.225). Over 12 weeks, both groups increased self-reported weekly minutes of moderate-to-vigorous PA (FITNET, 67 min/week (p = 0.009) vs. SC, 46 min/week (p = 0.045)), with no significant difference between groups. Increases in light PA were 135 min/week greater in the FITNET group relative to the SC group (p = 0.032), and the FITNET group reported significant weight loss over time (-2.1 kg, p = 0.004; p = 0.083 between groups).

Conclusion: Facebook-based intervention approaches demonstrated potential for increasing PA in young adult cancer survivors.

Implications For Cancer Survivors: Social networking sites may be a feasible way for young adult cancer survivors to receive health information and support to promote PA and healthy behaviors.
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http://dx.doi.org/10.1007/s11764-013-0279-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737370PMC
September 2013

Evaluating the dissemination of Body & Soul, an evidence-based fruit and vegetable intake intervention: challenges for dissemination and implementation research.

J Nutr Educ Behav 2012 Nov-Dec;44(6):530-8. Epub 2012 Mar 9.

Gillings School of Global Public Health, Department of Nutrition, University of North Carolina at Chapel Hill, NC 27599, USA.

Objective: To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve results similar to those of earlier efficacy and effectiveness trials.

Design: Prospective group randomized trial.

Setting: Churches with predominantly African American membership.

Participants: A total of 1,033 members from the 15 churches completed baseline surveys. Of these participants, 562 (54.4%) completed the follow-up survey 6 months later.

Intervention: Church-based nutrition program for African Americans that included pastoral involvement, educational activities, church environmental changes, and peer counseling.

Main Outcome Measure: Daily fruit and vegetable (FV) intake was assessed at pre- and posttest.

Analysis: Mixed-effects linear models.

Results: At posttest, there was no statistically significant difference in daily servings of FVs between the early intervention group participants compared to control group participants (4.7 vs 4.4, P = .38). Process evaluation suggested that added resources such as technical assistance could improve program implementation.

Conclusions And Implications: The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials, primarily because of a lack of program implementation. Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level.
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http://dx.doi.org/10.1016/j.jneb.2011.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374882PMC
January 2013

An examination of sociodemographic, health, psychological factors, and fruit and vegetable consumption among overweight and obese U.S. veterans.

Mil Med 2011 Nov;176(11):1281-6

Lineberger Comprehensive Cancer Center, University of North Carolina, 1700 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599-7294, USA.

A diet high in fruits and vegetables (F&Vs) is associated with decreased risk for cardiovascular disease, diabetes, and cancer. This study investigated the relationship between sociodemographic, health, and psychosocial factors and F&V consumption among overweight and obese U.S. veterans. Participants were recruited from two Veterans Affairs medical center sites in 2005. Two hundred eighty-nine participants completed a self-administered survey. Bivariate and multivariate linear regression models were built to examine the association between sociodemographic, health, and psychosocial variables and F&V consumption. Older age (B = 0.01; p < 0.001) and being Black (B = -0.18; p < 0.05) were related to increased F&V consumption. Reported tobacco use was inversely associated with F&V consumption (B = -0.30; p < 0.01). Greater self-efficacy (B = 0.07; p < 0.05), fewer perceived barriers (B = -0.14; p < 0.01), and correct knowledge of recommended daily F&V intake (B = 0.12; p <0.05) were related to eating more F&Vs. U.S. veterans disproportionately experience overweight and obese conditions. Age, race, tobacco use, and psychosocial factors should be considered carefully when developing dietary interventionsamong overweight ana obese U.S. veterans.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868336PMC
http://dx.doi.org/10.7205/milmed-d-11-00021DOI Listing
November 2011

Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network.

J Cancer Surviv 2011 Sep 10;5(3):271-82. Epub 2011 May 10.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7461, 1700 Martin Luther King Blvd, Room 316, Chapel Hill, NC 27599, USA.

Background: The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care.

Methods: Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits.

Results: Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions.

Conclusions: The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care.

Implications For Cancer Survivors: Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.
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http://dx.doi.org/10.1007/s11764-011-0180-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739450PMC
September 2011

Pilot weight control intervention among US veterans to promote diets high in fruits and vegetables.

Prev Med 2010 Sep-Oct;51(3-4):279-81. Epub 2010 Jun 22.

Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #7461, Chapel Hill, NC 27599, USA.

Background: Obesity is a significant problem among US veterans. Diets high in fruits and vegetables (FV) can lower obesity risk. Health communication interventions are promising strategies for promoting healthy eating. We evaluated whether an enhanced intervention with tailored newsletters and motivational interviewing calls would be more effective than the Veterans Affairs (VA) weight management program, MOVE!, at increasing FV intake among overweight/obese veterans.

Methods: Using a quasi-experimental design, 195 veterans at two clinics participated at baseline and 6-month follow-up from 2005 to 2006. Measures included daily FV intake and information processing of the intervention. The control group (MOVE!) received educational information, group sessions, and standard phone calls about weight. The intervention included MOVE! components plus tailored newsletters and motivational interviewing calls.

Results: The intervention group reported a statistically significant increase in FV servings compared to control (1.7 vs. 1.2; p ≤ 0.05). Veterans who read more of the tailored newsletters (β=0.15, p=0.01) and perceived the messages as important (β=0.12, p<0.01) and applicable to their lives (β=0.12, p<0.01) ate more FV than those who did not. However, receiving MI calls and information processing regarding the calls were not associated with FV intake.

Conclusion: A tailored intervention can impact short term FV intake for obesity prevention.
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http://dx.doi.org/10.1016/j.ypmed.2010.06.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939177PMC
January 2011

Women's experiences with genomic testing for breast cancer recurrence risk.

Cancer 2010 Apr;116(8):1992-2000

Department of Health Behavior and Health Education, University of North Carolina, Chapel Hill, North Carolina 27599, USA.

Background: Few studies have examined how patients understand and use genomic test results when deciding about treatment. This study examined how women receive and incorporate results of Oncotype DX, a genomic test that offers recurrence risk estimates, into decisions about adjuvant treatment for early stage breast cancer.

Methods: Participants in the cross-sectional study were 77 women with early stage, estrogen receptor-positive breast cancer with 0 to 3 positive lymph nodes who received Oncotype DX between 2004 and 2009. Mailed surveys, supplemented by medical chart review, assessed how women received and understood recurrence risk information based on the test.

Results: The most common test results were low (50%, 34 of 68) or intermediate (37%, 25 of 68) breast cancer recurrence risk. Most women accurately recalled their recurrence risk based on the test (71%) and felt they understood much of what they were told about it (67%). Approximately 25% of women recalled experiencing test-related distress. Women's perceived recurrence risk was associated with their actual genomic-based recurrence risks, having had a previous cancer diagnosis, and worry about recurrence. Women with high recurrence risk typically had chemotherapy (78%, 7 of 9), whereas only 2 with a low recurrence risk did (7%, 2 of 30).

Conclusions: This is among the first studies to describe patients' experiences with genomic testing for recurrence risk. Although many women understood discussions about their genomic test results, a third reported not fully understanding these discussions, suggesting a need to aid and improve risk communication and treatment decision making.
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http://dx.doi.org/10.1002/cncr.24990DOI Listing
April 2010

Evaluating the implementation of peer counseling in a church-based dietary intervention for African Americans.

Patient Educ Couns 2010 Oct 30;81(1):37-42. Epub 2009 Dec 30.

University of North Carolina at Chapel Hill, Department of Nutrition, Gillings School of Global Public Health and School of Medicine, 2004 Hooker, Chapel Hill, NC 27599, USA.

Objective: Body & Soul, an evidence-based nutrition program for African Americans churches, is currently being disseminated nationally and free of charge by the National Cancer Institute. For dissemination feasibility, the peer counseling training is done via DVD rather than by live trainers. We describe implementation and process evaluation of the peer counseling component under real world conditions.

Methods: The study sample included 11 churches (6 early intervention, 5 delayed intervention) in 6 states. Data sources included training observations, post-training debriefing sessions, coordinator interviews, and church participant surveys. Survey data analysis examined associations between exposure to peer counseling and change in dietary intake. Qualitative data were analyzed using the constant comparative method.

Results: Eight of 11 churches initiated the peer counseling program. Recall of talking with a peer counselor was associated with significantly (p<.02) greater fruit and vegetable intake. Data indicate sub-optimal program execution after peer counselor training.

Conclusion: Inconsistent implementation of the peer counseling intervention is likely to dilute program effectiveness in changing nutrition behaviors.

Practice Implications: Disseminating evidence-based programs may require added resources, training, quality control, and technical assistance for improving program uptake. Similar to earlier research phases, systematic efforts at the dissemination phase are needed for program success.
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http://dx.doi.org/10.1016/j.pec.2009.11.018DOI Listing
October 2010
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