Publications by authors named "Melissa J Vilaro"

13 Publications

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A Pilot Study Examining the Efficacy of Delivering Colorectal Cancer Screening Messages via Virtual Health Assistants.

Am J Prev Med 2021 Apr 19. Epub 2021 Apr 19.

Department of Computer & Information Science & Engineering, College of Engineering, University of Florida, Gainesville, Florida.

Introduction: Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening. It also examines the influence of animation and race concordance on intentions to complete colorectal cancer screening.

Methods: White and Black adults (N=1,363) aged 50-73 years and not adherent to colorectal cancer screening guidelines were recruited from Qualtrics Panels in 2018 to participate in a 3-arm (animated virtual healthcare assistant, static virtual healthcare assistant, attention control) message design experiment. In 2020, a probit regression model was used to identify the intervention effects.

Results: Participants assigned to the animated virtual healthcare assistant (p<0.01) reported higher intentions to talk to their doctor about colorectal cancer screening than participants assigned to the other conditions. There was a significant effect of race concordance on colorectal cancer screening intentions but only in the static virtual healthcare assistant condition (p=0.04). Participant race, age, trust in healthcare providers, health literacy, and cancer information overload were also significant predictors of colorectal cancer screening intentions.

Conclusions: Animated virtual healthcare assistants were efficacious compared with the static virtual healthcare assistant and attention control conditions. The influence of race concordance between source and participant was inconsistent across conditions. This warrants additional investigation in future studies given the potential for virtual healthcare assistant‒assisted interventions to promote colorectal cancer screening within guidelines.
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http://dx.doi.org/10.1016/j.amepre.2021.01.014DOI Listing
April 2021

A Subjective Culture Approach to Cancer Prevention: Rural Black and White Adults' Perceptions of Using Virtual Health Assistants to Promote Colorectal Cancer Screening.

Health Commun 2021 Apr 20:1-12. Epub 2021 Apr 20.

STEM Translational Communication Center, University of Florida.

In the US, Black adults are less likely than White adults to be screened for colorectal cancer (CRC). This study uses a subjective culture approach to describe and compare perceptions of a CRC screening intervention delivered via virtual health assistants (VHAs) among rural Black and White study participants. We analyzed 28 focus groups with Black ( = 85) and White ( = 69) adults aged 50-73. Participants, largely recruited through community engagement efforts, tested the VHA intervention on mobile phones provided by the research team. Moderated discussions were recorded, transcribed, and analyzed using thematic analysis. All groups preferred the VHA to be friendly. Other important cues included trustworthiness, authority, and expertise. Black participants expressed a preference for receiving information about their CRC risk from the VHA compared with White adults. Black participants also expressed the importance of sharing the intervention and the CRC screening messages with younger members of their networks, including family members who could benefit from screening messages before reaching the recommended age for screening. The key similarities and differences between Black and White adults' perceptions of the intervention that were identified in this study can help inform future efforts to develop effective communication strategies and reduce cancer screening inequities.
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http://dx.doi.org/10.1080/10410236.2021.1910166DOI Listing
April 2021

Promoting community health collaboration between CTSA programs and Cooperative Extension to advance rural health equity: Insights from a national Un-Meeting.

J Clin Transl Sci 2020 Feb 13;4(5):377-383. Epub 2020 Feb 13.

Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA.

Addressing rural health disparities has unique challenges that require cross-sector collaborations to address social determinants of health and help those in need to get connected to care continuum. We brought the Clinical and Translational Science Award, Institutional Development Award Program Infrastructure for Clinical and Translational Research, and Cooperative Extension System Programs together for a one-day semi-structured meeting to discuss collaborative opportunities to address rural health disparities. Session notes and event materials were analyzed for themes to facilitate collaboration such as defining rural, critical issues, and organizational strengths in support of collaboration. Across 16 sessions, there were 26 broad topics of discussion. The most frequent topics included "barriers and challenges," "strategies and opportunities," and "defining rural." There is a growing understanding of the opportunity that collaboration between these large programs provides in addressing rural health disparities.
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http://dx.doi.org/10.1017/cts.2020.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681129PMC
February 2020

Tailoring virtual human-delivered interventions: A digital intervention promoting colorectal cancer screening for Black women.

Psychooncology 2020 12 15;29(12):2048-2056. Epub 2020 Sep 15.

STEM Translational Communication Center, College of Journalism & Communications, University of Florida, Gainesville, Florida, USA.

Objective: Despite efforts to reduce cancer disparities, Black women remain underrepresented in cancer research. Virtual health assistants (VHAs) are one promising digital technology for communicating health messages and promoting health behaviors to diverse populations. This study describes participant responses to a VHA-delivered intervention promoting colorectal cancer (CRC) screening with a home-stool test.

Methods: We recruited 53 non-Hispanic Black women 50 to 73 years old to participate in focus groups and think-aloud interviews and test a web-based intervention delivered by a race- and gender-concordant VHA. A user-centered design approach prioritized modifications to three successive versions of the intervention based on participants' comments.

Results: Participants identified 26 cues relating to components of the VHA's credibility, including trustworthiness, expertise, and authority. Comments on early versions revealed preferences for communicating with a human doctor and negative critiques of the VHA's appearance and movements. Modifications to specific cues improved the user experience, and participants expressed increased willingness to engage with later versions of the VHA and the screening messages it delivered. Informed by the Modality, Agency, Interactivity, Navigability Model, we present a framework for developing credible VHA-delivered cancer screening messages.

Conclusions: VHAs provide a systematic way to deliver health information. A culturally sensitive intervention designed for credibility promoted user interest in engaging with guideline-concordant CRC screening messages. We present strategies for effectively using cues to engage audiences with health messages, which can be applied to future research in varying contexts.
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http://dx.doi.org/10.1002/pon.5538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821126PMC
December 2020

Prevalence and correlates of food insecurity among U.S. college students: a multi-institutional study.

BMC Public Health 2019 May 29;19(1):660. Epub 2019 May 29.

Food Science and Human Nutrition Department, University of Florida, PO Box 110370, Gainesville, FL, 32611-0370, USA.

Background: College students may be vulnerable to food insecurity due to limited financial resources, decreased buying power of federal aid, and rising costs of tuition, housing, and food. This study assessed the prevalence of food insecurity and its sociodemographic, health, academic, and food pantry correlates among first-year college students in the United States.

Methods: A cross-sectional study was conducted among first-year students (n = 855) across eight U.S. universities. Food security status was assessed using the U.S. Department of Agriculture Adult Food Security Survey Module. Cohen's Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Eating Attitudes Test-26 were used to assess perceived stress, sleep quality, and disordered eating behaviors, respectively. Participants self-reported their grade point average (GPA) and completed questions related to meal plan enrollment and utilization of on-campus food pantries.

Results: Of participating students, 19% were food-insecure, and an additional 25.3% were at risk of food insecurity. Students who identified as a racial minority, lived off-campus, received a Pell grant, reported a parental education of high school or less, and did not participate in a meal plan were more likely to be food-insecure. Multivariate logistic regression models adjusted for sociodemographic characteristics and meal plan enrollment indicated that food-insecure students had significantly higher odds of poor sleep quality (OR = 2.32, 95% CI: 1.43-3.76), high stress (OR = 4.65, 95% CI: 2.66-8.11), disordered eating behaviors (OR = 2.49, 95% CI: 1.20-4.90), and a GPA < 3.0 (OR = 1.91, 95% CI: 1.19-3.07) compared to food-secure students. Finally, while half of the students (56.4%) with an on-campus pantry were aware of its existence, only 22.2% of food-insecure students endorsed utilizing the pantry for food acquisition.

Conclusions: Food insecurity among first-year college students is highly prevalent and has implications for academic performance and health outcomes. Higher education institutions should screen for food insecurity and implement policy and programmatic initiatives to promote a healthier college experience. Campus food pantries may be useful as short-term relief; however, its limited use by students suggest the need for additional solutions with a rights-based approach to food insecurity.

Trial Registration: Retrospectively registered on ClinicalTrials.gov , NCT02941497.
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http://dx.doi.org/10.1186/s12889-019-6943-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542079PMC
May 2019

More than Fast Food: Development of a Story Map to Compare Adolescent Perceptions and Observations of Their Food Environments and Related Food Behaviors.

Int J Environ Res Public Health 2018 12 28;16(1). Epub 2018 Dec 28.

Department of Nutrition, University of Tennessee, Knoxville, TN 37996, USA.

The purpose of this convergent, multiphase, mixed methods study was to better understand the perceptions of adolescents' food environments and related food behaviors using grounded visualization and story mapping. Adolescents from one high school (13⁻16 years) in the southeastern United States were evaluated via data from health behavior surveys ( = 75), school environment maps, focus groups ( = 5 groups), and Photovoice ( = 6) from October 2016 to April 2017. Data from each phase were integrated using grounded visualization and new themes were identified ( = 7). A story map using ArcGIS Online was developed from data integration, depicting the newly identified themes. Participants failed to meet national recommendations for fruit and vegetable intake (2.71 cups). Focus group and Photovoice findings indicated the need for convenience food items in all environments. The story map is an online, interactive dissemination of information, with five maps, embedded quotes from focus groups, narrative passages with data interpretation, pictures to highlight themes, and a comparison of the participants' food environments. Story mapping and qualitative geographic information systems (GIS) approaches may be useful when depicting adolescent food environments and related food behaviors. Further research is needed when evaluating story maps and how individuals can be trained to create their own maps.
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http://dx.doi.org/10.3390/ijerph16010076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338885PMC
December 2018

Health Behaviors of Student Community Research Partners When Designing and Implementing a Healthy Lifestyle Intervention on College Campuses.

Behav Sci (Basel) 2018 Oct 26;8(11). Epub 2018 Oct 26.

Division of Animal and Nutritional Sciences, School of Agriculture, Davis College of Agriculture, Natural Resources and Design, West Virginia University, 1194 Evansdale Drive, G25 Agriculture Sciences Building, Morgantown, WV 26506, USA.

Few studies work with college students as equal partners in all aspects of Community-Based Participatory Research (CBPR) and even less evaluate behaviors of those college partners. The current study aimed to examine health behaviors of students by designing and implementing a peer-led, social marketing campaign (Get Fruved) to promote healthier lifestyles on their campuses. Enrolled students (n = 376) were trained to either design and implement a health promotion intervention (Social Marketing and Environmental Interventionists; SMEI, n = 78), be peer mentors (PM; n = 205), or serve as control participants (n = 93). Students' behaviors (dietary, activity, and stress) and anthropometrics were assessed at baseline, 6 months, and 12 months. The population was predominately Caucasian, female, and between 19 and 20 years old. On average, fruit and vegetable consumption slightly decreased across all time points for each group with control at a larger decline. Students International Physical Activity Questionnaire (IPAQ) scores showed students met recommended amounts of activity throughout the intervention, with males reporting higher activity levels. Cohen's Perceived Stress Scale (PSS) analyses indicated 19 year olds had higher stress along with females had higher than males. Students involved in a CBPR approach to be trained, design, and implement a lifestyle intervention can achieve maintenance of health behaviors throughout a college year when compared to control students.
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http://dx.doi.org/10.3390/bs8110099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262385PMC
October 2018

Food Choice Priorities Change Over Time and Predict Dietary Intake at the End of the First Year of College Among Students in the U.S.

Nutrients 2018 Sep 13;10(9). Epub 2018 Sep 13.

Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA.

This study assessed food choice priorities (FCP) and associations with consumption of fruits and vegetables (FV), fiber, added sugars from non-beverage sources, and sugar-sweetened beverages (SSB) among college students. Freshmen from eight U.S. universities ( = 1149) completed the Food Choice Priorities Survey, designed for college students to provide a way to determine the factors of greatest importance regarding food choices, and the NCI Dietary Screener Questionnaire. Changes in FCP and dietary intake from fall 2015 to spring 2016 were assessed. Multiple regression models examined associations between FCP and log-transformed dietary intake, controlling for sex, age, race, and BMI. Participant characteristics and FCP associations were also assessed. FCP importance changed across the freshmen year and significantly predicted dietary intake. The most important FCP were price, busy daily life and preferences, and healthy aesthetic. Students who endorsed healthy aesthetic factors (health, effect on physical appearance, freshness/quality/in season) as important for food choice, consumed more FV and fiber and less added sugar and SSB. Busy daily life and preferences (taste, convenience, routine, ability to feel full) predicted lower FV, higher added sugar, and higher SSB consumption. Price predicted lower FV, higher SSB, and more added sugar while the advertising environment was positively associated with SSB intake. FCP and demographic factors explained between 2%⁻17% of the variance in dietary intake across models. The strongest relationship was between healthy aesthetic factors and SSB (B = -0.37, < 0.01). Self-rated importance of factors influencing food choice are related to dietary intake among students. Interventions that shift identified FCP may positively impact students' diet quality especially considering that some FCP increase in importance across the first year of college.
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http://dx.doi.org/10.3390/nu10091296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164337PMC
September 2018

Development and Preliminary Testing of the Food Choice Priorities Survey (FCPS): Assessing the Importance of Multiple Factors on College Students' Food Choices.

Eval Health Prof 2017 12;40(4):425-449

1 University of Florida, Gainesville, FL, USA.

Understanding factors that influence food choice may help improve diet quality. Factors that commonly affect adults' food choices have been described, but measures that identify and assess food choice factors specific to college students are lacking. This study developed and tested the Food Choice Priorities Survey (FCPS) among college students. Thirty-seven undergraduates participated in two focus groups ( n = 19; 11 in the male-only group, 8 in the female-only group) and interviews ( n = 18) regarding typical influences on food choice. Qualitative data informed the development of survey items with a 5-point Likert-type scale (1 = not important, 5 = extremely important). An expert panel rated FCPS items for clarity, relevance, representativeness, and coverage using a content validity form. To establish test-retest reliability, 109 first-year college students completed the 14-item FCPS at two time points, 0-48 days apart ( M = 13.99, SD = 7.44). Using Cohen's weighted κ for responses within 20 days, 11 items demonstrated moderate agreement and 3 items had substantial agreement. Factor analysis revealed a three-factor structure (9 items). The FCPS is designed for college students and provides a way to determine the factors of greatest importance regarding food choices among this population. From a public health perspective, practical applications include using the FCPS to tailor health communications and behavior change interventions to factors most salient for food choices of college students.
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http://dx.doi.org/10.1177/0163278717735872DOI Listing
December 2017

Income differences in social control of eating behaviors and food choice priorities among southern rural women in the US: A qualitative study.

Appetite 2016 12 7;107:604-612. Epub 2016 Sep 7.

Department of Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, 1225 Center Drive, P.O. Box 100175 HSC, Gainesville, FL 32610-0175, USA.

The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities.
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http://dx.doi.org/10.1016/j.appet.2016.09.003DOI Listing
December 2016

Theory-Based Interventions for Long-Term Adherence to Improvements in Diet Quality: An In-depth Review.

Am J Lifestyle Med 2016 Nov-Dec;10(6):369-376. Epub 2016 Aug 19.

Food Science and Human Nutrition Department, University of Florida, Gainesville, Florida.

Many interventions aim to improve dietary patterns but not all are able to maintain these changes long term. Interventions informed by theory may facilitate dietary behavior changes and maintenance of these changes for longer periods of time. PubMed and PsychInfo were searched for theory-based interventions with long-term assessments of fruit and vegetable (FV) and fat intake. We identified 335 unique titles; 20 were included for review. Most interventions (65%) were based on social cognitive theory. Assessments of FV and fat ranged from 12 to 72 months postrandomization, and 15 studies reported significant intervention effects. Only 6 studies directly tested theory in relation to diet and of those, significant findings indicated self-efficacy, motivation for dietary change, perceived competence to eat more FV and less fat, and multiple processes of change were associated with long-term maintenance of healthy eating. Overall, this review indicates that theory-informed interventions are generally successful for long-term improvements in diet quality, although such improvements are often modest. Most studies did not directly measure theoretical constructs in relation to diet outcomes, thus limiting our ability to describe how theory-based interventions specifically promote long-term diet change. Recommendations for future research and practical recommendations for long-term maintenance of diet change are discussed.
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http://dx.doi.org/10.1177/1559827616661690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124976PMC
August 2016

Lifestyle Factors Associated With Sunscreen Use Among Young Adults.

Am J Lifestyle Med 2018 Jul-Aug;12(4):331-339. Epub 2016 Jul 28.

Department of Public Health, University of North Florida, Jacksonville, Florida (JWM, EL-W).

. Skin cancer is the most common cancer in the United States with melanoma rates increasing. Sunscreen use is an effective way to protect the skin and reduce skin cancer risk. Limited research has been conducted examining the relationship between sunscreen use and other lifestyle factors. Interventions aimed at multiple lifestyle factors have shown promise for prevention and reduced health care costs. . This study explores the relationship between sunscreen use and lifestyle factors associated with mortality and morbidity among young adults. Lifestyle factors examined included physical activity, substance abuse, smoking, sexual behavior, unintentional injury, and mental well-being. . A convenience sample of 747 college students was surveyed about sunscreen use and other health risks. Data were analyzed using SPSS 19. . White, female students older than 21 years were more likely to use sunscreen. Texting while driving, low life satisfaction, and binge drinking were associated with inadequate sunscreen use. . Convenience sampling limits generalizability and surveys are subject to recall, self-report, and self-selection bias. . The findings provide the framework to develop multiple risk factor interventions.
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http://dx.doi.org/10.1177/1559827616661472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993090PMC
July 2016

Skin Cancer Risk and Other Health Risk Behaviors: A Scoping Review.

Am J Lifestyle Med 2017 Mar-Apr;11(2):182-196. Epub 2016 Jun 23.

Department of Public Health, University of North Florida, Jacksonville, Florida (JWM).

To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.
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http://dx.doi.org/10.1177/1559827615594350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125028PMC
June 2016