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• • • • • Willa Doswell, PhD, University of Pittsburgh Teresia O’Connor, MD, Baylor College of Medicine Erin McClure, PhD, Johns Hopkins University Brie Turner-McGrievy, PhD, University of South Carolina Rajani Sadasivam, PhD, University of Massachusetts Medical School
Using the eButton in Studies Monitoring Obesity
Dr. Willa Doswell Associate Professor University of Pittsburgh School of Nursing
• It is a fully functional wearable computer with sophisticated electronic sensors to collect visual, location, motion, orientation, acoustic and/or physiological data (e.g., ECG) automatically. • It is as smart as an iPhone but can be naturally worn. Since it is unattended and always on, the device has many important applications, such as monitoring diet or physical activity.
Fig. 1 Our prototype eButton.
How it Works
This small and lightweight eButton has an array of sensors to perform a variety of measurements, including a GPS, one or two cameras, a 3-axial accelerometer, a 3-axial gyroscope, a temperature sensor, a audio sensor, and an indoor/outdoor sensor. The cameras take pictures either manually or automatically at selected rates. The acquired pictures contain foods and beverages consumed during the day, sedentary and physical activities performed, and social interactions with people. The GPS sensor records geographical information of the wearer providing information such as outdoor activity locations.
Freshman-15 Study Revisited
• The problem is obesity which has been handled thru classes, public health campaigns, weight reduction programs. • Study Objective: Investigate the changes in body weight, BMI, body composition and fat distribution among college freshmen women during their 1st year of college. • Study Objective: Investigate the changes in body weight, BMI, body composition and fat distribution among college freshmen women during their 1st year of college.
• What is the % weight gain in college freshman from baseline semester to month 4 and month 8? • What is the food intake of students at baseline, month 4 and month 8? • What psychosocial variables affect intake at baseline, month 4 and month 8? • What are the ethnic differences… • What is relationship of stress (3 levels) to weight gain/food intake?
More Specific Aims
• Examine acceptability, and functionality of the eButton in the study of eating habits and weight gain • Refine the development of the eButton device for its use in the study of eating habits and weight gain in young adults. • Conduct laboratory tests to assess device accuracy. • Modify device design and software to improve performance during the project according to received feedback. •
• How to preserve confidentiality and privacy in the real world of eating, working, learning. • How to prevent wear and tear on clothing the eButton is affixed to. • Is the gain worth the problems the device may cause? • Can it be used in children?
Feasibility of a mHealth child obesity 'app' targeting parents
Teresia O’Connor, MD, MPH
Pediatrics Assistant Professor of Pediatrics USDA/ARS Children’s Nutrition Research Center Academic General Pediatrics Baylor College of Medicine
Problem: Childhood Obesity
• 1/3 US children overweight or obese (NHANES data) • Childhood overweight tripled in 25 years (NHANES data) • Overweight Children → Overweight Adults (Whitaker 1997, Magarey 2003) • Medical expenditures of obesity related conditions: $147 billion (Health Affairs 2009) • Parents are an important influence on children's behaviors and therefore their weight status.
- Parenting styles → child obesity (Rhee 2006, Brotman 2012) - Parenting practices → child behaviors (Fisher 2002, O’Connor 2010, Davison 2003)
Historical Obesity Interventions
• School, childcare and community interventions with no-tominimal effects • Systematic Review of primary care interventions (Sargent 2010)
- Obesity treatment initiated by pediatricians offers promise of improving children’s weight status - Only 1/17 primary care interventions targeted parenting
• USPSTF: Evidence for moderate to high intensity interventions (25 contact hours over 6 months) for children ≥ 6 years old. (Barton 2010)
Helping HAND Pilot Study
• First line obesity intervention for primary care • 5-8 year old children with 85% ≤ BMI > 99% • Monthly visits for 6-months • Delivered by Health Plan health promotion specialists using patient-centered counseling • Parent & child self-selected behaviors to target, set goals and plans, and monitored • Recruited 40 families → randomized • 20 % attrition; positive feedback; change in some child and parenting behaviors
(O’Connor , C:CHD 2011)
Parent and neighborhood influences on Hispanic preschool children’s PA
QStarz BT1000X GPS data loggers Actigraph GT3X accelerometer
Neighborhood type (n, %) High crime, High traffic (orange) High crime, low traffic (green) Low crime, high traffic (pink) Low crime, low traffic (blue) (NIH NICHD-1R21-HD060925) Pediatrics
Whole Sample (n= 240)
67 (28%) 22 (9%) 75 (31%) 76 (32%)
Sub-sample wore Monitors (n=84)
22 (26%) 5 (6%) 31 (37%) 26 (31%)
How will mHealth Help?
• Propose to develop Helping HAND into a mobile Health app for Smartphones
- Allows increased accessibility of program and increased contact with families - Build in behavior change tools: behavior assessment, goal setting, implementation plans, monitoring, and feedback - Remote counseling by Health Advisor via phone - Has potential to include additional features in future: • GPS specific feedback for PA venues, healthy stores • Accelerometer based assessment with feedback • Similation games for behavior training (KIDDIO)
Smoking cessation: Incentives for behavior change
Erin A. McClure Medical University of South Carolina
2012 NIH mHealth Summer Training Institute
What is the problem?
• Smoking is the leading cause of preventable death in the United States • Annual health care expenditures related to smoking are approximately $96 billion • Smoking disproportionately affects ethnic minorities, socioeconomically marginalized, and vulnerable populations
(Centers for Disease Control, 2008)
How has the problem been addressed?
• Psychosocial education, motivational interviewing and enhancement, pharmacotherapy • Incentives to promote abstinence
– Delivered contingently on biologically-verified confirmation of abstinence
• Highly effective in promoting abstinence from smoking, but also (Higgins & Silverman, 2007)
– Abstinence from other substances of abuse – Medication compliance – Exercise, weight loss, nutrition
How has the problem been addressed?
• Implementation and adoption has been slow • Problems:
– Costly (incentives and biological testing) – Frequent samples required – Immediacy of test results and incentive delivery
Some mHealth solutions.
• Reducing clinic visits
– Assessments and self-report measures via voice or text
• Frequent monitoring
– Remote physiological monitoring – Inertial sensors to detect smoking movements
• Immediacy of reinforcer
– Delivered or alerted via text or voice
Some mHealth solutions.
• Beyond incentive-based interventions
– Motivational support upon request at times of high need – Assessments of real-time craving, lapse, and relapse (Ecological Momentary Assessment, mobile apps) – GPS-enabled devices to indicate “highrisk” areas
mHealth and Obesity Brie Turner-McGrievy, PhD, MS, RD Assistant Professor University of South Carolina Arnold School of Public Health Department of Health Promotion, Education, and Behavior
Public Health Issue/Problem
• Obesity and prevention/treatment/management of chronic diseases
– Through diet and physical activity
• Behavioral weight loss treatment
How my research is addressing the issue
• Self-monitoring using mHealth
• Behavioral counseling delivered via podcast • Group support via social networks
How mHealth can help
• • • • • Improve accuracy Lower burden (time, memory, etc.) Lower cost Increase reach Lengthen time of support
What’s next: mHealth and Obesity
• Tapping into location-based services and GPS • Learning from behaviors recorded on mobile devices and tailoring based on those • Predicting who engages in social networks and why • Customizing interventions based on personal preference (one size doesn’t have to fit all!)
Get to Know Me…
Rajani S. Sadasivam, Ph.D.
Div. of Health Informatics and Implementation Science Dept. of Quantitative Health Sciences Univ . of Massachusetts Medical School firstname.lastname@example.org
Smoking cessation challenges
How to increase demand for and use of proven cessation treatments (NIH State-of-the-Science conference on tobacco use )
How to make existing treatments more attractive?
Current WATIs are effective, but…
Expert-to-patient interventions have a natural limit
Peer-to-peer, collective intelligence, gaming, mHealth
Share2Quit - Peer to Peer referrals
Products exclusively marketed by peer referrals
Farmville has over 80 million users on Facebook
Can peer referrals be used to market health interventions?
Facebook referral Email referral …
Collective intelligence for computer tailoring
Amazon, Netflix – Products like these, People like you Computer tailoring – Messages like these, Smokers like you
CraveOut: mHealth gaming platform
A fun way to distract from cravings and reinforce benefits of quitting
Available on iTunes (Total downloads: 1067 as of 7/24/12)