Christopher C. Cushing

Objectives: Human resources (HR) initiatives can reduce healthcare costs and improve productivity, yet participation remains low. This study evaluated usability and predictors of engagement for Aspire2B, a personalized wellness application leveraging behavior change principles, alongside a 6-week HR-led movement challenge. Methods: Participants were US-based, salaried PepsiCo employees, aged 21-68. Aspire2B integrated step data and provided heart rate, stress index, and biological age via transdermal optical imaging. No monetary incentives were provided. Results: Of 512 registrants, 84% completed onboarding, 14% interacted with the app in week 2, 12% in week 3, and 6% in week 6, trending higher than commercial apps, though populations may not be directly comparable. Older age and higher heart and respiratory rates were associated with more steps and app usage. Conclusions: Aspire2B demonstrated preliminary feasibility for increasing engagement in HR wellness initiatives.

Nighttime hypoglycemia is a significant concern for caregivers of youth with type 1 diabetes (T1D), often leading to persistent worry and compensatory behaviors that maintain elevated nighttime glucose levels. In the present study, we qualitatively assessed specific fears related to nighttime hypoglycemia and behaviors to avoid nighttime hypoglycemia from caregivers of youth with T1D. In addition, we interviewed diabetes providers to assess if these topics are discussed in diabetes clinic. We completed semi-structured interviews with 10 diabetes providers and 15 caregivers. We used Framework Matrix Analysis theory to assess specific qualitative patterns. We identified 40 a priori codes and uncovered 3 de novo codes, which fit into 18 subthemes across three core themes: (1) specific fears about nighttime hypoglycemia, (2) caregiver behaviors to prevent it, and (3) negative outcomes stemming from these fears and behaviors. Both caregivers and providers acknowledged the prevalence of nighttime hypoglycemia, anxiety, and its potential impact on family well-being. These findings underscore the importance of addressing caregiver fears in clinical care, particularly for families managing frequent hypoglycemia or elevated nighttime glucose levels. Routine screening for fear-driven behaviors may help improve both caregiver and child outcomes.

Background: Adolescent asthma is a significant contributor to youth morbidity and is known to be best managed through consistent medication use and symptom management. However, adolescents often struggle to perceive their symptoms accurately and consistently use their medication at the recommended rate, risking worsened symptoms and impaired quality of life. The Responsive Asthma Care for Teens (ReACT) system is a project aimed at identifying and and providing supporting for several barriers adolescents may face in asthma management. By integrating both software and hardware to monitor medication adherence, ReACT provides a personalized support plan to improve asthma management and, subsequently, quality of life. Objective: The objective of this study is to conduct a proof-of-concept assessment of the ReACT system following an initial pilot study and adjusting for the feedback received. In addition to assessing the acceptability and usability of the current version, this study aims to assess whether the proposed ReACT system leads to indications of improvement in medication adherence because of the personalized support plans. Methods: Participants in the study were 5 adolescents aged 15 to 17 years recruited using a combination of consent-to-contact forms delivered via an in-person asthma clinic and Qualtrics panels. As a part of this study, participants met with the study team 3 times over 1 month. After completing initial surveys on stress, problem-solving, and asthma-related quality of life, we oriented the participants to the ReACT platform and asked them to interact with it as normal. After the month, the participants were interviewed, and they discussed the system and completed surveys assessing their opinions on acceptability and usability. Results: On a 4-point scale, participants reported high acceptability of ReACT (mean score 3, SD 0.32), willingness to use it again (mean score 4, SD 0.89), and willingness to recommend it to a friend (mean score 3.75, SD 0.55), and they considered it to be helpful (mean score 3.2, SD 0.84). Conclusions: Our findings suggest that ReACT is an acceptable and usable mobile health intervention to improve asthma self-management among adolescents, and it had promising results for improving self-regulation, problem-solving, and asthma control. The system continues improving based on feedback from a larger sample size of participants, and we hope that ReACT will aid adolescent development while delivering highly personalized support for each user.

Objective: The current study seeks to examine rational motivational variables central to self-determination theory (i.e., perceived competence, family social support, friend social support, autonomous motivation, controlled motivation, and amotivation) as moderators of the relationship between automatic motives (i.e., momentary affective states, fatigue, and energy) and physical activity (moderate-to-vigorous physical activity and sedentary behavior). Methods: We conducted a 20-day ecological momentary assessment (EMA) study, in which 100 adolescents aged 13–18 years old were recruited locally February 2016 to March 2017 and were asked to indicate baseline social support, motivation, and competence for physical activity. Subsequently, participants wore an Actigraph accelerometer 24 h per day and answered EMA surveys assessing automatic motives 4 times per day using time-based signaling. Results: There was a significant interaction between within-person positive affect and amotivation as a predictor of moderate-to-vigorous physical activity (MVPA) ( b = −0.02, p < 0.05) with 95% CI [−0.04, −0.01] and sedentary time ( b = 0.10, p < 0.01) with 95% CI [0.04, 0.16]. There was also a significant interaction between within-person negative affect and amotivation as a predictor of sedentary time ( b = −0.08, p < 0.05) with 95% CI [−0.14, −0.01]. Within-person fatigue interacted with friend social support ( b = 0.05, p < 0.01) with 95% CI [0.02, 0.08], amotivation ( b = 0.03, p < 0.05) with 95% CI [0.003, 0.06], and controlled motivation ( b = −0.03, p < 0.01) with 95% CI [−0.05, −0.01] in relation to MVPA. Conclusions: Overall, findings from this study suggest that rational and automatic motives are intertwined and should be explored together as targets for physical activity intervention efforts.

Purpose of Review Most youth with type 1 diabetes (T1D) do not meet the guidelines for physical activity engagement, thereby diminishing potential benefits to physical and mental health. This review synthesizes the recent literature on physical activity among youth with T1D and offers recommendations for future research. Recent Findings Studies highlight challenges related to the use of inconsistent measurement tools, which prevent definitive conclusions about the mechanistic factors underlying low physical activity in youth. There has been limited research examining young children and youth newly diagnosed with T1D. Additionally, most interventions to promote physical activity in youth with T1D have involved structured and supervised exercise sessions, leaving a gap in knowledge regarding the potential impact of unstructured and unsupervised exercise interventions. To address these gaps, rigorous studies employing validated measures of physical activity in youth are needed. Interventions should incorporate developmentally appropriate behavioral science theories and emerging technologies in their design. Additional priorities include integrating diabetes technologies into clinical care, more real-world data to improve the accuracy of machine learning models for predicting dysglycemia, and advancing personalized mHealth interventions to promote physical activity in youth. Summary While physical activity is an important area of pediatric diabetes research, gaps remain in our knowledge and intervention development. Physical activity consultations should be a part of routine diabetes care for youth. Research can inform these consultations by providing strategies to promote physical activity uptake and maintenance and by exploring ways to leverage new technologies to help youth with T1D exercise safely.

Background: Understanding relationships among inhibitory control, attentional bias to food cues, and food consumption in nonclinical adolescent samples can inform preventive efforts for disordered eating and associated health risks. Objective: This pilot study conducted preliminary testing of an inhibitory control training intervention on attentional bias toward food cues, hedonic appetite, and food consumption, as well as examined inhibitory control’s relationship with hedonic appetite, food consumption, binge eating, and cognitive restraint. Methods: Participants (N=43; mean age 15.1, SD 1.7 years; 31/43, 72% female) were randomized to a food cue–specific go/no go inhibitory control training intervention or control group, took part in a laboratory “taste test,” and completed surveys and a dietary recall. Additional data were collected for subsamples through an eye tracking task (15/43, 35%) and cognitive tasks (19/43, 44%). Results: The go/no go intervention showed preliminary associations with attentional bias toward food cues. There were preliminary associations between inhibitory control and sugar consumption measured via dietary recall, binge eating symptoms, and cognitive restraint, which should be examined in a fully powered study. Conclusions: The role of inhibitory control should be examined in larger studies to inform strategies for promotion of healthy eating behavior and prevention of disordered eating in adolescents.

Background: An adaptive text messaging intervention to promote adolescent physical activity has demonstrated feasibility, acceptability, and preliminary efficacy in a recent proof-of-concept study. To inform future intervention development, a secondary analysis of the data examined how physical activity is influenced by mood, environment, and physical feelings of energy and fatigue. Objective: This study aims to understand how both macro- and microtemporal variables (eg, psychological and environmental variables at both levels) influence the efficacy of a brief mobile health intervention (ie, NUDGE) for physical activity. Methods: Using a matched control design, we evaluated the effect of daily positive and negative affect, perceptions of the weather, energy, and fatigue as moderators of the effect of the intervention on 21 intervention participants and 21 matched controls. Results: Consistent with study hypotheses, macrotemporal (levels of the variable on a 3-week timescale) moderators of intervention effectiveness were observed for positive affect ( P <.001), negative affect ( P =.03), energy ( P <.001), fatigue ( P <.001), and perceived weather barriers ( P <.001) for moderate-to-vigorous physical activity. These effects were observed more consistently for moderate-to-vigorous physical activity than for sedentary behavior, which was only significant for energy ( P <.001). No effects for microtemporal variables (at the day level) were observed. Conclusions: There appears to be an optimization opportunity for mobile health physical activity interventions that can be achieved by personalizing intervention features and content based on approximately monthly assessments of affect, physical feeling states, and perceived weather barriers.

BACKGROUND Understanding relationships among inhibitory control, attentional bias to food cues, and food consumption in nonclinical adolescent samples can inform preventive efforts for disordered eating and associated health risks. OBJECTIVE This pilot study conducted preliminary testing of an inhibitory control training intervention on attentional bias toward food cues, hedonic appetite, and food consumption, as well as examined inhibitory control’s relationship with hedonic appetite, food consumption, binge eating, and cognitive restraint. METHODS Participants (N=43; mean age 15.1, SD 1.7 years; 31/43, 72% female) were randomized to a food cue–specific go/no go inhibitory control training intervention or control group, took part in a laboratory “taste test,” and completed surveys and a dietary recall. Additional data were collected for subsamples through an eye tracking task (15/43, 35%) and cognitive tasks (19/43, 44%). RESULTS The go/no go intervention showed preliminary associations with attentional bias toward food cues. There were preliminary associations between inhibitory control and sugar consumption measured via dietary recall, binge eating symptoms, and cognitive restraint, which should be examined in a fully powered study. CONCLUSIONS The role of inhibitory control should be examined in larger studies to inform strategies for promotion of healthy eating behavior and prevention of disordered eating in adolescents.

Background: There is significant global interest in promoting wellness, with digital solutions like mobile health apps being broadly downloaded; yet, there is a challenge in maintaining engagement for long-term behavior change. Developing a widely accepted mobile wellness app is imperative for advancing personalized wellness interventions. Objective: The primary objective of this study was to evaluate the Aspire2B wellness app (powered by Salus Optima), designed to exceed industry standards for participant engagement by incorporating evidence-based behavior change strategies and to assess its acceptability (eg, liking the face scan) and utility (eg, willing to use the face scan technology for other health insights) as a digital health solution. Methods: Participants aged 18-65 years, who were smartphone and fitness tracker users, were recruited in the United States during March-May 2022. Participants received US $5 compensation for downloading the app, with no further incentive for usage. Following completion of onboarding (ie, survey questions about lifestyle behaviors), participants were placed in either a nutrition, sleep, or fitness 4-week challenge. During the challenge, participants used various app features at their own will, such as a facial scan for wellness insights (eg, heart rate and biological age), recipes, and workout videos. These interactions with the app were cumulatively evaluated as engagement metrics. Participants were also asked to answer offboarding questions to evaluate any changes to lifestyle behaviors and experience using the app features (eg, acceptability of face scan experience). Results: Out of the 398 people who created an account, 85.9% (342/398) completed onboarding and a face scan. Following this, 74.9% (298/398) of users completed additional survey questions about current wellness behaviors. Notably, interaction with the app was relatively stable from week 2 to 4 (173/398, 43.5%), outperforming industry standards by roughly 3×. In addition, on average, participants completed 2.1‐2.7 face scans per week, with approximately 7% (24/342) of participants maintaining regular use of face scan technology for 4 weeks. In users who completed offboarding questions, 88.8% (111/125) found Aspire2B credible, 64.8% (81/125) liked the face scan experience, 7.2% (9/125) disliked the face scan experience, and 83.2% (104/125) said they would use face scan technology for other insights into their health. Conclusions: These findings highlight strong initial engagement with Aspire2B, followed by significant sustained user engagement over a 4-week period. Furthermore, users indicated high levels of credibility and willingness to use face scan technology for wellness insights. These findings collectively demonstrate the capability of a personalized wellness app using AI-enabled digital biomarkers and evidence-supported behavior change techniques to yield positive user perception and provide long-term engagement.

Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. Objective: The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents’ moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. Methods: Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions. Results: The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE. Conclusions: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants’ rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing.