Behavioral Counseling Sessions Research Articles

TESTING MULTICOMPONENT DIGITAL THERAPIES TO PROMOTE HEALTHIER LIFESTYLE BEHAVIORS IN OLDER ADULTS: A PILOT STUDY

Abstract Multicomponent digital interventions to encourage healthy diet and physical exercise in older persons at risk for cardiovascular disease are understudied. We compared the feasibility and effectiveness of Get FIT vs. Get FIT+, two digital-based therapies, to encourage healthier lifestyle behaviors in this high-risk population. Fifty-four older adults (66.6 ± 5.9 years, 61% females, 61% married, 50% Asians, 39% Whites) were randomized to Get FIT (n=24), which included a health app, an activity tracker, and one 45-minute behavioral counseling session on healthy eating and exercise, or Get Fit+ (n=30), which added three months of health coach-personalized text messaging. We assessed retention, engagement, satisfaction, diet, physical activity, weight, cardiometabolic risks, and psychological well-being pre-and post-intervention. At three months, both groups had a 100% retention rate. Get FIT+ participants expressed high satisfaction, with 92% reporting that they would recommend Get FIT+. Individuals in both groups increased their physical activity and reduced their caloric consumption from baseline to three months. However, these changes were significantly greater in the intervention group (p .0001). Get Fit+ participants averaged a three-pound weight loss, whereas their counterparts averaged a three-pound weight gain (p .0001). Get FIT+ individuals had significantly lower systolic and diastolic blood pressure, triglycerides, total cholesterol, and HgbAa1C than Get FIT participants from baseline to three months. Both groups showed similar psychological well-being over time. Our findings imply that the Get Fit+ intervention may be more effective in lowering cardiometabolic risk in this cohort, although longer-term trials are needed.

Interventions for waterpipe smoking cessation.

Interventions for waterpipe smoking cessation.

Enhancing Obesity Management Through a Nurse Practitioner-Guided Behavioral Counseling Program

Although the prevalence of obesity in the United States is increasing, its treatment in primary care remains subpar. Implementing obesity reduction programs can result in significant benefits to patients. This study demonstrates that the use of a nurse practitioner-led program can result in weight loss. Thirty-six participants who were overweight or had obesity received biweekly behavioral counseling sessions over a 10-week period. Significant improvement in weight, waist circumference, blood pressure, quality of life, and self-efficacy for exercise was noted. Implementing similar programs can help patients attain weight loss and have an overall improvement in quality of life.

Evaluating Smoking Cessation Counseling Bundle Behavioral Intervention for Mongolian Adults Who Use Nicotine Patches

Objectives: The objective of this study is to evaluate the effectiveness of a behavioral intervention based on the World Health Organization (WHO) 5A and 5R guidelines in Mongolia who use the Nicotine Replacement Therapy (NRT) patch. The study aims to assess the impact of the intervention on smoking cessation rate. The finding of this study will contribute to the existing literature on smoking cessation interventions and provide valuable insights into the effectiveness of a behavioral approach in a Mongolian population. Methods: In the intervention study, out of total of 806 people interested in the part of this study. The study team excluded their eligibility criteria of the study participant. A sample of 625 people who fulfilled study inclusion criteria received advice about the negative consequences of tobacco. After that, 479 people decided to quit smoking and 41 people were excluded due to health contraindications, and the final sample 454 people began nicotine replacement therapy to quit smoking. Participants in the treatment group received nicotine replacement patches for 28 days, while those in the counseling group received four sessions of behavioral change counseling (5A, 5R). Results: 454 were found to be eligible to take part in the study and were subsequently assigned to one of two groups, with 230 and 224 participants assigned to each group, respectively. In the second month of follow-up, 90 (39.1%) of participants who received NRT patches quit smoking. The group that received NRT + Behavioral intervention was 1.02 times as successful, or 0.7% more effective, than the group that did not receive behavioral intervention (P=0.872). Conclusion: WHO 5A, 5R brief counselling were more effective than group without behavioral intervention for smoking cessation, but difference was insignificant.

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service-Delivered Smoking Cessation Intervention for People With HIV in China: Qualitative Study.

BackgroundChina, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population.ObjectiveThis study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages.MethodsWe recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups.ResultsA total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level.ConclusionsWe identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.

Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity

Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may be more efficacious for weight loss. To compare a standardized low-fat vs a personalized diet regarding percentage of weight loss in adults with abnormal glucose metabolism and obesity. The Personal Diet Study was a single-center, population-based, 6-month randomized clinical trial with measurements at baseline (0 months) and 3 and 6 months conducted from February 12, 2018, to October 28, 2021. A total of 269 adults aged 18 to 80 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) ranging from 27 to 50 and a hemoglobin A1c level ranging from 5.7% to 8.0% were recruited. Individuals were excluded if receiving medications other than metformin or with evidence of kidney disease, assessed as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration equation, to avoid recruiting patients with advanced type 2 diabetes. Participants were randomized to either a low-fat diet (<25% of energy intake; standardized group) or a personalized diet that estimates PPGR to foods using a machine learning algorithm (personalized group). Participants in both groups received a total of 14 behavioral counseling sessions and self-monitored dietary intake. In addition, the participants in the personalized group received color-coded meal scores on estimated PPGR delivered via a mobile app. The primary outcome was the percentage of weight loss from baseline to 6 months. Secondary outcomes included changes in body composition (fat mass, fat-free mass, and percentage of body weight), resting energy expenditure, and adaptive thermogenesis. Data were collected at baseline and 3 and 6 months. Analysis was based on intention to treat using linear mixed modeling. Of a total of 204 adults randomized, 199 (102 in the personalized group vs 97 in the standardized group) contributed data (mean [SD] age, 58 [11] years; 133 women [66.8%]; mean [SD] body mass index, 33.9 [4.8]). Weight change at 6 months was -4.31% (95% CI, -5.37% to -3.24%) for the standardized group and -3.26% (95% CI, -4.25% to -2.26%) for the personalized group, which was not significantly different (difference between groups, 1.05% [95% CI, -0.40% to 2.50%]; P = .16). There were no between-group differences in body composition and adaptive thermogenesis; however, the change in resting energy expenditure was significantly greater in the standardized group from 0 to 6 months (difference between groups, 92.3 [95% CI, 0.9-183.8] kcal/d; P = .05). A personalized diet targeting a reduction in PPGR did not result in greater weight loss compared with a low-fat diet at 6 months. Future studies should assess methods of increasing dietary self-monitoring adherence and intervention exposure. ClinicalTrials.gov Identifier: NCT03336411.

In vivo Experience With NRT to Increase Adherence and Smoking Abstinence Among Individuals in the Criminal Legal System: Study Protocol for a Randomized Clinical Trial.

BackgroundWhile tobacco use among individuals involved in the criminal legal system remains 3–4 times higher than the general population, few interventions have been targeted for this population to aid in smoking cessation. Nicotine replacement therapy (NRT) is a relatively effective and accessible smoking cessation aid; however, individuals frequently stop use of NRT early due to side effects and misperceptions about the products. The present study aims to address low medication adherence by examining the efficacy of an “in vivo” NRT sampling experience in individuals under community criminal legal supervision.MethodsFollowing recruitment through community legal outlets, participants (N = 517) are randomized to either an “in vivo NRT sampling” group or a standard smoking cessation behavioral counseling group. The in vivo group uses NRT in session and discusses perceptions and experiences of using NRT in real time while the standard smoking cessation counseling group receives four sessions of standard behavioral smoking cessation counseling. Both groups receive four intervention sessions and 12 weeks of NRT following the intervention. The 6-month post-intervention primary outcome measures are smoking point-prevalence abstinence and medication adherence.ConclusionThis is a novel smoking cessation intervention specifically aimed at increasing NRT adherence and smoking cessation among those involved in the criminal legal system, a group of individuals with high smoking rates and low rates of pharmacotherapy use. If proven effective, the present treatment could be a novel intervention to implement in criminal legal settings given the minimal requirement of resources and training.This trial is registered with www.clinicaltrials.gov-NCT02938403

Abstract 007: The Impact Of A Personalized Weight Loss Diet On Dietary Measures In Adults With Prediabetes And Early-stage Type 2 Diabetes

Introduction: There is limited research examining dietary changes in adults with prediabetes who are following a diet personalized to predict postprandial glycemic response (PPGR). Objective: We compared dietary changes in subjects randomized to a low-fat, one-size-fits-all diet ( Standardized ) or to a diet personalized to minimize PPGR ( Personalized ). Methods: Dietary data collected to-date were analyzed from the Personal Diet study, a clinical trial to compare two behavioral weight loss interventions in adults with prediabetes or early-stage type 2 diabetes. All subjects had resting energy expenditure (REE) measured at baseline using indirect calorimetry. Both arms were instructed to restrict energy intake (-500 kcal/day, based on REE and a physical activity factor of 1.4), log daily dietary intake with a smartphone app, and attend scheduled behavioral counseling sessions. The Standardized arm received app feedback about energy and fat intake, while the Personalized arm received app feedback about energy intake and meal specific predicted PPGR determined from a gut microbiome-based machine learning algorithm. At baseline, 3 months, and 6 months, subjects completed one 24-hour dietary recall using the Automated Self-Administered 24-hour Dietary Assessment Tool. Total energy, total carbohydrate, total sugars, fiber, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, and protein were measured using the USDA Food and Nutrient Database for Dietary Studies 2011-2012. Macronutrient intakes were analyzed as percentage of energy (%E). Linear mixed modelling, with random intercepts and slopes and an unstructured covariance pattern, was used to analyze dietary changes within- and between-arms from baseline to 3 and 6 months. Fixed effects were included for study arm, time period, and interaction of study arm and time period. A random effect was included for subjects. Models were adjusted for age and sex. Results: Dietary assessments were completed at baseline (n=66 Personalized ; n=65 Standardized ), 3 months (n=50 Personalized ; n=36 Standardized ), and 6 months (n=47 Personalized ; n=39 Standardized ). The Personalized arm had a greater reduction than the Standardized arm in energy (β: -342 kcal; 95% CI: -672, -12) and %E from carbohydrate (β: -6.2; 95% CI: -11.7, -0.6) and sugars (β: -4.9; 95% CI: -8.8, -1.0) from baseline to 3 months, but there were no between-arm differences in dietary measures at 6 months. Within-arm, Personalized had decreases in energy (β: -327 kcal; 95% CI: -546, -108) and %E from carbohydrate (β: -4.6; 95% CI: -8.2, -0.9) from baseline to 3 months. In the Standardized arm, %E from sugars increased from baseline to 3 months (β: 3.0; 95% CI: 0.02, 5.9). Conclusions: Personalized had greater reductions than Standardized in energy and %E from carbohydrate and sugars over the first 3 months of the intervention, but dietary changes were similar by 6 months.

Randomized controlled trial testing a video-text tobacco cessation intervention among economically disadvantaged African American adults.

This pilot study tested the acceptability and short-term outcomes of a culturally specific mobile health (mHealth) intervention (Path2Quit) in a sample of economically disadvantaged African American adults. We hypothesized that Path2Quit would demonstrate greater acceptability, biochemically verified abstinence, and promote nicotine replacement therapy (NRT) use compared with a standard text-messaging program. In a 2-arm pilot randomized trial, adults who sought to quit smoking (N = 119) received either Path2Quit or the National Cancer Institute's (NCI) SmokefreeTXT, both combined with a brief behavioral counseling session plus 2 weeks of NRT. Outcomes included acceptability (intervention evaluation and use), NRT utilization, 24-hr quit attempts, self-reported 7-day point prevalence abstinence (ppa), and biochemically verified smoking abstinence at the 6-week follow-up. Participants were 52% female/48% male, mostly single (60%), completed ≥ 12 years of education (83%), middle-aged, and 63% reported a household income < $10K/year. Participants smoked 11 (SD = 8.2) cigarettes/day for 25 (SD = 16) years, and reported low nicotine dependence. There were no differences in intervention evaluations or use (ps > .05), yet Path2Quit led to significantly greater NRT utilization at follow-up (p < .05). There was no difference in quit attempts between conditions or 7-day ppa (p > .05). However, Path2Quit resulted in significantly greater carbon monoxide confirmed ppa (adjusted odds ratio [AOR] = 3.55; 95% CI [1.32, 9.54]) at the 6-week follow-up. A culturally specific mHealth intervention demonstrated positive effects on NRT use and short-term abstinence. Additional research in a larger sample and with long-term follow-up is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A symptom-adapted physical activity intervention during induction chemotherapy for older adults with acute myeloid leukemia (AML) to maintain physical function.

12009 Background: Older adults are at risk for physical function decline during therapy for AML. Impaired physical function after induction therapy is associated with shorter survival Interventions designed to maintain function may improve treatment outcomes. We piloted a physical activity (PA) intervention among older adults receiving intensive chemotherapy for AML designed to prevent functional decline. Methods: Single institution randomized pilot study of PA vs. usual care. Eligibility included age ≥60 years, newly-diagnosed AML, ambulatory, planned intensive induction chemotherapy. Intervention participants were offered a PA session five days/week tailored daily to symptoms and conditions during the induction hospitalization. Session options were: 1) Standard (ward-based), walking + balance trahining + resistance exercises; 2) Intermediate (room-based), upper-body ergometer + balance training + resistance exercises; 3) Low-intensity (bed-based), upper-body ergometer + resistance exercises. Behavioral counseling sessions to establish PA goals and overcome barriers were conducted weekly during hospitalization and continued monthly by phone for 6 months. Assessment of physical function occurred at baseline, weekly during hospitalization (approximately 4-6 weeks), 3 months, and 6 months. The primary functional outcome of interest was the Short Physical Performance Battery (SPPB; 5 repeat chair stands, gait speed, balance tests; score 0-12 higher indicates better function). Clinically significant change in physical function was defined as ≥1.0 on the SPPB. Proportions of those that declined, remained stable, or improved on the SPPB were compared by group using an exact test for trend. Results: Among 96 eligible patients 70 enrolled (recruitment rate 73%, average participation 3 sessions/week). The mean age was 72.1±6.3 years, 70% were male. Mean baseline SPPB score was 7.0±3.8. In the surviving intention to treat population (N = 66), more intervention participants, compared to controls, maintained or improved their SPPB score (38% vs. 25%) during induction hospitalization (p = 0.278). Among those who achieved remission (N = 42), function was maintained or improved in a greater proportion of intervention participants (55%) compared to controls (23%), p = 0.047. Maintenance or improvement in SPPB from baseline to last follow-up (3 or 6 months post enrollment) was 62% vs 54% for intervention versus control among the intention to treat cohort (N = 50) and 67% vs. 55% among those who achieved remission (N = 40). Conclusions: A symptom adapted PA intervention with behavioral counseling during induction chemotherapy shows promise in preventing clinically meaningful decline in physical function among older adults with AML who achieve remission. Continued maintenance intervention may sustain benefits. Clinical trial information: NCT01519596.

Feasibility and outcomes from an integrated bridge treatment program for opioid use disorder.

ObjectiveWith a significant proportion of individuals with opioid use disorder not currently receiving treatment, it is critical to find novel ways to engage and retain patients in treatment. Our objective is to describe the feasibility and preliminary outcomes of a program that used emergency physicians to initiate a bridge treatment, followed by peer support services, behavioral counseling, and ongoing treatment and follow‐up.MethodsWe developed a program called the Houston Emergency Opioid Engagement System (HEROES) that provides rapid access to board‐certified emergency physicians for initiation of buprenorphine, plus at least 1 behavioral counseling session and 4 weekly peer support sessions over the course of 30 days. Follow‐ups were conducted by phone and in person to obtain patient‐reported outcomes. Primary outcomes included percentage of patients who completed the 30‐day program and the percentage for successful linkage to more permanent ongoing treatment after the initial program.ResultsThere were 324 participants who initiated treatment on buprenorphine from April 2018 to July 2019, with an average age of 36 (±9.6 years) and 52% of participants were males. At 30 days, 293/324 (90.43%) completed the program, and 203 of these (63%) were successfully connected to a subsequent community addiction medicine physician. There was a significant improvement (36%) in health‐related quality of life.ConclusionLack of insurance is a predictor for treatment failure. Implementation of a multipronged treatment program is feasible and was associated with positive patient‐reported outcomes. This approach holds promise as a strategy for engaging and retaining patients in treatment.

The effect of the behavioral counseling on developing self-affirmation among a sample of delinquents Enrolled in the Social Observation House in Medina: تأثير الإرشاد السلوكي في تنمية توكيد الذات لدى عينة من الجانحين الملتحقين بدار الملاحظة الاجتماعية بالمدينة المنورة

This study aimed to investigate the effect of behavioral counseling on the development of self- affirmation among a sample of delinquents, perpetrators of theft and moral crimes, who joined the social observation in Medina, and this included two groups, an experimental group and another control group, and conducting pre and post measurements of self- affirmation. The study sample consisted of (24) event from inmates of the social observation house in Medina who obtained low scores on the self- affirmation scale, they were divided into two groups: (an experimental group consisting of (12) events, and a control group consisting of (12) events, and the (Ratus) scale was applied to measure self-affirmation, in addition to a behavioral counseling program in developing self-affirmation prepared by the researcher, which consisted of (13) behavioral counseling session over two and a half months, and the duration of each session is (60) minutes. The results of the study resulted in statistically significant differences between the average scores of the members of the experimental and control groups after applying the program, and the differences came in favor of the experimental group. The researcher recommended that there should be an intensification and development of behavioral counseling programs that related to the development of self-affirmation among some delinquents, and with different guidance methods as well.

A Pilot Study of Nicotine Replacement Therapy Sampling and Selection to Increase Medication Adherence in Low-Income Smokers.

Adherence to smoking cessation medications remains suboptimal, particularly among low-income smokers. Guided, experiential sampling of nicotine replacement therapies (NRTs) may increase NRT adherence and smoking cessation over gold standard counseling plus NRT. The present pilot study aimed to examine feasibility, acceptability, and preliminary efficacy of a novel experiential intervention. This pilot randomized controlled trial (N = 83) compared gold standard smoking cessation treatment (four weekly sessions of behavioral counseling followed by self-selected combination NRT in week 5) to a novel experiential approach (ie, In Vivo; four weekly sessions of sampling each short form of NRT-gum, lozenge, inhaler, nasal spray-in-session while wearing the nicotine patch followed by NRT selection in week 5). Both groups received 8 weeks of nicotine patch plus their selected additional short form NRT for smoking cessation followed by a 1-month assessment. Screening and enrollment rates supported feasibility. In Vivo was comparable in acceptability with the gold standard of care intervention; however, there was greater attrition in the In Vivo group compared with the gold standard of care group. Results suggested higher medication adherence and improvements in smoking behavior in the In Vivo intervention; with generally small-to-medium effect sizes. This experiential approach to sampling NRT is feasible and acceptable to low-income people who smoke. This intervention may increase adherence and reduce harmful smoking behavior but needs to be tested on a larger scale. Medication adherence remains a significant impediment to the successful smoking cessation. The results of this study suggest that guided sampling of NRT products improves adherence among low-income smokers. Additionally, this approach yielded greater improvements in smoking behavior compared with gold standard smoking cessation treatment. This intervention shows promise as a feasible smoking cessation treatment for low-income smokers.

Implementing a Novel Workplace Smoking Cessation Intervention Targeting Hispanic/Latino Construction Workers: A Pilot Cluster Randomized Trial.

U.S. Hispanic/Latino construction workers constitute a large and historically underserved group in terms of smoking cessation services. Using formative research, we developed a worksite smoking cessation intervention tailored to the life/work circumstances of these workers. This study aims to examine the feasibility, acceptability, and potential efficacy of the developed intervention "Enhanced Care" (EC; one group behavioral counseling session provided around the food truck + fax referral to tobacco quitline [QL] + 8-week nicotine replacement treatment [NRT]) compared with "Standard Care" (SC; fax referral to tobacco QL + 8-week NRT) in a pilot, two-arm, cluster randomized controlled trial. In collaboration with construction site safety managers, a sample of 17 construction sites (EC: nine sites/65 smokers; SC: eight sites/69 smokers) was enrolled. Participants received two follow-ups at 3 and 6 months after enrollment. Feasibility outcomes were enrollment rate, adherence to treatment, and 6-month retention rates. The primary efficacy outcome was 6 months prolonged abstinence verified by expired carbon monoxide <10 ppm. Enrollment rate was high (85.9%). Six-month follow-up rates were acceptable (EC = 76.9%, SC = 66.6%). Adherence to treatment was better in the EC group (received worksite intervention: EC = 93.8%, SC = 88.4%; contacted by QL: EC = 49.2%, SC = 40.6%). Abstinence rates were 27.7% for the EC and 20.3% for the SC (p = .315). The developed intervention was feasible and acceptable, and it substantially improved abstinence among Hispanic/Latino workers. The involvement of safety managers was essential to the implementation of the intervention. Training safety managers to deliver the intervention has great potential to implement a sustainable smoking cessation service in the construction sector.

Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment.

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the “cold call” following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.

Change In Physical Activity In The Health In Pregnancy And Postpartum (HIPP) Randomized Controlled Trial (RCT)

Despite the known benefits of physical activity (PA) in pregnancy, PA is consistently shown to decrease from early to late pregnancy. Very few antenatal interventions have targeted PA and included sensor-measured outcomes in overweight and obese pregnant women. PURPOSE: To examine whether a lifestyle intervention increased moderate- to vigorous-intensity PA (MVPA), light PA, and steps or reduced their decline from early to late pregnancy compared to a standard care condition. METHODS: HIPP is a RCT comparing the effects of a lifestyle intervention vs standard care on gestational weight gain (primary outcome) and health behaviors including PA (secondary outcomes) among women entering pregnancy overweight or obese. The lifestyle intervention was grounded in social cognitive theory and, during pregnancy, included an introductory behavioral counseling session followed by telephone counseling calls, behavioral podcasts, and a private Facebook group. Usual care participants received usual care from their obstetrician and received mailings and podcasts focused on a healthy pregnancy. Participants wore a SenseWear armband ≥ 21 hrs/d for ≥ 5 d at baseline (early pregnancy, n=205) and 32-wk gestation (n=167). We tested Randomization x Time interaction effects (SAS PROC MIXED) for min/d of MVPA, min/d of light PA, and steps/d. RESULTS: Participant demographics were: 30±5 years, 44% African American, 56% white, 60% college graduate, 61% employed full-time, 67% married, 42% nulliparous, and 13±2 wk gestation at baseline. While the time main effects indicated that MVPA (p=.007), light PA (p=.04), and steps (p<.0001) decreased significantly, intervention effects (Randomization x Time) were not significant for these PA variables (see Table). Table. Changes in MVPA, Light PA, and Steps Over Time, by Randomization Group, Least Square Means (SEs) CONCLUSION: A behaviorally based lifestyle intervention did not significantly lessen the decline in PA typically seen from early to late pregnancy. Assessments will be repeated at 6- and 12-mo postpartum. Funded by NIH/NICHD.

The effect of cognitive behavioral counseling on sexual knowledge, motivation to avoid risky sexual relationships, and sexual depression in female university students.

Introduction Misunderstanding of different aspects of sex makes individuals vulnerable to sexual dysfunction, sexually transmitted diseases, mental disorders, and illegal relationships. This study aimed to determine the effect of cognitive behavioral counseling on the sexual self-concept of female students at Kerman University of Medical Sciences. Methods This study is an intervention conducted with female students living in dormitories at Kerman and Rafsanjan Universities of Medical Sciences. The sample size was estimated at 63 students from different fields of study; 31 students from Kerman University of Medical Sciences comprised the experimental group and 32 students from Rafsanjan University of Medical Sciences comprised the control group. Cognitive behavioral group counseling sessions were held every 3 days. The instrument used for collecting pre-test and post-test data was Snell's Multidimensional Sexual Self-concept Questionnaire. Data analysis was conducted using measures of central tendency, t tests and chi-square tests. Results The two groups were homogenous in terms of demographic factors. Analysis of the results of the intervention revealed significant differences in sexual self-consciousness and motivation to avoid high risk sexual relationships, but there was no significant difference in terms of sexual depression. Discussion Cognitive behavioral group counseling can improve sexual self-concept. Therefore, this type of counseling is recommended from younger ages or at enrollment at university, to help correct development of this important part of identity.

Cognitive-behavioral counseling and mental health of pregnant women

BackgroundPregnancy is characterized with several physical and mental changes in women. These changes cause mental health problems in pregnant women and especially in nulliparous women. ObjectiveTo determine the effects of cognitive-behavioral counseling on mental health of pregnant women. MethodThe study was carried out as a quality of life clinical trial with a control group. The participants were 60 pregnant women (less than 20 weeks) who visited Kamyaran-based health centers (Iran) in 2018. The participants were allocated randomly to experiment and control groups (n = 30 each). The experiment group attended eight group behavioral cognitive counseling sessions (70-90min) on weekly basis. Pre-intervention data was collected using a demographics checklist and Goldberg's General Health Questionnaire. One month after the last counseling session, the questionnaires were filled out once more by all the participants. The data was analyzed using Mann-Whitney, independent t-test, Friedman, and Chi Squared tests using SPSS (23). ResultsThe results showed that the difference between the control and experiment groups in terms of mental health score was not significant before the intervention (p = 0.169). However, the difference between the two groups was significant immediately (p = 0.001) and one month (p = 0.001) after the group behavioral cognitive counseling. ConclusionThe group behavioral cognitive counseling sessions improved mental health in nulliparous women. Further studies with longer follow-up terms to ensure resilience of the effects of such interventions are recommended.

Adherence to Self-monitoring of Dietary Intake During a Weight Loss Intervention: Does a Personalized Approach Maintain Adherence? (FS11-04-19)

ObjectivesWe compared self-monitoring adherence in participants randomized to two weight loss programs: a STANDARDIZED, one-size-fits-all, low-fat diet, or a diet PERSONALIZED to minimize the postprandial glycemic response. MethodsParticipants were adults with pre-diabetes or type 2 diabetes, and a BMI >27 k/m2. Both groups were instructed to restrict total calories, monitor dietary intake with the Personal Nutrition Program (PNP) smartphone app, and attend videoconference behavioral counseling sessions on the same intervention schedule. STANDARDIZED (n = 12) received app feedback about intake of total calories and dietary fat. PERSONALIZED (n = 20) received app feedback about intake of total calories plus a meal-specific predicted glycemic score. Total meal entries were measured at 1, 2 and 3 months. Self-monitoring adherence was defined as logging >50% of expected meals each month into the PNP app, assuming 3 meals/day. Session attendance was also measured. Repeated measures binomial logistic regression analysis was used to assess change in adherence due to treatment group, time (i.e., months), and the interaction between treatment and time, adjusting for age, gender and BMI. ResultsProportion adherent was 75.0%, 41.7% and 8.3% in the STANDARDIZED group and 85.0%, 80.0% and 75.0% in the PERSONALIZED group during months 1, 2 and 3, respectively. The repeated measures model demonstrated a significant effect of month (P < 0.001) and a treatment*month interaction (P = 0.011). After adjusting for covariates, these effects remained significant, showing a significant reduction in odds of adherence by month (OR [95%CI]: 0.13 [0.05, 0.37]; P < 0.001). Moreover, compared to the STANDARDIZED, PERSONALIZED participants had greater odds of adherence over time (OR [95%CI]: 5.12 [1.49, 17.6]; P = 0.009). Higher BMI was significantly associated with lower adherence (OR [95%CI]: 0.92 [0.87, 0.98]; P = 0.006). The proportion of attendance at videoconference sessions was similar between groups (STANDARDIZED: 77.1%; PERSONALIZED: 77.5%). ConclusionsTwo weight loss programs having similar calorie targets, behavioral approach, and contact schedule resulted in similar session attendance. However, adherence to self-monitoring was better when feedback was personalized. Funding SourcesAmerican Heart Association.

Placebo-controlled randomized clinical trial testing the efficacy and safety of varenicline for smokers with HIV

BackgroundPeople living with HIV/AIDS (PLWH) smoke tobacco at higher rates and have more difficulty quitting than the general population, which contributes to significant life-years lost. The effectiveness of varenicline, one of the most effective tobacco dependence treatments, is understudied in HIV. We evaluated the safety and efficacy of varenicline for smoking cessation among PLWH. MethodsThis was a single-site randomized, double-blind, placebo-controlled, phase 3 clinical trial (NCT01710137). PLWH on antiretroviral therapy (ART) who were treatment-seeking daily smokers were randomized (1:1) to 12 weeks of varenicline (n = 89) or placebo (n = 90). All participants were offered six smoking cessation behavioral counseling sessions. The primary outcome was 7-day point prevalence abstinence, confirmed with breath carbon monoxide, at Weeks 12 and 24. Continuous abstinence and time to relapse were secondary outcomes. Safety measures were treatment-related side effects, adverse events, blood pressure, viral load, and ART adherence. ResultsOf the 179 smokers, 81% were African American, and 68% were male. Varenicline increased cessation at Week 12 (28.1% vs. 12.1%; OR = 4.54, 95% CI:1.83−11.25, P = .001). Continuous abstinence from Week 9 to 12 was higher for varenicline vs. placebo (23.6% vs. 10%; OR = 4.65, 95% CI:1.71−12.67, P = .003); at Week 24, there was no effect of varenicline for point prevalence (14.6% vs. 10%), continuous abstinence (10.1% vs. 6.7%), or time to relapse (Ps > .05). There were no differences between varenicline and placebo on safety measures (Ps > .05). ConclusionsVarenicline is safe and efficacious for short-term smoking cessation among PLWH and should be used to reduce tobacco-related life-years lost in this population.