This proposal responds to Challenge Area 01: Behavior, Behavioral Change, and Prevention and specific Challenge Topic, 01-HL-101: to develop innovative technologies and measurements to assess and provide real-time feedback on behavioral and environmental exposures for disease onset and progression for heart, lung, and blood diseases.
We aim to develop an innovative real-time assessment of behavioral exposures for cardiovascular disease (CVD). We will implement three new self-monitoring functions on GPS- and accelerometer-equipped smartphones to monitor diet, exercise, and stress for young overweight mothers. Today's smartphones can create reliable and valid records of these behaviors by autonomously and unobtrusively providing continuous, time-stamped, location and activity information for use by researchers, health care providers and patients across a broad range of disorders to inform the next generation of personalized medicine. Cardiovascular disease (CVD) is the leading cause of death amongst women (accounting for one third of all deaths), and accounts for higher female mortality than all forms of cancer combined. One of the major risk factors for CVD is weight. More than 60% of women are overweight or obese. This situation is worsened when women become mothers, which typically increases BMI each year, especially among African-American and Latina women. Such trends underscore the need for prevention or reduction in CVD risk factors for mothers beginning in young adulthood, even before heart disease is diagnosed. Diet, exercise, and stress can reduce CVD risk factors, but more affordable, valid, reliable, and feasible tools to self-monitor these behaviors are required to address the limitations in current methodology: retrospective self-reports are subject to recall error and bias;paper-based monitoring is easily delayed or ignored;biomarkers require lab preparation;and human-mediated feedback is time-intensive and costly. To avoid these sources of error and delay, ecological momentary assessment (EMA) was developed to monitor affect and behavior in real time in a person's natural environment. The GPS, accelerometer, and computing capabilities on smartphones can significantly increase the power of EMA by providing information on where a person has been and what they were doing there. Yet phones have not been sufficiently utilized to track and measure health behaviors through space and time. This project aims to develop and pilot test the validity and reliability of a smartphone application, called ANDWellness, which extends the current capacity of EMA in two important ways to improve the cost- effectiveness, timeliness, respondent burden, reliability and validity of self-monitoring. The phone will: 1) permit users to monitor their diet, stress, activity, and compliance using automated and intelligent sampling design, and 2) provide real-time feedback on these behaviors. ANDWellness will use interaction strategies that are accessible, acceptable, and attractive to young mothers (Moms). The proposed methods and development processes are well-grounded concepts in the field of computer science, but are novel in the application to behavioral and self-monitoring. As such, these innovative tracking services are likely to dramatically shift the methods available not only to self-monitoring, but also for interventions for sustainable behavior change. The Center for Embedded Networked Sensing (CENS) will partner with nationally and internationally recognized behavioral scientists at UCLA Global Center for Children and Families, and pioneers in the use of biomarkers for social epidemiology at the Laboratory for Comparative Human Biology at Emory University. This technology-behavioral interdisciplinary team will design, implement, and validate the ANDWellness method. Validity, reliability, acceptability, and compliance of Moms to ANDWellness will be assessed in a pilot study. In a preliminary fashion, the efficacy of ANDWellness to improve compliance, diet, stress, and activity will also be evaluated. A diverse sample of Moms, balanced in ethnicity and reflecting weight conditions will be randomized to a self-monitoring condition where participants carry phones (n=45) or a control condition with no phones (n=15) and assessed over 6 months. The technology innovations, provider and client feedback, and pilot data developed in this pilot study will prepare us to apply for an R01 efficacy or R18 dissemination trial. This proposal meets ARAA goals of job creation and maintenance, assisting those most affected by the recession, and advancing economically efficient health care provision. The creation of new jobs will stimulate the economy in the short term and the outcomes of the research will increase the health of the economy in the long run. This project will immediately and directly support 12 professionals (research staff, engineers, programmers, consultant), including hiring 3 new full-time employees. The proposed activities are highly consistent with the Strategic Plan of the National Heart, Lung, and Blood Institute (NHLBI). NHLBI is a leader in the movement towards personalized medicine, and the Strategic Plan includes a strong emphasis on """"""""Focused behavioral and social science research [that] may help uncover effective new approaches for...motivating and empowering individuals and communities to take charge of their health."""""""" ANDWellness includes customizable self-monitoring functions and personalized real- time feedback to achieve these goals. Cardiovascular disease (CVD) is the leading cause of death amongst women. Diet, stress, and exercise can reduce CVD risk factors, but more affordable, valid, reliable, and feasible tools to self-monitor these behaviors are required. Today's smartphones can create reliable and valid records of these behaviors by autonomously and unobtrusively providing continuous, time-stamped, location and activity information for use by researchers, health care providers and patients across a broad range of disorders to inform the next generation of personalized medicine.
Cardiovascular disease (CVD) is the leading cause of death amongst women. Diet, stress, and exercise can reduce CVD risk factors, but more affordable, valid, reliable, and feasible tools to self-monitor these behaviors are required. Today's smartphones can create reliable and valid records of these behaviors by autonomously and unobtrusively providing continuous, time-stamped, location and activity information for use by researchers, health care providers and patients across a broad range of disorders to inform the next generation of personalized medicine.
| Swendeman, Dallas; Comulada, Warren Scott; Koussa, Maryann et al. (2018) Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers. JMIR Mhealth Uhealth 6:e176 |
| Comulada, W Scott; Swendeman, Dallas; Koussa, Maryann K et al. (2018) Adherence to self-monitoring healthy lifestyle behaviours through mobile phone-based ecological momentary assessments and photographic food records over 6 months in mostly ethnic minority mothers. Public Health Nutr 21:679-688 |
| Ramanathan, Nithya; Swendeman, Dallas; Comulada, W Scott et al. (2013) Identifying preferences for mobile health applications for self-monitoring and self-management: focus group findings from HIV-positive persons and young mothers. Int J Med Inform 82:e38-46 |
