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Prokhorov AV, Calabro KS, Arya A, Russell S, Czerniak KW, Botello GC, Chen M, Yuan Y, Perez A, Vidrine DJ, Perry CL, Khalil GE. Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk. JMIR Mhealth Uhealth 2021; 9:e25618. [PMID: 34822339 PMCID: PMC8663493 DOI: 10.2196/25618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. OBJECTIVE Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. METHODS With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). RESULTS A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). CONCLUSIONS In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. TRIAL REGISTRATION ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10977.
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ashish Arya
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Health Disparities, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ying Yuan
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Austin, TX, United States
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Cheryl L Perry
- School of Public Health, Health Science Center, University of Texas, Austin, TX, United States
| | - Georges Elias Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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Khalil GE, Wang H, Calabro KS, Prokhorov AV. Revealing users' experience and social interaction outcomes following a web-based smoking prevention intervention for adolescents: A qualitative study. PLoS One 2019; 14:e0223836. [PMID: 31622397 PMCID: PMC6797109 DOI: 10.1371/journal.pone.0223836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tobacco smoking remains a public health problem among adolescents in the United States. While Web-based interventions for smoking prevention have been successful at the individual level, there is still an urgent need to understand their engagement capabilities and their effects at the social level. In the current study, we aimed to (1) learn about adolescents' subjective experience with a Web-based program called a smoking prevention interactive experience (ASPIRE), (2) obtain suggestions for improvement in ASPIRE content, (3) identify psychological outcomes of ASPIRE, and (4) explore outcomes of social interaction. MATERIALS AND METHODS After a randomized controlled trial with 110 adolescents, 20 adolescent users of ASPIRE, aged 11-18, were randomly selected to participate in one-on-one interviews at four after-school programs in Houston, Texas. Interviews involved questions concerning adolescents' experience with the intervention. Qualitative data were coded and analyzed using a constant comparison approach for the generation of themes. RESULTS Describing their experience with ASPIRE, participants expressed comfort in material that is tailored to their demographic and preferred interactive activities over entertaining videos. Presenting suggestions for improvement, participants mainly reported the need to include gaming features into ASPIRE. Presenting psychological outcomes, they expressed emotional engagement in the program, shifts in attitudes and beliefs, and unwillingness to smoke. Finally, as outcomes of social interaction, participants reported engagement with others in discussions about tobacco and their need to hold smokers accountable for their actions. CONCLUSIONS Adolescents' reports moved from their individual experience with ASPIRE to their active interactions with family members and friends and their attempt to persuade others to quit smoking. Future Web-based programs for adolescents may be designed with tailoring and game play in mind, in order to provide mobilization skills and foster social interactions against smoking.
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Affiliation(s)
- Georges Elias Khalil
- Department of Behavioral Science, the University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
| | - Hua Wang
- Department of Communication, University at Buffalo, the State University of New York, Buffalo, New York, United States of America
| | - Karen Sue Calabro
- Department of Behavioral Science, the University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Alexander V. Prokhorov
- Department of Behavioral Science, the University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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Prokhorov AV, Khalil GE, Calabro KS, Machado TC, Russell S, Czerniak KW, Botello GC, Chen M, Perez A, Vidrine DJ, Perry CL. Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10977. [PMID: 30322833 PMCID: PMC6231779 DOI: 10.2196/10977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier RR1-10.2196/10977
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Georges Elias Khalil
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Tamara Costello Machado
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Damon J Vidrine
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, OK, United States
| | - Cheryl L Perry
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
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McIntosh S, Johnson T, Wall AF, Prokhorov AV, Calabro KS, Ververs D, Assibey-Mensah V, Ossip DJ. Recruitment of Community College Students Into a Web-Assisted Tobacco Intervention Study. JMIR Res Protoc 2017; 6:e79. [PMID: 28483741 PMCID: PMC5440736 DOI: 10.2196/resprot.6485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/28/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background United States college students, particularly those attending community colleges, have higher smoking rates than the national average. Recruitment of such smokers into research studies has not been studied in depth, despite a moderate amount information on study recruitment success with smokers from traditional four-year colleges. Recruitment channels and success are evolving as technology evolves, so it is important to understand how to best target, implement, and evaluate recruitment strategies. Objective The aim of this paper is to both qualitatively and quantitatively explore recruitment channels (eg, mass email, in-person referral, posted materials) and their success with enrollment into a Web-Assisted Tobacco Intervention study in this priority population of underserved and understudied smokers. Methods Qualitative research methods included key informant interviews (n=18) and four focus groups (n=37). Quantitative research methods included observed online responsiveness to any channel (n=10,914), responses from those completing online screening and study consent (n=2696), and responses to a baseline questionnaire from the fully enrolled study participants (n=1452). Results Qualitative results prior to recruitment provided insights regarding the selection of a variety of recruitment channels proposed to be successful, and provided context for the unique attributes of the study sample. Quantitative analysis of self-reported channels used to engage with students, and to enroll participants into the study, revealed the relative utilization of channels at several recruitment points. The use of mass emails to the student body was reported by the final sample as the most influential channel, accounting for 60.54% (879/1452) of the total enrolled sample. Conclusions Relative channel efficiency was analyzed across a wide variety of channels. One primary channel (mass emails) and a small number of secondary channels (including college websites and learning management systems) accounted for most of the recruitment success. Trial Registration ClinicalTrials.gov NCT01692730; https://clinicaltrials.gov/ct2/show/NCT01692730 (Archived by WebCite at http://www.webcitation.org/6qEcFQN9Q)
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Affiliation(s)
- Scott McIntosh
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Tye Johnson
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Andrew F Wall
- School of Education, University of Redlands, Redlands, CA, United States
| | - Alexander V Prokhorov
- MD Anderson Cancer Center, Department of Behavioral Science, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- MD Anderson Cancer Center, Department of Behavioral Science, The University of Texas, Houston, TX, United States
| | - Duncan Ververs
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Vanessa Assibey-Mensah
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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Khalil GE, Wang H, Calabro KS, Mitra N, Shegog R, Prokhorov AV. From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents. J Med Internet Res 2017; 19:e44. [PMID: 28209560 PMCID: PMC5334517 DOI: 10.2196/jmir.7174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background Web-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes. Objective Based on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents’ intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model. Methods A total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted. Results A total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=−0.18, P=.008). Perceived interactivity (beta=−0.27, P=.004) and entertainment (beta=−0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=−0.16, P=.04). Conclusions Adolescents’ experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents’ psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes. Trial Registration Clinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0)
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Affiliation(s)
- Georges Elias Khalil
- MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, Houston, TX, United States
| | - Hua Wang
- University at Buffalo, Department of Communication, Buffalo, NY, United States
| | - Karen Sue Calabro
- MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, Houston, TX, United States
| | - Natasha Mitra
- Health Science Center at San Antonio, School of Public Health, University of Texas, San Antonio, TX, United States
| | - Ross Shegog
- Health Science Center at Houston, Center for Health Promotion and Prevention Research, University of Texas, Houston, TX, United States
| | - Alexander V Prokhorov
- MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, Houston, TX, United States
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Abstract
A survey about the professional characteristics of dietetics practice was mailed to 109 countries and representatives from 61 countries responded. Using the Human Development Index (HDI), a measure that reflects the life expectancy, education, and income of the population of each nation, countries were categorized as high, medium, or low HDI. This allowed comparisons among the HDI scores in the areas of education, professional practice, education, and practice competencies. Responding countries were 36.1% high HDI, 49.2% middle HDI, 8.2% low HDI, and 6.6% were unclassified. Dietetics was a nationally recognized profession in 81% of countries, with most having a professional association that represented dietitians. Clinical dietetics was the most frequently selected area of practice, followed by food service. Undergraduate academic programs in dietetics were available in 79% of countries and 49% offered graduate degrees. Most respondents rated competencies in clinical and community nutrition, along with competencies in professional practice, as important to their work. The results of this study can serve as a baseline as the profession evolves. Leaders in the dietetics profession can use these results to identify areas that need improvement. Collaboration with the United Nations family and sources that fund global initiatives can help in providing resources for the advancement of the profession. When the effectiveness of dietitians is improved, favorable changes in nutritional well-being on the global level can be expected.
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Affiliation(s)
- K S Calabro
- Health Science Center, University of Texas at Houston, Houston, Texas 77030, USA.
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Calabro KS, Bright KA, Cole FL, Mackey T, Lindenberg J, Grimm A. Child care work. Organizational culture and health and safety. AAOHN J 2000; 48:480-6. [PMID: 11760258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A nonrandom sample of child care workers was surveyed to assess whether child care work represented an "at risk" health and safety culture and to measure the organizational dimensions contributing to the health and safety culture. The child care workers in Houston, Texas, were surveyed by mail, using an instrument developed by the research team. The sample population represented 34 child care centers (n = 240 respondents). The analysis yielded five factors related to determinants of health and safety culture. The participants had a favorable perception of the five health and safety determinants. The participants also reported high levels of injury and illness in their environments, suggesting a less than favorable situation. A culture, work, and health model was useful in examining the relationship between health and safety and organizational culture.
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Affiliation(s)
- K S Calabro
- University of Texas-Houston Health Science Center, Houston, TX, USA
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