Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits

Online grocery shopping has the potential to improve access to food, particularly among low-income households located in urban food deserts and rural communities. The primary aim of this pilot intervention was to test whether a three-armed online grocery trial improved fruit and vegetable (F&V) purchases. Rural and urban adults across seven counties in Kentucky, Maryland, and North Carolina were recruited to participate in an 8-week intervention in fall 2021. A total of 184 adults were enrolled into the following groups: (1) brick-and-mortar “BM” (control participants only received reminders to submit weekly grocery shopping receipts); (2) online-only with no support “O” (participants received weekly reminders to grocery shop online and to submit itemized receipts); and (3) online shopping with intervention nudges “O+I” (participants received nudges three times per week to grocery shop online, meal ideas, recipes, Facebook group support, and weekly reminders to shop online and to submit itemized receipts). On average, reported food spending on F/V by the O+I participants was USD 6.84 more compared to the BM arm. Online shopping with behavioral nudges and nutrition information shows great promise for helping customers in diverse locations to navigate the increasing presence of online grocery shopping platforms and to improve F&V purchases.

Co-Production at Work: The Process of Breaking Up Sitting Time to Improve Cardiovascular Health. A Pilot Study

Prolonged sitting negatively affects several cardiovascular disease biomarkers. Current workplace physical activity interventions to reduce sitting result in inconsistent uptake and adherence rates. Co-production attempts to improve the translation of evidence to practice through engaging the participants within the intervention design, improving the context sensitivity and acceptability of the intervention. A needs analysis questionnaire was initially conducted (n = 157) to scope workplace behaviours and attitudes. A development group (n = 11) was consulted in focus groups around the needs analysis findings and asked to comment on the feasibility of a proposed intervention. A pilot intervention was then carried out (n = 5). The needs analysis indicated that only 1.8% (n = 4) engaged in occupational physical activity, and 68.7% (n = 103) sat for ≥6 h during their working day. Through the focus groups, an intervention breaking up sitting time hourly with five-minute walking breaks was co-produced. Cultural and pragmatic issues concerning the implementation of frequent physical activity breaks from sitting and the subsequent impact on work productivity were highlighted. The pilot intervention increased the number of breaks from sedentary behaviour from 2 to 11. The co-production methodology resulted in a research- and stakeholder-guided compromise. Large-scale intervention implementation is required before firm effectiveness conclusions can be made.

Interventions That Successfully Reduced Adults Salt Intake—A Systematic Review

Background: Adequate sodium intake is important for lowering blood pressure and thus reducing cardiovascular disease risk and other complications. The aim of this review is to identify recent interventions around the world that have been successful in reducing salt intake. Methods: A search in the PubMed, Web of Science and Scopus databases was performed. We include studies published in the last 10 years; randomized trials, pilot intervention without a control arm or experimental study; adult participants; and interventions that successfully reduced salt intake. Study quality was assessed. Results: We included 21 studies, 16 randomized intervention trials and five nonrandomized intervention studies. Eleven interventions described health and nutritional education, seven interventions described nutritional education plus other interventions, and three studies used salt meters to reduce sodium intake. Conclusion: Health and nutritional education, nutritional education plus other interventions and estimates of salt intake showed success in the reduction of salt consumption. There is no evidence that one type of intervention analyzed is more effective than other in reducing salt consumption, so we must analyze each in which individuals or subpopulations will have the intervention performed and use the most suitable approaches to lead to better results.

The PrEP Up Pharmacies Study: Protocol for integrating and disseminating pre-exposure prophylaxis (PrEP) screening and dispensing in community pharmacies for Black men who have sex with men in Atlanta, Georgia (Preprint)

BACKGROUND Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce risk of HIV infection by 99% among MSM, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP including inconvenient locations of PrEP-prescribing physicians and distrust of physicians and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in high poverty, racial minority neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (e.g. vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE To develop a sustainable pharmacy PrEP delivery model that can be implemented to increase PrEP access in high poverty, racial minority neighborhoods for BMSM. METHODS This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model’s feasibility, acceptability and safety, and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed methods approach will be performed including three study phases: 1) a completed formative phase with qualitative interviews from key stakeholders; 2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and 3) a planned pilot intervention phase which will test the delivery model in two Atlanta pharmacies in high poverty, racial minority neighborhoods. RESULTS Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists and pharmacy staff. Important factors were identified to facilitate implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS Pharmacies have proven to be a feasible source for offering PrEP for White MSM, but have failed to reach the most at-risk, vulnerable population – BMSM. Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources.

Mediators and moderators of physical activity changes in a school-based intervention targeting childhood obesity

This study identifies mediators and moderators of changes in physical activity (PA) following a school-based pilot intervention. Students from two Lebanese schools were randomly allocated into intervention ( n = 191) and control ( n = 183) groups. The multiple-mediation analysis revealed that active self-identity and perceived barriers mediated the intervention’s effect on PA changes. Baseline intention, attitude, PBC, and age moderated PA changes at post-intervention. The youngest participants and those reporting the lowest PA scores at baseline benefited most from the intervention. Future interventions with students should target these mediators and moderators to promote positive change in PA behavior.

Emerging Concepts in Dyadic Research

This session includes four papers that explore and expand upon emerging concepts in dyadic research in health, illness, and end-of-life. First, Dr. Karen Lyons and colleagues examine the concept of dyadic mental health in mid-late life couples living with lung cancer. The paper examines the impact of having optimal versus poor dyadic mental health at diagnosis on the physical health of the couple over time, but also explores the ways we examine the concept of dyadic health in research and potential implications of these methods. Second, Dr. Lyndsey Miller and colleagues take a dyadic approach to understanding the roles of social activity and connectedness on depressive symptoms in a sample of community-dwelling older couples. The paper not only highlights important gender differences, but also the salient role of incongruent dyadic physical health. Third, Dr. Ranak Trivedi and colleagues describe the findings of a novel pilot intervention targeted at improving dyadic self-management in care dyads where one member is a Veteran with chronic conditions. The paper draws upon concepts of collaboration and dyadic coping to conceptualize self-management as a dyadic phenomenon. Finally, Dr. Buck and colleagues explore the novel concept of dyadic dissolution in a sample of family caregivers after the death of their care partner. The paper explores the concept as a cognitive and affective process with implications for how the surviving partner adapts over time. Speakers and Discussant, Dr. Amy Rauer, will focus on implications of these concepts for advancing dyadic science of health and illness across the lifespan.

Measuring Mindfulness: Assessing the Utility of the FFMQ in the Older Veterans With Dementia and Their Caregivers

Mindfulness is increasingly popular as a low cost, convenient, and accessible way to address mental health and chronic health conditions. Despite its popularity, best practices in measuring mindfulness in clinical settings and intervention research are still being defined. The Five Facet Mindfulness Questionnaire (FFMQ-15) measures mindfulness traits; however, its use has been limited in older adults, those with dementia, and caregivers. Method: Caregivers (N=82) and veterans with dementia (N=62) enrolled in a randomized pilot intervention study completed the 15-item FFMQ at baseline, 6-month, and 12-month assessments. Veterans were mostly male (98%), White/Caucasian (65%), and living with a partner/spouse (79%). Caregivers (M=65 years old) were mostly female (89%) and White/Caucasian (66%). FFMQ response options were simplified to a 3-point Likert-scale for individuals with dementia (0=rarely true to 2=often true). Results Internal consistency statistics (Cronbach’s alphas) at the scale-level were acceptable among caregivers at baseline and 6-months (.71-.75) but questionably reliable at 12-months (.59, N=46). For individuals with dementia, the simplified version of the FFMQ (with 3 response options) achieved questionable reliability at baseline (.57, N=56) and 6-months (.67, N=32), but improved to acceptable at 12-month assessments (.75, N=15), after significant attrition. Conclusion Researchers should apply caution when using the FFMQ total score with caregivers and those with cognitive impairments. Though simplified response options eased administration, utility of the tool may be limited in those who are more impaired. Before mindfulness measures can be used meaningfully, reliability of available tools like the FFMQ-15 need to be examined in more diverse samples.