Digital Lifestyle Medicine: Designing, Delivering, and Scaling for Impact.

Digital Lifestyle Medicine (DLM) is a consumer-centric model of care which elevates the importance of daily behaviors in preventing and reversing chronic disease using virtual and digital modalities to reach patients in the context where lifestyle behaviors occur and empower them to stay well. DLM is health care reimagined, designed to inspire patients to live their best life by enabling skill-building, self-efficacy, and sustainable behavior change supported by peers, scientific-evidence, and a multidisciplinary team of lifestyle medicine (LM) clinicians. Importantly, it requires insights and collaboration from healthcare experts and technology entrepreneurs to provide a profoundly different "user experience" layered with context, relevance, and scalability.

Using mHealth to Deliver Behavior Change Interventions Within Prenatal Care at Community Health Centers.

Purpose: To test an iPad-delivered multiple behavior tailored intervention (Healthy Pregnancy: Step by Step) for pregnant women that addresses smoking cessation, stress management, and fruit and vegetable consumption.

Design: A randomized 2 × 5 factorial repeated measures design was employed with randomization on the individual level stratified on behavior risk. Women completed three sessions during pregnancy and two postpartum at postdelivery months 1 and 4.

Coaction in multiple behavior change interventions: consistency across multiple studies on weight management and obesity prevention.

Objective: Coaction refers to the extent to which taking action on one behavior increases the odds of taking action on a second behavior. This integrative study examines the generalization of coaction in three studies on weight-related behaviors.

Method: Data from three randomized trials of tailored interventions (n = 1,277, n = 1,800, and n = 6,000) were examined to determine if coaction of behavior change occurred differentially in treatment and control groups.

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students.

This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months.

Validity and reliability of a dietary stages of change measure among economically disadvantaged African-American adolescents.

Purpose: To examine the construct validity and 2-month test-retest reliability of a staging measure for assessing readiness to consume five or more daily servings of fruits and vegetables among economically disadvantaged African-American adolescents.

Design: Longitudinal survey.

Setting: Youth services agencies serving low-income communities in New York, New Jersey, and Pennsylvania.

Designing a health behavior change program for dissemination to underserved pregnant women.

Objectives: The paper describes the formative research conducted toward developing a health behavior change program for underserved pregnant women. It is provided as an example to guide researchers, academics, and practitioners on how to incorporate dissemination in all aspects of project planning and implementation.

Design And Sample: A series of formative research was conducted, including an advisory council, expert interviews, 6 focus groups and 5 usability interviews with the target population (n=53), key informant interviews, expert reviews of the pilot program, and a pilot test (n=87).

Acceptability and feasibility of a multiple-behavior, computer-tailored intervention for underserved pregnant women.

Introduction: A pilot test of a computer-tailored intervention designed to promote positive health behaviors during pregnancy among a low-income population across multiple ethnic groups was conducted.

Methods: Intervention content, based on the transtheoretical model, offered pregnant women assistance with smoking cessation, stress management, and increasing fruit and vegetable consumption. Pregnant women (N = 87) were recruited from federally qualified health centers.

An Internet-Based Computer-Tailored Intervention to Promote Responsible Drinking: Findings from a Pilot Test with Employed Adults.

This paper describes pilot test findings of an Internet-based, Transtheoretical Model-based, computer tailored intervention for adults who exceed national guidelines for low-risk drinking. In a pilot test, 166 adults recruited from worksites completed one session and evaluated the program. Pre and post assessments indicate intention to make behavioral changes.

Results of a multi-media multiple behavior obesity prevention program for adolescents.

Background: This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents.

Methods: Using school as level of assignment, students (n=1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007.

Results: Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling.

Using interactive behavior change technology to intervene on physical activity and nutrition with adolescents.

The use of interactive technologies to promote health behaviors is a rapidly expanding field. Yet, the integration of these technologies in the development of physical activity and nutrition interventions for adolescents is in its infancy. Health in Motion, a multimedia obesity-prevention program for adolescents, is described as a case example of a Web-based interactive program for promoting physical activity and fruit and vegetable consumption among high school students.

Assessment of the pros and cons of stress management among adolescents: development and validation of a decisional balance measure.

Purpose: This article reports on the development of a decisional balance measure based on the transtheoretical model (TTM) for stress management among adolescents.

Design: Measurement development was conducted with participants of a pilot survey.

Setting: Surveys were completed in health and physical education classes.

Relationships among multiple behaviors for childhood and adolescent obesity prevention.

Background: Curbing the epidemic of childhood and adolescent obesity requires impacting multiple behaviors. This article examines the interrelationships of physical activity, fruit and vegetable consumption, and limiting television time among elementary, middle, and high school students.

Methods: Nationwide samples of students in grades 4 through 12 (n=4091) completed self-administered questionnaires assessing Transtheoretical Model constructs and behavioral indicators for physical activity, fruit and vegetable consumption, and limiting television time.

Acceptability of a school-based intervention for the prevention of adolescent obesity.

This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development.

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O.

Prevention profiles: Understanding youth who do not use substances.

This study replicates innovative profiles of prevention among students not using substances but who may be at different risks for acquisition. Using the Transtheoretical Model constructs of Decisional Balance and Temptations, cluster analyses were performed on four independent samples of students (n=1240) in the USA, England and Israel. For each sample, the same four distinct profiles emerged.