About

Dr. Belinda Borrelli, PhD, is a Professor and Director of the Center for Behavioral Science Research at Boston University, within the Department of Health Policy and Health Services Research at the Henry M. Goldman School of Dental Medicine. She also serves as the Principal Investigator and Director of Boston University's Mobile and Electronic Health-ARC. In 2013, she was invited to be a Visiting Professor at the University of Manchester, UK, a role she continues to hold. Previously, Dr. Borrelli was a Professor at Brown University in both the School of Public Health and the Department of Psychiatry and Human Behavior, and she maintains an adjunct Professorship there. She earned her MA and PhD in Clinical Psychology from the University of Illinois at Chicago and completed residency and fellowship training in Behavioral and Preventive Medicine at Brown University, where she advanced through academic ranks to become a Full Professor in 2009. Dr. Borrelli is a Clinical Psychologist specializing in motivating behavior change, with over 170 peer-reviewed publications. Her research focuses on developing and testing treatments to motivate health behavior change across diverse areas including smoking and vaping cessation, secondhand smoke reduction, oral health and dietary behaviors, and promoting adherence to medications and treatment regimens for chronic diseases such as sleep apnea, cystic fibrosis, and asthma. She emphasizes integrating theory-based treatments into public health contexts and targets underserved populations including low-income individuals, inner-city youth and adults, Latinos, people with mobility impairments, medically ill populations, older adults, and Native Americans. Additionally, she is developing and testing mobile health platforms such as text messaging, mobile apps, and Virtual Reality to initiate and sustain health behavior change. Dr. Borrelli has held over 25 NIH grant awards as Principal Investigator and Co-Investigator, along with numerous grants from other agencies and foundations. She has served on grant review panels in the US, Europe, and the UK, and is a Fellow of the American College of Reviewers. She has advised multiple NIH institutes on treatment fidelity and has published several invited articles on best practice guidelines with over 4,200 citations. She was invited to speak on this topic at the National Academy of Science and Engineering and provided expert testimony to the Health Resources and Services Administration on motivating health behavior change. She chairs an NIH/NIA Data Safety and Monitoring Board and is a Fellow of the American Psychological Association, the Society of Behavioral Medicine, and the Society for Research on Nicotine & Tobacco. Dr. Borrelli serves on several journal editorial boards and has held editorial roles at leading psychology and addiction science journals. She has taught Motivational Interviewing to healthcare practitioners nationally and internationally, delivered over 100 invited talks, was named a TEDMED Research Scholar in 2015, and received Boston University's Research Collaborator of the Year award in 2017. She has mentored over 40 interns, postdoctoral fellows, and NIH K award recipients.

Research topics

• Medicine
• Nursing
• Computer Science
• Internal medicine
• Dentistry
• Gerontology
• Obstetrics
• Physical therapy
• Demography
• Psychology
• Environmental health
• Psychiatry

Selected publications

• Virtual Reality for the Prevention and Cessation of Nicotine Vaping in Youths: Protocol for a Randomized Controlled Trial (Preprint)

  2025-02-03

  preprint1st authorCorresponding

  <sec> <title>BACKGROUND</title> Only a few trials target high school-aged teens with vaping interventions, typically focusing on prevention rather than cessation, with content limited to vaping harms and refusal skills. Given the co-occurrence and increasing incidence of vaping and mental health issues in teens, both must be simultaneously addressed by vaping interventions. </sec> <sec> <title>OBJECTIVE</title> This randomized controlled trial aimed to evaluate the feasibility and preliminary efficacy of a virtual reality (VR) intervention for teens that targets both determinants of vaping (eg, mood and stress) and vaping prevention and cessation skills. </sec> <sec> <title>METHODS</title> The participants are 150 students attending 1 of 2 racially and ethnically diverse Boston-area high schools. Health classes are randomly assigned to VR or control (assessment only). Students are eligible if not opted out by their parents, provided assent, and did not have health issues that preclude participation. While control classes (and ineligible students within them) have their regular classroom activity, VR classes are provided with Oculus Meta Quest 2 headsets and engage with the intervention during 3 class periods, once per week. Players solve a mystery with a vaping subplot and play a series of minigames to teach emotional regulation, coping strategies, and building resilience. A mobile app connects to the VR game, providing a home-based experience to reinforce skills learned. VR and control classes complete baseline and postintervention surveys on the same schedule. Primary outcome measures include feasibility, satisfaction and engagement with game play, and vaping awareness, knowledge, attitudes, and intentions to avoid or quit vaping. Secondary outcomes include vaping quit attempts, 7- and 30-day point prevalence abstinence, motivation and self-efficacy to quit or avoid vaping, positive and negative affect, emotional regulation and coping, and motion sickness. </sec> <sec> <title>RESULTS</title> The project was approved by the institutional review board on April 2, 2024, and data collection began in April 2024 and concluded in June 2024, and 150 participants were recruited (98 intervention and 52 control). Although freshmen and sophomore classes were targeted in this study, there were several juniors and seniors (n=5) in these classes due to school transfers and the need for them to take the mandatory curriculum. Data cleaning has been completed, and analyses are ongoing. The results are expected to be submitted for publication in August of 2025. </sec> <sec> <title>CONCLUSIONS</title> As VR is visual, auditory, and tactile, it is ideal for practicing skills, facilitating memory, and increasing the likelihood of transfer to real-world settings. The immersion of VR promotes engagement with the intervention, rather than external digital temptations. Our study is innovative due to the cluster-randomized design, focus on both prevention and cessation, integration of mood management, and implementation among racially and ethnically diverse teens. Incorporation into school-based health curricula allows for proactive reach. </sec> <sec> <title>CLINICALTRIAL</title> ClinicalTrials.gov NCT06003439; https://clinicaltrials.gov/study/NCT06003439 </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> DERR1-10.2196/71961 </sec>

  PublisherDOI

• OP0225 KNEE BRACING PLUS ADVICE, WRITTEN INFORMATION AND EXERCISE INSTRUCTION VERSUS ADVICE, WRITTEN INFORMATION AND EXERCISE INSTRUCTION ALONE IN ADULTS WITH KNEE OSTEOARTHRITIS: THE PROP OA PARALLEL-GROUP, SUPERIORITY, RANDOMISED CONTROLLED TRIAL

  Annals of the Rheumatic Diseases · 2025-06-01

  articleOpen access

  <h2>Abstract</h2><h3>Background:</h3> International clinical guidelines offer contradictory recommendations about knee bracing as an adjunct to core recommended treatment for people with knee osteoarthritis (OA). There is a paucity of high-quality evidence on the benefits, harms, and costs of knee braces from large, publicly-funded, pragmatic, clinical trials. <h3>Objectives:</h3> To determine the clinical- and cost-effectiveness of adding knee bracing (matched to participants' clinical and radiographic presentation, with adherence support) to advice, written information and exercise instruction (AIE+B) compared with advice, written information and exercise instruction alone (AIE) among people with knee OA. <h3>Methods:</h3> PROP OA (ISRCTN28555470) was a multi-centre, parallel-group, superiority, randomised, controlled trial, with embedded patient and public involvement. Adults 45 years and over with clinically diagnosed symptomatic knee OA reporting moderate-severe knee pain on weight-bearing activity (≥4 on 0-10 numerical rating scale) were recruited from general practices and community advertisements around four regions in England. Participants were randomly assigned (1:1; stratified; block; centralised web-based) to either AIE or AIE+B. The trial statistician was masked to treatment allocation; participants and intervention deliverers were unmasked. AIE was delivered within a single, in-person consultation by a trained physiotherapist. Participants randomised to AIE+B were additionally fitted with either a patellofemoral, tibiofemoral unloading, or neutral stabilising knee brace, according to their predominant compartmental distribution of knee OA. They attended a follow-up consultation with the physiotherapist at two weeks. Brief motivational interviewing and motivational text messages were used to support adherence to brace use. The primary outcome was the composite patient-reported Knee Osteoarthritis Outcomes Score (KOOS-5) (0-100) at 6 months post randomisation. Key secondary outcomes included KOOS-5 at 3 and 12 months, and KOOS subscale scores and knee pain on weight-bearing activity at 3, 6 and 12 months. Primary analysis was estimated using linear mixed models (treatment policy approach). A within-trial economic evaluation was conducted from a United Kingdom National Health Service perspective via a cost-utility analysis (cost per quality-adjusted life year (QALY) gained). <h3>Results:</h3> Between November 2019 and September 2022, 466 participants (mean (SD) age: 64 (9) years; 213 (46%) female; 449 (97%) self-reported White ethnicity; 195 (42%) higher education; 193 (42%) employed) were randomised, with 86%, 85% and 79% returning analysable data at 3, 6, and 12 months respectively. Both groups reported improvements in KOOS-5 at 6 months, with greater improvement in AIE+B compared to AIE (AIE: adjusted between group mean difference 3·39, 95% CI 0·96 to 5·82). Key secondary outcomes generally followed a similar pattern with greatest benefits on pain and activities of daily living (Table 1). Irritation/redness of skin was more common in AIE+B vs AIE (16% vs 5%); increased swelling, and temporary increased soreness were less common in AIE+B (10% vs 27% and 18% vs 28% respectively) at 6-months. No related serious adverse events were observed. AIE+B had an incremental cost-effectiveness ratio of £10,456 per QALY with an 84% probability of being cost-effective compared to AIE at the £20,000 per QALY threshold. <h3>Conclusion:</h3> Adding knee bracing (matched to participants' clinical and radiographic presentation and with adherence support) to advice, written information and exercise instruction produces small additional benefits on patient-reported outcomes for people with knee OA compared to advice, written information and exercise instruction alone. This safe and cost-effective intervention provides a treatment option for managing this common condition. <h3>REFERENCES:</h3> <b>NIL</b>. Table 1Primary and key secondary outcome measures: treatment effects estimates using longitudinal mixed modelsOutcome measures3-monthsN = 4016-monthsN=39412-monthsN=370Primary outcome measureKOOS-5: (0-100)AIE: Mean (SD)50.4 (15.1)52.3 (17.3)53.3 (18.6)AIE+B: Mean (SD)54.1 (15.8)55.3 (17.0)56.6 (17.4)AIE vs AIE+B: Adj‡,§ mean diff (95% CI)3.67 (1.47, 5.87)3.39 (0.96, 5.82)2.67 (-0.24, 5.57)Key secondary outcomesAIE vs AIE+B: Adj‡,§ mean diff (95% CI)KOOS: pain (0-100)4.30 (1.71, 6.89)6.13 (3.36, 8.91)4.76 (1.48, 8.04)KOOS: symptoms (0-100)2.97 (0.95, 4.98)2.15 (-0.08, 4.39)2.01 (-0.19, 4.20)KOOS: ADL (0-100)4.12 (1.55, 6.69)5.24 (2.47, 8.02)3.60 (0.30, 6.89)KOOS: Sport/recreation (0-100)3.32 (-0.75, 7.38)1.09 (-3.34, 5.53)0.30 (-4.70, 5.29)KOOS: Knee related QOL (0-100)3.86 (1.19, 6.53)3.16 (0.22, 6.11)2.61 (-0.97, 6.19)Knee pain during activity (0-10 NRS)-0.97 (-1.30, -0.63)-0.80 (-1.15, -0.44)-0.72 (-1.15, -0.29)<b>95%CI</b> 95 percent confidence interval; <b>ADL</b> Activities of Daily Living; <b>AIE</b> Advice, written information, exercise instruction; <b>+B</b> plus knee bracing; <b>KOOS</b> Knee injury and Osteoarthritis Outcome Score (0-100, with 0 indicating extreme knee problems and 100 representing no knee problems); <b>NRS</b> Numerical rating scale; <b>QOL</b> Quality of Life‡§Adjusted mean difference, fitted using linear mixed models, and adjusting for PROP-OA clinic site, predominant compartmental distribution, presence/absence of instability (buckling), age, sex, baseline anxiety, baseline depression, and baseline in the outcome of interest <h3>Acknowledgements:</h3> This project was funded by the National Institute of Health & Care Research (NIHR) Health Technology Assessment programme (16/160/03). The braces supplied by Össur were donated and we received a discounted price on braces supplied by Bioskin, Beagle Orthopaedics, and Donjoy. NEF is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182). CJ is part funded by the NIHR ARC West Midlands (NIHR200165). We would like to thank those that supported the development and running of the PROP OA randomised controlled trial: participants, physiotherapists, Trial Steering Group Committee and Data Monitoring Committee members, public contributors, the Clinical Advisory Group, Keele Clinical Trials Unit and participating sites. We gratefully acknowledge contribution by representatives from the brace companies to the delivery of the physiotherapist training programme. <h3>Disclosure of Interests:</h3> <b>None declared</b>. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

  PublisherDOI

• Parent-Targeted Oral Health Text Messaging for Underserved Children Attending Pediatric Clinics

  JAMA Network Open · 2025-01-02 · 5 citations

  articleOpen access1st authorCorresponding

  Importance: Caries is the most common chronic childhood disease, with substantial health disparities. Objective: To test whether parent-targeted oral health text (OHT) messages outperform child wellness text (CWT) messages on pediatric caries increment and oral health behaviors among underserved children attending pediatric well-child visits. Design, Setting, and Participants: The parallel randomized clinical trial, Interactive Parent-Targeted Text Messaging in Pediatric Clinics to Reduce Caries Among Urban Children (iSmile), included participants who were recruited during pediatric medical clinic visits at 4 sites in Boston, Massachusetts, that serve low-income and racially and ethnically diverse (herein, underserved) populations. English-speaking or Spanish-speaking caregivers of children younger than 7 years with at least 1 tooth were eligible. The study, which had a dose-matched design, was conducted from March 9, 2018, to February 28, 2022, with a 24-month follow-up. Text messages were sent for 4 months, plus a 1-month booster at 12 months. Intervention: Text messages were bilingual, automated, interactive, customized, and gamified. OHT messages focused on child toothbrushing and preventive dental visits. CWT messages focused on reading and child safety. Both included a choice of other content topics pertinent to their randomized arm. Main Outcomes and Measures: The primary outcome was 24-month caries increment assessed by calibrated examiners. Secondary outcomes were oral health behaviors known to predict pediatric caries (eg, toothbrushing, sugar-sweetened beverages, diet, fluoride toothpaste use, and preventive dental visits), which were assessed by self-report, and participant satisfaction with the text message program. Caries examinations occurred at baseline and 12 and 24 months later. Self-report surveys occurred at these time points and at the end of the text message program (4 months). Results: Among 1388 caregivers who were approached for eligibility, 969 were eligible. Of these, 754 caregivers (mean [SD] age, 32.9 [7.2] years; 713 female [94.6%]) and 754 children (mean [SD] age, 2.9 [1.7] years; 377 female [50.0%]) were randomized (77.8%); 449 of 657 participants (68.3%) were below the poverty line. Responses to text messages were high (OHT group: 67.9%; CWT group: 69.6%). There were no significant group differences in caries increment (OHT group: 43.0% vs CWT group: 42.7%; adjusted odds ratio, 0.99 [95% CI, 0.63-1.56]). Children in the OHT messaging group were significantly more likely to meet toothbrushing guidelines (odds ratio [OR], 1.77 [95% CI, 1.13-2.78]), have preventive dental visits (pooled OR, 1.51 [95% CI, 1.18-1.94]), and use fluoride toothpaste (pooled OR, 1.46 [95% CI, 1.06-2.01]) compared with those in the CWT messaging group over 24 months. OHT messages had a significant effect on caregivers' own toothbrushing (pooled mean difference, 0.48 [95% CI, 0.03-0.92]). Conclusion and Relevance: The findings of this randomized clinical trial including underserved children and their caregivers suggest that OHT messages had significant and sustained effects on preventive dental behaviors known to reduce caries among both caregivers and children, but had no effect on caries increment in children. Highly appealing and low-burden text messages coupled with evidence of change in oral health behaviors may be important in reducing oral health disparities. Trial Registration: ClinicalTrials.gov Identifier: NCT03294590.

  PublisherOA PDFDOI

• Guidance for intervention fidelity in nondrug, nonsurgical trials: a scoping review

  Journal of Clinical Epidemiology · 2025-06-13 · 3 citations

  reviewOpen access

  OBJECTIVES: Intervention fidelity is poorly reported in trials of nondrug, nonsurgical interventions. We aimed to review existing intervention fidelity guidance documents, assess their development methods, and synthesize their terminology, definitions, domains, and recommendations. STUDY DESIGN AND SETTING: We searched 6 databases from inception to September 2023 to identify documents describing explicit, actionable, and overarching recommendations on intervention fidelity. We supplemented this with backward citation searching in April 2024. Two reviewers independently screened titles, abstracts, and full texts. We conducted a qualitative content analysis, following JBI guidance, to extract and synthesize data on document characteristics, scope, methods, terminology, definitions, domains, and recommendations. RESULTS: After screening 7142 records from database searches and 1768 from citation searching, we included 73 documents. Most documents were unclear about the core methods used to develop recommendations (67/73, 92%), and only one document explicitly reported using consensus (1/73, 1%). We identified definitions of intervention fidelity across 6 categories and 7 intervention fidelity domain categories. Of these, only 2 ("provider delivery-related aspects" and "participant involvement-related aspects") were reported in most documents (>50%). We identified 81 recommendations across 10 categories, with only 14 being reported across more than half of the documents. CONCLUSION: Existing documents providing recommendations on intervention fidelity reflect the evolving nature of the field, with consensus still needed on several aspects. The gaps and inconsistencies identified in this review emphasize the need for clearer, more systematic, and globally applicable guidelines. These findings will inform the development of ReFiND, an international, consensus-based reporting guideline for intervention fidelity in nondrug, nonsurgical trials. PLAIN LANGUAGE SUMMARY: When studies are conducted to test how well an intervention works, it is key to evaluate the extent to which the intervention is delivered as planned. This is called intervention fidelity. We looked at 73 guides on how to check and report this. Most of these guides did not explain the methods used to decide what to include. The advice in these guides was often different from each other. As the field of intervention fidelity is still developing, many of these guides represent early attempts, where less structured methods were used before more organized approaches were established. This shows we need a global effort to create clear guidelines for reporting how well interventions are followed.

  PublisherDOI

• Smartphone App–Based Survey Deployment Patterns and Longitudinal Response Rate: Randomized Controlled Trial (Preprint)

  2025-03-14

  articleOpen access

  <sec> <title>BACKGROUND</title> Survey fatigue is a common challenge in longitudinal studies, particularly when using smartphone apps to collect survey data. Evidence-based strategies are needed to maintain longitudinal response rates. </sec> <sec> <title>OBJECTIVE</title> This study aims to evaluate the effect of a more frequent smartphone-administered survey deployment strategy with smaller survey batches on participant response rates over an extended period. </sec> <sec> <title>METHODS</title> We conducted a randomized controlled trial (NCT04752657) embedded in the electronic Framingham Heart Study cohorts between June 2021 and December 2023. Participants were randomly allocated to receive a full set of surveys every 4 weeks (control group) or half of the survey set biweekly, such that the full set is completed every 4 weeks (experimental group). Randomization was stratified by age (≤75 y vs &gt;75 y) and phone type (Android vs iPhone). Married couples were assigned to the same group using a blocked randomization approach. The primary outcome was the proportion of surveys returned per participant assessed longitudinally across four periods (baseline to wk 8, wk 8-16, wk 16-24, and wk 24-32), with 19, 17, 16, and 15 unique surveys deployed, respectively. We used mixed-effects regression models with random intercepts to compare the repeated outcome between groups. Stratified analyses by age and sex were performed. </sec> <sec> <title>RESULTS</title> Among 492 participants (mean age 74, SD 6.3 y; 58%, n=284 women, 84%, n=413 non-Hispanic White), there was evidence that the experimental group had higher response rates over time compared to the control group (&lt;i&gt;P&lt;/i&gt;=.003 for interaction between deployment pattern and time). Both groups showed similar proportions of surveys returned during the first period (75% vs 76%). The experimental group had higher response rates than the control group in subsequent periods (70% vs 67% in wk 8-16, 64% vs 59% in wk 16-24, and 58% vs 50% in wk 24-32). The proportion of participants not returning any surveys increased from 3% to 38% in the control group compared to 1% to 28% in the experimental group across the four time periods. Stratified analyses revealed that among younger participants (≤75 y), the experimental group showed 12% higher survey response rates compared to the control group in the final period, while the difference was minimal among older participants (&gt;75 years). The effect of the deployment pattern was similar for men and women. Three-way interaction analyses revealed no significant differences in the deployment pattern effect over time by age group (&lt;i&gt;P&lt;/i&gt;=.95) or sex (&lt;i&gt;P&lt;/i&gt;=.65). </sec> <sec> <title>CONCLUSIONS</title> Administering half of the surveys every 2 weeks, as compared to all surveys every 4 weeks, was associated with higher maintained longitudinal survey response rates. This strategy may help mitigate survey fatigue and improve data quality in digital health studies. </sec> <sec> <title>CLINICALTRIAL</title> ClinicalTrials.gov NCT04752657; https://clinicaltrials.gov/study/NCT04752657 </sec>

  PublisherDOI

• Smartphone App–Based Survey Deployment Patterns and Longitudinal Response Rate: Randomized Controlled Trial

  Journal of Medical Internet Research · 2025-10-10

  articleOpen access

  BACKGROUND: Survey fatigue is a common challenge in longitudinal studies, particularly when using smartphone apps to collect survey data. Evidence-based strategies are needed to maintain longitudinal response rates. OBJECTIVE: This study aims to evaluate the effect of a more frequent smartphone-administered survey deployment strategy with smaller survey batches on participant response rates over an extended period. METHODS: We conducted a randomized controlled trial (NCT04752657) embedded in the electronic Framingham Heart Study cohorts between June 2021 and December 2023. Participants were randomly allocated to receive a full set of surveys every 4 weeks (control group) or half of the survey set biweekly, such that the full set is completed every 4 weeks (experimental group). Randomization was stratified by age (≤75 y vs >75 y) and phone type (Android vs iPhone). Married couples were assigned to the same group using a blocked randomization approach. The primary outcome was the proportion of surveys returned per participant assessed longitudinally across four periods (baseline to wk 8, wk 8-16, wk 16-24, and wk 24-32), with 19, 17, 16, and 15 unique surveys deployed, respectively. We used mixed-effects regression models with random intercepts to compare the repeated outcome between groups. Stratified analyses by age and sex were performed. RESULTS: Among 492 participants (mean age 74, SD 6.3 y; 58%, n=284 women, 84%, n=413 non-Hispanic White), there was evidence that the experimental group had higher response rates over time compared to the control group (P=.003 for interaction between deployment pattern and time). Both groups showed similar proportions of surveys returned during the first period (75% vs 76%). The experimental group had higher response rates than the control group in subsequent periods (70% vs 67% in wk 8-16, 64% vs 59% in wk 16-24, and 58% vs 50% in wk 24-32). The proportion of participants not returning any surveys increased from 3% to 38% in the control group compared to 1% to 28% in the experimental group across the four time periods. Stratified analyses revealed that among younger participants (≤75 y), the experimental group showed 12% higher survey response rates compared to the control group in the final period, while the difference was minimal among older participants (>75 years). The effect of the deployment pattern was similar for men and women. Three-way interaction analyses revealed no significant differences in the deployment pattern effect over time by age group (P=.95) or sex (P=.65). CONCLUSIONS: Administering half of the surveys every 2 weeks, as compared to all surveys every 4 weeks, was associated with higher maintained longitudinal survey response rates. This strategy may help mitigate survey fatigue and improve data quality in digital health studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04752657; https://clinicaltrials.gov/study/NCT04752657.

  PublisherDOI

• Virtual Reality for the Prevention and Cessation of Nicotine Vaping in Youths: Protocol for a Randomized Controlled Trial

  JMIR Research Protocols · 2025-04-25 · 3 citations

  articleOpen access1st authorCorresponding

  BACKGROUND: Only a few trials target high school-aged teens with vaping interventions, typically focusing on prevention rather than cessation, with content limited to vaping harms and refusal skills. Given the co-occurrence and increasing incidence of vaping and mental health issues in teens, both must be simultaneously addressed by vaping interventions. OBJECTIVE: This randomized controlled trial aimed to evaluate the feasibility and preliminary efficacy of a virtual reality (VR) intervention for teens that targets both determinants of vaping (eg, mood and stress) and vaping prevention and cessation skills. METHODS: The participants are 150 students attending 1 of 2 racially and ethnically diverse Boston-area high schools. Health classes are randomly assigned to VR or control (assessment only). Students are eligible if not opted out by their parents, provided assent, and did not have health issues that preclude participation. While control classes (and ineligible students within them) have their regular classroom activity, VR classes are provided with Oculus Meta Quest 2 headsets and engage with the intervention during 3 class periods, once per week. Players solve a mystery with a vaping subplot and play a series of minigames to teach emotional regulation, coping strategies, and building resilience. A mobile app connects to the VR game, providing a home-based experience to reinforce skills learned. VR and control classes complete baseline and postintervention surveys on the same schedule. Primary outcome measures include feasibility, satisfaction and engagement with game play, and vaping awareness, knowledge, attitudes, and intentions to avoid or quit vaping. Secondary outcomes include vaping quit attempts, 7- and 30-day point prevalence abstinence, motivation and self-efficacy to quit or avoid vaping, positive and negative affect, emotional regulation and coping, and motion sickness. RESULTS: The project was approved by the institutional review board on April 2, 2024, and data collection began in April 2024 and concluded in June 2024, and 150 participants were recruited (98 intervention and 52 control). Although freshmen and sophomore classes were targeted in this study, there were several juniors and seniors (n=5) in these classes due to school transfers and the need for them to take the mandatory curriculum. Data cleaning has been completed, and analyses are ongoing. The results are expected to be submitted for publication in August of 2025. CONCLUSIONS: As VR is visual, auditory, and tactile, it is ideal for practicing skills, facilitating memory, and increasing the likelihood of transfer to real-world settings. The immersion of VR promotes engagement with the intervention, rather than external digital temptations. Our study is innovative due to the cluster-randomized design, focus on both prevention and cessation, integration of mood management, and implementation among racially and ethnically diverse teens. Incorporation into school-based health curricula allows for proactive reach. TRIAL REGISTRATION: ClinicalTrials.gov NCT06003439; https://clinicaltrials.gov/study/NCT06003439. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/71961.

  PublisherDOI

• Association of Smartwatch-Based Heart Rate and Physical Activity With Cardiorespiratory Fitness Measures in the Community: Cohort Study

  Journal of Medical Internet Research · 2024-06-13 · 6 citations

  articleOpen access

  Background Resting heart rate (HR) and routine physical activity are associated with cardiorespiratory fitness levels. Commercial smartwatches permit remote HR monitoring and step count recording in real-world settings over long periods of time, but the relationship between smartwatch-measured HR and daily steps to cardiorespiratory fitness remains incompletely characterized in the community. Objective This study aimed to examine the association of nonactive HR and daily steps measured by a smartwatch with a multidimensional fitness assessment via cardiopulmonary exercise testing (CPET) among participants in the electronic Framingham Heart Study. Methods Electronic Framingham Heart Study participants were enrolled in a research examination (2016-2019) and provided with a study smartwatch that collected longitudinal HR and physical activity data for up to 3 years. At the same examination, the participants underwent CPET on a cycle ergometer. Multivariable linear models were used to test the association of CPET indices with nonactive HR and daily steps from the smartwatch. Results We included 662 participants (mean age 53, SD 9 years; n=391, 59% women, n=599, 91% White; mean nonactive HR 73, SD 6 beats per minute) with a median of 1836 (IQR 889-3559) HR records and a median of 128 (IQR 65-227) watch-wearing days for each individual. In multivariable-adjusted models, lower nonactive HR and higher daily steps were associated with higher peak oxygen uptake (VO2), % predicted peak VO2, and VO2 at the ventilatory anaerobic threshold, with false discovery rate (FDR)–adjusted P values &lt;.001 for all. Reductions of 2.4 beats per minute in nonactive HR, or increases of nearly 1000 daily steps, corresponded to a 1.3 mL/kg/min higher peak VO2. In addition, ventilatory efficiency (VE/VCO2; FDR-adjusted P=.009), % predicted maximum HR (FDR-adjusted P&lt;.001), and systolic blood pressure-to-workload slope (FDR-adjusted P=.01) were associated with nonactive HR but not associated with daily steps. Conclusions Our findings suggest that smartwatch-based assessments are associated with a broad array of cardiorespiratory fitness responses in the community, including measures of global fitness (peak VO2), ventilatory efficiency, and blood pressure response to exercise. Metrics captured by wearable devices offer a valuable opportunity to use extensive data on health factors and behaviors to provide a window into individual cardiovascular fitness levels.

  PublisherOA PDFDOI

• Baseline Smartphone App Survey Return in the Electronic Framingham Heart Study Offspring and Omni 1 Study: eCohort Study

  JMIR Aging · 2024-11-06 · 5 citations

  articleOpen access

  Background: Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone [Apple Inc] and Android [Google LLC] users). We also aim to report survey results for selected baseline surveys and participant experience with this study's app. Methods: Framingham Heart Study Offspring and Omni (multiethnic cohort) participants who owned a smartphone were invited to download this study's app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed 4 tasks including 2 cognitive and 2 physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Scale (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6, SD 6.3 y; n=346, 56.6% women; n=88, 14.4% Omni participants; 478, 78.2% iPhone users) and 596 (97.5%) returned at least 1 baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5% to 98.3% vs 73.8% to 95.2%, respectively), but survey completion rates did not differ in the 2 smartphone groups. The return rate for the 4 iPhone tasks ranged from 80.9% (380/470) for the gait task to 88.9% (418/470) for the Trail Making Test task. The Electronic Framingham Heart Study participants had better standardized t scores in 6 of 7 PROMIS surveys compared to the general population mean (t score=50) including higher cognitive function (n=55.6) and lower fatigue (n=45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score=8.6 on a 1-10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of this study's app.

  PublisherDOI

• Smartphone App Designed to Collect Health Information in Older Adults: Usability Study (Preprint)

  2024-01-22 · 1 citations

  preprintOpen accessSenior author

  <sec> <title>BACKGROUND</title> Studies evaluating the usability of mobile-phone assessments in older adults are limited. </sec> <sec> <title>OBJECTIVE</title> This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. </sec> <sec> <title>METHODS</title> We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). </sec> <sec> <title>RESULTS</title> In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. </sec> <sec> <title>CONCLUSIONS</title> Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. </sec> <sec> <title>CLINICALTRIAL</title> <p/> </sec>

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01HL062165

  NIH · $4.4M · 2010

• NIH Grant R01CA074553

  NIH · $693k · 2002

• NIH Grant R01CA137616

  NIH · $2.8M · 2016

• NIH Grant R01HL06216509

  NIH · $618k · 2012

Frequent coauthors

• Elizabeth L. McQuaid

  83 shared

• Emelia J. Benjamin

  Boston Medical Center

  66 shared

• Joanne M. Murabito

  66 shared

• Bess H. Marcus

  Brown University

  48 shared

• Andrew M. Busch

  University of Minnesota

  47 shared

• Beth C. Bock

  Brown University

  42 shared

• Kristin A. Riekert

  Johns Hopkins University

  42 shared

• Christina S. Lee

  Boston Medical Center

  39 shared

Labs

• Center for Behavioral Science ResearchPI

Education

• Ph.D., Clinical Psychology

  University of Illinois at Chicago

• M.A., Clinical Psychology

  University of Illinois at Chicago

• Other, Behavioral and Preventive Medicine

  Brown University

Awards & honors

• BU's Research Collaborator of the Year award (2017)
• citation abstract award winner at the Society of Behavioral…
• IADR Giddon Award for Distinguished Research in Behavioral S…
• TEDMED Research Scholar (2015)