Abstract P074: A Cluster Randomized Trial Of An Mhealth Intervention To Promote Cardiovascular Health In Emerging Adults: Results Of The Nuyou Study
Authors: Angela Pfammatter, Christine Jovanovic, H. Gene McFadden, Charles Olvera, Juned Siddique, Donald Hedeker, Bonnie Spring
Journal: Circulation (2022)

Background: Cardiovascular disease (CVD) persists as the leading preventable cause of death in the US and worldwide. The American Heart Association (AHA) defines ideal cardiovascular health as the presence of: non-smoking, normal weight, adequate physical activity, healthy diet, normal blood pressure, normal fasting plasma glucose, and normal cholesterol. Only 45% of youth under 20 years old in the US exhibit five of the seven factors at ideal levels and that proportion plummets to 10% by age 40. Thus, novel strategies are needed to support primordial prevention of CVD via promotion of the seven health factors. Targeting young adults could stave off the alarming drop in cardiovascular health and contribute to healthier longevity. Objective: The NUYou trial was a two arm prospective cluster randomized trial to evaluate whether an mHealth intervention focused on cardiovascular health promotion improved cardiovascular health more than an active comparator in college students. Methods: Northwestern University Freshmen were cluster randomized by dormitory into two mHealth intervention groups: 1) Cardiovascular Health (CVH), addressing behaviors related to CVD risk; or 2) Whole Health (WH), addressing behaviors unrelated to CVD. Both groups received smartphone applications, co-designed with students to help them manage time, connect via social media, and report health behaviors weekly. The CVH group also received tailored self-monitoring features to track their risk behaviors. Cardiovascular health was assessed at the beginning of freshman, sophomore, and junior years. Health questionnaires, blood pressure, height, weight, glucose, and cholesterol were used to calculate the AHA’s Life’s Simple Seven (LSS) composite score (0-14, 14 being ideal health). Linear mixed models were used to compare CVD vs WH on LSS score. Results: Over 2 years, we recruited 302 participants (60% female). Participants were an average age of 18.1 (1.2) years and had a mean LSS score of 11.3 (1.4). Participant race was reported as, 28% Asian, 10% Black, 12% other/unknown/unreported, and 50% White. Ethnicity was reported as 12% Hispanic, 79% Non-Hispanic, and 9% unknown or unreported. There were no group, time, or group by time differences in LSS over 2-years. However, cholesterol increased as a function of time, by 7.39 mg/dL from Freshmen to Junior year and was not different by group. Conclusion: Despite using evidence-based behavior change techniques and employing a co-development approach with students, the groups did not differ on LSS over the 2-year intervention. The non-significant effects could be explained by high baseline LSS scores, the relatively short follow up time where a drop in LSS score would not be evident, or the absence of a human contact in the intervention. More research over a longer time span is needed to identify opportunistic time frames and strategies to intervene during young adulthood.