547546

research-article2014

PED0010.1177/1757975914547546Global Health PromotionJ. Schwartz and C. G. Richardson

Original Article Exploring the potential for internet-based interventions for treatment of overweight and obesity in college students Jennifer Schwartz1 and Chris G. Richardson1

Abstract: Objective: To assess the use of internet-enabled technology for seeking health information and resources in overweight/obese college students. Participants: College students (N = 706) in Vancouver, Canada surveyed in April 2012. Methods: An online survey assessed socio-demographics, health behaviors, and use of internetenabled technology. Results: Eating habits, dieting and/or exercising to lose weight, and weight satisfaction differed by weight status (all p < 0.05). Of overweight/obese participants, 48% reported they would use online student health resources. When seeking general health information, 91% would use websites; 45% would use online videos; and 75% trusted information from government or health organizations. Conclusions: Overweight/obesity is prevalent among college students. The majority of overweight/ obese students reported trying to lose weight and would use the internet for health information, especially if a website is associated with a health organization. The internet is a cost-effective channel for screening coupled with the delivery of tailored, evidence-based interventions for college students. Keywords: college students, internet-based interventions, overweight/obesity

Introduction The escalating overweight/obesity epidemic is a significant public health concern, threatening the health of many North Americans (1,2). An alarming 62% of adults are overweight or obese in Canada (3). In the 1986–92 period, 13% of men and 16% of women were obese, and by 2011 that percentage had almost doubled to 25% among both men and women in Canada (2,3). Approximately 34.1% of North American college students are overweight or obese (4). Overweight and obesity are responsible for nearly one in 10 premature deaths, making it the third greatest risk factor for early mortality in adult men and women in North America (5). Obesity reduces quality and duration of life, and is a major risk factor

for numerous chronic conditions such as type 2 diabetes, hypertension, cardiovascular disease, and some cancers (1,6). During the transition from adolescence to adulthood – which typically occurs during the college years – critical health behaviors are shaped and often permanently adopted (7). Specifically, the transition into college life has been shown to be a critical period for significant weight gain, often attributed to changes in unhealthy eating and physical activity behaviors, social influences, newly found independence, and stress (8,9). Research indicates that the majority of college students gain weight, and several studies have shown an average

1. School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada. Correspondence to: Jennifer Schwartz, School of Population & Public Health, University of British Columbia, 2206 East Mall Vancouver, BC, V6T1Z3, Canada. Email: [email protected] (This manuscript was submitted on 2 October 2013. Following blind peer review, it was accepted for publication on 4 July 2014) Global Health Promotion 1757-9759; Vol 0(0): 1­ –9; 547546 Copyright © The Author(s) 2014, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975914547546 http://ghp.sagepub.com Downloaded from ped.sagepub.com at UNIV CALIFORNIA SANTA BARBARA on August 25, 2015

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weight gain ranging from 4.6 to 7.4 pounds among those who gained weight (10–12). It is estimated that only 5% of college students consumed the recommended five or more servings of fruits and vegetables per day, and only 47% met the American Heart Association’s recommendation for exercise (moderate intensity aerobic exercise for ⩾30 minutes on five or more days per week or vigorousintensity aerobic exercise for ⩾20 minutes on three or more days per week) (4). Numerous studies suggest that adolescents and young adults who become obese tend to remain obese into adulthood, as this condition is very difficult to reverse (13,14). One approach to halting the rising obesity epidemic and preventing the associated long-term health consequences is to develop multifaceted interventions targeting college students’ behaviors, attitudes, and/or perceptions that may contribute to weight gain. Given that many health behaviors adopted during college may be maintained in adulthood, intervening at this stage in a student’s life could have lasting effects on their future health and wellbeing. Although nutrition and physical activity education is used for a broad range of populations to deliver healthy diet and exercise information, interventions targeting college students are infrequently implemented (15). With internet-enabled technology (e.g. smart phones, tablets, and computers) becoming ubiquitous among college students, the internet represents an important means for overweight/ obesity and related risk factor screening coupled with the delivery of tailored, evidence-based online interventions targeting college students. However, technology-based health behavior interventions specifically targeting college students are scarce. Researchers recently conducted a study of an online intervention to prevent weight gain in first-year college students using a randomized controlled trial (16). This study demonstrated that students who received a six-week online intervention combined with weight and caloric feedback had lower body mass indexes (BMIs) at post-test than those who received one of the other three interventions (no treatment; six-week online intervention only; or sixweek weight and caloric feedback via email only) (16). Specifically, among students who received the combined intervention (online with feedback), the unadjusted mean BMI decreased by 0.20 kg/m2, while those who received the internet only

intervention, the feedback only intervention, and no intervention had increases in BMI of 0.21 kg/m2, 0.21 kg/m2, and 0.30 kg/m2, respectively. These authors concluded that online interventions to prevent weight gain in college students can be effective (16). Three other known studies have demonstrated beneficial changes in weight, dietary habits, and physical activity levels among college students following implementation of online health behavior interventions (16–18). The primary objectives of this study were to assess the use of internet-enabled technology for seeking health information and resources and to examine attitudes related to the use of the internet to deliver evidence-based interventions for the prevention and treatment of overweight and obesity among a sample of college students in Vancouver, British Columbia. By quantifying the types, channels, and frequencies with which overweight/obese college students use internet-enabled technology when seeking health information online, and identifying the ways in which they assess the trustworthiness of online health information, we hope to contribute to the development of timely internet-based interventions that aim to reduce the incidence and prevalence of overweight and obesity during the influential college years.

Methods Data collection: the Douglas College student health and wellness survey The Douglas College student health and wellness survey – developed by researchers at the University of British Columbia and Douglas College – was conducted in partnership with the Centre for Campus Life and Athletics (mandated to provide student health and wellness services) and Counseling Services of Douglas College to better understand the health issues facing students, prioritize student needs, allocate resources, and design efficient and effective programs and strategies for health promotion and interventions. The survey included a wide range of questions on physical and mental health, substance use, and the use of internet-enabled technology to support personal health. All Douglas College students enrolled during the winter–spring semester of 2012 (n = 10,383) received an email invitation in early April to participate in the online health and wellness

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Original Article

survey. The 74-item survey was administered online from April 11 to April 17, 2012. Participant enrollment was stopped after one week due to a rapid response rate and a predetermined funding limit for incentives. Students received a $10 Tim Horton’s coffee shop gift card as incentive to participate in the study. Students were required to present their student identification card to pick up the gift card, as only one gift card was provided for each identification number. The study was approved by the University of British Columbia Ethics Review Board and the Douglas College Research Ethics Board.

Survey measures

habits did not include information or criteria to help guide students’ responses. Alcohol consumption was categorized as never, less than three days per week, and 3–7 days per week. Smoking status was categorized as current/former smoker (has smoked ⩾100 cigarettes in lifetime) or never smoker. Students answered ‘yes’ or ‘no’ to questions about whether they had dieted or exercised to lose weight in the past 30 days, and whether or not they were trying to lose weight. With regard to health perceptions, students were asked via the survey to rate their own health with the following response options: ‘excellent/very good’, ‘good’, and ‘fair/poor’. Students also indicated whether or not they were satisfied with their weight (‘satisfied’ or ‘unsatisfied’).

Socio-demographics and weight status The online survey contained questions about students’ age, sex, ethnicity, socio-economic status (parental education) and BMI. Data on height and weight were obtained by participant report, and BMI was calculated as the ratio of weight in kilograms to height in meters squared. Students were classified as underweight or normal weight if they had a BMI