As science has progressed, sleep deficiency has been discovered to be associated with declines in both mental and physical health, and similarly, sleep deficiency has been noted as a public safety concern with 20 percent of motor vehicle crashes linked to driving while drowsy. The National Sleep Foundation has identified that 62 percent of Americans do nothing to address their sleep deficiency, and with a society that normalizes coping mechanisms such as napping and caffeine consumption, it is easy to see why nothing has been done to resolve this issue. Nevertheless, with sleep technology falling in the hands of more and more Americans this thesis aims to explore how these technologies are being adopted and how the introduction of sleep-oriented features for established products may lead to more sleep conscious consumers.

Introduction: There is currently a lack of industry-wide gold standardization in accelerometer study
protocols, including within sleep-focused studies. This study seeks to address accuracy of
accelerometer data in detection of the beginnings and ends of sleep bouts in young adults with
polysomnography (PSG) corroboration. An existing algorithm used to differentiate valid/invalid wear
time and detect bouts of sleep has been modified with the goal of maximizing accuracy of sleep bout
detection. Methods: Three key decisions and thresholds of the algorithm have been modified with three
experimental values each being tested. The main experimental variable Sleepwindow controls the
amount of time before and after a determined bout of sleep that is searched for additional sedentary
time to incorporate and consider part of the same sleep bout. Results were compared to PSG and sleep
diary data for absolute agreement of sleep bout start time (START), end time (END) and time in bed
(TIB). Adjustments were made for outliers as well as sleep latency, snooze time, and the sum of both.
Results: Only adjustments made to a sleep window variable yielded altered results. Between a 5-, 15-,
and 30-minute window, a 15-minute window incurred the least error and most agreement to
comparisons for START, while a 5-minute window was best for END and TIB. Discussion: Contrary
to expectation, corrections for snooze, latency, and both did not substantially improve agreement to
PSG. Algorithm-derived estimates of START and END always fell after sleep diary and PSG both,
suggesting either participants’ sedentary behavior beginning and ends were at a delay from sleep and
wake times, or the algorithm estimates consistently later times than appropriate. The inclusion of a
sleep window variable yields substantial variety in results. A 15-minute window appears best at
determining START while a 5-minute window appears best for END and TIB. Further investigation on
the optimal window length per demographic and condition is required.

No studies have evaluated the impact of tracking resting energy expenditure (REE) and modifiable health behaviors on gestational weight gain (GWG). In this controlled trial, pregnant women aged >18 years (X=29.8±4.9 years) with a gestational age (GA) <17 weeks were randomized to Breezing™ (N=16) or control (N=12) for 13 weeks. The Breezing™ group used a real-time metabolism tracker to obtain REE. Anthropometrics, diet, and sleep data were collected every 2 weeks. Rate of GWG was calculated as weight gain divided by total duration. Early (GA weeks 14-21), late (GA weeks 21-28), and overall (GA week 14-28) changes in macronutrients, sleep, and GWG were calculated. Mediation models were constructed using SPSS PROCESS macro using a bootstrap estimation approach with 10,000 samples. The majority of women were non-Hispanic Caucasian (78.6%). A total of 35.7% (n=10), 35.7% (n=10), and 28.6% (n=8) were normal weight, overweight, and obese, respectively, with 83.3% (n=10) and 87.5% (n=14) of the Control and Breezing™ groups gaining above IOM GWG recommendations. At baseline, macronutrient consumption did not differ. Overall (Breezing™ vs. Control; M diff=-349.08±150.77, 95% CI: -660.26 to -37.90, p=0.029) and late (M diff=-379.90±143.89, 95% CI:-676.87 to -82.93, p=0.014) changes in energy consumption significantly differed between the groups. Overall (M diff=-22.45±11.03, 95% CI: -45.20 to 0.31, p=0.053), late (M diff=-23.16±11.23, 95% CI: -46.33 to 0.01, p=0.05), and early (M diff=20.3±10.19, 95% CI: -0.74 to 41.34, p=0.058) changes in protein differed by group. Nocturnal total sleep time differed by study group (Breezing vs. Control; M diff=-32.75, 95% CI: -68.34 to 2.84, p=0.069). There was a 11.5% increase in total REE throughout the study. Early changes in REE (72±211 kcals) were relatively small while late changes (128±294 kcals) nearly doubled. Interestingly, early changes in REE demonstrated a moderate, positive correlation with rates of GWG later in pregnancy (r=0.528, p=0.052), suggesting that REE assessment early in pregnancy may help predict changes in GWG. Changes in macronutrients did not mediate the relationship between the intervention and GWG, nor did sleep mediate relationships between dietary intake and GWG. Future research evaluating REE and dietary composition throughout pregnancy may provide insight for appropriate GWG recommendations.

The purpose of this study was to examine the overall maintenance of behavior during the 12 to 24 month period of the ​Stand&Move@Work​ study and the impact of implementation factors (i.e., facilitators, advocate activity, and the amount of strategies used) on behavior change. The design of the study was a cluster randomized trial which was facilitated by researchers for the first 12 months of the study. The primary aim of the study was to examine the maintenance of behavior change (i.e., sitting time) at the 12 month and 24 month marks using objectively measured sedentary behavior (activPAL micro). The secondary aim of the study was to examine the impact of implementation factors (i.e., facilitators, advocate activity, and the amount of strategies used) on behavior change during the 12 through 24 months maintenance period. Participants (N=630) included full-time, caucasian, middle-aged office workers. For the primary aim, descriptive means were used to cluster for observations within-persons and were adjusted for age, gender, race, job-type, and ordering effects.. For the secondary aim, descriptive means adjusted for workplace culture and environment were computed. At the 24 month mark, participants spent 280.67 ± 87.67 min/8hr workday sitting and 161.94 ± 85.87 min/8hr workday standing. The top performing worksites displayed reductions in sitting time which largely translated into standing time by about 30 minutes per 8 hour workday at 24 months. Feasibility findings indicated that implementation strategies do not show differences between the top 25% and bottom 25% performing worksites. This study provides insight to implementation strategies for interventions in the workplace.

While type 2 diabetes (T2D) rates have soared, the number of Americans classified as ‘prediabetic’ has also increased. Despite this, current preventative approaches are costly and often not without undue side-effects. Instead, behavioral lifestyle approaches hold promise in reducing conversion rates of T2D as the latest treatment option that could mitigate and transform disease management. However, present interventions do not possess the scope necessary for implementation in a realistic, scalable way that can target the large at-risk population.
The application (app) “BeWell24” mitigates this diabetes risk through targeting sleep, physical activity, sedentary behavior, and diet, and is being delivered through mHealth technology to attenuate the higher-risk of the prediabetic Veteran population. In order for full scale dissemination, this thesis examines a provider perspective of the ‘Post-intervention interview guide’, performed with a Phoenix Veterans Affairs Health Care System (PVAHCS) provider. It then suggests revisions to the interview guide based on the provider’s interview and existing literature. This thesis also emphasizes the rationale behind these proposed changes to be organized in line with the iPARIHS framework (integrated Promoting Action on Research Implementation in Health Services).
Overall, the provider responded positively to BeWell24 and the ‘Post-intervention interview guide’, with constructive suggestions for each question in the interview guide. The main theme of the provider’s answers and comments were to prioritize efficiency and preserve standard clinical flow. A revised interview guide is provided, which prospectively presents as a more brief and focused interview organized by the iPARIHS framework. This revised interview guide could aid in the clarity of provider responses, specifically for the prospective interviews of the ongoing larger BeWell24 study and future studies.

Cardiovascular disease attributed to about 800,000 deaths per year and is the leading cause of all-cause mortality in the U.S. Previous studies indicate that reducing sedentary time or increasing physical activity (PA) can independently reduce cardiometabolic risk (CMR). Further, studies have shown that higher levels of moderate-to-vigorous PA can attenuate the negative effects of sedentary behavior on CMR.
In this study, we evaluated the association between sedentary time, light-intensity PA (LPA), and moderate-vigorous PA (MVPA) and CMR biomarkers (high density lipoprotein level, low density lipoprotein level, triglycerides, fasting glucose, total cholesterol, blood pressure, and body mass index). Additionally, we examined if the detrimental association between sedentary time and CMR biomarkers is partially or fully attenuated by MVPA. Baseline objective physical activity and cardiometabolic risk data from a two-arm-cluster randomized trial (Stand&Move@work) were used in this study. Multilevel models clustered by worksite evaluated the fixed effects and interaction between MVPA and sedentary time on CMR. Data from 630 sedentary working adults (from 24 worksites) were included in the analysis. The sample was mainly middle aged (44.6±11.2) females (74%) with race distributions as follows; 70.5% white, 13.8% hispanic, 4.1% black, 5.1% asian, and 2.1% other. Our study showed detrimental trends consistent with previous studies between sedentary behavior and cardiometabolic outcomes including HDL, LDL, and total cholesterol. MVPA demonstrated beneficial associations with lipoproteins including HDL, LDL, total cholesterol, and triglycerides. We observed that high levels of MVPA may be able to partially attenuate the negative effects of highly sedentary behavior on fasting glucose, total cholesterol, and LDL levels. Overall, sedentary behavior indicated deleterious associations with cardiometabolic outcomes. Future directions for this study could examine a more at-risk population or a highly active population for further assessment of CMR biomarkers and the effects of behavior.

Pitchers are a vital part of the game of baseball and may account for up to two-thirds of the variance in win percentage. As they rise through the ranks of competition, physical skill set becomes less of a factor when compared to mentality. Pitchers are the “first line of defense” for keeping opponents from having an opportunity to score, as well as for holding onto their own team’s lead. Baseball pitchers not only face pressure to perform, but also experience stress from factors such as low pay, adjusting to higher levels of competition, and internal team competition for a limited number of spots. Athletes are often resistant to seeking aid from sport psychologists and often turn to unfavorable means to cope (i.e. drugs/alcohol, excessive exercise) with stress instead. Meditation has been shown to have beneficial effects on psychological factors associated with performance including emotional regulation, anxiety, confidence, focus, and mindfulness. Mobile applications have become a popular means of delivering mindfulness. The purpose of this study was to determine the feasibility and preliminary effectiveness of delivering a mindful meditation intervention using a mobile meditation application to improve psychological factors associated with performance (i.e. emotional regulation, anxiety (somatic and cognitive), confidence, focus, mindfulness) to minor league baseball pitchers. Pitchers in instructional league (Phase one) and off season (Phase two) were asked to meditate daily for 10-minutes each day for three weeks (Phase one) and eight weeks (Phase two). Pitchers were asked to complete self-report questionnaires and satisfaction surveys at pre- and post-intervention. Pitchers in phase one reported enjoying meditation, had improvements in self-confidence and sport confidence, and reported moderate decreases in cognitive anxiety and concentration disruption. Pitchers in phase two also enjoyed meditating (94.7%) and had improvements in self-confidence and moderate decreases in somatic anxiety. Low adherence due to timing (off-season) of intervention may have been a contributing factor to fewer outcomes. Future research should explore the feasibility and effectiveness of implementing meditation during the baseball season.

Mobile health or "mHealth" defines a broad spectrum of medical or public health practice supported by mobile devices. The patient's perception of mobile health applications is the key point in confronting whether or not patients will utilize the tools at their disposal As such, the primary aim of this study was to examine participant feedback through quantitative and qualitative measures using the Therapy Evaluation Questionnaire and a patient interview, respectively, to further understand the patient rated acceptability of using BeWell24 and SleepWell24 for improving health outcomes. For BeWell24, it was hypothesized that patients who received the Multicomponent version would report higher acceptability scores than those randomized to the Health Education version. Furthermore, in regard to SleepWell24, it was hypothesized that the SleepWell24 patient would provide positive feedback and suggestions regarding their own experience with the SleepWell24 app. Data from this thesis was pulled from two ongoing randomized controlled trials currently being conducted at the Phoenix Veteran Affairs Health Care Service (PVACHS) and Mayo Clinic hospitals. Means, standard deviations, frequencies, and percentages were commuted to summarize demographics and TEQ scores. In addition, key concepts from a qualitative interview with a SleepWell24 participant were derived. The results showed a greater acceptability of the multicomponent versions of BeWell24 and SleepWell24 but a lower TEQ score of perceived usability. mHealth implementations pose a potential to become an important part of the health sector for establishing innovative approaches to delivering care, and while benefits have been highly praised, it is clear that the perceptions of mHealth must be positive if the technology is to transcend into a practical clinical setting.

Learning how to manage time efficiently is something that many people struggle with, college students in particular. The purpose of this study was to examine if personalization via self-experimentation of strategies to improve time management skills is a useful strategy for achieving this goal. This study used a multiple baseline approach with three phases: phase one, the baseline, phase two, which included individuals receiving examples of plausible strategies to improve time management skills, and phase three, which involved the self-experimentation component. Results of this study suggest no significant changes in time management based on self-reported completion of tasks but do indicate a trend towards improved time management skills overall based on the time management questionnaire taken at the beginning and end of the study. These results suggest that further exploration in the use of self-experimentation strategies for improving time management is likely warranted but that current strategies likely require additional research. Results from the interviews indicate that the self-experimentation strategy, as delivered via PACO does increase awareness and thinking about time management.

Sleep diaries and actigraphy are two common methods used to assess sleep subjectively and objectively, respectively. Compared to the gold standard of sleep assessment, polysomnography, sleep diaries and actigraphic methods are more cost-effective and simpler to use. This study aimed to compare the sleep parameters derived from actigraphy and sleep diaries (total sleep time, sleep onset latency, number of awakenings, wake after sleep onset, percentage of time awake, and sleep efficiency). Based on results from previous similar studies, it was hypothesized that the sleep diaries would overestimate the total sleep time parameter and underestimate wake parameters. Twenty healthy young adults without sleep problems volunteered to participate. The participants wore an Actiwatch 2 on their wrist and filled out a sleep diary every morning for the duration of six days. A high intraclass correlation coefficient value between subjective and objective sleep was found for the parameter total sleep time, even though total sleep time was found to be slightly overestimated by the sleep diaries. Sleep onset latency, wake after sleep onset, number of awakenings, percentage of time awake, and sleep efficiency were underestimated by the sleep diaries and did not have high correlation values. Based off of the ICC results, there does not seem to be a strong correlation between the Actiwatch 2 and the sleep diaries, but looking at the Bland Altman plots, there seems to be agreement between the methods.