Stealth Health:Youth Innovation, Mobile Technology, Online Social Networking and Informal Learning to Promote Physical Activity

STEALTH HEALTH:YOUTH INNOVATION, MOBILE TECHNOLOGY, ONLINE SOCIAL NETWORKING AND INFORMAL LEARNING TO PROMOTE PHYSICAL ACTIVITY

Sponsoring Institution

National Institute of Food and Agriculture

Project Status

TERMINATED

Funding Source

NRI COMPETITIVE GRANT

Reporting Frequency

Annual

Accession No.

0216814

Grant No.

2009-55215-05187

Project No.

ARZT-3135800-G23-521

Proposal No.

2008-04436

Multistate No.

(N/A)

Program Code

31.5

Project Start Date

Jan 1, 2009

Project End Date

Dec 31, 2012

Grant Year

2009

Project Director
Going, S.

Recipient Organization
UNIVERSITY OF ARIZONA
888 N EUCLID AVE
TUCSON,AZ 85719-4824

Performing Department
NUTRITIONAL SCIENCES

Non Technical Summary
Youth obesity is at an all time high, and physical inactivity and poor dietary habits are important contributors. Although considered a contributing factor, popular technology must also be a part of the solution. We propose to increase physical activity (PA) and improve nutrition knowledge and behavior using a youth friendly informal approach that capitalizes on activities and technologies (e.g., mobile phones, GPS; instant messaging) that youth enjoy and social networking environments (e.g., Facebook; MySpace) they inhabit. We aim to capture youth who do not participate in traditional interventions (an overwhelming majority) by infusing PA and informal learning into settings they do not associate with health promotion. With youth helping, we will develop customizable, miniature software applications ("widgets") which incorporate communication and location-based technology that motivate PA and support informal health and nutrition education. Geocaching is one such application, although our widget will be designed to be easily adapted to suit diverse interests and to be shared through online social networks. Working with national partners (4H, YMCA and America on the Move), after initial development, we will sponsor a national youth contest to use, adapt and share the widgets. Novel uses will be rewarded and posted on partners' websites, and advertised to other youth. Thus, we can test adoption, diffusion, and effects on PA and nutrition behavior.

Animal Health Component

(N/A)

Research Effort Categories

Basic

(N/A)

Applied

90%

Developmental

10%

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
724	6099	1010	25%
724	6099	3030	25%
806	6099	1010	25%
806	6099	3030	25%

Knowledge Area
806 - Youth Development; 724 - Healthy Lifestyle;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism; 3030 - Information and communication;

Keywords

software applications

Goals / Objectives
The overall goal of this project is to develop and test a novel approach integrating communication and location-based technologies with informal education for promotion of healthy behaviors aimed at decreasing the incidence of adolescent obesity. Specifically, we propose to increase physical activity (PA) and improve nutrition knowledge and behaviors using an informal approach that capitalizes on activities and technologies (GPS; instant messaging) that youth enjoy and social networking environments that they inhabit (Facebook; MySpace). Year one objectives include: 1) work with youth to develop a youth friendly widget (customizable, simple software application); 2) develop instruments for activity and nutrition assessment; 3) develop qualitative formative research instruments; 4) conduct youth focus groups. In year 2, the objective is to test the intervention in up to 20 groups of youth for its effects on PA and nutrition. In year 3, working with national partners (4H, YMCA, America on the Move), the objective is to test diffusion and youth-driven modification of the widget, by conducting a national contest encouraging youth throughout the U.S. to develop further variations on the baseline widget. Expected outputs include youth adapted widgets that promote physical activity and nutrition, quantitative instruments for assessing physical activity and nutrition, and qualitative formative research instruments.

Project Methods
We aim to develop a simple, customizable software application ("widget"), integrating communication (MySpace, Facebook, instant messaging) and location-based (GPS, GIS, imagery) technologies with informal education (pop up nutrition and health messages), designed to promote increased physical activity and improved nutrition knowledge and behavior in youth. In year one, working with youth, we will develop the initial widget, emphasizing simplicity of use, future modification by youth, and application in diverse settings not necessarily associated with health promotion. We will conduct frequent focus groups with youth and ongoing process evaluation (participant observation and other feedback) to develop "popup" messages (nutrition, physical activity, health, etc.) that respond to adolescents' concerns and questions, to maximize appeal, and to understand how youth respond to and utilize social networking and location-based technologies. We will test the baseline widget in year 2 in 20 diverse groups of youth, asking them to integrate it into their ongoing activities and modify it to suit their interests. We will assess novel uses and their effects on nutrition knowledge and physical activity, using GPS and pedometers to measure PA. In year 3, with our national partners (4H, YMCA, America on the Move), we will conduct a national contest incentivizing youth to use and share widgets. A panel of experts will review modified widgets and suggestions for novel uses. Those meeting predetermined criteria will be rewarded, posted on partners' websites, and advertised through national networks. Thus, we will have a large national audience of youth in which to test adoption and diffusion of the widget, and its effect on health behaviors. Given the nature of our approach and technology, we can readily quantify the number of youth who use the widget and the level of PA encouraged by its use, and thereby test the impact of our intervention in the target audience.

Progress 01/01/09 to 12/31/12

Outputs
OUTPUTS: Student Mentoring: Undergrad (n=9), software develop, intervention content/delivery, data collection; Grad (n=9), intervention delivery, data collection; Youth interns (n=13), user perspective; Foreign scholar (n=1);message development, lit review, marketing. Teaching: Hingle M., 03/21/11 - UA Diabetes and Endocrine Medical Fellows Journal Club The Use of Mobile Technologies to Impact Health Behavior. Conducting/analyzing experiments/surveys: Focus groups, youth and youth leaders; tested Stealth Health intervention in 152 participants; Refined SMS delivery software app Conferences/Presentations: Going S & Hingle M Human Institute for Performance, Hong Kong University, and Chinese Hong Kong University, New Approaches to Increasing Physical Activity in Youth 2/8-9/11; Hingle M ADA FNCE, San Diego, CA Texting Health to Teens: Nutrition Education in 140 Characters or Less 9/25/2011; Hingle et al mHealth summit Development and evaluation of health messages and an SMS-based software delivery system for distribution to and use by adolescents 12/4/11. AFRI Investigators Meeting: Going S et al, Stealth Health reports, yearly 2009-2012. Products: 300+ health messages sent via SMS-to-IM software app; Software and web app FAQs and training materials designed to support program leaders and youth in using tech to achieve program goals, foster exploration. Data/databases: Large-scale data collection and management system captures and compiles usage data for study mobile devices and apps for analyzing network traffic trends and relationships. Network collaborations:Collaborations with 14 youth programs. Software:GeoKnect, GeoSnap, Akshen web, SMS apps. Design, development, and testing of: GeoSnap (Android phone application for sharing and messaging); GeoKnect (Android appication for mapping with GPS); BlueFox Android app (automated SMS communication); FarmFox Android app (advanced SMS Listserv via mobile Android device.); AkshenWeb (a Drupal Web Application); KML Module (custom Drupal module to display kml files); Akshen Messages Module (custom Drupal module that provides permanent storage, reporting, and display of SMS conversations); Gateway Module (custom Drupal module that provides a gateway module to interface BlueFox Android app). Technology/methods/techniques: Train-the-Trainer manuals:materials designed to teach leaders and youth to use the apps to further goals and explore interests outside youth program;print and electronic media. Website URL:www.akshenweb.org. Information/skills/technology for individuals, communities, and programs:SH software:GeoKnect, GeoSnap, web apps . Dissemination:Trainings: 3 program leader trainings:use of software applications, smartphone, and activities and curricula;Youth interns (n=13) recruited to refine software apps and website for dissemination;Akshen website, portal through which youth and program leaders interact with one another and content(e.g. photos with descriptions, and geospatial data) created through geospatial apps:GeoKnect, GeoSnap;Nutrition education delivered through SMS application;1 message/dx5 d/wk, sent to youth, program leaders participating in our intervention. PARTICIPANTS: Individuals: S Going, PD, concept, design/implement, student mentoring, staff supervision; B Orr, Co-PD; concept, design/implement, supervision of grad and undergrad students; M Nichter, Co-PD, design/implement, supervision of grad students; D Roe, Co-PD, design, statistical analysis; S Marsh, Co-PD, student/staff supervision, project implement; L Borden, Co-PD, partner organization coordination; K Astroth, Co-PD, partner organization coordination; N Merchant, Co-PD, design/implement, student mentoring; M Hingle, project management, design/implement; T Crane, project management, design/implement; K Wisneski, GRA, curriculum development, design, training; S Grace; GRA, message development, observations/interviews; V Pryzbyl, GRA message development, observations/interviews; D Laddu, GRA, software application testing; R Alman, MPH Intern, data collection; M Graves, measurement team, data management; R Blew, measurement team, training of staff; L Macias Navarro, visiting scholar, software app R&D; J Choquehuanca, staff, program leader training, software app R&D with youth; D Hammond, programmer, software app development and testing; D Parizek; programmer, website development; software app development and testing; S Reddy, programmer, mobile phone application and website development; D Kulansinghe, undergrad res assist, programmer, SMS app; D. Seethur, undergrad res assist, programmer, mobile Android app; N Knutson, undergrad res assist, design and testing; J Vancel, undergrad res assist, design and testing; I Liang, undergrad res assist, design and testing. PARTNER ORGANIZATIONS: YMCA of Southern Arizona;Ironwood Tree Experience;Skrappys Youth Center;Wildcat Charter School; 4-H Arizona. OPPORTUNITIES FOR PROFESSIONAL TRAINING: Faculty/staff/students/program leaders use smart phones, download/install software for devices, collect data using apps, and share data with others. Students mentored youth (e.g. teaching them to use technology; explaining geospatial data collection procedures; conducting anthropometric measurements; interview/observation). TARGET AUDIENCES: Youth program leaders and participants; our youth organizations serve the diverse Tucson population, 30% Hispanic, many being low income. Youth utilize the SH apps to achieve goals and share activities and information with others through the project website. PROJECT MODIFICATIONS: Aims were not modified. Phone software upgrades and technology changes delayed our timeline by 9 months. The formal pre-post test of our program (n=152 enrolled) occurred in Jan-Oct 2011 and data analysis continued into 2012, the approved no-cost extension year. In 2012, we also engaged a new group of youth interns (n=13) who worked under Co-PD Dr. Orr to revise our training and visioning materials following scaffolding methods with the aim of simplifying them for dissemination. The Akshen website was also revised.

Impacts
Program leader trainings. Program leaders trained in Android applications plus website; project visioning curriculum and training. Youth trainings. Youth interns (n=13) trained in scaffolding framework; thereafter, they undertook revisions of teaching and project visioning materials, Akshen website from an expert youth user perspective. Youth trainings. Youth in the principle intervention completed visioning training and developed projects.

Publications

Wisneski, Nichter, Roe, Saboda, Orr. 2013. Youth-driven practices for rediscovering community & the environment: location and communication technologies and online collaborative tools for empowerment and learning.
Barron J. Orr, Kristin D. Wisneski, Nicholas B. Knutson, James H. Vancel, Irene Liang. 2013. Empowering youth to identify and solve community/environmental problems through a scaffolding-based mobile/online application. Curricula: Wisneski, K., and B. Orr. 2011. Digital Look at the Land: Smartphone Apps for Android and iPhone [professional pamphlet fact sheet] Tucson, AZ: Office of Arid Lands Studies, University of Arizona.
Wisneski, K., M. Hingle, and B. Orr. 2011. Technology Empowering Youth to Create Change in Their Communities & the Environment [professional pamphlet fact sheet] Stealth Health Initiative. Tucson, AZ: Office of Arid Lands Studies, University of Arizona.
Wisneski, K., B. Orr, C. Hannah, J. Choquehuanca, J. Davies, K. Nakazny, and M. Moreno-Baez. 2010. Guidelines and how to fact sheets for integrating participatory, collaborative mapping into community and youth programs. Arizona Geospatial Extension Program, Arizona Remote Sensing Center, University of Arizona. (5 fact sheets, English and Spanish language versions).
Hingle M., Nichter M., Merchant N., Hongu N., Roe D., Orr B., Going S. 2012. Development and Evaluation of an Informal SMS-Based Intervention to Promote Healthy Lifestyle Behaviors in Adolescents. Society for Nutrition Education and Behavior, Washington, D.C.
Going S. on behalf of SH Investigators Stealth Health 2012. Youth Innovation, Mobile Technology, Online Social Networking, and Informal Learning to Promote Physical Activity. Society for Nutrition Education and Behavior, Washington, D.C. and the USDA AFRI 2012 PD Meeting.
Wisneski, K.D. 2012. Reconnecting Youth with Community and Environment: Keys to Civic Engagement Education Program Success. Master Thesis. University of Arizona.
Manuscripts in Preparation: Hongu, K., Benjamin T. Pope, Scott B. Going, Nirav C. Merchant, Barron J. Orr, Asuka Suzuki, Denise J. Roe. 2013. Usability and acceptability of food photo records using a smart phone application.
Choquehuanca, J., K. Wisneski, C. Hannah, K. Nakazny, D. Parizek, D. Hammond, N. Merchant, B. Orr, S. Going, T. Crane, M. Hingle. 2010. FAQ and How-To documents on AkshenWeb.org (Phase II). Arizona Geospatial Extension Program, Arizona Remote Sensing Center, University of Arizona. 25 Fact Sheets and FAQ.
Training Videos: Nakazny, K, J. Choquehuanca, C. Hannah, K. Wisneski, B. Orr. 2010. Akshen.org: Intro to GeoZat App. [video - GeoZat_HD.mov] Online: http://www.youtube.com/watchv=KI71XBGBVRQ&feature=plcp.
Nakazny, K, J. Choquehuanca, C. Hannah, K. Wisneski, B. Orr. 2010. Akshen.org: Mapping safety during collecting data in the field . [video] Available: http://www.youtube.com/watchv=Ir3G1qSDoHU.
Nakazny, K, J. Choquehuanca, C. Hannah, K. Wisneski, B. Orr. 2010. Akshen.org: What your civic engagement project might look like. [video] Available: http://www.youtube.com/watchv=zgnbEFToQYo.
Nakazny, K, J. Choquehuanca, C. Hannah, K. Wisneski, B. Orr. 2010. Akshen.org: Promo [video] Available: http://www.youtube.com/watchv=vDoYLRehSao.
Presentations: Hongu K., Hingle M., Orr B., Nichter M., Merchant N., Roe D., Astroth K., Borden L., Going S. 2010. Obesity Society, San Diego, CA.
Merchant N. Is there an app for that A quest in bioinformation. 2010. UA SISTA lecture series, University of Arizona.
Hingle M. 2010. The Use of Mobile Technologies to Impact Health Behavior: Nutrition Education in 160 Characters or Less. UA, N SC seminar, Department of Nutritional Sciences.
Going S. & Hingle M. for the SH Investigator Team. 2011. New Approaches to Increasing Physical Activity in Youth. Human Institute for Performance, Hong Kong University and Chinese Hong Kong University.
Hingle, M. for the SH Investigator Team. 2011.The Use of Mobile Technologies to Impact Health Behavior. University of Arizona, Diabetes and Endocrine Conference Journal Club.
Scott Going for the SH Investigator Team. 2011. AFRI Investigators (Virtual) Meeting, Tucson, A.Z. Stealth Health: Youth Innovation, Mobile Technology, Online Social Networking and Informal Learning to Promote Physical Activity.
Clark, M., A. Contreras, A.F. Contreras, D. Dumel, J. Farias, A. Gray, P. Joshevama, A. Kerg, K. Martinez, B. Steklis, W. Steklis, S. Tomlin-Brown, C. Walton, I. Liang, J. Vancel, N. Knutson, K. Wisneski, D. Hammon, D. Parizek, N. Merchant, and B. Orr. 2012. Akshen 3: Youth-driven smartphone application development. Champions 4 Change Student Showcase at Flandrau Science Center, April 28 3rd Annual Teacher Day at UA.
Hingle M, Roe D, Saboda K, Going S. 2012. Motivations for healthy eating and dietary behavior in a diverse group of adolescents. May 22-26, 2012 - International Society for Behavioral Nutrition & Physical Activity, Austin, TX.
NASA Student Interns Research Symposium, Spring 2012: Kulasinghe, Dimuth. 2012. SMS Group Messaging Applications. 21st Arizona/NASA Space Grant Undergraduate Research Symposium. Tucson, Arizona.
Page, Chelsea. 2012. Promoting Physical Activity and Nutrition Awareness in Middle School Youth through the Design of Activities Using Geospatial Technologies. 21st Arizona/NASA Space Grant Undergraduate Research Symposium. Tucson, Arizona.
Liang, Irene. 2012. Maximizing Problem-based Learning and Tools for Collaborative Mapping to Empower Youth for Civic and Environmental Engagement. 21st Arizona/NASA Space Grant Undergraduate Research Symposium. Tucson, Arizona.
Vancel, James. 2012. The Wiring Underneath: Developing an Interactive Economy in Youth Environmental Education Software. 21st Arizona/NASA Space Grant Undergraduate Research Symposium. Tucson, Arizona.
Peer-Reviewed Manuscripts: Going, S., Hongu, N., Hingle, M., Orr, B., Marsh, S., Merchant, N., Nichter, M., Roe, D., Astroth, K., and Borden, L. 2011. Stealth Health promotes PA: Engaging computer technology. The GPS in Health Research News Updates. http://www.gps-hrn.org.
Hongu, N., K.D. Wisneski, and B.J. Orr. 2012. Bringing university innovation to the retirement community: An outdoor walking program for older adults. The Forum for Family and Consumer Issues 17(1) Online: http://ncsu.edu/ffci/publications/2012/v17-n1-2012-spring/hongu-wisne ski-orr.php.
Wisneski, K.D., and B.J. Orr. 2012. Taking Akshen in communities and the environment with mobile, social and geospatial technologies. [Text Box] In: R. Sagarin and A. Pauchard, (eds.) Observation and Ecology: Broadening the Scope of Science to Understand a Complex World. Washington D.C.: Island Press.
Hongu, N., B.J. Orr, J.M. Wise, R.G. Reed, D. Roe, S.B. Going. 2013. In press. Global Positioning System (GPS) watches for estimating energy expenditure during walking. The Journal of Strength & Conditioning Research.
Hingle M, Macias Navarro L, Rezaimalek A, Going S. 2012. under review. The Use of Technology to Promote Nutrition & Physical Activity Behavior Change in Youth: A Systematic Review. Research Digest, Research: A Dietetic Practice Group of the Academy of Nutrition & Dietetics.
Abstracts: Mosqueda, M.I., Martinez, C.L., Orr, B., Merchant, N.C., Going, S.B., and Hongu, N. 2012. A nutrition and physical activity intervention using smart phones in physical education classes at a junior high school. FASEB J. 26, 257.2.
Suzuki, A., Pope, B.T., Roe, D.T., Orr, B.J., Merchant, N.C., Going, S.B., and Hongu, N. 2012. Food photo records for assessing daily food intake using a smart phone application in college students. FASEB J 26, 131.4.
Hongu, N., Orr, B.J., Wise, J.M., Sanches, S.A., Wisneski, K.D., Kataura, M.P., and Mosqueda, M.I. 2009. GPS Watches For Estimating Energy Expenditure and Promoting Physical Activity. American College of Sports Medicine Annual Meeting, Seattle, WA.
Hingle M., Nichter M., Merchant N., Medeiros M., Grace S., Kulasinghe D., Parizek D., Hongu K., Orr B., Roe D., Going S. 2011. Development and evaluation of health messages and an SMS-based software delivery system for distribution to and use by adolescents: Akshen Talk. mHealth summit, Washington, D.C.
Orr, B.J., K.D. Wisneski, N.B. Knutson, J.H. Vancel, and I. Liang. 2012. Empowering youth to identify and solve community/environmental problems through a scaffolding-based mobile/online application. Proceedings of the 3rd International Problem-based Learning (PBL) Symposium, Singapore. [peer reviewed abstract/paper presentation] p. 175. http://www.rp.edu.sg/symposium/2012/ March 5-9, 2012 - Problem-Based Learning Symposium, Singapore.
Going S. Hongu K. Hingle M. Orr B. Merchant N. Nichter M. Roe D. Astroth K. Borden L. Marsh S. 2009. Stealth Health: Youth Innovation, Mobile Technology, Online Social Networking and Informal Learning to Promote Physical Activity. AFRI Investigators Meeting, Baltimore, MD.
Going S. Hongu K. Hingle M. Orr B. Merchant N. Nichter M. Roe D. Astroth K. Borden L. Marsh S. 2010. Stealth Health: Youth Innovation, Mobile Technology, Online Social Networking and Informal Learning to Promote Physical Activity. International Society for Behavioral Nutrition & Physical Activity, Minneapolis, MN.
Going S. Hongu K. Hingle M. Orr B. Merchant N. Nichter M. Roe D. Astroth K. Borden L. Marsh S. 2010. Stealth Health: Youth Innovation, Mobile Technology, Online Social Networking and Informal Learning to Promote Physical Activity. AFRI Investigators Meeting, Denver, CO.
Nichter, M., Medeiros M., Grace S. 2011. The Role of Education in Nutrition and Diet. Meeting of the Society for Applied Anthropology, Seattle, WA.
Hingle M. 2011. Innovation in Practice Session: Texting Health to Teens: Nutrition Education in 140 Characters or Less. ADA FNCE, San Diego, CA.

Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: Student Mentoring: Undergrad (n=9), software develop, intervention content/delivery, data collection; Grad (n=9), intervention delivery, data collection; Youth interns (n=13), user perspective; Foreign scholar (n=1);message development, lit review, marketing. Teaching: Hingle M., 03/21/11 - UA Diabetes and Endocrine Medical Fellows Journal Club "The Use of Mobile Technologies to Impact Health Behavior" Conducting/analyzing experiments/surveys: 01/11-12/11 tested Stealth Health intervention in 152 participants; Refined SMS delivery software app Conferences/Presentations: Going S & Hingle M Human Institute for Performance, Hong Kong University, and Chinese Hong Kong University,"New Approaches to Increasing Physical Activity in Youth" 2/8-9/11; Hingle M ADA FNCE, San Diego, CA "Texting Health to Teens: Nutrition Education in 140 Characters or Less" 9/25/2011; Hingle et al mHealth summit "Development and evaluation of health messages and an SMS-based software delivery system for distribution to and use by adolescents" 12/4/11 -AFRI Investigator's Meeting: Going S et al "Stealth Health: Youth Innovation, Mobile Technology, Online Social Networking and Informal Learning to Promote Physical Activity"- 11/12/2011. Products: 300+ health messages sent via SMS-to-IM software app; Software and web app FAQs and training materials designed to support program leaders and youth in using tech to achieve program goals, foster exploration. Data/databases: Large-scale data collection and management system captures and compiles usage data for study mobile devices and apps for analyzing network traffic trends and relationships. Network collaborations:Collaborations with 14 youth programs. Software:GeoKnect, GeoSnap, Akshen web, SMS apps. Technology/methods/techniques: Train-the-Trainer manuals:materials designed to teach leaders and youth to use the apps to further goals and explore interests outside youth program;print and electronic media. Website URL:www.akshenweb.org. Information/skills/technology for individuals, communities, and programs:SH software:GeoKnect, GeoSnap, web apps . Dissemination:Trainings: 3 program leader trainings:use of software applications, smartphone, and activities and curricula;Youth interns (n=13) recruited to refine software apps and website for dissemination;Akshen website, portal through which youth and program leaders interact with one another and content(e.g. photos with descriptions, and geospatial data) created through geospatial apps:GeoKnect, GeoSnap;Nutrition education delivered through SMS application;1 message/dx5 d/wk, sent to youth, program leaders participating in our intervention. PARTICIPANTS: Individuals: S Going, PD, concept, design/implement, student mentoring, staff supervision; B Orr, Co-PD; concept, design/implement, supervision of grad and undergrad students; M Nichter, Co-PD, design/implement, supervision of grad students; D Roe, Co-PD, design, statistical analysis; S Marsh, Co-PD, student/staff supervision, project implement; L Borden, Co-PD, partner organization coordination; K Astroth, Co-PD, partner organization coordination; N Merchant, Co-PD, design/implement, student mentoring; M Hingle, project management, design/implement; T Crane, project management, design/implement; K Wisneski, GRA, curriculum development, design, training; S Grace; GRA, message development, observations/interviews; V Pryzbyl, GRA message development, observations/interviews; D Laddu, GRA, software application testing; R Alman, MPH Intern, data collection; M Graves, measurement team, data management; R Blew, measurement team, training of staff; L Macias Navarro, visiting scholar, software app R&D; J Choquehuanca, staff, program leader training, software app R&D with youth; D Hammond, programmer, software app development and testing; D Parizek; programmer, website development; software app development and testing; S Reddy, programmer, mobile phone application and website development; D Kulansinghe, undergrad res assist, programmer, SMS app; D. Seethur, undergrad res assist, programmer, mobile Android app; N Knutson, undergrad res assist, design and testing; J Vancel, undergrad res assist, design and testing; I Liang, undergrad res assist, design and testing. PARTNER ORGANIZATIONS: YMCA of Southern Arizona;Ironwood Tree Experience;Skrappy's Youth Center;Wildcat Charter School; 4-H Arizona. OPPORTUNITIES FOR PROFESSIONAL TRAINING: Faculty/staff/students/program leaders use "smart phones," download/install software for devices, collect data using apps, and share data with others. Students learned how to work with youth (e.g. teaching them to use technology; explaining geospatial data collection procedures; conducting anthropometric measurements; interview/observation). TARGET AUDIENCES: Youth program leaders and participants - our youth organizations serve the diverse Tucson population- over 30% Hispanic, many of whom are low income. Youth utilize the software apps built by SH to help them achieve goals and share activities and information with others through the project website. PROJECT MODIFICATIONS: We continue to pursue the same aims. Phone software upgrades and technology/device changes were a challenge and delayed our timeline by 9 months. Consequently, the formal pre-post proof of principle test of our program occurred in Jan-Oct 2011 in 3, 3 month waves of intervention and data collection; n =152 total enrolled. Data analysis will continue into the approved no-cost extension year, in which we will also evaluate the "contagion" (dissemination) effect. In the past year, we also engaged a new group of youth interns (n=13) who worked under Co-PD Dr. Orr to revise our training and visioning materials following "scaffolding" methods with the aim of simplifying them for dissemination. Aspects of the Akshen website were similarly revised with the same aim.

Impacts
Program leader trainings - Program leaders (n=10) trained in 2011 - Android applications + website; project visioning curriculum and training; 4 out of 10 program leaders were previously unfamiliar with smart phones and mobile software applications; they were also introduced to the idea of "project visioning" which helps them to focus their youth program activities in way that is youth-driven. Youth trainings - Youth interns (n=13) were trained in "scaffolding" framework, after which they were engaged in revisions of teaching materials, project visioning materials and Akshen website from an "expert" youth user perspective. Youth trainings - youth in the pre-post proof of principle intervention completed visioning training and developed projects.

Publications

Mosqueda M, Hongu N. 2011. Extension publication, Make My Map in Google.
Hongu N.K., Hingle M., Merchant N., Orr B., Thomson C., Going S.B. 2011 Dietary Assessment Tools Using Mobile Technology. Topics in Clinical Nutrition, Volume 26 (4):300-311.
Hingle M., Nichter M., Medeiros M., Grace S. 2011. Youth-Participatory Research to Inform the Development of Messages to Promote Healthy Lifestyle Behaviors in Adolescents. Journal of Nutrition Education and Behavior (under review).
Hingle M., Macias Navarro L., & Going S.B. 2011. The Use of Technology to Promote Nutrition and Physical Activity Behavior Change in Youth: A Review. Journal of Medical Internet Research (under review).

Progress 01/01/10 to 12/31/10

Outputs
OUTPUTS: Student Mentoring:1)Undergrad(n=17), software develop, intervention content/delivery, data collection;2)Grad(n=8), intervention content, focus groups, field observations; 3)High School(n=1), software develop;4)Middle School(n=1), user perspective;5)foreign scholars(n=3);message development, lit review, marketing. Teaching:Oct 2010. UA/SISTA Lecture Series; "Is there an app for that A quest in bio-information" Merchant N.,Oct 2010. UA/NSc Seminar; "The Use of Mobile Technologies to Impact Health Behavior:Nutrition Education in 160 Characters or Less" Hingle M. Conducting/analyzing experiments/surveys:Software app design, engineering, testing:1)SMS delivery app;2)GeoKnect app- track movement in real time, visualize location on a map/mark waypoints/send/share data;3)GeoSnap app-take a photo/describe/tag with key words, send/share data to website. Formative work with youth determined the most acceptable method of health education delivery using SMS app:4 focus groups(n=40 youth; 4 cognitive interview sessions),(n=96 youth; Youth Think Tank) (n=7; and youth advisors, n=4). Conferences/Presentations: June 2010. International Society for Behavioral Nutrition/Physical Activity, Minn, MN, Stealth Health(SH) concept; Going S.B., Hingle M. for SH Team; Jun 2010. AFRI Investigator's Meeting, Denver, CO. SH concept and preliminary data; Going S.B.,Hingle M. for SH Team; Oct 2010. Obesity Society, San Diego, CA. SH concept and preliminary data; Hongu K. for SH Team. Products:7 videos posted to YouTube demonstrating uses of apps and activities. Curricula:a)300+ health messages sent via SMS app;messages include short factoids/quizzes/polls/recipes reviewed by youth/faculty for comprehension and acceptability;b)Software and web app FAQs:training materials designed for program leaders and youth to support use,program goals, foster exploration. Data/databases:proxy server captures usage of mobile device and compiles information into database for analyzing network traffic trends. Network collaborations:Collaborations with 6 youth programs. Software:GeoKnect, GeoSnap, SMS apps. Technology/methods/techniques:Formative work with youth determined the most acceptable method of health education delivery using the SMS application. Train-the-Trainer manuals:materials designed to teach leaders and youth to use the apps to further goals and explore interests outside youth program;print and electronic media. Website URL:www.akshenweb.org. Information/skills/technology for individuals, communities, and programs:SH software:GeoKnect, GeoSnap, and the website. Dissemination:Trainings:3 program leader trainings:use of software applications, smartphone, and activities and curricula;Youth Think Tank-3 youth workshops on software apps, smart phones to provide feedback to developers used to refine software apps and website;Akshen website, portal through which youth and program leaders interact with one another and content(e.g. photos with descriptions, and geospatial data) created through geospatial apps:GeoKnect, GeoSnap;Nutrition education delivered through SMS application;1 message/dx5 d/wk, sent to youth, program leaders participating in our intervention. PARTICIPANTS: PARTICIPANTS Individuals: S Going, PD; concept, design/implement, student mentoring, staff supervision B Orr, Co-PD; concept, design/implement, supervision of grad and undergrad students M Nichter, Co-PD; design/implement; supervision, grad students D Roe, Co-PD; design, statistical analysis S Marsh, Co-PD; student/staff supervision; project implement L Borden, Co-PD; partner organization coordination K Astroth, Co-PD; partner organization coordination N Merchant, Co-PD; design/implement; student mentoring M Hingle; project management; design/implement; T Crane; project management; design/implement K Wisneski; GRA; curriculum development; design; training S Grace; GRA; message development; observations/interviews M Medeiros; GRA; message development; observations/interviews V Pryzbyl; GRA message development; observations/interviews D Laddu; GRA; software application testing M Graves; measurement team; data management R Blew; measurement team; training of staff L Macias Navarro; visiting scholar; software app R&D J Choquehuanca; staff; program leader training; software app R&D with youth K Nagazy; staff; software app R&D with youth D Hammond; programmer; software app development and testing D Thompson; programmer; software app development and testing D Chow; undergrad res assist; programmer; software development and testing; database development D Parizek; programmer; website development S Reddy; programmer; mobile phone application and website development D Welch; graphic designer; art for website and messages N Bryant; systems analyst; inventory and equipment management; proxy server programming D Kulansinghe; undergrad res assist; programmer, SMS app Deepak; undergrad res assist; programmer; mobile Android app N Knutson; undergrad res assista design and testing R Reed; undergrad res assist; design and testing M Mosqueda; undergrad res assist; design and testing B Teran; undergrad res assist; design and testing PARTNER ORGANIZATIONS: Subcontractors/partners:YMCA of Southern Arizona;Ironwood Tree Experience;Skrappy's Youth Center;Wildcat Charter School(new in 2010); 4-H Arizona(new in 2010). OPPORTUNITIES FOR PROFESSIONAL TRAINING: Faculty/staff/students/program leaders use "smart phones," download/install software for devices, collect data using apps, and share data with others. Students learned how to work with youth (e.g. teaching them to use technology; explaining geospatial data collection procedures; conducting anthropometric measurements; interview techniques during focus groups and interviews). TARGET AUDIENCES: TARGET AUDIENCES: Youth program leaders and participants - our youth organizations serve the diverse Tucson population- over 30% Hispanic, many of whom are low income. Youth will utilize the software apps built by SH to help them achieve goals and share activities and information with others through website. PROJECT MODIFICATIONS: PROJECT MODIFICATIONS: We continue to pursue the same aims. Phone software upgrades and technology/device changes have been a challenge. In the past year, we made the decision to switch from the Windows Mobile software platform to Android software platform. Android is an easier platform to develop compared to Windows and allows for easier sharing of open source apps. Android appeals more with youth participants. Approximately 6-9 months was spent developing the Windows platform, consequently, the switch to Android set our project timeline back approx 4-6 months. Therefore, we have only recently begun the formal pre-post proof of principle test of our program. The first cohort (n=65) is engaged in the program and a second enrollment begins summer 2011.

Impacts
Program leader trainings - Program leaders (n=12) trained in 2010 - Windows Mobile software applications + website; Android versions of applications; Android applications + website; project visioning curriculum and training; 10 out of 12 program leaders were previously unfamiliar with smart phones and mobile software applications; they were also introduced to the idea of "project visioning" which helps them to focus their youth program activities in way that is youth-driven. Stealth Health Co-I, Mimi Nichter, attended the NIH mHealth Summit in November 2010 in Washington D.C. 

Publications

Going, S., Hongu, N., Hingle, M., Orr, B., Marsh, S., Merchant, N., Nichter, M., Roe, D., Astroth, K., and Borden, L. Stealth Health promotes PA: Engaging computer technology. The GPS in Health Research News Updates. http://www.gps-hrn.org, 2011.
Mosqueda M, Hongu N. 2010 Extension publication, Make My Map in Google, 2011.
Hongu, N. Stealth Health: Impacting Youth Physical Activity and Nutrition Behaviors Through Mobile Technologies. Obesity, 28th Annual Scientific Meeting, Symposium (New Ways Media is Used: Can it Help to Prevent Obesity),San Diego, California, October 9, 2010.
Pending: Hingle, M., Medeiros, M., Grace, S., and Nichter, M. Texting Health: Innovative Approaches to Youth Messaging for Nutrition and Physical Activity JADA, 2011.
Hingle, M., Macias-Navarro, L., and Going, S. The Use of Technology to Promote Physical Activity and Dietary Behavior Change in Youth: A Systematic Review, Nutrition Reviews, 2011.
Nichter, M., Medeiros, M., and Grace, S. Session title: The role of education in nutrition and diet, Mimi Nichter, Chair; Texting; Developing Youth Friendly Nutrition. Meeting of the Society for Applied Anthropology - Seattle, March 29-April 2nd, 2011.

Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: Activities: i) student training (1 high school intern; 18 undergraduate students in Nutritional Sciences, Physiology, and Computer Science Departments) and mentoring (4 graduate students from the School of Anthropology, the School of Natural Resources, and Nutritional Sciences); ii) software engineering and design activities for Phase 1 of the project; iii) customization and regression testing of the mobile device with My Experience software; iv) comparison of handheld GPS, pedometer, and mobile device (with built-in GPS/accelerometer) data to determine reliability of mobile device for pedometer step counts; v) 5 focus groups with youth to assess acceptability of nutrition messages and preferred delivery method (e.g. text, email) (approximately 6 youth per session); vi) informal observations of youth interacting with technology (6 sessions, approximately 4-5 youth per session). Events: i) conference attendance (Where 2.0 Conference on mobile technology/geospatial integration, July 2009; The Obesity Society, October 2009; Youth Science, Engineering, and Technology for Life eXtension Community of Practice web conferences, October, November, December 2009) and presentations (poster at American College of Sports Medicine, May 2009; part of symposium at NEAFCS, Summer 2009); ii) 4 trainings/demonstrations on effective use of mobile technology with online social networking and media applications, physical activity (pedometer) and GPS based photography for our partner organizations. Products: i) an initial prototype of mobile phone survey and messaging software and a web portal with survey - we have planned for first release of software before April 2010 and the initial mobile prototype "Application Suite" is currently in an early test phase; ii) youth program leader training materials (Use of Mobile Technologies for Community Asset Mapping); iii) several hundred nutrition and physical activity messages that are under internal review and will go through youth focus groups, and eventually, will be delivered through the mobile device to youth. PARTICIPANTS: S Going,PD; concept, design/implementation, student mentoring, staff supervision B Orr,Co-PD; concept, design/implementation, supervision of grad and undergrad students/staff N Hongu,Co-PD; concept, design/implementation, supervision of grad and undergradstudents M Nichter,Co-PD; design/implementation; supervision,grad students D Roe,Co-PD; design S Marsh,Co-PD; student/staff supervision; project implementation L Borden,Co-PD; collaborator/partner organization coord. K Astroth,PhD, Co-PD; collaborator/partner organization coord. N Merchant,Co-PD; design/implementation; student mentoring M Hingle,Project Mgr; design/implementation K Wisneski,Grad Res Ass't/NASA Space Grant Student; curriculum development; design; training and recruitment of personnel and youth participants S Grace,Grad ResAss't, curriculum/message development; informal observations and focus groups with youth M Madeiros,Grad Res Ass't curriculum/message development; informal observations/focus groups with youth J Cornelius, Grad Res Ass't, curriculum/message development M Mosqueda,Undergrad Res Assoc/design T Yuhas,App Personnel, website design/development D Hammond,Staff, software application design/development Partner Organizations. Skrappy's is a safe, positive, drug & alcohol free youth center for young people to freely express themselves through music, theater, art, etc. It serves hundreds of youth in Tucson, AZ, from all ethnic and social backgrounds. During 2009, Skrappy's program leaders attended Stealth Health planning meetings, and provided staff with youth for several focus groups and informal observations. The YMCA of Southern Arizona is dedicated to improving the quality of life and to helping all people realize their full potential through the development of Spirit, Mind and Body. It serves over 50,000 facility members, and offers a variety of programs and services that foster leadership skills in youth, support the needs of families, encourage healthy lifestyles and lead to collaborations with other community groups. During 2009, YMCA program leaders were involved in several Stealth Health planning meetings in anticipation of project implementation in 2010. Ironwood Tree Experience (ITE) empowers young people, aged 12-19 through active, mindful and educational eco-programs that cultivate a holistic sense of community. All ITE Eco-programming integrates youth wellness, community action, sustainable practices, and youth character development. ITE trained ~40-50 youth in 2009, and provided project investigators access to its youth members for focus groups and informal observations. Training or Professional Development. Project faculty, and staff learned to use GPS and develop methods combining GPS with mapping software on a mobile device. Youth involved in our focus groups and informal observations learned how to use GPS applications and mobile technologies while being physically active and playing games, plus participated in discussions on nutrition and physical activity topics. TARGET AUDIENCES: Target audiences The primary purpose of the Stealth Health project is to develop an informal education program that can be adapted and used by youth organizations (serving youth ages 12 to 18) to fulfill their mission/goals, while "stealthily" promoting physical activity and nutrition knowledge. Hence, one of our ongoing discussions includes our plan for the national dissemination (through our partners, America on the Move and National YMCA) of our software and our website so that youth everywhere can access our informal education tools. Our youth organizations (Skrappy's, YMCA, Ironwood Tree Experience) from which we will recruit our study subjects serve the diverse Tucson population - over 30% Hispanic, many of whom are low income. A focus of Skrappy's is to provide services and activities to address the unique challenges faced by homeless or displaced youth and those who have been placed in group homes or diversion programs. YMCA offers scholarships and subsidized memberships to lower-income families. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Project faculty, staff, and students have learned how to use GPS and have developed methods combining GPS with mapping software on a mobile device; all of the project personnel from faculty to students have benefited from learning how these technologies work, their potential applications in community asset mapping, and some of the limitations. Involvement in Stealth Health contributed to successful applications to the NASA Space Grant program: three students - two undergraduate students and one graduate student have received NASA Space Grants to work on the Stealth Health project, which includes several experiments designed to inform aspects of the project (e.g. comparison of GPS devices in walking, running, climbing stairs).

Publications

Mosqueda, M. and Hongu, N. Extension publication, entitled, Make My Map in Google submitted on September 5, 2009 - under review.