Results suggested that personal control and emotional cause beliefs were positively associated wi... more Results suggested that personal control and emotional cause beliefs were positively associated with physical activity, whereas medical cause beliefs were inversely associated with physical activity. In addition, the relationship between symptoms and physical activity appeared to be statistically mediated by emotional cause beliefs. With regard to SCT beliefs, negative medication outcome expectancies (NMOE) was inversely associated with medication adherence, and the relationship between medication adherence self-efficacy ...
Resumen Las conceptualizaciones teóricas del trastorno de ansiedad generalizada (TAG) siguen some... more Resumen Las conceptualizaciones teóricas del trastorno de ansiedad generalizada (TAG) siguen sometidas a control y refinamiento. Este artículo critica los modelos contemporáneos de TAG: el modelo de evitación de la preocupación y TAG [Borkovec, TD (1994). La naturaleza, las funciones y los orígenes de la preocupación. En: G. Davey & F. Tallis (Eds). Preocupación: perspectivas sobre la evaluación de la teoría y el tratamiento (pp. 5-33). Sussex,
Recognition that the built environment (BE) can impact opportunities for active living has result... more Recognition that the built environment (BE) can impact opportunities for active living has resulted in the proliferation of environmental assessment tools. These are traditionally designed for use by researchers as opposed to community residents. The Stanford Healthy Neighborhood Discovery Tool (SHNDT) is a hand-held computerized audit tool recently developed to allow community residents to record audio narratives and collect photographs of individuals' BE. This study assessed the inter-rater reliability (IRR) between coders (n=8) who rated audio narratives (n=153) and photographs (n=164) recorded by 28 older adults in San Mateo County, California. BE features were identified a priori from existing validated audit tools and interviews with stakeholders. Both users and coders required minimal training. Evaluation of IRR was conducted for 14 audio and 16 photographic items, issue valence (positive, negative, neutral) and user-identified solutions to recorded issues. Results indica...
A feasibility study was run on an immersive, embodied exergame ("Alien Health Game&q... more A feasibility study was run on an immersive, embodied exergame ("Alien Health Game") designed to teach 4th-12th-grade students about nutrition and several U.S. Department of Agriculture MyPlate guidelines. This study assessed acceptability and limited efficacy. Students learned about the amount of nutrients and optimizers in common food items and practiced making rapid food choices while engaging in short cardiovascular activities. Nineteen 4th graders played a "mixed reality" game that included both digital components (projected graphics on the floor) and tangible, physical components (hand-held motion-tracking wands). Players made food choices and experienced immediate feedback on how each item affected the Alien avatar's alertness/health state. One member of the playing dyad had to run short distances to make the game work. The final level included a digital projection of the MyPlate icon, and each food item filled the appropriate quadrant dynamically. All students remained engaged with the game after approximately 1 hour of play. Significant learning gains were seen on a pretest and posttest that assessed nutrition knowledge (paired t18=4.13, P<0.001). In addition, significant learning gains were also seen in knowledge regarding MyPlate (paired t18=3.29, P<0.004). Results suggest preliminary feasibility via demonstrated acceptability and improved within-group content knowledge. Future research should explore improved measures of knowledge gains, alternative mechanisms for supporting the game mechanics to increase the scalability of the system (i.e., via Kinect(®) [Microsoft(®), Redmond, WA] sensors), and the formal evaluation of the system via a randomized controlled trial.
Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of prev... more Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of preventable deaths, in addition to their unfavorable effects on quality of life and economics. Our current understanding of human behavior is largely based on static Bsnapshots^of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social, personal, and environmental states. This paper first discusses how new technologies (i.e., mobile sensors, smartphones, ubiquitous computing, and cloudenabled processing/computing) and emerging systems modeling techniques enable the development of new, dynamic, and empirical models of human behavior that could facilitate just-in-time adaptive, scalable interventions. The paper then describes concrete steps to the creation of robust dynamic mathematical models of behavior including: (1) establishing Bgold standard^measures, (2) the creation of a behavioral ontology for shared language and understanding tools that both enable dynamic theorizing across disciplines, (3) the development of data sharing resources, and (4) facilitating improved sharing of mathematical models and tools to support rapid aggregation of the models. We conclude with the discussion of what might be incorporated into a Bknowledge commons,^which could help to bring together these disparate activities into a unified system and structure for organizing knowledge about behavior.
Local food and physical activity environments are known to impact health, and older adults are ge... more Local food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the "community action teams" to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among old...
In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards o... more In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children's meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children's menus), and the energy and nutrient content of all orders and children's-meal-only orders purchased for children aged 0 through 12 years. Restaurant responses were examined from January 2010 through March 2012. Parent-caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012. Both restaurant chains responded to the ordinance by selling toys separately from children's meals, but neither changed thei...
Proceedings of the 32nd annual ACM conference on Human factors in computing systems - CHI '14, 2014
ABSTRACT Exergames, video game systems that require exertion and interaction, have been rising in... more ABSTRACT Exergames, video game systems that require exertion and interaction, have been rising in popularity in the past years. However, research on popular exergames shows mixed health benefits, potentially due to minimal energy expenditure and decreasing use over time. This paper presents a 2x2 experimental study (N = 44), using a popular exergame, where we vary the framing of intention (i.e., "Gameplay" or "Exercise") and feedback (i.e., "Health" or "No health") to explore their single and interactive impacts on perceived exertion, objectively measured energy expenditure, affect, and duration of usage in a single session. Our study showed that participants primed with exercise used the system significantly longer than those primed with game play (M = 49.2 ±2.0 min versus M = 39.3 ±2.0 min). We discuss our results and possible design implications based on our single-session experiment. We conclude with a discussion on the potential impact of focusing on "healthifying" exergames -highlighting an exergames" dual purpose as both a game and exercise - as opposed to gamifying health behaviors.
Recent research highlights the potential value of differentiating between categories of physical ... more Recent research highlights the potential value of differentiating between categories of physical activity intensities as predictors of health and well-being. This study sought to assess reliability and concurrent validity of sedentary (ie, 1 METs), low-light (ie, >1 and ≤2 METs; eg, playing cards), high-light (ie, >2 and <3 METs; eg, light walking), moderate-to-vigorous physical activity (MVPA, ≥3 METs), and "total activity" (≥2 METs) from the CHAMPS survey. Further, this study explored over-reporting and double-reporting. CHAMPS data were gathered from the Seniors Neighborhood Quality of Life Study, an observational study of adults aged 65+ years conducted in 2 US regions. Participants (N = 870) were 75.3 ± 6.8 years old, with 56% women and 71% white. The CHAMPS sedentary, low-light, high-light, total activity, and MVPA variables had acceptable test-retest reliability (ICCs 0.56-0.70). The CHAMPS high-light (ρ = 0.27), total activity (ρ = 0.34), and MVPA (ρ = 0.3...
The combination of inexpensive wearable sensors, powerful mobile phones, and always-connected clo... more The combination of inexpensive wearable sensors, powerful mobile phones, and always-connected cloud computing are enabling new, real-time feedback and coaching via mobile technologies. This paper explores the use of avatars -digital representations of the self -as an ideal user interface for mobile health application. Specifically, a justification for using avatars is provided, both based on empirical studies and the psychology of human body interpretation. We then provide an organized, theoretical description of how an avatar's traits (appearance, behavior, and virtual environment) can be manipulated to convey specific healthrelated behavior change messages.
INTRODUCTION Personal informatics and reflection has been an emerging trend in computing in the p... more INTRODUCTION Personal informatics and reflection has been an emerging trend in computing in the past years through ubiquitously connected mobile devices. Mobile sensing technologies have allowed sophisticated inferences through a variety of physical modalities. Research ...
There is increasing interest in the use of online forums as a component of eHealth weight loss in... more There is increasing interest in the use of online forums as a component of eHealth weight loss interventions. Although the research is mixed on the utility of online forums in general, results suggest that there is promise to this, particularly if the systems can be designed well to support healthful interactions that foster weight loss and continued engagement. The purpose of this study was to examine the relationship between the styles of utterances individuals make on an online weight loss forum and week-to-week fluctuations in weight. This analysis was conducted to generate hypotheses on possible strategies that could be used to improve the overall design of online support groups to facilitate more healthful interactions. A convenience sample of individuals using an online weight loss forum (N=4132) included data both on online forum use and weight check-in data. All interactions were coded utilizing the Linguistic Inquiry and Word Count (LIWC) system. Mixed model analyses were conducted to examine the relationship between these LIWC variables and weight over time. Results suggested that increased use of past-tense verbs (P=.05) and motion (P=.02) were associated with lower weekly weights whereas increased use of conjunctions (eg, and, but, whereas; P=.001) and exclusion words (eg, but, without, exclude; P=.07) were both associated with higher weight during the weeks when these utterances were used more. These results provide some insights on the styles of interactions that appear to be associated with weight fluctuations. Future work should explore the stability of these findings and also explore possibilities for fostering these types of interactions more explicitly within online weight loss forums.
Results suggested that personal control and emotional cause beliefs were positively associated wi... more Results suggested that personal control and emotional cause beliefs were positively associated with physical activity, whereas medical cause beliefs were inversely associated with physical activity. In addition, the relationship between symptoms and physical activity appeared to be statistically mediated by emotional cause beliefs. With regard to SCT beliefs, negative medication outcome expectancies (NMOE) was inversely associated with medication adherence, and the relationship between medication adherence self-efficacy ...
Resumen Las conceptualizaciones teóricas del trastorno de ansiedad generalizada (TAG) siguen some... more Resumen Las conceptualizaciones teóricas del trastorno de ansiedad generalizada (TAG) siguen sometidas a control y refinamiento. Este artículo critica los modelos contemporáneos de TAG: el modelo de evitación de la preocupación y TAG [Borkovec, TD (1994). La naturaleza, las funciones y los orígenes de la preocupación. En: G. Davey & F. Tallis (Eds). Preocupación: perspectivas sobre la evaluación de la teoría y el tratamiento (pp. 5-33). Sussex,
Recognition that the built environment (BE) can impact opportunities for active living has result... more Recognition that the built environment (BE) can impact opportunities for active living has resulted in the proliferation of environmental assessment tools. These are traditionally designed for use by researchers as opposed to community residents. The Stanford Healthy Neighborhood Discovery Tool (SHNDT) is a hand-held computerized audit tool recently developed to allow community residents to record audio narratives and collect photographs of individuals' BE. This study assessed the inter-rater reliability (IRR) between coders (n=8) who rated audio narratives (n=153) and photographs (n=164) recorded by 28 older adults in San Mateo County, California. BE features were identified a priori from existing validated audit tools and interviews with stakeholders. Both users and coders required minimal training. Evaluation of IRR was conducted for 14 audio and 16 photographic items, issue valence (positive, negative, neutral) and user-identified solutions to recorded issues. Results indica...
A feasibility study was run on an immersive, embodied exergame (&quot;Alien Health Game&q... more A feasibility study was run on an immersive, embodied exergame (&quot;Alien Health Game&quot;) designed to teach 4th-12th-grade students about nutrition and several U.S. Department of Agriculture MyPlate guidelines. This study assessed acceptability and limited efficacy. Students learned about the amount of nutrients and optimizers in common food items and practiced making rapid food choices while engaging in short cardiovascular activities. Nineteen 4th graders played a &quot;mixed reality&quot; game that included both digital components (projected graphics on the floor) and tangible, physical components (hand-held motion-tracking wands). Players made food choices and experienced immediate feedback on how each item affected the Alien avatar&#39;s alertness/health state. One member of the playing dyad had to run short distances to make the game work. The final level included a digital projection of the MyPlate icon, and each food item filled the appropriate quadrant dynamically. All students remained engaged with the game after approximately 1 hour of play. Significant learning gains were seen on a pretest and posttest that assessed nutrition knowledge (paired t18=4.13, P&lt;0.001). In addition, significant learning gains were also seen in knowledge regarding MyPlate (paired t18=3.29, P&lt;0.004). Results suggest preliminary feasibility via demonstrated acceptability and improved within-group content knowledge. Future research should explore improved measures of knowledge gains, alternative mechanisms for supporting the game mechanics to increase the scalability of the system (i.e., via Kinect(®) [Microsoft(®), Redmond, WA] sensors), and the formal evaluation of the system via a randomized controlled trial.
Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of prev... more Adverse and suboptimal health behaviors and habits are responsible for approximately 40 % of preventable deaths, in addition to their unfavorable effects on quality of life and economics. Our current understanding of human behavior is largely based on static Bsnapshots^of human behavior, rather than ongoing, dynamic feedback loops of behavior in response to ever-changing biological, social, personal, and environmental states. This paper first discusses how new technologies (i.e., mobile sensors, smartphones, ubiquitous computing, and cloudenabled processing/computing) and emerging systems modeling techniques enable the development of new, dynamic, and empirical models of human behavior that could facilitate just-in-time adaptive, scalable interventions. The paper then describes concrete steps to the creation of robust dynamic mathematical models of behavior including: (1) establishing Bgold standard^measures, (2) the creation of a behavioral ontology for shared language and understanding tools that both enable dynamic theorizing across disciplines, (3) the development of data sharing resources, and (4) facilitating improved sharing of mathematical models and tools to support rapid aggregation of the models. We conclude with the discussion of what might be incorporated into a Bknowledge commons,^which could help to bring together these disparate activities into a unified system and structure for organizing knowledge about behavior.
Local food and physical activity environments are known to impact health, and older adults are ge... more Local food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the "community action teams" to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among old...
In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards o... more In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children's meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children's menus), and the energy and nutrient content of all orders and children's-meal-only orders purchased for children aged 0 through 12 years. Restaurant responses were examined from January 2010 through March 2012. Parent-caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012. Both restaurant chains responded to the ordinance by selling toys separately from children's meals, but neither changed thei...
Proceedings of the 32nd annual ACM conference on Human factors in computing systems - CHI '14, 2014
ABSTRACT Exergames, video game systems that require exertion and interaction, have been rising in... more ABSTRACT Exergames, video game systems that require exertion and interaction, have been rising in popularity in the past years. However, research on popular exergames shows mixed health benefits, potentially due to minimal energy expenditure and decreasing use over time. This paper presents a 2x2 experimental study (N = 44), using a popular exergame, where we vary the framing of intention (i.e., &quot;Gameplay&quot; or &quot;Exercise&quot;) and feedback (i.e., &quot;Health&quot; or &quot;No health&quot;) to explore their single and interactive impacts on perceived exertion, objectively measured energy expenditure, affect, and duration of usage in a single session. Our study showed that participants primed with exercise used the system significantly longer than those primed with game play (M = 49.2 ±2.0 min versus M = 39.3 ±2.0 min). We discuss our results and possible design implications based on our single-session experiment. We conclude with a discussion on the potential impact of focusing on &quot;healthifying&quot; exergames -highlighting an exergames&quot; dual purpose as both a game and exercise - as opposed to gamifying health behaviors.
Recent research highlights the potential value of differentiating between categories of physical ... more Recent research highlights the potential value of differentiating between categories of physical activity intensities as predictors of health and well-being. This study sought to assess reliability and concurrent validity of sedentary (ie, 1 METs), low-light (ie, >1 and ≤2 METs; eg, playing cards), high-light (ie, >2 and <3 METs; eg, light walking), moderate-to-vigorous physical activity (MVPA, ≥3 METs), and "total activity" (≥2 METs) from the CHAMPS survey. Further, this study explored over-reporting and double-reporting. CHAMPS data were gathered from the Seniors Neighborhood Quality of Life Study, an observational study of adults aged 65+ years conducted in 2 US regions. Participants (N = 870) were 75.3 ± 6.8 years old, with 56% women and 71% white. The CHAMPS sedentary, low-light, high-light, total activity, and MVPA variables had acceptable test-retest reliability (ICCs 0.56-0.70). The CHAMPS high-light (ρ = 0.27), total activity (ρ = 0.34), and MVPA (ρ = 0.3...
The combination of inexpensive wearable sensors, powerful mobile phones, and always-connected clo... more The combination of inexpensive wearable sensors, powerful mobile phones, and always-connected cloud computing are enabling new, real-time feedback and coaching via mobile technologies. This paper explores the use of avatars -digital representations of the self -as an ideal user interface for mobile health application. Specifically, a justification for using avatars is provided, both based on empirical studies and the psychology of human body interpretation. We then provide an organized, theoretical description of how an avatar's traits (appearance, behavior, and virtual environment) can be manipulated to convey specific healthrelated behavior change messages.
INTRODUCTION Personal informatics and reflection has been an emerging trend in computing in the p... more INTRODUCTION Personal informatics and reflection has been an emerging trend in computing in the past years through ubiquitously connected mobile devices. Mobile sensing technologies have allowed sophisticated inferences through a variety of physical modalities. Research ...
There is increasing interest in the use of online forums as a component of eHealth weight loss in... more There is increasing interest in the use of online forums as a component of eHealth weight loss interventions. Although the research is mixed on the utility of online forums in general, results suggest that there is promise to this, particularly if the systems can be designed well to support healthful interactions that foster weight loss and continued engagement. The purpose of this study was to examine the relationship between the styles of utterances individuals make on an online weight loss forum and week-to-week fluctuations in weight. This analysis was conducted to generate hypotheses on possible strategies that could be used to improve the overall design of online support groups to facilitate more healthful interactions. A convenience sample of individuals using an online weight loss forum (N=4132) included data both on online forum use and weight check-in data. All interactions were coded utilizing the Linguistic Inquiry and Word Count (LIWC) system. Mixed model analyses were conducted to examine the relationship between these LIWC variables and weight over time. Results suggested that increased use of past-tense verbs (P=.05) and motion (P=.02) were associated with lower weekly weights whereas increased use of conjunctions (eg, and, but, whereas; P=.001) and exclusion words (eg, but, without, exclude; P=.07) were both associated with higher weight during the weeks when these utterances were used more. These results provide some insights on the styles of interactions that appear to be associated with weight fluctuations. Future work should explore the stability of these findings and also explore possibilities for fostering these types of interactions more explicitly within online weight loss forums.
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Papers by Eric Hekler