BackgroundOlder people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.MethodsA randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.ResultsIntervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.ConclusionsA lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.Trial Registrationclinicaltrials.gov identifier: NCT0078634.

Purpose Online social networking sites (SNSs) have become a popular mode of communication between adolescents. However, little is known about the effects of social online activity on health behaviors. The authors examine the use of SNSs between friends and the degree to which SNS activities relate to face-to-face peer influences and adolescent risk behaviors. Methods Longitudinal egocentric friendship network data along with adolescent social media use and risk behaviors were collected from 1,563 tenth grade students across five Southern California high schools. Measures of online and offline peer influences were computed and assessed using fixed effects models. Results The frequency of adolescent SNS use and the number of their closest friends on the same SNS were not significantly associated with risk behaviors. However, exposure to friends’ online pictures of partying or drinking was significantly associated with both smoking (β=.07, p<.001) and alcohol use (β=.08, p<.05). While adolescents with drinking friends had higher risk levels for drinking, adolescents without drinking friends were more likely to be affected by increasing exposure to risky online pictures (β=−.10, p<.10). Myspace and Facebook had demographically distinct user characteristics and had differential effects on risk behaviors. Conclusions Exposure to risky online content had a direct impact on adolescents’ risk behaviors and significantly interacted with risk behaviors of their friends. These results provide evidence that friends’ online behaviors should be considered a viable source of peer influence and that increased efforts should focus on educating adolescents on the negative effects of risky online displays.

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Childhood obesity continues to be a significant public health issue. mHealth systems offer state-of-the-art approaches to intervention design, delivery, and diffusion of treatment and prevention efforts. Benefits include cost effectiveness, potential for real-time data collection, feedback capability, minimized participant burden, relevance to multiple types of populations, and increased dissemination capability. However, these advantages are coupled with unique challenges. This commentary discusses challenges with using mHealth strategies for child obesity prevention, such as lack of scientific evidence base describing effectiveness of commercially available applications; relatively slower speed of technology development in academic research settings as compared with industry; data security, and patient privacy; potentially adverse consequences of increased sedentary screen time, and decreased focused attention due to technology use. Implications for researchers include development of more nuanced measures of screen time and other technology-related activities, and partnering with industry for developing healthier technologies. Implications for health practitioners include monitoring, assessing, and providing feedback to child obesity program designers about users' data transfer issues, perceived security and privacy, sedentary behavior, focused attention, and maintenance of behavior change. Implications for policy makers include regulation of claims and quality of apps (especially those aimed at children), supporting standardized data encryption and secure open architecture, and resources for research-industry partnerships that improve the look and feel of technology. Partnerships between academia and industry may promote solutions, as discussed in this commentary. KEYWORDSChildhood, Obesity, Mobile technology, mHealth, Screen time, Focused attention, Sedentary behavior Childhood obesity continues to be a significant public health issue, increasing children's risk for elevated blood pressure and lipid concentrations, musculoskeletal pain, depression, anxiety, bullying, and later heart disease, asthma, and diabetes in adulthood [1][2][3]. Poor diet, lack of exercise, food marketing, a built environment that promotes sedentary forms of transport and leisure, lack of sleep, and television sets in children's bedrooms are some of the multiple sources contributing to children's obesogenic environment [4,5]. Behavior-based interventions are essential for prevention and treatment [6]. Many forms of behavioral obesity interventions have been tested in the past such as school, community, family, and physician based, which have shown moderate success [7][8][9]. Electronic media offers opportunities to extend current approaches and to develop new ones [8,10]. POTENTAIL SUCCESS OF MHEALTH APPROACHESElectronic mobile technologies (e.g., smartphones, iPod touch, tablets, wireless sensors, etc.) that can be employed in mobile health (mHealth) surveil-

This study has implications for research, service delivery, and policy making for health care of ethnic elderly persons, particularly in addressing structural and cultural issues in access and compliance.