Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study
BS Christine Cislo, BS Caroline Ashley Clingan, Kristen N Gilley, Michelle Lois Rozwadowski, MSc Izzy Gainsburg, Christina Bradley, Jenny Barabas, Erin Sandford, Mary Olesnavich, Jonathan Tyler, Caleb Mayer, BS Matthew Stephen Demoss, Christopher Flora, PhD Daniel B Forger, PhD Julia Lee Cunningham, PhD; Muneesh Muneesh Tewari, MD, PhD Sung Won Choi
JMIR Research Protocols, doi:10.2196/29561
Background: The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. Objective: This study leveraged mobile health (mHealth) technology and sought to (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine.
Authors' Contributions KNG drafted the manuscript, coordinated the study, carried out recruitment, provided consent, carried out onboarding, and curated the data and figures. LB and MY drafted the manuscript and curated the data and figures. IG and CB critically reviewed and edited the manuscript, selected the survey measurements, and designed the study methodology. NR critically reviewed and edited the manuscript and curated the data. C Cislo, MLR, and C Clingan critically reviewed and edited the manuscript, coordinated the study, carried out recruitment and onboarding, obtained consent, and curated the data. MSD critically reviewed and edited the manuscript, designed the study methodology, and curated the data and figures. TC critically reviewed and edited the manuscript. KB, NC, MC, JG, and RFZ critically reviewed and edited the manuscript and designed the study methodology. DF designed the study methodology, supervised the study, critically reviewed and edited the manuscript, and created the Social Rhythms app. JLC critically reviewed and edited the manuscript, selected the study measurements, and designed the study methodology. SC critically reviewed and edited the manuscript, supervised the study, and designed the study methodology. MT and SC curated the data, carried out the investigation, curated the resources, supervised the study, visualized the data, and drafted, edited, and critically revised the manuscript. SC created the Roadmap 2.0 app.
Conflicts of Interest..
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doi:10.1016/j.jad.2009.01.001{ 'indexed': {'date-parts': [[2022, 4, 19]], 'date-time': '2022-04-19T15:51:06Z', 'timestamp': 1650383466911},
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'abstract': '<jats:sec>\n'
' <jats:title>Background</jats:title>\n'
' <jats:p>The COVID-19 pandemic triggered a seismic shift in education to web-based '
'learning. With nearly 20 million students enrolled in colleges across the United States, the '
'long-simmering mental health crisis in college students was likely further exacerbated by the '
'pandemic.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Objective</jats:title>\n'
' <jats:p>This study leveraged mobile health (mHealth) technology and sought to (1) '
'characterize self-reported outcomes of physical, mental, and social health by COVID-19 '
'status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and '
'(3) identify risk factors associated with COVID-19 positivity in a population of college '
'students prior to release of the vaccine.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>After completing a baseline assessment (ie, at Time 0 [T0]) of '
'demographics, mental, and social health constructs through the Roadmap 2.0 app, participants '
'were instructed to use the app freely, wear the Fitbit, and complete subsequent assessments '
'at T1, T2, and T3, followed by a COVID-19 assessment of history and timing of COVID-19 '
'testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using mean '
'(SD) values, while categorical measures were summarized as n (%) values. Formal comparisons '
'were made on the basis of COVID-19 status. The multivariate model was determined by entering '
'all statistically significant variables (P<.05) in univariable associations at once and '
'then removing one variable at a time through backward selection until the optimal model was '
'obtained.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>During the fall 2020 semester, 1997 participants consented, enrolled, and '
'met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the '
'State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 970 (49%) '
'students, respectively. Approximately one-third of students reported having a mental health '
'disorder (n=656, 33%). The average daily steps recorded in this student population was '
'approximately 6500 (mean 6474, SD 3371). Neither reported mental health nor step count were '
'significant based on COVID-19 status (P=.52). Our analyses revealed significant associations '
'of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) '
'and with lower belief in public health measures (P=.003). In addition, graduate students were '
'less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis '
'(P=.009).</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Conclusions</jats:title>\n'
' <jats:p>Mental health problems were common in this student population. Several '
'factors, including substance use, were associated with the risk of COVID-19. These data '
'highlight important areas for further attention, such as prioritizing innovative strategies '
'that address health and well-being, considering the potential long-term effects of COVID-19 '
'on college students.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>Trial Registration</jats:title>\n'
' <jats:p>ClinicalTrials.gov NCT04766788; '
'https://clinicaltrials.gov/ct2/show/NCT04766788</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>International Registered Report Identifier (IRRID)</jats:title>\n'
' <jats:p>RR2-10.2196/29561</jats:p>\n'
' </jats:sec>',
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