Kasisomayajula Viswanath

Harvard University, Cambridge, Massachusetts, United States

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Publications (151)395.13 Total impact

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    Carina K Y Chan, Brian Oldenburg, Kasisomayajula Viswanath
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    ABSTRACT: The enormous time lag between the discovery of new knowledge and its implementation poses a significant challenge to improving public health because of the very slow uptake into policy and practice. The field of dissemination and implementation research in behavioral medicine is receiving increased attention because of the keen interest in accelerating knowledge transfer from relevant research to improve the health and wellbeing of populations in many different settings, contexts, and countries around the world. This is particularly important in high-risk populations, resource-poor and developing regions of the world where the difference in health systems, languages, and cultures very significantly influences the translation of evidence into policy and practice. Moreover, demonstrating the broader societal and economic value of behavioral interventions in settings where they are implemented can further support the sustainability, uptake, and implementation of these findings in other settings and contexts. This special issue presents a series of empirical studies, reviews, and case studies that address dissemination, implementation, and translation issues in both developed and developing countries. Specifically, the learnings from the application of many and varied theories and research methodologies are very relevant for bridging the current division between research findings and their translation and uptake into policy and practice.
    International Journal of Behavioral Medicine 05/2015; 22(3). DOI:10.1007/s12529-015-9490-2 · 2.63 Impact Factor
  • Minsoo Jung, Leesa Lin, Kasisomayajula Viswanath
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    ABSTRACT: While several studies have examined the crucial role that parents' vaccination behaviors play in reducing disease spread and severity among children, few have evaluated the connection between parents' media use and their decision on whether or not to vaccinate their child, specifically in relation to the BCG (Bacillus Calmetter Guerin), DPT (Diptheria, Pertussis, Tetanus) polio, and measles vaccines. Media channels are a critical source of health information for parents, which is especially true in Sub-Saharan Africa, as there is often a dearth of local healthcare providers. The aim of this paper is to investigate the role that media use plays in a mothers' choice to vaccinate their infant children in sub-Saharan Africa, specifically focusing on whether media use is associated with socioeconomic status (SES) and a mothers' vaccination of their children. Cross-sectional data from the Demographic Health Surveys of 13 sub-Saharan countries (2004-2010) were pooled. A multivariate Poisson regression of 151,209 women was used to calculate adjusted relative ratios and 95% confidence intervals for the associations among SES, media use, and immunization. Education and wealth were found to be strongly and positively associated with vaccine-uptake behaviors. The effects of media use (radio and television) were found to be associated with the relationships between SES and vaccine uptake. However, it did not reduce the impact of SES on vaccination. These findings indicate that mass media may be an important tool for future efforts to reduce the health discrepancies between children from high- and low-socioeconomic backgrounds. Going forward, immunization strategies should include communication plans that will address and mitigate potential immunization disparities among parents of different SES backgrounds. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 04/2015; 33(22). DOI:10.1016/j.vaccine.2015.04.021 · 3.49 Impact Factor
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    ABSTRACT: BACKGROUND We used a latent class analysis (LCA) to characterize coping styles of urban youth and examined if coping styles moderated the association between experiencing discrimination and bullying and depressive symptoms. METHODS The data come from the 2006 Boston Youth Survey, where students were asked to select 2 behaviors they do most often when they are upset, from a list of 15 options. A total of 927 (75%) students contributed to the LCA analytic sample (44% non-Hispanic Blacks, 29% Hispanics, and 58% girls). Relative and absolute fit indices determined the number of classes. An interaction term between types of discrimination and bullying experienced and coping style tested for moderation. RESULTSThe LCA revealed that a 3-class solution had the best fit (Lo-Mendell-Rubin likelihood ratio test, 4-class vs 3-class, p-value .12). The largest coping style class was characterized by high endorsement of distractive coping strategies (59%), the second class was characterized by using supportive coping strategies (27%), and the third class was characterized by using avoidance coping strategies (12%). We found a significant interaction between discrimination and coping style for depressive symptoms. CONCLUSIONS The relationship between experiencing discrimination and depression varied based on coping style and the type of discrimination and bullying experienced.
    Journal of School Health 02/2015; 85(2):109-117. DOI:10.1111/josh.12225/abstract?campaign=woletoc · 1.66 Impact Factor
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    ABSTRACT: Combustible tobacco use remains the number one preventable cause of disease, disability, and death in the United States. Electronic nicotine delivery systems (ENDS), which include e-cigarettes, are devices capable of delivering nicotine in an aerosolized form. ENDS use by both adults and youth has increased rapidly, and some have advocated these products could serve as harm-reduction devices and smoking cessation aids. ENDS may be beneficial if they reduce smoking rates or prevent or reduce the known adverse health effects of smoking. However, ENDS may also be harmful, particularly to youth, if they increase the likelihood that nonsmokers or formers smokers will use combustible tobacco products or if they discourage smokers from quitting. The American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) recognize the potential ENDS have to alter patterns of tobacco use and affect the public's health; however, definitive data are lacking. AACR and ASCO recommend additional research on these devices, including assessing the health impacts of ENDS, understanding patterns of ENDS use, and determining what role ENDS have in cessation. Key policy recommendations include supporting federal, state, and local regulation of ENDS; requiring manufacturers to register with the FDA and report all product ingredients, requiring childproof caps on ENDS liquids, and including warning labels on products and their advertisements; prohibiting youth-oriented marketing and sales; prohibiting child-friendly ENDS flavors; and prohibiting ENDS use in places where cigarette smoking is prohibited. Clin Cancer Res; 21(3); 1-12. ©2015 AACR. American Association for Cancer Research and American Society of Clinical Oncology. ©2015 American Association for Cancer Research and American Society of Clinical Oncology.
    Clinical Cancer Research 01/2015; 21(3). DOI:10.1158/1078-0432.CCR-14-2544 · 8.19 Impact Factor
  • Danielle Blanch-Hartigan, Kasisomayajula Viswanath
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    ABSTRACT: With 14 million cancer survivors in the United States, identifying and categorizing their use of sources of cancer-related information is vital for targeting effective communications to this growing population. In addition, recognizing socioeconomic and sociodemographic differences in the use of cancer-related information sources is a potential mechanism for reducing health disparities in survivorship. Fourteen sources of information survivors (N = 519) used for cancer-related information were factor-analyzed to create a taxonomy of source use. The association between social determinants and use of these source types was analyzed in regression models. Factor analysis revealed 5 categories of information source use (mass media; Internet and print; support organizations; family and friends; health care providers), and use varied based on sociodemographic and socioeconomic characteristics. Higher education predicted increased use of all source categories except mass media. African American cancer survivors turned to health care providers as a source for cancer-related information less often than did White survivors. Social determinants predicted differences in the type of cancer-related information sources used. Providers and health communicators should target communication platforms based on the demographic profile of specific survivor audiences.
    Journal of Health Communication 12/2014; 20(2):1-7. DOI:10.1080/10810730.2014.921742 · 1.61 Impact Factor
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    ABSTRACT: In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana's Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons. © The Author(s) 2014.
    11/2014; DOI:10.1177/2325957414557268
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    ABSTRACT: Studies have shown communication inequalities - differences among individuals and social groups in accessing and using information on health and specific threats - have consequential impacts on people’s knowledge, emotions and behavior responses, and ultimately health outcomes. Without being properly addressed, these inequalities could result in leaks in the surveillance net and compromise public health systems’ efforts to prevent and respond to pandemic influenza outbreaks or other types of emergencies. Here we have investigated the role communication inequalities play during the 2009/2010 A(H1N1) pandemics focusing on the associations among people’s concerns about being infected by the A(H1N1) virus, levels of A(H1N1)-related knowledge, and the subsequent health behavioral responses. Using nationally-representative cross-sectional survey data collected during the 2009/2010 A(H1N1) pandemic among American adults, we conducted hierarchical ordered or general logistic regression analyses, whenever appropriate. We found a strong association persists between health behavioral and levels of concerns about the possibility of self or family members being infected by the A(H1N1) virus, even after adjustment for socioeconomic position. Specifically, concerns, general media exposure, and being Hispanic were positively associated with the uptake of hygienic practices, employment of social distancing, and seeking of medical consultation. Knowing the modes of transmission of A(H1N1) virus was also positively related to the use of non-pharmaceutical interventions. Therefore, carefully crafted health communication campaigns that raise the public sense of urgency to a proper level could help cue people to take actions to protect themselves and loved ones.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient-physician communication, improve HIV testing, and increase use of mHealth. (Am J Public Health. Published online ahead of print October 16, 2014: e1-e5. doi:10.2105/AJPH.2014.302120).
    American Journal of Public Health 10/2014; DOI:10.2105/AJPH.2014.302120 · 4.23 Impact Factor
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    ABSTRACT: Inequalities in Internet use and health information seeking are well documented, but less is known about information for family life activities.
    Journal of Medical Internet Research 10/2014; 16(10):e227. DOI:10.2196/jmir.3386 · 4.67 Impact Factor
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    Minsoo Jung, Carina Ka Yee Chan, Kasisomayajula Viswanath
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    ABSTRACT: Reducing fear of cancer is significant in developing cancer screening interventions, but the levels of fear may vary depending on the degrees of media exposure as well as individuals' socioeconomic positions (SEP). However, few studies have examined how the SEP influences the fear of cancer under the moderating process of general and specific forms of media exposure. We investigated the moderating effect of media exposure on the relationship between SEP and the level of fear of cancer by assuming that cancer knowledge is a covariate between those two. In particular, this study examined how exposure to both general and specific media changes the series of processes from SEP to fear of cancer. We conducted path analyses with three types of media - television, radio and the Internet- using data from a health communication survey of 613 adults in Massachusetts in the United States. We found that SEP influences cancer knowledge directly and fear of cancer indirectly, as moderated by the level of media exposure. Health-specific exposure, however, had a more consistent effect than general media exposure in lowering the fear of cancer by increasing knowledge about cancer. A higher level of health-specific exposure and greater amount of cancer knowledge lessened the fear of cancer. In addition, the more people were exposed to health information on television and the Internet, the lower the level of fear of cancer as a result. These findings indicate a relationship between SEP and fear of cancer, as moderated by the level and type of media exposure. Furthermore, the findings suggest that for early detection or cancer prevention strategies, health communication approaches through mass media need to be considered.
    Asian Pacific journal of cancer prevention: APJCP 07/2014; 15. DOI:10.7314/APJCP.2014.15.14.5845 · 2.51 Impact Factor
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    ABSTRACT: It is known that HIV-related stigma hinders prevention efforts. Previous studies have documented that HIV-related stigma may be associated with socioeconomic and socioecological factors. Mass media use may moderate this association, but there is limited research addressing that possibility. In this study, based on cross-sectional data pooled from the 2006-2011 Demographic and Health Surveys of 11 sub-Saharan African countries (N = 204,343), we investigated the moderating effects of exposure to mass media on HIV-related stigma. Hierarchical regression analysis indicated that HIV-related stigma tends to be higher among rural residents and individuals with low levels of education and HIV knowledge, as well as those who do not know people living with HIV. Media use was generally associated with low levels of HIV-related stigma, and attenuated the gap between individuals with high and low educational levels. However, the effect of mass media was found to be stronger among urbanites rather than among rural residents, which could lead to a widening gap between the two groups in endorsement of HIV-related stigma. The implication of this study regarding the effect of media use on HIV-related stigma in sub-Saharan Africa is twofold: 1) mass media may have the potential to minimize the gap in HIV-related stigma between individuals with high and low educational levels, and hence future efforts of reducing HIV-related stigma in the region may benefit from utilizing media; 2) due perhaps to low media penetration to rural sub-Saharan Africa, mass media could have the unintended effect of widening the urban-rural gap further unless other more customized and rural-focused communication interventions are put in place.
    PLoS ONE 06/2014; DOI:10.1371/journal.pone.0100467 · 3.53 Impact Factor
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    Leesa Lin, Elena Savoia, Foluso Agboola, Kasisomayajula Viswanath
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    ABSTRACT: During public health emergencies, public officials are busy in developing communication strategies to protect the population from existing or potential threats. However, population's social and individual determinants (i.e. education, income, race/ethnicity) may lead to inequalities in individual or group-specific exposure to public health communication messages, and in the capacity to access, process, and act upon the information received by specific sub-groups- a concept defined as communication inequalities.The aims of this literature review are to: 1) characterize the scientific literature that examined issues related to communication to the public during the H1N1 pandemic, and 2) summarize the knowledge gained in our understanding of social determinants and their association with communication inequalities in the preparedness and response to an influenza pandemic.
    BMC Public Health 05/2014; 14(1):484. DOI:10.1186/1471-2458-14-484 · 2.32 Impact Factor
  • 10th Annual Harvard University Junior Investigators’ Health Disparities Research Poster Session. Boston, MA, USA, 8 May 2014.; 05/2014
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    ABSTRACT: Objective:In 2006, the US Centers for Disease Control and Prevention recommended routine HIV testing in health care settings and called for HIV testing campaigns targeting African Americans. In a 2011 national survey, 63% of African Americans wanted information on HIV testing.Methods:In our study, 176 African Americans were surveyed to determine channels and spokespersons for an HIV testing campaign.Results:Among 9 media channels, the top 3 ranked as "very likely" to convince them to get HIV tested were television, poster, and brochure. Among 10 spokespersons, the top 3 were doctor, nurse, and "real person like me."Conclusion:The media are a cost-effective strategy to promote HIV prevention. Posters and brochures are inexpensive and easy to reproduce for clinical settings. Television campaigns may be feasible in clinics with closed-circuit televisions. Research is needed on campaign messages. An effective health center HIV testing campaign may help mitigate the disproportionate toll HIV is having on African Americans.
    04/2014; DOI:10.1177/2325957414529823
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    ABSTRACT: Promoting healthy behaviors may reduce the risk of co-morbidities among childhood and young adult (CYA) cancer survivors. Although behavioral interventions are one way to encourage such activities, there is increasing evidence that health media use-particularly health information seeking-also may influence health knowledge, beliefs, and behaviors. The current study explores patterns of health media use among survivors of CYA cancer. Our focus is on survivors who smoke and thus are at even greater risk of co-morbidities. We analyzed data from the Partnership for Health-2 study, a web-based smoking cessation intervention, to examine the prevalence of and factors associated with health media use (N = 329). Nearly two thirds (65.3 %) of CYA survivors who smoke reported infrequent or no online health information seeking. Many reported never reading health sections of newspapers or general magazines (46.2 %) or watching health segments on local television news (32.3 %). Factors associated with health media use include education and employment, cancer-related distress, and smoking quit attempts. Health information engagement is low among CYA survivors who smoke, particularly active seeking of health information online. Population subgroups differ in their media use patterns; some of these differences reflect communication inequalities, which have the potential to exacerbate health disparities. Clinicians have an opportunity to guide CYA survivors towards useful and reliable information sources. This guidance could help survivors fulfill their unmet information and support needs and may be particularly important for less educated survivors and other underserved populations.
    Supportive Care in Cancer 04/2014; 22(9). DOI:10.1007/s00520-014-2236-x · 2.50 Impact Factor
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    Danielle Blanch-Hartigan, Kelly D Blake, Kasisomayajula Viswanath
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    ABSTRACT: A large proportion of the 14 million cancer survivors in the USA are actively seeking health information. This study builds on the informed- and shared-decision making literature, examining cancer survivors' health information seeking behaviors to (1) quantify the number of health information sources used; (2) create a demographic profile of patients who report seeking cancer information from numerous sources versus fewer sources in five areas: cancer information overall, disease/treatment, self-care/management, health services, and work/finances; and (3) examine whether seeking cancer information from numerous sources is associated with self-efficacy, fear of recurrence, perceptions of information seeking difficulty, and resultant patient-provider communication. Data came from a survey of post-treatment cancer survivors (N = 501) who responded to a mailed questionnaire about health information seeking. Participants were divided into two groups using a median split: those who sought health information from more than five sources (numerous source seekers) and those that sought information from less than five sources (fewer source seekers). Multivariable logistic regression was used to model differential information seeking behaviors and outcomes for numerous versus fewer source seekers. On average, survivors sought cancer-related information from five different sources. Numerous source seekers were more likely to be women, have higher levels of education, and report fewer problems with cancer information-seeking. Overall, numerous source seekers were no more or less likely to discuss information with their providers or bring conflicting information to their providers. Understanding the characteristics, behaviors, and experiences of survivors who seek cancer-related information from numerous sources can contribute to informed decision making and patient-centered care.
    Journal of Cancer Education 04/2014; 29(3). DOI:10.1007/s13187-014-0642-x · 1.05 Impact Factor
  • Man Ping Wang, Xin Wang, Tai Hing Lam, Kasisomayajula Viswanath, Sophia S Chan
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    ABSTRACT: To investigate the cross-sectional association between smoking and happiness in Chinese adults in Hong Kong. Telephone surveys were conducted between 2009 and 2012 with 4,553 randomly sampled Chinese adults (male 54%, mean age 58.3) in Hong Kong. Measurements Happiness was measured using the four-item Subjective Happiness Scale (SHS) and single-item Global Happiness Item (GHI). Smoking status was categorised as current smokers (9.0%), ex-smokers (6.7%, 93% quit for > 6 months) and never smokers (84.3%). Linear and ordinal logistic regressions were used to calculate adjusted β-coefficients for SHS and proportional odds ratios (aOR) for GHI in relation to smoking. Compared with current smokers, ex-smokers enjoyed greater happiness according to both SHS (adjusted β=0.16, P < 0.05) and GHI (aOR = 1.52, P < 0.05) measurements, but current and never smokers were similar. Among current smokers, the number of cigarettes smoked was not associated with happiness, but the lack of any attempt to quit was significantly associated with greater happiness (adjusted β=0.31 for SHS, aOR = 1.82 for GHI) compared with smokers who had tried to quit but not succeeded. Smokers not intending to quit in the next 6 months had higher odds of happiness (GHI) than those wanting to quit within 6 months (aOR = 1.86, P < 0.05). Ex-smokers in Hong Kong are happier than current smokers and never smokers, whose happiness measurements are similar. Causal associations have yet to be established.
    Addiction 03/2014; 109(7). DOI:10.1111/add.12531 · 4.60 Impact Factor
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    ABSTRACT: Purpose Athlete's report of concussion symptoms to coaching or medical personnel is an important component of concussion risk reduction. This study applies a model based on the Theory of Planned Behavior (TPB) to the prediction of concussive symptom underreporting among late adolescent and young adult male ice hockey players. Methods Participants were members of an American Tier III Junior A ice hockey league (ages 18–21 years; male; n = 256). Twelve of 14 league teams and 97% of players within these teams agreed to participate. Written survey items assessed symptom reporting behavior, intention, perceived norms, self-efficacy, perceived outcomes of reporting, and concussion knowledge. Structural equation modeling was used to assess the significance of relationships hypothesized by the TPB-based model and the overall model fit. Data were collected in January 2013. Results Results supported the fit of the TPB-based model in explaining reporting behavior; all model pathways were significant in the hypothesized direction. Of the perceived reporting outcomes assessed, those related to athletic performance were identified as most strongly associated with reporting intention. Conclusions Results of this study suggest the importance of considering factors such as perceived outcomes of reporting, perceived norms, and self-efficacy, in addition to knowledge, when analyzing concussion underreporting among adolescent athletes. As concussion education for athletes becomes increasingly mandated, testing and applying psychosocial theories such as TPB may help increase program efficacy.
    Journal of Adolescent Health 03/2014; 54(3):269–274.e2. DOI:10.1016/j.jadohealth.2013.11.011 · 2.75 Impact Factor
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    ABSTRACT: Background:Despite the 2006 US Centers for Disease Control and Prevention (CDC) recommendations for routine HIV testing in health care settings, many persons remain untested.Purpose:To determine physician barriers to HIV testing, we surveyed primary care physicians in community health centers in a high HIV prevalence city.Methods:Primary care physicians were invited via e-mail to participate in a Web-based survey. One hundred and thirty-seven physicians participated (response rate: 43.9%).Results:Fifty-five physicians (41.0%) were unaware of updated CDC HIV-testing recommendations. Physicians were unaware that testing should be routinely offered in primary care settings caring for adolescents (62 physicians, 45.6%) and primary care settings caring for adults (33, 24.3%). Physicians were also unaware that teenage years patients aged 13 to 17 years (68, 49.6%) and adult patients aged 18 to 64 years (40, 29.2%) should be routinely HIV tested.Conclusion:With the new 2013 US Preventive Services Task Force recommendations to support routine HIV testing, it is critical to address ongoing physician HIV-testing barriers to mitigate the HIV epidemic.
    01/2014; DOI:10.1177/2325957413517140
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    ABSTRACT: Obesity is increasing dramatically in the Asia-Pacific region particularly China. The population of Hong Kong was exposed to modernization far earlier than the rest of China, reflecting conditions that are likely to be replicated as other Chinese cities undergo rapid change. This study examined the relationship between television viewing and obesity in a Hong Kong sample. Information about the relationship between a key sedentary behavior, TV viewing, and obesity, and its moderation by demographic characteristics may identify sectors of the population at highest risk for excess weight. Data were from Hong Kong Family and Health Information Trends Survey (2009-2010), a population-based survey on the public's use of media for health information and family communication by telephone interviews with 3,016 Hong Kong adults (age≥18 years). TV viewing time, body mass index (BMI), physical activity and other lifestyle variables were analyzed. Viewing time was longer in women, increased with age but decreased with education level and vigorous physical activity (all P<0.01). Longer TV viewing time was significantly associated with higher BMI (Coefficients B = 0.17, 95% CI: 0.11, 0.24) after adjusting for age, gender, employment status, marital status, education level, smoking activity and vigorous physical activity. This association was stronger in women than men (Coefficients B: 0.19 versus 0.15) and strongest in those aged 18 to 34 years (Coefficients B = 0.35). Furthermore, an hour increase in daily TV viewing was associated with 10% greater odds of being obese. A significant socioeconomic gradient in television viewing time was observed. TV viewing time positively associated with BMI and obesity. The TV viewing - BMI associations were strongest in women and young adults, suggesting vulnerable groups to target for obesity prevention by decreasing TV viewing.
    PLoS ONE 01/2014; 9(1):e85440. DOI:10.1371/journal.pone.0085440 · 3.53 Impact Factor

Publication Stats

3k Citations
395.13 Total Impact Points


  • 2007–2015
    • Harvard University
      • Department of Society, Human Development, and Health
      Cambridge, Massachusetts, United States
    • Massachusetts Department of Public Health
      Boston, Massachusetts, United States
  • 2005–2015
    • Dana-Farber Cancer Institute
      • • Center for Community-Based Research
      • • McGraw/Patterson Center for Population Sciences
      Boston, Massachusetts, United States
  • 2006–2014
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2013
    • The University of Hong Kong
      • School of Public Health
      Hong Kong, Hong Kong
  • 2009–2013
    • Baylor College of Medicine
      • Section of Infectious Diseases
      Houston, TX, United States
    • Emory University
      • Department of Behavioral Sciences and Health Education
      Atlanta, GA, United States
  • 2007–2010
    • University of Texas MD Anderson Cancer Center
      • Health Disparities Research
      Houston, Texas, United States
  • 2004–2005
    • National Cancer Institute (USA)
      • Division of Cancer Control and Population Sciences
      Bethesda, MD, United States
  • 1990–2000
    • The Ohio State University
      Columbus, Ohio, United States
  • 1993
    • University of Kentucky
      Lexington, Kentucky, United States
  • 1991
    • University of Minnesota Duluth
      Duluth, Minnesota, United States