Bonnie Spring

• PhD
• Professor at Northwestern University

Purpose This study explored oncologists’ reported conversations with adult cancer survivors about three modifiable risk behaviors: poor diet, smoking, and insufficient physical activity. These behaviors can increase disease recurrence and early mortality. By asking oncologists to report their approach to these discussions, we can begin to identify...

Purpose Increasing physical activity (PA) is safe and associated with improved health outcomes in patients with metastatic breast cancer (MBC). Mobile health (mHealth) PA interventions that allow for remote monitoring and tailoring to abilities may be particularly useful for MBC patients. However, limited data exist on the acceptability of these in...

Stepped-care obesity treatments aim to improve efficiency by early identification of non-responders and adjusting interventions but lack validated models. We trained a random forest classifier to improve the predictive utility of a clinical decision rule (>0.5 lb weight loss/week) that identifies non-responders in the first 2 weeks of a stepped-car...

Obesity is associated with alterations in circulating IGF1, IGF1-binding proteins (IGFBPs), insulin, inflammatory markers, and hormones implicated in cardiovascular disease, diabetes, cancer, and aging. However, the effects of 4 and 6 h time-restricted eating (TRE) on circulating IGF1 and IGFBPs is uncertain. Objective: This study aimed to investig...

Background Digital, or eHealth, interventions are highly promising approaches to help adolescents improve their health behaviours and reduce their risk of chronic disease. However, they often have low uptake and retention. There is also a paucity of high-quality research into the predictors of eHealth engagement, and a lack of studies that have sys...

Objective This study experimentally tested whether coach access to participants' digital self‐monitoring data improved behavioral weight‐loss outcomes. Methods Participants ( N = 322) received 12 weeks of group‐based behavioral weight‐loss sessions via videoconference and were instructed to engage in daily self‐monitoring of weight, physical activ...

Background South Asian Americans bear a high burden of atherosclerotic cardiovascular disease (ASCVD), but little is known about the sustainability of evidence-based interventions (EBI) to prevent ASCVD in this population. Using community-based participatory research, we previously developed and implemented the South Asian Healthy Lifestyle Interve...

Importance South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. Objective To evaluate whether a culturally adapted, group lifestyle intervention will improve C...

BACKGROUND Digital health behavior change interventions play an important role in helping cancer survivors improve their quality of life and reduce the risk of cancer recurrence. Clinician-patient communication is central to promoting the uptake of and adherence to digital health behavior change interventions. However, oncologists face significant...

Background Opt2Move is a theory-guided moderate and vigorous physical activity (MVPA) promotion trial that uses multiphase optimization strategy (MOST) methodology to evaluate the individual and combined effects of four intervention components in a full factorial experiment among young adult cancer survivors (YACS; N = 304). All participants will r...

Objective To evaluate whether the neighborhood social and built environment moderates response to a mobile health multiple health behavior change intervention targeting fruit/vegetable intake, sedentary behavior, and physical activity. Methods Participants were 156 Chicago-residing adults with unhealthy lifestyle behaviors. Using linear mixed mode...

Purpose Physical activity research among patients with metastatic breast cancer (MBC) is limited. This study examined the feasibility and potential benefits of Fit2ThriveMB, a tailored mHealth intervention. Methods Insufficiently active individuals with MBC (n = 49) were randomized 1:1 to Fit2ThriveMB (Fit2ThriveMB app, Fitbit, and weekly coaching...

Northwestern University’s Center for Scalable Telehealth Cancer Care (STELLAR) is 1 of 4 Cancer Moonshot Telehealth Research Centers of Excellence programs funded by the National Cancer Institute to establish an evidence base for telehealth in cancer care. STELLAR is grounded in the Institute of Medicine’s vision that quality cancer care includes n...

The COVID-19 pandemic placed a spotlight on the potential to dramatically increase the use of telehealth across the cancer care continuum, but whether and how telehealth can be implemented in practice in ways that reduce, rather than exacerbate, inequities are largely unknown. To help fill this critical gap in research and practice, we developed th...

Importance Lifestyle interventions for weight loss are difficult to implement in clinical practice. Self-managed mobile health implementations without or with added support after unsuccessful weight loss attempts could offer effective population-level obesity management. Objective To test whether a wireless feedback system (WFS) yields noninferior...

Objectives To investigate the effectiveness of a school‐based multiple health behaviour change e‐health intervention for modifying risk factors for chronic disease (secondary outcomes). Study design Cluster randomised controlled trial. Setting, participants Students (at baseline [2019]: year 7, 11–14 years old) at 71 Australian public, independen...

OBJECTIVES/GOALS: To introduce the new Team Science Community Toolkit, co-created by community and academic partners, and showcase its potential to empower Community Organizations (COs) in achieving equity in community-engaged research (CER). METHODS/STUDY POPULATION: In response to the challenges faced by COs in CER collaborations, qualitative int...

Purpose For the same reasons that rural telehealth has shown promise for enhancing the provision of care in underserved environments, social media recruitment may facilitate more inclusive research engagement in rural areas. However, little research has examined social media recruitment in the rural context, and few studies have evaluated the feasi...

Importance Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear. Objective To study whether home-based walking exercise im...

Physical activity (PA) guidelines recommend that PA be accumulated in bouts of 10 minutes or more in duration. Recently, researchers have sought to better understand how participants in PA interventions increase their activity. Participants can increase their daily PA by increasing the number of PA bouts per day while keeping the duration of the bo...

Background Overweight and obesity are associated with adverse functional outcomes in people with peripheral artery disease (PAD). The effects of weight loss in people with overweight/obesity and PAD are unknown. Methods The PROVE (Promote Weight Loss in Obese PAD Patients to Prevent Mobility Loss) Trial is a multicentered randomized clinical trial...

To describe the reach, implementation, and sustainability of COVID-19 vaccination programs delivered by social service community organizations. Five academic institutions in the Chicagoland CEAL (Community Engagement Alliance) program partnered with 17 community organizations from September 2021—April 2022. Interviews, community organizations progr...

Introduction As the COVID-19 pandemic placed a spotlight on the health inequities in the United States, this study aimed to determine the local programmatic needs of community organizations (CO) delivering COVID-19 interventions across Chicago. Methods In the summer of 2021, the Chicagoland CEAL Program interviewed 34 COs that were providing educa...

Objective: Assess trusted sources of information, perceived message effectiveness, and preferred dissemination strategies regarding adolescent HPV vaccination among U.S. Vietnamese parents. Methods: Data came from an observational, explanatory sequential mixed-methods study with U.S. Vietnamese parents of adolescents (408 survey participants; 32...

Background: Moderate to vigorous physical activity (MVPA) interventions improve patient-reported outcomes (PROs) of physical and psychological health among breast cancer survivors (BCS); however, the effects of specific intervention components on PROs are unknown. Purpose: To use the Multiphase Optimization Strategy (MOST) to examine overall eff...

Psychological interventions, especially those leveraging mobile and wireless technologies, often include multiple components that are delivered and adapted on multiple timescales (e.g., coaching sessions adapted monthly based on clinical progress, combined with motivational messages from a mobile device adapted daily based on the person’s daily emo...

Objectives: Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors...

Background: Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective: This stud...

Background: Lifestyle risk behaviours are prevalent among adolescents and commonly co-occur, but current intervention approaches tend to focus on single risk behaviours. This study aimed to evaluate the efficacy of the eHealth intervention Health4Life in modifying six key lifestyle risk behaviours (ie, alcohol use, tobacco smoking, recreational sc...

Background: Participants in behavioral weight loss (BWL) programs increasingly use digital tools to self-monitor weight, physical activity, and dietary intake. Data collected with these tools can be systematically shared with other parties in ways that might support behavior change. Methods: Adults age 18 to 70 with overweight/obesity (BMI 27-50...

Despite the known benefits of moderate-to-vigorous physical activity (MVPA) for breast and endometrial cancer survivors, most are insufficiently active, interventions response is heterogeneous, and MVPA programming integration into cancer care is limited. A stepped care approach, in which the least resource-intensive intervention is delivered first...

Psychological interventions, especially those leveraging mobile and wireless technologies, often include multiple components that are delivered and adapted on multiple timescales (e.g., coaching sessions adapted monthly based on clinical progress, combined with motivational messages from a mobile device adapted daily based on the person's daily emo...

Background: Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in be...

Background Rural Appalachian residents experience among the highest prevalence of chronic disease, premature mortality, and decreased life expectancy in the nation. Addressing these growing inequities while avoiding duplicating existing programming necessitates the development of appropriate adaptations of evidence-based lifestyle interventions. Ye...

Introduction: An optimal exercise intervention for individuals with peripheral artery disease (PAD) should improve both objective measures of walking and patient reported outcomes (PROs). This study evaluated whether home-based walking exercise conducted at a pace that induced ischemic leg symptoms (high intensity) improved both treadmill walking d...

Objective: Concerns have been raised regarding the impact of time-restricted eating (TRE) on sex hormones in females. This study examined how TRE affects sex steroids in premenopausal and postmenopausal females. Methods: This is a secondary analysis of an 8-week TRE study (4- to 6-hour eating window) conducted in adults with obesity. Men and per...

BACKGROUND Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. OBJECTIVE This study ai...

Importance Consuming a whole food plant-based diet (WFPBD) is a promising, low-risk strategy for reducing risk of prevalent chronic disease and certain cancers, with synergistic benefits for climate and environment. However, few US adults report consuming a WFPBD. Understanding the reasons for this inconsistency is important for developing and impl...

Background : Digital approaches are frequently described as an ideal way to engage young people with health interventions. However, uptake and adherence to these interventions is often poor. Identifying factors associated with engagement, and the best methods to encourage engagement, is a critical issue for the digital health field. This presentati...

Lifestyle risk behaviors often co-occur and are prevalent among adolescents. Parent-based interventions addressing risk behaviors concurrently have the potential to improve youth and parent outcomes. This systematic review evaluated the efficacy of parent-based interventions targeting multiple lifestyle risk behaviors among adolescents and parents....

A growing evidence base suggests that complex healthcare problems are optimally tackled through cross-disciplinary collaboration that draws upon the expertise of diverse researchers. Yet, the influences and processes underlying effective teamwork among independent researchers are not well-understood, making it difficult to fully optimize the collab...

BACKGROUND Obesity-attributable medical expenditures remain high, but effective and economical interventions have not been adequately identified. Predicting the likelihood of success of weight loss in interventions using machine learning (ML) models may enhance intervention effectiveness by enabling timely and dynamic modification of intervention c...

Background Predicting the likelihood of success of weight loss interventions using machine learning (ML) models may enhance intervention effectiveness by enabling timely and dynamic modification of intervention components for nonresponders to treatment. However, a lack of understanding and trust in these ML models impacts adoption among weight mana...

Objectives Despite the presence of several weight loss apps on the market, the validity of the diet data collected from these apps has rarely been tested. A granular analysis of app validity at the food-level, rather than overall intake, is needed to closely examine factors that contribute to the variability of diet data between these apps and stan...

Objectives This study examined the effect of 10-h time restricted diet on breast cancer risk, assessing changes in body weight, insulin, IGF-1, and IGF binding protein 1, 2, and 3 among pre and postmenopausal women with overweight and obesity. Methods Women with overweight or obesity (n = 25) were enrolled into a time-restricted diet for 6 months....

Although US tobacco use trends show overall improvement, social disadvantage continues to drive significant disparities. Traditional tobacco cessation interventions and public policy initiatives have failed to equitably benefit socially-disadvantaged populations. Advancements in mobile digital technologies have created new opportunities to develop...

Importance: Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults. Objective: To evaluate whether a moderate-intensity exercise intervention can af...

Background Obesity is a substantial public health concern; however, gold-standard behavioral treatments for obesity are costly and burdensome. Existing adaptations to the efficacious Diabetes Prevention Program (DPP) demonstrate mixed results. Our prior research applying the Multiphase Optimization Strategy (MOST) to DPP identifies a more parsimoni...

Background: Despite emerging evidence that a whole food plant-based diet (WFPBD) can reduce risk for CVD morbidity and mortality, adoption rates in the US remain low (~4%). Little is known about why this disconnect exists, and understanding this is critical to designing and implementing interventions intended to increase WFPBD consumption in the US...

Background: Cardiovascular disease (CVD) persists as the leading preventable cause of death in the US and worldwide. The American Heart Association (AHA) defines ideal cardiovascular health as the presence of: non-smoking, normal weight, adequate physical activity, healthy diet, normal blood pressure, normal fasting plasma glucose, and normal chole...

Background In people with peripheral artery disease, post hoc analyses of the LITE (Low Intensity Exercise Intervention in Peripheral Artery Disease) randomized trial were conducted to evaluate the effects of walking exercise at a pace inducing ischemic leg symptoms on walking velocity and the Short Physical Performance Battery, compared with walki...

The Lupus Intervention Fatigue Trial (LIFT) is a prospective, randomized controlled trial to assess the effectiveness of a six-month motivational interviewing intervention program versus an educational control to reduce fatigue in persons with systematic lupus erythematosus (SLE). Participants are randomized using a stratified, 1:1 allocation desig...

Self-reports indicate that stress increases the risk for smoking; however, intensive data from sensors can provide a more nuanced understanding of stress in the moments leading up to and following smoking events. Identifying personalized dynamical models of stress-smoking responses can improve characterizations of smoking responses following stress...

Background The benefits of moderate to vigorous physical activity (MVPA) for breast cancer survivors are well established. However, most are insufficiently active. Fit2Thrive used the Multiphase Optimization Strategy methodology to determine the effect of 5 intervention components on MVPA in this population. Methods Two hundred sixty‐nine particip...

Objective: In a randomized clinical trial of people with lower extremity peripheral artery disease (PAD), to test whether walking exercise conducted at a pace without ischemic leg symptoms improved physical activity more than walking exercise conducted at a pace that induced ischemic leg symptoms and more than an attention control group. Methods &...

Introduction: Recent evidence showed that among people with peripheral artery disease (PAD), walking exercise conducted at a pace inducing ischemic leg symptoms improved six-minute walk distance (6MW), while walking exercise conducted at a pace without ischemic leg symptoms had no effect on 6MW. This report describes associations of walking exercis...

Background Raised low-density lipoprotein cholesterol (LDL-C) in young adulthood (aged 18-39 years) is associated with atherosclerotic cardiovascular disease (ASCVD) later in life. Most young adults with elevated LDL-C do not currently receive lipid-lowering treatment. Objectives This study aimed to estimate the prevalence of elevated LDL-C in ASC...

To improve understanding of how interventions work or why they do not work, there is need for methods of testing hypotheses about the causal mechanisms underlying the individual and combined effects of the components that make up interventions. Factorial mediation analysis, i.e., mediation analysis applied to data from a factorial optimization tria...

Background Commercial nutrition apps are increasingly used to evaluate diet. Evaluating the comparative validity of nutrient data from commercial nutrition app databases is important to determine the merits of using these apps for dietary assessment. Objective Nutrient data from four commercial nutrition apps were compared with a research-based fo...

Background/Objective Growing recognition that collaboration among scientists from diverse disciplines fosters the emergence of solutions to complex scientific problems has spurred initiatives to train researchers to collaborate in interdisciplinary teams. Evaluations of collaboration patterns in these initiatives have tended to be cross-sectional,...

Background Physical inactivity, poor diet, sedentary recreational screen time, poor sleep, alcohol use and smoking (the “Big 6”) are key lifestyle risk factors for chronic disease. The Big 6 typically emerge during adolescence, co-occur and continue into adulthood. To improve short- and long-term health, early and effective prevention is critical....

Increased moderate and vigorous physical activity (MVPA) is associated with better health outcomes in breast cancer survivors; yet, most are insufficiently active. Smartphone applications (apps) to promote MVPA have high scalability potential, but few evidence-based apps exist. The purpose is to describe the testing and usability of Fit2Thrive, a M...

Background: Relapse to smoking is commonly triggered by stress, but behavioral interventions have shown only modest efficacy in preventing stress-related relapse. Continuous digital sensing to detect states of smoking risk and intervention receptivity may make it feasible to increase treatment efficacy by adapting intervention timing. Objective:...

Background: Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. Howeve...

Background and Aims: Self-reports indicate that stress increases risk for smoking; however, intensive data from sensors can provide a more nuanced understanding of stress in the moments leading up to and following smoking events. Identifying personalized dynamical models of stress-smoking responses can improve characterizations of smoking responses...

This study investigated cross-sectional associations of peripheral artery disease (PAD) severity (defined by the ankle–brachial index (ABI)) and amounts of daily sustained physical activity (PA) (defined as > 100 activity counts per minute lasting 5 consecutive minutes or more). This study also investigated associations of amounts of daily sustaine...

Importance Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor. Objective To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people wi...

Background In older adults, increases in physical activity may prevent decline in lower-extremity function, but whether the benefit differs according to metabolic syndrome (MetS) status is uncertain. We aim to investigate whether structured physical activity is associated with less decline in lower-extremity function among older adults with versus...

IMPACT: Our research identifies key opportunities for increased cross-CTSA collaboration, as a means to improve community-research cooperation and better CBPR practices. OBJECTIVES/GOALS: Currently, team science training prioritizes developing the collaborative competencies of interdisciplinary scientists to work with each other and, more recently,...

Objective: We applied the ORBIT model to digitally define dynamic treatment pathways whereby intervention improves multiple risk behaviors. We hypothesized that effective intervention improves the frequency and consistency of targeted health behaviors and that both correlate with automaticity (habit) and self-efficacy (self-regulation). Method:...

Objective Associations between cancer beliefs and health behavior engagement are largely unexplored in cancer survivors, particularly among those with overweight and obesity. We investigated belief-behavior associations for cancer survivors, and whether obesity altered these associations. Methods Cancer survivors were identified from the National...

Background Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limited adjunctive cancer care, as many lack access to pain therapists trained in behavioral interven...

Background: eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective: The objective of this study was to determin...

African Americans have disproportionate rates of post-cessation weight gain compared to non-Hispanic whites, but few studies have examined this weight gain in a multiracial sample of smokers receiving evidence-based treatment in a community setting. We examined race differences in short-term weight gain during an intervention to foster smoking cess...

Background and Aims To estimate and compare the change in moderate-to-vigorous physical activity (MVPA) between an accelerometer and technology-supported physical activity (PA) log across a 3-week PA intervention. Method Participants ( N = 204, 77% female, age = 33 ± 11 years, body mass index = 28.2 ± 7.1 kg/m ² ) were randomized to one of two act...

Team science (TS) is a new interdisciplinary field that examines the processes by which scientific teams organize, communicate, and conduct research to achieve scientific breakthroughs that surpass those attainable by individual or simply additive efforts. Whereas the science of TS examines conditions that facilitate or hinder interdisciplinary res...

Background: Cardiovascular disease (CVD) remains the leading cause of death globally. Seven health factors are associated with ideal cardiovascular health: being a non-smoker; not overweight; physically active; having a healthy diet; and normal blood pressure; fasting plasma glucose and cholesterol. Whereas approximately half of U.S. youth have id...

BACKGROUND Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However,...

BACKGROUND Electronic health (eHealth) technologies have been found to facilitate health-promoting practices among cancer survivors with overweight or obesity. However, little is known about the characteristics of cancer survivors who demonstrate engagement with eHealth to promote weight management and facilitate patient-clinician communication. O...

The development and validation of computational models to detect daily human behaviors (e.g., eating, smoking, brushing) using wearable devices requires labeled data collected from the natural field environment, with tight time synchronization of the micro-behaviors (e.g., start/end times of hand-to-mouth gestures during a smoking puff or an eating...

Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the m...

BACKGROUND Accounting for how end-users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. OBJECTIVE This mixed-methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a mobile intervention for obesity and binge eating. METH...

Background Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating....

Objective Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt‐IN) study applied the Multiphase Optimization Strategy to develop an entirely re...

Introduction Lifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease. These behaviours often emerge during adolescence and co-occur. School-based interventions have the potential to...

Clinical trials are a fundamental tool used to evaluate the efficacy and safety of new drugs and medical devices and other health system interventions. The traditional clinical trials system acts as a quality funnel for the development and implementation of new drugs, devices and health system interventions. The concept of a “digital clinical trial...

Objectives Cancer-specific diet and exercise recommendations are not often discussed during oncology visits due to limited time and resources. eHealth [i.e., apps, activity trackers, electronic medical records (EMR)] could facilitate patient-clinician communication about health behaviors, but it is unknown how cancer survivors use eHealth and how e...

Objectives Increasing interest in using commercial nutrition apps to evaluate energy intake and diet quality warrants further investigation of how diet data are being analyzed by clinicians. Few studies have compared food composition databases from commercial apps with a validated nutrient database used by the scientific community. We investigated...

OBJECTIVES/GOALS: A new researcher-facing module to support community engaged research has been added to the updated COALESCE website and user traffic was tracked since last reporting. We describe the process of development and the features of the new module, past 2-year traffic, and plans to develop a community facing module. METHODS/STUDY POPULAT...

Background: Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve...