Wholesome Data: Using IT to Promote Healthy Behaviors

By Gordy Slack

The journey to health is made of hundreds of small, daily steps: the decision to take the stairs, not the elevator; to eat veggies, not fries; to bike to school, not drive. Edmund Seto employs sensor and cell-phone technologies to connect people to relevant, real-time data about themselves and their environments, creating applications that make the journey of small, healthy steps easier to navigate and stick to.

For example, CalFit is an Android-based program that tracks and monitors the caloric expenditure of users.   The original prototype, designed to help teens struggling with obesity, was made before the reign of smart phones.  Seto, Associate Adjunct Professor at the UC Berkeley School of Public Health and the new Associate Faculty Director of CITRIS’s Health Care Initiative worked with Berkeley Professor of Engineering Ruzena Bajcsy, who was then the CITRIS Director, to cobble together an Internet tablet, a mobile GPS, an accelerometer, a heart-rate monitor, and a radio transmitter. Users wore the device, which recorded heart rate and activity type and informed the wearer about how many calories he was burning and when and where he was burning them. Seto composed an algorithm to convert accelerometer data from the CalFit program into caloric measurements, so that a user could tally up calories burned based simply on sensor-detected body movements. Bajcsy and Seto tested the CalFit system in the real world with the help of Jay Han, who runs a pediatric muscular dystrophy clinic at Davis.

Seto and colleagues make Android-based applications that monitor a body function, user location, and activity type to provide feedback that encourages healthy behavior.

“It is a prime example of the CITRIS type of cross-disciplinary research,” Seto says. A public health researcher identified the need for such a device, which was then prototyped by engineers and produced data that the IT scientists could analyze. “We tested our mobile device, and Jay got something he could give his young muscular dystrophy patients to monitor their activity remotely so they would not have to come into the clinic so often,” says Seto.

Last month Dr. Han was named Medical Director of CITRIS and co-director, with Seto, of the CITRIS Health Care Initiative. “The mission of the CITRIS Health Care Initiative,” says CITRIS Director Paul Wright, is to use IT to improve access and reduce disparities in California health care, to make quality health care available to all Californians.”

While Han and Seto are both devoted to that aim, their approaches and emphases are different.

“Jay’s work focuses on clinical questions like, What are the most cost-effective and highest-impact technologies we can introduce to improve the clinical setting, the nursing realm, doctor’s office, or into patients’ homes?” says Seto. “Jay is thinking about people who are already in the medical system. My focus is on health promotion, on keeping people out of health care system in the first place.”

“If we can keep people healthy, especially young people, and keep them out of the cycle of chronic clinical care, then we can both prevent a lot of suffering and reduce skyrocketing health care costs,” says Seto.

While CalFit started on as a purpose-built device, the emergence of affordable smart phones has provided a perfect platform for Seto’s programs. In addition to tracking activities engaged in and calories burned, today’s Android-based CalFit now also has a social networking component, which employs competition and cooperation to keep its young users physically active.   But the social aspects of the program present some new challenges. For example, one of the major challenges with devices that monitor personal behaviors is how to keep that information secure and private. “Users’ data shouldn’t go to anyone the user doesn’t want it to,” says Bajcsy.  “So some of the technologies we are developing are aimed at protecting people’s privacy, but allow for them to express who they do and do not wish to share data with.”

Some early city planning research that suggests people are more likely to exercise if they have ready access to parks and green belts. “But until now, the tools available to study this relationship have been very crude,” says Seto. “And just what kinds of inviting places are most likely to get people out is still an open question. Do communities with more green space promote more exercise? Or are city amenities like restaurants and shops better at getting people out and walking?” he asks. “And we want to know if the relationships between environment and exercise are universal, or if they have to do with specific populations, neighborhoods, and cultural contexts. At this point we only have theories.”

To address those questions, Seto and collaborators in southern California and in Europe are using CalFit-like applications to see how people who live near or pass by different kinds of environments actually use them for exercise.

These new studies will occur over the next 2 to 5 years. “It’s an exciting time for us,” says Seto.

The first versions of CalFit are being applied to physical activity research, but Seto and his colleagues have begun to explore another application for asthma sufferers. The application coordinates activity data with air-quality sensing to let asthmatics know when and where they are at high risk of an attack.

“Users like it because it may help them stay active, while avoiding areas likely to induce an asthma attack,” says Seto. “But there are also tremendous opportunities to use the devices for environmental health research.  We could use them to study people’s exposures to asthma triggers like air pollution in different environments.’”

Seto’s research may also help communities take charge of their own environmental monitoring. The incidence of asthma, for instance, is much higher in neighborhoods near freeways or in parts of port cities, like Oakland, where a lot of high-emission diesel trucks carry containers unloaded from ships. Helping communities affordably monitor air quality in real time will help at-risk individuals to avoid unhealthy environmental pollutants. Deploying monitors and communicating the information they collect may help city planners and air pollution managers to regulate and reduce pollutants emitted under their jurisdictions.

Monitoring air-quality conditions and correlating them with health care data can help asthmatics minimize the chance of having an attack.

As part of his Make AQ (Air Quality) project, Seto held six design workshops at Abraham Lincoln High School in San Francisco. Students from the school’s Advanced Placement Environmental Science course were shown a $20,000 commercial air-pollution monitor and asked to design something similar for less. Working with Seto, Berkeley graduate student, David Holstius and industrial designer Dan Letson built working prototypes from the high schoolers’ designs.

One was a noise sensor to put in the school hallway to measure noise pollution. Another was a helicopter equipped with an air-quality sensor. It could fly around and sniff out air pollution. A third invention was a bracelet that measures air quality and ties it to locations; it communicates wirelessly with a phone that records and analyzes the data, says Seto.

Within a few weeks of the design workshops, and at a cost of only a few hundred dollars, the students were able to see their designs come to life as working prototypes that could one day be used in their own communities.

“Professor Seto’s project was a valuable experience for my students,” says Lincoln High’s AP Environmental Sciences program director, Jeffrey Kim.  “They especially enjoyed implementing their own ideas about how the sensors can be used.  It would be great to see more of this at other high schools.”