1016 Poorer Sleep Efficiency Predicts Attrition from a Lifestyle Medicine Intervention in World Trade Center Responders

Abstract Introduction World Trade Center (WTC) responders suffer from high rates of chronic diseases such cancer, cardiovascular disease, respiratory disease, and mental health conditions. Lifestyle medicine approaches — which focus on promoting healthy behaviors such as regular exercise, Mediterranean diet, and adequate sleep — can prevent and reverse WTC-associated diseases. Lifestyle medicine interventions are effective but are constrained by high attrition rates (~50%). Behavioral predictors of attrition from these interventions are not well-understood. To address this gap, we examined: 1) Fitbit estimates of sleep and physical activity, 2) self-reported personality and mental health, and 3) large language model (LLM) derived estimates of sleep and physical activity as predictors of attrition from a lifestyle medicine intervention. Methods Participants were 323 WTC first responders enrolled in the WTC Health Program in Long Island, NY between 2023-2025. Participants completed a 6-month lifestyle medicine intervention, which involved 4 visits with a registered dietician, wearing a Fitbit Inspire 3 device for one week at baseline, as well as completing self-report surveys to assess personality and mental health. LLM derived variables were computed using ChatGPT5 estimates of sleep and physical activity from intake visit audio transcripts between participants and dieticians. Results Together, predictors explained 9% of the variance in attrition (AUC = 67%). Higher Fitbit sleep efficiency at baseline predicted lower odds of attrition from the lifestyle medicine intervention (OR = 0.58, p = 0.004). Higher self-reported extraversion predicted higher odds of attrition (OR = 1.54, p = 0.005). Other Fitbit, self-report, and LLM-derived variables did not predict attrition. Conclusion Results suggest fragmented sleep may be a strong risk factor for study dropout. Targeting sleep via cognitive behavioral therapy for insomnia may improve study engagement and adherence to lifestyle medicine practices. Support (if any) CDC/NIOSH R21OH012614 (PI: Kotov)