Urban-Rural Disparities in Food Insecurity and Weight Status among Children in the United States.

Place of residence (urban versus rural) is a contextual determinant of health that has received less attention in the food insecurity literature. The purpose of this study was to assess the urban-rural disparity in the prevalence of food insecurity and weight status among US children. Using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 with three age groups of children (2-5, 6-11, and 12-17 years old), the associations of weight status and child and household food security status by urban-rural residence were examined using Rao-Scott Chi-square tests. Statistical significance was set at p < 0.05. Children living in urban areas were significantly more likely to experience household food insecurity (29.15%) compared to their rural counterparts (19.10%), among those aged 6-11 years. The associations between children's weight status and child and household food security status were significant for children living in urban areas overall and different age groups but not for children living in rural areas. These trends were more pronounced in older age groups. Given the link between food insecurity and higher obesity rates, particularly among urban children, this study highlights the importance of incorporating food security interventions into future obesity prevention programs.

Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis.

BACKGROUND: The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information. OBJECTIVE: We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living. METHODS: The first-appearing 202 TikTok posts that resulted from a search of the hashtag #mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests. RESULTS: TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1% vs 2/96, 2.1%; P=.001), use scientific citations to support claims (26/106, 24.5% vs 0/96, 0%; P<.001), and discuss specific nutrients (33/106, 31.1% vs 6/96, 6.3%; P<.001) and diseases related to the diet (27/106, 25.5% vs 5/96, 5.2%; P<.001) compared to posts created by nonhealth professionals. CONCLUSIONS: Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures.

Expert review of child and caregiver critiques of a therapeutic guided imagery therapy mobile application targeting disorders of gut-brain interaction in children.

Background: A guided imagery therapy mobile application (GIT App) is a novel platform for treating children with disorders of gut-brain interaction (DGBI). Previous feedback from child/caregiver dyads suggested modifications for our App prototype. However, their feedback had the potential to affect the intervention's efficacy. Thus, we aimed to have their critiques vetted by relevant experts prior to further App refinement. Objective: Compare expert reviews of the GIT App with end-users' (i.e., child/caregiver dyads') feedback. Methods: This mixed-methods study with experts included a hands-on App evaluation, a survey assessing usability, and focus groups comparing their perspectives with those previously provided by end-users. Results: Eight medical and technology experts were enrolled. Their average usability survey score of the GIT App was 69.0 ± 27.7, which was marginally above the 50th percentile. While the expert and end-user usability assessments were generally favorable, both groups agreed that the App's reminder notification feature location was not intuitive, detracting from its usability. Experts agreed with end-users that the App's aesthetics were acceptable and suggested increasing icon and font sizes. Like the end-users, the experts did not achieve consensus regarding the ideal session length or inclusion of background sounds and screen animations. Lastly, the experts agreed with end-users that gamification techniques (e.g., gift cards and virtual badges) would promote user engagement. Conclusion: An expert review of our therapeutic App revealed findings consistent with end-users and provided insight for modifying the interface and GIT sessions. Based on this experience, we recommend expert vetting of end-user suggestions as a routine checkpoint when developing therapeutic Apps.

Social marketing and the challenges of participant recruitment.

Recruitment of research participants often has not obtained a desired sample size, thereby becoming a major problem inhibiting investigators' ability to adequately test the specified hypotheses. Social marketing with its four Ps, originally developed by the business world to sell products and adapted for public health initiatives, is proposed as a dynamic comprehensive conceptual framework to apply marketing principles and practices to enhance participant recruitment. Applying a social marketing approach to research recruitment would require initial investigation to understand the motivations of the target audience in regard to research participation, and continued research throughout the main project to adapt the recruitment efforts as limitations arise. Additional funding would be needed for successful social marketing research recruitment programs to be systematically implemented and evaluated as part of research projects. In this paper, we define social marketing concepts, briefly review the available literature supporting social marketing applied to recruitment for research studies, and consider ethical issues that may arise when using a social marketing approach.

Recruitment for research projects has been challenging, putting studies at risk of not being able to adequately test a priori hypotheses. Social marketing, an adaptation of traditional marketing principles and practices, may provide a solution. Marketing was developed to sell commercial products to consumers, and the strategies and practices therein could be applied to selling participation in the "intervention" (the health program) to "end users" (participants). The four Ps, product, price, place, and promotion, are the conceptual elements considered in a marketing plan. Applying a social marketing approach to recruitment for research projects has been demonstrated to be successful in a small number of cases. Implementing this approach would require preimplementation research to specify the key characteristics of the target audience; continuous monitoring of recruitment success during the research to assess changes in strategies, as needed; and enhanced funding to accommodate the additional research within an expanded early project time frame.

Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study.

BACKGROUND: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. OBJECTIVE: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. METHODS: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. RESULTS: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. CONCLUSIONS: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth's desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations.

Regional Variability in the Prevalence of Food Insecurity and Diet Quality among United States Children.

Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index-HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in the FNAP, and 88% were enrolled in school lunch programs. Children in urban areas were significantly more likely to report household food insecurity than those in rural areas (29.15% vs. 19.10%). The overall HEI-2015 score was 48.2. The associations between child/household FSS and FNAP participation as well as between child/household FSS and diet quality did not differ by urban/rural residence status, irrespective of the children's age groups. There is a need for improvement in children's diet quality, regardless of age or urban/rural residence. The findings suggest that improving children's diets requires broader action as well as the prioritizing of children in urban areas experiencing food insecurity in future dietary interventions.

Health equity in action: using community-engaged research to update an intervention promoting a healthy home food environment to Black/African American families.

PURPOSE: Describe the method for conducting community-engaged research to identify needed changes for an existing evidence-based intervention, and prepare it for implementation in a community setting within the Dan L Duncan Comprehensive Cancer Center catchment area in an effort to achieve more equitable outcomes in diet-related disease risk factors. METHODS: The intervention, Family Eats, was developed over 10 years ago. It works directly with parents of Black/African American 9-12 year old children to create a healthy home food environment to support prevention of obesity and related cancers. Data collection with community stakeholders occurred through a series of  Community Advisory Board (CAB) meetings guided by the Delphi Technique, an iterative approach for gaining group consensus on a topic. RESULTS: Key information on needed changes and potential implementation strategies were identified. Perceived level of engagement among CAB members was high overall and in terms of both quantity and quality. CONCLUSION: The Delphi Technique shows promise as a method for conducting community-engaged research that promotes engagement and identifies key information needed to adapt and implement an existing intervention in a community setting.

Exploring Factors Associated With Accelerometer Validity Among Ethnically Diverse Toddlers.

PURPOSE: Studying physical activity in toddlers using accelerometers is challenging due to noncompliance with wear time (WT) and activity log (AL) instructions. The aims of this study are to examine relationships between WT and AL completion and (1) demographic and socioeconomic variables, (2) parenting style, and (3) whether sedentary time differs by AL completion. METHODS: Secondary analysis was performed using baseline data from a community wellness program randomized controlled trial for parents with toddlers (12-35 mo). Parents had toddlers wear ActiGraph wGT3x accelerometers and completed ALs. Valid days included ≥600-minute WT. Analysis of variance and chi-square analyses were used. RESULTS: The sample (n = 50) comprised racial and ethnically diverse toddlers (mean age = 27 mo, 58% male) and parents (mean age = 31.7 y, 84% female). Twenty-eight families (56%) returned valid accelerometer data with ALs. Participants in relationships were more likely to complete ALs (P < .05). Toddler sedentary time did not differ between those with ALs and those without. CONCLUSIONS: We found varied compliance with WT instructions and AL completion. Returned AL quality was poor, presenting challenges in correctly characterizing low-activity counts to improve internal validity of WT and physical activity measures. Support from marital partners may be important for adherence to study protocols.

See Me, Hear Me, Know Me: Perspectives on Diet and Physical Activity Influences among Teens Living in Rural Texas Communities.

Teens in rural communities are at greater risk of obesity than teens in urban areas. Diet and physical activity influence obesity risk. Understanding their perspectives is an important step in intervention design. This qualitative investigation explored teen perspectives on how living in a rural community influenced their diet and physical activity choices. Forty parent-teen pairs were recruited. Data collection included surveys and telephone interviews. This paper reports teen perspectives identified in the first interview. Thematic analysis was used to code and analyze the data. Findings revealed that the primary factor driving teens' diet and physical activity behaviors was the teens themselves. They clearly understood their role in the choices they made, although they acknowledged not always making the healthiest choice. This belief was driven by their motivation to engage in healthy behaviors, which was influenced by the perceived benefits derived from making healthy choices and from the synergistic relationship between diet and physical activity. Diet and physical activity, in turn, were influenced by the environment, particularly the home, social, and community environments. Family and friends were particularly influential, as well as resource availability. These findings can serve as a foundation for designing interventions tailored to this population.

Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: a convergent mixed methods study.

OBJECTIVE: To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity. DESIGN: This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES and dietitian visits. Feasibility benchmarks assessed were acceptability (> 50 % participants satisfied), demand (> 50 % used program components) and implementation (75 % adherence, 80 % retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants and key staff. Enrollment, recruitment and retention rates were summarised; qualitative data were analysed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display. SETTING: Food bank and Federally Qualified Health Center in the Southwestern U.S. PARTICIPANTS: English- or Spanish-speaking adults with T2DM and food insecurity. RESULTS: In total, 247 patients with T2DM and food insecurity were recruited, seventy-one expressed interest and twenty-five consented. Twenty-one participants completed study measurements. 71 % (n 15) received six home food deliveries and ≥ 1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion - most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g. timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention. CONCLUSIONS: The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.

An SMS Text Message-Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process.

BACKGROUND: SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. OBJECTIVE: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. METHODS: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message-based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. RESULTS: The background phase revealed that few SMS text message-based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. CONCLUSIONS: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message-based strategies among high-risk adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2023.107117.

Designing a Digital Culinary Education Intervention for Parents With Low Income.

OBJECTIVE: To examine cooking practices, online information-seeking habits, and intervention preferences among parents with low income to inform the development of a digital cooking intervention on the basis of the Healthy Cooking Index. METHODS: This formative research study included a brief survey followed by in-depth interviews (from February to April, 2021) with parents of a child aged 6-11 years with low income (n = 20; 100% female, 70% African American or Hispanic White). Interview transcripts were analyzed using a semistructured hybrid coding approach. RESULTS: Three main themes were identified to inform the development of the intervention: (1) current Healthy Cooking Index behaviors, (2) preferences for digital cooking intervention content, and (3) design and delivery preferences. A 7-step process was used to develop the intervention and integrate qualitative findings. CONCLUSIONS AND IMPLICATIONS: Online culinary programs targeting parents with low income may consider short, mobile-friendly video formats and focus on easy-to-prepare recipes adaptable to family preferences.

Diet Quality among Pre-Adolescent African American Girls in a Randomized Controlled Obesity Prevention Intervention Trial.

Consuming an unhealthy diet increases health risks. This study assessed the impact of a culturally adapted behaviorally innovative obesity prevention intervention (The Butterfly Girls and the Quest for Founder's Rock) on diet quality in pre-adolescent non-Hispanic Black/African American girls. The RCT consisted of three groups (experimental, comparison, and waitlist control); block randomization allocated participants to each group. The two treatment groups varied in terms of whether or not they set goals. Data were collected at baseline (prior to receiving the intervention), post 1 (3 months post-baseline), and post 2 (6 months post-baseline). Two dietitian-assisted 24 h dietary recalls were collected at each timepoint. Healthy Eating Index 2015 (HEI-2015) was used to determine diet quality. A total of 361 families were recruited; 342 completed baseline data collection. No significant differences in overall HEI score or component scores were observed. To attain more equitable health outcomes, future efforts to promote dietary intake change among at-risk children should explore other behavior change procedures and employ more child-friendly dietary assessment methods.

Determinants of retention in care of newborns diagnosed with sickle cell disease in Liberia: Results from a mixed-methods study of caregivers.

High-income nations have established that early diagnosis and preventive treatment reduces early deaths in sickle cell disease (SCD). However, in low-/middle-income countries where SCD is common, attrition from clinical care is common. Reasons for poor retention in care are multi-factorial and poorly understood. The objective of this study was to identify factors that influence caregiver decision-making around chronic health care needs of a child with SCD. We conducted an exploratory sequential mixed methods study of caregivers of children diagnosed with SCD during a newborn screening program in Liberia. Caregivers completed questionnaires and semi-structured interviews designed to identify drivers of health decision-making. Interviews were digitally recorded, transcribed, coded, and analyzed using semi-structured thematic analysis to identify themes. Data integration occurred by using quantitative results to expand and clarify the qualitative themes. Twenty-six caregivers participated in the study. The mean age of the child at the interview was 43.7 months. Five themes influencing health decisions were identified: grief, the importance of support networks, stigma, perceived benefits, and the burden of chronic disease. The five themes crossed multiple domains of a socioecological model and identified complex interactions between family, community, social and cultural norms, and organizational structures. This study highlights the importance of community awareness of SCD and appropriate health communication by healthcare workers. Healthcare decision-making is multifactorial and complex. These results provide a framework for improving retention in care. In a low-resource country such as Liberia, much can be done by leveraging existing resources and cultural practices.

Children's and Caregivers' Review of a Guided Imagery Therapy Mobile App Designed to Treat Children With Functional Abdominal Pain Disorders: Leveraging a Mixed Methods Approach With User-Centered Design.

BACKGROUND: Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform. OBJECTIVE: Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers. METHODS: Children aged 7 to 12 years with Rome IV-defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized. RESULTS: We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75% (12/16) of children and 69% (11/16) of caregivers had difficulty setting the reminder notification. The children's interviews confirmed the app's usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app's usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app's ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children's motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation. CONCLUSIONS: Children and caregivers rated our GIT app's usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements.

Promoting Health Equity: Identifying Parent and Child Reactions to a Culturally-Grounded Obesity Prevention Program Specifically Designed for Black Girls Using Community-Engaged Research.

The Butterfly Girls (BFG) Study is a culturally and developmentally appropriate online obesity prevention program for 8-10-year-old Black girls designed with key stakeholders in the Black community. This multi-methods investigation, conducted with parent-child dyads who participated in an outcome evaluation of the intervention, aimed to understand parent and child reactions to the program. We were particularly interested in understanding perceptions regarding its cultural and developmental appropriateness, relevance and acceptability. Program participation and survey data (demographics, parent and child write-in comments on process evaluation surveys) were analyzed. Participation data demonstrated high adherence in treatment and comparison groups. Descriptive statistics were calculated for survey data and highlighted the socioeconomic diversity of the sample. Post intervention surveys included two fill-in-the-blank questions for parents (n = 184 for question 1, n = 65 for question 2) and one for children (n = 32). Comments were analyzed using structured thematic analysis. The majority of the feedback from child participants was complimentary and many found the program relatable. Among the parent responses, the majority found the program to be beneficial in its educational nature and in promoting behavior change. This multi-methods analysis suggests that the BFG program was perceived as beneficial by parents while being culturally and developmentally appropriate and engaging for young Black girls, highlighting the importance of co-collaboration in program development.

Fit24, a digital health intervention to reduce type 2 diabetes risk among Hispanic youth: Protocol for a feasibility pilot study.

BACKGROUND: Poor physical activity (PA) and sleep behaviors in Hispanic adolescents contributes to increased risk for type 2 diabetes. Commonly owned digital devices and services like smartphones and text-messaging are highly used among adolescents and are promising intervention tools for reaching this age group. Personal activity trackers assess activity and sleep, making them ideal tools for addressing these behaviors. We propose to examine the feasibility of a 12-week intervention that uses theoretically grounded text messages and a Fitbit device to improve PA and sleep among Hispanic adolescents with obesity, as compared to a wait-list control group with a Fitbit device only. METHODS: Participants (N = 48; 14-16 years) will be randomized (1:1) to the intervention or wait-list control group. Youth in the intervention will receive a Fitbit Charge 5 and daily text messages. Youth in the wait-list control group will receive a Fitbit Charge 5 and information on PA and sleep guidelines. RESULTS: Feasibility will be examined by collecting process evaluation data on the following criteria: (1) recruit 48 Hispanic adolescents 14-16 years; (2) retain 85% of participants for post-assessments; (3) Fitbit wear ≥4 days/week and respond to 80% of text messages when prompted; (4) ≤10% technical issues; and (5) obtain 80% satisfaction from participants. DISCUSSION: This study will advance our knowledge on the feasibility of digital prevention strategies to promote PA and sleep behaviors to reduce T2D risk among Hispanic youth. If feasible, this approach has the potential to be a scalable, cost-effective diabetes prevention strategy among high-risk youth. TRIAL REGISTRATION: NCT04953442, registered on July 8, 2021.

Examination of parent-reported differences in children's daily screen use, sleep, and sleep hygiene behaviors during the school year and summer and their association with BMI.

OBJECTIVE: The current study examined school-summer differences in children's sleep patterns and sleep hygiene. Cross-sectional relationships with children's sleep, sleep hygiene, and weight status were explored during the school year and summer. METHODS: Children (5-8 years) and their parents (n = 197 dyads) were recruited from 4 schools in southeastern Texas and via Facebook. Parents reported children's school year and summer sleep, sleep hygiene, and screen media use. Children's body mass index (BMI) was objectively assessed at the beginning and end of the summer. Associations between children's sleep hygiene and screen media use, sleep duration, and weight status were explored. RESULTS: Children's sleep midpoint was earlier during the school year (1:54 AM ± 0.03) than in the summer (2:06 AM ± 0.03; t = 4.07, p < .0001). During summer, children increased their screen media use by 38 minutes (t = 2.32, p = .023) and decreased their caffeine intake from 7.43 to 7.0 (with scores ranging from 3 to 15; t = 2.83, p = .006). Greater sleep-inhibiting (ß = 0.40, p = .011) and fewer sleep-promoting (ß = -0.28, p = .049) behaviors during the school year were associated with having a higher BMI. There were no associations among sleep patterns, sleep hygiene and BMI during summer. CONCLUSIONS: More positive school year sleep hygiene behaviors were supportive of having a healthier weight status. Changes in these behaviors during the summer did not portend worse weight outcomes. Supporting families in the establishment of sleep-promoting behaviors, particularly during the school year may help address the child obesity epidemic.

Growing Up After Adolescent Bariatric Surgery.

This study investigates the effects of adolescent bariatric surgery among young adults approximately 10 years post-surgery. Participants were recruited from a hospital-based bariatric registry. We used an exploratory, qualitatively-driven mixed methods design. Findings were integrated with medical chart data and the SF-36, Body QoL, and the Transition Readiness Assessment Questionnaire. Of the 22 participants who completed surveys (14 females and 8 males), 20 participants also completed a phone interview. Median participant age was 25 years (range = 19-30). Median weight-loss was 23% (6.0%‒58%). Four themes emerged: taking control, weight loss challenges, body image adjustment, and growing up. Participants reported physical benefits of surgery yet were challenged by eating habits, body image, and interpersonal relationships. Participants were indifferent to preventative healthcare, despite the potential for vitamin deficiencies and the return of weight-related comorbidities. Clinicians can facilitate the transition to young adulthood by providing continued mental support, education, and medical monitoring.

How much did it cost to develop and implement an eHealth intervention for a minority children population that overlapped with the COVID-19 pandemic?

BACKGROUND: eHealth interventions using active video games (AVGs) offer an alternative method to help children exercise, especially during a pandemic where options are limited. There is limited data on costs associated with developing and implementing such interventions. OBJECTIVES: We quantified the costs of delivering an eHealth RCT intervention among minority children during COVID-19. METHODS: We categorized the total trial cost into five subcategories: intervention material development, advertising and recruitment, intervention delivery, personnel salaries, and COVID-19-related equipment costs. RESULTS: The total RCT cost was $1,927,807 (Direct: $1,227,903; Indirect: $699,904) with three visits required for each participant. The average cost per participant completing the RCT (79 participants/237 visits) was $24,403 (Direct: $15,543; Indirect: $8860). Due to no-shows and cancellations (198 visits) and dropouts before study completion (61 visits; 56 participants), 496 visits had to be scheduled to ensure complete data collection on 79 participants. If all 496 visits were from participants completing the three-visit protocol, that would correspond to 165 participants, bringing the average cost per participant down to $11,684 (Direct: $7442; Indirect: $4242). Of the subcategories, intervention material development accounted for the largest portion, followed by personnel salaries. While the direct COVID-19-specific cost constituted <1% of the entire budget, the indirect effects were much larger and significantly impacted the trial. CONCLUSION: RCTs typically involve significant resources, even more so during a pandemic. Future eHealth intervention investigators should budget and plan accordingly to prepare for unexpected costs such as recruitment challenges to increase flexibility while maximizing the intervention efficacy.