@Article{info:doi/10.2196/69425, author="Seiter{\"o}, Anna and Henriksson, Pontus and Thomas, Kristin and Henriksson, Hanna and L{\"o}f, Marie and Bendtsen, Marcus and M{\"u}ssener, Ulrika", title="Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="22", volume="27", pages="e69425", keywords="mHealth", keywords="multiple behavior", keywords="high school students", keywords="digital behavior change intervention", keywords="public health", keywords="telemedicine", keywords="randomized controlled trial", abstract="Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ?4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69\%, 520/756 females; 31\%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71\% (539/756) of participants at 2 months and 57\% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58\%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95\% CI 0.13-0.52), physical activity (50 minutes per week, 95\% CI --0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95\% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95\% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95\% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95\% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 ", doi="10.2196/69425", url="https://www.jmir.org/2025/1/e69425" } @Article{info:doi/10.2196/67885, author="Sidhu, Amrita and Shegog, Ross and Craig-Rushing, Stephanie and Trevino, Nicole and Singer, Michelle and Jessen, Cornelia and Gorman, Gwenda and Simpson, Sean and Peskin, Melissa and Hernandez, Belinda and Markham, Christine", title="Using the Healthy Native Youth Implementation Toolbox to Provide Web-Based Adolescent Health Promotion Decision Support to American Indian and Alaska Native Communities: Implementation Study", journal="JMIR Form Res", year="2025", month="Apr", day="16", volume="9", pages="e67885", keywords="implementation", keywords="culturally relevant program", keywords="evidence-based health promotion", keywords="user engagement", keywords="reach", keywords="decision support system", keywords="American Indian", keywords="Alaska", keywords="native communities", keywords="youth", keywords="adolescent", keywords="decision support", keywords="Alaska native", keywords="health inequities", keywords="sexual", keywords="reproductive", keywords="mental health", keywords="AI/AN", keywords="Tribal organization", keywords="Google Analytics", keywords="toolbox", abstract="Background: American Indian and Alaska Native (AI/AN) youth experience numerous health inequities, including those in sexual, reproductive, and mental health. Implementation of culturally relevant, age-appropriate evidence-based programs may mitigate these inequities. However, numerous barriers limit the adoption and implementation of evidence-based adolescent health promotion programs in AI/AN communities. Objective: This study examines user reach and engagement from 2022 to 2024 of web-based decision support (the Healthy Native Youth [HNY] website and the embedded HNY Implementation Toolbox), designed to increase the implementation of evidence-based adolescent health promotion programming in AI/AN communities. Methods: Promotional strategies were designed for optimal geographic reach to Tribal organizations, opinion leaders, federal decision makers, and funders. Promotional channels included grassroots, community, and professional networks. We used Google Analytics to examine the uptake of the HNY website and HNY Implementation Toolbox from January 2022 to January 2024. The Toolbox provides culturally relevant tools and templates to help users navigate through 5 phases of program adoption and implementation: Gather, Choose, Prepare, Implement, and Grow. User reach was estimated by demographic characteristics and geographic location; user engagement was estimated by visit frequency and duration, bounce rates, and frequency of page and tool access. Results: Over the study period, page views of the HNY website and HNY Toolbox increased 10-fold and 27-fold, respectively. Over the 2-year evaluation period since the Toolbox ``go live'' date, approximately 1 in 8 users of the HNY website visited the Toolbox. The majority of HNY website users were located in Washington (n=1515), California (n=1290), and Oregon (n=1019) and were aged between 18 and 24 (n=1559, 21.7\%) and 25?34 (n=1676, 23.29\%) years. Toolbox users were primarily located in California (n=1238), Washington (n=1142), and Oregon (n=986), mostly aged between 35 and 44 years (n=444, 35\%). Both website and Toolbox users were primarily female, who accessed the site and Toolbox via desktop computers. The most frequently accessed phase pages within the Implementation Toolbox were Gather, Choose, Implement, and Prepare, as supported by bounce rates and average time on page. The most viewed phase was the ``Gather'' phase, with 3278 views. The most frequently downloaded tools within the Toolbox were Gather: Community Needs and Resource Assessment, with 136 downloads. The phases and tools accessed may have differed based on the user's goal or stage of implementation. Conclusions: Findings indicate positive initial reach and engagement of the HNY website and HNY Implementation Toolbox among AI/AN educators that has consistently increased over the 2 years. The provision of web-based decision support that guides AI/AN users through the adoption, implementation, and maintenance of culturally relevant, age-appropriate, evidence-based adolescent health promotion programs in their communities may help increase the implementation of effective adolescent health promotion programs to ultimately increase health equity among AI/AN youth. ", doi="10.2196/67885", url="https://formative.jmir.org/2025/1/e67885" } @Article{info:doi/10.2196/59238, author="Toh, Hui Siao and Davis, Courtney and Bte Khaider, Khairunisa and Ong, Quan Zhi and Lim, Kai Ethel Jie and Chew, Elaine Chu Shan", title="Codevelopment of an mHealth App With Health Care Providers, Digital Health Experts, Community Partners, and Families for Childhood Obesity Management: Protocol for a Co-Design Process", journal="JMIR Res Protoc", year="2025", month="Mar", day="5", volume="14", pages="e59238", keywords="childhood obesity", keywords="mHealth", keywords="mobile health", keywords="co-design", keywords="IDEAS framework", abstract="Background: Childhood obesity is increasing in Singapore, with most cases persisting into adulthood and leading to poor health outcomes. The current evidence for childhood obesity interventions shows a clear dose-response effect, where effectiveness improves with an increasing number of treatment hours. A minimum threshold of ?26 hours over a 2- to 12-month period is required to achieve significant outcomes. The Kick Start Move Smart program is the first online community-based multidisciplinary program to treat pediatric obesity in Singapore. It has demonstrated feasibility and acceptability, with 70\% of participants completing the recommended ?26 hours of intervention. Preliminary data show significantly lower BMI and improved quality of life in participants compared to controls. Successful families are positive outliers who developed strategies for health in the context of an obesogenic environment. This positive outlier approach indicates that solutions to challenges that a community faces exist within certain individual members, and these strategies can be generalized and promoted to improve the health of others in the same community. A mobile health (mHealth) app targeting parents is a critical missing link in the currently available interventions to support parental self-management of childhood obesity. Using a combination of behavioral theory and user-centered design approaches is important for designing mHealth apps. One recommended framework is Integrate, Design, Assess, and Share (IDEAS), which aims to facilitate the development of more effective interventions by engaging perspectives from different stakeholders. Objective: This study aims to (1) describe the co-design protocol of an mHealth app using the IDEAS framework as a low-intensity intervention or as an adjunct to more intensive existing pediatric obesity interventions and (2) assess the usability, acceptability, and engagement of the app by parents. Methods: A clinician-led co-design approach will be undertaken with a multidisciplinary team using the IDEAS framework. Phase 1 involves stakeholder engagement and the formation of a core committee and a parent advisory board. Phase 2 involves developing the app content through focus group and expert panel discussions. Phase 3 involves developing a prototype app and gathering feedback. Phase 4 involves piloting the minimum viable product by parent users and evaluating its effectiveness through interviews and questionnaires. Results: In April 2023, a parent advisory board was formed, and stakeholders were engaged as part of phase 1. Phases 2 and 3 were completed in June 2024. Focus group discussions were held with the parent advisory board and stakeholders to identify family strategies and patient-centric outcomes and provide feedback on the app. As of January 2025, the app is complete, and we are now in the middle of data collection from participants. Participants will provide feedback to the research team, and the app will be updated accordingly. Conclusions: An evidence-based, theory-driven mHealth app developed using a structured design framework can bridge the gap in delivering multidisciplinary care in community settings for families with overweight children. International Registered Report Identifier (IRRID): DERR1-10.2196/59238 ", doi="10.2196/59238", url="https://www.researchprotocols.org/2025/1/e59238", url="http://www.ncbi.nlm.nih.gov/pubmed/40053786" } @Article{info:doi/10.2196/65169, author="Fisher, Dominic and Maart, Rentia and Thabane, Lehana and Louw, Quinette", title="A Classroom-Based Intervention for Reducing Sedentary Behavior and Improving Spinal Health: Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Feb", day="24", volume="9", pages="e65169", keywords="sedentary behavior", keywords="spinal health", keywords="classroom-based intervention", keywords="sit-stand desks", keywords="spinal", keywords="African", keywords="Africa", keywords="primary school", keywords="child", keywords="youth", keywords="randomized controlled trial", keywords="RCT", keywords="infectious disease", keywords="acceptability", keywords="data collection", keywords="teacher", keywords="classroom-based interventions", keywords="primary school learners", keywords="physical activity", keywords="closed-cohort", keywords="interview", keywords="quantitative data", keywords="wearable", keywords="wearable sensor", keywords="spine", abstract="Background: Noncommunicable diseases (NCDs) resulting from sedentary behavior (SB) are adding a further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture, allowing learners to interrupt prolonged bouts of sitting with standing without interrupting their school work. Alternating between sitting and standing also benefits spinal health by interrupting prolonged periods of high spinal loading, but no such intervention has been trialed in South Africa. The potential to reduce strain on the health system by reducing the incidence of NCDs and improving spinal health requires further consideration. Before embarking on a large classroom-based trial, it is essential to determine the acceptability of the intervention, its impact on teachers' practices, and the logistical and pragmatic considerations of data collection. Objective: This study aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners, to assess the pragmatics of delivering and adherence to the intervention, and assess the pragmatics of measuring physical activity and postural dynamism data with wearable sensors. Methods: We used a stratified, closed-cohort, randomized, 2-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and grade 6 class each was recruited from contrasting socioeconomically categorized, state-funded primary schools in the Western Cape province, South Africa. Classroom furniture was substituted with sit-stand desks, and health education and movement videos (HEMVs) were shown during class time. Skin-mounted activPAL physical activity monitors were used to measure SB and postural topography and Noraxon myoMOTION inertial measurement units (IMUs) to measure spinal movement. The study was evaluated for feasibility by tracking school retention, successful delivery of the HEMVs, the use of sit-stand desks, compliance with the wearable sensors, and data accuracy. We deductively analyzed teachers' interviews and learners' focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was performed using Microsoft Excel. Results: Cluster 1 withdrew from the study before follow-up SB, postural topography, and spinal movements were measured. All feasibility outcomes, namely (1) classroom retention, (2) delivery of HEMVs, (3) learner and teacher acceptance and usage of sit-stand classroom furniture, (4) 100\% compliance with wearing skin-mounted sensors for the duration of the intended measurement period, and (5) minimum 80\% eligibility of sensor data gathered included in data analysis, were met in cluster 2. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology. Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualized teacher training on how sit-stand desks and HEMVs can be used as classroom management tools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR2-10.2196/18522 ", doi="10.2196/65169", url="https://formative.jmir.org/2025/1/e65169" } @Article{info:doi/10.2196/71897, author="Lewis, C. Callum and Taba, Melody and Allen, B. Tiffany and Caldwell, H.Y Patrina and Skinner, Rachel S. and Kang, Melissa and Henderson, Hamish and Bray, Liam and Borthwick, Madeleine and Collin, Philippa and McCaffery, Kirsten and Scott, M. Karen", title="Authors' Reply: ``Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders''", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e71897", keywords="adolescent health", keywords="digital health literacy", keywords="adolescents", keywords="online health information", keywords="co-design", keywords="health education", keywords="eHealth literacy", keywords="social media", doi="10.2196/71897", url="https://www.jmir.org/2025/1/e71897" } @Article{info:doi/10.2196/70020, author="Yang, Alina", title="Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e70020", keywords="adolescent health", keywords="digital health literacy", keywords="adolescents", keywords="online health information", keywords="co-design", keywords="health education", keywords="eHealth literacy", keywords="social media", doi="10.2196/70020", url="https://www.jmir.org/2025/1/e70020" } @Article{info:doi/10.2196/67213, author="Zuair, Areeg and Alhowaymel, M. Fahad and Jalloun, A. Rola and Alzahrani, S. Naif and Almasoud, H. Khalid and Alharbi, H. Majdi and Alnawwar, K. Rayan and Alluhaibi, N. Mohammed and Alharbi, S. Rawan and Aljohan, M. Fatima and Alhumaidi, N. Bandar and Alahmadi, A. Mohammad", title="Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non--Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="24", volume="8", pages="e67213", keywords="adolescent obesity", keywords="macronutrient education", keywords="cardiovascular fitness", keywords="body composition", keywords="health literacy", keywords="body image", keywords="macronutrient", keywords="educational", keywords="obesity", keywords="weight", keywords="overweight", keywords="fitness", keywords="nutrition", keywords="diet", keywords="patient education", keywords="student", keywords="school", keywords="youth", keywords="adolescent", keywords="teenager", keywords="metabolic", keywords="eating", keywords="physical activity", keywords="exercise", abstract="Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non--weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non--weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and $\chi${\texttwosuperior} tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9\% (36/95), while 50.5\% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial $\eta${\texttwosuperior}=0.268). There was no significant change in students' body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6\% and a retention rate of 72.6\%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non--weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. ", doi="10.2196/67213", url="https://pediatrics.jmir.org/2025/1/e67213" } @Article{info:doi/10.2196/58460, author="Leung, May May and Mateo, F. Katrina and Dublin, Marlo and Harrison, Laura and Verdaguer, Sandra and Wyka, Katarzyna", title="Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Jan", day="15", volume="9", pages="e58460", keywords="childhood obesity", keywords="preadolescents", keywords="racial and ethnic minority populations", keywords="dietary behaviors", keywords="BMI", keywords="digital health", abstract="Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61\% were female, 62\% were Black, 42\% were Hispanic, 53\% were overweight or obese, and 34\% had an annual household income of