@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/10.2196/69242, author="Brown, Marie Jacqueline and Rita, Nicholas and Franco-Arellano, Beatriz and LeSage, Ann and Arcand, Joanne", title="Evaluation of a Curriculum-Based Nutrition Education Intervention Protocol in Elementary Schools: Nonrandomized Feasibility Study", journal="JMIR Form Res", year="2025", month="Apr", day="16", volume="9", pages="e69242", keywords="nutrition education", keywords="serious games", keywords="children", keywords="food literacy", keywords="school nutrition intervention", keywords="feasibility", abstract="Background: Improving children's food literacy through school-based interventions can support developing healthy eating habits. However, teachers lack appropriate resources, time, and training to provide nutrition education in schools. Serious games, which are games designed for a purpose other than entertainment, have been demonstrated to improve children's food literacy and dietary intake and can address the barriers teachers face in providing nutrition education. Foodbot Factory (Arcand Lab) is a nutrition education intervention that is aligned with curricula and uses a serious game to provide nutrition education to students. Further evidence is needed to understand how serious games, including Foodbot Factory, can be researched in schools to support nutrition education. Objective: The objective of this study was to evaluate the feasibility of a research study protocol that implements the curriculum-based nutrition education intervention Foodbot Factory into a real-world classroom setting. The evaluation of the protocol included study processes, resources, and management feasibility outcomes, as well as a preliminary assessment of scientific outcomes relevant to the intervention. Methods: A nonrandomized study determined the feasibility of intervention implementation. Grade 4 and 4/5 classrooms were assigned to have nutrition education lessons for 5 days with either the Foodbot Factory or a control intervention. Outcomes were assessed in 4 feasibility domains of study processes (eg, recruitment and attrition rates), resources (eg, time taken to deliver the intervention), and management (eg, challenges with intervention delivery), and a preliminary assessment of scientific outcomes pertaining to the acceptability and impacts of the interventions. These outcomes were captured in semistructured field notes completed by study staff and a Nutrition Attitudes and Knowledge questionnaire and acceptability questionnaire completed by participants. Data were analyzed descriptively and using a paired t test to assess within-group changes in nutrition knowledge. Results: In total, 4 classrooms participated in the feasibility study, with varying recruitment rates for schools (3/20, 15\%), classrooms (4/4, 100\%), parents (54/102, 53\%), and children (49/54, 91\%). The time required to implement the research protocol, including data collection and lesson plans, was sufficient and management of the intervention implementation was overall successful. Some challenges were experienced with classroom management during data collection, specifically with electronic data collection. After the intervention, participants reported a positive affective experience (26/41, 63\%) and learning something new about healthy eating (31/41, 76\%). Participants in both study groups improved their nutrition knowledge, but the changes were not statistically significant. The Foodbot Factory group had a statistically significant improvement in their knowledge of vegetables and fruit (P=.04) and protein foods (P=.03). Conclusions: These findings indicate that the study protocol is feasible to implement and evaluate Foodbot Factory in a representative sample with select modifications to improve recruitment and data collection procedures. ", doi="10.2196/69242", url="https://formative.jmir.org/2025/1/e69242" } @Article{info:doi/10.2196/60092, author="Wang, Naibo and Wang, Chen and Zhang, Puhong and Li, Yinghua and He, J. Feng and Li, Li and Li, Yuan and Luo, Rong and Wan, Dezhi and Xu, Lewei and Deng, Lifang and Wu, Lei", title="Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up", journal="J Med Internet Res", year="2025", month="Mar", day="27", volume="27", pages="e60092", keywords="school-based health education", keywords="EduSaltS", keywords="mobile health", keywords="salt reduction", keywords="cluster randomized trial", abstract="Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)-- and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention's effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96\%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02\%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48\%) children and 47 (8.97\%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren's salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were --0.24 g/day (95\% CI --0.82 to 0.33), --0.68 mm Hg (95\% CI --2.32 to 0.95), and --1.37 mm Hg (95\% CI --2.79 to 0.06), respectively. For adults, the intervention group's salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were --1.06 g/day (95\% CI --1.81 to --0.30), --2.26 mm Hg (95\% CI --4.26 to --0.26), and --2.33 mm Hg (95\% CI --3.84 to --0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 ", doi="10.2196/60092", url="https://www.jmir.org/2025/1/e60092", url="http://www.ncbi.nlm.nih.gov/pubmed/40017342" } @Article{info:doi/10.2196/58586, author="Jalaludin, Yazid Muhammad and Kiau, Bee Ho and Hasim, Suriati and Lee, Khew Wai and Low, Angie and Kazim, Nik Nik Harlina and Hoi, Tse Jia and Taher, Wahyu Sri", title="A Noninvasive Approach to Assess the Prevalence of and Factors Associated With Anemia Risk in Malaysian Children Under Three Years of Age: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2025", month="Mar", day="24", volume="8", pages="e58586", keywords="anemia", keywords="iron deficiency", keywords="children", keywords="Masimo Rad-67", keywords="noninvasive assessment", keywords="Malaysia", abstract="Background: Anemia remains a significant public health concern with adverse effects among children. Noninvasive screening assessments enable the early detection and prompt treatment of anemia. However, there is limited literature on the use of such screening assessments. Objective: The study aimed to assess the prevalence of and factors associated with being at risk of anemia among Malaysian children aged ?6 months to ?36 months by using a noninvasive hemoglobin assessment. Methods: This was a cross-sectional study (from July to December 2022) of outpatient Malaysian children, aged ?6 months to ?36 months, who were selected from five maternal-and-child health clinics by convenience sampling. At risk of anemia was defined as a total hemoglobin level of <12 g/dL, measured using the Masimo Rad-67, a noninvasive screening device for total hemoglobin levels. The $\chi$2 and multiple logistic regression analyses were used to assess the prevalence and factors associated with being at risk of anemia, using R-Studio (version 4.0.0). Results: The study included 1201 participants, of whom 30\% (95\% CI 28?33) were at risk of anemia. Children aged 6?12 months (210/364, 57.7\%, P<.001), those of Asian Malay race (238/364, 65.4\%, P<.05), those residing in the Klang district (123/371, 33.9\%, P<.05), those born via a normal vaginal delivery (275/364, 75.5\%, P<.05), those without a family history of thalassemia (284/364, 78.0\%, P<.05), and those with lower weight-for-age Z scores (P<.05) were associated with being at risk of anemia. Children aged 6?12 months (adjusted odds ratio=1.73; 95\% CI 1.34?2.24) had higher odds of being at risk of anemia compared to children aged >12?36 months. However, weight-for-age (adjusted odds ratio=0.88; 95\% CI 0.80?0.98) was associated with lower odds of being at risk of anemia. Conclusions: The current study revealed a substantial prevalence of Malaysian children being at risk of developing anemia. The study results therefore imply a need for more community education and awareness on anemia, including nutrition education, as well as targeted community screening to enable the early detection and prompt treatment of anemia cases. Anemia reduction strategies in Malaysia should consider the highlighted factors indicative of higher risk of anemia. Trial Registration: Clinicaltrials.gov NCT05181436, https://clinicaltrials.gov/study/NCT05181436 ", doi="10.2196/58586", url="https://pediatrics.jmir.org/2025/1/e58586" } @Article{info:doi/10.2196/60891, author="Dupuis, Roxanne and Musicus, A. Aviva and Edghill, Brittany and Keteku, Emma and Bragg, A. Marie", title="How TikTok Influencers Disclose Food and Beverage Brand Partnerships: Descriptive Study", journal="J Med Internet Res", year="2025", month="Feb", day="28", volume="27", pages="e60891", keywords="social media", keywords="social media marketing", keywords="social media influencer", keywords="food and beverage marketing", keywords="adolescent health", abstract="Background: Food and beverage marketing is an important influence on the health and diets of adolescents. Food and beverage companies spend billions of dollars annually on advertisements to promote their products and are increasingly focusing on social media influencers. Influencer product endorsements blur the line between entertainment and marketing. Objective: This study aimed to quantify how often TikTok influencers promote products from food and beverage brands and document the range of ways they disclose brand relationships in their content. Methods: We collected up to 100 videos posted on or before July 1, 2022, from each of the top 100 influencers on TikTok in the United States and recorded information about the influencer (eg, number of followers) and video (eg, number of views and likes). For each video that contained food or beverage products, we identified the main product featured. A team of research assistants then coded each video for how the product was featured (ie, in the video, audio, or caption) and, for branded products, whether the video was accompanied by any disclosures of brand relationships. Average pairwise percentage agreement among coders was 92\%, and average pairwise Cohen $\kappa$ was 0.82. Results: Among the 8871 videos from 97 influencers that made up the final analytical sample, we identified 1360 videos (15.3\%) that featured at least one food or beverage product. These 1360 videos were viewed >9 million times and received >1 million likes each. Nearly half (n=648, 47.6\%) of the videos featured a branded product. Most videos featuring a branded product did not contain a brand relationship disclosure (n=449, 69.3\%). Among videos that disclosed a brand relationship, influencers used 10 different types of disclosures. Tagging a brand in the video's caption was the most common disclosure method (n=182, 28.1\%). Six types of caption hashtags were used to disclose brand relationships, including \#[brandname] (n=63, 9.7\%) and \#ad (n=30, 4.6\%). Only 1 video (0.2\%) made use of TikTok's official disclosure label and only 1 video (0.2\%) verbally mentioned a contractual agreement with a brand. Conclusions: Among the food and beverage videos with disclosures we identified, the most frequently used mechanism---tagging the brand---did not clearly differentiate between sponsored content and the influencer trying to attract a brand or followers who may like that brand. Social media users, particularly adolescents, need clearer, more robust disclosures from influencers to protect against the undue influence of food marketing. These findings may also inform calls for the Children's Food and Beverage Advertising Initiative---the largest self-regulatory pledge to reduce unhealthy food marketing---to include older adolescents, who are heavily targeted by food and beverage companies on social media. ", doi="10.2196/60891", url="https://www.jmir.org/2025/1/e60891", url="http://www.ncbi.nlm.nih.gov/pubmed/40053812" } @Article{info:doi/10.2196/66807, author="Pickard, Abigail and Edwards, Katie and Farrow, Claire and Haycraft, Emma and Blissett, Jacqueline", title="Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study", journal="JMIR Form Res", year="2025", month="Feb", day="27", volume="9", pages="e66807", keywords="pediatric", keywords="paediatric", keywords="child", keywords="child eating", keywords="parent feeding", keywords="parent", keywords="ecological momentary assessment", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="application", keywords="smartphone", keywords="digital", keywords="digital health", keywords="digital technology", keywords="digital intervention", abstract="Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents' feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers' compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children's eating occasions and parents' feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39\%) parents initiated the EMA study, of which 118 (96.7\%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4\%) parents provided at least 7 ``full'' days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2\%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9\% response rate), 3 daily mood surveys (78.7\% response rate), and an end-of-day survey (84.6\% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89\%) and activities (93/118, 79\%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents' involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 ", doi="10.2196/66807", url="https://formative.jmir.org/2025/1/e66807" } @Article{info:doi/10.2196/65451, author="Thompson, R. Jessica and Weber, J. Summer and Mulvaney, A. Shelagh and Goggans, Susanna and Brown, Madeline and Faiola, Anthony and Maamari, Lynn and Hull, C. Pamela", title="Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="19", volume="8", pages="e65451", keywords="mHealth", keywords="childhood obesity", keywords="mixed methods", keywords="pediatric", keywords="healthy lifestyle behaviors", keywords="preschool children", keywords="mobile application", keywords="diet", keywords="physical activity", keywords="exercise", keywords="media use", keywords="sleep", keywords="development", keywords="semi-structured interviews", keywords="healthy eating", keywords="parents", keywords="caregivers", abstract="Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. ", doi="10.2196/65451", url="https://pediatrics.jmir.org/2025/1/e65451" } @Article{info:doi/10.2196/60495, author="Perez Ramirez, Alejandra and Ortega, Adrian and Stephenson, Natalie and Mu{\~n}oz Osorio, Angel and Kazak, Anne and Phan, Thao-Ly", title="mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e60495", keywords="obesity", keywords="user testing", keywords="mHealth", keywords="mobile health", keywords="Spanish", keywords="child", keywords="rural population", abstract="Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform---the Healthy Lifestyle (Nemours Children's Health) dashboard---was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100\% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100\%) selected the same dashboard icon and 71\% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. ", doi="10.2196/60495", url="https://formative.jmir.org/2025/1/e60495", url="http://www.ncbi.nlm.nih.gov/pubmed/39932772" } @Article{info:doi/10.2196/58434, author="Kearns, Amanda and Moorhead, Anne and Mulvenna, Maurice and Bond, Raymond", title="Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review", journal="J Med Internet Res", year="2025", month="Feb", day="10", volume="27", pages="e58434", keywords="digital communication", keywords="digital technology", keywords="digital transformation", keywords="health professional", keywords="mental health", keywords="obesity", keywords="complex needs", keywords="artificial intelligence", keywords="AI", keywords="PRISMA", abstract="Background: Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication. Methods: A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs' use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: ``What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?'' Results: In total, 8 studies---featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email---met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P?.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals' complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs. ", doi="10.2196/58434", url="https://www.jmir.org/2025/1/e58434" } @Article{info:doi/10.2196/64749, author="Seol, Jaehoon and Iwagami, Masao and Kayamare, Tawylum Megane Christiane and Yanagisawa, Masashi", title="Relationship Among Macronutrients, Dietary Components, and Objective Sleep Variables Measured by Smartphone Apps: Real-World Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Jan", day="30", volume="27", pages="e64749", keywords="sleep quality", keywords="dietary health", keywords="unsaturated fatty acids", keywords="dietary fiber intake", keywords="sodium-to-potassium ratio", keywords="compositional data analysis", keywords="sleep", keywords="smartphone", keywords="application", abstract="Background: Few studies have explored the relationship between macronutrient intake and sleep outcomes using daily data from mobile apps. Objective: This cross-sectional study aimed to examine the associations between macronutrients, dietary components, and sleep parameters, considering their interdependencies. Methods: We analyzed data from 4825 users of the Pok{\'e}mon Sleep and Asken smartphone apps, each used for at least 7 days to record objective sleep parameters and dietary components, respectively. Multivariable regression explored the associations between quartiles of macronutrients (protein; carbohydrate; and total fat, including saturated, monounsaturated, and polyunsaturated fats), dietary components (sodium, potassium, dietary fiber, and sodium-to-potassium ratio), and sleep variables (total sleep time [TST], sleep latency [SL], and percentage of wakefulness after sleep onset [\%WASO]). The lowest intake group was the reference. Compositional data analysis accounted for macronutrient interdependencies. Models were adjusted for age, sex, and BMI. Results: Greater protein intake was associated with longer TST in the third (+0.17, 95\% CI 0.09-0.26 h) and fourth (+0.18, 95\% CI 0.09-0.27 h) quartiles. In contrast, greater fat intake was linked to shorter TST in the third (--0.11, 95\% CI --0.20 to --0.27 h) and fourth (--0.16, 95\% CI --0.25 to --0.07 h) quartiles. Greater carbohydrate intake was associated with shorter \%WASO in the third (--0.82\%, 95\% CI --1.37\% to --0.26\%) and fourth (--0.57\%, 95\% CI --1.13\% to --0.01\%) quartiles, while greater fat intake was linked to longer \%WASO in the fourth quartile (+0.62\%, 95\% CI 0.06\%-1.18\%). Dietary fiber intake correlated with longer TST and shorter SL. A greater sodium-to-potassium ratio was associated with shorter TST in the third (--0.11, 95\% CI --0.20 to --0.02 h) and fourth (--0.19, 95\% CI --0.28 to --0.10 h) quartiles; longer SL in the second (+1.03, 95\% CI 0.08-1.98 min) and fourth (+1.50, 95\% CI 0.53-2.47 min) quartiles; and longer \%WASO in the fourth quartile (0.71\%, 95\% CI 0.15\%-1.28\%). Compositional data analysis, involving 6\% changes in macronutrient proportions, showed that greater protein intake was associated with an elevated TST (+0.27, 95\% CI 0.18-0.35 h), while greater monounsaturated fat intake was associated with a longer SL (+4.6, 95\% CI 1.93-7.34 min) and a larger \%WASO (+2.2\%, 95\% CI 0.63\%-3.78\%). In contrast, greater polyunsaturated fat intake was associated with a reduced TST (--0.22, 95\% CI --0.39 to --0.05 h), a shorter SL (--4.7, 95\% CI to 6.58 to --2.86 min), and a shorter \%WASO (+2.0\%, 95\% CI --3.08\% to --0.92\%). Conclusions: Greater protein and fiber intake were associated with longer TST, while greater fat intake and sodium-to-potassium ratios were linked to shorter TST and longer WASO. Increasing protein intake in place of other nutrients was associated with longer TST, while higher polyunsaturated fat intake improved SL and reduced WASO. ", doi="10.2196/64749", url="https://www.jmir.org/2025/1/e64749" } @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/10.2196/68372, author="Hayek, Joyce and Dickson, Kelsi and Lafave, Z. Lynne M.", title="Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="22", volume="8", pages="e68372", keywords="eHealth", keywords="early childhood educators", keywords="ECE", keywords="early childhood education and care", keywords="ECEC", keywords="knowledge synthesis", keywords="digital technology", keywords="health technology", keywords="digital public health", keywords="eating", keywords="diet", abstract="Background: Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators' practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking. Objective: The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness. Methods: This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature. Results: The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53\%). The largest proportion of studies were conducted in the United States (11 studies, 37\%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42\%), physical activity (5 tools, 26\%), or both nutrition and physical activity (6 tools, 32\%). All tools were web based (19 tools, 100\%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57\%) and the United States (3 tools, 43\%). The majority targeted nutrition (4 tools, 57\%) and were primarily web based (6 tools, 86\%), with 1 mobile app (1 tool, 14\%). Conclusions: This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): RR2-10.2196/52252 ", doi="10.2196/68372", url="https://pediatrics.jmir.org/2025/1/e68372" } @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