@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/10.2196/67137,
author="Ibrahim, Hussein Radhwan
and Yaas, Hussein Marghoob
and Hamarash, Qadir Mariwan
and Al-Mukhtar, Hazim Salwa
and Abdulghani, Faris Mohammed
and Al Mushhadany, Osama",
title="Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes",
journal="JMIR Pediatr Parent",
year="2025",
month="Apr",
day="11",
volume="8",
pages="e67137",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="psychotherapy",
keywords="mHealth",
keywords="app",
keywords="adolescents",
keywords="teenager",
keywords="mental health",
keywords="usability",
keywords="engagement",
keywords="anxiety",
keywords="depression",
keywords="user experience",
keywords="UX",
keywords="focus group",
keywords="interview",
keywords="digital health",
abstract="Background: Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited. Objective: This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes. Methods: A qualitative study was conducted with 40 adolescents aged 13?19 years (mean age 15.8, SD 1.9 years; 18/40, 45\% male; 22/40, 55\% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50\%), depression (15/40, 38\%), and both (5/40, 13\%). Of these, 10 (25\%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests. Results: The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16?19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13?15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95\% CI 1.6?5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95\% CI 1.7?5.6; P=.001). Usability challenges included complex navigation (20/40, 50\%), interface design issues (12/40, 30\%), and content overload (8/40, 20\%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50\%) and gamification features (10/40, 25\%), while lack of personalization (14/40, 35\%) and external distractions (18/40, 45\%) were significant barriers. Mood improvement (15/40, 38\%) and learning new coping skills (12/40, 30\%) were the most reported outcomes. Conclusions: The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement. ",
doi="10.2196/67137",
url="https://pediatrics.jmir.org/2025/1/e67137"
}


@Article{info:doi/10.2196/70508,
author="Schulz, Johannes Peter
and Boldi, Marc-Olivier
and van Ackere, Ann",
title="Adolescent Cyberbullying and Cyber Victimization: Longitudinal Study Before and During COVID-19",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="25",
volume="27",
pages="e70508",
keywords="cyberbullying and cyber victimization among adolescents",
keywords="COVID-19",
keywords="panel study",
keywords="longitudinal data analysis",
keywords="parental communication",
keywords="exposure to violent media content",
abstract="Background: Adolescent cyberbullying has been a persistent issue, exacerbated by the shift to remote learning and increased screen time during the COVID-19 pandemic. These changes have sparked concerns about potential increases in cyberbullying and its associated risks. Objective: This study aims to explore how factors such as age, exposure to violent media, parental communication quality, internet access, sex, and sibling relationships influence cyberbullying behavior at school. Additionally, we examine how the COVID-19 pandemic may have altered these dynamics. Methods: Leveraging a panel dataset, we examine the same group of adolescents both before and during the pandemic. The analysis focused on identifying relationships between the selected factors and cyberbullying perpetration and victimization, with an emphasis on the dynamics introduced by the COVID-19 pandemic. Results: Perceived quality of parental communication was found to reduce the risk of both cyberbullying perpetration and victimization, with the former effect becoming more pronounced during the COVID-19 pandemic. Exposure to violent media increased both cyberbullying perpetration and victimization, but the effect on perpetration decreased during the COVID-19 pandemic. The well-established correlation between internet access and both cyberbullying perpetration and victimization remained unaffected by COVID-19. Surprisingly, adolescents with siblings were less likely to become victims or perpetrators of school-related cyberbullying, irrespective of the pandemic. Conclusions: In hindsight, COVID-19, functioning as a kind of natural experiment, has provided us with a unique opportunity to examine the effects of a global event, forcing major behavioral changes on the persistent challenge of cyberbullying in middle schools. ",
doi="10.2196/70508",
url="https://www.jmir.org/2025/1/e70508"
}


@Article{info:doi/10.2196/67454,
author="Knapp, A. Ashley
and Cohen, Katherine
and Kruzan, P. Kaylee
and Kornfield, Rachel
and Herrera, Miguel
and Pederson, B. Aderonke
and Lee, Sydney
and Macapagal, Kathryn
and Roulston, A. Chantelle
and Clarke, Kaleigh
and Wijaya, Clarisa
and Simmons, Robert
and Jackson, Latonia
and Kour, Simrandeep
and Franco, Sandra
and Mohr, C. David",
title="Teen Perspectives on Integrating Digital Mental Health Programs for Teens Into Public Libraries (``I Was Always at the Library''): Qualitative Interview Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="13",
volume="9",
pages="e67454",
keywords="public libraries",
keywords="digital mental health",
keywords="teens",
keywords="youth",
keywords="adolescents",
keywords="anxiety",
keywords="mental health",
keywords="implementation",
keywords="safe spaces",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: Rising rates of anxiety among teens necessitate innovative approaches for implementing evidence-based mental health support. Public libraries, seen as safe spaces for patrons with marginalized identities, offer free public services such as broadband internet access. Many teens spend significant amounts of time in their local libraries due to the safety of this space as well as the trusted adults working there. The American Library Association has shifted its priorities to focus more on mental health through employing social workers and providing mental health programs. As such, public libraries may be promising sites for the implementation of digital mental health (DMH) programs for teens. Objective: This study aimed to examine how teens who attended their local public library experienced and managed their anxiety, what mental health supports they were interested in receiving, and how DMH programs and public libraries can meet their needs. Methods: We interviewed 16 teens aged 12-18 (mean 15.2, SD 2.0) years who used the library frequently at the time of the interviews. Of these teen patrons, 56\% (9/16) identified as female, 31\% (5/16) identified as male, and 12\% (2/16) identified as nonbinary. Most (11/16, 69\%) identified as either White or Black or African American individuals, with the remainder (5/16, 31\%) identifying as Hispanic or Latino or Chinese American individuals or with ?2 races. The interviews were individual and semistructured, designed to elicit recommendations for designing and implementing digital tools in libraries to improve teen mental health. Interview transcripts were coded by multiple coders using thematic analysis to synthesize key themes. Results: Teens reported experiencing uncontrollability, unpredictability, and anger related to their anxiety, which they managed using strategies such as guided breathing, distress tolerance, and social connection. They also talked about other helpful management techniques (eg, progressive muscle relaxation, journaling, and mood tracking). Teens underscored the importance of pairing mood tracking with daily activities to reveal patterns. They also stressed the significance of context and anxiety severity when choosing anxiety management strategies. Teens underscored the centrality of the public library in their lives and their view of it as a safe space where they can easily access resources and connect with friends and trusted adults. When considering the design of a DMH program implemented in libraries, they suggested including personalization for different identities, gamification, and simple navigation. Teens emphasized the importance of protecting their privacy within digital programs and that their end goal was to use the skills learned in the DMH program offline. Conclusions: Teens who frequently used their local public library expressed interest in receiving digital tools via libraries to help them manage anxiety. Their recommendations will help inform future research on the adaptation and implementation of DMH programs for teens in public libraries. ",
doi="10.2196/67454",
url="https://formative.jmir.org/2025/1/e67454"
}


@Article{info:doi/10.2196/60844,
author="Gulec, Hayriye
and Muzik, Michal
and Smahel, David
and Dedkova, Lenka",
title="Longitudinal Associations Between Adolescents' mHealth App Use, Body Dissatisfaction, and Physical Self-Worth: Random Intercept Cross-Lagged Panel Study",
journal="JMIR Ment Health",
year="2025",
month="Mar",
day="11",
volume="12",
pages="e60844",
keywords="mHealth app",
keywords="body dissatisfaction",
keywords="physical self-worth",
keywords="random intercept cross-lagged panel model",
keywords="RI-CLPM",
keywords="longitudinal study",
keywords="adolescent",
abstract="Background: Longitudinal investigation of the association between mobile health (mHealth) app use and attitudes toward one's body during adolescence is scarce. mHealth apps might shape adolescents' body image perceptions by influencing their attitudes toward their bodies. Adolescents might also use mHealth apps based on how they feel and think about their bodies. Objective: This prospective study examined the longitudinal within-person associations between mHealth app use, body dissatisfaction, and physical self-worth during adolescence. Methods: The data were gathered from a nationally representative sample of Czech adolescents aged between 11 and 16 years (N=2500; n=1250, 50\% girls; mean age 13.43, SD 1.69 years) in 3 waves with 6-month intervals. Participants completed online questionnaires assessing their mHealth app use, physical self-worth, and body dissatisfaction at each wave. The mHealth app use was determined by the frequency of using sports, weight management, and nutritional intake apps. Physical self-worth was assessed using the physical self-worth subscale of the Physical Self Inventory-Short Form. Body dissatisfaction was measured with the items from the body dissatisfaction subscale of the Eating Disorder Inventory-3. The random intercept cross-lagged panel model examined longitudinal within-person associations between the variables. A multigroup design was used to compare genders. Due to the missing values, the final analyses used data from 2232 adolescents (n=1089, 48.8\% girls; mean age 13.43, SD 1.69 years). Results: The results revealed a positive within-person effect of mHealth app use on the physical self-worth of girls: increased mHealth app use predicted higher physical self-worth 6 months later ($\beta$=.199, P=.04). However, this effect was not consistent from the 6th to the 12th month: a within-person increase in using apps in the 6th month did not predict changes in girls' physical self-worth in the 12th month ($\beta$=.161, P=.07). Regardless of gender, the within-person changes in the frequency of using apps did not influence adolescents' body dissatisfaction. In addition, neither body dissatisfaction nor physical self-worth predicted app use frequency at the within-person level. Conclusions: This study highlighted that within-person changes in using mHealth apps were differentially associated with adolescents' body-related attitudes. While increased use of mHealth apps did not influence body dissatisfaction across genders, it significantly predicted higher physical self-worth in adolescent girls 6 months later. A similar association was not observed among boys after 6 months. These findings indicate that using mHealth apps is unlikely to have a detrimental impact on adolescents' body dissatisfaction and physical self-worth; instead, they may have a positive influence, particularly in boosting the physical self-worth of adolescent girls. ",
doi="10.2196/60844",
url="https://mental.jmir.org/2025/1/e60844"
}


@Article{info:doi/10.2196/57962,
author="Kim, Seokjun
and Jo, Hyesu
and Son, Yejun
and Shin, Kyung Min
and Lee, Kyeongmin
and Park, Jaeyu
and Lee, Hayeon
and Smith, Lee
and Dragioti, Elena
and Fond, Guillaume
and Boyer, Laurent
and L{\'o}pez S{\'a}nchez, F. Guillermo
and Tully, A. Mark
and Rahmati, Masoud
and Pizzol, Damiano
and Woo, Selin
and Yon, Keon Dong",
title="Nationwide Trends in Screen Time and Associated Risk Factors by Family Structures Among Adolescents, 2008-2022: Nationwide Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Mar",
day="10",
volume="11",
pages="e57962",
keywords="adolescents",
keywords="family type",
keywords="pandemic",
keywords="screen time",
keywords="South Korea",
keywords="sedentary activity",
keywords="risk factor",
keywords="mobile phone",
abstract="Background: Although understanding long-term trends in adolescent screen time and the influence of family structure is essential, there is a lack of research addressing these issues comprehensively. Objective: This study aimed to conduct comprehensive investigations into adolescent screen time before and during the COVID-19 pandemic, with a particular focus on family structures. Methods: This study used nationwide, large-scale data from the Korea Youth Risk Behavior Web-Based Survey from South Korea. We aimed to indicate the changes in adolescent screen time over 15 years from 2008 to 2022. Weighted linear regression was used to analyze annual trends in screen time before and during the pandemic, and stratified analyses were conducted to examine associated risk factors across different family structures. Results: This study used data from a total of 836,972 individuals (n=403,456, 48.2\% women), with an age range of 12-18 years. The analysis revealed an overall increase in screen time prepandemic ($\beta$=8.06, 95\% CI 7.74-8.39), with a notable increase observed at the onset of the pandemic ($\beta$=162.06, 95\% CI 159.49-164.64). Among diverse family structures, the orphanage group showed the most substantial increase in screen time during the pandemic ($\beta$diff=221.90, 95\% CI 159.62-284.17). Risk factors associated with screen time during the pandemic varied by family structure. Notably, the nuclear family group presented distinct screen time--related risk factors, including grade, region of residence, physical activity frequency, sadness and despair, and the highest education level of parents. Conclusions: There has been a notable increase in average screen time among adolescents since the onset of the pandemic, with the orphanage group exhibiting a pronounced trend. The risk factors associated with screen time during the pandemic varied for each family structure. Findings from this study suggest that the implementation of individualized measures tailored to each family structure should be adopted to effectively address the increased issue of adolescent screen time since the pandemic. ",
doi="10.2196/57962",
url="https://publichealth.jmir.org/2025/1/e57962"
}


@Article{info:doi/10.2196/59215,
author="Hamp, Nicole
and Radesky, Jenny
and Weeks, M. Heidi
and Miller, L. Alison
and Kaciroti, Niko",
title="Novel Profiles of Family Media Use: Latent Profile Analysis",
journal="JMIR Pediatr Parent",
year="2025",
month="Mar",
day="6",
volume="8",
pages="e59215",
keywords="preschool",
keywords="child",
keywords="digital media",
keywords="mobile media",
keywords="media use",
keywords="latent profile analysis",
keywords="computer use",
keywords="LPA",
keywords="technology use",
keywords="survey",
keywords="questionnaire",
keywords="pediatrics",
abstract="Background: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as ``screen time'' must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information. Objective: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media. Methods: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership. Results: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership. Conclusions: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes. ",
doi="10.2196/59215",
url="https://pediatrics.jmir.org/2025/1/e59215"
}


@Article{info:doi/10.2196/64672,
author="DuPont-Reyes, J. Melissa
and Villatoro, P. Alice
and Tang, Lu",
title="Health Information Scanning and Seeking in Diverse Language, Cultural and Technological Media Among Latinx Adolescents: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="5",
volume="27",
pages="e64672",
keywords="adolescent behaviors",
keywords="mental health",
keywords="Latino",
keywords="social media",
keywords="adolescent",
keywords="media use",
keywords="internet use",
keywords="health information seeking",
keywords="health information scanning",
keywords="mobile phone",
abstract="Background: Continuous scientific and policy debate regarding the potential harm and/or benefit of media and social media on adolescent health has resulted, in part, from a deficiency in robust scientific evidence. Even with a lack of scientific consensus, public attitudes, and sweeping social media prohibitions have swiftly ensued. A focus on the diversity of adolescents around the world and their diverse use of language, culture, and social media is absent from these discussions. Objective: This study aims to guide communication policy and practice, including those addressing access to social media by adolescent populations. This study assesses physical and mental health information scanning and seeking behaviors across diverse language, cultural, and technological media and social media among Latinx adolescent residents in the United States. This study also explores how Latinx adolescents with mental health concerns use media and social media for support. Methods: In 2021, a cross-sectional survey was conducted among 701 US-based Latinx adolescents aged 13-20 years to assess their health-related media use. Assessments ascertained the frequency of media use and mental and physical health information scanning and seeking across various media technologies (eg, TV, podcasts, and social media) and language and cultural types (ie, Spanish, Latinx-tailored English, and general English). Linear regression models were used to estimate adjusted predicted means of mental and physical health information scanning and seeking across diverse language and cultural media types, net personal and family factors, in the full sample and by subsamples of mental health symptoms (moderate-high vs none-mild). Results: Among Latinx adolescents, media and social media use was similar across mental health symptoms. However, Latinx adolescents with moderate-high versus none-mild symptoms more often scanned general English media and social media for mental health information (P<.05), although not for physical health information. Also, Latinx adolescents with moderate-high versus none-mild symptoms more often sought mental health information on Latinx-tailored and general English media, and social media (P<.05); a similar pattern was found for physical health information seeking. In addition, Latinx adolescents with moderate-high versus none-mild symptoms often sought help from family and friends for mental and physical health problems and health care providers for mental health only (P<.05). Conclusions: While media and social media usage was similar across mental health, Latinx adolescents with moderate-high symptoms more often encountered mental health content in general English media and social media and turned to general English- and Latinx-tailored media and social media more often for their health concerns. Together these study findings suggest more prevalent and available mental health content in general English versus Spanish language and Latinx-tailored media and underscore the importance of providing accessible, quality health information across diverse language, cultural, and technological media and social networks as a viable opportunity to help improve adolescent health. ",
doi="10.2196/64672",
url="https://www.jmir.org/2025/1/e64672",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053766"
}


@Article{info:doi/10.2196/65343,
author="Chen, Hao
and Sun, Yi
and Luo, Sha
and Ma, Yingyan
and Li, Chenshu
and Xiao, Yingcheng
and Zhang, Yimeng
and Lin, Senlin
and Jia, Yingnan",
title="Association of Screen Content With Early Development Among Preschoolers in Shanghai: 7-Day Monitoring Study With Auto Intelligent Technology",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="5",
volume="27",
pages="e65343",
keywords="types of screen content",
keywords="screen time",
keywords="intelligent technology",
keywords="early development",
keywords="preschool",
abstract="Background: It is unclear how exposure to different types of screen content is associated with early development among preschool children. Objective: This study aims to precisely evaluate the screen exposure time across different content types and to explore the associations with the Ages and Stages Questionnaire, Third Edition (ASQ-3) score and 5 capacity domains in children aged 34.5-66 months. Methods: This monitoring study used intelligent technology to collect data on the 7-day screen time and the time spent viewing each content type. The participants were 2 groups of Shanghai kindergarten kids. The data were collected between March 2023 and July 2023. Screen exposure data (total daily time and time for each type of content) were collected from children aged between 34.5 and 66 months. A self-designed questionnaire and the Healthy Screen Viewing for Children intelligent technology app were used to assess screen exposure to all media and tablets. The ASQ-3 was used to assess early development in children aged 34.5-66 months. Results: In the 535-child sample, the results of linear regression analysis indicated that both screen time of more than 60 minutes and exposure to smartphones and tablets were negatively associated with ASQ-3 score. Among 365 participants with data collected by the Healthy Screen Viewing for Children app, median regression showed that the median total ASQ-3 score was negatively associated with screen time for noneducational content ($\beta$=--.055; 95\% CI --0.148 to --0.006; P=.03), screen time for both educational and noneducational content ($\beta$=--.042; 95\% CI --0.081 to --0.007; P=.001), and fast-paced content ($\beta$=--.034; 95\% CI --0.062 to --0.011; P=.049). The median gross motor score was negatively associated with screen time for parental guidance-13--rated content ($\beta$=--.015; 95\% CI --0.022 to 0.009; P=.03), educational and noneducational content ($\beta$=--.018, 95\% CI --0.038 to --0.001; P=.02), static content ($\beta$=--.022; 95\% CI --0.050 to 0.007; P=.02). This study also revealed that the median fine motor score was negatively associated with screen time for guidance--rated content ($\beta$=--.032, 95\% CI --0.057 to --0.003; P=.006), parental guidance (PG) rated content ($\beta$=--.020; 95\% CI --0.036 to --0.007; P=.004), noneducational content ($\beta$=--.026; 95\% CI --0.067 to --0.003; P=.01), both educational and noneducational content ($\beta$=--.020; 95\% CI --0.034 to --0.001; P<.001), fast-paced content ($\beta$=--.022; 95\% CI --0.033 to --0.014; P<.001), static content ($\beta$=--.034; 95\% CI --0.050 to 0.018; P<.001), animated content ($\beta$=--.038; 95\% CI --0.069 to --0.001; P=.004), and screen use during the daytime ($\beta$=--.026; 95\% CI --0.043 to 0.005; P=.005). Conclusions: The results indicated that the time spent viewing noneducational, static, fast-paced, and animated content was negatively associated with early development among preschool children. Limiting screen time in relevant aspects is recommended. ",
doi="10.2196/65343",
url="https://www.jmir.org/2025/1/e65343",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053802"
}


@Article{info:doi/10.2196/65859,
author="Turvey, Jake
and Raggatt, Michelle
and Wright, C. Cassandra J.
and Davis, C. Angela
and Temple-Smith, J. Meredith
and Lim, C. Megan S.",
title="A Digital Pornography Education Prototype Co-Designed With Young People: Formative Evaluation",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="4",
volume="9",
pages="e65859",
keywords="pornography",
keywords="education",
keywords="website",
keywords="prototyping",
keywords="evaluation",
keywords="sexual health",
keywords="sexual wellbeing",
keywords="pornography literacy",
keywords="young people",
keywords="youth",
keywords="adolescents",
keywords="The Gist",
keywords="sexual education",
keywords="Australia",
keywords="efficacy",
keywords="digital health",
keywords="co-design",
abstract="Background: Interventions to help young people make sense of sex and relationships in the context of widely available pornography are becoming increasingly supported in school settings. However, young people who experience disruptions to their education often have less access to such programs. Digital platforms may offer a more accessible method to deliver tailored sexual health and pornography literacy to young people who are disengaged from mainstream schooling, or who experience other types of structural disadvantage. Objective: This study aimed to describe the formative evaluation of ``The Gist'' a co-designed online sexual health education and pornography literacy prototype designed to meet the sexual health information needs of structurally marginalized young people in Australia. Methods: We conducted iterative workshops with 33 young people aged between 15 and 24 years recruited from an alternative education school in Melbourne, Australia. Through interactive activities, participants evaluated the overall prototype design, including its usability, desirability, inclusiveness, and potential for impact. Results: Participants reported The Gist to be easy to use (17/20, 85\%) and safe (19/23, 83\%), with ``hot'' branding (25/30, 83\%). However, perceived content relevance was dependent on the participants' existing level of sexual health knowledge and experience, with only 31\% (7/23) agreeing that ``The Gist feels like it was made for me.'' The interactive learning activities such as the debunked (myth-busting) and quiz features were among the most used and well-liked on The Gist platform. Low unprompted engagement with the prototype outside of facilitated workshop settings also confirmed previous researcher postulations that The Gist as a standalone digital platform is unlikely to meet the needs of this population group. Further design refinements are needed to improve user experience, including more interactive activities and visual information in place of heavily text-based features. Conclusions: This study provides important insights into the design and sexual health information needs of structurally marginalized young people. Further research is needed to assess the overall efficacy of The Gist prototype, as well as its ability to positively influence young people's sexual attitudes, beliefs, and behaviors. Future iterations should consider hybrid or face-to-face delivery models to better capture student engagement. ",
doi="10.2196/65859",
url="https://formative.jmir.org/2025/1/e65859"
}


@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/10.2196/66448,
author="Kim, I. Sol
and Jin, Jae-Chan
and Yoo, Seo-Koo
and Han, Hyun Doug",
title="Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Feb",
day="11",
volume="8",
pages="e66448",
keywords="coronavirus pandemic",
keywords="internet use pattern",
keywords="internet games",
keywords="short-form videos",
keywords="social network system",
keywords="depressed mood",
keywords="internet use",
keywords="pandemic",
keywords="internet",
keywords="COVID-19",
keywords="video",
keywords="internet behavior",
keywords="social media",
keywords="internet addiction",
keywords="depression",
keywords="anxiety",
keywords="digital platforms",
keywords="mobile phone",
abstract="Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents' psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 ($\chi$23=8.16, P=.04). Furthermore, this study showed that the Young's Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. ",
doi="10.2196/66448",
url="https://pediatrics.jmir.org/2025/1/e66448"
}


@Article{info:doi/10.2196/62955,
author="Chemnad, Khansa
and Aziz, Maryam
and Al- Harahsheh, Sanaa
and Abdelmoneium, Azza
and Baghdady, Ahmed
and Alsayed Hassan, Diana
and Ali, Raian",
title="Assessing the Relationship Between the Type of Internet Use and Internet Addiction in Early and Middle Adolescents: Cross-Sectional Study From Qatar",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="10",
volume="12",
pages="e62955",
keywords="internet addiction",
keywords="internet use",
keywords="early adolescence",
keywords="middle adolescence",
keywords="mobile phone",
abstract="Background: With the increasing prevalence of digital technology, adolescent internet addiction (IA) has become a global concern. Excessive internet use, especially among adolescents, has been linked to various negative outcomes such as poor academic performance, social isolation, and mental health issues. Conducted among adolescents of Arab origin, our study addressed the limitations of the literature, which predominantly focuses on Western, educated, industrialized, rich, and democratic populations. Objective: This study aimed to differentiate between essential and nonessential internet use and how they relate to IA in early and middle adolescents, as well as the relationship between subjective happiness with the amount of time spent on nonessential internet use and IA. Methods: A cross-sectional survey was conducted among 377 students from 16 schools in Qatar. The survey measured essential and nonessential internet use, subjective happiness with nonessential use, and IA symptoms using the Internet Addiction Diagnostic Questionnaire, as well as participant demographics. To explore age-specific associations, participants were categorized into early (age 11-13 years) and middle (age 14-17 years) adolescents. Factorial analysis, multiple regression, and logistic regression were used for statistical analysis. Results: Nonessential internet use significantly predicted IA in both early (P<.001) and middle (P<.001) adolescents, with early adolescents showing a stronger association. Subjective happiness with nonessential internet use negatively predicted IA only in middle adolescents (P<.001) as greater dissatisfaction led to a higher IA risk. Essential internet use did not predict IA in either group. Conclusions: Differentiating between essential and nonessential internet use is crucial in understanding IA. This study highlights the importance of developmental differences in shaping IA symptoms. The findings suggest that interventions aimed at addressing IA should be age specific and focus on addressing nonessential use specifically rather than considering internet use and screen time in general as a single entity. Cultural and regional factors also play a role in shaping internet use patterns and IA in the Middle East, necessitating context-specific, culturally sensitive approaches to IA prevention. ",
doi="10.2196/62955",
url="https://humanfactors.jmir.org/2025/1/e62955"
}


@Article{info:doi/10.2196/63799,
author="Liu, Yujie
and Ge, Xin
and Wang, Ying
and Yang, Xue
and Liu, Shangbin
and Xu, Chen
and Xiang, Mi
and Hu, Fan
and Cai, Yong",
title="Urban-Rural Differences in the Association Between Internet Use Trajectories and Depressive Symptoms in Chinese Adolescents: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="7",
volume="27",
pages="e63799",
keywords="internet use",
keywords="trajectory",
keywords="depressive symptoms",
keywords="adolescent",
keywords="urban",
keywords="rural",
abstract="Background: Internet use exhibits diverse trajectories during adolescence, which may contribute to depressive symptoms. Currently, it remains unclear whether the association between internet use trajectories and depressive symptoms varies between urban and rural areas. Objective: This study aimed to investigate the association between internet use trajectories and adolescent depressive symptoms and to explore variation in this association between urban and rural areas. Methods: This longitudinal study used 3-wave data from the 2014-2018 China Family Panel Study. Weekly hours of internet use and depressive symptoms were measured using self-reported questionnaires. Latent class growth modeling was performed to identify the trajectories of internet use. Multivariable logistic regressions were used to examine the association between internet use trajectories and depressive symptoms, stratified by rural and urban residence. Results: Participants were 2237 adolescents aged 10 to 15 years at baseline (mean age 12.46, SD 1.73 years). Two latent trajectory classes of internet use were identified: the low-growth group (n=2008, 89.8\%) and the high-growth group (n=229, 10.2\%). The high-growth group was associated with higher odds of depressive symptoms (OR 1.486, 95\% CI 1.065-2.076) compared to the low-growth group. In the stratified analysis, the association between internet use trajectories and depressive symptoms was significant solely among rural adolescents (OR 1.856, 95\% CI 1.164-2.959). Conclusions: This study elucidates urban-rural differences in the associations between trajectories of internet use and adolescent depressive symptoms. Our findings underscore the importance of prioritizing interventions for rural adolescents' internet use behaviors to mitigate negative effects on their mental health. ",
doi="10.2196/63799",
url="https://www.jmir.org/2025/1/e63799"
}


@Article{info:doi/10.2196/54531,
author="Sankesara, Heet
and Denyer, Hayley
and Sun, Shaoxiong
and Deng, Qigang
and Ranjan, Yatharth
and Conde, Pauline
and Rashid, Zulqarnain
and Asherson, Philip
and Bilbow, Andrea
and Groom, J. Madeleine
and Hollis, Chris
and Dobson, B. Richard J.
and Folarin, Amos
and Kuntsi, Jonna",
title="Identifying Digital Markers of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Remote Monitoring Setting: Prospective Observational Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="29",
volume="9",
pages="e54531",
keywords="ADHD",
keywords="smartphones",
keywords="wearable devices",
keywords="mobile health",
keywords="mHealth",
keywords="remote monitoring",
keywords="surveillance",
keywords="digital markers",
keywords="attention-deficit/hyperactivity disorder",
keywords="behavioral data",
keywords="real world",
keywords="adult",
keywords="adolescent",
keywords="participants",
keywords="digital signals",
keywords="restlessness",
keywords="severity",
keywords="predicting outcomes",
abstract="Background: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)--base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. Objective: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. Methods: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. Results: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). Conclusions: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes. ",
doi="10.2196/54531",
url="https://formative.jmir.org/2025/1/e54531"
}


@Article{info:doi/10.2196/62944,
author="Thompson, Lauren
and Charitos, Sydney
and Bird, Jon
and Marshall, Paul
and Brigden, Amberly",
title="Exploring the Use of Smartwatches and Activity Trackers for Health-Related Purposes for Children Aged 5 to 11 years: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="27",
volume="27",
pages="e62944",
keywords="children",
keywords="systematic review",
keywords="wearable activity trackers",
keywords="smartwatches",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: ?Digital health interventions targeting behavior change are promising in adults and adolescents; however, less attention has been given to younger children. The proliferation of wearables, such as smartwatches and activity trackers, that support the collection of and reflection on personal health data highlights an opportunity to consider novel approaches to supporting health in young children (aged 5-11 y). Objective: ?This review aims to investigate how smartwatches and activity trackers have been used across child health interventions (for children aged 5-11 y) for different health areas, specifically to identify the population characteristics of those being?targeted, describe the characteristics of the devices being used, and report the feasibility and acceptability of these devices for health-related applications with children. Methods: We searched 10 databases (CINAHL, Embase, ACM Digital Library, IEEE Xplore, Cochrane Library, PsycINFO, Web of Science, PubMed, Scopus, and MEDLINE) to identify relevant literature in March 2023. The inclusion criteria for studies were as follows: (1) peer-reviewed, empirical studies; (2) published in English; (3) involved a child aged 5 to 11 years using a smartwatch for health-related purposes. Two researchers independently screened articles to assess eligibility. One researcher extracted data relating to the 3 aims and synthesized the results using narrative and thematic synthesis. Results: ?The database searches identified 3312 articles, of which 15 (0.45\%) were included in this review. Three (20\%) articles referred to the same intervention. In 77\% (10/13) of the studies, the devices were used to target improvements in physical activity. Other applications included using smartwatches to deliver interventions for emotional regulation and asthma management. In total, 9 commercial devices were identified, many of which delivered minimal data feedback on the smartwatch or activity tracker, instead relying on a partner app running on a linked parental smartphone with greater functionality. Of the 13 studies, 8 (62\%) used devices designed for adults rather than children. User feedback was positive overall, demonstrating the acceptability and feasibility of using these devices with children. However, the studies often lacked a child-focused approach, with 3 (23\%) studies gathering user feedback only from parents. Conclusions: ?Interventions involving smartwatches and activity trackers for children aged 5 to 11 years remain limited, primarily focusing on enhancing physical activity, with few studies investigating other health applications. These devices often provide limited data feedback and functionality to support children's independent engagement with the data, relying on paired smartphone apps managed by caregivers, who control access and facilitate children's interaction with the data. Future research should adopt child-centered methods in the design and evaluation of these technologies, integrating children's perspectives alongside their caregivers, to ensure that they are not only feasible and acceptable but also meaningful and effective for young children. Trial Registration: PROSPERO CRD42022373813, https://tinyurl.com/4kxu8zss ",
doi="10.2196/62944",
url="https://www.jmir.org/2025/1/e62944"
}


@Article{info:doi/10.2196/57636,
author="Zhang, Jinghui
and Zhang, Qing
and Xiao, Bowen
and Cao, Yuxuan
and Chen, Yu
and Li, Yan",
title="Parental Technoference and Child Problematic Media Use: Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="22",
volume="27",
pages="e57636",
keywords="parental technoference",
keywords="child",
keywords="problematic media use",
keywords="meta-analysis",
keywords="children",
keywords="youth",
keywords="adolescents",
keywords="phubbing",
keywords="screen distraction",
keywords="systematic reviews",
keywords="interventions",
keywords="mental health",
keywords="digital health",
abstract="Background: Parental technoference, the interruption of parent-child interactions by technology, has been associated with negative outcomes in children's media use. However, the magnitude of this relationship and its moderating factors remain unclear. Objective: This study aims to systematically examine the relationship between parental technoference and child problematic media use, as well as to identify moderating factors such as age, parental technoference group, study design, and type of problematic media use. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted up to August 2024 across multiple databases, including Web of Science, EBSCO, ProQuest, PubMed, PsycINFO, and China National Knowledge Infrastructure, using predefined search strings. A total of 53 studies with a total of 60,555 participants (mean age of 13.84, SD 1.18 years) were included. Inclusion criteria comprised studies involving children under the age of 22 years, assessing the association between parental technoference and child problematic media use with valid measures, and reporting necessary statistical data. Exclusion criteria included studies focusing on other child outcomes, having sample sizes <30, or being case reports or review papers. The risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A random-effects meta-analysis was performed using R (version 4.2.1; R Foundation for Statistical Computing) with the meta and metafor packages to evaluate the association and conduct moderator analyses. Results: The meta-analysis identified a significant positive association between parental technoference and child problematic media use (r=0.296, 95\% CI 0.259-0.331). Moderator analyses revealed that both parental technoference group (P<.001) and study design (P=.008) significantly influenced this relationship. Specifically, the association was stronger when both parents engaged in technoference compared to when only 1 parent did, and in cross-sectional studies compared to longitudinal studies. Age, gender, publication status, and type of problematic media use did not significantly moderate the relationship (all P>.05). Conclusions: This meta-analysis provides robust evidence of the association between parental technoference and child problematic media use. The findings highlight the need for family-based interventions and underscore the importance of longitudinal research to understand the temporal dynamics of this relationship better. Trial Registration: PROSPERO CRD42023471997; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=471997 ",
doi="10.2196/57636",
url="https://www.jmir.org/2025/1/e57636"
}


@Article{info:doi/10.2196/53231,
author="Ezimora, Ifunanya
and Lundberg, Tylia
and Miars, Dylan
and Trujeque, Jeruel
and Papias, Ashley
and Del Cid, V. Margareth
and Folk, B. Johanna
and Tolou-Shams, Marina",
title="Reflections of Foster Youth Engaging in the Co-Design of Digital Mental Health Technology: Duoethnography Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="20",
volume="9",
pages="e53231",
keywords="foster youth",
keywords="digital health technology",
keywords="co-design",
keywords="app development",
keywords="mental health",
keywords="adolescent",
keywords="young adult",
keywords="mobile health",
keywords="mHealth",
keywords="foster care",
keywords="duoethnography",
abstract="Background: Current research on digital applications to support the mental health and well-being of foster youth is limited to theoretical applications for transition-aged foster youth and support platforms developed without intentional input from foster youth themselves. Centering the lived expertise of foster youth in digital solutions is crucial to dismantling barriers to care, leading to an increase in service access and improving mental health outcomes. Co-design centers the intended end users during the design process, creating a direct relationship between potential users and developers. This methodology holds promise for creating tools centered on foster youth, yet little is known about the co-design experience for foster youth. Understanding foster youth's experience with co-design is crucial to identifying best practices, knowledge of which is currently limited. Objective: The aim of this paper is to reflect on the experiences of 4 foster youth involved in the co-design of FostrSpace, a mobile app designed through a collaboration among foster youth in the San Francisco Bay Area; clinicians and academics from the Juvenile Justice Behavioral Health research team at the University of California, San Francisco; and Chorus Innovations, a rapid technology development platform specializing in participatory design practices. Key recommendations for co-designing with foster youth were generated with reference to these reflections. Methods: A duoethnography study was conducted over a 1-month period with the 4 transition-aged former foster youth co-designers of FostrSpace via written reflections and a single in-person roundtable discussion. Reflections were coded and analyzed via reflexive thematic analysis. Results: In total, 4 main themes were identified from coding of the duoethnography reflections: power and control, resource navigation, building community and safe spaces, and identity. Themes of power and control and resource navigation highlighted the challenges FostrSpace co-designers experienced trying to access basic needs, support from caregivers, and mental health resources as foster youth and former foster youth. Discussions pertaining to building community and safe spaces highlighted the positive effect of foster youth communities on co-designers, and discussions related to identity revealed the complexities associated with understanding and embracing foster youth identity. Conclusions: This duoethnography study highlights the importance of centering the lived expertise of co-designers throughout the app development process. As the digital health field increasingly shifts toward using co-design methods to develop digital mental health technologies for underserved youth populations, we offer recommendations for researchers seeking to ethically and effectively engage youth co-designers. Actively reflecting throughout the co-design process, finding creative ways to engage in power-sharing practices to build community, and ensuring mutual benefit among co-designers are some of the recommended core components to address when co-designing behavioral health technologies for youth. ",
doi="10.2196/53231",
url="https://formative.jmir.org/2025/1/e53231"
}


@Article{info:doi/10.2196/59441,
author="Zhu, Shimin
and Qi, Di",
title="Reciprocal Relationship Between Self-Control Belief and Gaming Disorder in Children and Adolescents: Longitudinal Survey Study",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="15",
volume="13",
pages="e59441",
keywords="growth mindset",
keywords="gaming disorder",
keywords="cross-lagged panel model",
keywords="children",
keywords="self-control",
keywords="adolescents",
abstract="Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. It is essential to identify the modifiable psychosocial factors influencing gaming disorder development. The lay theories of self-control (ie, the beliefs about whether self-control can be improved, also called self-control mindsets) may interplay with self-control and gaming disorder and serve as a promising influential factor for gaming disorder. Objective: This study aims to answer the research questions ``Does believing one's self-control is unchangeable predict more severe gaming disorder symptoms later?'' and ``Does the severity of gaming disorder symptoms prospectively predict self-control mindsets?'' with a 1-year, 2-wave, school-based longitudinal survey. Methods: A total of 3264 students (338 in grades 4?5 and 2926 in grades 7?10) from 15 schools in Hong Kong participated in the classroom surveys. We used cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity (the cross-lagged path from mindsets to gaming disorder: regression coefficients [b] with 95\% CI [0.070, 0.020-0.12o, P=.006]; and from gaming disorder to mindsets: b with 95\% CI [0.11, 0.060-0.160, P<.001]). Subgroup analyses of boy and girl participants revealed that more growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls (b=0.12, 95\% CI 0.053-0.190, P=.001) but not in boys (b=0.025, 95\% CI --0.050 to 0.100, P=.51), while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys (b=0.15, 95\% CI 0.069-0.230, P<.001) and girls (b=0.098, 95\% CI 0.031-0.170, P=.004) after 1 year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one's self-control malleability beliefs and implied that promoting a growth mindset regarding self-control might be a promising strategy for gaming disorder prevention and early intervention, especially for girls. ",
doi="10.2196/59441",
url="https://games.jmir.org/2025/1/e59441"
}


@Article{info:doi/10.2196/62943,
author="Kakon, Hafiz Shahria
and Soron, Rashid Tanjir
and Hossain, Sharif Mohammad
and Haque, Rashidul
and Tofail, Fahmida",
title="Supervised and Unsupervised Screen Time and Its Association With Physical, Mental, and Social Health of School-Going Children in Dhaka, Bangladesh: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="14",
volume="8",
pages="e62943",
keywords="screen time",
keywords="parental supervision",
keywords="Strength and Difficulties Questionnaire",
keywords="Spencer Children Anxiety Scale",
keywords="Pittsburgh Sleep Quality Scale",
keywords="children",
keywords="sleep quality",
keywords="headache",
keywords="behavioral problems",
abstract="Background: Children's screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6?14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56\%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1\% versus 161/336 students, 47.9\%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3\%) and peer difficulties (121/420 students, 28.8\%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools. ",
doi="10.2196/62943",
url="https://pediatrics.jmir.org/2025/1/e62943"
}


@Article{info:doi/10.2196/59968,
author="Colder Carras, Michelle
and Aljuboori, Dahlia
and Shi, Jing
and Date, Mayank
and Karkoub, Fatima
and Garc{\'i}a Ortiz, Karla
and Abreha, Molla Fasika
and Thrul, Johannes",
title="Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="18",
volume="26",
pages="e59968",
keywords="digital well-being",
keywords="internet addiction",
keywords="gaming disorder",
keywords="social media",
keywords="screen time",
keywords="prevention",
keywords="children",
keywords="adolescents",
keywords="mobile phone",
keywords="PRISMA",
abstract="Background: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. Objective: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. Methods: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. Results: We found 6416 citations, of which 41 (0.64\%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79\%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. Conclusions: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. Trial Registration: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=444387 ",
doi="10.2196/59968",
url="https://www.jmir.org/2024/1/e59968",
url="http://www.ncbi.nlm.nih.gov/pubmed/39693138"
}


@Article{info:doi/10.2196/60674,
author="Peterson, M. Colleen
and Visclosky, Timothy
and Flannagan, A. Carol
and Mahajan, Prashant
and Gabanyicz, Andrew
and Bouchard, Jean-Jacques
and Cervantes, Vincent
and Gribbin, William
and Hashikawa, Nobuhide Andrew",
title="Evaluating a Virtual Reality Game to Enhance Teen Distracted Driving Education: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="26",
volume="8",
pages="e60674",
keywords="safety",
keywords="virtual reality",
keywords="VR",
keywords="distracted driving",
keywords="intervention",
keywords="inattention",
keywords="smartphone",
keywords="novice drivers",
keywords="risky driving",
keywords="mobile phone",
keywords="awareness",
keywords="game",
keywords="driving education",
keywords="gamification",
keywords="adolescent",
abstract="Background: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers. Objective: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game ``Distracted Navigator'' to educate novice teenage drivers about DDB. Methods: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming. Results: Of the 24 participants, 15 (63\%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29\%), the intervention group (n=17, 71\%) was more likely to report that the programming had positively changed how they felt about texting and driving (?218=--8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; $\beta$=--.78; t46=--2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion. Conclusions: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study. ",
doi="10.2196/60674",
url="https://formative.jmir.org/2024/1/e60674"
}


@Article{info:doi/10.2196/59585,
author="Hall, A. Jeffrey",
title="Ten Myths About the Effect of Social Media Use on Well-Being",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="25",
volume="26",
pages="e59585",
keywords="social media",
keywords="well-being",
keywords="health promotion",
keywords="depressive disorder",
keywords="depression",
keywords="anxiety",
keywords="adolescent",
keywords="mental health",
doi="10.2196/59585",
url="https://www.jmir.org/2024/1/e59585"
}


@Article{info:doi/10.2196/57747,
author="Afolabi, Aliyyat
and Cheung, Elaine
and Lyu, Chen Joanne
and Ling, M. Pamela",
title="Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="22",
volume="8",
pages="e57747",
keywords="health communication",
keywords="video informed consent",
keywords="randomized experiment",
keywords="informed consent",
keywords="adolescent",
keywords="video",
keywords="consent",
keywords="e-cigarette",
keywords="vaping",
keywords="health research",
keywords="social media",
keywords="vaping cessation",
keywords="smoking cessation",
abstract="Background: Adolescents and young adults have the highest prevalence of e-cigarette use (``vaping''), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media--based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4\%; written: n=220, 50.6\%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2\% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3\% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. ",
doi="10.2196/57747",
url="https://formative.jmir.org/2024/1/e57747",
url="http://www.ncbi.nlm.nih.gov/pubmed/39576682"
}


@Article{info:doi/10.2196/44553,
author="Gollier-Briant, Fanny
and Ollivier, Laurence
and Joalland, Pierre-Hugues
and Mouchabac, St{\'e}phane
and Leray, Philippe
and Bonnot, Olivier",
title="Digital Homework Support Program for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="21",
volume="13",
pages="e44553",
keywords="attention-deficit/hyperactivity disorder",
keywords="mobile app",
keywords="assisted homework session",
keywords="digital mental health",
keywords="e-health",
keywords="smartphone",
keywords="psychiatry",
keywords="neurodeveloppemental disorders",
abstract="Background: Attention-deficit/hyperactivity disorder (ADHD) affects 4\% to 5\% of the general population. Homework sessions are frequent conflictual moments characterized by increased anxiety in children and stress in their parents, contributing to a lower family quality of life. Children with ADHD experience more severe homework problems than typically developing peers. Poor academic performance in individuals with ADHD is partly attributed to challenging homework. Psychoeducational and school-based approaches are time-consuming and not fully accessible to professionals. Digital tools, such as smartphone and tablet apps, might offer an interesting alternative. We present our digital homework support program for children and adolescents, known as ``Programme d'Aide Num{\'e}rique aux Devoirs pour Enfant avec TDA-H'' (PANDAH), along with the study protocol of our ongoing randomized controlled trial. Objective: This study aims to test PANDAH's efficacy in improving homework performance and family quality of life. Methods: Individuals aged 9-16 years with an ADHD diagnosis and no comorbid psychiatric disorders are included. This is a multicenter study involving 9 reference centers for ADHD in France. The study comprises (1) a 3-month period with a randomized controlled trial design, where participants are divided into 2 parallel groups (group 1: care as usual or waiting list; group 2: PANDAH app), followed by (2) an extension period of 3 months (months 3-6), during which all participants will have access to the app. This second phase serves as a crucial incentive for patients initially randomly assigned to group 1. Assessments will be conducted at baseline, month 3, and month 6 for each patient by trained psychologists. The primary end point will be the global Homework Performance Questionnaire (HPQ), Parent version score at 6 months. The main analysis will adhere to the ``intent-to-treat principle'' (all patient data will be analyzed according to their initial group determined by randomization). We expect (1) HPQ score improvement in individuals using the app during the first 3-month period compared to individuals not using the app; (2) greater HPQ score improvement for individuals using the app for 6 months compared to those using the app for 3 months only; and (3) adherence to the PANDAH program, measured with in-app metrics. Results: Recruitment began in January 2024, and the trial is ongoing. Conclusions: This study contributes to the digital transformation of health care. The use of smartphone apps in self-care and self-management is a societal phenomenon, and its implementation in the field of psychiatry is of particular interest. The app might serve as both valuable support for patients and an opportunity for parents to distance themselves from conflict-laden homework sessions. Since the market for smartphone apps in the health care and well-being sector is primarily industry driven, it is crucial to have an academic conception and evaluation of such digital tools. Trial Registration: ClinicalTrials.gov NCT04857788; https://clinicaltrials.gov/ct2/show/NCT04857788 International Registered Report Identifier (IRRID): PRR1-10.2196/44553 ",
doi="10.2196/44553",
url="https://www.researchprotocols.org/2024/1/e44553"
}


@Article{info:doi/10.2196/52478,
author="Yu, Yanqiu
and Ng, Hoi-Yuk Joyce
and Li, Ji-bin
and Zhang, Jianxin
and Lau, F. Joseph T.",
title="Cognitive Mechanisms Between Psychosocial Resources and the Behavioral Intention of Professional Help-Seeking for Internet Gaming Disorder Among Chinese Adolescent Gamers: Cross-Sectional Mediation Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="14",
volume="10",
pages="e52478",
keywords="professional help-seeking",
keywords="behavioral intention",
keywords="internet gaming disorder",
keywords="IGD",
keywords="perception",
keywords="China",
keywords="mental health",
keywords="psychosocial resource",
keywords="secondary school",
keywords="gamer",
keywords="cross-sectional survey",
abstract="Background: Internet gaming disorder (IGD) is a global public health concern for adolescents due to its potential severe negative consequences. Professional help-seeking is important for early screening, diagnosis, and treatment of IGD. However, research on the factors associated with professional help-seeking for IGD as well as relevant mediation mechanisms among adolescents is limited. Objective: Based on the stress coping theory, the conservation of resource theory, and behavioral change theories, this study investigated the prevalence and factors influencing the behavioral intention of professional help-seeking for internet gaming disorder (BI-PHSIGD). The research also explored the underlying mechanisms, including psychosocial resources like resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy, in professional help-seeking among adolescent internet gamers. Methods: A cross-sectional survey was conducted among secondary school students who were internet gamers in 2 Chinese cities from October 2019 to January 2020. Data from the full sample (N=1526) and a subsample of 256 IGD cases (according to the 9-item DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] IGD Checklist) were analyzed. Multivariate logistic regression analysis was conducted to examine the factors of BI-PHSIGD, while structural equation modeling was performed to test the proposed mediation mechanisms. Results: The prevalence of BI-PHSIGD was 54.3\% (829/1526) in the full sample and 40.6\% (104/256) in the IGD subsample (vs 708/1239, 57.1\% among non-IGD cases). In the full sample, psychosocial resources of resilience (adjusted odds ratio [aOR] 1.03, 95\% CI 1.02-1.05) and social support (aOR 1.03, 95\% CI 1.02-1.04) as well as self-efficacy in professional help-seeking (aOR 1.64, 95\% CI 1.49-1.81) were positively associated with BI-PHSIGD, while perceived resource loss due to reduced gaming time was negatively associated with BI-PHSIGD (aOR 0.97, 95\% CI 0.96-0.98); the positive association between psychosocial resources and BI-PHSIGD was fully mediated via 2 single-mediator indirect paths (via self-efficacy in professional help-seeking alone: effect size=53.4\%; indirect effect/total effect=0.10/0.19 and via perceived resource loss due to reduced gaming time alone: effect size=17.8\%; indirect effect/total effect=0.03/0.19) and one 2-mediator serial indirect path (first via perceived resource loss due to reduced gaming time then via self-efficacy in professional help-seeking: effect size=4.7\%; indirect effect/total effect=0.009/0.19). In the IGD subgroup, a full mediation via self-efficacy in professional help-seeking alone but not the other 2 indirect paths was statistically significant. Conclusions: Many adolescent internet gamers, especially those with IGD, were unwilling to seek professional help; as a result, early treatment is often difficult to achieve. To increase BI-PHSIGD, enhancing psychosocial resources such as resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy in professional help-seeking may be effective. Future longitudinal and intervention studies are needed to confirm and extend the findings. ",
doi="10.2196/52478",
url="https://publichealth.jmir.org/2024/1/e52478"
}


@Article{info:doi/10.2196/50418,
author="Yu, Yanqiu
and Yen, Y. Stefanie H.
and Wang, Baofeng Deborah
and Wu, S. Anise M.
and Chen, Honglei Juliet
and Zhang, Guohua
and Du, Mengni
and Du, Dajin
and Du, Mingxuan
and Lau, F. Joseph T.",
title="School Climate and School Identification as Determinants of Internet Gaming Disorder Among Chinese Adolescent Internet Gamers: Cross-Sectional Mediation Study",
journal="JMIR Serious Games",
year="2024",
month="Nov",
day="12",
volume="12",
pages="e50418",
keywords="school climate",
keywords="school identification",
keywords="adolescent",
keywords="structural equation modeling",
keywords="internet gaming disorder",
abstract="Background: School climate and school identification are important features of the school environment and potential determinants of adolescent internet gaming disorder (IGD). Objective: This novel study investigated their joint effects on IGD and related mediation mechanisms via the interpersonal factor of teacher-student relationship and the individual factors of academic stress and anxiety. Methods: A large-scale cross-sectional study was conducted among adolescent internet gamers of junior, senior, and vocational middle schools in Taizhou City, China, from February to March 2022 (N=5778). Participants self-administered an anonymous, structured questionnaire in classrooms. Adjusted logistic regression and structural equation modeling (SEM) were used for data analysis. Results: Among all participants, the prevalence of IGD was 8\% (461/5778). The 4 school climate subscales (student-student relationship subscale: adjusted odds ratio [ORa] 0.88, 95\% CI 0.85-0.91; student-staff relations subscale: ORa 0.87, 95\% CI 0.84-0.90; academic emphasis subscale: ORa 0.88, 95\% CI 0.85-0.91; shared values approach: ORa 0.88, 95\% CI 0.85-0.90), the school identification subscale (ORa 0.85, 95\% CI 0.83-0.88), and teacher-student relationship (ORa 0.80, 95\% CI 0.76-0.84) were significant protective factors against IGD, while academic stress (ORa 1.18, 95\% CI 1.14-1.23) and anxiety (ORa 1.16, 95\% CI 1.14-1.18) were risk factors of IGD. The SEM showed that the negative associations between school climate and IGD and between school identification and IGD were mediated via (1) three 2-step paths, each involving a single mediator---teacher-student relationship, academic stress, and anxiety, respectively---and (2) two 3-step paths involving 2 mediators---teacher-student relationship and academic stress first, respectively, and then anxiety. The direct effect of school climate on IGD was statistically nonsignificant (ie, full mediation with effect size ranging from 4.2\% to 20.4\%), while that of school identification was statistically significant (ie, partial mediation with effect size ranging from 4.5\% to 38.2\%). Conclusions: The relatively high prevalence of IGD among Chinese adolescents may be reduced through school-based interventions to improve school climate and school identification. Such improvements may reduce the levels of risk factors of IGD (poor teacher-student relationship, academic stress, and anxiety) and hence the risk of IGD. Future longitudinal and intervention studies are needed to confirm the findings. ",
doi="10.2196/50418",
url="https://games.jmir.org/2024/1/e50418"
}


@Article{info:doi/10.2196/51833,
author="Yewale, Prasad
and Rathi, Renu
and Mate, Swapnali",
title="Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="11",
volume="13",
pages="e51833",
keywords="addiction",
keywords="Ayurveda",
keywords="gadget addiction",
keywords="children",
keywords="Kaumarbhritya",
keywords="Medhya Rasayana",
keywords="yoga",
keywords="complementary and alternative medicine",
abstract="Background: Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. Objective: This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children's gadget addiction. Methods: A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups' interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. Results: In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. Conclusions: This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children's gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population's psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. International Registered Report Identifier (IRRID): PRR1-10.2196/51833 ",
doi="10.2196/51833",
url="https://www.researchprotocols.org/2024/1/e51833"
}


@Article{info:doi/10.2196/51594,
author="Zhou, Xinyi
and Hao, Xinyu
and Chen, Yuhang
and Deng, Hui
and Fang, Ling
and Zhang, Lingyun
and Yan, Xiaotao
and Zheng, Pinpin
and Wang, Fan",
title="Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e51594",
keywords="e-cigarette",
keywords="marketing strategy",
keywords="social media",
keywords="teenagers",
keywords="content analysis",
abstract="Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52\%) mentioned product characteristics. In 313 (36.3\%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3\%) posts, and purchase channels were not mentioned in 790 (98.3\%) posts. Social interaction--related posts received attention (n=548, 63.5\%), particularly those featuring hashtag content (n=538, 62.3\%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6\%) or information on health warnings (n=839, 97.2\%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. ",
doi="10.2196/51594",
url="https://www.jmir.org/2024/1/e51594"
}


@Article{info:doi/10.2196/58127,
author="Bowen-Forbes, Camille
and Khondaker, Tilovatul
and Stafinski, Tania
and Hadizadeh, Maliheh
and Menon, Devidas",
title="Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="5",
volume="12",
pages="e58127",
keywords="children",
keywords="youth",
keywords="personal safety apps",
keywords="smartphones",
keywords="mobile apps",
keywords="violence",
keywords="bullying",
keywords="suicide prevention",
keywords="youth support",
keywords="homeless support",
keywords="mobile phone",
abstract="Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be ``at risk.'' Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users' experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1\%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44\% of apps), bullying and school violence prevention (n=2, 22\% of apps), self-harm and suicide prevention (n=2, 22\% of apps), and homeless youth support (n=1, 11\% of apps). Of the 41 articles, 25 (61\%) provided data solely on app descriptions and features, while the remaining 16 (39\%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users' experiences, and effectiveness. Four articles reported on app use, 3 (75\%) of which reported relatively high app use. Data on users' experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40\% dating and sexual violence prevention; n=2, 40\% self-harm and suicide prevention; and n=1, 20\% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95\% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. ",
doi="10.2196/58127",
url="https://mhealth.jmir.org/2024/1/e58127"
}


@Article{info:doi/10.2196/58684,
author="Turvey, Jake
and McKay, Dana
and Kaur, T. Sarah
and Castree, Natasha
and Chang, Shanton
and Lim, C. Megan S.",
title="Exploring the Feasibility and Acceptability of Technological Interventions to Prevent Adolescents' Exposure to Online Pornography: Qualitative Research",
journal="JMIR Pediatr Parent",
year="2024",
month="Nov",
day="5",
volume="7",
pages="e58684",
keywords="pornography",
keywords="sexual health",
keywords="young people",
keywords="co-design",
keywords="online safety",
keywords="age verification",
keywords="adolescents",
keywords="attitudes",
keywords="acceptability",
keywords="usability",
keywords="feasibility",
abstract="Background: Amid growing concern over children's access to online pornography, policy makers are looking toward new and emerging technological concepts for unexplored solutions including artificial intelligence and facial recognition. Objective: This study sought to explore and ideate emerging technological interventions that are feasible, acceptable, and effective in preventing and controlling the exposure of young people to online pornographic material. Methods: We conducted a series of qualitative co-design workshops with both adult (n=8; aged 32-53 years) and adolescent participants (n=4; aged 15-17 years) to ideate potential technological interventions that are feasible, acceptable, and effective at preventing and controlling the exposure of young people to online pornographic material. A story stem methodology was used to explore participants' attitudes toward two unique technological prototypes. Results: Participants expressed a generally favorable view of the proposed technological concepts but remained unconvinced of their overall utility and effectiveness in preventing the intentional viewing of pornography by young people. Age-appropriate parent-child conversations remained participants' preferred approach to mitigating potential harms from pornographic material, with parents also expressing a desire for more educational resources to help them better navigate these discussions. User privacy and data security were a primary concern for participants, particularly surrounding the use and collection of biometric data. Conclusions: Internationally, policy makers are taking action to use age assurance technologies to prevent children's access to online pornography. It is important to consider the needs and opinions of parents and young people in the use and implementation of these technologies. Participants in this study were generally supportive of new and emerging technologies as useful tools in preventing the accidental exposure of young people to online pornographic material. However, participants remained less convinced of their ability to avert intentional viewing, with substantial concerns regarding technological efficacy, adaptability, and user privacy. Further, co-design and prototype refinement are needed to better understand user acceptability and comfortability of these new technological interventions, alongside additional research exploring sociocultural differences in information needs and user experiences. ",
doi="10.2196/58684",
url="https://pediatrics.jmir.org/2024/1/e58684"
}


@Article{info:doi/10.2196/64626,
author="McAlister, L. Kelsey
and Beatty, C. Clare
and Smith-Caswell, E. Jacqueline
and Yourell, L. Jacqlyn
and Huberty, L. Jennifer",
title="Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors",
journal="JMIR Ment Health",
year="2024",
month="Nov",
day="4",
volume="11",
pages="e64626",
keywords="adolescent social media",
keywords="social media bans",
keywords="emotion regulation",
keywords="youth",
keywords="adolescent",
keywords="media use",
keywords="social platform",
keywords="social network",
keywords="self-regulation",
keywords="behavioral health",
keywords="mental health",
keywords="digital health",
keywords="technology",
keywords="digital literacy",
doi="10.2196/64626",
url="https://mental.jmir.org/2024/1/e64626"
}


@Article{info:doi/10.2196/59490,
author="Fong, CT Ted
and Cui, Kunjie
and Yip, SF Paul",
title="Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="4",
volume="26",
pages="e59490",
keywords="Chinese",
keywords="impulsivity",
keywords="interaction effects",
keywords="internet gaming disorder",
keywords="latent moderation",
keywords="meaning in life",
keywords="self-control",
keywords="temper",
abstract="Background: Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning. Objective: This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model. Methods: A sample of 2064 adolescents (967, 46.9\% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning. Results: All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity ($\beta$=.20, P=.01), temper ($\beta$=.25, P<.001), and search for meaning ($\beta$=.11, P=.048) and significantly and negatively associated with presence of meaning ($\beta$=--.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect ($\beta$=--.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL ($\beta$=.08, SE .04; P=.03) and search for MIL ($\beta$=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL. Conclusions: This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning. ",
doi="10.2196/59490",
url="https://www.jmir.org/2024/1/e59490"
}


@Article{info:doi/10.2196/58681,
author="Rachmayanti, D. Riris
and Dewi, Tetra Fatwa Sari
and Setiyawati, Diana
and Megatsari, Hario
and Diana, Rian
and Vinarti, Retno",
title="Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="16",
volume="13",
pages="e58681",
keywords="adolescents",
keywords="digital media",
keywords="mental health",
keywords="resilience",
keywords="scoping review",
abstract="Background: Global databases show a high prevalence of mental health problems among adolescents (13.5\% among those aged 10-14 years and 14.65\% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems. Objective: This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths. Methods: The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted. Results: The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education. Conclusions: The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents' resilience skills. International Registered Report Identifier (IRRID): DERR1-10.2196/58681 ",
doi="10.2196/58681",
url="https://www.researchprotocols.org/2024/1/e58681"
}


@Article{info:doi/10.2196/60604,
author="Horita, Hideki
and Seki, Yoichi
and Yamaguchi, Takumi
and Shiko, Yuki
and Kawasaki, Yohei
and Shimizu, Eiji",
title="Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2024",
month="Oct",
day="3",
volume="7",
pages="e60604",
keywords="internet addiction",
keywords="adolescents",
keywords="parents",
keywords="cognitive behavioral therapy",
keywords="digital health",
abstract="Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent's problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46\%) or the waitlist control group (n=7, 54\%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents' hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46\%) at week 0 to 56.2 (SD 25.1; 5/9, 56\%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54\%) to 68.0 (SD 18.7; 4/9, 44\%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 ",
doi="10.2196/60604",
url="https://pediatrics.jmir.org/2024/1/e60604",
url="http://www.ncbi.nlm.nih.gov/pubmed/39361415"
}


@Article{info:doi/10.2196/54066,
author="Feng, Yonggang
and Xue, Qihui
and Yu, Peng
and Peng, Lanxiang",
title="The Relationship Between Epidemic Perception and Cyberbullying Behaviors of Chinese Adolescents During the COVID-19 Pandemic: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="2",
volume="10",
pages="e54066",
keywords="COVID-19",
keywords="epidemic perception",
keywords="cyberbullying behaviors",
keywords="insomnia",
keywords="anxiety and depression",
abstract="Background: In response to the COVID-19 outbreak, the government initiated measures for social distancing, leading to a gradual transition of adolescents' social interactions toward web-based platforms. Consequently, web-based behaviors, particularly cyberbullying, have become a prominent concern. Considering that adolescents experience more intense feelings, the widely increased negative emotions and strains perceived from the COVID-19 pandemic may end up engaging in cyberbullying behaviors. In addition, during the COVID-19 pandemic, adolescents experiencing insomnia and negative affect are more prone to diminished self-control, which is associated with cyberbullying behaviors. Objective: This study aims to investigate the relationship between epidemic perception and cyberbullying behaviors, while also examining the serial mediating roles of insomnia and negative affect on the relationship between epidemic perception and cyberbullying behaviors. Methods: This study presents a large-scale web-based survey conducted during the period of concentrated COVID-19 outbreaks, encompassing 20,000 Chinese adolescents. A total of 274 submitted questionnaires were discarded because of high levels of missing data or their answers were clearly fictitious or inconsistent. The final count of valid participants amounted to 19,726 (10,371 boys, age range: 12?18 years; mean 14.80, SD 1.63 years). The Perceptions of COVID-19 Scale, Negative Affect Scale, Insomnia Scale, and Cyberbullying Behavior Scale were used to assess participants' responses on the Questionnaire Star platform. Results: The results show that epidemic perception is positively correlated with cyberbullying behaviors (r=0.13; P<.001), insomnia (r=0.19; P<.001), and negative affect (r=0.25; P<.001). Insomnia is positively correlated with negative affect (r=0.44; P<.001) and cyberbullying behaviors (r=0.30; P<.001). Negative affect is positively correlated with cyberbullying behaviors (r=0.25; P<.001). And insomnia and negative affect play independent mediating and serial mediating roles in epidemic perception and cyberbullying behaviors. Conclusions: This study provides additional empirical evidence on the relationship between the perception of COVID-19 pandemic and cyberbullying in adolescents. In addition, the study offers recommendations for implementing interventions targeted at mitigating cyberbullying in adolescents during the COVID-19 pandemic. ",
doi="10.2196/54066",
url="https://publichealth.jmir.org/2024/1/e54066"
}


@Article{info:doi/10.2196/53101,
author="Li, Juanjuan
and Sun, Weidi
and Luo, Zeyu
and Liu, Yi
and Huang, Xuanyin
and Jiang, Denan
and Li, Shuting
and Meng, Jia
and Gu, Fang
and Zhang, Ronghua
and Song, Peige",
title="Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="23",
volume="10",
pages="e53101",
keywords="internet use",
keywords="internet addiction",
keywords="depression",
keywords="children",
keywords="adolescents",
keywords="China",
keywords="depressive symptoms",
abstract="Background: Children's lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2\%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95\% CI 1.34?1.74) and girls using internet for 1.1?2 hours/day (OR 1.22, 95\% CI 1.06?1.39) and >2 hours/day (OR 1.70, 95\% CI 1.50?1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95\% CI 1.83?2.21; 2 IA behaviors: 2.91, 95\% CI 2.57?3.29; and ?3 IA behaviors: 4.72, 95\% CI 4.26?5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. ",
doi="10.2196/53101",
url="https://publichealth.jmir.org/2024/1/e53101"
}


@Article{info:doi/10.2196/52670,
author="Martin, Kevin
and Peh, Chun Rachel Wei
and Tembo, Mandikudza
and Mavodza, Vimbayi Constancia
and Doyle, M. Aoife
and Dziva Chikwari, Chido
and Dauya, Ethel
and Bandason, Tsitsi
and Azizi, Steven
and Simms, Victoria
and Ferrand, A. Rashida",
title="Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="23",
volume="26",
pages="e52670",
keywords="Zimbabwe",
keywords="youth",
keywords="digital technology",
keywords="household wealth",
abstract="Background: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. Objective: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. Methods: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. Results: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82\%) had access to a mobile phone, and 15,454 (87.63\%) owned a mobile phone. Among participants with access to a mobile phone, 58.61\% (9594/16,370) and 57.79\% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95\% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95\% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95\% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95\% CI 1.60-2.39; tertiary: aOR 8.36, 95\% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ?2 years were associated with higher levels of internet and social media use. Conclusions: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status. ",
doi="10.2196/52670",
url="https://www.jmir.org/2024/1/e52670",
url="http://www.ncbi.nlm.nih.gov/pubmed/39312390"
}


@Article{info:doi/10.2196/48439,
author="Yu, Yanqiu
and Wu, S. Anise M.
and Fong, I. Vivian W.
and Zhang, Jianxin
and Li, Ji-bin
and Lau, F. Joseph T.",
title="Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study",
journal="JMIR Serious Games",
year="2024",
month="Sep",
day="19",
volume="12",
pages="e48439",
keywords="internet gaming disorder",
keywords="suicidal ideation",
keywords="adolescents",
keywords="mediation",
keywords="structural equation modelling",
keywords="resilience",
keywords="loneliness",
keywords="social support",
keywords="social anxiety",
abstract="Background: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. Objective: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. Methods: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60\% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: ``Have you ever considered committing suicide in the past 12 months?'' Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. Results: Among all participants, the prevalence of IGD and suicidal ideation was 16.95\% (287/1693) and 43.06\% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95\% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95\% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95\% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95\% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7\% (indirect effect/total effect: 0.016/0.15), 30.0\% (0.05/0.15), and 13.3\% (0.02/0.15), respectively. The direct path remained statistically significant. Conclusions: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study. ",
doi="10.2196/48439",
url="https://games.jmir.org/2024/1/e48439"
}


@Article{info:doi/10.2196/52978,
author="Guo, Yufang
and Yue, Fangyan
and Lu, Xiangyu
and Sun, Fengye
and Pan, Meixing
and Jia, Yannan",
title="COVID-19--Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="10",
volume="26",
pages="e52978",
keywords="COVID-19 pandemic",
keywords="internet gaming disorder",
keywords="self-control",
keywords="social isolation",
keywords="university students",
keywords="game",
keywords="gaming",
keywords="games",
keywords="addict",
keywords="addictive",
keywords="addiction",
keywords="addictions",
keywords="university",
keywords="universities",
keywords="college",
keywords="colleges",
keywords="postsecondary",
keywords="higher education",
keywords="student",
keywords="students",
keywords="China",
keywords="Chinese",
keywords="isolation",
keywords="isolated",
keywords="self-compassion",
keywords="mental health",
keywords="association",
keywords="associations",
keywords="correlation",
keywords="causal",
keywords="correlated",
keywords="correlations",
abstract="Background: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. Objective: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. Methods: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. Results: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=--0.355; P<.001) and internet gaming disorder (r=--0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder ($\beta$=--.185, 95\% CI --.295 to --.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. Conclusions: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed. ",
doi="10.2196/52978",
url="https://www.jmir.org/2024/1/e52978"
}


@Article{info:doi/10.2196/49453,
author="Lewis, C. Callum
and Taba, Melody
and Allen, B. Tiffany
and Caldwell, HY 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="Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e49453",
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",
abstract="Background: Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. Objective: This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. Methods: Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. Results: In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. Conclusions: Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL. ",
doi="10.2196/49453",
url="https://www.jmir.org/2024/1/e49453"
}


@Article{info:doi/10.2196/51206,
author="Mateo-Orcajada, Adri{\'a}n
and Vaquero-Crist{\'o}bal, Raquel
and Mota, Jorge
and Abenza-Cano, Luc{\'i}a",
title="Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="30",
volume="12",
pages="e51206",
keywords="body composition",
keywords="detraining",
keywords="new technologies",
keywords="physical education subject",
keywords="physical fitness",
keywords="youth",
abstract="Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants' PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3\%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD --0.170; P<.001), maximal oxygen uptake (MD --1.006; P<.001), countermovement jump test (MD --1.337; P=.04), curl-up test (MD --3.791; P<.001), and push-up test (MD --1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 ",
doi="10.2196/51206",
url="https://mhealth.jmir.org/2024/1/e51206"
}


@Article{info:doi/10.2196/48964,
author="Bear, Alice Holly
and Ayala Nunes, Lara
and Ramos, Giovanni
and Manchanda, Tanya
and Fernandes, Blossom
and Chabursky, Sophia
and Walper, Sabine
and Watkins, Edward
and Fazel, Mina",
title="The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="30",
volume="26",
pages="e48964",
keywords="adolescent mental health",
keywords="marginalized groups",
keywords="smartphone apps",
keywords="engagement",
keywords="implementation science",
keywords="mobile app",
keywords="smartphone",
keywords="mobile health",
keywords="mHealth",
keywords="mental health",
keywords="challenges",
keywords="acceptability",
keywords="young",
keywords="effectiveness",
keywords="mobile phone",
abstract="Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in ``real-world'' settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=254241 ",
doi="10.2196/48964",
url="https://www.jmir.org/2024/1/e48964",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078699"
}


@Article{info:doi/10.2196/54322,
author="Ladune, Raphaelle
and Hayotte, Meggy
and Vuillemin, Anne
and d'Arripe-Longueville, Fabienne",
title="Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="30",
volume="8",
pages="e54322",
keywords="cystic fibrosis",
keywords="decisional balance",
keywords="digital app",
keywords="acceptability",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. Objective: This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. Methods: This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. Results: In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO\_BALAD, designed for people with CF aged ?18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. Conclusions: This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study. ",
doi="10.2196/54322",
url="https://formative.jmir.org/2024/1/e54322",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078689"
}


@Article{info:doi/10.2196/51307,
author="Grahlher, Kristin
and Morgenstern, Matthis
and Pietsch, Benjamin
and Gomes de Matos, Elena
and Rossa, Monika
and Lochb{\"u}hler, Kirsten
and Daubmann, Anne
and Thomasius, Rainer
and Arnaud, Nicolas",
title="Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="23",
volume="12",
pages="e51307",
keywords="prevention",
keywords="vocational students",
keywords="adolescents",
keywords="mobile intervention",
keywords="voluntary commitment",
keywords="substance use",
keywords="internet-related problems",
keywords="mobile phone",
keywords="adolescent",
keywords="youths",
keywords="student",
keywords="students",
keywords="use",
abstract="Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (``Meine Zeit ohne'') has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (``congruent use'': eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6\%; mean age 19.0, SD 3.5 years; 830/1458, 56.9\% male) of them provided full data. Of these 1458 students, 894 (61.3\%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6\% female). Of these 894 students, 466 (52.1\%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1\%). A total of 407 (45.5\%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x ",
doi="10.2196/51307",
url="https://mhealth.jmir.org/2024/1/e51307"
}


@Article{info:doi/10.2196/58724,
author="Kim, Sunghak
and Wilson, Paije
and Abraham, Olufunmilola",
title="Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review",
journal="JMIR Serious Games",
year="2024",
month="Jul",
day="10",
volume="12",
pages="e58724",
keywords="serious games",
keywords="cancer control",
keywords="children",
keywords="adolescents",
keywords="scoping review",
keywords="game",
keywords="games",
keywords="gaming",
keywords="cancer",
keywords="oncology",
keywords="pediatric",
keywords="pediatrics",
keywords="paediatric",
keywords="paediatrics",
keywords="child",
keywords="youth",
keywords="adolescent",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="synthesis",
keywords="review methods",
keywords="review methodology",
keywords="search",
keywords="searches",
keywords="searching",
keywords="scoping",
abstract="Background: Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention. Objective: This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents. Methods: This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search. Results: From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87\%) and a small number of studies were cancer prevention serious game papers (8/63, 13\%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63\%; cancer care: 35/55, 64\%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38\%; cancer care: 24/55, 44\%) and North America (cancer prevention: 4/8, 50\%; cancer care: 17/55, 31\%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100\%; cancer care: 46/55, 84\%). All (8/8, 100\%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82\%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50\%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51\%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24\%) and physical symptoms (10/55, 18\%). Conclusions: This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas. ",
doi="10.2196/58724",
url="https://games.jmir.org/2024/1/e58724",
url="http://www.ncbi.nlm.nih.gov/pubmed/38985502"
}


@Article{info:doi/10.2196/53233,
author="Turuba, Roxanne
and Cormier, Willow
and Zimmerman, Rae
and Ow, Nikki
and Zenone, Marco
and Quintana, Yuri
and Jenkins, Emily
and Ben-David, Shelly
and Raimundo, Alicia
and Marcon, R. Alessandro
and Mathias, Steve
and Henderson, Jo
and Barbic, Skye",
title="Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth",
journal="JMIR Infodemiology",
year="2024",
month="Jul",
day="5",
volume="4",
pages="e53233",
keywords="youth",
keywords="adolescents",
keywords="young adults",
keywords="mental health",
keywords="TikTok",
keywords="social media",
keywords="qualitative research",
abstract="Background: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. Objective: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. Methods: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. Results: A total of 3 overarching themes were identified describing youth's experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. Conclusions: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online. ",
doi="10.2196/53233",
url="https://infodemiology.jmir.org/2024/1/e53233",
url="http://www.ncbi.nlm.nih.gov/pubmed/38967966"
}


@Article{info:doi/10.2196/57041,
author="Shimkhada, Riti
and Ponce, A. Ninez",
title="Social Media Use and Serious Psychological Distress Among Adolescents",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="23",
volume="7",
pages="e57041",
keywords="social media",
keywords="socials",
keywords="youth",
keywords="adolescents",
keywords="teens",
keywords="teenager",
keywords="mental health",
keywords="mental illness",
keywords="mental disease",
keywords="mental illnesses",
keywords="psychological distress",
keywords="psychological",
keywords="psychology",
doi="10.2196/57041",
url="https://pediatrics.jmir.org/2024/1/e57041"
}


@Article{info:doi/10.2196/49168,
author="Morales-Cahuancama, Bladimir
and Verdezoto, Nervo
and Gonzales-Achuy, Elena
and Quispe-Gala, Cinthia
and Bautista-Olortegui, William
and Hinojosa-Mamani, Paul
and Aparco, Pablo Juan",
title="Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="14",
volume="8",
pages="e49168",
keywords="child",
keywords="children",
keywords="schoolchildren",
keywords="youth",
keywords="student",
keywords="students",
keywords="adolescent",
keywords="formative research",
keywords="digital media",
keywords="digital games",
keywords="serious game",
keywords="serious games",
keywords="nutrition",
keywords="obesity",
keywords="obese",
keywords="overweight",
keywords="mHealth",
keywords="caregivers' perspectives",
keywords="perspective",
keywords="perspectives",
keywords="diet",
keywords="healthy eating",
abstract="Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8\% girls). Of the caregivers, 83\% (3267/3937) were mothers, and 56.5\% (2223/3937) had a secondary education. Only 5.2\% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6\%) and mobile internet (1314/3937, 33.4\%). In addition, 95.3\% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3\% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2\% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7\% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9\% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7\%) preferred to use a mobile phone. Only 38.3\% (1509/3937) indicated they preferred a computer. In addition, 47.9\% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7\% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38\% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. ",
doi="10.2196/49168",
url="https://formative.jmir.org/2024/1/e49168",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743472"
}


@Article{info:doi/10.2196/50259,
author="Cho, Kwangsu
and Kim, Minah
and Cho, Youngeun
and Hur, Ji-Won
and Kim, Hyung Do
and Park, Seonghyeon
and Park, Sunghyun
and Jang, Moonyoung
and Lee, Chang-Gun
and Kwon, Soo Jun",
title="Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study",
journal="JMIR Ment Health",
year="2024",
month="Apr",
day="29",
volume="11",
pages="e50259",
keywords="adolescents",
keywords="digital biomarkers",
keywords="digital phenotyping",
keywords="digital psychiatry",
keywords="early detection",
keywords="IGD",
keywords="internet gaming disorder",
keywords="pediatric psychiatry",
keywords="proactive medicine",
keywords="secondary school",
keywords="universal screening",
abstract="Background: Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7\% and 15.6\%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges. Objective: This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases. Methods: A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53\% (89/168) female and 47\% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes. Results: A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=--0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23\% of the IGDS score variance: stroke acceleration ($\beta$=.33; P<.001), time interval between keys ($\beta$=--0.26; P=.01), word spacing ($\beta$=--0.25; P<.001), deletion ($\beta$=--0.24; P<.001), and horizontal length of strokes ($\beta$=0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD. Conclusions: The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures. ",
doi="10.2196/50259",
url="https://mental.jmir.org/2024/1/e50259",
url="http://www.ncbi.nlm.nih.gov/pubmed/38683658"
}


@Article{info:doi/10.2196/55364,
author="Theopilus, Yansen
and Al Mahmud, Abdullah
and Davis, Hilary
and Octavia, Renny Johanna",
title="Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives",
journal="JMIR Pediatr Parent",
year="2024",
month="Apr",
day="26",
volume="7",
pages="e55364",
keywords="addiction therapist",
keywords="children",
keywords="digital intervention",
keywords="internet addiction",
keywords="digital devices",
keywords="parents",
keywords="parental control",
keywords="mobile phone",
abstract="Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps' functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children's competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children's internet use, providing tailored or personalized content to suit users' characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. ",
doi="10.2196/55364",
url="https://pediatrics.jmir.org/2024/1/e55364",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669672"
}


@Article{info:doi/10.2196/50368,
author="Carey, Grace Emma
and Adeyemi, Oluwasemilore Faith
and Neelakantan, Lakshmi
and Fernandes, Blossom
and Fazel, Mina
and Ford, Tamsin
and 
and Burn, Anne-Marie",
title="Preferences on Governance Models for Mental Health Data: Qualitative Study With Young People",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="23",
volume="8",
pages="e50368",
keywords="young people",
keywords="mental health",
keywords="data",
keywords="governance",
keywords="deliberative democracy",
keywords="mobile phone",
abstract="Background: Improving access to mental health data to accelerate research and improve mental health outcomes is a potentially achievable goal given the substantial data that can now be collected from mobile devices. Smartphones can provide a useful mechanism for collecting mental health data from young people, especially as their use is relatively ubiquitous in high-resource settings such as the United Kingdom and they have a high capacity to collect active and passive data. This raises the interesting opportunity to establish a large bank of mental health data from young people that could be accessed by researchers worldwide, but it is important to clarify how to ensure that this is done in an appropriate manner aligned with the values of young people. Objective: In this study, we discussed the preferences of young people in the United Kingdom regarding the governance, sharing, and use of their mental health data with the establishment of a global data bank in mind. We aimed to determine whether young people want and feel safe to share their mental health data; if so, with whom; and their preferences in doing so. Methods: Young people (N=46) were provided with 2 modules of educational material about data governance models and background in scientific research. We then conducted 2-hour web-based group sessions using a deliberative democracy methodology to reach a consensus where possible. Findings were analyzed using the framework method. Results: Young people were generally enthusiastic about contributing data to mental health research. They believed that broader availability of mental health data could be used to discover what improves or worsens mental health and develop new services to support young people. However, this enthusiasm came with many concerns and caveats, including distributed control of access to ensure appropriate use, distributed power, and data management that included diverse representation and sufficient ethical training for applicants and data managers. Conclusions: Although it is feasible to use smartphones to collect mental health data from young people in the United Kingdom, it is essential to carefully consider the parameters of such a data bank. Addressing and embedding young people's preferences, including the need for robust procedures regarding how their data are managed, stored, and accessed, will set a solid foundation for establishing any global data bank. ",
doi="10.2196/50368",
url="https://formative.jmir.org/2024/1/e50368",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652525"
}


@Article{info:doi/10.2196/45563,
author="Lee, Eugene
and Schulz, J. Peter
and Lee, Eun Hye",
title="The Impact of COVID-19 and Exposure to Violent Media Content on Cyber Violence Victimization Among Adolescents in South Korea: National Population-Based Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="22",
volume="26",
pages="e45563",
keywords="cyber violence",
keywords="adolescents",
keywords="victimization",
keywords="perpetration",
keywords="COVID-19",
abstract="Background: Because of the COVID-19 pandemic and consequent stay-at-home mandates, adolescents faced isolation and a decline in mental health. With increased online activity during this period, concerns arose regarding exposure to violent media content and cyber victimization among adolescents. Yet, the precise influence of pandemic-related measures on experiences of cyber violence remains unclear. Hence, it is pertinent to investigate whether the pandemic altered the dynamics of cyber violence victimization for individuals. Objective: This study aims to investigate the effects of COVID-19 and exposure to violent media content on cyber violence victimization among adolescents in South Korea. Methods: We used national survey data from 2019 (n=4779) and 2020 (n=4958) to investigate the potential impact of COVID-19 on the prevalence of cyber violence among young adolescents. The data encompassed responses from elementary fourth-grade students to senior high school students, probing their exposure to violent media content, average internet use, as well as experiences of victimization and perpetration. Results: The analysis revealed a noteworthy decline in cyber victimization during 2020 compared with 2019 (B=--0.12, t=--3.45, P<.001). Furthermore, being a perpetrator significantly contributed to cyber victimization (B=0.57, t=48.36, P<.001). Additionally, younger adolescents ($\beta$=--.06, t=--6.09, P<.001), those spending more time online ($\beta$=.18, t=13.83, P<.001), and those exposed to violent media ($\beta$=.14, t=13.89, P<.001) were found to be more susceptible to victimization. Conclusions: Despite the widespread belief that cyber violence among adolescents surged during COVID-19 due to increased online activity, the study findings counter this assumption. Surprisingly, COVID-19 did not exacerbate cyber victimization; rather, it decreased it. Given the strong correlation between cyber victimization and offline victimization, our attention should be directed toward implementing real-life interventions aimed at curbing violence originating from in-person violence at school. ",
doi="10.2196/45563",
url="https://www.jmir.org/2024/1/e45563",
url="http://www.ncbi.nlm.nih.gov/pubmed/38517467"
}


@Article{info:doi/10.2196/44861,
author="Lightfoot, Marguerita
and Campbell, Chadwick
and Maragh-Bass, C. Allysha
and Jackson-Morgan, Joi
and Taylor, Kelly",
title="What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="28",
volume="26",
pages="e44861",
keywords="adolescents",
keywords="clinics",
keywords="HIV/STI testing",
keywords="intervention",
keywords="mobile health",
keywords="peer",
keywords="screening",
keywords="sexually active",
keywords="STI",
keywords="text messaging",
keywords="young adult",
abstract="Background: While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. Objective: This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. Methods: We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. Results: We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40\%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Conclusions: Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults. ",
doi="10.2196/44861",
url="https://www.jmir.org/2024/1/e44861",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416541"
}


@Article{info:doi/10.2196/54414,
author="Berg, Valeska
and Arabiat, Diana
and Morelius, Evalotte
and Kervin, Lisa
and Zgambo, Maggie
and Robinson, Suzanne
and Jenkins, Mark
and Whitehead, Lisa",
title="Young Children and the Creation of a Digital Identity on Social Networking Sites: Scoping Review",
journal="JMIR Pediatr Parent",
year="2024",
month="Feb",
day="21",
volume="7",
pages="e54414",
keywords="digital identity",
keywords="children",
keywords="social networking sites",
keywords="sharenting",
keywords="scoping review",
keywords="perspectives",
abstract="Background: There is limited understanding of the concept of the digital identity of young children created through engagement on social networking sites. Objective: The objective of this scoping review was to identify key characteristics of the concept of digital identity for children from conception to the age of 8 years on social networking sites. Methods: This scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The key databases searched were EBSCO, Web of Science, ProQuest ERIC, and Scopus. Gray literature sources (National Grey Literature Collection, ProQuest Dissertations and Theses, and Google Scholar) were also searched to identify unpublished studies. Articles were selected if they were published in English and reported data on the digital identity of children in relation to social networking sites. Results: The key terms used in the literature were sharenting, followed by digital footprints and children's identities. Our study revealed 2 approaches to the creation of digital identity: social digital identity and performative digital identity. The articles in this review most commonly used the term sharenting to describe the behavior parents engage in to create digital identities for children on social networking sites. Motivations to post information about children differed among parents; however, the most common reasons were to share with friends and family and create digital archives of childhood photos, termed social digital identity. The second motivation was categorized as performative digital identity. The risk of digital kidnapping and identity theft associated with the creation of digital identities also influenced parents' behaviors. Conclusions: The creation of a digital identity for children is an emerging concept. Our review develops a deeper understanding of sharenting behaviors that can be used to better support parents and their children in creating a digital identity with children and awareness of the potential future impact. We recommend that future studies explore the perspectives of children as key stakeholders in the creation of their digital identity. ",
doi="10.2196/54414",
url="https://pediatrics.jmir.org/2024/1/e54414",
url="http://www.ncbi.nlm.nih.gov/pubmed/38381499"
}


@Article{info:doi/10.2196/45114,
author="Shen, Chen
and Smith, B. Rachel
and Heller, Joel
and Spiers, V. Alexander D.
and Thompson, Rhiannon
and Ward, Helen
and Roiser, P. Jonathan
and Nicholls, Dasha
and Toledano, B. Mireille",
title="Depression and Anxiety in Adolescents During the COVID-19 Pandemic in Relation to the Use of Digital Technologies: Longitudinal Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="7",
volume="26",
pages="e45114",
keywords="COVID-19",
keywords="depression",
keywords="anxiety",
keywords="public health",
keywords="adolescence",
keywords="digital technology use",
keywords="sleep",
keywords="mobile phone",
abstract="Background: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. Objective: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. Methods: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. Results: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3\%; anxiety: 125/425, 29.4\%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5\%; anxiety: 58/425, 13.6\%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95\% CI 1.5-4.18) and anxiety (OR 2.11, 95\% CI 1.23-3.61) at T2. A high level of total mobile phone use at T1 was associated with developing depression at T2 (OR 1.89, 95\% CI 1.02-3.49). Social network site use was associated with depression and anxiety cross-sectionally at T1 and T2 but did not appear to be associated with developing depression or anxiety longitudinally. Insufficient sleep at T1 was associated with developing depression at T2 (OR 2.26, 95\% CI 1.31-3.91). Conclusions: The mental health of this large sample of adolescents from London deteriorated during the pandemic without noticeable variations relating to public health measures. The deterioration was exacerbated in girls, those with preexisting high total mobile phone use, and those with preexisting disrupted sleep. Our findings suggest the necessity for allocating resources to address these modifiable factors and target high-risk groups. ",
doi="10.2196/45114",
url="https://www.jmir.org/2024/1/e45114",
url="http://www.ncbi.nlm.nih.gov/pubmed/38324379"
}


@Article{info:doi/10.2196/44199,
author="Whitehead, Lisa
and Robinson, Suzanne
and Arabiat, Diana
and Jenkins, Mark
and Morelius, Evalotte",
title="The Report of Access and Engagement With Digital Health Interventions Among Children and Young People: Systematic Review",
journal="JMIR Pediatr Parent",
year="2024",
month="Jan",
day="17",
volume="7",
pages="e44199",
keywords="access",
keywords="engagement",
keywords="digital health technology",
keywords="mobile phone",
keywords="children",
abstract="Background: Digital health interventions are increasingly used to deliver health-related interventions for children and young people to change health behaviors and improve health outcomes. Digital health interventions have the potential to enhance access to and engagement with children and young people; however, they may also increase the divide between those who can access technology and are supported to engage and those who are not. This review included studies that reported on the access to or engagement with digital health interventions among children and young people. Objective: This review aims to identify and report on access and engagement in studies involving digital health interventions among children and young people. Methods: A systematic review following the Joanna Briggs Institute methods for conducting systematic reviews was conducted. An electronic literature search was conducted for all studies published between January 1, 2010, and August 2022, across sources, including MEDLINE, CINAHL, and PsycINFO. Studies were included if they examined any aspect of access or engagement in relation to interventions among children and young people. The quality of the included papers was assessed, and data were extracted. Data were considered for meta-analysis, where possible. Results: A total of 3292 references were identified using search terms. Following the exclusion of duplicates and review by inclusion criteria, 40 studies were independently appraised for their methodological quality. A total of 16 studies were excluded owing to their low assessed quality and flawed critical elements in the study design. The studies focused on a variety of health conditions; type 1 diabetes, weight management and obesity, mental health issues, and sexual health were the predominant conditions. Most studies were conducted in developed countries, with most of them being conducted in the United States. Two studies reported data related to access and considered ethnicity and social determinants. No studies used strategies to enhance or increase access. All studies included in the review reported on at least 1 aspect of engagement. Engagement with interventions was measured in relation to frequency of engagement, with no reference to the concept of effective engagement. Conclusions: Most digital health interventions do not consider the factors that can affect access and engagement. Of those studies that measured either access or engagement or both, few sought to implement strategies to improve access or engagement to address potential disparities between groups. Although the literature to date provides some insight into access and engagement and how these are addressed in digital health interventions, there are major limitations in understanding how both can be enhanced to promote equity. Consideration of both access and engagement is vital to ensure that children and young people have the ability to participate in studies. Trial Registration: PROSPERO CRD42020170874; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=170874 ",
doi="10.2196/44199",
url="https://pediatrics.jmir.org/2024/1/e44199",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231560"
}


@Article{info:doi/10.2196/49019,
author="Liang, Haiyan
and Wang, Xi
and An, Ruopeng",
title="Influence of Pok{\'e}mon GO on Physical Activity and Psychosocial Well-Being in Children and Adolescents: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="13",
volume="25",
pages="e49019",
keywords="Pok{\'e}mon GO",
keywords="artificial intelligence",
keywords="physical activity",
keywords="psychosocial well-being",
keywords="children",
keywords="adolescent",
abstract="Background: Pok{\'e}mon GO, an augmented reality game with widespread popularity, can potentially influence players' physical activity (PA) levels and psychosocial well-being. Objective: This review aims to systematically examine the scientific evidence regarding the impact of Pok{\'e}mon GO on PA and psychosocial well-being in children and adolescents. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, we conducted keyword and reference searches in the PubMed, CINAHL, Web of Science, and Scopus databases. We performed title and abstract screening, full-text review, evidence synthesis, and identified research gaps. Results: Our review included 10 studies that explored the effect of Pok{\'e}mon GO on PA or psychosocial well-being among children and adolescents. These studies used diverse designs across multiple countries and regions. Pok{\'e}mon GO use measures encompassed frequency, experience, adherence, and motivation. PA assessment methods ranged from self-reported questionnaires to technology-based evaluations and qualitative approaches. Psychosocial well-being measures included emotional intelligence, personal well-being, self-control, emotionality, and sociability. In general, the estimated impact of Pok{\'e}mon GO on PA was positive, with gaming elements and engagement correlating with increased PA levels. However, the effect on psychosocial well-being presented mixed results, with positive associations for sociability but a complex relationship involving well-being and internet gaming disorder. The limitations of these studies comprised the absence of randomized controlled trials, heterogeneity in study designs and outcome measures, and potential confounding bias. Conclusions: Overall, Pok{\'e}mon GO tends to positively affect PA levels, while the impact on psychosocial well-being remains complex and requires further investigation. Future research should investigate the mechanisms connecting Pok{\'e}mon GO use with PA and psychosocial well-being and the potential risks of excessive gameplay. These findings can help inform public health interventions to harness gaming technologies for promoting PA and enhancing well-being among the younger generation. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023412032; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=412032 ",
doi="10.2196/49019",
url="https://www.jmir.org/2023/1/e49019",
url="http://www.ncbi.nlm.nih.gov/pubmed/37955949"
}


@Article{info:doi/10.2196/40190,
author="Zendle, David
and Flick, Catherine
and Halgarth, Darel
and Ballou, Nick
and Cutting, Joe
and Drachen, Anders",
title="The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="8",
volume="25",
pages="e40190",
keywords="COVID-19",
keywords="lockdown policy",
keywords="disordered gaming",
keywords="big data",
keywords="playtime",
keywords="policy",
keywords="lockdown",
keywords="public health",
keywords="side effects",
keywords="pandemic",
keywords="video games",
keywords="playing",
keywords="gaming",
keywords="time",
keywords="disordered",
abstract="Background: COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide. Objective: The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games. Methods: Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19--related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country. Results: No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001). Conclusions: Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure (``lockdown'') procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness. ",
doi="10.2196/40190",
url="https://www.jmir.org/2023/1/e40190",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938889"
}


@Article{info:doi/10.2196/50984,
author="Cascio, N. Christopher
and Selkie, Ellen
and Moreno, A. Megan",
title="Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="13",
volume="12",
pages="e50984",
keywords="social media",
keywords="adolescents",
keywords="teenagers",
keywords="health",
keywords="well-being",
keywords="risk behavior",
keywords="brain",
keywords="functional magnetic resonance imaging",
keywords="fMRI",
keywords="mobile phone",
abstract="Background: Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as ``digital natives,'' since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM's connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. Objective: This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. Methods: We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non--sexual and gender minority adolescents. Results: Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. Conclusions: This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. International Registered Report Identifier (IRRID): DERR1-10.2196/50984 ",
doi="10.2196/50984",
url="https://www.researchprotocols.org/2023/1/e50984",
url="http://www.ncbi.nlm.nih.gov/pubmed/37703071"
}


@Article{info:doi/10.2196/46949,
author="Litke, Grace Shannon
and Resnikoff, Annie
and Anil, Ashley
and Montgomery, Meredith
and Matta, Rishabh
and Huh-Yoo, Jina
and Daly, P. Brian",
title="Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity",
journal="JMIR Ment Health",
year="2023",
month="Aug",
day="23",
volume="10",
pages="e46949",
keywords="mHealth",
keywords="mobile app",
keywords="children",
keywords="adolescents",
keywords="mental health",
keywords="effectiveness",
keywords="efficacy",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. Objective: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? Methods: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app--based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. Results: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. Conclusions: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process. ",
doi="10.2196/46949",
url="https://mental.jmir.org/2023/1/e46949",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610818"
}


@Article{info:doi/10.2196/44920,
author="Lebby, R. Stephanie
and Shyam, Sangeetha
and Ramadas, Amutha
and Bohm, R. Andrew
and Hill, C. Julia
and Fortuna, L. Karen
and Zoltick, R. Stephanie",
title="Prospective Association Between Video and Computer Game Use During Adolescence and Incidence of Metabolic Health Risks: Secondary Data Analysis",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="6",
volume="6",
pages="e44920",
keywords="video games",
keywords="obesity",
keywords="pediatrics",
keywords="computer games",
keywords="portable device",
keywords="teenager",
keywords="adolescents",
keywords="health data",
keywords="BMI",
keywords="diabetes",
keywords="high blood pressure",
keywords="high cholesterol",
keywords="metabolic disorder",
abstract="Background: Video and computer games are popular activities, with 72\% of adolescents aged 13 to 17 years reporting video game use on either a computer, game console, or portable device. Despite high levels of video and computer game use in adolescence, relatively little scientific literature exists examining the association and effects of video and computer games on adolescents. Objective: The objective of this study was to examine the prevalence of video and computer game use among US adolescents and rates of positive screens for obesity, diabetes, high blood pressure (BP), and high cholesterol. Methods: A secondary data analysis was conducted using the National Longitudinal Study of Adolescent to Adult Health (Add Health) data, including adolescents aged 12 to 19 years between 1994 and 2018. Results: Respondents (n=4190) who played the most video and computer games had a significantly (P=.02) higher BMI and were more likely to self-report having at least one of the evaluated metabolic disorders: obesity (BMI >30 kg/m2), diabetes, high BP (BP >140/90), and high cholesterol (>240). With increased video or computer game use, there was a statistically significant increase in high BP rates in each quartile, with those with more frequent use also having higher rates of high BP. A similar trend was observed for diabetes, though the association did not reach statistical significance. No significant association was observed between video or computer game use and diagnoses of dyslipidemia, eating disorders, or depression. Conclusions: Frequency of video and computer game use is associated with obesity, diabetes, high BP, and high cholesterol in adolescents aged 12 to 19 years. Adolescents who play the most video and computer games have a significantly higher BMI. They are more likely to have at least one of the evaluated metabolic disorders: diabetes, high BP, or high cholesterol. Public health interventions designed to target modifiable disease states through health promotion and self-management may support the health of adolescents aged 12 to 19 years. Video and computer games can integrate health promotion interventions in gameplay. This is an important area for future research as video and computer games are integrated into the lives of adolescents. ",
doi="10.2196/44920",
url="https://pediatrics.jmir.org/2023/1/e44920",
url="http://www.ncbi.nlm.nih.gov/pubmed/37410530"
}


@Article{info:doi/10.2196/41694,
author="Rimel, E. Sarah
and Bam, Dina
and Farren, Laura
and Thaanum, Ayana
and Smith, Alessandro
and Park, Y. Susanna
and Boeldt, L. Debra
and Nicksic Sigmon, A. Chloe",
title="Technology Use During the COVID-19 Pandemic and the Ways in Which Technology Can Support Adolescent Well-being: Qualitative Exploratory Study",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="8",
volume="7",
pages="e41694",
keywords="adolescents",
keywords="mental health",
keywords="technology use",
keywords="well-being",
keywords="COVID-19",
keywords="compassion",
keywords="social connectedness",
keywords="mobile phone",
abstract="Background: Most adolescents in the United States engage with technology. Social isolation and disruptions in activities owing to the COVID-19 pandemic have been linked to worsening mood and overall decreased well-being in adolescents. Although studies on the direct impacts of technology on adolescent well-being and mental health are inconclusive, there are both positive and negative associations depending on various factors, such as how the technology is used and by whom under certain settings. Objective: This study applied a strengths-based approach and focused on the potential to leverage technology to benefit adolescent well-being during a public health emergency. This study aimed to gain an initial and nuanced understanding of how adolescents have used technology to support their wellness throughout the pandemic. In addition, this study aimed to further motivate future large-scale research on how technology can be leveraged to benefit adolescent well-being. Methods: This study used an exploratory qualitative approach and was conducted in 2 phases. Phase 1 consisted of interviewing subject matter experts who work with adolescents to inform the creation of a semistructured interview for phase 2. Subject matter experts were recruited from existing connections with the Hemera Foundation and National Mental Health Innovation Center's (NMHIC) networks. In phase 2, adolescents (aged 14-18 years) were recruited nationally through social media (eg, Facebook, Twitter, LinkedIn, and Instagram) and via email to institutions (eg, high schools, hospitals, and health technology companies). High school and early college interns at NMHIC led the interviews via Zoom (Zoom Video Communications) with an NMHIC staff member on the call in an observational role. A total of 50 adolescents completed interviews regarding their technology use and its role during the COVID-19 pandemic. Results: The overarching themes identified from the data were COVID-19's impact on adolescent lives, positive role of technology, negative role of technology, and resiliency. Adolescents engaged with technology as a way to foster and maintain connection in a time of extended isolation. However, they also demonstrated an awareness of when technology was negatively affecting their well-being, prompting them to turn to other fulfilling activities that do not involve technology. Conclusions: This study highlights how adolescents have used technology for well-being throughout the COVID-19 pandemic. Guidelines based on insights from the results of this study were created for adolescents, parents, caregivers, and teachers to provide recommendations for how adolescents can use technology to bolster overall well-being. Adolescents' ability to recognize when they need to engage in nontechnology-related activities and their ability to use technology to reach a larger community indicate that technology can be facilitated in positive ways to benefit their overall well-being. Future research should focus on increasing the generalizability of recommendations and identifying additional ways to leverage mental health technologies. ",
doi="10.2196/41694",
url="https://formative.jmir.org/2023/1/e41694",
url="http://www.ncbi.nlm.nih.gov/pubmed/36795671"
}


@Article{info:doi/10.2196/40898,
author="Schwarz, Ayla
and Winkens, H. Laura H.
and de Vet, Emely
and Ossendrijver, Dian
and Bouwsema, Kirsten
and Simons, Monique",
title="Design Features Associated With Engagement in Mobile Health Physical Activity Interventions Among Youth: Systematic Review of Qualitative and Quantitative Studies",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="6",
volume="11",
pages="e40898",
keywords="systematic review",
keywords="youth",
keywords="physical activity",
keywords="design features",
keywords="engagement",
keywords="mHealth",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Globally, 81\% of youth do not meet the physical activity (PA) guidelines. Youth of families with a low socioeconomic position are less likely to meet the recommended PA guidelines. Mobile health (mHealth) interventions are preferred by youth over traditional in-person approaches and are in line with their media preferences. Despite the promise of mHealth interventions in promoting PA, a common challenge is to engage users in the long term or effectively. Earlier reviews highlighted the association of different design features (eg, notifications and rewards) with engagement among adults. However, little is known about which design features are important for increasing engagement among youth. Objective: To inform the design process of future mHealth tools, it is important to investigate the design features that can yield effective user engagement. This systematic review aimed to identify which design features are associated with engagement in mHealth PA interventions among youth who were aged between 4 and 18 years. Methods: A systematic search was conducted in EBSCOhost (MEDLINE, APA PsycINFO, and Psychology \& Behavioral Sciences Collection) and Scopus. Qualitative and quantitative studies were included if they documented design features associated with engagement. Design features and related behavior change techniques and engagement measures were extracted. Study quality was assessed according to the Mixed Method Assessment Tool, and one-third of all screening and data extraction were double coded by a second reviewer. Results: Studies (n=21) showed that various features were associated with engagement, such as a clear interface, rewards, multiplayer game mode, social interaction, variety of challenges with personalized difficulty level, self-monitoring, and variety of customization options among others, including self-set goals, personalized feedback, progress, and a narrative. In contrast, various features need to be carefully considered while designing mHealth PA interventions, such as sounds, competition, instructions, notifications, virtual maps, or self-monitoring, facilitated by manual input. In addition, technical functionality can be considered as a prerequisite for engagement. Research addressing youth from low socioeconomic position families is very limited with regard to engagement in mHealth apps. Conclusions: Mismatches between different design features in terms of target group, study design, and content translation from behavior change techniques to design features are highlighted and set up in a design guideline and future research agenda. Trial Registration: PROSPERO CRD42021254989; https://tinyurl.com/5n6ppz24 ",
doi="10.2196/40898",
url="https://mhealth.jmir.org/2023/1/e40898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877551"
}


@Article{info:doi/10.2196/37711,
author="Liang, Elisa
and Kutok, R. Emily
and Rosen, K. Rochelle
and Burke, A. Taylor
and Ranney, L. Megan",
title="Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents",
journal="JMIR Ment Health",
year="2023",
month="Feb",
day="23",
volume="10",
pages="e37711",
keywords="social media",
keywords="adolescents",
keywords="COVID-19",
keywords="emotions",
keywords="connectivity",
abstract="Background: The COVID-19 pandemic provided a unique opportunity to examine social media and technology use during a time in which technology served as adolescents' primary form of socialization. The literature is mixed regarding how increased screen time during this period affected adolescent mental health and well-being. The mechanisms by which screen time use affected adolescent psychosocial outcomes are also unknown. Objective: We aimed to deepen our understanding of how social media and technology use, social connectivity, and emotional well-being intersected during pandemic-related school closures. Methods: English-speaking adolescents aged 13 to 17 years were recruited on Instagram for a brief screening survey; 39 participants were purposefully selected to complete a semistructured interview regarding their social media and technology use during the pandemic. Interview summaries were abstracted from recordings, and deductive codes were created for the primary question stems. These codes were subsequently reviewed for the main themes. Results: The main themes were as follows: adolescent social media and technology use during school closures usually allowed for more and easier social connectivity, but the amount and relative ease of connectivity differed according to purpose and type of use. Emotions, particularly those of stress and happiness, were connected to whether adolescents actively or passively engaged with social media and technology. Conclusions: Our results suggest a nuanced relationship among social media and technology use, adolescent social support, and emotional well-being, including during the pandemic. Specifically, how adolescents use or engage with web-based platforms greatly influences their ability to connect with others and their feelings of stress and happiness. In the context of the COVID-19 pandemic and as technology in general remains at the core of the adolescent experience, future research should continue to examine how adolescents navigate and use web-based spaces in beneficial and harmful ways. This will inform education and interventions that foster healthy social media and technological habits. ",
doi="10.2196/37711",
url="https://mental.jmir.org/2023/1/e37711",
url="http://www.ncbi.nlm.nih.gov/pubmed/36054613"
}


@Article{info:doi/10.2196/43160,
author="Shatwan, M. Israa
and Alhefani, S. Rabab
and Bukhari, F. Mawadah
and Hanbazazah, A. Danah
and Srour, K. Jumanah
and Surendran, Shelini
and Aljefree, M. Najlaa
and Almoraie, M. Noha",
title="Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="9",
volume="6",
pages="e43160",
keywords="smartphone app",
keywords="fruit and vegetable consumption",
keywords="Saudi Arabia",
keywords="adolescents",
keywords="nutrition",
keywords="health outcome",
keywords="digital health intervention",
keywords="digital health app",
keywords="pediatrics",
keywords="youth",
abstract="Background: Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. Objective: This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. Methods: This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. Results: The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. Conclusions: These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. Trial Registration: ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765 ",
doi="10.2196/43160",
url="https://pediatrics.jmir.org/2023/1/e43160",
url="http://www.ncbi.nlm.nih.gov/pubmed/36757770"
}


@Article{info:doi/10.2196/41480,
author="Skripkauskaite, Simona
and Fazel, Mina
and ",
title="Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis",
journal="JMIR Pediatr Parent",
year="2022",
month="Nov",
day="18",
volume="5",
number="4",
pages="e41480",
keywords="gaming",
keywords="adolescents",
keywords="latent profile analysis",
keywords="mobile phone",
keywords="well-being",
keywords="mental ill-health",
keywords="mental health",
keywords="digital technology",
abstract="Background: The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern. Objective: This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk. Methods: We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences. Results: In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2\%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44\%); casual computer gamers (873/3970, 22\%); casual phone gamers (595/3970, 15\%); unknown device gamers (476/3970, 12\%); maladaptive computer gamers (238/3970, 6\%); and maladaptive phone gamers (79/3970, 2\%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95\% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95\% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95\% CI 1.23-4.12), aggressive behavior (OR 2.83, 95\% CI 1.65-4.88), and web-based gambling (OR 2.18, 95\% CI 1.24-3.81). Conclusions: A substantial number of adolescents are spending ?3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8\%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers. ",
doi="10.2196/41480",
url="https://pediatrics.jmir.org/2022/4/e41480",
url="http://www.ncbi.nlm.nih.gov/pubmed/36399378"
}


@Article{info:doi/10.2196/39261,
author="Soltero, G. Erica
and Lopez, Callie
and Hernandez, Edith
and O'Connor, M. Teresia
and Thompson, Debbe",
title="Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review",
journal="JMIR Pediatr Parent",
year="2022",
month="Nov",
day="4",
volume="5",
number="4",
pages="e39261",
keywords="obesity",
keywords="technology",
keywords="adolescents",
keywords="health disparities",
keywords="prevention interventions",
keywords="prevention",
keywords="intervention",
keywords="feasibility",
keywords="effectiveness",
keywords="Hispanic",
keywords="engagement",
abstract="Background: Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions. Objective: The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths. Methods: A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers. Results: Of the 7 included studies, half (n=4, 57\%) used a randomized control trial design, with equal implementation in school (n=3, 43\%) and clinic (n=4, 57\%) settings. Studies commonly targeted improvements in diet (n=4, 57\%) and physical activity (n=7, 100\%), with only 1 (14\%) study focused on sedentary behaviors. Just 2 (29\%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71\%) or middle (n=6, 86\%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43\%) study conducted formative work, and few (n=3, 43\%) reported on acceptability. Only 1 (14\%) study reported that materials were available in Spanish and English, and only 1 (14\%) study used culturally tailored content. Additionally, 3 (43\%) studies used strategies that considered social determinants of health. Conclusions: To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents. Trial Registration: CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442 ",
doi="10.2196/39261",
url="https://pediatrics.jmir.org/2022/4/e39261",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331547"
}


@Article{info:doi/10.2196/40704,
author="Richter, Aliah
and Adkins, Victoria
and Selkie, Ellen",
title="Youth Perspectives on the Recommended Age of Mobile Phone Adoption: Survey Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Oct",
day="31",
volume="5",
number="4",
pages="e40704",
keywords="adolescent",
keywords="youth",
keywords="child",
keywords="mobile phone",
keywords="technology",
keywords="media",
keywords="phone use",
keywords="phone ownership",
keywords="parental guidance",
keywords="parenting",
keywords="cell phone",
keywords="smartphone",
abstract="Background: Despite increasing prevalence of phone ownership in early adolescence, there is a deficit of evidence-based guidance on the appropriate time to provide youth their first phone. Objective: This survey study explored age recommendations for phone ownership among a diverse panel of youths, as their experiences are an important contribution to the development of ownership guidelines. Methods: Participants were recruited from MyVoice, a national panel of over 765 youth (14 to 24 years old) who respond to weekly SMS text message--based surveys. Questions were distributed between January 24 2018, and March 20, 2018. Inductive qualitative analysis was used to identify major themes among youths' open-ended responses. Results: In all, 469 youth (mean age 18.8 years; female: 299/469, 63.8\%; White race: 332/468, 70.8\%) responded. On average, respondents obtained their first phone at 12.2 years of age. Most participants (325/459, 71.1\%) stated they received their first phone out of necessity rather than for entertainment or social reasons. Youth recommended that early adolescents receive their first phone between 12 and 13 years of age primarily for reasons of necessity (146/448, 32.6\%). Conclusions: According to the participants, phones supported safety and independence by allowing communication with parents and participation in activities. Youth-serving professionals and parents can incorporate these youth perspectives into shared decision-making about phone ownership among families. This can include discussions about essential features, safety, or phone use, as well as maturity and responsibility milestones, which were all key considerations reported by participants in the survey. ",
doi="10.2196/40704",
url="https://pediatrics.jmir.org/2022/4/e40704",
url="http://www.ncbi.nlm.nih.gov/pubmed/36315219"
}


@Article{info:doi/10.2196/35240,
author="Hayixibayi, Alimila
and Strodl, Esben
and Chen, Wei-Qing
and Kelly, B. Adrian",
title="Associations Between Adolescent Problematic Internet Use and Relationship Problems in Chinese Families: Findings from a Large-scale Survey",
journal="JMIR Pediatr Parent",
year="2022",
month="Oct",
day="24",
volume="5",
number="4",
pages="e35240",
keywords="problematic internet use",
keywords="parental bonding",
keywords="verbal conflict",
keywords="emotional abuse",
keywords="physical abuse",
keywords="adolescent",
keywords="teenager",
keywords="internet use",
keywords="internet usage",
keywords="abuse",
keywords="abusive",
keywords="conflict",
keywords="family",
keywords="parental bond",
keywords="student",
keywords="Asia",
keywords="China",
keywords="parent-child bond",
keywords="high school",
keywords="child",
abstract="Background: Problematic internet use (PIU) is prevalent among Chinese adolescents. There is a need to better understand how the quality of parent-adolescent relationship is associated with adolescent PIU to guide the development of effective prevention and early intervention programs. Objective: This study aims to evaluate parent-adolescent conflict and parenting styles as potential risk factors associated with adolescent PIU. Methods: A sample of 6552 students (aged 10-19 years) from 22 schools in Guangdong, China, was recruited. The participants completed self-report questionnaires measuring their perceptions of conflict with their parents (involving verbal conflict, emotional abuse, and physical abuse) as well as their perceptions of their parents' parenting styles (including parental care and parental control as measured by the Parental Bonding Inventory), and PIU using the Adolescent Pathological Internet Use Scale. Grade level and gender were examined as moderators of these associations. Results: Using multiple regression analyses, we found that greater mother-adolescent conflict, father-adolescent conflict, and parental control, and lower levels of parental care, were associated with higher levels of adolescent PIU (P<.001). The association between mother-adolescent conflict and PIU was stronger in older students than in younger students (P=.04), whereas the association between father-adolescent conflict and PIU was stronger in male students than in female students (P=.02). Compared with those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU (P<.001). Compared with those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse, and physical abuse from their fathers had significantly higher levels of PIU (P<.001, P<.001, and P=.02, respectively). Conclusions: These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse, and physical abuse, and to increase positive parenting styles, to lower the risk of PIU in Chinese adolescents. ",
doi="10.2196/35240",
url="https://pediatrics.jmir.org/2022/4/e35240",
url="http://www.ncbi.nlm.nih.gov/pubmed/36279160"
}


@Article{info:doi/10.2196/37424,
author="Ravaccia, Gaia Giulia
and Johnson, Laura Sophie
and Morgan, Nicholas
and Lereya, Tanya Suzet
and Edbrooke-Childs, Julian",
title="Experiences of Using the Digital Support Tool MeeToo: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Oct",
day="20",
volume="5",
number="4",
pages="e37424",
keywords="mHealth",
keywords="mental health",
keywords="peer support",
keywords="COVID-19",
keywords="well-being",
keywords="young people",
abstract="Background: Digital peer support is an increasingly used form of mental health support for young people. However, there is a need for more research on the impact of digital peer support and why it has an impact. Objective: The aim of this research is to examine young people's experiences of using a digital peer support tool: MeeToo. After the time of writing, MeeToo has changed their name to Tellmi. MeeToo is an anonymous, fully moderated peer support tool for young people aged 11-25 years. There were two research questions: (1) What impacts did using MeeToo have on young people? (2) Why did using MeeToo have these impacts on young people? Methods: A mixed methods study was conducted. It involved secondary analysis of routinely collected feedback questionnaires, which were completed at two time points (T1 and T2) 2-3 months apart. Questionnaires asked about young people's (N=876) experience of using MeeToo, mental health empowerment, and well-being. Primary data were collected from semistructured interviews with 10 young people. Results: Overall, 398 (45.4\%) of 876 young people completed the T1 questionnaire, 559 (63.8\%) completed the T2 questionnaire, and 81 (9.2\%) completed both. Descriptive statistics from the cross-sectional analysis of the questionnaires identified a range of positive impacts of using MeeToo, which included making it easier to talk about difficult things, being part of a supportive community, providing new ways to help oneself, feeling better, and feeling less alone. Subgroup analysis (paired-sample t test) of 58 young females who had completed both T1 and T2 questionnaires showed a small but statistically significant increase in levels of patient activation, one of the subscales of the mental health empowerment scale: time 1 mean=1.83 (95\% CI 1.72-1.95), time 2 mean=2.00 (95\% CI 1.89-2.11), t59=2.15, and P=.04. Anonymity and the MeeToo sense of community were identified from interviews as possible reasons for why using MeeToo had these impacts. Anonymity helped to create a safe space in which users could express their feelings, thoughts, and experiences freely without the fear of being judged by others. The MeeToo sense of community was described as a valuable form of social connectedness, which in turn had a positive impact on young people's mental health and made them feel less isolated and alone. Conclusions: The findings of this research showed a range of positive impacts and possible processes for young people using MeeToo. Future research is needed to examine how these impacts and processes can be sustained. ",
doi="10.2196/37424",
url="https://pediatrics.jmir.org/2022/4/e37424",
url="http://www.ncbi.nlm.nih.gov/pubmed/36264619"
}


@Article{info:doi/10.2196/35540,
author="Moreno, A. Megan
and Binger, Kole
and Zhao, Qianqian
and Eickhoff, Jens
and Minich, Matt
and Uhls, Tehranian Yalda",
title="Digital Technology and Media Use by Adolescents: Latent Class Analysis",
journal="JMIR Pediatr Parent",
year="2022",
month="May",
day="4",
volume="5",
number="2",
pages="e35540",
keywords="digital technology",
keywords="adolescents",
keywords="latent class analysis",
keywords="social media",
keywords="mobile phone",
abstract="Background: Digital technology and media use is integral to adolescents' lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use. Objective: The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators. Methods: Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents' Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs. Results: Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3\% (1842/3981) were female, 67.8\% (2701/3981) were White, and 75\% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8\% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators. Conclusions: Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support. ",
doi="10.2196/35540",
url="https://pediatrics.jmir.org/2022/2/e35540",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507401"
}


@Article{info:doi/10.2196/35067,
author="Fleary, A. Sasha",
title="Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach",
journal="JMIR Pediatr Parent",
year="2022",
month="Apr",
day="15",
volume="5",
number="2",
pages="e35067",
keywords="adolescents",
keywords="health communications",
keywords="health literacy",
keywords="measurement",
keywords="media health literacy",
keywords="Rasch",
keywords="mobile phone",
abstract="Background: High media use has been implicated in negative social and health outcomes among adolescents. Therefore, it is critical that adolescents develop skills to healthily engage with media content. Media health literacy (MHL), skills for assessing and responding to health-related media content, and potentially targetable moderators for the relationship between media use and health-related outcomes are understudied in adolescents. The lack of MHL assessment tools may have contributed to this research gap. Objective: This study aimed to develop and validate test-based scales of adolescents' MHL. Methods: The items developed were vetted iteratively via community reviews and cognitive interviews to establish content and face validity. Adolescents (N=355) completed a questionnaire that included the revised MHL items. The scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) were validated using Rasch measurement models. Convergent validity was assessed by correlating the summed scores of the three scales with existing functional and internet-related health literacy measures. Criterion validity was assessed by modeling logistic regressions for predicting health literacy--related behaviors from each scale after controlling for demographics. Effect sizes were estimated, and a short form was also validated. Results: The final MHL scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) fit their Rasch models. The 9-item Recognition/Identification and 9-item Influence/Critical Analysis scales had good convergent validity with functional and internet-related health literacy measures and were positively related to reading instructions before taking medicines and questioning the truthfulness of health information found online. The 12-item MHL Scales-Short Form also had good convergent and criterion validity. However, convergent and criterion validity were not established for the 3-item Action/Reaction Scale. Conclusions: The Recognition/Identification and Influence/Critical Analysis scales and the MHL Scales-Short Form may be used to determine the impact of MHL on media use and health outcome relationships and ultimately inform the development of interventions and policies to affect these relationships in multiple settings. ",
doi="10.2196/35067",
url="https://pediatrics.jmir.org/2022/2/e35067",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436219"
}


@Article{info:doi/10.2196/34698,
author="Vanden Bempt, Femke
and Economou, Maria
and Dehairs, Ward
and Vandermosten, Maaike
and Wouters, Jan
and Ghesqui{\`e}re, Pol
and Vanderauwera, Jolijn",
title="Feasibility, Enjoyment, and Language Comprehension Impact of a Tablet- and GameFlow-Based Story-Listening Game for Kindergarteners: Methodological and Mixed Methods Study",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="23",
volume="10",
number="1",
pages="e34698",
keywords="serious gaming",
keywords="language comprehension",
keywords="enjoyment",
keywords="feasibility",
keywords="GameFlow",
abstract="Background: Enjoyment plays a key role in the success and feasibility of serious gaming interventions. Unenjoyable games will not be played, and in the case of serious gaming, learning will not occur. Therefore, a so-called GameFlow model has been developed, which intends to guide (serious) game developers in the process of creating and evaluating enjoyment in digital (serious) games. Regarding language learning, a variety of serious games targeting specific language components exist in the market, albeit often without available assessments of enjoyment or feasibility. Objective: This study evaluates the enjoyment and feasibility of a tablet-based, serious story-listening game for kindergarteners, developed based on the principles of the GameFlow model. This study also preliminarily explores the possibility of using the game to foster language comprehension. Methods: Within the framework of a broader preventive reading intervention, 91 kindergarteners aged 5 years with a cognitive risk for dyslexia were asked to play the story game for 12 weeks, 6 days per week, either combined with a tablet-based phonics intervention or control games. The story game involved listening to and rating stories and responding to content-related questions. Game enjoyment was assessed through postintervention questionnaires, a GameFlow-based evaluation, and in-game story rating data. Feasibility was determined based on in-game general question response accuracy (QRA), reflecting the difficulty level, attrition rate, and final game exposure and training duration. Moreover, to investigate whether game enjoyment and difficulty influenced feasibility, final game exposure and training duration were predicted based on the in-game initial story ratings and initial QRA. Possible growth in language comprehension was explored by analyzing in-game QRA as a function of the game phase and baseline language skills. Results: Eventually, data from 82 participants were analyzed. The questionnaire and in-game data suggested an overall enjoyable game experience. However, the GameFlow-based evaluation implied room for game design improvement. The general QRA confirmed a well-adapted level of difficulty for the target sample. Moreover, despite the overall attrition rate of 39\% (32/82), 90\% (74/82) of the participants still completed 80\% of the game, albeit with a large variation in training days. Higher initial QRA significantly increased game exposure ($\beta$=.35; P<.001), and lower initial story ratings significantly slackened the training duration ($\beta$=?0.16; P=.003). In-game QRA was positively predicted by game phase ($\beta$=1.44; P=.004), baseline listening comprehension ($\beta$=1.56; P=.002), and vocabulary ($\beta$=.16; P=.01), with larger QRA growth over game phases in children with lower baseline listening comprehension skills ($\beta$=?0.08; P=.04). Conclusions: Generally, the story game seemed enjoyable and feasible. However, the GameFlow model evaluation and predictive relationships imply room for further game design improvements. Furthermore, our results cautiously suggest the potential of the game to foster language comprehension; however, future randomized controlled trials should further elucidate the impact on language comprehension. ",
doi="10.2196/34698",
url="https://games.jmir.org/2022/1/e34698",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319480"
}


@Article{info:doi/10.2196/35137,
author="Clare, M. Isabelle
and Gamage, Nisali
and Alvares, A. Gail
and Black, J. Lucinda
and Francis, Jacinta
and Jaimangal, Mohinder
and Lucas, M. Robyn
and Strickland, Mark
and White, James
and Nguyen, Rebecca
and Gorman, Shelley",
title="The Effects of Using the Sun Safe App on Sun Health Knowledge and Behaviors of Young Teenagers: Results of Pilot Intervention Studies",
journal="JMIR Dermatol",
year="2022",
month="Mar",
day="16",
volume="5",
number="1",
pages="e35137",
keywords="app development",
keywords="co-design",
keywords="knowledge gain",
keywords="sun exposure",
keywords="sun protection",
keywords="sun behaviors",
keywords="teenagers",
keywords="UV Index",
keywords="vitamin D",
keywords="young adolescents",
keywords="mobile phone",
abstract="Background: A balanced approach toward sun exposure and protection is needed by young people. Excessive sun exposure increases their risk for skin cancers such as melanoma, whereas some exposure is necessary for vitamin D and healthy bones. We have developed a new iOS smartphone app---Sun Safe---through a co-design process, which aims to support healthy and balanced decision-making by young teenagers (aged 12-13 years). Objective: The aim of this study was to test the capacity of Sun Safe to improve sun health knowledge and behaviors of young teenagers in 3 pilot intervention studies completed in 2020. Methods: Young teenagers (aged 12-13 years; N=57) were recruited through the web or through a local school via an open-access website and given access to Sun Safe (29/57, 51\%) or a placebo (SunDial) app (28/57, 49\%). Participants completed sun health questionnaires and knowledge quizzes before and after the 6-week intervention (either on the web or in class) and rated the quality of the app they used via a survey. Results: Of the 57 participants, 51 (89\%) participants (26, 51\% for placebo arm and 25, 49\% for the Sun Safe arm) completed these studies, with most (>50\%) reporting that they used a smartphone to access their designated app either ``once a fortnight'' or ``once/twice in total.'' Improved sun health knowledge---particularly about the UV Index---was observed in participants who were given access to Sun Safe compared with those who used the placebo (?6.2 [percentage correct] difference in predicted means, 95\% CI --12.4 to --0.03; P=.049; 2-way ANOVA). Unexpectedly, there were significantly more sunburn events in the Sun Safe group (relative risk 1.7, 95\% CI 1.1-1.8; P=.02; Fisher exact test), although no differences in time spent outdoors or sun-protective behaviors were reported. COVID-19 pandemic--related community-wide shutdowns during April 2020 (when schools were closed) reduced the time spent outdoors by >100 minutes per day (--105 minutes per day difference in predicted means, 95\% CI --150 to --59 minutes per day; P=.002; paired 2-tailed Student t test). Sun Safe was well-rated by participants, particularly for information (mean 4.2, SD 0.6 out of 5). Conclusions: Access to the Sun Safe app increased sun health knowledge among young teenagers in these pilot intervention studies. Further investigations with larger sample sizes are required to confirm these observations and further test the effects of Sun Safe on sun-protective behaviors. ",
doi="10.2196/35137",
url="https://derma.jmir.org/2022/1/e35137",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632872"
}


@Article{info:doi/10.2196/35984,
author="Elavsky, Steriani
and Blaho{\vs}ov{\'a}, Jana
and Lebed{\'i}kov{\'a}, Michaela
and Tkaczyk, Micha?
and Tancos, Martin
and Plh{\'a}k, Jarom{\'i}r
and Sotol{\'a}?, Ond?ej
and Smahel, David",
title="Researching the Links Between Smartphone Behavior and Adolescent Well-being With the FUTURE-WP4 (Modeling the Future: Understanding the Impact of Technology on Adolescent's Well-being Work Package 4) Project: Protocol for an Ecological Momentary Assessment Study",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="8",
volume="11",
number="3",
pages="e35984",
keywords="well-being",
keywords="adolescents",
keywords="smartphones",
keywords="intensive data",
keywords="ecological momentary assessment",
abstract="Background: Smartphone ownership has increased among teens within the last decade, with up to 89\% of adolescents owning a smartphone and engaging daily with the online world through it. Although the results of recent meta-analyses suggest that engaging digital technology plays only a small role in adolescent well-being, parents, professionals, and policymakers remain concerned about the impact that the instant connectivity of smartphones has on adolescent well-being. Objective: Herein, we introduce the protocol of a research study investigating the associations between adolescent smartphone use and different facets of well-being (social, physical, and psychological), with the aim to apply innovative methods to address the limitations of existing empirical studies. Methods: This 12-month prospective study of adolescents uses a repeated measurement-burst design with the ecological momentary assessment methodology. Adolescents (N=203; age range 13-17 years) complete baseline assessments through online questionnaires, four 14-day intensive data collection bursts, and an online questionnaire at the end of the study. As part of the 4 measurement bursts, adolescent smartphone behavior is assessed objectively by passive data collection of smartphone data logs and through self-reports in short questionnaires administered via a custom-built Android app. Results: The protocol describes the study objectives, research tools (including the development of the Android app and specialized software), and process (including pilot studies, the main study, and targets for machine learning approaches). Two of the 203 enrolled participants provided no data during the first data collection burst of the main study. Preliminary analyses of the data from the first data collection burst indicated an acceptable level of compliance (72.25\%) with the daily questionnaires. The design of the study will allow for the assessment of both within- and between-person variabilities in smartphone behavior, as well as short-term variation and long-term change in smartphone behavior and how it impacts the indicators of social, physical, and psychological well-being. Conclusions: The innovative methods applied in this study (objective smartphone logs, ecological momentary assessment, and machine learning) will allow for a more nuanced assessment of the links between smartphone use and well-being, informing strategies to help adolescents navigate the online world more constructively in terms of the development of their physical, social, and psychological well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/35984 ",
doi="10.2196/35984",
url="https://www.researchprotocols.org/2022/3/e35984",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258467"
}


@Article{info:doi/10.2196/32758,
author="Vaingankar, Ajit Janhavi
and van Dam, M. Rob
and Samari, Ellaisha
and Chang, Sherilyn
and Seow, Esmond
and Chua, Chian Yi
and Luo, Nan
and Verma, Swapna
and Subramaniam, Mythily",
title="Social Media--Driven Routes to Positive Mental Health Among Youth: Qualitative Enquiry and Concept Mapping Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Mar",
day="4",
volume="5",
number="1",
pages="e32758",
keywords="teens",
keywords="young adults",
keywords="concept mapping",
keywords="mental well-being",
keywords="digital media",
keywords="social media",
keywords="mental health",
keywords="social support",
keywords="mental health promotion",
keywords="self-expression",
abstract="Background: Social media influence almost every aspect of our lives by facilitating instant many-to-many communication and self-expression. Recent research suggests strong negative and positive impacts of social media exposure on youth mental health; however, there has been more emphasis on harmful relationships. Objective: Given the limited research on the benefits of social media for mental health, this qualitative study explored the lived experiences of youth to understand how social media use can contribute to positive mental health among youth. Methods: Using an interpretivist epistemological approach, 25 semistructured interviews and 11 focus group discussions were conducted with male and female youth of different ethnicities (aged 15 to 24 years) residing in Singapore, who were recruited through purposive sampling from the community. We conducted inductive thematic analysis and concept mapping to address the research aims. Results: We found that youth engaged in a wide range of activities on social media from connecting with family and friends to participating in global movements, and these served as avenues for building positive mental health. Based on participants' narratives, our analysis suggested that positive mental health among youth could be influenced by 3 features of social media consumption (connection with friends and their global community, engagement with social media content, and the value of social media as an outlet for expression). Through these, pathways leading to the following 5 positive mental health components were identified: (1) positive relationships and social capital, (2) self-concept, (3) coping, (4) happiness, and (5) other relevant aspects of mental health (for example, positivity and personal growth). Conclusions: The study results highlight the integral role of social media in the lives of today's youth and indicate that they can offer opportunities for positive influence, personal expression, and social support, thus contributing to positive mental health among youth. The findings of our research can be applied to optimize engagement with youth through social media and enhance the digital modes of mental health promotion. ",
doi="10.2196/32758",
url="https://pediatrics.jmir.org/2022/1/e32758",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254285"
}


@Article{info:doi/10.2196/33376,
author="Cena, Loredana
and Rota, Matteo
and Trainini, Alice
and Zecca, Sara
and Bonetti Zappa, Sofia
and Tralli, Nella
and Stefana, Alberto",
title="Investigating Adolescents' Video Gaming and Gambling Activities, and Their Relationship With Behavioral, Emotional, and Social Difficulties: Protocol for a Multi-Informant Study",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="25",
volume="11",
number="2",
pages="e33376",
keywords="adolescents",
keywords="gaming disorder",
keywords="gambling disorder",
keywords="pathological video gaming",
keywords="pathological gambling",
abstract="Background: Growing empirical evidence suggests that adolescents have a relatively greater propensity to develop problematic video gaming or gambling habits. Objective: The main objectives of this study are to estimate the prevalence of potential pathological gambling and video game use among adolescent students and to evaluate their risk factors. Methods: This is a cross-sectional multi-informant study based on an online survey. It will include a sample of adolescents attending secondary schools located in Brescia, northern Italy, their schoolteachers, and parents. The survey includes extensive data on adolescents' (1) demographic, social, economic, and environmental characteristics; (2) behavioral, emotional, and social problems and adaptive functioning; (3) emotional and social loneliness; (4) perception of the reasons to use social networks; (5) video game habits and pathological use of video gaming; and (6) gambling behaviors. Results: This protocol was approved by the Institutional Ethics Board of the Spedali Civili of Brescia (Italy). We expect to collect data from 793 or more adolescent students, as determined by our sample size calculation. Conclusions: This multisite project will make a substantial contribution to (1) the implementation of a system for identifying pathological gambling and pathological video game use among adolescents, allowing for interventions aimed at improving adolescents' financial, emotional, and social well-being; and (2) the identification of distinct profiles of gamblers and pathological video gamers that will contribute to setting up effective targeted prevention measures. Understanding the causes and impact of gambling and pathological video gaming on adolescents is a public health issue. International Registered Report Identifier (IRRID): DERR1-10.2196/33376 ",
doi="10.2196/33376",
url="https://www.researchprotocols.org/2022/2/e33376",
url="http://www.ncbi.nlm.nih.gov/pubmed/35212638"
}


@Article{info:doi/10.2196/27852,
author="Jee, Muhammad
and Khan, Alsa
and Nazneen, Nazneen",
title="Understanding Adolescents' Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="23",
volume="5",
number="12",
pages="e27852",
keywords="adolescents' perceptions",
keywords="personal technology",
keywords="technology relationship",
keywords="adolescents as technology users",
keywords="adolescents as technology bystanders",
abstract="Background: Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95\% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends. Objective: The aim of this formative study was to understand adolescents' perception of their own and others' relationship with personal technology. Methods: A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future. Results: ``Essential,''  ``Distractive,'' and ``Addictive'' were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1\%; distractive: 105/619, 17\%; addictive: 88/619, 14.2\% ) and others' relationship as well (essential: 96/619, 15.6\%; distractive: 88/619, 14.3\%; addictive: 90/619, 14.5\%). Adolescents selected ``Provides an escape'' more to describe their own relationship with technology. Whereas, they selected ``It's just a tool'' and ``Creates Barrier'' more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was ``best friend'', 16 to 17-year olds' top choice was ``I don't believe in personal connection with mobile technology,'' and 18 to 19-year olds' top choice was ``My personal assistant.'' Conclusions: Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research. ",
doi="10.2196/27852",
url="https://formative.jmir.org/2021/12/e27852",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941556"
}


@Article{info:doi/10.2196/30889,
author="Claesdotter-Knutsson, Emma
and Andr{\'e}, Frida
and Fridh, Maria
and Delfin, Carl
and Hakansson, Anders
and Lindstr{\"o}m, Martin",
title="Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e30889",
keywords="smartphone",
keywords="cell phone",
keywords="adolescent",
keywords="sleep",
keywords="anxiety",
keywords="substance use",
keywords="nicotine",
keywords="alcohol drinking",
keywords="smartphone use",
keywords="addiction",
keywords="behavioral addiction",
keywords="worry",
keywords="pathology",
keywords="internet",
abstract="Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77\% (9143/11,868) among 9th grade pupils and 73.4\% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. ",
doi="10.2196/30889",
url="https://pediatrics.jmir.org/2021/4/e30889",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813492"
}


@Article{info:doi/10.2196/31789,
author="Kaiser, Sabine
and Martinussen, Monica
and Adolfsen, Frode
and Breivik, Kyrre
and Kyrrestad, Henriette",
title="An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="8",
volume="10",
number="11",
pages="e31789",
keywords="cyberbullying",
keywords="intervention",
keywords="mobile app",
keywords="adolescents",
keywords="NettOpp",
keywords="mental health",
keywords="health care",
abstract="Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 ",
doi="10.2196/31789",
url="https://www.researchprotocols.org/2021/11/e31789",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747704"
}


@Article{info:doi/10.2196/30681,
author="Basch, H. Corey
and Fera, Joseph
and Pellicane, Alessia
and Basch, E. Charles",
title="Videos With the Hashtag \#vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Oct",
day="25",
volume="4",
number="4",
pages="e30681",
keywords="vaping",
keywords="TikTok",
keywords="social media",
keywords="misinformation",
keywords="decision-making",
keywords="adolescents",
keywords="young adults",
keywords="e-cigarettes",
keywords="public health",
keywords="informed decision-making",
abstract="Background: Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service. Objective: The purpose of this study is to describe the content of TikTok videos related to vaping. Methods: By searching the hashtag \#vaping in the discover feature, {\textasciitilde}478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance. Results: The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5\% of cumulative views). A total of 42\% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22\% (>35 million) of the total views. Conclusions: It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers' attention and harness the strength of this communication channel to promote informed decision-making about vaping. ",
doi="10.2196/30681",
url="https://pediatrics.jmir.org/2021/4/e30681",
url="http://www.ncbi.nlm.nih.gov/pubmed/34694231"
}


@Article{info:doi/10.2196/29426,
author="Wade, E. Natasha
and Ortigara, M. Joseph
and Sullivan, M. Ryan
and Tomko, L. Rachel
and Breslin, J. Florence
and Baker, C. Fiona
and Fuemmeler, F. Bernard
and Delrahim Howlett, Katia
and Lisdahl, M. Krista
and Marshall, T. Andrew
and Mason, J. Michael
and Neale, C. Michael
and Squeglia, M. Lindsay
and Wolff-Hughes, L. Dana
and Tapert, F. Susan
and Bagot, S. Kara
and ",
title="Passive Sensing of Preteens' Smartphone Use: An Adolescent Brain Cognitive Development (ABCD) Cohort Substudy",
journal="JMIR Ment Health",
year="2021",
month="Oct",
day="18",
volume="8",
number="10",
pages="e29426",
keywords="preadolescents",
keywords="smartphone use",
keywords="passive sensing",
keywords="screen use",
keywords="screen time",
keywords="mobile phone",
abstract="Background: Concerns abound regarding childhood smartphone use, but studies to date have largely relied on self-reported screen use. Self-reporting of screen use is known to be misreported by pediatric samples and their parents, limiting the accurate determination of the impact of screen use on social, emotional, and cognitive development. Thus, a more passive, objective measurement of smartphone screen use among children is needed. Objective: This study aims to passively sense smartphone screen use by time and types of apps used in a pilot sample of children and to assess the feasibility of passive sensing in a larger longitudinal sample. Methods: The Adolescent Brain Cognitive Development (ABCD) study used passive, objective phone app methods for assessing smartphone screen use over 4 weeks in 2019-2020 in a subsample of 67 participants (aged 11-12 years; 31/67, 46\% female; 23/67, 34\% White). Children and their parents both reported average smartphone screen use before and after the study period, and they completed a questionnaire regarding the acceptability of the study protocol. Descriptive statistics for smartphone screen use, app use, and protocol feasibility and acceptability were reviewed. Analyses of variance were run to assess differences in categorical app use by demographics. Self-report and parent report were correlated with passive sensing data. Results: Self-report of smartphone screen use was partly consistent with objective measurement (r=0.49), although objective data indicated that children used their phones more than they reported. Passive sensing revealed the most common types of apps used were for streaming (mean 1 hour 57 minutes per day, SD 1 hour 32 minutes), communication (mean 48 minutes per day, SD 1 hour 17 minutes), gaming (mean 41 minutes per day, SD 41 minutes), and social media (mean 36 minutes per day, SD 1 hour 7 minutes). Passive sensing of smartphone screen use was generally acceptable to children (43/62, 69\%) and parents (53/62, 85\%). Conclusions: The results of passive, objective sensing suggest that children use their phones more than they self-report. Therefore, use of more robust methods for objective data collection is necessary and feasible in pediatric samples. These data may then more accurately reflect the impact of smartphone screen use on behavioral and emotional functioning. Accordingly, the ABCD study is implementing a passive sensing protocol in the full ABCD cohort. Taken together, passive assessment with a phone app provided objective, low-burden, novel, informative data about preteen smartphone screen use. ",
doi="10.2196/29426",
url="https://mental.jmir.org/2021/10/e29426",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661541"
}


@Article{info:doi/10.2196/27723,
author="Dolcini, Margaret M.
and Canchola, A. Jesse
and Catania, A. Joseph
and Song Mayeda, M. Marissa
and Dietz, L. Erin
and Cotto-Negr{\'o}n, Coral
and Narayanan, Vasudha",
title="National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="12",
volume="23",
number="10",
pages="e27723",
keywords="internet access",
keywords="smartphone use",
keywords="Black youth",
keywords="Hispanic youth",
keywords="low-income youth",
keywords="disparities",
keywords="mobile phone",
abstract="Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23\%) and for Black youth (no home access=18\%) and Hispanic youth (no home access=14\%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29\%; low SES Hispanic youth=21\%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities. ",
doi="10.2196/27723",
url="https://www.jmir.org/2021/10/e27723",
url="http://www.ncbi.nlm.nih.gov/pubmed/34636728"
}


@Article{info:doi/10.2196/21316,
author="Li, Ji-Bin
and Feng, Li-Fen
and Wu, S. Anise M.
and Mai, Jin-Chen
and Chen, Yu-Xia
and Mo, H. Phoenix K.
and Lau, F. Joseph T.",
title="Roles of Psychosocial Factors on the Association Between Online Social Networking Use Intensity and Depressive Symptoms Among Adolescents: Prospective Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="21",
volume="23",
number="9",
pages="e21316",
keywords="online social networking use intensity",
keywords="depressive symptoms",
keywords="psychosocial factors",
keywords="mediation and suppression",
keywords="longitudinal study",
abstract="Background: The potential mechanisms underlying the association between online social networking use intensity and depressive symptoms are unclear and underresearched. Objective: We aimed to investigate the potential roles of interpersonal psychosocial factors on the association between online social networking use intensity and depressive symptoms among early adolescents. Methods: A total of 4237 adolescents from a 9-month longitudinal study were included. Score changes (indicated as ?) for the social function use intensity (SFUI) and entertainment function use intensity (EFUI) subscales of the Online Social Networking Activity Intensity Scale and for friendship quality, perceived family support, perceived friend support, parent--adolescent conflict, social nonconfidence, and depressive symptoms were analyzed. The potential mediation effects of unfavorable psychosocial factors and suppression effects of favorable psychosocial factors on the association of ?SFUI with ?CES-D and the association of ?EFUI with ?CES-D were tested using hierarchical regression models. Results: The association between ?SFUI and ?CES-D was partially mediated by ?mother--adolescent conflict (mediation effect size 5.11\%, P=.02) and ?social nonconfidence (mediation effect size 20.97\%, P<.001) but partially suppressed by ?friendship quality, ?perceived family support, and ?perceived friend support, with suppression effects of --0.011 (P=.003), --0.009 (P=.003), and --0.022 (P<.001), respectively. The association between ?EFUI and ?CES-D was partially mediated by ?social nonconfidence (mediation effect size 30.65\%, P<.001) but partially suppressed by ?perceived family support and ?perceived friend support, with suppression effects of --0.036 (P<.001) and --0.039 (P<.001), respectively. Conclusions: The association between online social networking use intensity and depressive symptoms was partially mediated through the indirect increase in social nonconfidence and mother--adolescent conflict; however, better perceived social support and friendship quality would partially compensate for the harmful impact of online social networking use intensity on depressive symptoms among early adolescents. ",
doi="10.2196/21316",
url="https://www.jmir.org/2021/9/e21316",
url="http://www.ncbi.nlm.nih.gov/pubmed/34546173"
}


@Article{info:doi/10.2196/30240,
author="Levey, J. Elizabeth
and Onyeaka, Henry
and Bartles, M. Sophia
and Sanchez Calderon, Elena
and Sanchez, E. Sixto
and Prom, C. Maria
and Fesseha, M. Eden
and Gelaye, Bizu",
title="Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Sep",
day="17",
volume="4",
number="3",
pages="e30240",
keywords="access to care",
keywords="adolescent motherhood",
keywords="LMICs",
keywords="mobile phone",
keywords="perinatal mental health",
keywords="telehealth",
abstract="Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. ",
doi="10.2196/30240",
url="https://pediatrics.jmir.org/2021/3/e30240",
url="http://www.ncbi.nlm.nih.gov/pubmed/34533473"
}


@Article{info:doi/10.2196/26273,
author="Hamilton, Leigh Jessica
and Lee, Woanjun",
title="Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26273",
keywords="adolescents",
keywords="social media",
keywords="daytime sleepiness",
keywords="parenting",
keywords="bedtime",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents' mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health. Objective: This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships. Methods: This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use. Results: Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45\% (1929/4153) identified as female, and 67.93\% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=?0.34, SE 0.09; P<.001) and importance (B=?0.16, SE 0.04; P<.001) on daytime sleepiness. Conclusions: The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth's perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health. ",
doi="10.2196/26273",
url="https://mental.jmir.org/2021/9/e26273",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524967"
}


@Article{info:doi/10.2196/26203,
author="Hwang, Juwon
and Toma, L. Catalina",
title="The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents' Problematic Internet Use: Moderation Analysis",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26203",
keywords="problematic internet use",
keywords="PIU",
keywords="subjective mental well-being",
keywords="perceived parental supportiveness",
keywords="adolescents",
keywords="well-being",
keywords="young adult",
keywords="internet",
keywords="mental health",
keywords="support",
keywords="parent",
keywords="engagement",
keywords="social media",
abstract="Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents' subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents' engagement in PIU. Objective: This paper aimed to examine the role played by adolescents' perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology \& Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4\% (2130/4592) female and 66.9\% (3370/4592) White. Findings revealed that, controlling for adolescents' demographics and social media use, higher levels of perceived parental supportiveness ($\beta$=--.285, P<.001) and higher levels of subjective mental well-being ($\beta$=--.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being ($\beta$=--.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents' mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents' mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. ",
doi="10.2196/26203",
url="https://mental.jmir.org/2021/9/e26203",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524093"
}


@Article{info:doi/10.2196/26176,
author="Campos-Castillo, Celeste
and Thomas, Jason Brian
and Reyes, Felipe
and Laestadius, Irina Linnea",
title="Seeking Help From Trusted Adults in Response to Peers' Social Media Posts About Mental Health Struggles: Qualitative Interview Study Among Latinx Adolescents",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26176",
keywords="adolescents",
keywords="confidants",
keywords="ethnicity",
keywords="gender",
keywords="network resources",
keywords="privacy",
keywords="race",
keywords="social media",
keywords="social support",
keywords="tie activation",
keywords="trust",
abstract="Background: Rather than confiding in adults about their mental health struggles, adolescents may use social media to disclose them to peers. Disclosure recipients are tasked with deciding whether to alert an adult and, if so, whom to alert. Few studies have examined how adolescents decide on a trusted adult to help a friend who posts on social media about his/her mental health struggles. Moreover, Latinx adolescents are underrepresented in research on social media use, which creates gaps in understanding how social media may influence their well-being. Objective: This qualitative study presents findings from semistructured interviews with Latinx adolescents to investigate how they seek out trusted adults when a friend posts on social media about their mental health struggles. Specifically, we sought to determine which adult ties they activated, the resources they believed the adult could provide, and the support they expected the adult to provide. Methods: We recruited participants through a nonprofit organization serving the Latinx community (primarily of Mexican origin) located in Milwaukee, Wisconsin. We conducted 43 semistructured interviews, each lasting 60-90 minutes, with Latinx adolescents (25 females, 18 males) aged 13-17 years. All interviews were conducted in English, at the adolescents' request. Using a grounded theory approach, we identified the nature of the relationship between the trusted adult and either the disclosure recipient or distressed friend, and the resources and support the trusted adult is expected to provide. Results: Participants nominated adults who were emotionally or physically proximate to either the disclosure recipient or distressed friend, particularly parents (of the recipient and friend) and school staff. However, some felt that not all parents and school staff were emotionally proximate. Adolescents sought trusted adults with access to two resources: experiential knowledge and authority. Some, particularly males, avoided adults with authority because of the risk of punishment and others thought their immigrant parents did not have relevant experiential knowledge to assist them. Interviewees felt that trusted adults with either resource could provide emotional and instrumental support either directly or indirectly, while those with experiential knowledge could provide informational support. Notably, interviews did not problematize the fact that the disclosure occurred on social media when deliberating about adults. Conclusions: To assist a distressed friend posting on social media, Latinx adolescents look not only for trusted adults who are emotionally and physically proximate but also those who have key resources that facilitate support. Efforts should focus on connecting adolescents with trusted adults and training adults who hold positions of authority or experiential knowledge to offer both direct and indirect support. Additionally, efforts should consider how immigrant experiences shape parent-child relations and address the potential long-term consequences of oversurveillance of Latinx youth, particularly males, by school staff for their access to social support. ",
doi="10.2196/26176",
url="https://mental.jmir.org/2021/9/e26176",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524088"
}


@Article{info:doi/10.2196/26154,
author="Fadiran, Babayosimi
and Lee, Jessica
and Lemminger, Jared
and Jolliff, Anna",
title="How Our Technology Use Changed in 2020: Perspectives From Three Youths",
journal="JMIR Ment Health",
year="2021",
month="Sep",
day="15",
volume="8",
number="9",
pages="e26154",
keywords="mental health",
keywords="social media",
keywords="digital technology",
keywords="youth",
keywords="adolescent",
keywords="commentary",
keywords="technology",
keywords="wellness",
doi="10.2196/26154",
url="https://mental.jmir.org/2021/9/e26154",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524108"
}


@Article{info:doi/10.2196/25900,
author="Ranney, L. Megan
and Pittman, K. Sarah
and Moseley, Isabelle
and Morgan, E. Kristen
and Riese, Alison
and Ybarra, Michele
and Cunningham, Rebecca
and Rosen, Rochelle",
title="Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="27",
volume="5",
number="8",
pages="e25900",
keywords="adolescent",
keywords="mobile health",
keywords="digital health",
keywords="cyberbullying",
keywords="user-centered design",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58\% (11/19) female, 42\% (8/19) male, 63\% (12/19) Hispanic, 37\% (7/19) non-Hispanic, 79\% (15/19) people of color, and 21\% (4/19) White. A total of 73\% (14/19) self-identified as having a low socioeconomic status, and 37\% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34\% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0\% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50\% (2/4) of I2 participants and 86\% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9\% (235/392) of messages in I1, compared to 79.9\% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. ",
doi="10.2196/25900",
url="https://formative.jmir.org/2021/8/e25900",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448702"
}


@Article{info:doi/10.2196/14004,
author="Ribanszki, Robert
and Saez Fonseca, Andres Jose
and Barnby, Matthew Joseph
and Jano, Kimberly
and Osmani, Fatima
and Almasi, Soma
and Tsakanikos, Elias",
title="Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="27",
volume="5",
number="8",
pages="e14004",
keywords="qualitative",
keywords="adolescents",
keywords="mental health",
keywords="digital smartphone app",
keywords="digital mental health",
keywords="mobile phone",
abstract="Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. ",
doi="10.2196/14004",
url="https://formative.jmir.org/2021/8/e14004",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128814"
}


@Article{info:doi/10.2196/25801,
author="Allen, J. Brittany
and Stratman, E. Zoe
and Kerr, R. Bradley
and Zhao, Qianqian
and Moreno, A. Megan",
title="Associations Between Psychosocial Measures and Digital Media Use Among Transgender Youth: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="13",
volume="4",
number="3",
pages="e25801",
keywords="transgender person",
keywords="internet",
keywords="sex and gender minorities",
keywords="well-being",
keywords="adolescent",
keywords="mobile phone",
abstract="Background: Transgender, nonbinary, and gender-diverse (TNG) youth encounter barriers to psychosocial wellness and also describe exploring identities and communities on the web. Studies of cisgender youth connect increased digital technology use with lower well-being, parent relationships, and body image scores as well as increased loneliness and fear of missing out (FOMO). However, little is known about the psychosocial factors associated with digital technology use among TNG compared with cisgender youth. Objective: This study aims to examine the associations between psychosocial measures and digital technology use and its importance for cisgender and TNG youth. Methods: We surveyed a nationally representative sample of adolescents (aged 13-18 years) about psychosocial wellness and digital technology use. Psychosocial measures included assessment of well-being, parental relationships, body image, loneliness, and FOMO. Digital media use assessments included the short Problematic and Risky Internet Use Screening Scale-3 and the Adolescent Digital Technology Interactions and Importance (ADTI) scale and subscales. We compared psychosocial measures between gender identity groups. We also compared stratified correlations for psychosocial measures (well-being, parent relationships, body image, loneliness, and FOMO) with ADTI and Problematic and Risky Internet Use Screening Scale-3 scores between gender identity groups. All comparisons were adjusted for age, race, and ethnicity. Results: Among 4575 adolescents, 53 (1.16\%) self-identified as TNG youth. TNG youth had lower scores for well-being (23.76 vs 26.47; P<.001), parent relationships (19.29 vs 23.32; P<.001), and body image (13.50 vs 17.12; P<.001), and higher scores for loneliness (9.28 vs 6.55; P<.001) and FOMO (27.93 vs 23.89; P=.004), compared with cisgender peers. In a pattern different from that of their cisgender peers, better well-being scores and body image for TNG youth predicted higher problematic internet use (PIU) scores (correlation coefficients of 0.32 vs ?0.07; P=.004 and 0.26 vs ?0.21; P=.002, respectively). FOMO was a stronger positive predictor of higher ADTI total and subscale scores for cisgender youth compared with TNG youth. Conclusions: Overall, this study supports previously demonstrated disparities in the psychosocial wellness of TNG youth and adds that these disparities include loneliness and FOMO. This study shows prediction of PIU by both higher well-being and better body image, indicating that PIU may not be unilaterally driven by problematic factors among TNG youth. We suggest that this may be because of the specific digital media functions that TNG youth engage with as a disenfranchised population. ",
doi="10.2196/25801",
url="https://pediatrics.jmir.org/2021/3/e25801",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398792"
}


@Article{info:doi/10.2196/25568,
author="Rankine, Jacquelin
and Yeramosu, Deepika
and Matheo, Loreta
and Sequeira, M. Gina
and Miller, Elizabeth
and Ray, N. Kristin",
title="Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design",
journal="JMIR Hum Factors",
year="2021",
month="Aug",
day="5",
volume="8",
number="3",
pages="e25568",
keywords="referral",
keywords="consultation",
keywords="telemedicine",
keywords="telehealth",
keywords="adolescents",
keywords="child health",
keywords="child health services",
keywords="confidentiality",
keywords="access to health care",
abstract="Background: e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. Objective: This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. Methods: We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. Results: Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. Conclusions: Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs. ",
doi="10.2196/25568",
url="https://humanfactors.jmir.org/2021/3/e25568",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383665"
}


@Article{info:doi/10.2196/27981,
author="March, Sonja
and Batterham, J. Philip
and Rowe, Arlen
and Donovan, Caroline
and Calear, L. Alison
and Spence, H. Susan",
title="Trajectories of Change in an Open-access Internet-Based Cognitive Behavior Program for Childhood and Adolescent Anxiety: Open Trial",
journal="JMIR Ment Health",
year="2021",
month="Jun",
day="18",
volume="8",
number="6",
pages="e27981",
keywords="iCBT",
keywords="child",
keywords="adolescent",
keywords="anxiety",
keywords="online",
keywords="trajectories of change",
abstract="Background: Although evidence bolstering the efficacy of internet-based cognitive behavioral therapy (iCBT) for treating childhood anxiety has been growing continuously, there is scant empirical research investigating the timing of benefits made in iCBT programs (eg, early or delayed). Objective: This study aims to examine the patterns of symptom trajectories (changes in anxiety) across an iCBT program for anxiety (BRAVE Self-Help). Methods: This study's participants included 10,366 Australian youth aged 7 to 17 years (4140 children aged 7-12 years; 6226 adolescents aged 12-17 years) with elevated anxiety who registered for the BRAVE Self-Help program. Participants self-reported their anxiety symptoms at baseline or session 1 and then at the commencement of each subsequent session. Results: The results show that young people completing the BRAVE Self-Help program tend to fall into two trajectory classes that can be reliably identified in terms of high versus moderate baseline levels of anxiety and subsequent reduction in symptoms. Both high and moderate anxiety severity trajectory classes showed significant reductions in anxiety, with the greatest level of change being achieved within the first six sessions for both classes. However, those in the moderate anxiety severity class tended to show reductions in anxiety symptoms to levels below the elevated range, whereas those in the high symptom group tended to remain in the elevated range despite improvements. Conclusions: These findings suggest that those in the high severity group who do not respond well to iCBT on a self-help basis may benefit from the additional support provided alongside the program or a stepped-care approach where progress is monitored and support can be provided as necessary. ",
doi="10.2196/27981",
url="https://mental.jmir.org/2021/6/e27981",
url="http://www.ncbi.nlm.nih.gov/pubmed/34142971"
}


@Article{info:doi/10.2196/29411,
author="Hammons, J. Amber
and Villegas, Elizabeth
and Robart, Ryan",
title="``It's Been Negative for Us Just All the Way Across the Board'': Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic",
journal="JMIR Pediatr Parent",
year="2021",
month="Jun",
day="8",
volume="4",
number="2",
pages="e29411",
keywords="children",
keywords="COVID-19",
keywords="experiences",
keywords="family",
keywords="outcomes",
keywords="pandemic",
keywords="parenting",
keywords="parents",
keywords="screen time",
abstract="Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families' experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children's ST habits as the country attempts to establish a new normal. ",
doi="10.2196/29411",
url="https://pediatrics.jmir.org/2021/2/e29411",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081606"
}


@Article{info:doi/10.2196/18771,
author="Donelle, Lorie
and Facca, Danica
and Burke, Shauna
and Hiebert, Bradley
and Bender, Emma
and Ling, Stephen",
title="Exploring Canadian Children's Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="26",
volume="5",
number="5",
pages="e18771",
keywords="child",
keywords="children",
keywords="internet",
keywords="social media",
keywords="digital literacy",
keywords="digital inclusion",
keywords="quality of life",
keywords="mobile phone",
abstract="Background: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results: Of the 42 children who participated in this study, 24 (57\%) reported that they used social media, specifically YouTube (19/24, 79\% reported use), Snapchat (16/24, 67\% reported use), and Facebook (8/24, 33\% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50\%), videos or pictures of others (8/24, 33\%), and their birthday (12/24, 50\%), whereas only one-third (9/24, 38\%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71\%) children never felt sad, half (12/24, 50\%) never had difficulty making new friends, and nearly one-third (7/24, 30\%) indicated that they never had difficulty wanting to play outside. Conclusions: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends. ",
doi="10.2196/18771",
url="https://formative.jmir.org/2021/5/e18771",
url="http://www.ncbi.nlm.nih.gov/pubmed/34037525"
}


@Article{info:doi/10.2196/24196,
author="Buabbas, Ali
and Hasan, Huda
and Shehab, Abdulmohsen Abrar",
title="Parents' Attitudes Toward School Students' Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2021",
month="May",
day="20",
volume="4",
number="2",
pages="e24196",
keywords="smartphones",
keywords="overuse impact",
keywords="school students",
keywords="parents' attitudes",
abstract="Background: Parents' awareness of the risks of the overuse of smartphones (SPs) among their children and parents' attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue. Objective: This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it. Methods: The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait. Results: A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5\%) than male (45/120, 37.5\%) respondents. Almost all of the participants (118/120, 98.3\%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children's health (117/120, 97.5\%). Although the participants, mostly the mothers, supervised their children's use of SPs closely (106/120, 88.3\%), the majority could not control their children's length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children. Conclusions: Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested. ",
doi="10.2196/24196",
url="https://pediatrics.jmir.org/2021/2/e24196",
url="http://www.ncbi.nlm.nih.gov/pubmed/33878024"
}


@Article{info:doi/10.2196/24566,
author="Bowling, B. April
and Slavet, James
and Hendrick, Chelsea
and Beyl, Robbie
and Nauta, Phillip
and Augustyn, Marilyn
and Mbamalu, Mediatrix
and Curtin, Carol
and Bandini, Linda
and Must, Aviva
and Staiano, E. Amanda",
title="The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="14",
volume="5",
number="5",
pages="e24566",
keywords="exercise",
keywords="diet",
keywords="sleep",
keywords="mental health",
keywords="children",
keywords="adolescent",
keywords="health promotion",
keywords="telehealth",
keywords="exergaming",
abstract="Background: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. Objective: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. Methods: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. Results: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83\%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67\%) reported intention to continue, and 8 (89\%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (?58.8 min; P=.04) but not for the intervention group (?5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. Conclusions: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. Trial Registration: ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415. ",
doi="10.2196/24566",
url="https://formative.jmir.org/2021/5/e24566",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988508"
}


@Article{info:doi/10.2196/24482,
author="Armstrong, C. Courtney
and Odukoya, J. Erica
and Sundaramurthy, Keerthi
and Darrow, M. Sabrina",
title="Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis",
journal="JMIR Ment Health",
year="2021",
month="Apr",
day="22",
volume="8",
number="4",
pages="e24482",
keywords="qualitative",
keywords="mHealth",
keywords="mobile phone",
keywords="behavior monitoring",
keywords="youth",
abstract="Background: Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. Objective: The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. Methods: Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. Results: During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. Conclusions: Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers. ",
doi="10.2196/24482",
url="https://mental.jmir.org/2021/4/e24482",
url="http://www.ncbi.nlm.nih.gov/pubmed/33885364"
}


@Article{info:doi/10.2196/17856,
author="Park, Eunhee
and Kwon, Misol",
title="Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="15",
volume="23",
number="3",
pages="e17856",
keywords="adolescent",
keywords="digital health literacy",
keywords="ehealth literacy",
keywords="cognitive interview",
abstract="Background: Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. Objective: This study aims to explore the usability and content validity of DHLI. Methods: Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50\% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. Results: Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. Conclusions: The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy. ",
doi="10.2196/17856",
url="https://www.jmir.org/2021/3/e17856",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720031"
}


@Article{info:doi/10.2196/25062,
author="Sauch Valma{\~n}a, Gl{\`o}ria
and Vidal-Alaball, Josep
and Garcia Furi{\'o}, Victoria
and Testoni, Giorgia
and Espelt, Albert
and Exposito, Katarin
and Saig{\'i}-Rubi{\'o}, Francesc
and Carr{\'e}, N{\'u}ria
and Sanz, Ikuska
and Vicens, Victor",
title="An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="3",
volume="10",
number="2",
pages="e25062",
keywords="mHealth",
keywords="telehealth",
keywords="teenager",
keywords="health promotion and sexual health",
keywords="health promotion",
keywords="sexual health",
abstract="Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients' safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 ",
doi="10.2196/25062",
url="https://www.researchprotocols.org/2021/2/e25062",
url="http://www.ncbi.nlm.nih.gov/pubmed/33533729"
}


@Article{info:doi/10.2196/18286,
author="Lupton, Deborah",
title="Young People's Use of Digital Health Technologies in the Global North: Narrative Review",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="11",
volume="23",
number="1",
pages="e18286",
keywords="digital health",
keywords="young people",
keywords="Global North",
keywords="social research",
keywords="narrative review",
abstract="Background: A diverse array of digital technologies are available to children and young people living in the Global North to monitor, manage, and promote their health and well-being. Objective: This article provides a narrative literature review of the growing number of social research studies published over the past decade that investigate the types of digital technologies used by children and young people in the Global North, in addition to investigating which of these technologies they find most useful or not useful. Key findings as well as major gaps and directions for future research are identified and discussed. Methods: A comprehensive search of relevant publications listed in Google Scholar was conducted, supported by following citation trails of these publications. The findings are listed under type of digital technology used for health: cross-media, internet, social media, apps and wearable devices, sexual health support and information, and mental health support and information. Results: Many young people in the Global North are active users of digital health technologies. However, it is notable that they still rely on older technologies, such as websites and search engines, to find information. Apps and platforms that may not have been specifically developed for young people as digital health resources often better suit their needs. Young people appreciate the ready availability of information online, the opportunities to learn more about their bodies and health states, and the opportunities to learn how to improve their health and physical fitness. They enjoy being able to connect with peers, and they find emotional support and relief from distress by using social media platforms, YouTube, and online forums. Young people can find the vast reams of information available to them difficult to navigate. They often look to trusted adults to help them make sense of the information they find online and to provide alternative sources of information and support. Face-to-face interactions with these trusted providers remain important to young people. Risks and harms that young people report from digital health use include becoming overly obsessed with their bodies' shape and size when using self-tracking technologies and comparing their bodies with the social media influencers they follow. Conclusions: Further details on how young people are using social media platforms and YouTube as health support resources and for peer-to-peer sharing of information, including attention paid to the content of these resources and the role played by young social media influencers and microcelebrities, would contribute important insights to this body of literature. The role played by visual media, such as GIFs (Graphics Interchange Format) and memes, and social media platforms that have recently become very popular with young people (eg, Snapchat and TikTok) in health-related content creation and sharing requires more attention by social researchers seeking to better understand young people's use of digital devices and software for health and fitness. ",
doi="10.2196/18286",
url="http://www.jmir.org/2021/1/e18286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427684"
}


@Article{info:doi/10.2196/23854,
author="Kavosi, Zahra
and Vahedian, Sara
and Montazeralfaraj, Razieh
and Dehghani Tafti, Arefeh
and Bahrami, Amin Mohammad",
title="The Correlation of Online Health Information--Seeking Experience With Health-Related Quality of Life: Cross-Sectional Study Among Non--English-Speaking Female Students in a Religious Community",
journal="JMIR Med Inform",
year="2020",
month="Dec",
day="2",
volume="8",
number="12",
pages="e23854",
keywords="general health",
keywords="SF-36",
keywords="information seeking behavior",
keywords="online health information",
keywords="high school students",
keywords="health literacy",
abstract="Background: Given the increasing availability of the internet, it has become a common source of health information. However, the effect of this increased access on health needs to be further studied. Objective: This study aimed to investigate the correlation between online health information--seeking behavior and general health dimensions in a sample of high school students in Iran. Methods: A cross-sectional study was conducted in 2019. A total of 295 female students participated in the study. The data were collected using two validated questionnaires: the e-Health Impact Questionnaire and the 36-Item Short Form Health Survey. The collected data were analyzed through descriptive statistics and Pearson correlation coefficients using SPSS version 23 (IBM Corp). Results: The participants moderately used online information in their health-related decisions, and they thought that the internet helped people in health-related decision making. They also thought that the internet could be used to share health experiences with others. Participants had moderate confidence in online health information and stated that the information provided by health websites was moderately understandable and reliable and moderately encouraged and motivated them to play an active role in their health promotion. Nevertheless, the results showed that online health information--seeking experience had no significant correlation with health-related quality of life. Conclusions: This study provides insights into the effect of using internet information on the health of adolescents. It has important implications for researchers and policy makers to build appropriate policies to maximize the benefit of internet access for health. ",
doi="10.2196/23854",
url="https://medinform.jmir.org/2020/12/e23854",
url="http://www.ncbi.nlm.nih.gov/pubmed/33263546"
}


@Article{info:doi/10.2196/20590,
author="Lunsford-Avery, R. Jessica
and Keller, Casey
and Kollins, H. Scott
and Krystal, D. Andrew
and Jackson, Leah
and Engelhard, M. Matthew",
title="Feasibility and Acceptability of Wearable Sleep Electroencephalogram Device Use in Adolescents: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="1",
volume="8",
number="10",
pages="e20590",
keywords="sleep",
keywords="wearable",
keywords="mHealth",
keywords="adolescents",
keywords="EEG",
keywords="feasibility",
keywords="acceptability",
keywords="tolerability",
keywords="actigraphy",
abstract="Background: Adolescence is an important life stage for the development of healthy behaviors, which have a long-lasting impact on health across the lifespan. Sleep undergoes significant changes during adolescence and is linked to physical and psychiatric health; however, sleep is rarely assessed in routine health care settings. Wearable sleep electroencephalogram (EEG) devices may represent user-friendly methods for assessing sleep among adolescents, but no studies to date have examined the feasibility and acceptability of sleep EEG wearables in this age group. Objective: The goal of the research was to investigate the feasibility and acceptability of sleep EEG wearable devices among adolescents aged 11 to 17 years. Methods: A total of 104 adolescents aged 11 to 17 years participated in 7 days of at-home sleep recording using a self-administered wearable sleep EEG device (Zmachine Insight+, General Sleep Corporation) as well as a wristworn actigraph. Feasibility was assessed as the number of full nights of successful recording completed by adolescents, and acceptability was measured by the wearable acceptability survey for sleep. Feasibility and acceptability were assessed separately for the sleep EEG device and wristworn actigraph. Results: A total of 94.2\% (98/104) of adolescents successfully recorded at least 1 night of data using the sleep EEG device (mean number of nights 5.42; SD 1.71; median 6, mode 7). A total of 81.6\% (84/103) rated the comfort of the device as falling in the comfortable to mildly uncomfortable range while awake. A total of 40.8\% (42/103) reported typical sleep while using the device, while 39.8\% (41/103) indicated minimal to mild device-related sleep disturbances. A minority (32/104, 30.8\%) indicated changes in their sleep position due to device use, and very few (11/103, 10.7\%) expressed dissatisfaction with their experience with the device. A similar pattern was observed for the wristworn actigraph device. Conclusions: Wearable sleep EEG appears to represent a feasible, acceptable method for sleep assessment among adolescents and may have utility for assessing and treating sleep disturbances at a population level. Future studies with adolescents should evaluate strategies for further improving usability of such devices, assess relationships between sleep EEG--derived metrics and health outcomes, and investigate methods for incorporating data from these devices into emerging digital interventions and applications. Trial Registration: ClinicalTrials.gov NCT03843762; https://clinicaltrials.gov/ct2/show/NCT03843762 ",
doi="10.2196/20590",
url="https://mhealth.jmir.org/2020/10/e20590",
url="http://www.ncbi.nlm.nih.gov/pubmed/33001035"
}


@Article{info:doi/10.2196/16388,
author="Arias-de la Torre, Jorge
and Puigdomenech, Elisa
and Garc{\'i}a, Xavier
and Valderas, M. Jose
and Eiroa-Orosa, Jose Francisco
and Fern{\'a}ndez-Villa, Tania
and Molina, J. Antonio
and Mart{\'i}n, Vicente
and Serrano-Blanco, Antoni
and Alonso, Jordi
and Espallargues, Mireia",
title="Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="26",
volume="22",
number="8",
pages="e16388",
keywords="mobile technologies and social media",
keywords="depression",
keywords="adolescents",
keywords="review",
abstract="Background: Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect. Objective: The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents. Methods: An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out. Results: The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results. Conclusions: Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence. ",
doi="10.2196/16388",
url="http://www.jmir.org/2020/8/e16388/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663157"
}


@Article{info:doi/10.2196/16317,
author="Liverpool, Shaun
and Mota, Pinheiro Catarina
and Sales, D. C{\'e}lia M.
and ?u{\vs}, Anja
and Carletto, Sara
and Hancheva, Camellia
and Sousa, S{\'o}nia
and Cer{\'o}n, Conejo Sonia
and Moreno-Peral, Patricia
and Pietrabissa, Giada
and Moltrecht, Bettina
and Ulberg, Randi
and Ferreira, Nuno
and Edbrooke-Childs, Julian",
title="Engaging Children and Young People in Digital Mental Health Interventions: Systematic Review of Modes of Delivery, Facilitators, and Barriers",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="23",
volume="22",
number="6",
pages="e16317",
keywords="mHealth",
keywords="eHealth",
keywords="technology",
keywords="smartphone",
keywords="children",
keywords="adolescent mental health",
keywords="mobile phone",
abstract="Background: There is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible. Objective: This review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs. Methods: A literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts ``child and adolescent mental health,'' ``digital intervention,'' and ``engagement.'' Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively. Results: This study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP's engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79\% in studies involving various DHIs. Conclusions: The development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs. ",
doi="10.2196/16317",
url="http://www.jmir.org/2020/6/e16317/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442160"
}


@Article{info:doi/10.2196/18558,
author="Bjornestad, Jone
and Moltu, Christian
and Veseth, Marius
and Tjora, Tore",
title="Rethinking Social Interaction: Empirical Model Development",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="23",
volume="22",
number="4",
pages="e18558",
keywords="social interaction",
keywords="social functioning",
keywords="social media",
keywords="model",
keywords="empirical",
keywords="adolescence",
keywords="health science",
abstract="Background: Social media is an integral part of human social life. More than 90\% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions. Objective: To develop a theoretically based empirical model of current social interfaces to inform relevant measures. Methods: A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents' relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique. Results: We developed an empirical model that categorizes adolescents' social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges. Conclusions: We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures. ",
doi="10.2196/18558",
url="http://www.jmir.org/2020/4/e18558/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32324144"
}


@Article{info:doi/10.2196/16736,
author="Moreno, A. Megan
and Binger, Kole
and Zhao, Qianqian
and Eickhoff, Jens",
title="Measuring Interests Not Minutes: Development and Validation of the Adolescents' Digital Technology Interactions and Importance Scale (ADTI)",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="12",
volume="22",
number="2",
pages="e16736",
keywords="technology",
keywords="adolescents",
keywords="methodology, survey",
keywords="social media",
keywords="screen time",
keywords="instrument development",
abstract="Background: Interactive digital technology use is integral to adolescents' lives and has been associated with both health benefits and risks. Previous studies have largely focused on measuring the quantity of technology use or understanding the use of specific platforms. To better understand adolescents' interactive digital technology use, we need new approaches that consider technology interactions and their importance. Objective: This study aimed to develop an assessment tool to evaluate adolescents' digital technology interactions and their perceived importance. Methods: We used a validated scale development approach comprising 2 initial steps to create an item pool: item pool development and item pool refinement. These steps relied upon empirical literature review and an expert convening. We then evaluated the item pool using a Web-based survey. Data were collected via Qualtrics panel recruitment from a national sample of 12- to 18-year-olds. Participant data were randomly split into a development subsample for exploratory factor analysis (EFA) and a test subsample for confirmatory factor analysis (CFA). We assessed Cronbach alpha as well as model fit characteristics including root mean square error of approximation (RMSEA) and comparative fit index (CFI). Results: Our initial item pool had 71 items and the refined item pool contained 40. A total of 761 adolescents assessed the item pool via Web-based survey. Participants had a mean age of 14.8 (SD 1.7) years and were 52.8\% (402/761) female and 77.5\% (590/761) white. The EFA analysis included 500 participants and an 18-item draft scale was created. The CFA included 261 participants to test the draft scale. Adequate model fit for the scale was indicated by an RMSEA of 0.063 and a CFI of 0.95. The final scale included 18 items in a 3-factor model, with Cronbach alpha for the 3 factors of .87 (factor 1), .90 (factor 2) and .82 (factor 3). The 3 factors were named (1) technology to bridge online and offline experiences, (2) technology to go outside one's identity or offline environment, and (3) technology for social connection. Conclusions: The resulting Adolescents' Digital Technology Interactions and Importance (ADTI) scale is a promising and psychometrically validated tool for identifying the importance of distinct technology interactions. The scale is informed by relevant theory and expert input. The 3 subscales have utility for future studies to understand whether certain subscale score ranges are associated with health or well-being outcomes. ",
doi="10.2196/16736",
url="https://www.jmir.org/2020/2/e16736",
url="http://www.ncbi.nlm.nih.gov/pubmed/32049068"
}


@Article{info:doi/10.2196/12176,
author="Ntalindwa, Theoneste
and Soron, Rashid Tanjir
and Nduwingoma, Mathias
and Karangwa, Evariste
and White, Rebecca",
title="The Use of Information Communication Technologies Among Children With Autism Spectrum Disorders: Descriptive Qualitative Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Sep",
day="27",
volume="2",
number="2",
pages="e12176",
keywords="autism spectrum disorders",
keywords="information communication technologies",
keywords="inclusive education",
abstract="Background: The prevalence of Autism Spectrum Disorder (ASD) appears to be increasing globally due to the complex interaction of multiple biopsychosocial and environmental factors. Mobile phones, tablets, and other electronic gadgets have transformed our means of communication, and have also changed both healthcare and how we learn. These technological enhancements may have a positive impact on the lives of children, but there is currently a global scarcity of information on how information technology influences the education of children with ASD. Objective: This study was conducted in Rwandan schools and communities, and aimed to understand the perceptions of students with ASD, their parents, and their teachers, on the use of Information and Communication Technology (ICT) in the education of those with ASD. Methods: This qualitative descriptive study was conducted from December 2017 to July 2018. Researchers conducted four focus group discussions (FGDs) with 54 participants from different backgrounds: teachers, parents, and students with ASD. Each of the FGDs took approximately two and a half hours. A predefined set of open-ended questions were selected to discover people's perceptions regarding assistive technologies used in ASD, their effectiveness, the scope of using them in their context, and upcoming challenges during implementation. The interviews were recorded, transcribed, and analyzed. Results: The findings of the study revealed seven key themes: (1) the use of ICT for the education of children with ASD; (2) existing augmentative facilities for learning; (3) current patterns of use of ICT in education; (4) preferred areas of learning for ASD students; (5) integration of ICT into educational programs; (6) areas of interest outside the classroom; and (7) future opportunities and challenges in Rwanda. We found most of the study participants assumed that appropriate technology and related innovations might solve the challenges faced by learners with ASD in classrooms. Moreover, they thought that children with ASD more so enjoyed watching television, playing digital games, and drawing objects using gadgets than interacting with people or playing with other children. Conclusions: The use of various low-cost technical devices can aid with teaching and the education of children with autism in Rwanda. However, this area requires further research to discover the impact ICT can have on the education of children with ASD, so this study may become a starting point for further research in the area. ",
doi="10.2196/12176",
url="http://pediatrics.jmir.org/2019/2/e12176/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573940"
}


@Article{info:doi/10.2196/11584,
author="Reen, Kaur Gurpreet
and Muirhead, Linden
and Langdon, Wendy Dawn",
title="Usability of Health Information Websites Designed for Adolescents: Systematic Review, Neurodevelopmental Model, and Design Brief",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="23",
volume="21",
number="4",
pages="e11584",
keywords="adolescents",
keywords="health communication",
keywords="internet",
keywords="information seeking behavior",
keywords="usability",
keywords="systematic review",
abstract="Background: Adolescence is a unique developmental period characterized by biological, social, and cognitive changes, as well as an interest in managing one's own health care. Many adolescents use the internet to seek health care information. However, young people face barriers before they can understand and apply the health information that they access on the web. It is essential that usability of adolescent health websites on the internet is improved to help adolescents overcome these barriers and allow them to engage successfully with web-based health care content. Objective: The aim of this review was to synthesize the usability of specific health information websites. These findings were mapped onto the adolescent neurodevelopmental profile, and a design brief based on the findings was developed to tailor future websites for specific adolescent requirements. Methods: A systematic search conducted using PubMed, PsycINFO, and Education Resources Information Center (ERIC) identified 25 studies that assessed the usability of health information websites. Adolescent feedback was collected by a mixture of surveys, focus groups, interviews, and think-aloud procedures. Results: A majority of the information websites were developed for specific health issues that may be relevant to adolescents. The most preferred website features were interactive content such as games and quizzes, as well as videos, images, audio clips, and animations. Participants also preferred communicating with other adolescents with similar conditions or learning about their experience through real stories and testimonials. Adolescents found it difficult to use health information websites if they contained too much text, were too cluttered, or had features that made it difficult to access. The findings are considered in the context of adolescent social processes, low tolerance of delayed gratification, and attraction to novelty and mapped onto a neurodevelopmental model of adolescence. Conclusions: Young people's feedback can determine usability and content that make a health information website easy or informative to use. Neurodevelopmental profiles and the users' specific preferences and skills should be addressed in future development of health information websites for adolescents. ",
doi="10.2196/11584",
url="http://www.jmir.org/2019/4/e11584/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31012856"
}


@Article{info:doi/10.2196/11404,
author="Leary, P. Miriam
and Clegg, N. Emily
and Santella, E. Madison
and Murray, J. Pamela
and Downs, S. Julie
and Olfert, D. Melissa",
title="Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study",
journal="JMIR Form Res",
year="2019",
month="Mar",
day="01",
volume="3",
number="1",
pages="e11404",
keywords="adolescent",
keywords="female",
keywords="social media",
keywords="health information",
keywords="health behaviors",
abstract="Background: Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information. Objective: This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied. Methods: Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey. Results: A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media. Conclusions: Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information. ",
doi="10.2196/11404",
url="http://formative.jmir.org/2019/1/e11404/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30821696"
}


@Article{info:doi/10.2196/publichealth.9332,
author="Andrade, Louise Elizabeth
and Evans, Douglas W.
and Barrett, Nicole
and Edberg, Cameron Mark
and Cleary, D. Sean",
title="Strategies to Increase Latino Immigrant Youth Engagement in Health Promotion Using Social Media: Mixed-Methods Study",
journal="JMIR Public Health Surveill",
year="2018",
month="Dec",
day="19",
volume="4",
number="4",
pages="e71",
keywords="social media",
keywords="health promotion",
keywords="Latinos",
keywords="immigrants",
keywords="adolescent",
keywords="Hispanic Americans",
keywords="emigrants and immigrants",
keywords="adolescent health",
abstract="Background: Generating participant engagement in social media applications for health promotion and disease prevention efforts is vital for their effectiveness and increases the likelihood of effecting sustainable behavior change. However, there is limited evidence regarding effective strategies for engaging Latino immigrant youth using social media. As part of the Avance Center for the Advancement of Immigrant/Refugee Health in Washington, DC, USA, we implemented Adelante, a branded primary prevention program, to address risk factors for co-occurring substance use, sexual risk, and interpersonal violence among Latino immigrant adolescents aged 12 to 19 years in a Washington, DC suburb. Objective: The objectives of this study were to (1) characterize Adelante participant Facebook reach and engagement and (2) identify post content and features that resulted in greater user engagement. Methods: We established the Adelante Facebook fan page in October of 2013, and the Adelante social marketing campaign used this platform for campaign activities from September 2015 to September 2016. We used Facebook Insights metrics to examine reach and post engagement of Adelante Facebook page fans (n=743). Data consisted of Facebook fan page posts between October 1, 2013 and September 30, 2016 (n=871). We developed a 2-phased mixed-methods analytical plan and coding scheme, and explored the association between post content categories and features and a composite measure of post engagement using 1-way analysis of variance tests. P<.05 determined statistical significance. Results: Posts on the Adelante Facebook page had a total of 34,318 clicks, 473 comments, 9080 likes or reactions, and 617 shares. Post content categories that were statistically significantly associated with post engagement were Adelante program updates (P<.001); youth achievement showcases (P=.001); news links (P<.001); social marketing campaign posts (P<.001); and prevention topics, including substance abuse (P<.001), safe sex (P=.02), sexually transmitted disease prevention (P<.001), and violence or fighting (P=.047). Post features that were significantly associated with post engagement comprised the inclusion of photos (P<.001); Spanish (P<.001) or bilingual (P=.001) posts; and portrayal of youth of both sexes (P<.001) portrayed in groups (P<.001) that were facilitated by adults (P<.001). Conclusions: Social media outreach is a promising strategy that youth programs can use to complement in-person programming for augmented engagement. The Latino immigrant youth audience in this study had a tendency toward more passive social media consumption, having implications for outreach strategies and engagement measurement in future studies. While study findings confirmed the utility of social marketing campaigns for increasing user engagement, findings also highlighted a high level of engagement among youth with posts that covered casual, day-to-day program activity participation. This finding identifies an underexplored area that should be considered for health messaging, and also supports interventions that use peer-to-peer and user-generated health promotion approaches. ",
doi="10.2196/publichealth.9332",
url="http://publichealth.jmir.org/2018/4/e71/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30567689"
}


@Article{info:doi/10.2196/jmir.7731,
author="Park, Eunhee
and Kwon, Misol",
title="Health-Related Internet Use by Children and Adolescents: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="03",
volume="20",
number="4",
pages="e120",
keywords="Internet",
keywords="child",
keywords="adolescent",
keywords="health information",
keywords="health-related Internet use",
keywords="eHealth",
abstract="Background: The internet is widely used by children and adolescents, who generally have a high level of competency with technology. Thus, the internet has become a great resource for supporting youth self-care and health-related services. However, few studies have explored adolescents' internet use for health-related matters. Objective: The objective of this systematic literature review was to examine the phenomenon of children and adolescents' health-related internet use and to identify gaps in the research. Methods: A total of 19 studies were selected from a search of major electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO using the following search terms: ``health-related internet use,'' ``eHealth,'' ``Internet use for health-related purpose,'' ``Web-based resource,'' ``health information seeking,'' and ``online resource,'' combined with ``child,'' ``adolescent,'' ``student,'' ``youth,'' and ``teen.'' The children's and adolescents' ages were limited to 24 years and younger. The search was conducted from September 2015 to October 2017. The studies identified to contain youth (<24 years) health-related internet use were all published in peer-reviewed journals in the past 10 years; these studies examined general internet use seeking health care services, resources, information, or using the internet for health promotion and self-care. Studies were excluded if they explored the role of the internet as a modality for surveys, recruitment, or searching for relevant literature without specifically aiming to study participants' health-related internet use; focused solely on quality assurance for specific websites; or were designed to test a specific internet-based intervention. Results: Interesting patterns in adolescents' health-related internet use, such as seeking preventative health care and specific information about medical issues, were identified. Quantitative studies reported rates of the internet use and access among youth, and the purpose and patterns of health-related internet use among youth were identified. A major objective of health-related internet use is to gain information, but there are inconsistencies in adolescents' perceptions of health-related internet use. Conclusions: This study's findings provide important information on how youth seek information and related support systems for their health care on the internet. The conceptual and methodological limitations of the identified studies, such as the lack of a theoretical background and unrepresentative samples, are discussed, and gaps within the studies are identified for future research. This review also suggests important features for potential Web-based health interventions for children and adolescents. ",
doi="10.2196/jmir.7731",
url="http://www.jmir.org/2018/4/e120/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29615385"
}


@Article{info:doi/10.2196/jmir.8340,
author="Thompson, A. Lindsay
and Mercado, Rebeccah
and Martinko, Thomas
and Acharya, Ratna",
title="Novel Interventions and Assessments Using Patient Portals in Adolescent Research: Confidential Survey Study",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="21",
volume="20",
number="3",
pages="e101",
keywords="adolescent health services",
keywords="preventive health services",
keywords="health information technology",
abstract="Background: While adolescents can receive confidential health care without parental or guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap. Objective: Because use of a confidential online adolescent patient portal is high at our academic institution, we hypothesized that adolescents would also respond to survey-based research via the portal, especially if asked anonymously and without parental consent. We used a clinical scenario of needing to better understanding adolescent and young adults' views about their health and health care, including information on a long-acting reversible contraceptive (LARC) to test if and how they will use a portal for research. Methods: Upon receiving Institutional Review Board approval, we sent 2 portal-based surveys about confidential services to 2 groups of females, ages 14 to 25 years, who had attended an adolescent clinic in the past 3 years. This clinic mostly serves Medicaid recipients (80\%) and is racially and ethnically diverse with half of patients identifying as African American and roughly 10\% Hispanic. The control group was a random sample of female patients who never received a LARC (n=150) and the intervention group included all female adolescents who had received a LARC from the same clinic (n=107). This second sample was manually cross-checked to confirm they had an office visit for this reason. Consenting for themselves, the control group received an email through the patient portal with a link and a request to perform an assessment. The survey for the control group included items assessing health literacy and health communication preferences. The survey for the intervention group included health literacy items as well as items to assess their opinions and perceptions regarding LARCs. We tracked click-through rates and opened messages; each participant received 4 reminders. Results: While only 3 participants fully completed either survey, email read rates (29/107 [27.1\%] of LARC recipients and 39/150 [26.0\%] of controls) were encouraging. Additionally, of those who opened the messages, almost twice as many of the LARC recipients (10/107 [9.3\%]) read through the entire survey, while less than half read the entire survey as compared to those who received the survey asking about health literacy and health care preferences (6/150 [4.0\%]). Conclusions: The methodology of using adolescent portals for online surveys provides a new avenue for research even though the study did not yield sufficient participation to understand these adolescents' preferences. Future studies need to test if a different survey topic would engage adolescents or if other methods like text-based reminders would improve participation. ",
doi="10.2196/jmir.8340",
url="http://www.jmir.org/2018/3/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29563077"
}


@Article{info:doi/10.2196/pediatrics.8677,
author="Radovic, Ana
and McCarty, A. Carolyn
and Katzman, Katherine
and Richardson, P. Laura",
title="Adolescents' Perspectives on Using Technology for Health: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2018",
month="Mar",
day="14",
volume="1",
number="1",
pages="e2",
keywords="adolescent",
keywords="adolescent health services, technology",
keywords="primary health care, social media",
keywords="qualitative research",
abstract="Background: Adolescents' wide use of technology opens up opportunities to integrate technology into health visits and health care. In particular, technology has the potential to influence adolescent behavior change by offering new avenues for provider communication and support for healthy choices through many different platforms. However, little information exists to guide the integration of technology into adolescent health care, especially adolescents' perspectives and preferences for what they find useful. Objective: This qualitative study aimed to take a broad approach to understanding adolescents' use of technology for supporting their overall health and to understand whether and how adolescents envision using technology to enhance their health and clinical care, particularly in communicating with their provider. Methods: Adolescents (13-18 years) were recruited to participate in semi-structured, in-depth individual interviews. Potential participants were approached in-person through the Seattle Children's Hospital Adolescent Medicine Clinic while they were waiting for consultation appointments, through outreach to youth who expressed interest in other local research study activities, and via flyers in waiting rooms. Interviews were recorded, transcribed, and analyzed using a thematic analysis approach. Results: Thirty-one adolescents (58\% female, mean age 15.2 years) were interviewed and described 3 main uses of technology: (1) to gather information, (2a) to share their own experiences and (2b) view others' experiences in order to gain social support or inspiration, and (3) to track behaviors and health goals. Perceived benefits and potential downsides were identified for technology use. Teens desired to use technology with their provider for 3 main reasons: (1) have questions answered outside of visits, (2) have greater access to providers as a way to build relationship/rapport, and (3) share data regarding behaviors in between visits. Social media was not a preferred method for communicating with providers for any of the youth due to concerns about privacy and intrusiveness. Conclusions: Although youth are avid users of technology in general, in regard to technology for health, they display specific use preferences especially in how they wish to use it to communicate with their primary care provider. Health care providers should offer guidance to youth with regard to how they have used and plan to use technology and how to balance potential positives and negatives of use. Technology developers should take youth preferences into account when designing new health technology and incorporate ways they can use it to communicate with their health care provider. ",
doi="10.2196/pediatrics.8677",
url="http://pediatrics.jmir.org/2018/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30740590"
}