%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69425 %T Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial %A Seiterö,Anna %A Henriksson,Pontus %A Thomas,Kristin %A Henriksson,Hanna %A Löf,Marie %A Bendtsen,Marcus %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Linköping, SE-58183, Sweden, 46 700895376, anna.seitero@liu.se %K mHealth %K multiple behavior %K high school students %K digital behavior change intervention %K public health %K telemedicine %K randomized controlled trial %D 2025 %7 22.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI –0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 %M 40262133 %R 10.2196/69425 %U https://www.jmir.org/2025/1/e69425 %U https://doi.org/10.2196/69425 %U http://www.ncbi.nlm.nih.gov/pubmed/40262133 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67885 %T 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 %A Sidhu,Amrita %A Shegog,Ross %A Craig-Rushing,Stephanie %A Trevino,Nicole %A Singer,Michelle %A Jessen,Cornelia %A Gorman,Gwenda %A Simpson,Sean %A Peskin,Melissa %A Hernandez,Belinda %A Markham,Christine %K implementation %K culturally relevant program %K evidence-based health promotion %K user engagement %K reach %K decision support system %K American Indian %K Alaska %K native communities %K youth %K adolescent %K decision support %K Alaska native %K health inequities %K sexual %K reproductive %K mental health %K AI/AN %K Tribal organization %K Google Analytics %K toolbox %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/67885 %U https://formative.jmir.org/2025/1/e67885 %U https://doi.org/10.2196/67885 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59238 %T Codevelopment of an mHealth App With Health Care Providers, Digital Health Experts, Community Partners, and Families for Childhood Obesity Management: Protocol for a Co-Design Process %A Toh,Siao Hui %A Davis,Courtney %A Bte Khaider,Khairunisa %A Ong,Zhi Quan %A Lim,Ethel Jie Kai %A Chew,Chu Shan Elaine %+ Physiotherapy Department, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 63941588, toh.siao.hui@kkh.com.sg %K childhood obesity %K mHealth %K mobile health %K co-design %K IDEAS framework %D 2025 %7 5.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity is increasing in Singapore, with most cases persisting into adulthood and leading to poor health outcomes. The current evidence for childhood obesity interventions shows a clear dose-response effect, where effectiveness improves with an increasing number of treatment hours. A minimum threshold of ≥26 hours over a 2- to 12-month period is required to achieve significant outcomes. The Kick Start Move Smart program is the first online community-based multidisciplinary program to treat pediatric obesity in Singapore. It has demonstrated feasibility and acceptability, with 70% of participants completing the recommended ≥26 hours of intervention. Preliminary data show significantly lower BMI and improved quality of life in participants compared to controls. Successful families are positive outliers who developed strategies for health in the context of an obesogenic environment. This positive outlier approach indicates that solutions to challenges that a community faces exist within certain individual members, and these strategies can be generalized and promoted to improve the health of others in the same community. A mobile health (mHealth) app targeting parents is a critical missing link in the currently available interventions to support parental self-management of childhood obesity. Using a combination of behavioral theory and user-centered design approaches is important for designing mHealth apps. One recommended framework is Integrate, Design, Assess, and Share (IDEAS), which aims to facilitate the development of more effective interventions by engaging perspectives from different stakeholders. Objective: This study aims to (1) describe the co-design protocol of an mHealth app using the IDEAS framework as a low-intensity intervention or as an adjunct to more intensive existing pediatric obesity interventions and (2) assess the usability, acceptability, and engagement of the app by parents. Methods: A clinician-led co-design approach will be undertaken with a multidisciplinary team using the IDEAS framework. Phase 1 involves stakeholder engagement and the formation of a core committee and a parent advisory board. Phase 2 involves developing the app content through focus group and expert panel discussions. Phase 3 involves developing a prototype app and gathering feedback. Phase 4 involves piloting the minimum viable product by parent users and evaluating its effectiveness through interviews and questionnaires. Results: In April 2023, a parent advisory board was formed, and stakeholders were engaged as part of phase 1. Phases 2 and 3 were completed in June 2024. Focus group discussions were held with the parent advisory board and stakeholders to identify family strategies and patient-centric outcomes and provide feedback on the app. As of January 2025, the app is complete, and we are now in the middle of data collection from participants. Participants will provide feedback to the research team, and the app will be updated accordingly. Conclusions: An evidence-based, theory-driven mHealth app developed using a structured design framework can bridge the gap in delivering multidisciplinary care in community settings for families with overweight children. International Registered Report Identifier (IRRID): DERR1-10.2196/59238 %M 40053786 %R 10.2196/59238 %U https://www.researchprotocols.org/2025/1/e59238 %U https://doi.org/10.2196/59238 %U http://www.ncbi.nlm.nih.gov/pubmed/40053786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65169 %T A Classroom-Based Intervention for Reducing Sedentary Behavior and Improving Spinal Health: Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial %A Fisher,Dominic %A Maart,Rentia %A Thabane,Lehana %A Louw,Quinette %+ School of Health Professions, Faculty of Health, University of Plymouth, North Road East, InterCity Place, Plymouth, PL4 6AB, United Kingdom, 44 01752587580, dominic.fisher@plymouth.ac.uk %K sedentary behavior %K spinal health %K classroom-based intervention %K sit-stand desks %K spinal %K African %K Africa %K primary school %K child %K youth %K randomized controlled trial %K RCT %K infectious disease %K acceptability %K data collection %K teacher %K classroom-based interventions %K primary school learners %K physical activity %K closed-cohort %K interview %K quantitative data %K wearable %K wearable sensor %K spine %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable diseases (NCDs) resulting from sedentary behavior (SB) are adding a further strain on the South African health system, which is already struggling to manage infectious diseases. Some countries have enabled children to reduce SB at school by substituting traditional furniture with sit-stand classroom furniture, allowing learners to interrupt prolonged bouts of sitting with standing without interrupting their school work. Alternating between sitting and standing also benefits spinal health by interrupting prolonged periods of high spinal loading, but no such intervention has been trialed in South Africa. The potential to reduce strain on the health system by reducing the incidence of NCDs and improving spinal health requires further consideration. Before embarking on a large classroom-based trial, it is essential to determine the acceptability of the intervention, its impact on teachers’ practices, and the logistical and pragmatic considerations of data collection. Objective: This study aimed to assess the feasibility of implementing a classroom-based intervention to reduce SB and improve spinal health in primary school learners, to assess the pragmatics of delivering and adherence to the intervention, and assess the pragmatics of measuring physical activity and postural dynamism data with wearable sensors. Methods: We used a stratified, closed-cohort, randomized, 2-cluster, stepped-wedge design with a pragmatic approach. One grade 5 and grade 6 class each was recruited from contrasting socioeconomically categorized, state-funded primary schools in the Western Cape province, South Africa. Classroom furniture was substituted with sit-stand desks, and health education and movement videos (HEMVs) were shown during class time. Skin-mounted activPAL physical activity monitors were used to measure SB and postural topography and Noraxon myoMOTION inertial measurement units (IMUs) to measure spinal movement. The study was evaluated for feasibility by tracking school retention, successful delivery of the HEMVs, the use of sit-stand desks, compliance with the wearable sensors, and data accuracy. We deductively analyzed teachers’ interviews and learners’ focus groups using Atlas.ti 9 software. Descriptive analysis of quantitative data was performed using Microsoft Excel. Results: Cluster 1 withdrew from the study before follow-up SB, postural topography, and spinal movements were measured. All feasibility outcomes, namely (1) classroom retention, (2) delivery of HEMVs, (3) learner and teacher acceptance and usage of sit-stand classroom furniture, (4) 100% compliance with wearing skin-mounted sensors for the duration of the intended measurement period, and (5) minimum 80% eligibility of sensor data gathered included in data analysis, were met in cluster 2. The study found that it is feasible to conduct a larger trial with minor modifications to the methodology. Conclusions: We recommend a whole-school approach to support the intervention and a monitoring strategy to track the impact of the intervention on the classroom. Furthermore, we recommend contextualized teacher training on how sit-stand desks and HEMVs can be used as classroom management tools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR2-10.2196/18522 %M 39993285 %R 10.2196/65169 %U https://formative.jmir.org/2025/1/e65169 %U https://doi.org/10.2196/65169 %U http://www.ncbi.nlm.nih.gov/pubmed/39993285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e71897 %T Authors’ Reply: “Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders” %A Lewis,Callum C %A Taba,Melody %A Allen,Tiffany B %A Caldwell,Patrina H.Y %A Skinner,S Rachel %A Kang,Melissa %A Henderson,Hamish %A Bray,Liam %A Borthwick,Madeleine %A Collin,Philippa %A McCaffery,Kirsten %A Scott,Karen M %+ Education Office, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Room 208D, Edward Ford Building, Sydney, 2006, Australia, 1 298453385, karen.scott@sydney.edu.au %K adolescent health %K digital health literacy %K adolescents %K online health information %K co-design %K health education %K eHealth literacy %K social media %D 2025 %7 20.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39977857 %R 10.2196/71897 %U https://www.jmir.org/2025/1/e71897 %U https://doi.org/10.2196/71897 %U http://www.ncbi.nlm.nih.gov/pubmed/39977857 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70020 %T Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders %A Yang,Alina %+ Scarsdale High School, 1057 Post Road, Scarsdale, NY, 10583, United States, 1 (914) 721 2500, alinayang5@gmail.com %K adolescent health %K digital health literacy %K adolescents %K online health information %K co-design %K health education %K eHealth literacy %K social media %D 2025 %7 20.2.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39977854 %R 10.2196/70020 %U https://www.jmir.org/2025/1/e70020 %U https://doi.org/10.2196/70020 %U http://www.ncbi.nlm.nih.gov/pubmed/39977854 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67213 %T Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non–Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study %A Zuair,Areeg %A Alhowaymel,Fahad M %A Jalloun,Rola A %A Alzahrani,Naif S %A Almasoud,Khalid H %A Alharbi,Majdi H %A Alnawwar,Rayan K %A Alluhaibi,Mohammed N %A Alharbi,Rawan S %A Aljohan,Fatima M %A Alhumaidi,Bandar N %A Alahmadi,Mohammad A %K adolescent obesity %K macronutrient education %K cardiovascular fitness %K body composition %K health literacy %K body image %K macronutrient %K educational %K obesity %K weight %K overweight %K fitness %K nutrition %K diet %K patient education %K student %K school %K youth %K adolescent %K teenager %K metabolic %K eating %K physical activity %K exercise %D 2025 %7 24.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non–weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non–weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and χ² tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9% (36/95), while 50.5% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial η²=0.268). There was no significant change in students’ body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non–weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. %R 10.2196/67213 %U https://pediatrics.jmir.org/2025/1/e67213 %U https://doi.org/10.2196/67213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58460 %T Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial %A Leung,May May %A Mateo,Katrina F %A Dublin,Marlo %A Harrison,Laura %A Verdaguer,Sandra %A Wyka,Katarzyna %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, United States, 1 6176363676, maymay.leung@tufts.edu %K childhood obesity %K preadolescents %K racial and ethnic minority populations %K dietary behaviors %K BMI %K digital health %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of 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. %M 37632872 %R 10.2196/35137 %U https://derma.jmir.org/2022/1/e35137 %U https://doi.org/10.2196/35137 %U http://www.ncbi.nlm.nih.gov/pubmed/37632872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30675 %T Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis %A Kouvari,Matina %A Karipidou,Melina %A Tsiampalis,Thomas %A Mamalaki,Eirini %A Poulimeneas,Dimitrios %A Bathrellou,Eirini %A Panagiotakos,Demosthenes %A Yannakoulia,Mary %+ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Eleftheriou Venizelou 70, Athens, 17671, Greece, 30 6944362633, myianna@hua.gr %K childhood obesity %K eHealth %K mHealth %K digital health %K youth %K mobile phone %D 2022 %7 14.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. %M 35156934 %R 10.2196/30675 %U https://www.jmir.org/2022/2/e30675 %U https://doi.org/10.2196/30675 %U http://www.ncbi.nlm.nih.gov/pubmed/35156934 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e35165 %T Navigating the Online World of Lifestyle Health Information: Qualitative Study With Adolescents %A Raeside,Rebecca %A Jia,Si Si %A Redfern,Julie %A Partridge,Stephanie R %+ Engagement and Co-Design Research Hub, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Westmead Hospital, Westmead, 2145, Australia, 61 412961432, rebecca.raeside@sydney.edu.au %K adolescents %K chronic disease prevention %K websites %K social media %K smartphone applications %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescence is a critical life stage characterized by an interplay of biological, social, and environmental factors. Such factors influence lifestyle health-related trajectories, including dietary behaviors, physical activity levels, body weight, and sleep. Generation Z (born 1995-2015) is the most internet-dependent and technologically savvy generation in history with increasing rates of smartphone ownership across high- and low-income countries. Gaps exist in understanding what online platforms adolescents are using and barriers and facilitators of these platforms to seek lifestyle health information. Objective: We evaluated adolescents’ perceptions on the use of contemporary digital platforms (websites, social media platforms, smartphone apps) to seek lifestyle heath information or advice. Methods: Virtual focus groups were held via Zoom teleconference between July 2021 and August 2021. Eligible participants were 13 years to 18 years old, were living in Australia, and had searched for online lifestyle health information in the previous 3 months. For this study, lifestyle health information referred to key behaviors and risk factors for chronic disease, namely, diet, physical activity, weight management, and sleep. Participants were recruited through an existing database of research participants and networks of the research team. Focus groups were analyzed using the framework approach, in which data are systematically searched to recognize patterns in the data and manage, analyze, and identify themes. Focus group audio files were transcribed verbatim and independently coded by 2 researchers (RR, SSJ). Through an iterative, reflexive process, a final coding matrix was agreed on by all researchers and used to thematically analyze the data. Results: We held 5 focus groups (n=32; mean age: 16.3 [SD 1.4] years; 18/32, 56% female; 13/32, 41% spoke language other than English at home). Thematic analysis revealed participants searched for information both actively (eg, on Google or YouTube) and passively (eg, scrolling social media and using existing apps preloaded to their smartphone such as Apple Health, Samsung Health, or Google Fit apps). Participants identified that the most helpful information was well-presented in terms of aesthetic appeal and layout and came from a credible and reliable source (eg, any sponsorships disclosed), and they expressed the need for the information to be relatable. Mixed views were reported for the application of lifestyle health information found online. Some participants reported behavior change, while others noted that certain advice was hard to maintain and incorporate into their lifestyle. Conclusions: This study highlights the abundance and complexity of lifestyle health information online for adolescents. Adolescents in the digital age seek access to information that is appealing, credible, relevant, and actionable for lifestyle health behaviors. To appeal to needs of adolescents, future interventions for adolescents relating to lifestyle health must consider co-design methodological approaches. Furthermore, the regulation of lifestyle health information available online warrants further investigation. %M 35147506 %R 10.2196/35165 %U https://pediatrics.jmir.org/2022/1/e35165 %U https://doi.org/10.2196/35165 %U http://www.ncbi.nlm.nih.gov/pubmed/35147506 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30526 %T An Evidence Map on Serious Games in Preventing Sexually Transmitted Infections Among Adolescents: Systematic Review About Outcome Categories Investigated in Primary Studies %A Ilskens,Karina %A Wrona,Kamil J %A Dockweiler,Christoph %A Fischer,Florian %+ School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld, 33615, Germany, 49 5211065160, kamil.wrona@uni-bielefeld.de %K serious games %K entertainment education %K STI %K STD %K sexual health %K effect %K impact %K sexually transmitted infections %K adolescents %K adolescent sexual health %D 2022 %7 2.2.2022 %9 Review %J JMIR Serious Games %G English %X Background: Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective: The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods: A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results: Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions: This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior. %M 35107438 %R 10.2196/30526 %U https://games.jmir.org/2022/1/e30526 %U https://doi.org/10.2196/30526 %U http://www.ncbi.nlm.nih.gov/pubmed/35107438 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31172 %T Exploring Middle School Students’ Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study %A Abraham,Olufunmilola %A Szela,Lisa %A Khan,Mahnoor %A Geddam,Amrita %+ Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescents %K adolescent education %K adolescent health %K older children %K middle school students %K cancer awareness %K cancer education %K cancer prevention %K health education %K serious games %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students’ preferences for the use of SGs for cancer prevention education. The study also characterized the students’ perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on “Cancer, Clear & Simple,” a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants’ gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least “some” gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters’ outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. %M 34643533 %R 10.2196/31172 %U https://games.jmir.org/2022/1/e31172 %U https://doi.org/10.2196/31172 %U http://www.ncbi.nlm.nih.gov/pubmed/34643533 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31381 %T Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study %A Decker,Martha J %A Harrison,Salish %A Price,Melisa %A Gutmann-Gonzalez,Abigail %A Yarger,Jennifer %A Tenney,Rachel %+ Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 550 16th Street, Second Floor, San Francisco, CA, 94158, United States, 1 (415) 476 3095, Mara.Decker@ucsf.edu %K adolescent %K sex education %K technology %K mobile app %K implementation %K California %K health educator %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 %M 35019842 %R 10.2196/31381 %U https://humanfactors.jmir.org/2022/1/e31381 %U https://doi.org/10.2196/31381 %U http://www.ncbi.nlm.nih.gov/pubmed/35019842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28230 %T Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review %A Swindle,Taren %A Poosala,Anwesh B %A Zeng,Nan %A Børsheim,Elisabet %A Andres,Aline %A Bellows,Laura L %+ Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR, United States, 1 8702360997, tswindle@uams.edu %K physical activity %K preschool children %K digital %K technology %K intervention %D 2022 %7 11.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children. Objective: The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions. Methods: This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes. Results: In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies. Conclusions: The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children. %M 35014962 %R 10.2196/28230 %U https://www.jmir.org/2022/1/e28230 %U https://doi.org/10.2196/28230 %U http://www.ncbi.nlm.nih.gov/pubmed/35014962 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25902 %T Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial %A Barnes,Courtney %A Yoong,Sze Lin %A Nathan,Nicole %A Wolfenden,Luke %A Wedesweiler,Taya %A Kerr,Jayde %A Ward,Dianne S %A Grady,Alice %+ Hunter New England Population Health, Locked Bag 10, Wallsend, Newcastle, 2287, Australia, 61 0249246678, courtney.barnes@health.nsw.gov.au %K childcare center %K web-based %K nutrition %K healthy eating %K randomized controlled trial %K intervention %K implementation %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w %M 34914617 %R 10.2196/25902 %U https://www.jmir.org/2021/12/e25902 %U https://doi.org/10.2196/25902 %U http://www.ncbi.nlm.nih.gov/pubmed/34914617 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e17959 %T The Role of Education, Monitoring, and Symptom Perception in Internet-Based Self-management Among Adolescents With Asthma: Secondary Analysis of a Randomized Controlled Trial %A Beerthuizen,Thijs %A Rikkers-Mutsaerts,E R V M %A Snoeck-Stroband,Jiska B %A Sont,Jacob K %+ Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, J-10-S, Leiden, 2333ZA, Netherlands, 31 715264578, j.k.sont@lumc.nl %K web-based monitoring %K internet self-management %K adolescents %K asthma %K education %K perception %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider. Objective: We aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs. Methods: We conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention. Results: Adolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: −0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: −0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: −0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers. Conclusions: Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life. %M 34879001 %R 10.2196/17959 %U https://pediatrics.jmir.org/2021/4/e17959 %U https://doi.org/10.2196/17959 %U http://www.ncbi.nlm.nih.gov/pubmed/34879001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e24840 %T Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study %A Mastorci,Francesca %A Piaggi,Paolo %A Trivellini,Gabriele %A Doveri,Cristina %A Casu,Anselmo %A Bastiani,Luca %A Marinaro,Irene %A Vassalle,Cristina %A Pingitore,Alessandro %+ Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Via Moruzzi 1, Pisa, 56124, Italy, 39 050312605, pingi@ifc.cnr.it %K adolescent %K well-being management %K schools %K web tool %K health promotion %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups. %M 34860668 %R 10.2196/24840 %U https://formative.jmir.org/2021/12/e24840 %U https://doi.org/10.2196/24840 %U http://www.ncbi.nlm.nih.gov/pubmed/34860668 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 3 %P e29945 %T Developing Graphic Messages for Vaping Prevention Among Black and Latino Adolescents: Participatory Research Approach %A Cartujano-Barrera,Francisco %A Azogini,Chiamaka %A McIntosh,Scott %A Bansal-Travers,Maansi %A Ossip,Deborah J %A Cupertino,Ana Paula %+ Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420644, Rochester, NY, 14642, United States, 1 585 298 2031, Francisco_cartujano@urmc.rochester.edu %K vaping %K electronic cigarettes %K adolescents %K Latino %K Black %D 2021 %7 23.11.2021 %9 Original Paper %J J Particip Med %G English %X Background: As an important transition stage in human development, adolescence is a critical window for vaping prevention. There is a substantial gap in communication research on vaping prevention among racial and ethnic minority groups. Their representation is essential to develop, implement, and disseminate innovative and effective interventions for vaping prevention. Objective: The aim of this study is to describe the participatory research (PR) procedures used with Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. Methods: This PR study used a qualitative, user-centered design method. We conducted a series of focus groups with 16 Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. The biobehavioral model of nicotine addiction provided a framework for the development of the graphic messages. Participants met 4 times to provide iterative feedback on the graphic messages until they reached a consensus on overall quality and content. Results: At baseline, the participants’ mean age was 15.4 years (SD 1.4). Of the participants, 50% (8/16) were female, 88% (14/16) were heterosexual, 56% (9/16) were Black/African American, and 44% (7/16) were Hispanic/Latino. A total of 12 of the 16 participants (75%) chose to participate in the English sessions. Participants decided to create four types of graphic messages: (1) financial reward, (2) health reward, (3) social norms, and (4) self-efficacy. Meeting 4 times with the 4 groups provided sufficient opportunities for iterative feedback on the graphic messages to reach a consensus on overall quality and content. Conclusions: It is feasible and practical to build PR among Black and Latino adolescents focused on vaping prevention. Adolescents added innovation and creativity to the development of culturally and linguistically appropriate graphic messages for vaping prevention. Appropriate staffing, funding, and approaches are key for successful PR efforts among Black and Latino adolescents. Future research is needed to evaluate the impact of the graphic messages on vaping prevention. %M 34812734 %R 10.2196/29945 %U https://jopm.jmir.org/2021/3/e29945 %U https://doi.org/10.2196/29945 %U http://www.ncbi.nlm.nih.gov/pubmed/34812734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29003 %T Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis %A Park,Jihyun %A Park,Mi-Jeong %A Seo,Young-Gyun %+ Department of Family Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Republic of Korea, 82 31 380 3805, yg035@daum.net %K ICT %K eHealth %K mHealth %K weight loss %K obesity %K BMI %K meta-analysis %K randomized controlled trial %K children %K adolescents %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=−1.26 kg/m2, 95% CI −2.24 to −0.28), lifestyle modification comparator (WMD=−1.75, 95% CI −2.76 to −0.74), intervention involving both boys and girls (WMD=−1.30, 95% CI −2.14 to −0.46), and intervention involving obesity only (WMD=−1.92, 95% CI −3.75 to −0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. %M 34787572 %R 10.2196/29003 %U https://www.jmir.org/2021/11/e29003 %U https://doi.org/10.2196/29003 %U http://www.ncbi.nlm.nih.gov/pubmed/34787572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30449 %T Young Adults’ Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement %A Baker,Venetia %A Arnold,Georgia %A Piot,Sara %A Thwala,Lesedi %A Glynn,Judith %A Hargreaves,James %A Birdthistle,Isolde %+ Department of Population Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 8636, venetia.baker1@lshtm.ac.uk %K COVID-19 %K adolescents %K young people %K social media %K edutainment %D 2021 %7 29.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In April 2020, as cases of the novel COVID-19 spread across the globe, MTV Staying Alive Foundation created the educational entertainment miniseries MTV Shuga: Alone Together. In 70 short episodes released daily on YouTube, Alone Together aimed to disseminate timely and accurate information to increase young people’s knowledge, motivation, and actions to prevent COVID-19. Objective: We sought to identify Alone Together viewer’s perspectives on the global COVID-19 pandemic and national lockdowns by examining the words, conversations, experiences, and emotions expressed on social media in response to the Alone Together episodes. We also assessed how viewers used the series and its online community as a source of support during the global pandemic. Methods: A total of 3982 comments and 70 live chat conversations were extracted from YouTube between April and October 2020 and analyzed through a data-led inductive thematic approach. Aggregated demographic and geographical data were collected using YouTube Analytics. Results: The miniseries had a global reach across 5 continents, with a total of 7.7 million views across MTV Shuga platforms. The series had over 1 million views over 70 episodes on YouTube and an average of 5683 unique viewers per episode on YouTube. The dominant audience was adults under the age of 35 years and women. Across diverse countries such as Nigeria, Ghana, the United States, and the UK, viewers believed that COVID-19 was serious and expressed that it was socially responsible to follow public health measures. Storylines of the series about the impact of self-isolation on mental health, exposure to violence in lockdowns, and restricted employment opportunities due to the pandemic resonated with young viewers. Tuning in to the miniseries provided viewers with reliable information, entertainment, and an online community during an isolating, confusing, and worrying time. Conclusions: During the first wave of COVID-19, viewers from at least 53 countries connected on social media via the MTV miniseries. The analysis showed how digitally connected people under the age of 35 years, predominantly women, felt compelled to follow COVID-19 safety measures despite the pandemic’s impact on their social, educational, and financial needs. Viewers used social media to reach out to fellow viewers for advice, solace, support, and resources. Organizations, governments, and individuals have been forced to innovate during the pandemic to ensure people can access services safely and remotely. This analysis showed that women under 35 years of age were especially receptive to receiving support from online communities and media services. Peer influence and support online can be a powerful public health tool as people have a great capacity to influence each other and shape norms around public health. However, online services are not accessible to everyone, and COVID-19 has increased disparities between digitally connected and unconnected younger adults. %M 34596568 %R 10.2196/30449 %U https://formative.jmir.org/2021/10/e30449 %U https://doi.org/10.2196/30449 %U http://www.ncbi.nlm.nih.gov/pubmed/34596568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31240 %T Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals %A Gilkey,Melissa B %A Kong,Wei Yi %A Huang,Qian %A Grabert,Brigid K %A Thompson,Peyton %A Brewer,Noel T %+ Department of Health Behavior, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC, 27599, United States, 1 9199668650, gilkey@email.unc.edu %K adolescent health %K primary care %K telemedicine %K health communication %K health services %K telehealth %K adolescent %K young adult %K teenager %K COVID-19 %K survey %K policy %K access %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs’ recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. %M 34406974 %R 10.2196/31240 %U https://www.jmir.org/2021/9/e31240 %U https://doi.org/10.2196/31240 %U http://www.ncbi.nlm.nih.gov/pubmed/34406974 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30499 %T Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial %A Anderson,Pamela %A Coyle,Karin %A Guinosso,Stephanie %A Ferrand,John L %A Owora,Arthur %A Houghton,Rebecca F %A Walsh-Buhi,Eric %+ Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, Room 116, Bloomington, IN, 47405, United States, 1 8128554867, erwals@iu.edu %K adolescents %K youth %K teens %K healthy relationships %K unintended pregnancy %K teen pregnancy %K sexually transmitted infections %K sexually transmitted diseases %K sexual health education %K school-based health center %K randomized controlled trial %D 2021 %7 1.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study—the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. Trial Registration: ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876 International Registered Report Identifier (IRRID): DERR1-10.2196/30499 %M 34468330 %R 10.2196/30499 %U https://www.researchprotocols.org/2021/9/e30499 %U https://doi.org/10.2196/30499 %U http://www.ncbi.nlm.nih.gov/pubmed/34468330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e25900 %T Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design %A Ranney,Megan L %A Pittman,Sarah K %A Moseley,Isabelle %A Morgan,Kristen E %A Riese,Alison %A Ybarra,Michele %A Cunningham,Rebecca %A Rosen,Rochelle %+ Center for Digital Health, Brown University, 139 Point St, Providence, RI, 02903, United States, 1 4014445159, megan_ranney@brown.edu %K adolescent %K mobile health %K digital health %K cyberbullying %K user-centered design %K qualitative %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 34448702 %R 10.2196/25900 %U https://formative.jmir.org/2021/8/e25900 %U https://doi.org/10.2196/25900 %U http://www.ncbi.nlm.nih.gov/pubmed/34448702 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28273 %T Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial %A Van de Kop,Huib %A Toussaint,Huub %A Janssen,Mirka %A Busch,Vincent %A Verhoeff,Arnoud %+ Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, Amsterdam, 1067 SM, Netherlands, 31 0 621158166, j.h.van.de.kop@hva.nl %K physical activity %K participatory %K adolescents %K protocol %K assets %K school-based %K students %K participation %K school-age children %K teenagers %K exercise %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. Objective: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. Methods: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students’ assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. Results: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10× 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). Conclusions: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. Trial Registration: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636 International Registered Report Identifier (IRRID): DERR1-10.2196/28273 %M 34121666 %R 10.2196/28273 %U https://www.researchprotocols.org/2021/7/e28273 %U https://doi.org/10.2196/28273 %U http://www.ncbi.nlm.nih.gov/pubmed/34121666 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e30115 %T Predicting Writing Styles of Web-Based Materials for Children’s Health Education Using the Selection of Semantic Features: Machine Learning Approach %A Xie,Wenxiu %A Ji,Meng %A Liu,Yanmeng %A Hao,Tianyong %A Chow,Chi-Yin %+ School of Languages and Cultures, The University of Sydney, Room 635 A18, Brennan MacCallum Building, Sydney, 2006, Australia, 61 449858887, christine.ji@sydney.edu.au %K online health education %K health educational resource development %K machine learning %K health linguistics %D 2021 %7 22.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Medical writing styles can have an impact on the understandability of health educational resources. Amid current web-based health information research, there is a dearth of research-based evidence that demonstrates what constitutes the best practice of the development of web-based health resources on children’s health promotion and education. Objective: Using authoritative and highly influential web-based children’s health educational resources from the Nemours Foundation, the largest not-for-profit organization promoting children’s health and well-being, we aimed to develop machine learning algorithms to discriminate and predict the writing styles of health educational resources on children versus adult health promotion using a variety of health educational resources aimed at the general public. Methods: The selection of natural language features as predicator variables of algorithms went through initial automatic feature selection using ridge classifier, support vector machine, extreme gradient boost tree, and recursive feature elimination followed by revision by education experts. We compared algorithms using the automatically selected (n=19) and linguistically enhanced (n=20) feature sets, using the initial feature set (n=115) as the baseline. Results: Using five-fold cross-validation, compared with the baseline (115 features), the Gaussian Naive Bayes model (20 features) achieved statistically higher mean sensitivity (P=.02; 95% CI −0.016 to 0.1929), mean specificity (P=.02; 95% CI −0.016 to 0.199), mean area under the receiver operating characteristic curve (P=.02; 95% CI −0.007 to 0.140), and mean macro F1 (P=.006; 95% CI 0.016-0.167). The statistically improved performance of the final model (20 features) is in contrast to the statistically insignificant changes between the original feature set (n=115) and the automatically selected features (n=19): mean sensitivity (P=.13; 95% CI −0.1699 to 0.0681), mean specificity (P=.10; 95% CI −0.1389 to 0.4017), mean area under the receiver operating characteristic curve (P=.008; 95% CI 0.0059-0.1126), and mean macro F1 (P=.98; 95% CI −0.0555 to 0.0548). This demonstrates the importance and effectiveness of combining automatic feature selection and expert-based linguistic revision to develop the most effective machine learning algorithms from high-dimensional data sets. Conclusions: We developed new evaluation tools for the discrimination and prediction of writing styles of web-based health resources for children’s health education and promotion among parents and caregivers of children. User-adaptive automatic assessment of web-based health content holds great promise for distant and remote health education among young readers. Our study leveraged the precision and adaptability of machine learning algorithms and insights from health linguistics to help advance this significant yet understudied area of research. %M 34292167 %R 10.2196/30115 %U https://medinform.jmir.org/2021/7/e30115 %U https://doi.org/10.2196/30115 %U http://www.ncbi.nlm.nih.gov/pubmed/34292167