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Poster Session D

D1 - Mindfulness skills-building group intervention: Outcomes for older-adults in a community-based outpatient clinic

Poster Number: D1
Time: 11:00 AM - 11:50 AM
Topics: Aging, Mental Health

Background: Mindfulness is an ability to stay present and accept thoughts and feelings without judgement. Going beyond just a state of mind, mindfulness is a skill that can be learned and developed with practice. Research suggests that mindfulness-based interventions effectively increase emotional well-being and reduce psychological symptoms, such as depressive symptoms, stress, and chronic pain. For older adults, mindfulness is an accessible and adaptable intervention that can support emotional well-being and be incorporated into daily life.
Methods: The present study aimed to examine the effectiveness of a group-based mindfulness intervention for older adults. Quantitative and qualitative data were gathered across three 8-week mindfulness skill-building groups, which were conducted in a community outpatient clinic for older adults in Colorado Springs, Colorado. Participants (N = 17, Mage = 72.12, SD = 6.35, 70.59% female) completed pre- and post-measures of depression, anxiety, stress, well-being, pain, sleep, and trait-mindfulness. During the final group session, participants gave feedback on how mindfulness had influenced their lives and what changes they had noticed in themselves because of their mindfulness practice. This feedback was recorded and transcribed for thematic analysis.
Results: Paired-sample t-tests were conducted on the pre- and post-group outcome measures. Data indicated a significant decrease in perceived stress [t(14) = 3.76, p<.05], depressive symptoms [t(10) = 2.62, p<.05], and anxiety symptoms [t(12) = 2.15, p<.05], as well as an increase in trait mindfulness [t(12) = -5.08, p< .01] and overall well-being [t(13) = -3.10, p<.01].Thematic analyses were conducted with moderate-good inter-rater reliability (κgroup 1=.59, κgroup 2=.56, κgroup 3 =.63), and revealed themes related to the primary empirical outcome variables, as well as themes of overall effectiveness, interpersonal functioning, group cohesion, mindfulness skills, and insight.
Discussion: The results suggest that mindfulness-based group interventions can be effective for reducing psychological symptoms and improving mental health and well-being in older adults. Feedback from participants provided insight into the subjective benefits they experienced from the group intervention. Thematic analyses highlighted that participants valued mindfulness for its positive impact on various aspects of their lives and appreciated learning and practicing mindfulness in a group setting.

Keywords: Aging, Mindfulness

Authors:

Author - Tiana Broen, MA,
University of Colorado, Colorado Springs

Author - Jonathan Sundby, MA,
University of Colorado, Colorado Springs

Author - Christopher X. Griffith, MA,
University of Colorado Colorado Springs

Author - Leilani Feliciano, PhD,
University of Colorado, Colorado Springs

D2 - Implications of Cannabis Use for Behavioral Medicine: Comparing Heart Rate Response to Acute Cannabis Use in Older with Different Physical Activity Status

Poster Number: D2
Time: 11:00 AM - 11:50 AM
Topics: Aging, Physical Activity

Legalized cannabis has resulted in increased rates of use, especially among older adults who seek to alleviate aging symptoms. However, older adults have a greater risk of developing cardiovascular disease (CVD) raising public health concerns regarding cannabis use in this demographic. Cannabis products with higher tetrahydrocannabinol (THC) are particularly concerning, as they are associated with increased heart rate (HR), an important indicator of cardiovascular health. Engagement in moderate to vigorous physical activity (PA), may mitigate CVD risk in cannabis users but research has yet to explore associations between PA status, cannabis use, and HR within older adults. The present study sought to address this gap using data from a larger observational study among older adults (age 60+) seeking to use cannabis for sleep, pain, or mood problems. Participants (N=197, 91.88% white, 53.57% female, age 70.14±5.64) were grouped into different PA categories based on their responses to the Leisure-Time Activity Categorical Item (L-Cat) survey (1 or 2=low levels of PA (LPA), 3 or 4=moderate levels of PA (MPA), 5 or 6=high levels of PA (HPA)). Heart rate was collected before (pre-use) and 1-hour after (post-use) participants consumed an edible cannabis product containing varying amounts of THC. A mixed effects model with PA group, time, ingested mg of THC, their two-level interactions (e.g., time x PA group), and age as predictors of HR demonstrated a significant main effect of time (F(1,148)=14.97, p<0.0001). Across all participants, HR increased from 68.5±10.34 bpm pre-use to 71.1±10.39 bpm post-use. There was also a significant interaction between PA group and ingested THC (F(2,148)=3.38, p=0.04) such that ingested THC was significantly, positively associated with HR within the HPA group. A similar pattern was observed in the MPA group, while a negative association was seen in the LPA group, but neither of these were significant. These results align with previous research in younger populations where acute THC use is related to higher HR but expands on these findings to suggest these effects may be dependent on PA status. This highlights the importance of exploring cannabis-related changes in cardiovascular physiological parameters and PA status in older adults, and how this might impact risk for CVD.

Keywords: Aging, Physical activity

Authors:

Presenter - Ellie Sundali,
University of Colorado Boulder

Co-Author - Carillon J. Skrzynski, PhD, PhD,
University of Colorado Boulder

Co-Author - Angela D. Bryan, PhD, FSBM, PhD, FSBM,
University of Colorado Boulder

Co-Author - Jonathon K. Lisano, PhD,
University of Colorado Boulder

D3 - Early Barriers and Facilitators to Implementing Geriatric Mental Health Tele-Consultative Services from the Department of Veterans Affairs to State Veterans Homes

Poster Number: D3
Time: 11:00 AM - 11:50 AM
Topics: Aging, Military and Veterans' Health

Background: The Department of Veterans Affairs (VA) began piloting a congressionally-mandated program providing geriatric psychiatry consultative services to four State Veterans Homes (SVHs) in December 2023. Of the four SVHs, one began receiving telehealth services from a VA geriatric psychiatrist in 2012. As part of the program evaluation, we conducted site visits to the four SVHs to ascertain implementation barriers and facilitators from the first six months of implementation.
Methods: Evaluation team members conducted individual and group interviews with SVH staff (N=30) in July and August 2024. Staff included nursing leaders, social workers, administrators, health information management personnel, and information technology personnel. Interviews were recorded and transcribed; two coders summarized data through rapid qualitative analysis guided by the Consolidated Framework for Implementation Research 2.0.
Results: Facilitators to provision of VA tele-consultative services included the innovation itself, with staff highlighting the relative advantage of using telehealth for Veterans with cognitive impairment and dementia as it decreased travel time and allowed residents to remain in the milieu at the SVH. Staff shared that tailoring treatment strategies during program implementation, such as the use of medications from the VA formulary, helped to implement services. The SVH receiving telehealth since 2012 identified more facilitators compared with the other SVHs, such as staff trust of VA provider and perceived ease of communications. Staff found communication between SVHs and VA providers facilitated service delivery, but identified use of VA jargon as a barrier. Relatedly, establishing formal meetings (i.e., teaming) for the SVHs and VA geriatric psychiatrists to discuss cases facilitated implementation at one of the SVHs. Barriers identified included information technology infrastructure (i.e., complications in information sharing between VA and SVH) and available resources (i.e., lack of updated technology equipment for visits).
Discussion: Findings highlight the value of strong communications networks, teaming, and appropriate telehealth modalities for smooth VA teleconsultation to SVHs. Challenges largely related to lack of proper telehealth equipment and difficulties establishing formal and secure transfer of medical records across separate healthcare systems. These elements are important in larger-scale projects across health care entities.

Keywords: Aging, Tele-health

Authors:

Author - Christine Gould, PhD,
VA Palo Alto

Co-Author - Leah Haverhals, PhD, MA,
Rocky Mountain Regional VA Medical Center

Co-Author - Chelsea Manheim, MSW, LCSW,
Rocky Mountain Regional VA Medical Center

Co-Author - Marika B. Humber, PhD,
VA Palo Alto Health Care System

Co-Author - Marsden H. McGuire, MD, MBA,
VA Central Office

Co-Author - Michele Karel, PhD,
VA Central Office

D4 - Item Non-Response in Survey Taking as Predictors of Cognitive Decline

Poster Number: D4
Time: 11:00 AM - 11:50 AM
Topics: Aging, Decision Making

Cognitive impairment at older ages is a significant public health concern. Dependable predictors of cognitive decline are essential for early intervention aimed at mitigating the effects of cognitive decline before it becomes severe and challenging to treat. We used survey data from the Understanding America Study (UAS), a nationally representative internet panel of American households recruited for their demographic diversity. UAS respondents answer queries from researches once to twice a month, in which each day’s data is immediately available to researchers. We use a sample with 4508 participants aged 50 years and older to track patterns of participants survey-response behaviors with hypothesized potential to act as early indicators of cognitive decline. We investigated response patterns of skipping questions and responding “Don’t Know” (DK) to items. These response patterns may indicate a participant’s difficulty in answering questions, which may be indicative of cognitive functioning.
UAS participants take surveys on a regular basis, and complete various cognitive tests that assess their cognitive functioning across multiple domains. Furthermore, an index predicting each participants’ probability of cognitive impairment (PCI) is available. We calculated the percentage of question skipping and DK responses across a two-year period for survey participants, and used these to predict scores on subsequent cognitive-functioning tests and the PCI index. A higher proportion of skipped questions predicted lower scores on the cognitive functioning tests involving working memory (b = -.05, SE = .01, p = .029), perceptual speed (b = -.08, SE = .021, p > .001), executive functioning (b = -.05, SE = .004, p = .015), verbal episodic memory (b =-.07, SE = .007, p > .001), and visual motor integration (b = -.08, SE = .002, p > .001). Similarly, a higher percentage of DK responses successfully predicted lower scores on the cognitive functioning tests regarding fluid intelligence (b = -.14, SE = .02, p > .001), verbal ability (b = -.17, SE = .06, p > .001), perceptual speed (b = -.05, SE = .805, p =. 004), working memory (b = -.15, SE = .029, p > .001), verbal episodic memory (b = -.04, SE = .41, p = .038), visual motor integration (b = -.09, SE = .115, p > .001), and the PCI index (b = .06, SE = .06, p = .004). The results of this study suggest that skipping questions and “Don’t Know” responses might represent early indicators of cognitive decline.

Keywords: Aging, Missing data

Authors:

Author - Frank Olvera Lopez, BA,
University of Southern California

Co-Author - Raymond Hernandez, OTR/L,
University of Southern California

Co-Author - Stefan Schneider, PhD,
University of Southern California

Co-Author - Titus Galama, PhD,
University of Southern California

D5 - Quality of Life after Therapeutic Mastectomy and Pre-Pectoral Implant-Based Reconstruction: A Scoping Review

Poster Number: D5
Time: 11:00 AM - 11:50 AM
Topics: Quality of Life, Cancer

Abstract: Placing breast implants above the pectoralis major muscle (in the prepectoral plane, or PP) rather than below it (in the subpectoral plane) during implant-based breast reconstruction (IBBR) following mastectomy has shown favorable outcomes in patient satisfaction, aesthetic results, and low risk of complications. With about half of U.S. surgeons choosing PP IBBR for their patients, there is a growing need to examine its associated quality-of-life (QOL) outcomes. This scoping review aimed to summarize QOL outcomes following therapeutic post-mastectomy PP IBBR using validated patient-reported outcome measures to assess QOL and well-being. Following PRISMA-ScR guidelines, we searched Ovid (Medline, PubMed, PsycINFO), Google Scholar, Embase, and CINAHL for English, peer-reviewed studies assessing QOL outcomes using the BREAST-Q BR QOL framework. Review articles and studies with mixed prophylactic/therapeutic samples were excluded. Of 179 articles retrieved, 24 met the inclusion criteria. Six QOL outcomes were assessed: physical well-being (general), chest, back/shoulder, animation deformity (AD), psychosocial, and sexual well-being. Physical well-being showed mixed results, with one study reporting significant worsening in PP patients 1 year post-treatment, while conversion to PP reconstruction resulted in sustained benefits. Back and shoulder outcomes were mixed, with one study showing advantages for PP placement in reducing shoulder dysfunction. For AD, one study found 14.3% of subpectoral patients experienced AD compared to 0% in PP patients. Conversion resolved most AD cases, with few recurrences. Psychosocial well-being showed mixed results, with one study indicating higher scores in subpectoral patients. Sexual well-being outcomes were mixed, with no significant differences between PP and subpectoral groups, but conversion led to improvements in both domains. This review identifies gaps in QOL research for PP IBBR. Further studies are needed to explore under examined domains, such as radiation, cancer worry, and fatigue. Longitudinal cohort studies with larger sample sizes and qualitative research on patient perceptions are essential to identify predictors of QOL outcomes after a therapeutic mastectomy and PP IBBR. Addressing these gaps will guide interventions and inform medical decision-making. Healthcare centers can use these findings to refine care strategies and identify the most effective procedures for improving patient outcomes.

Keywords: Quality of life, Cancer survivorship

Authors:

Presenter - Kiersten N. Pflueger, MPH,
Stony Brook University

Co-Author - Anne Moyer, PhD,
Stony Brook University

Co-Author - Marci Lobel, PhD, FSBM, PhD, FSBM,
Stony Brook University

Co-Author - Tara Huston, MD,
Stony Brook University Medical Center

Co-Author - Anastasia Bakoulis, DO,
Stony Brook University Medical Center

D6 - Experiences of pregnancy, childbirth, and childcare in women with Chiari Malformation

Poster Number: D6
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Pain

Introduction: Chiari Malformation (CM) is a chronic health condition characterized by displacement of the brain and spinal cord that causes a variety of symptoms including chronic head and neck pain, dizziness, balance issues, and cognitive difficulties. Because CM is more prevalent in women and typically diagnosed in young-to-middle adulthood, individuals with CM may have specific needs related to pregnancy, childbirth, and childcare.
Methods: Women with CM were recruited online using social networking sites. All participants completed questions about their attitudes towards pregnancy. Women who had children also completed questions about their childbirth experience and the Parenting Behaviors Questionnaire, which examines the extent to which a chronic illness interferes with common parenting behaviors. Participants also completed the Brief Pain inventory and the Depression, Anxiety, and Stress Scale (DASS-21).
Results: Forty-six women with CM were recruited (Mean age=46, SD=11). Women reported moderate “usual” pain (M=5, SD=2), moderately high levels of pain interference (M=6.54, SD=1.65), moderate levels of depression (M=15, SD=11), and mild levels of anxiety (M=11, SD=8). On average, women reported that they did not have enough information about how CM might impact their pregnancy, were afraid that pregnancy and giving birth is “dangerous” for people with CM, and that having CM makes caring for an infant/young child more difficult. Regarding childcare, women reported the most difficulty with physically demanding tasks such as bathing a child, picking up or carrying a child, and playing with a child outdoors. Women with children had higher usual pain (t(38)=2, p=.03) than women without children, but there were no differences for pain interference, depression, or anxiety.
Conclusion: Women with CM may benefit from additional information related to the risks of pregnancy and childbirth. Providers should consider using principles of health communication and shared decision making to address women’s concerns regarding pregnancy and CM. Some women with children struggle with functional limitations related to their CM and may also experience increases in pain. Women with CM and children and may benefit from additional services to improve functioning such as physical or occupational therapy or psychological interventions such as cognitive behavioral therapy or acceptance and commitment therapy.

Keywords: Pregnancy, Pain

Authors:

Author - Emily Rabinowitz, M.A.,
Kent state university

Co-Author - Karlee Patrick, M.A.,
Kent state university

Co-Author - Chase Lemek,
Kent state university

Co-Author - Grant Ripley, B.A,
Syracuse University

Co-Author - Doug Delahanty, Ph.D.,
Kent state university

D7 - Assessing the contextual factors of a remotely delivered exercise intervention to guide future implementation: application of the RE-AIM framework

Poster Number: D7
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity

Background: Understanding the local context of physical activity interventions in racially diverse populations is vital for sustainability. We applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to assess contextual factors of Breast cancer Resiliency Exercise Program (B-REP), a 12-week supervised, remote-delivered exercise intervention compared to a minimal contact control group (MCC). Methods: Female breast cancer survivors (N=47 [n=26 intervention]; Mage=55.0 years, SD=11.9; 57.4% White, 23.4% Black, and 14.8% Asian; 69.6% married; 58.1% Stage 1) enrolled in B-REP. Reach (representativeness) was assessed by descriptively comparing participant sociodemographic to Rutgers Cancer Institute catchment area data. Efficacy (intervention impact) was measured by changes in pre-to post-intervention physical function (six-minute walk test [6MWT; meters], chair sit-to-stand [CSTS; repetitions], and arm curl test [repetitions]). Adoption (individual-level engagement) was evaluated by open-response barriers and facilitators. Implementation (fidelity) was examined with a checklist assessing 5% (n=16) of recorded exercise sessions. Maintenance (sustainability) was measured by participant retention relative to an 80% benchmark. Descriptive statistics, repeated-measures analyses of variance, and content analysis were used. Results: Reach. Comparing percentages, B-REP participants were similar to the catchment area. Efficacy. Compared to MCC, B-REP participants only significantly improved CSTS (F(1, 42)=10.26, p≤.05 Mpre=12.81, SD=3.03; Mpost=16.89, SD=5.02) and arm curl test (F(1, 42)=7.55, p≤.05; Mpre=19.07, SD=3.54; Mpost=22.74, SD=4.56). Adoption. Facilitators included a supportive exercise trainer (n=33) and accessible sessions (n=21), while barriers were low frequency of sessions (n=16) and treatment side effects (n=9). Implementation. B-REP was delivered as intended with 100% completing the workout with cues and modifications, and time for breaks (81%). Maintenance. Completion of post-intervention assessment was 91.5%. Discussion: B-REP positively impacted muscular physical function, and participants were representative of the racially diverse catchment area. Yet, recruitment efforts were not targeted for racial diversity, which may improve individual-level uptake. Next steps for B-REP are to identify salient cultural and contextual factors to tailor the intervention, which may positively impact sustainability.

Keywords: Dissemination, Physical activity

Authors:

Co-Author - Oceane Streubel,
University of Michigan

Co-Author - Mary K. Schmitz, PhD, MPH, FACSM, PhD, MPH, FACSM,
University of Pittsburgh

Co-Author - Siobhan M. Phillips, PhD, MPH, FSBM, PhD, MPH, FSBM,
Northwestern University

Co-Author - Adana Llanos, PhD, MPH,
Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center and Herbert Irving Comprehensive Cancer Center

Co-Author - Sharon L. Manne, PhD, FSBM, PhD, FSBM,
Rutgers Cancer Institute of New Jersey

Co-Author - Angela J. Fong, PhD, PhD,
University of Michigan

D8 - Clinical trial knowledge, discussions, and participation: The importance of trust in patient-provider relationships among cancer survivors

Poster Number: D8
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Health Communication and Policy

Background: It is important for cancer survivors to be involved in clinical trials for achieving equitable health outcomes, but their participation rates are low. Based on the stimulus-organism-response (SOR) theory, this study examined how patient-provider dynamics (i.e.
optimal patient-centered care, trust in healthcare providers, discussing clinical trials), one’s technological environment (i.e., online
information seeking, Internet use) and their family cancer health history would increase patients’ clinical trial knowledge and
participation.
Methods: Data included 1130 cancer survivors who participated in the Health Information National Trends Survey - Surveillance,
Epidemiology, and End Results (HINTS-SEER). STATA v18 was used to conduct structural equation modeling with mediation analysis.
Results: Only 7% of the participants (n = 79) participated in the clinical trials; only 14.3% of all participants (n = 162) reported knowing “a lot”
about clinical trials. Significant factors of clinical trial participation included clinical trial knowledge (β = .09, p < .01) and providers’
discussion of clinical trials (p < .01). Clinical trial knowledge significantly mediated the effects of age, education, Internet use,
information seeking, discussion of clinical trials, and trust in healthcare providers. The model explained about 17.3% and 33.8% of
the variances in clinical trial knowledge and participation, respectively.
Conclusion: Addressing factors associated with clinical trial participation, particularly related to trust, is needed to engage cancer survivors in
biomedical research to improve representation and ultimately achieve more equitable health outcomes. Strategies to support
healthcare providers in introducing clinical trials to cancer survivors could help promote engagement in these studies and reduce
disparities in clinical trial participation. Media strategies could be used to improve knowledge and stimulate interest in clinical trial
participation among cancer survivors (e.g., notifying healthcare providers through targeted media blasts specifically to them).

Keywords: Clinical applications, Cancer

Authors:

Co-Author - Qiwei Wu, PhD,
University of Texas Arlington

Co-Author - Yue Liao, MPH, PhD, CPH, MPH, PhD, CPH,
University of Texas at Arlington

Co-Author - Vinicio Sinta, PhD,
University of Texas Arlington

Co-Author - Salene Jones, PhD,
Fred Hutchinson Cancer Center

Author - Grace Brannon, PhD,
University of Texas Arlington

D9 - Understanding patient and clinician needs and preferences for a physical activity intervention during chemotherapy for breast cancer

Poster Number: D9
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity

Background: Cognitive decline is a side effect of breast cancer chemotherapy that may be prevented by physical activity (PA). Early intervention during active cancer treatment is critical but often difficult to deliver. We assessed patients’ and clinical stakeholders’ needs and preferences for a PA intervention during chemotherapy via semi-structured interviews.
Methods: We conducted virtual semi-structured interviews from May 2022-May 2023 with patients with stage I-III breast cancer (n=16) and clinical stakeholders (n=11) at a Midwestern comprehensive cancer center and surrounding community clinics. We double-coded transcripts and identified themes using deductive and inductive thematic analysis.
Results: Patients were mostly White, non-Hispanic females with an average (SD) age of 56.0 (12.0) years. Clinicians were primarily medical oncologists (n=5) with >5 years of experience. Participants (i.e., patients and clinicians) overwhelmingly viewed PA programs as desirable and beneficial and stated that they should be integrated into standard care during chemotherapy. Participants felt that if PA programs were presented as part of treatment, patients would be more likely to engage and adhere. Other key themes included: preferences regarding intervention components and structure, preferences regarding program implementation and delivery, and participation barriers and desired supports. Patients preferred a flexible program with both group and individual elements that allowed them to decide when and how they would complete PA. Remote activities were desired to increase the convenience of the program and overcome physical and logistical barriers (e.g., chemotherapy side effects, transportation). In-person group elements were desired for social support and accountability, with individual options for patients concerned with social discomfort and potential disease exposure. Clinicians expressed strong support for PA programs delivered by a physical therapist with oncology training and automated referrals in the electronic health record.
Conclusions: Both patients and clinicians support PA programs delivered during chemotherapy. Key features of desirable PA programs were supervision by physical therapists, flexibility and convenience with a mix of in-person and remote options and group and individual components to facilitate patient participation. These findings can inform the design and implementation of future PA programs during chemotherapy for breast cancer.

Keywords: Physical activity, Cancer

Authors:

Author - D. Carolina Andrade, MPH,
Washington University in St. Louis

Co-Author - Loni Parrish, PhD,
Washington University in St. Louis

Co-Author - Courtney Harris, MHA,
Washington University in St. Louis

Co-Author - Lindsay L. Peterson, MD,
Washington University School of Medicine

Co-Author - Ryan P. Duncan, DPT,
Washington University School of Medicine in St. Louis

Co-Author - Jingqin Luo, PhD,
Washington University in St. Louis

Co-Author - Maura Kepper, PhD,
Washington University in St. Louis

Co-Author - Christine Marx, MA,
Washington University in St. Louis

Co-Author - Mary Politi, PhD,
Washington University in St. Louis

Co-Author - Elizabeth A. Salerno, PhD, MPH,
Washington University School of Medicine in St. Louis

D10 - Exploring the lived experiences of Canadian parents of youth on and off cancer treatment during the COVID-19 pandemic: A qualitative examination

Poster Number: D10
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Child and Family Health

Background and Aims: Although the impact of the COVID-19 pandemic has been widespread, youth diagnosed with cancer and their parents were particularly vulnerable given the already present medical and psychosocial burdens of childhood cancer. Despite this, little is known about the lived experiences of these families during the pandemic. We aimed to explore the family lived experience of the COVID-19 pandemic from the perspective of Canadian parents of youth on- and off-cancer treatment.

Methods: Canadian parents (English or French speaking) of youth on- or off- cancer treatment during the COVID-19 pandemic were recruited via social media and cancer advocacy groups. Parents participated in audio-recorded, semi-structured virtual interviews. Interviews were translated, transcribed, inductively coded, and analyzed using thematic analysis.

Results: Twenty parents participated (mean age = 42.8 years, range = 27-53, 90% female). Associated youth were most commonly diagnosed with leukemia (45%) or lymphoma (20%) (mean age = 10.5 years, range = 2-17, 70% female). Six distinct themes were identified: (1) normalization of families’ cancer-related precautionary health measures (e.g., masking) and public knowledge of disease transmission; (2) heightened concern around COVID-19 infection risk; (3) improved care access, including via virtual care; (4) fewer available healthcare resources; (5) limited social support due to visiting restrictions; and (6) a “leveled playing field” where perceived cancer-related constraints (e.g. virtual school) were shared across families impacted by cancer and in the general population.

Conclusions: These data highlight the complex experience of the COVID-19 pandemic among families impacted by childhood cancer. Canadian parents described concerns regarding contracting COVID-19, difficulties accessing care, and a lack of social support. Unintended positive experiences included greater awareness of disease transmission risks within the general population and opportunities to leverage virtual options for health care and education. New learning should be leveraged to inform the recovery phase of this pandemic, clinical practices in cancer and other chronic disease populations, and to improve readiness for other disasters/major incidents. Parents’ lived experiences of the COVID-19 pandemic can be used to help understand the care and wellbeing needs of youth and families impacted by cancer.

Keywords: Cancer, Children's health

Authors:

Presenter - Claire R. Galvin, MSc,
Concordia University

Author - Alex Pizzo, MSc,
Concordia University

Co-Author - Kelly Mazzocca, BA,
Concordia University

Co-Author - Elham Hashemi, MA,
Hospital for Sick Children

Co-Author - Sarah Alexander, MD,
Hospital for Sick Children

Co-Author - Maxime Caru, PhD, PhD,
Penn State College of Medicine

Co-Author - Thomas Hadjistavropoulos, PhD,
University of Regina

Co-Author - Jennifer Jones, PhD,
Princess Margaret Cancer Centre

Co-Author - Faith Gibson, PhD,
Great Ormond Street Hospital, University of Surrey

Co-Author - Paul C. Nathan, MD,
Hospital for Sick Children

Co-Author - Serge Sultan, PhD,
Université de Montréal

Co-Author - Lindsay A. Jibb, PhD,
Hospital for Sick Children

Co-Author - Nicole M. Alberts, PhD, PhD,
Concordia University

D11 - Symptoms in a Sample of Colorectal Cancer Patients in Early to Mid-Adulthood Enrolled in a mHealth Coping Skills Training Program (mCOPE)

Poster Number: D11
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Pain

Introduction: Colorectal cancer (CRC) patients in early to mid-adulthood are challenged by high symptom burden and age-related stressors. Cognitive behavioral therapy (CBT) reduces symptoms and improves quality of life in cancer patients. We developed a CBT-based mHealth coping skills training program (mCOPE) to reduce pain, fatigue and distress for younger CRC patients. The current analysis aims to characterize mCOPE trial participants and to examine baseline correlations among demographic, clinical, and symptom variables.

Methods: We conducted a secondary analysis of baseline data from an ongoing RCT testing the efficacy of mCOPE (N=165). Eligible patients were 18-50 years old with CRC diagnosis (stage I-IV) within the last 3 years, and ≥3/10 on 2/3 symptoms of pain, fatigue, and distress. Demographic (age, sex, marital status, race, education), clinical (time since diagnosis, cancer stage, CRC family history) and symptom-related variables (pain [BPI], fatigue [PROMIS], distress [BSI-18], self-efficacy for managing symptoms [PROMIS]) were collected via self-report and chart review. Descriptive and correlational statistics were used to characterize the sample and examine relationships among variables.

Results: Participants (53% female, 70% White, M age=42, 38% some college or less, 75% married/partnered, 48% stage IV, 26% CRC family history, M=1 year post-diagnosis) on average endorsed mild-moderate baseline levels of pain severity (M=3.0, SD=2.1), fatigue (M=55.9, SD=7.1), and distress (M=.91, SD=.7), and below average self-efficacy (M T-score=46.4, SD=7.6). Pain, fatigue and distress were moderately to highly correlated (r’s .38-.68, p’s<.01). Self-efficacy was inversely correlated with symptom severity (r’s -.26 to -.5, p’s<.01). Being unmarried/single was associated with greater pain severity (r=.17) and distress (r=.21) and lower levels of self-efficacy (r=-.17) (p’s<.05). Having less than a bachelor’s degree was associated with greater pain severity (r=-.27) and distress (r=-.16) (p’s<.05). Female sex was associated with greater fatigue (r=.16, p<.05). Age, race, and clinical variables were not significantly associated with symptoms.

Conclusion: Exploring baseline characteristics associated with symptoms in younger patients with CRC can help identify potential intervention moderators. Correlations among pain, fatigue, and distress at baseline indicate a need for accessible interventions like mCOPE that address this constellation of symptoms.

Keywords: Cancer survivorship, Pain

Authors:

Presenter - Sara Hogan, MS,
Duke University School of Medicine

Co-Author - Kelly Hyland, PhD,
Duke University School of Medicine

Co-Author - Hannah Fisher, PhD,
Duke University School of Medicine

Co-Author - Allison Diachina, BA,
Duke University School of Medicine

Co-Author - Catherine Majestic, PhD,
Duke University School of Medicine

Co-Author - Joseph Winger, PhD,
Duke University School of Medicine

Co-Author - Hope Uronis, MD,
Duke University School of Medicine

Co-Author - Tamara Somers, PhD,
Duke University School of Medicine

Co-Author - Sarah Kelleher, PhD,
Duke University School of Medicine

D12 - Preferences regarding lifestyle-related services and programs among breast cancer survivors

Poster Number: D12
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Multiple Health Behavior Change

Purpose: Suboptimal diet and physical inactivity are prevalent among breast cancer survivors and correlate with poor outcomes. Lifestyle trials are common in this population, yet little is known about survivors’ uptake and preferences regarding lifestyle-related services outside of research studies. This cross-sectional study explored use, preferences, and barriers to lifestyle-related services among breast cancer survivors in Connecticut.

Methods: Breast cancer survivors diagnosed between 2018-2022,  6-months post-diagnosis, and treated in the Smilow Cancer Hospital Care Network were mailed invitations to a one-time survey on fruit and vegetable intake, weekly exercise, use of lifestyle services/programs, desired services, and barriers to participating in lifestyle programs. Clinical data were extracted from the Yale Tumor Registry.

Results: Out of 1,592 invitations, 333 (21%) women responded with a mean age of 58.1 (12.0) years. Most had Stage I disease (67.3%), were non-Hispanic white (87.4%), had  college degree (68.8%), and were diagnosed 25.3 months prior. Overall, 42% and 48% met the national median for fruit and vegetable consumption, respectively, with variation by race and ethnicity as only 22% of Hispanics met the fruit median and 0% met the vegetable median. One-third met the physical activity goal of 150+ min/week. All other racial and ethnic groups were less likely to meet this exercise goal compared to white survivors (Odds ratio [OR]: 0.29; 95% Confidence Interval [CI]: 0.1-0.9). While 29.1% consulted with a dietitian since their diagnosis, 37.7% wished they had access to a dietitian during and after treatment. Only 16.2% consulted with an exercise trainer since their diagnosis, yet 52.1% expressed a desire for access during and after treatment. Additionally, despite low participation in healthy eating (11.7%) and exercise (12.5%) programs, 55.9% expressed interest in these programs. All other racial and ethnic groups reported greater interest in programs compared to white survivors (OR: 3.4; 95% CI: 1.3-8.7). Work schedules and lack of energy from treatment were cited as barriers to utilization.

Conclusions: These breast cancer survivors expressed high interest in lifestyle-related services, though utilization was low. Cancer centers could offer lifestyle programs to address patient preferences, including during cancer treatment. Data from more diverse populations are needed to ensure services effectively meet all survivors’ needs.

Keywords: Cancer survivorship, Health behavior change

Authors:

Co-Author - Eric Winer, MD,
Yale Cancer Center

Co-Author - Michelle Zupa, BS,
Yale School of Public Health

Co-Author - Melinda Irwin, PhD, MPH,
Yale School of Public Health

Co-Author - Leah Ferrucci, PhD, MPH,
Yale School of Public Health

D13 - A proof-of-concept trial of a nutrition program for cancer survivors is feasible and acceptable for integration into a clinical exercise oncology program and improves diet quality and cardiometabolic health

Poster Number: D13
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Multiple Health Behavior Change

Background: Multiple health behavior change interventions increase adherence to evidence-based guidelines for lifestyle behaviors and improve outcomes in cancer survivorship. The objectives were to: (1) assess the feasibility and acceptability of implementing a survivorship nutrition program for delivery alongside an exercise oncology program and (2) explore effects of the integrated program on diet, physical activity, weight, and cardiometabolic health.
Methods: Cancer survivors not meeting diet and physical activity guidelines (100% female, 91% White, age 56.3±10.1 years, BMI 32.6±4.5 kg/m2) completed a 12-week single-arm trial. Participants were enrolled in an exercise oncology program and received added nutrition program components: (1) group nutrition education and support, (2) group skills development, and (3) individual counseling with a registered dietitian. Data were collected at baseline, week 6, and week 12. Dietary intake was assessed via 30-day food frequency questionnaires and diet quality determined using Healthy Eating Index (HEI). Physical activity was assessed via activPAL. Clinical outcome data were collected using standard measures. Acceptability was assessed weekly using the Acceptability of Intervention Measure (AIM) and Net Promoter Score (NPS), and a program evaluation was conducted post-intervention. Changes were assessed via one-way repeated measures ANOVA using linear mixed effects.
Results: Of the n=78 screened, n=11 (14%) were deemed eligible and enrolled. Mean nutrition program attendance was 88%, and study retention was 91%. Across all sessions, mean AIM score was 4.5 out of 5 and mean NPS was 65. From baseline to week 12, HEI scores increased from 62.5±11.4 to 74.0±9.5 (p<0.001). Moderate-to-vigorous physical activity increased from 137±104 to 185±137 minutes/week (p=0.374). Weight decreased from 88.8±15.9 to 84.4±12.7 kg (p=0.094) and waist circumference decreased from 113.0±9.0 to 110.5±8.9 cm (p=0.026). Total cholesterol decreased from 179.5±36.0 to 159.3±36.3 mg/dL (p=0.030); LDL cholesterol decreased from 112.9±34.0 to 101.3±31.8 mg/dL (p=0.062). All participants reported the program positively impacted their overall health and they would recommend it to other survivors.
Conclusions: Integrated delivery of nutrition and exercise programming was feasible and acceptable. A pilot optimization trial of the nutrition program is underway to explore main effects of individual components on adherence to guidelines and health.

Keywords: Cancer survivorship, Nutrition

Authors:

Presenter - Emily Hill, PhD, RDN,
University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition

Co-Author - Claudia Schaefer, BS,
University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition

Co-Author - Kristen Bing, RD,
University of Colorado Anschutz Medical Campus, Anschutz Health and Wellness Center

Co-Author - Zhaoxing Pan, PhD,
University of Colorado Anschutz Medical Campus, Department of Pediatrics, Division of Endocrinology

Co-Author - Danielle Ostendorf, PhD,
University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes

Co-Author - Ryan Marker, PhD, PT,
University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation

Co-Author - Paul MacLean, PhD,
University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes

Co-Author - Victoria Catenacci, MD,
University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes

D14 - Identifying Latent Profiles of Quality of Life and Lifestyle Behaviors in Cancer Survivors: The Interplay of Sedentary Behavior, Physical Activity, and Sleep

Poster Number: D14
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Quality of Life

Background: Cancer survivors often experience side effects that impact their quality of life, including increased sedentary behavior, poor physical activity, and inadequate sleep. These lifestyle factors are key components of the 24-hour movement guidelines, which negatively affect survivors' quality of life and lead to further health complications.
Methods: A cross-sectional, observational survey was conducted among cancer survivors aged 18 years and older, recruited globally from July to November 2020. The modified version of the Domain-Specific Sitting Time Questionnaire assessed sedentary behavior and sleep, the Godin Leisure-Time Exercise Questionnaire measured physical activity, and quality of life (QoL) was evaluated using the Functional Assessment of Cancer Therapy scale. Latent profile analysis identified subgroups based on these lifestyle factors, and multinomial logistic regression examined associations with clinical and demographic characteristics.
Results: Cancer survivors (N = 477; Mage= 48.5±15.4 years) were predominantly female (69.6%) and diagnosed with breast cancer (29.3%). Three distinct latent profiles were identified: Class 1 “Limited 24-Hour Movement Integration with Low Well-being” with the highest sedentary behavior (675.7 mins/day), lowest moderate-to-vigorous intensity physical activity (126.3 mins/week), and poorest QoL across all domains; Class 2 “Partial 24-Hour Movement Integration with Moderate Well-being” Ishowing moderate sedentary behavior (624.0 mins/day), physical activity (143.84 mins/week), and quality of life; and Class 3 “Complete 24-Hour Movement Integration with High Well-being” characterized by the lowest sedentary behavior (576.7 mins/day), highest physical activity (186.0 mins/week), and highest QoL. Class 3 was associated with older age (RRR=1.071, 95% CI: 1.043, 1.099, p<0.001), lower body mass index (RRR=0.931, 95% CI: 0.885, 0.978, p=0.005), and fewer comorbidities. Class 3 also had lower rates of chemotherapy (RRR=0.466, 95% CI: 0.230, 0.941, p=0.033) and hormone therapy (RRR=0.229, 95% CI: 0.089, 0.594, p=0.002) compared to the other classes.
Conclusions: Identifying latent profiles of QoL and lifestyle behaviors in may help tailor interventions to the unique needs of cancer survivors. These findings emphasize the importance of integrating 24-hour movement guidelines—reducing sedentary behavior, promoting physical activity, and ensuring adequate sleep—to enhance overall well-being in cancer survivors.

Keywords: Cancer survivorship, Health behaviors

Authors:

Author - Hui Xiao, PhD,
University of Toronto

Co-Author - Golnaz Ghazinour, BSC,
University of Toronto

Co-Author - Allyson Tabaczynski, MSc, PhD,
University of Toronto

Co-Author - Christy Chong,
University of Toronto

Co-Author - Ina Koperwas,
University of Toronto

Co-Author - Linda Trinh, PhD, FSBM, PhD, FSBM,
University of Toronto

D15 - Decision-making and Understanding of Ovarian Function Suppression Treatments Amongst Survivors of HR+ Breast Cancer

Poster Number: D15
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Women's Health

Background: Ovarian Function Suppression (OFS) is an effective way to reduce the risk of recurrence in pre-menopausal women with early stage, hormone receptor positive (HR+) breast cancer. Despite the long-term benefits, utilization and adherence to OFS treatments is low. This study seeks to explore patient decision-making amongst survivors of HR+ breast cancer.

Methods: Semi-structured interviews were conducted with 16 participants with non-metastatic HR+ breast cancer. All but 4 had received OFS treatments, though some had since had their ovaries removed. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was then used to explore decision-making processes and factors.

Results: Patient comprehension of OFS treatment lowering the risk of recurrence was the primary motivator behind decision-making. However, age (i.e., premenopausal status), confidence in the provider making the recommendation, cost, time commitments, and understandings of side effects also influenced decision-making. Furthermore, while some participants intended to stay on OFS long-term, others received OFS in the interim while waiting for an oophorectomy. Preferences for ovary removal rather than OFS injections were often rooted in the long-term cost and time commitment of monthly appointments. Several patients expressed a preference for quarterly injections of OFS, due to the time commitment but these were often not covered by insurance and were prohibitively expensive compared to monthly injections. Ultimately, participants learned about OFS from their provider and though they may have discussed their decision with family member or friends, providers remain the primary source of information and influence on patient decision-making.

Conclusion: To increase utilization and adherence to OFS, it is imperative that providers engender trust amongst their patients and that they properly explain the impact of OFS on recurrence. Additionally, information on side effects (and management of those side effects) along with connecting patients to available resources that assist with insurance and costs might further encourage patients to initiate and continue receiving OFS treatments.

Keywords: Cancer, Decision making

Authors:

Author - Kimberley Lee, MD, MHS, MD, MHS,
Moffitt Cancer Center

Author - Melinda Maconi, PhD,
Moffitt Cancer Center

Author - Carley Geiss, PhD, PhD,
Moffitt Cancer Center

Co-Author - Susan Vadaparampil, PhD,
Moffitt Cancer Center

Co-Author - Heather S. Jim, PhD, FSBM, PhD, FSBM,
H. Lee Moffitt Cancer Center

Co-Author - Clement K. Gwede, PhD, MPH, RN, FSBM, PhD, MPH, RN, FSBM,
H Lee Moffitt Cancer Center and Research Institute

Author - Hatem Soliman, MD,
Moffitt Cancer Center

D16 - "It's too late for me": Results from a Qualitative Evidence Synthesis on HPV Catch-up Vaccination

Poster Number: D16
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Decision Making

BACKGROUND: The Human papillomavirus (HPV) causes many cancers, including cervical, anal, penile, and oropharyngeal cancers. Although HPV vaccines are safe and effective in preventing HPV-related cancers, the global adolescent vaccination coverage is approximately 15% for girls and 4% for boys. HPV vaccine coverage is heavily monitored for adolescents through age 17, but young adults aged 18-26 are still eligible to be vaccinated. The suboptimal adolescent coverage rate leaves many young adults at increased risk for developing vaccine preventable HPV-related cancers. This qualitative evidence synthesis explores the influences of HPV vaccination uptake and decision making among young adults.

METHODS: This review was guided by the Cochrane Handbook on qualitative evidence synthesis. After protocol registration, we comprehensively searched seven databases for studies from 2006 to October 2023 on HPV vaccination among young adults aged 18-26 that used qualitative research methods. We purposively sampled the included articles to manage the volume of qualitative data. Lastly, we assessed the methodological quality of included studies and determined the strength of the findings.

RESULTS: Forty-two studies from fourteen countries were purposively sampled and included in this review. There were 29 findings generated across 10 thematic areas. Some vaccine-eligible young adults believed they were ineligible for the vaccine because they were "too old" or were already having sex. Some participants also believed that using condoms or regularly getting screened negated the need for the HPV vaccine. Young adults’ relationship status was also influential, with some individuals in committed/monogamous relationships perceiving themselves to be at lower risk for HPV infection, reducing the need for the vaccine. Notably, parents were still influential in the decision process of whether young adults received the vaccine. Lastly, additional challenges with HPV vaccination included the costs associated with getting vaccinated, the multiple appointments required to complete the series, and the accessibility of vaccination sites.

CONCLUSION: HPV vaccines remain the most effective form of prevention against HPV infections and HPV-associated cancers. The findings of this review contextually highlight the range of factors that influence HPV vaccination uptake and decision making among young adults that are valuable to consider in addressing HPV-related health disparities.

Keywords: Cancer, Health behaviors

Authors:

Presenter - Namoonga M. Mantina, MSPH, MBA,
University of Arizona

Co-Author - Jonathan Smith, MA,
University of Arizona

Co-Author - Flavia Nakayima Miiro, MS,
University of Arizona

Co-Author - Deborah J. McClelland, MLS,
University of Arizona

Co-Author - Priscilla Magrath, PhD,
University of Arizona

Co-Author - Leila Barraza, JD, MPH,
University of Arizona

Co-Author - John Ruiz, PhD,
University of Arizona

Co-Author - Purnima Madhivanan, MBBS, MPH, PhD,
University of Arizona

D17 - Improving Psychological Health in Patients with Metastatic Lung Cancer: Outcomes from a Pilot Feasibility Trial of LiveWell, An Adapted Dialectical Behavioral Therapy Skills Training Program

Poster Number: D17
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Mental Health

INTRO: Recent advances in lung cancer treatment have led to patients living longer with metastatic disease. However, these patients experience heightened psychological distress and decrements in emotional wellbeing which are associated with disease-related symptoms, treatment side effects, and uncertainty about clinical outcomes. To address this, we developed LiveWell, an 8-session adapted dialectical behavioral therapy skills training intervention. We evaluated feasibility and acceptability and hypothesized that LiveWell participants would demonstrate improvement in psychological variables and emotional wellbeing from pre- to post-treatment.

METHODS: Patients receiving systemic therapy for metastatic lung cancer who endorsed an NCCN distress score ≥3 were eligible. Self-report assessments including anxiety/depression (PROMIS), intolerance of uncertainty (IUS), emotion dysregulation (DERS18), peaceful acceptance of illness (PEACE), and emotional wellbeing (FACT-L EWB) were completed at baseline (A1), post treatment (A2), and 1-month follow-up (A3). Paired sample t-tests examined change over time. Effects sizes were computed using Cohen’s d and are exploratory.

RESULTS: Participants (N=30, 77% female, Mage=63 yrs, 87% White, 60% on targeted therapy) were an average of 4.6 years from lung cancer diagnosis. LiveWell was feasible (accrual=30 in 8 months, 90% sessions attended, 84% retention at A2) and acceptable (96% satisfaction). From A1 to A2, participants (N=26) demonstrated improvements in anxiety (Mdiff=2.1, d=0.22), depression (Mdiff=2.9, d=0.35), intolerance of uncertainty (Mdiff=4.0, d=0.71), emotion dysregulation (Mdiff=2.6, d=0.49), illness acceptance (Mdiff=-1.2, d=-0.45), and emotional wellbeing (Mdiff=-1.3, d=-0.36). From A1 to A3, participants (N=24) demonstrated sustained or continued improvement in anxiety (Mdiff=5.7, d=0.76), depression (Mdiff=3.6, d=0.48), intolerance of uncertainty (Mdiff=3.6, d=0.58), emotion dysregulation (Mdiff=3.8, d=0.71), illness acceptance (Mdiff=-1.3, d=-0.58), and emotional wellbeing (Mdiff=-1.8, d=-0.43).

DISCUSSION: LiveWell was feasible, acceptable, and participants demonstrated promising improvements in psychological variables and emotional wellbeing. As advances in lung cancer treatment continue to extend survival, it is important to attend to psychological health to ensure patients are not only living longer but living well. Future work will test the LiveWell protocol in a fully powered efficacy trial.

Keywords: Cancer, Emotions

Authors:

Co-Author - Natalie Chou,
Duke Psychiatry and Behavioral Sciences

Co-Author - Hannah Fisher, PhD,
Duke Psychiatry and Behavioral Sciences

Co-Author - Allison Diachina,
Duke Psychiatry and Behavioral Sciences

Co-Author - Thomas Stinchcombe, MD,
Duke Cancer Institute

Co-Author - Kevin Oeffinger, MD,
Duke Cancer Institute

Co-Author - Laura Porter, PhD,
Duke Psychiatry and Behavioral Sciences

Co-Author - Andrada Neacsiu, PhD,
Duke Psychiatry and Behavioral Sciences

Co-Author - Tamara Somers, PhD,
Duke Psychiatry and Behavioral Sciences

Co-Author - Kelly Hyland, PhD,
Duke Psychiatry and Behavioral Sciences

D18 - Confidence of providers and nursing staff in addressing parents’ concerns about HPV vaccine

Poster Number: D18
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Health Communication and Policy

Introduction. A provider recommendation is one of the strongest predictors of HPV vaccine receipt. However, many parents still have questions about HPV vaccine after a recommendation and providers may have limited time to counsel parents during a routine visit. This presents an opportunity for other clinical staff to play a role in addressing parents’ concerns about HPV vaccine. We sought to understand providers and nursing staff’s perceived ability to address parent hesitancy about HPV vaccine.

Methods. Participants were a national sample of 2,527 US health care providers and nursing staff working in primary care who had a role in HPV vaccination for children 9-12. They completed an online survey in mid-2022 (response rate = 57%). We defined providers as physicians, physician assistants, and advanced practice nurses. We defined nursing staff as licensed practical nurses, registered nurses, medical assistants, and certified nursing assistants. We conducted a multivariable logistic regression that controlled for participant and clinic characteristics.

Results. Twenty-eight percent of respondents were nursing staff and 72% were providers. Nearly all providers (n=1,771, 97%) and most nursing staff (n=581, 83%) addressed parents’ questions and concerns about HPV vaccine. Providers were more likely to address parents’ questions and concerns ‘frequently’ or ‘all the time’ compared to nursing staff (53% vs. 31%, p<.001). Across all levels of training, respondents more often believed that providers could effectively address parents’ concerns about HPV vaccine than nursing staff (98% vs. 51%, p<.001). Nursing staff were more likely than providers to believe that nursing staff could effectively address parents’ concerns about HPV vaccine (78% vs. 41%, p<.001) and somewhat less likely to believe that providers could effectively address parent concerns, although most believed providers could effectively address parents’ concerns (94% vs. 99%, p<.001).

Discussion. Many nursing staff believe they can effectively address parents’ questions and concerns about HPV vaccine, but fewer than a third are currently doing so with any frequency. This presents an opportunity to expand the clinical role of nursing staff in HPV vaccine communication.

Keywords: Prevention, Cancer

Authors:

Presenter - Mallory K. Ellingson, PhD,
University of North Carolina at Chapel Hill

Co-Author - Benjamin Z. Kahn,
UNC Gillings School of Global Public Health

Co-Author - Katherine I. Kritikos,
University of North Carolina at Chapel Hill

Co-Author - Tara Queen,
UNC Gillings School of Global Public Health

Co-Author - Paul L. Reiter, PhD,
The Ohio State University

Co-Author - Noel T. Brewer, PhD, PhD,
University of North Carolina

D19 - Cultural Adaptation of Psychotherapy for Mandarin- and Vietnamese-Speaking Metastatic Cancer Patients: Perspectives from Bicultural Healthcare Professionals

Poster Number: D19
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Health of Marginalized Populations

Background: Cancer is the leading cause of death for Asian Americans and psychological distress is elevated for those with metastatic disease. Additionally, those with limited English proficiency (LEP) experience quality of life disparities. Few evidence-based psychotherapeutic interventions exist for Mandarin and Vietnamese-speaking patients, and cultural adaptation in psychotherapies results in medium-sized effects in reducing distress-related symptoms. This study examines the perspectives of bicultural healthcare professionals (HCPs) on the cultural adaptation of an evidence-based psychotherapy for Mandarin and Vietnamese-speaking patients with metastatic cancer.

Methods: Thematic analysis was used to examine 12 semi-structured interviews conducted with bicultural HCPs reporting regular use of Mandarin or Vietnamese in visits with patients with LEP. Participants were asked to comment on Managing Cancer and Living Meaningfully across cultural dimensions of the ecological validity model (EVM).

Results: HCPs (58% Chinese-heritage, 42% Vietnamese-heritage; M=45.67, SD=13.63) included 6 physicians, 2 nurses, 1 patient navigator, 1 physician assistant, 1 patient service worker, and 1 social worker. Interviewees had on average 12.67 years (SD=10.47) of experience serving Chinese/Vietnamese-heritage metastatic cancer patients.

Preliminary themes include (1) establishment of trust over time, grounded in reciprocal actions, (2) necessity for careful linguistic approach when addressing sensitive topics (3) importance of demographic factors in pairing patient and therapist and (4) leaning into individual sociohistorical backgrounds to shape alliance. Cultural adaptation was suggested across all eight EVM dimensions of language, persons, metaphors, content, concepts, goals, methods, and context. For example, one interviewee observed that appropriate language is temporal, and that they would use different verbiage for someone who immigrated prior to the Vietnamese War than that for someone who had immigrated recently. The slow process of establishing trust was at the forefront of most conversations.

Conclusions and Implications:
HCPs emphasized a clear need for psychological support for their patients with particular attention to cultural norms in the therapeutic process to build relational trust. Future research should examine patient and caregiver perspectives on how to best culturally adapt and deliver evidence-based psychotherapeutic interventions.

Keywords: Culture, Cancer survivorship

Authors:

Co-Author - Peter Phung, MD, MD,
University of Southern California

Co-Author - Becky Nguyen, MPH MPA,
Vital Access Care Foundation

Co-Author - Carol Wang,
Herald Cancer Association

Co-Author - Jenny Tran, PhD,
Simms Mann UCLA Center for Integrative Oncology

Co-Author - Tan Nguyen, MD,
University of California, Irvine

Co-Author - Sarah Hales, MD,
Princess Margaret Cancer Centre

Co-Author - Gary Rodin, MD,
University of Toronto

Co-Author - Jacqueline H. J. Kim, PhD, PhD,
University of California, Irvine

D20 - Designing the Cancer survivor nutrition Assistance Research Trial (CART) Study

Poster Number: D20
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Health of Marginalized Populations

Background
The American Cancer Society recommends a nutritious diet rich in whole grains, fruits, and vegetables to improve quality of life and reduce risk of mortality and cancer recurrence among cancer survivors. However, most cancer survivors don’t meet dietary recommendations. This is especially true for those with food insecurity or limited access to food. "Food is Medicine" (integrating nutrition programs with healthcare) is a promising approach for cancer survivors but remains understudied. This exploratory study aims to understand cancer survivors’ access to nutritious food and nutrition education in order to design a tailored Food is Medicine intervention.

Methods
We recruited participants in partnership with community-based organizations serving low-income cancer survivors. We conducted 5 online focus groups with 40 cancer survivors living in the California Bay Area. Discussions were audio recorded, transcribed verbatim, and analyzed with NVivo.

Results
Analysis reveals four key themes influencing cancer survivors experiences: affordability, access, social support, and nutrition education.

Affordability - Participants described attempts to optimize food budgets so they could afford higher quality (e.g. organic) foods. Methods included home gardening or using zero-waste recipes such as juicing to retain nutrients.

Accessibility of quality food - Participants described lack of time or energy for grocery shopping or cooking, and shared concerns about shopping in-store while immunocompromised. Concerns about food contamination, both bacterial (e.g. salmonella) and chemical, also impacted their shopping choices.

Social support – Participants reported varying degrees of support or resistance from friends and family, such as when cooking for household members or dining with friends.

Nutrition education - Finally, participants reported receiving varying levels and types of nutrition education during cancer treatment and survivorship. Some received guidance from clinicians or dietitians, others learned from friends or self-teaching.

Conclusion
Food is Medicine programs for low-income cancer survivors should take into account these four factors to better serve this population.

Learning Objectives
1. Identify the unique nutrition and food needs of cancer survivors and their household members
2. Describe the design of a Food is Medicine intervention tailored to cancer survivors’ needs
3. Share next steps in implementing the CART study

Keywords: Cancer survivorship, Nutrition

Authors:

Co-Author - Alethea Marti,
Stanford

Co-Author - Lisa Goldman Rosas, PhD, MPH, FSBM,
Stanford University School of Medicine

Co-Author - Wei-ting Chen, PhD,
Stanford Medicine

Co-Author - Rebecca Grey, MPH, MSW,
Stanford

Co-Author - Erin Van Blarigan, ScD,
UCSF

Co-Author - Sorbarikor Piawah, MD,
UCSF

D21 - Bridging Patients to Interventions in Exercise Oncology: Contextual Insights from Patient Demographics, Recruitment Modes, and Attendance in the EXercise for Cancer to Enhance Living Well (EXCEL) Study

Poster Number: D21
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity

Introduction: The EXercise for Cancer to Enhance Living Well (EXCEL) study is a hybrid effectiveness-implementation trial that delivers 12-week exercise programs for Canadians living with and beyond cancer in rural/remote communities. Patients are recruited through print materials, word of mouth, social media (self referral), or direct or indirect health care provider (HCP) referral. Recruitment sources for EXCEL may influence attendance in the program. The purpose of this analysis was to examine the relationship between referral source (self vs HCP indirect vs HCP direct) to EXCEL and participant attendance throughout the 12-week intervention. This is a preliminary analysis of patients to-date and EXCEL is ongoing.

Methods: Program attendance was calculated as a percentage derived from the exercise sessions attended vs. the available exercise sessions. Direct referrals were defined as referrals sent from an HCP to the EXCEL team. Indirect referrals were defined as referrals where the HCP offered information about EXCEL and the patient contacted the EXCEL team of their own volition. Self-referrals occurred when a patient found information about EXCEL from any non-HCP source and contacted the team. A one-way ANOVA was conducted to examine differences in program attendance between the three referral sources. Demographic characteristics were reported as means with accompanying standard deviations.

Results: To date, N = 1006 patients have been recruited with an average age of 59 years ± 12 years and 87% identifying as female, 13% as male. Direct HCP referrals had a mean program attendance of 77.8% ± 20.5%, indirect HCP referrals of 74.3% ± 21.8%, and self-referrals 78.9% ± 19.1%. There was a significant association of referral source on program attendance, F(2, 850) = 2.92, p = 0.05). Post hoc comparisons using Tukey’s HSD test indicated that indirect HCP referrals (74.3%) had significantly lower program attendance than self-referrals (78.9%) (p = 0.04).
Conclusions: There appear to be differences in program attendance between those who self-refer versus those who learn about the program from an HCP source but are not directly referred. Patients who were indirectly referred by an HCP may need more support to adhere to the program when compared to those who were self-referred. Further examination of other factors, such as type and stage of disease, may reveal additional knowledge to inform optimizing referral pathways that support exercise behavior change.

Keywords: Exercise, Cancer

Authors:

Author - Jonathan Low, PhD,
Faculty of Kinesiology, University of Calgary

Co-Author - Julianna Dreger, CSEP-CEP, M.ClinExPhys,
Faculty of Kinesiology, University of Calgary

Co-Author - Chad Wagoner, PhD,
Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee

Co-Author - Emma McLaughlin, MSc,
University of Calgary

Co-Author - Jocelyn Cannon, MSc,
Faculty of Kinesiology, University of Calgary

Co-Author - Margaret McNeely, PhD,
Department of Physical Therapy, University of Alberta

Co-Author - Melanie Keats, PhD,
Faculty of Health, School of Health and Human Performance, Dalhousie University

Co-Author - Daniel Santa Mina, PhD,
Faculty of Kinesiology and Physical Education, University of Toronto

Co-Author - Linda Trinh, PhD, FSBM,
Faculty of Kinesiology and Physical Education, University of Toronto

Co-Author - Kristin Campbell, PT, PhD,
Department of Physical Therapy, Faculty of Medicine, University of British Columbia

Co-Author - Isabelle Doré, PhD,
School of Kinesiology and Physical Activity Sciences, Faculté de Médecine, Université de Montréal

Co-Author - Colleen Cuthbert, NP, MN, PhD,
Faculty of Nursing, University of Calgary, Calgary

Co-Author - Lauren Capozzi, MD, PhD,
Cumming School of Medicine, University of Calgary

Co-Author - Daniel Sibley, PhD,
Faculty of Kinesiology and Physical Education, University of Toronto

Co-Author - Tom Christensen, CSEP-CEP, MSc,
Faculty of Health, School of Health and Human Performance, Dalhousie University

Co-Author - Alexia Piché, MSc,
School of Kinesiology and Physical Activity Sciences, Faculté de Médecine, Université de Montréal

Co-Author - Kelly Mackenzie, CSEP-CEP, MSc,
Department of Physical Therapy, Faculty of Medicine, University of British Columbia

Co-Author - Sean Sawer, PhD,
Department of Physical Therapy, Faculty of Medicine, University of British Columbia

Co-Author - Nicole Culos-Reed, PhD,
University of Calgary

D22 - Assessing the Feasibility and Acceptability of ExerciseGuide UK: A Digital Intervention for Those Living With and Beyond Lung Cancer Using the Pillar Integration Process

Poster Number: D22
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Digital Health

Background:
Lung cancer, with its high global mortality, has seen limited exploration in tailored exercise interventions, particularly digital ones. ExerciseGuide UK, a novel website offering personalised exercise programs and resources for those living with and beyond lung cancer (LWBLC), was developed. The feasibility and acceptability of the intervention were examined using the Pillar Integration Process (PIP). This approach bridged the gap between digital health innovation and the specific needs of this underserved population.

Methods:
Eighteen participants (mean age 65 ± 14.42) were recruited. Feasibility was assessed through metrics such as screen-to-consent ratios, retention rates (66.67%), and reasons for ineligibility (e.g., lack of digital access). Acceptability was measured using the System Usability Scale (SUS), post-study questionnaires, and interviews. PIP synthesised findings across three pillars: Feasibility, Acceptability, and Barriers to Engagement.

Results:
Feasibility themes included recruitment, retention, sample size, and participation. Acceptability themes included perceptions of digital design and usability, impact on physical activity attitudes and behaviours, perceived value for cancer care, and burden. Barriers to engagement were identified as digital accessibility, complexity, health-related outcomes, and timing. The SUS score of 72.12% (±14.15) indicated good usability. PIP revealed reduced website usage due to participants reaching "learning saturation." The platform’s flexibility and its impact on managing breathlessness significantly improved quality of life, highlighting the importance of context-specific interventions.

Conclusion:
ExerciseGuide UK demonstrated moderate feasibility and high acceptability of digital health interventions tailored to those LWBLC, bridging critical gaps in exercise oncology. The PIP provided a comprehensive integration of diverse data, offering novel insights into the contextual factors influencing engagement with digital tools. These findings underscore the need for equitable, patient-centred eHealth solutions in oncology care. Future research should focus on large-scale efficacy studies and strategies to ensure that digital interventions are accessible to all, addressing both the physical and psychosocial needs of those LWBLC.

Keywords: Cancer, e-Health

Authors:

Presenter - Jordan Curry,
University of Hull

Co-Author - Holly Evans,
Flinders University

Co-Author - Michel Lind,
University of Hull

Co-Author - Camille Short,
The University of Melbourne

Co-Author - Corneel Vandelanotte,
Central Queensland University

Co-Author - Mark Pearson,
University of Hull

Co-Author - Cynthia Forbes,
University of Hull

D23 - Understanding Diverse Caregivers’ Challenges with Patient Comorbidity Management and Care Coordination During Cancer Treatment

Poster Number: D23
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Stress

Background: Chronic comorbidities can impact cancer care, especially for medically underserved patients, causing treatment delays and poorer outcomes. Caregivers face major challenges managing comorbidities due to limited resources and difficulties navigating the healthcare system. The socioecological model(SEM) and the 5 A’s of Access framework (Availability, Accessibility, Affordability, Accommodation, and Acceptability) provides a comprehensive lens to these challenges by identifying barriers and potential areas for intervention. This study, grounded in these models, examines the specific challenges and unmet needs of caregivers managing patient comorbidities during cancer treatment. Methods: We recruited 16 caregivers from an ongoing trial. Using a mixed methods approach, we assessed caregiver burden and psychological distress through surveys and explored the psychological impact of managing multiple health conditions, access to resources, and barriers to care coordination through qualitative interviews. Results: The caregiver sample was predominantly Hispanic (68.8%), female (81.3%), with an average age of 42.3 years. Most were either spouses or children of the patients (68.3%). Survey data revealed a high caregiver burden (mean score of 70.75, SD = 25.95 on the Zarit Burden Interview) and mild psychological distress (average T-score for depression (47.4, SD= 7.5) and anxiety (48.6, SD=7.4), measured on PROMIS scales. Qualitative analysis identified challenges at various levels: psychological distress (individual), lack of support (interpersonal), limited access to resources (community), and long waiting times and care coordination issues (organizational). Consistent with the 5 A’s framework, caregivers faced difficulties with availability (limited supportive services), accessibility (transportation issues), affordability (high cost of healthy food), accommodation (need for flexible appointments), and acceptability (culturally tailored support). Conclusion: Our findings underscore the multifaceted challenges of diverse caregivers managing comorbidities during cancer treatment. The data reveal significant psychological distress and barriers to care coordination across various socioecological levels, compounded by gaps in the 5 A’s of Access framework. Targeted interventions with culturally tailored support, community-based services, and care coordination are needed in oncology settings, to alleviate caregiver burden and improve outcomes.

Keywords: Caregiving, Stress

Authors:

Presenter - Maria Rangel, DrPH, MPH,
Baylor College of Medicine

Co-Author - Kiara Rivera, MPH,
Baylor College of Medicine

Co-Author - Cassandra Martinez, BA,
Baylor College of Medicine

Co-Author - Hoda J. Badr, PhD, PhD,
Baylor College of Medicine

D24 - Risk Factors Associated with Pain Intensity in Prostate Cancer Survivors

Poster Number: D24
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Pain

Background: Pain in prostate cancer (PC) survivors is a multifaceted issue resulting from cancer, its treatment, and other factors with detrimental impacts on patient quality of life. This study aimed to identify demographic, clinical, and patient-reported outcome factors associated with pain intensity in PC survivors to inform a more comprehensive approach to pain management that addresses both physical and psychosocial aspects of pain in PC care.
Methods: PC survivors were recruited between January 2021 and September 2023. Participants completed measures to assess physical and psychosocial functioning (PROMIS), sleep quality (PSQI), PC-related symptoms (EPIC-26), and overall quality of life (EQ-5D-5L). PC survivors with elevated pain intensity were defined as those endorsing pain severity ≥ 4 based on published recommendations. Bivariate associations between high pain intensity and various factors were examined using chi-square tests, t-tests, or Wilcoxon tests, as appropriate. Logistic regression models were then conducted, adjusting for demographic and clinical factors.
Results: The study included 410 PC survivors (mean age at diagnosis: 63 years, SD=7.8; at recruitment: 69 years, SD=7.9; mean years post-treatment: 5.9, SD=1.6), with 29% reporting elevated pain intensity. Most participants had localized PC (82%) and received active treatment (79%). The sample was racially/ethnically diverse (45% non-Hispanic White, 38% non-Hispanic Black, 18% Hispanic). Demographic and clinical factors significantly associated with elevated pain intensity included younger age, less educational attainment, lower household income, higher BMI, and more medical comorbidities (ps ≤.05). Self-reported race/ethnicity was not associated with pain intensity (p=.22). Elevated pain intensity was also associated with increased anxiety, depression, fatigue, and sleep disturbance; decreased physical, social, urinary, bowel, and hormonal functioning; and overall worse quality of life (ps ≤.01), with medium to large effect sizes across most measures. After adjusting for demographic and clinical covariates, these associations remained significant.
Conclusion: Multiple demographic, clinical, and patient-reported factors are associated with pain intensity in PC survivors, advancing our understanding of the multifaceted pain experience in PC and providing potential targets for developing comprehensive pain management strategies in PC care.

Keywords: Cancer, Pain

Authors:

Author - Bihe Hu,
Moffitt cancer center

Co-Author - Xiaoyin Li, PhD, PhD,
Moffitt Cancer Center

Co-Author - Zhihua Chen,
Moffitt Cancer Center

Co-Author - Wenyi Fan,
Moffitt Cancer Center

Co-Author - Aasha I. Hoogland, PhD, PhD,
Moffitt Cancer Center

Co-Author - Kimberly P.,
Moffitt Cancer Center

Co-Author - Lisa M. Gudenkauf, PhD, PhD,
Moffitt Cancer Center

Co-Author - Taylor L. Welniak,
Moffitt Cancer Center

Co-Author - Yvelise Rodriguez,
Moffitt Cancer Center

Co-Author - Crystal A. Bryant,
Moffitt Cancer Center

Co-Author - Hannah L. Decosta,
Moffitt Cancer Center

Co-Author - Nathaly E. Irizarry-Arroyo,
Moffitt Cancer Center

Co-Author - Kosj Yamoah,
Moffitt Cancer Center

Co-Author - Laura B. Oswald,
Moffitt Cancer Center

Co-Author - Heather S.L. Jim,
Moffitt Cancer Center

Co-Author - Brent J. Small, PhD, PhD,
University of North Carolina at Chapel Hill

Co-Author - Clement K. Gwede, PhD, MPH, RN, FSBM, PhD, MPH, RN, FSBM,
H Lee Moffitt Cancer Center and Research Institute

Co-Author - Frank J. Penedo, PhD, FSBM, PhD, FSBM,
University of Miami

Co-Author - Jong Y. Park,
Moffitt Cancer Center

Co-Author - Brian D. Gonzalez, PhD, PhD,
Moffitt Cancer Center

D25 - Living well with uncertainty in advanced, metastatic or incurable cancers: A pragmatic feasibility study of the Adapting to life with Cancer Cognitive ExisteNtial Therapy (ACCENT)

Poster Number: D25
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Mental Health

Background: New treatments are contributing to individuals living longer with advanced, metastatic, or incurable (AMI) cancers. The impact of these treatments is unpredictable, resulting in considerable uncertainty for these patients. Currently, there are no interventions that effectively address uncertainty in AMI cancers. To fill this gap, we designed the Adapting to life with Cancer Cognitive ExisteNtial Therapy (ACCENT) intervention. The purpose of this study was to evaluate the feasibility, acceptability, and preliminary efficacy of ACCENT in AMI cancers.
Methods: ACCENT was delivered online for 6 consecutive weekly sessions of 1.5 hours to 5 groups of 6-7 patients. Thirty-two patients were interested in participating, 4 withdrew, and 3 did not complete the assessments, for a final sample of 25 participants. A pragmatic feasibility study was conducted. Participants completed the Intolerance of Uncertainty Scale, the Generalized Anxiety Disorder scale, and the Impact of Events Scale before and after the intervention. Post-intervention, participants answered open-ended questions to assess acceptability, rated their perceptions of improvement and usefulness, and completed the Satisfaction with Therapy and Therapist Scale.
Results: ACCENT appears feasible with participants completing the intervention and all assessments between January 2022 and November 2023. It appears acceptable with an attrition rate of 12.5%, and a high degree of attendance and satisfaction. There was a non-significant decrease in intolerance of uncertainty, and a significant decrease in anxiety, and cancer-specific distress post-intervention.
Conclusion: ACCENT appears feasible, acceptable, and showed preliminary efficacy in patients with AMI cancers. A randomized controlled pilot study is warranted to further evaluate ACCENT.

Keywords: Cancer, Anxiety

Authors:

Author - Cheryl Harris,
The Ottawa Hospital Research Institute, Neuroscience Program, The Ottawa Hospital, Ottawa, ON, Canada

Presenter - Lauriane Giguère,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

Co-Author - Alanna Chu,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

Co-Author - Jani Lamarche,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

Co-Author - Tori Langmuir,
The Ottawa Hospital Research Institute, Neuroscience Program, The Ottawa Hospital, Ottawa, ON, Canada

Co-Author - Kerry Menelas,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

Co-Author - Nicole Rutkowski,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

Co-Author - Ghizlène Sehabi,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

Co-Author - Sophie Lebel, PhD, PhD,
School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada

D26 - Longitudinal Impact of Hereditary Genetic Testing on Psychological Outcomes in Prostate Cancer Patients Under Active Surveillance

Poster Number: D26
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Decision Making

Background: Prostate cancer (PCa) is often managed through active surveillance (AS) for low-risk cases to avoid treatment side effects. However, this approach can leave men uncertain about their cancer's progression. Although genetic testing is not routinely recommended in this context, it might enhance decision-making, albeit adding complexity due to the probabilistic nature of genetic results. The psychological effects of this compounded uncertainty remain unexplored. This study evaluates the psychological and behavioral impact of hereditary genetic testing results on men with PCa under AS. Method: As part of an alternative testing model, 349 patients (ages 41- 83; 85.7% White) received standardized pre-test education and completed surveys before genetic testing (T0), at 1 week (T1) and 6 months (T2) after results and post-test counseling. Measured constructs included ambiguity aversion (AmbA), emotional distress (Hospital Anxiety and Depression Scale-HADS), and comfort with AS decision. Results: Testing identified 7.7% participants with pathogenic variants and 12.3% with variants of uncertain significance. Repeated measures ANOVAs indicated a significant main effect of time for the HADS-Anxiety subscale, with a decrease from T0 to T1 in anxiety levels (Mdiff= -0.77; 95% CI -1.07,-0.48; p<.001). No interaction between time and test results on anxiety, but a significant interaction between time and AmbA levels was found: only participants with high AmbA showed increased anxiety from T1 to T2 (Mdiff= 1.81; 95% CI 0.21,3.39; p=.020). A significant main effect of time was found on comfort with AS decision, with a significant decrease from T1 to T2 (Mdiff= -0.44; 95% CI -0.77,-0.12 p=.003). No interaction between time and test results, but a significant interaction between time and AmbA was found (p=.026). Participants with low (Mdiff= 0.41; 95% CI 0.05,0.76; p=.020) and average AmbA (Mdiff= 0.16; 95% CI 0.00,0.34; p=.050) significantly increased their comfort from T0 to T1, whereas those with high AmbA remained stable from T0 to T1 but reported a significant decrease in comfort from T1 to T2 (Mdiff= -1.07; 95% CI -1.92,-0.22; p=.008). Conclusion: AmbA levels, rather than the genetic test results, play a crucial role in influencing emotional and behavioral responses over time. Personalized psychological support to enhance coping with uncertainty in PCa management is recommended, particularly for individuals with high AmbA who are more vulnerable over time.

Keywords: Cancer screening, Genetics

Authors:

Presenter - Giulia Ongaro, PhD,
Memorial Sloan Kettering Cancer Center

Co-Author - Kelsey E. Breen, MS, MSc,
Memorial Sloan Kettering Cancer Center

Co-Author - Gina Yanza, BS,
Memorial Sloan Kettering Cancer Center

Co-Author - Joshua Penna,
Memorial Sloan Kettering Cancer Center

Co-Author - Elizabeth Schofield, DrPH,
Memorial Sloan Kettering Cancer Center

Co-Author - Kenneth Offit, MD, MPH,
Memorial Sloan Kettering Cancer Center

Co-Author - Mark E. Robson, MD,
Memorial Sloan Kettering Cancer Center

Co-Author - Samson W. Fine, MD,
Memorial Sloan Kettering Cancer Center

Co-Author - Andrew Vickers, PhD,
Memorial Sloan Kettering Cancer Center

Co-Author - Behfar Ehdaie, MD, MPH,
Memorial Sloan Kettering Cancer Center

Co-Author - Maria I. Carlo, MD,
Memorial Sloan Kettering Cancer Center

Co-Author - Jada G. Hamilton, PhD, MPH,
Memorial Sloan Kettering Cancer Center

D27 - An Exploration of Themes about Sexual Health Among Black and Latina Young Adult Female Cancer Survivors

Poster Number: D27
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Mental Health

Young adulthood is a period characterized by identity development, which includes development of sexual health and sexual wellbeing. Young adults diagnosed with cancer may experience challenges in a variety of areas, including sexual health, due to the impact of cancer on identity, body image, and social factors. This study aimed to explore the ways in which Black and Latina female cancer survivors talked about their sexual health in connection to their identity as cancer survivors. Twenty-six Black and Latina female cancer survivors, between 18 and 40 and currently between six- and 24-months post treatment were eligible to take part in a larger qualitative study consisting of semi structured interviews. Participants ranged from 26 to 40 years old (M=34, SD=5) with approximately half identifying as African American/Black (46.2%) and half Hispanic/ Latina/ Spanish origin (53.8%). Approximately half of participants completed post-graduate education (42.3%). Twenty-five participants identified as heterosexual and 17 were married or cohabitating at the time of recruitment. Of the 26 participants, 16 were diagnosed with breast cancer, 5 with female genital tract cancer, 4 with leukemia, and one with lymphoma. The mean age at first diagnosis was 29.5 (SD=4.86). Data was coded using Dedoose by a team and then themes relevant to sexual health and well-being were explored. Six themes emerged from the data, and included: body image, physiological impact of cancer, partner reaction, physician communication, sexual self-concept, and the influence of culture. These themes were reflective of participants’ thoughts, feelings, and experiences with their sexual health and sexual well-being. Participants expressed desire for open conversations about sex and supported the literature on cancer’s impact on sexual health. Regarding culture, Black and Latina participants expressed unique challenges about body image and sexual self-concept related to cultural expectations. Additional research should focus on the impact of the intersection of Black and Latina identity and cancer survivor identity on sexual health, sexual well-being, and sexual self-concept.

Keywords: Sexual functioning, Cancer survivorship

Authors:

Author - Olivia Whalen-Kipp, BA,
Hunter Psycho-Oncology

Co-Author - Zeba Ahmad, PhD,
Massachusetts General Hospital and Harvard Medical School

Co-Author - Megan Wirtz, MA,
Hunter Psycho-Oncology

Co-Author - Jennifer Ford, PhD,
Hunter Psycho-Oncology

D28 - Advance directives in patients with advanced cancer: Associations with demographic and psychosocial characteristics

Poster Number: D28
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Decision Making

Advance directives (ADs) are legal documents informing healthcare providers about patients’ medical decisions in the event they are too ill to speak for themselves. Completion of ADs is associated with improvements in end-of-life care, helping ensure patients receive care consistent with their preferences, reducing aggressive treatments, and decreasing distress for patients and family. ADs are often completed in consultation with close family members. Despite the benefits of ADs, most patients with advanced cancer do not have one in place before death. Research on predictors of AD completion has primarily focused on sociodemographic characteristics. Given that psychosocial factors (e.g., distress, family communication) may influence patients’ willingness to complete ADs, in this study we examined associations between AD completion and a range of demographic and psychosocial variables.

Participants were 179 patients with Stage III-IV cancer (93% Stage IV; 58% female, 85% White, mean age=58.0) who were enrolled along with their spouses in an RCT of a dyadic behavioral intervention. At baseline, they completed measures assessing AD completion, demographics (age, gender, race, education, income), global quality of life, physical well-being, psychological distress (Hospital Anxiety and Depression Scale), spiritual/existential well-being (Life Completion and Preparation scales of the Quality of Life at End of Life Scale), communication (Protective Buffering Scale) and relationship satisfaction (Couple Satisfaction Index-8). A multivariate general linear regression model was used to examine whether completion of ADs was predicted by medical (e.g., cancer site and stage), demographic, and psychosocial variables. The overall regression was significant [R2= 0.43, F(34,144)=3.14, p<.0001]. Significant predictors of AD completion were older age (p<.0001), female gender (p=.03), higher income (p=.03), higher QOL (p=.049), less anxiety (p=.04), and higher levels of spiritual/existential well-being (Preparation, p=.002).

These findings suggest that, in addition to sociodemographic variables, emotional and spiritual resources may be important in understanding patients’ likelihood to complete ADs. Thus, interventions to increase completion of ADs may need to address factors such as anxiety and spiritual/existential well-being. It is also possible that completion of ADs leads to greater well-being, a question which could be addressed in longitudinal studies.

Keywords: Palliative care, Cancer

Authors:

Co-Author - Katherine Ramos, PhD, PhD,
Duke University School of Medicine

Co-Author - Karena Leo, PhD, PhD,
Duke University Medical Center

Co-Author - Karen Steinhauser, Ph.D.,
Duke University School of Medicine

Co-Author - Al Erkanli, PhD,
Duke University School of Medicine

Co-Author - Donald Baucom, Ph.D.,
University of North Carolina at Chapel Hill

Co-Author - Timothy Strauman, Ph.D.,
Duke University

Co-Author - Hope Uronis, M.D.,
Duke University School of Medicine

Co-Author - Francis Keefe, Ph.D.,
Duke University School of Medicne

D29 - Development of a text-messaging communication micro-intervention for couples coping with advanced GI cancer.

Poster Number: D29
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Digital Health

Effective communication between partners is integral in helping couples to navigate and adapt to cancer-related challenges. However, many couples have difficulty communicating about cancer-related topics, which can lead to poorer individual and relational outcomes. Current couple-based interventions to improve communication between partners have proven to be efficacious, however, most interventions are time intensive, consisting of 4-8 one-hour long sessions. Additionally, there are well-documented challenges in recruiting couples into couple-based intervention trials, especially among underserved couples, which limits generalizability.

One potential solution is to develop micro-interventions, which consist of short activities and educational materials that can be delivered via mobile applications or text-messages. Micro-interventions are designed to offer greater flexibility and reduce barriers to participation and utilization. Previous studies have found micro-interventions to be effective in promoting health behavior change and in enhancing relationship functioning among community couples. To our knowledge, there are no existing micro-interventions that have been developed and tested in couples coping with cancer.

The current project aims to develop, and pilot test a micro-intervention focused on improving communication skills for couples coping with advanced GI cancer. The content of the micro-intervention utilizes animated videos, images, and messages to relay information and skills related to effective couples’ communication, which will be delivered via text-messaging. Currently, the project is in the intervention development phase. We have met with community advisory groups, whose members provided insightful recommendations including 1) the optimal text-messaging frequency (~3 text-messages/week), 2) adding a phone call or zoom session for participants to check-in, and 2) resources for recruitment of underserved couples. Currently, we are conducting qualitative interviews with couples to obtain feedback regarding potential feasibility and acceptability, strengths, and barriers related to the text-messaging micro-intervention. We will discuss the preliminary results from our meeting with the community advisory groups and the qualitative interviews with couples coping with advanced GI cancer. We will discuss our process in developing and refining the text-messaging communication micro-intervention, including lessons learned and future directions.

Keywords: Cancer, Couple-focused

Authors:

Co-Author - Laura S. Porter, PhD,
Duke University Medical Center

D30 - Exploring the Role of Social Drivers of Health and Protective Factors on Quality of Life Among Adolescent and Young Adult Cancer Survivors

Poster Number: D30
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Quality of Life

Background: Adolescent and young adult cancer survivors (AYAs) are an understudied population with distinct challenges related to their developmental life stage—transitioning from adolescence to adulthood. AYAs are at higher risk for long-term and late effects (e.g., cardiovascular and second malignancies). Additionally, relative to pediatric and older cancer survivors, AYAs have overall worse health-related quality of life (HRQoL) outcomes. Social drivers of health (SDoH) likely play a key role in AYA's HRQoL. The goal of this study was to understand the role of SDoH in the lived experiences of AYAs and to identify potential protective factors to inform future interventions.

Methods: We recruited 20 AYAs, age 18-39 yrs, who were diagnosed between age 15-39 yrs (M age = 27.7±7.0 yrs), and completed cancer therapy > 6 months. Participants were 29.8±6.0 yrs, 85% non-Hispanic white and 90% female. Semi-structured interviews were conducted via Zoom or phone. A semi-structured interview guide was used to explore HRQoL (e.g., physical functioning, social and psychological health), SDoH (e.g., food insecurity, housing instability, transportation needs, discrimination), and coping (self-efficacy, resilience, spiritual well-being). Interviews were audio recorded, transcribed, and analyzed using inductive applied thematic analysis to identify qualitative themes.

Results: Thematic analysis identified four major themes that impact AYAs in survivorship with several emerging subthemes: 1) HRQoL (e.g., physical, fatigue, social isolation; symptoms of anxiety related to fear of recurrence; disruption in work, changes in goal attainment, and difficulty concentrating); 2) SDoH (e.g., cancer-related financial burden, insurance, food insecurity, and age-related discrimination); 3) protective factors (e.g., resilience and self-efficacy); and 4) coping strategies, including taking breaks and limiting social activities to manage fatigue, and use of support groups and mental health treatment.

Conclusion: Findings elucidate unmet needs among AYAs, including numerous SDoH that adversely impact HRQoL. Importantly, results also highlight resilience, self-efficacy, and positive coping strategies as important factors to consider in the design of strengths-based interventions to enhance HRQoL among this population.

Keywords: Quality of life, Cancer survivorship

Authors:

Author - Kristina L. Tatum, PsyD,
Virginia Commonwealth University

Co-Author - Jennifer S. Ford, PhD, FSBM,
Hunter College, City University of New York

Co-Author - Taryn Henning, MS,
Virginia Commonwealth University, Richmond, VA

Co-Author - Karly M. Casanave-Phillips, PhD,
Virginia Commonwealth University School of Public Health

Co-Author - Melanie K. Bean, PhD, FSBM,
Children's Hospital of Richmond at Virginia Commonwealth University

Co-Author - Jessica Gokee LaRose, PhD, FSBM,
Virginia Commonwealth University School of Public Health

D31 - The influence of depressive and anxious symptoms on cardiovascular risk factors at 12-weeks amongst those who complete cardiac rehabilitation

Poster Number: D31
Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Mental Health

Background: Cardiac rehabilitation (CR) shows beneficial effects on both psychological distress (i.e., symptoms of depressed mood and anxiety) and traditional CVD risk factors. This study examined whether a clinically meaningful improvement in psychological distress [i.e., Hospital Anxiety and Depression Scale (HADS) subscale change >= 1.7-points] during CR was associated with greater improvements in cardiorespiratory fitness (CRF), lipid profile, blood pressure (BP), hemoglobin A1c (HbA1c), body composition (BMI), and smoking status.
Methods: This was an observational study of CVD patients after coronary catheterization who completed 12-week comprehensive CR (TotalCardiologyTM, Calgary) between 2009-2019. Demographics, HADS, and risk factors were measured at baseline and at 12-weeks. Cox proportional hazards regression models examined whether HADS-Anxiety and HADS-Depression improvement were associated with 12-week risk factor control after statistical adjustment of covariates (e.g., attendance, Cognitive Behaviour Therapy participation, wait time to access CR, participation in a home CR program) and predictors that showed significance in univariable models.
Results: Among 6208 patients (Mage=60.46yrs±10.78, 20.8% female), 10.6 and 24.3% reported at least mild severity depressed mood and anxiety, respectively. Patients with clinically significant improvement in depressed mood (n=806, 13.0%) achieved higher post-CR CRF (n=3645, OR=1.10, 95% CI 1.01, 1.20), BMI (n=3582, OR=1.10, 95%CI 1.01, 1.20), systolic BP (n=3653, OR=1.10, 95% CI 1.01, 1.20) and diastolic BP (n=3653, OR=1.10, 95% CI 1.01, 1.20). In the subset of patients with baseline HADS-Depression>=8(n=657), improvement in depressed mood was associated with lower LDL cholesterol (n=284, OR=0.68, 95%CI 0.53, 0.87), HDL cholesterol (n=293, OR=0.69, 95%CI 0.54-0.88), total cholesterol (n=296, OR=0.68, 95% CI 0.53, 0.86), and triglycerides (n=295, OR=0.67, 95%CI 0.53, 0.86). Patients with clinically significant improvement in anxiety (n=989, 15.9%) achieved lower Hb1Ac (n=1025, OR=0.86, 95% CI 0.74, 0.99). No associations were observed for smoking status across groups.
Conclusion: CR completion may contribute to improvements in psychological distress that may in turn contribute to improved CRF and lipid control. Future research is needed to determine the direction of association between psychological distress and CVD risk in larger samples.

Keywords: Cardiovascular disease, Mental health

Authors:

Presenter - Laura Hernández, MSc,
University of Calgary

Author - Tavis Campbell, PhD,
University of Calgry

Author - Sandeep Aggarwal, MD,
University of Calgary

Author - Ross Arena, PhD,
University of Illinois Chicago

Author - Stephen Wilton, MD,
University of Calgary

Author - Tianqi Tao, BSc,
University of Calgary

Author - Codie Rouleau, PhD,
University of Calgary

D32 - Using Staff Perspectives to Inform Program Improvements for a Physical Activity Intervention in Cardiac Rehab

Poster Number: D32
Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Education, Training, and Career Development

Background: High rates of inactivity (>60%) and reoccurring heart attacks (>210,000 annually) plague patients who complete cardiac rehab (CR). This study examines the feasibility/impact of staff training for the Cardiac Commitment Course (C3), a CR education program based on the Health Action Process Approach (HAPA), designed to improve physical activity (PA) adherence in phase 2 CR patients.

Methods: Staff experiences/adaptations were gathered from 2 CR sites, where 9 staff members attended 4 weekly C3 training sessions. C3 resources included PowerPoints, staff manual, and patient education materials. Assessments involved pre/post-training surveys and weekly staff meeting recordings with staff tips, questions, adaptations, and feedback qualitatively coded to identify program strengths/weaknesses.

Results:
Staff questions centered on admin duties (87.5%) and patient education processes (75%), particularly involving educational tools (50%)(Motivational/Volitional (M/V) screeners 25% & Patient Education Packets/Tools (PETs) 25%). This informed the need for clearer guidance on integrating C3 tools/admin duties. Staff also had questions/concerns about delivering group sessions (37.5%).
Staff tips for treatment prioritized enhancing patient self-efficacy (68%), meeting care outcomes (58%), and reframing PA perceptions (58%). Staff demonstrated competence with several tips related to patient PA planning (53%). Lack of tips regarding education tools (26%), including PET (21%) & M/V screeners (5%) exposed program shortcomings.
Admin adaptations included simplified tracking of patient education and structured schedules to reduce educator fatigue. Education tool adaptations included refined M/V screener use and incentives to complete the new weekly PET structure. Post-training results indicated moderate positive effects, with staff reporting improved confidence in PA discussions (d=0.34) and favorable program reception (avg. 3.66/5, 3 = neutral). Nonetheless, admin demands (4.22/5), and time commitments (3.88/5) revealed a need for further streamlining and support.

Conclusion: C3 training enhanced staff confidence in promoting PA showing promise in supporting long-term PA adherence in CR patients. Findings emphasize the importance of adaptable CR education programs that provide clear guidelines, resources, and tools to address patient PA behavior. Utilizing coding for staff experiences was an effective way to document and address adaptations to C3.

Keywords: Cardiovascular disease, Health behavior change

Authors:

Co-Author - Aidan Field, NASM-CPT,
Kansas State University

Co-Author - Isabella Pond, CMA, CNA,
Kansas State University

Co-Author - Dr. Emily Mailey, PhD,
Kansas State University

Co-Author - Justin Montney, PhD (c), MS,
Kansas State University

D33 - Does Hope in Cardiac Surgery Patients Improve Their Postoperative Symptoms?

Poster Number: D33
Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Integrative Health and Spirituality

Background: Extensive research has shown the health benefit of optimism, an indicator of hope— a Character Strength in positive psychology. It predicts low mortality, especially in patients with cardiovascular disease—the number one killer of all subgroups in the United States (U.S.). Open-heart surgery (OHS) is an expensive but lifesaving intervention for certain patients with severe cardiac diseases advanced cardiac diseases. But, it is often accompanied by high levels of depression and anxiety and is highly stressful, especially in the pre- and postoperative months. Both poor mental health and distress symptoms, indicating low levels of wellbeing (WB), have been linked to poor postoperative. However, research has seldomly investigated the protective role of hope/optimism in OHS patients. Method: The prospective study followed 311 U.S. patients undergoing cardiac surgery via in-person (Wave-1 at a heart center) and telephone (Waves-2 and 3 at home) interviews, respectively. Using structural equation modeling (SEM), we evaluated a hypothetical model involving the mediation of pre-OHS hope, as indicated by dispositional optimism (Waves-2), on post-OHS wellbeing one month after cardiac surgery (Wave-3). Preoperative mental health was assessed with depression and anxiety (Waves-1), and postoperative WB was indicated by three low symptom levels of somatization, depression, and anxiety as measured by the SCL-90 subscales. Also, confirmatory factor analyses were performed to validate WB with three subscales. Results/Conclusion. Preoperative anxiety and depression were inversely correlated with the two indicators of optimism. The final solution showed an adequate fit. Squared multiple correlations suggested that this model accounted for 45% of the variance in postoperative WB. The finding suggests that character strength hope alleviates the negative effects of preoperative depression and anxiety on postoperative WB, or low psychological distress symptoms. Older age and female gender were positively and directly associated with low levels of post-OHS WB but had no effect on hope. Implications. The finding supports the beneficial role of hope/optimism in buffering the damage of poor mental health in a postoperative outcome of cardiac patients. The desirable function of this character strength calls for the attention of health providers to mobilize patients’ internal resource strength for improving WB of cardiac patients in the critical post-OHS recovery period.

Keywords: Health outcomes, Depression

Authors:

Author - Amy L. Ai, PhD, FSBM, PhD, FSBM,
Florida State University

Author - Bu Huang, PhD, PhD,
University of Washington

D34 - Positive Emotional Well-Being, Cardiovascular Risk, and Associated Biomarkers in a Nationwide Sample of Adults

Poster Number: D34
Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Integrative Health and Spirituality

Introduction: Positive emotional well-being (PEWB) is defined as high levels of positive affect (PA) and life satisfaction (LS) in the absence of depressive symptoms. The present study examines the relationship between PEWB and several cardiovascular biomarkers: blood pressure, HDL cholesterol, total cholesterol, ratio of total cholesterol to HDL cholesterol, and a composite measure of cardiovascular risk.

Methods: Data were from a nationwide survey of adults (age 18 to 96) who had biomarker data (N= 2295). PA and LS were assessed via self-report questionnaires. Blood pressure was collected in-person according to AHA standards. A bloodspot finger-prick was used to measure HDL and total cholesterol, Hemoglobin A1c (HbA1c), and C-Reactive Protein (CRP). The composite measure of cardiovascular risk included these plus systolic blood pressure (SBP) and diastolic blood pressure (DBP). The mediating role of health behaviors (smoking, alcohol, BMI, and moderate exercise) was also examined.

Results: Regression analysis showed that both PA and LS were significantly negatively related to the composite cardiovascular risk score (PA: β = -.047, t = -3.145, p = .002; LS: β = -.059, t = -2.711, p = .007) and DBP (PA: β = -.167, t= -2.943, p= 0.003; LS: β = -.141, t= -2.433, p= 0.016) when controlling for demographic variables, BMI, depression, and HbA1c. Additionally, PA (but not LS) was significantly related to higher levels of HDL cholesterol. No significant relationships were found between either PA or LS with SBP, total cholesterol, or the ratio of total cholesterol divided by HDL. BMI was the health behavior that most consistently partially mediated the significant relationships between PEWB and cardiovascular risk/biomarkers. Moderate exercise partially mediated the relationship between LS and cardiovascular risk.

Discussion: This study adds to previous literature documenting a significant relationship between PEWB and cardiovascular risk and several related biomarkers. Assessing aspects of individuals’ emotional well-being such as PA and LS may be helpful to gain a better understanding of an individuals’ mental health, quality of life, and cardiovascular risk. Interventions to improve PEWB may be especially beneficial among individuals with high cardiovascular disease risk. Given the cross-sectional design of this study, more longitudinal studies are necessary to understand directionality and mechanisms explaining the observed relationships.

Keywords: Cardiovascular disease, Emotions

Authors:

Author - Yasmin Shemali, M.S.,
University of Miami

Co-Author - Gail Ironson, PhD, MD, FSBM, PhD, MD, FSBM,
University of Miami

Co-Author - Patrice Saab, PhD,
University of Miami

D35 - Understanding Vaccine Access and Concerns: Sociodemographic Insights from Tennessee

Poster Number: D35
Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Integrated Primary Care

Background: Understanding the relationship between sociodemographic factors and vaccine barriers is essential for developing targeted public health interventions. This study is part of the Community Registered Nurse Navigator (CRNN) project, which aims to decrease vaccine barriers in Tennessee through targeted interventions. This study investigates the association between sociodemographic variables and three categories of vaccine barriers—access, concern, and importance—in Tennessee.

Methods: This cross-sectional study analyzed data (N = 9,333) from the CRNN project. The survey collected data from the Search for Hardships and Obstacles to Shots (SHOTS), which divides parental hesitancy into three major constructs: immunization access, immunization concern, and immunization importance. Surveys were distributed to parents/caregivers of children under 18 years by 16 CRNNs at community events, with data collected between July 2022 and May 2024. The study employed descriptive statistics and Multivariate Analysis of Variance (MANOVA) to examine the effects of different sociodemographic variables on immunization access, concern, and importance scores.

Results: The majority of participants were White (84.6%) and high school graduates (39.7%). The analysis revealed that race significantly impacted all three immunization barrier categories, with race-related F values of 28.74 for access, 7.59 for concern, and 20.13 for importance, all with p-values less than 0.001. Family income significantly influenced immunization access barrier (F =14.83, p<0.001) and immunization importance barrier scores (F =5.08, p<0.001). The social vulnerability index was also a significant factor, affecting immunization access barrier (F =5.48, p<0.005) and immunization concern barrier scores (F =4.84, p <0.01). Additionally, health insurance status significantly impacted the importance score (F =15.33, p<0.001), as did the education level of parents (F=2.89, p<0.05)

Conclusion: This study underscores the significant influence of sociodemographic factors on vaccine barriers in Tennessee, revealing that race, family income, SVI, health insurance status, and education of parents are critical determinants across the categories of parental vaccine barriers. Targeted interventions that focus on reducing access and concern-related barriers, particularly within vulnerable populations, are crucial for improving overall immunization rates and ensuring equitable healthcare access across the state.

Keywords: Health disparities, Children's health

Authors:

Presenter - SANJAYA REGMI,
University of Tennessee

Co-Author - Elizabeth Sowell,
University of Tennessee Knoxville

Co-Author - Chenoa Allen, PhD, MPH,
University of Tennessee Knoxville

Co-Author - Ben Jones,
University of Tennessee Knoxville

Co-Author - Nan M Gaylord,
University of Tennessee Knoxville

Co-Author - Victoria Niederhauser,
University of Tennessee Knoxville

D36 - Establishing Healthy Habits at a Young Age: Satisfaction and Acceptability of a Mindful Eating Program for Rural Economically Marginalized Families

Poster Number: D36
Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Dissemination and Implementation

Background:
To help address childhood obesity disparities related to socioeconomic status and urban/rural settings, a mindful eating intervention, “Eat My ABC,” was developed for preschoolers from rural economically marginalized families. The intervention demonstrated promising effects on preventing obesity and reducing food insecurity. To further guide future improvements, this study aimed to evaluate the intervention’s satisfaction and acceptability among parents and childcare teachers.

Methods:
A pragmatic trial with a pre- and post-test design was conducted with 200 preschoolers from 26 Head Start classrooms in rural Michigan. The 14-week intervention, delivered by trained childcare teachers, included weekly lessons on fruits and vegetables, mindful taste-testing activities, and letters sent home about the childcare lessons. After the intervention ended, 23 teachers and 153 parents completed evaluation surveys. Additionally, 8 teachers and 17 parents completed individual interviews on their experiences participating. The interview transcripts were analyzed using thematic qualitative analysis.

Results:
Among the 153 parents (Mage=32.6), 97.4% were female, 91.5% white and 4.6% Hispanic. The 23 surveyed teachers (Mage=38.5) were mostly female (95.7%) and all were non-Hispanic white. Overall, 88.9% of parents and 87% of teachers were satisfied with the intervention. Many (66.7-94.7%) parents found the intervention acceptable and felt it improved their whole family’s eating behaviors. They mentioned that their children “liked trying new things” and that the intervention was “getting them excited to try new foods.” They also shared that the weekly letters facilitated positive changes in their families’ eating habits and served as “helpful little nudges” to remind them to purchase fresh fruits and vegetables. Similarly, the majority (82.6-100%) of teachers agreed that the intervention was “developmentally appropriate” and increased their classroom children’s fruit/vegetable intake. All childcare teachers planned to continue teaching the curriculum in the future.

Conclusion:
Overall, the “Eat My ABC” intervention was considered satisfactory and acceptable by parents and teachers. Integrating a mindful eating program into childcare daily routines may be a promising approach to prevent obesity.

Keywords: Low-income groups, Mindfulness

Authors:

Author - Hannah Lalonde, MPH,
Michigan State University

Co-Author - Yingcen Xie, MS,
Michigan State University

Co-Author - Jiying Ling, PhD, MS, RN, PhD, MS, RN,
Michigan State University

D37 - Navigating Life: Assessing the Quality of Life for Families with Children and Adolescents with Autism Spectrum Disorder in Caldas, Colombia

Poster Number: D37
Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Quality of Life

xBackground: Autism Spectrum Disorder (ASD) significantly impacts the development and daily lives of individuals affected by it, as well as the Quality of Life (QL) of their families, due to the specialized and often continuous care required. It is estimated that, worldwide, one in every 100 children has autism. Although there have been legislative advancements in support of individuals with ASD in Colombia, studies, statistics, and institutional programs remain insufficient. In this country, particularly in a particular area (Caldas), 246 individuals were diagnosed with ASD in 2020, including 144 children and adolescents. Objective: This research aimed to assess the QL of families with children and adolescents diagnosed with ASD, that attended a developmental institution for children. Methods: This quantitative study had a non-experimental, cross-sectional, and descriptive design with a purposive sampling of 55 families with a primary caregiver of children and adolescents diagnosed with ASD participated. The Quality of Family Life Scale (ECVF) with its dimensions: family interactions, parental roles, health, safety, family resources, support for patients with disabilities. This scale was analyzed with numerical descriptive statistics such median – scale and standard deviation. The second scale utilized was the services and support scale, which was represented with frequencies and percentages. The analysis was conducted with SPSS software version 27. Results: The study highlighted the importance of various dimensions such as family interactions (p- value: 0,00), parental roles (p- value: 0,00), health, and safety (valor p 0,01). The most needed services among participants were counseling, psychological services (90,9%), occupational therapy (78,2%), Health services - medical evaluations, nutrition, nursing – (72,7%), and speech services (70,9%). More than 70% of families indicated a need for these services. Conclusion: This study provides insights about the QL of families with such dissatisfaction with the health services received. Such as the unmet needs of caregivers given their critical role in the care of children and adolescents with ASD. Likewise, the findings underscore the need for improved comprehensive care and services to enhance the QL for these families and a general dissatisfaction with the health services received or required. Moreover, these findings might inform the development of strategies and public policies in the studied population.

Keywords: Quality of life, Children

Authors:

Author - Sandra Lorena Giraldo,
University of Caldas

Author - Jose Osorio,
university of Caldas

D38 - Association between social media and adolescent health behaviors using the ecological momentary assessment (EMA) strategy: A systematic review

Poster Number: D38
Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Methods and Measurement

Purpose: The utilization of recent methodological and technological advancements has enhanced the assessment of social media use (SMU)’s impact on adolescent health behaviors (HB). Specifically, mobile device-assisted ecological momentary assessment (EMA), a novel assessment tool, holds potential to minimize recall bias and participant burden while maximizing ecological validity. However, less is known about characterizing the use of EMA in examining social media’s influence on adolescent HB. Therefore, this systematic review aimed to examine the existing literature on the relationship between SMU and health-risk behaviors among adolescents using an EMA approach.
Methods: We searched Academic Search Ultimate, CINAHL Ultimate, Health Policy Reference Center, MEDLINE Ultimate, APA PsychInfo, APA PsychArticles, and Sociology Source Ultimate, for peer-reviewed, English articles with quantitative methodology published between January 2017 and July 2024. Articles utilizing the EMA approach to examine the impact of SMU on adolescent HB (e.g., substance use, eating, physical activity, etc.) were included. Data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the study was assessed using the Checklist for Reporting EMA Studies.
Results: Ten studies met all inclusion criteria, involving a total of 1,433 adolescents. Half were conducted in the U.S. (N=5), while the remainder were conducted in European countries (N=3) or Australia (N=2). Participants’ ages ranged from 11 to 18 years, with most studies reporting a mean participant age between 14 and 16 years (N=7). Across all studies, mobile phones were used to deliver EMA prompts, with the majority using text or email (N=6). EMA duration varied from 4 to 28 days, with 1 to 9 prompts daily. Only two studies included a follow-up component, both of which were brief. Of the ten studies reviewed, four (40%) reported that increased screen time and SMU negatively impacted sleep duration, while one (10%) suggested that lower physical activity time combined with higher levels of SMU had a negative impact.
Conclusion: This review demonstrates that EMA approach is feasible for use in social media research among adolescents, has the potential to reduce participants’ recall bias and increase ecological validity. Furthermore, the results provide the foundational insights into examining the relationship between SMU and adolescent health in an EMA setting.

Keywords: Adolescents, Health behaviors

Authors:

Co-Author - Saylor Mealing,
Texas A&M University

Co-Author - Andrea Dong,
Texas A&M University

Co-Author - Jeffery Dou,
Texas A&M University

Co-Author - Kevin Wang,
Texas A&M University

Co-Author - Kelly Yang,
Texas A&M University

Co-Author - Sneha John,
Texas A&M University

Co-Author - Taylor Harber,
Texas A&M University

Co-Author - Angela Nguyen,
Texas A&M University

Co-Author - Ping Ma,
TAMU

D39 - Development of an Intervention to Address Weight Bias Internalization within an Adolescent Intensive Lifestyle Intervention

Poster Number: D39
Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Obesity

Introduction: Internalization of weight stigma and negative societal messages around weight or weight bias internalization (WBI) can lead to worsened health outcomes through a positive feedback loop in which weight stigma elicits a physiological stress reaction, leading to increased weight status and heightened risk for experiencing weight stigma. Addressing WBI and high weight status simultaneously provides one pathway for protecting against negative health consequences such as increased weight gain and cardiometabolic risk through both physiological (i.e., stress reactivity and systemic inflammation) and behavioral (i.e., unhealthy eating behaviors) mechanisms. The goal of this qualitative study was to obtain feedback from adolescents on the development of an intervention to integrate treatment for WBI into an evidence-based intensive lifestyle intervention (ILI).

Methods: Seven focus groups were conducted with 24 adolescents (ages 13-17) at higher weight status (BMI >95th%ile). Participants were asked about their experiences with weight stigma, weight bias internalization, ILI, and the intersection of these topics. In addition, they were asked to provide feedback on specific concepts to be embedded into the intervention. Rapid analysis was conducted of executive summaries of each focus group to iteratively refine the intervention.

Results: Overall, themes identified included: importance of terminology, impact of social media, negative peer interactions, and benefit of integration of weight stigma and ILI concepts. Almost no participants had heard the terms weight stigma or bias, however teens readily acknowledged examples of stigma when discussed. Adolescents reported experiencing or observing weight stigma primarily on social media and around eating behaviors. Teens viewed integration of WBI into lifestyle intervention positively, with many sharing that they appreciated knowing that they would not be judged for talking about weight in a supportive environment.

Discussion: Findings highlighted the importance of language that is accessible to teens (e.g., body positivity, body acceptance), rather than more scientific terms (e.g., weight bias internalization). Topics should include attention to key areas relevant to adolescents (e.g., social media, eating behaviors) and should include attention towards specific examples provided by adolescents (such as internalization of negative comments on social media and “joking” terminology among peers).

Keywords: Children's health, Weight control

Authors:

Presenter - Annabelle Derrick,
The Miriam Hospital

Author - Katherine Darling, PhD,
The Miriam Hospital; Alpert Medical School of Brown University

Co-Author - Emma Small,
The Miriam Hospital

Co-Author - Elissa Jelalian, PhD, PhD,
The Miriam Hospital; Alpert Medical School of Brown University

D40 - Development of a Pediatrician Intervention to Improve Communication around Weight and Related Health Behaviors in Adolescent Primary Care

Poster Number: D40
Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Obesity

Introduction: Weight stigma and bias are widespread in healthcare settings. Weight bias among healthcare professionals can impede positive health behaviors, increase distress about body shape and weight, and perpetuate healthcare avoidance. A shift in training is needed to overcome weight stigma experienced by adolescents with obesity during primary care visits, and to empower pediatricians to improve health behaviors of the adolescents they treat. Qualitative interviews were conducted to understand current practices and develop a pediatrician focused intervention for communication around weight and related health behaviors in adolescent primary care.

Methods: Qualitative interviews were conducted with 30 participants, including 9 adolescents at high weight status (ages 13-17, BMI >85th%ile), 9 caregivers of these adolescents, and 11 adolescent primary care providers, reaching saturation in each category. Interviews focused on current and desired primary care discussions of weight and related health behaviors and feedback on conversation prompts for PCPs to use when discussing weight with adolescents. Applied thematic analysis was conducted to identify themes to inform intervention development.

Results: Three main themes were identified from adolescent and caregiver interviews: importance of patient-centered care, preferences for when and how to discuss weight, and ideal treatment discussions and resources. Pediatrician themes focused on intervention development. Specifically, these included: preferred mode of intervention delivery, feasibility of incorporating changes into practice, and lack of prior training around weight-related communication. Overall, participants from all groups identified the importance of addressing weight status and related health behaviors when explicitly identified by the adolescent as a goal or when weight appears to be having a direct impact on health of the teen.

Discussion: Findings informed development of a multi-pronged remote intervention for pediatricians with modules specific to complexity of development of high weight status, weight bias/stigma in healthcare, recognition of disordered eating behaviors, combatting weight bias in clinical practice, patient centered care, and key considerations related to weight and related health behaviors (e.g., social media, anti-obesity medications). Future research will test impacts of the developed intervention on both primary care pediatrician and adolescent outcomes.

Keywords: Primary care, Health behavior change

Authors:

Presenter - Annabelle Derrick,
The Miriam Hospital

Author - Katherine E. Darling, PhD, PhD,
The Miriam Hospital/Alpert Medical School of Brown University

Co-Author - Emma Small,
The Miriam Hospital

Co-Author - Elissa Jelalian, PhD, PhD,
The Miriam Hospital; Alpert Medical School of Brown University

D41 - Hope is more powerful than fear: Eco-anxiety, emotions, and climate activism among older adolescents in northern California

Poster Number: D41
Time: 11:00 AM - 11:50 AM
Topics: Climate Change and Health, Mental Health

Background.
Climate change is a global concern and is causing mental distress and anxiety, especially among young people. Youth have complex feelings about climate change and engagement in climate activism may provide a constructive response to strong emotions. The present study explored how feelings about climate change relate to well-being and activism among youth in northern California.

Methods.
In Fall 2022, 521 first- and second-year college students (average age = 19) were surveyed. Respondents were racially diverse (78% non-white), female (73%), and getting by on their present income (68%). Many (43%) identified as environmental activists.

Established measures and scales were used to assess key variables. Respondents were asked about the emotions they felt when thinking about climate change, including six negative (e.g., angry, afraid) and six positive (e.g., motivated, supported) emotions.

General linear models tested associations between variables; positive and negative emotion scales were entered simultaneously, and all models controlled for race, gender, and income.

Results.
Negative emotions about climate change were strongly associated with eco-anxiety (F[9, 453] = 164.03, p < .001), while positive emotions were not. Positive emotions connected to hope for the present and future (F[9, 466] = 24.64, p <.001), and negative emotions linked to compassion (F[9, 467] = 6.86, p =.009). Stronger positive (F[9, 446] = 127.41, p < .001) and negative emotions (F[9, 446] = 44.99, p <.001) were both associated with increased confidence that environmental actions make a difference.

Higher positive (F[9, 446] = 127.41, p < .001) and negative F[9, 446] = 44.99, p <.001) emotions also were strongly associated with environmental activism. Activism was associated with eco-anxiety (F[8, 413] = 53.90, p <.001) and increased compassion (F[8, 415] = 7.72, p = .006).

Discussion.
Youth who express strong emotions about climate change – whether negative or positive – are environmental activists who have high confidence that their actions will make a difference. But young people who feel fearful and angry about the impacts of climate change also suffer from high eco-anxiety, while youth who feel motivated and supported are more hopeful about the present and future. Climate education and communication that support young people in their activism and highlight hope, empowerment, and determination is essential for promoting youth mental health and well-being.

Keywords: Mental health, Adolescents

Authors:

Presenter - Kelly L. L'Engle, PhD, MPH, PhD, MPH,
University of San Francisco

D42 - The Impact of Extreme Heat Exposure on Physical Activity Interventions

Poster Number: D42
Time: 11:00 AM - 11:50 AM
Topics: Climate Change and Health, Physical Activity

A primary impact of climate change is an increase in severity and frequency of extreme heat events, which negatively impact physical health. Previous research has shown that physiological characteristics such as age and pre-existing health conditions increase an individual’s risk of heat-related concerns, but little work has examined how the efficacy of behavioral interventions is affected by extreme heat.

Data was collected as a part of the WalkIT Arizona study, where healthy, inactive adults (n = 512) were instructed to wear an accelerometer daily for one year and provided daily goals for moderate-to-vigorous physical activity. This study took place in Maricopa County, AZ, where during summer months temperature frequently rises above 110 degrees Fahrenheit. Participants were randomly assigned to one of four treatment conditions in a 2x2 factorial design with static vs. adaptive physical activity goals crossed with delayed vs. immediate reinforcement reward timing. A hurdle model was fit to daily-level data with MVPA minutes as the dependent variable and i.) study condition, ii.) the occurrence of an extreme heat event, defined as a daily average temperature of 90 degrees Fahrenheit or greater, and iii.) their interaction as independent variables. Accelerometer wear time, neighborhood SES and walkability, and time of year were included as covariates.

The effect of extreme heat varied by treatment group, with the largest effect being with the static goals/immediate reinforcement group. In this group, the odds of performing no MVPA were 1.23 times higher on days with extreme heat (p < 0.001) and on days with any MVPA, participants performed 6.2 % less MVPA on days with extreme heat (p<0.001). The largest between-group disparity in the effect of extreme heat was between static goals/immediate reinforcement and adaptive goals/immediate reinforcement groups. In the latter, on extreme heat days, the odds ratio of performing no MVPA was 0.83 times as large (p<0.006) and when MVPA was performed, its rate was 4.1% larger (p=0.007).

Extreme heat exposure disproportionately affected participants in the static goals/immediate reinforcement group, highlighting the need for future physical activity interventions to consider the effects of extreme heat exposure when assigning treatment conditions. Climate change is a significant concern affecting all aspects of life, and behavioral medicine must adapt to these challenges to effectively help the public.

Keywords: Physical activity, Environment

Authors:

Author - Analisa Vavoso,
Chapman University

Co-Author - Vincent Berardi, PhD, PhD,
Chapman University

Co-Author - Marc A. Adams, PhD, MPH, PhD, MPH,
Arizona State University

D43 - Supporting Research Partnerships in a Spinal Cord Injury Research Centre: Theory-Based Qualitative Investigation

Poster Number: D43
Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Dissemination and Implementation

Background: Research partnerships are a promising approach for ensuring science is relevant, useful, and used. The Integrated Knowledge Translation (IKT) Guiding Principles (iktprinciples.com) define expectations for meaningful engagement within the context of Spinal Cord Injury (SCI) research. The International Collaboration on Repair Discoveries (ICORD) is a multi-disciplinary SCI research organization (N>80 research teams) dedicated to supporting SCI research partnerships. The objective of this study was to apply the Consolidated Framework for Implementation Research (CFIR), Theoretical Domains Framework (TDF), and Behaviour Change Wheel (BCW) to understand barriers and facilitators to using a research partnership approach and the IKT Guiding Principles within ICORD (i.e., a SCI research system) to inform support for research partnerships.

Methods: Guided by pragmatism and IKT, ICORD researchers, trainees, and research users were recruited to complete a survey (N=35) and interview (n=10; 80% women; 40% trainees). The CFIR informed the survey and interview questions, and the TDF and BCW guided deductive analyses. Inductive thematic analysis was conducted within and across domains for each behaviour.

Results: Two coders identified 112 factors (32 barriers, 80 facilitators) related to using a partnership approach, and 32 factors (14 barriers, 18 facilitators) related to using the IKT Guiding Principles (79% agreement). A total of 13 TDF domains were identified and linked to 8 intervention functions and 7 policy categories (Kappa=0.78; PABAK=0.93). Key themes included academia's unsupportive culture, uncertainty about partnership and the IKT Guiding Principles, and gaps in knowledge. Participants identified learning areas and resources to enhance their capability and opportunity to partner and apply the IKT Guiding Principles.

Conclusion: Findings are being mobilized to foster changes at the individual, relational, and institutional levels within ICORD. Ultimately, this work will support partnered research within ICORD and beyond, offering valuable lessons for diverse SCI research contexts. Specific calls to action include dedicated funding, partnership training, and opportunities for connecting with partners. These findings point to the need for changes across all levels of SCI research to ensure that partnerships become a fundamental part of the research process, leading to discoveries that truly benefit those impacted by SCI.

Keywords: Systems thinking, Research to practice translation

Authors:

Presenter - Alanna Shwed,
The University of British Columbia Okanagan

Co-Author - Kelsey Wuerstl, PhD,
The University of British Columbia Okanagan

Co-Author - Nancy Thorogood, PhD,
International Collaboration on Repair Discoveries (ICORD)

Co-Author - SCI IKT Guiding Principles Partnership,
The University of British Columbia

Co-Author - Heather Gainforth, PhD,
The University of British Columbia Okanagan

D44 - Nothing about us without us: youth advisory boards amplify adolescent voice in health services decision making

Poster Number: D44
Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Decision Making

The importance of youth participation in decisions affecting their health and well-being has been increasingly recognized in contemporary health discourse. Youth councils and advisory boards have emerged as pivotal structures in this context, serving as platforms where young individuals can actively contribute to discussions, policies, and practices that directly affect their health and well-being. These councils, typically comprising adolescents from diverse backgrounds, act as liaisons between their peers and health institutions, ensuring that health strategies are not only evidence-based but also youth-informed. However, research in this form of extracurricular involvement remains under-explored. This mixed-methods study employing a convergent parallel design evaluated the impact and efficacy of a youth advisory board (YAB) in a metropolitan health center over a two-year period. Quantitative data were collected through surveys of health center staff (n=22) and adolescent patients (n=481) pre- and post-YAB implementation. Qualitative data were gathered via semi-structured interviews with YAB members (n=15), health practitioners (n=20), and focus groups with adolescent beneficiaries (n=20). Statistical analysis revealed significant improvements in adolescent engagement (t(499)=4.72, p<0.001, d=0.42) and satisfaction with health services (χ²(1)=18.63, p<0.001, φ=0.19). Health center staff reported enhanced understanding of adolescent needs (F(1,48)=15.27, p<0.001, η²=0.24). Structural equation modeling demonstrated that YAB influence on health outcomes was mediated by increased youth engagement (indirect effect: β=0.18, 95% CI [0.11, 0.25], p<0.001). Thematic analysis identified key themes: (1) enhanced relevance of health interventions, (2) improved youth-provider communication, and (3) challenges in maintaining equitable youth participation. Our research accentuates the imperative of embedding youth voice within health decision-making paradigms, and insights gained warrant the broader institutionalization of youth advisory boards and councils, underscoring their salient role in optimizing adolescent health interventions.

Keywords: Decision making, Public health

Authors:

Co-Presenter - Rick Yang,
Harvard College

Co-Presenter - Alina Yang,
Scarsdale High School

D45 - The Impact of a Community Research Partner Training Program

Poster Number: D45
Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Cancer

Abstract

Background As part of its mission to address disparities in cancer outcomes and research participation, the Philadelphia Communities Conquering Cancer (PC3) coalition conducted a Community Partner Research Training program. The goal was to increase knowledge about cancer research and to prepare community members to partner on research activities.
Methods Eighteen out of 36 applicants were selected for a 5-week training program on research methods. Trainees completed baseline (N= 18) and follow-up surveys (N=10) to measure knowledge acquisition. Demographic data were analyzed with descriptive statistics. For repeated cross-sectional group comparisons, Wilcoxon nonparametric tests were used to test statistical differences between medians on baseline and follow-up surveys. P values ≤ .05 were considered statistically significant.
Results Trainees were mostly female (78%). Median age was 61.5 years. Forty-four percent were Black, 22% White, 17% Asian, and 17% other race. Twenty-eight percent were Hispanic. Forty-four percent were cancer survivors. We observed that perceived knowledge about research generally increased post-training from a median of 2 to 4 across a 5-point Likert scale (p < .001). This increase is shown for several items, including, for “how to conduct a research study” and “how to share findings with the community.” Program ratings averaged 4 out of 5, indicating positive participant experiences in program organization and content.
Conclusion Involving diverse populations in cancer research is crucial for reducing health disparities. This training program demonstrated that we could increase knowledge about cancer research methodology among community partners. These results will be used to guide future research activities with PC3.

Keywords: Cancer, Health education

Authors:

Co-Author - Oluwademilade Adefarati, MPH,
Fox Chase Cancer Center

Co-Author - Rickisa Yearwood, BS,
Fox Chase Cancer Center

Co-Author - Yawei Song, MPH, MSW, LSW,
Sidney Kimmel Cancer Center, Jefferson Health

Co-Author - Amy Leader, DrPH, MPH,
Thomas Jefferson University

Co-Author - Karen Glanz, PhD MPH, FSBM,
University of Pennsylvania

Co-Author - Evelyn Gonzalez, MA,
Fox Chase Cancer Center

Co-Author - Scott W. Keith, PhD, MS,
Thomas Jefferson University

Co-Author - Nilsa R. Graciani, PhD,
Esperanza

Co-Author - Thierry Fortune, MBA,
Philadelphia Department of Public Health

Co-Author - Charnita Zeigler-Johnson, PhD, MPH,
Fox Chase Cancer Center

D46 - Patience is a Virtue: Lessons from a participatory approach to contextually tailor an employee wellness intervention for community health educators

Poster Number: D46
Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Dissemination and Implementation

Background
Community health educators (CHE) are crucial bridges to translate empirical health evidence into actionable information for underserved populations. However, the wellbeing of CHE themselves is threatened by chronic work-related stress. By using a participatory approach to adapt existing core elements of employee wellness interventions, our objective is to co-create a wellness intervention that is feasible and acceptable to CHE of the federal Cooperative Extension System.

Methods
We gathered formative data from an ongoing integrated research-practice partnership (IRPP) with CHE of Cooperative Extension to guide adaptations on intervention content, dose, and delivery. IRPP members shared key intervention considerations which informed a sequential exploratory mixed-methods approach. To garner contextual considerations and phenomena, we conducted four focus group sessions with CHE from different states (N=21, n=4 to 6 per session, 9 states represented). We built a follow up survey based on qualitative findings to inform intervention delivery.

Results
Members of the IRPP preferred holistic wellbeing, i.e., flourishing, as a comprehensive target for a CHE wellness intervention. Eighty-one percent (n=17) of focus group participants (90% Female, 62% White) completed the follow up survey. Focus group findings demonstrated a desire for a multi-component intervention (e.g., education, accessible group yoga practices) to address the multiple domains of flourishing and provided guidance on imagery and messaging of recruitment materials. Notably, participants emphasized scheduling as the greatest barrier to overcome. One participant shared that “I think there are probably solutions for this, but it may take a lot of patience while figuring it out.” Survey data elucidated intervention delivery preferences including timing for the intervention (47% preferring a Jan-Mar launch), time of day (early morning ranked highest); facilitator (52% yoga teachers, 24% peer CHE, 0% administrators); as well as the order of content delivery in intervention sessions.

Conclusions
Data from an IRPP with CHE captured often overlooked nuance important for implementation, particularly tailoring the timing of intervention delivery. Beginning with the end in mind and taking careful consideration of contextual factors may improve feasibility and acceptability of intervention characteristics and ultimately increase reach, representativeness, and efficacy.

Keywords: Worksite health, Participatory research

Authors:

Co-Author - Megan J. Pullin, M.S.,
Virginia Tech

Co-Author - Samantha M. Harden, PhD,
Virginia Tech

D47 - Methods for Community Engagement in Research Priority Setting with Low Grade Glioma Partners

Poster Number: D47
Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Cancer

Background: Low grade glioma (LGG) is a rare malignant brain tumor primarily affecting younger adults, leading to significant disability and eventual mortality. Advances in tumor molecular characterization and treatment, alongside strong partnerships with the LGG community, present opportunities for community-engaged research.
Objective: Describe the methods and results of engaging the LGG Registry’s Research Advisory Council (RAC) in prioritizing research topics.
Methods: We adapted a process from the nominal group technique (NGT) to engage the RAC in prioritizing research for the 3rd year of a grant (starting September 2023). NGT involved facilitated group discussions and asynchronous surveys to select top priorities of RAC member interest. This process led to the establishment of four working groups, a grant proposal, and at least one manuscript. The RAC and broader research team partnered to plan and implement the research priorities.
Results: Research priorities included enhancing LGG Registry recruitment and participant communication and incorporating additional research on topics such as quality of life, chronic disease management, and cognitive rehabilitation. We secured a pilot and feasibility grant to support co-design of a chronic disease management intervention for people with LGG. Four working groups, each co-led by a RAC member and research facilitator, met monthly to develop proposals: 1) strategies for improving Registry recruitment , 2) a manuscript on LGG patient and care partner perspectives on cognitive rehabilitation, 3) new patient-facing templates about genomic testing, and 4) a video series featuring RAC patient stories.
Discussion: Engaging LGG community in research prioritization yielded additional research funding, academic and non-academic dissemination, scientific meeting participation, and innovative solutions for research recruitment and return of genetic results. The engagement methods ensured all partners had a voice in research planning, conduct, and dissemination, prioritizing topics such as chronic disease management, mental health, cognitive rehabilitation, genomics, and dissemination science. This experience contributes to the growing body of evidence on the science and practice of engagement, generating valuable insights into how to engage patients and care partners in the process of research.

Keywords: Methodology, Cancer survivorship

Authors:

Presenter - Bethany M. Kwan, PhD, MSPH, FSBM,
University of Colorado School of Medicine

Co-Author - Lindsay Lennox,
University of Colorado School of Medicine

Co-Author - Carly Ritger,
University of Colorado School of Medicine

Co-Author - Juliana Barnard, MA,
University of Colorado School of Medicine

Co-Author - Kisori Thomas,
University of Colorado School of Medicine

Co-Author - Ricardo Gonzalez-Fisher, MD,
Servicios de la Raza

Co-Author - Kevin C. Johnson, PhD,
Yale University

Co-Author - Nancy Ortiz,
Community Partner

Co-Author - Daniel Myers,
Community Partner

Co-Author - Annie Heffernan,
Yale University

Co-Author - Mathew Krick,
Yale University

Co-Author - Elizabeth Claus, MD, PhD,
Yale University

Co-Author - Roel Verhaak, PhD,
Yale University

Co-Author - Liz Salmi,
Beth Israel Deaconness Medical Center

D48 - Associations of Interoceptive Awareness with Leisure Time Physical Activity Engagement, Intensity, and Duration

Poster Number: D48
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Mental Health

Moderate-vigorous leisure time physical activity (MV LTPA), or moderate and/or vigorous physical activity done in one’s disposable time, has been tied to many favorable physical and mental health outcomes (e.g., cardiovascular, weight, bone density, mood, stress, sleep, cognitive function). Yet only 46.9% of U.S. adults meet aerobic physical activity guidelines (Bull et al., 2020). While MV LTPA remains a primary focus, assessing total and mild LTPA is important to compare the potential unique characteristics of those engaging in higher-intensity LTPA. Interoceptive awareness (IA)—one’s self-reported attention, emotional, and regulatory responses to appraise and regulate one’s bodily sensations (Mehling et al., 2012)—has emerged as a potential modifiable factor for promoting LTPA.

This two-study project examined the relationship of four dimensions of IA (Trusting, Not-Worrying, Self-Regulation, and Body Listening) on both the engagement in and duration of different intensities of LTPA. In Study 1, 234 college students (Mage= 19.25, SD=1.40) completed surveys at one timepoint. One dimension of IA, Trusting, was associated with greater likelihood of MV LTPA engagement (r = .14; p = .031). Not-Worrying, or refraining from excessive worry about uncertain future events or negative outcomes, was associated with total LTPA. For participants who engaged in MV LTPA, accounting for gender and age, Body Listening (B=.15, SE=.057, p=.005) and Not-Worrying (B=.15, SE=.074, p=.043) were each associated with more minutes of MV LTPA. In Study 2, 265 participants from a community sample completed a baseline survey of IA then daily surveys of LTPA. Self-regulation (r=.19, p=.002), Body Listening (r=.25, p<.001), and Trusting (r=.24, p<.001) were all associated with likelihood of engagement in MV LTPA. These three dimensions of IA were also associated with mild and total LTPA. After accounting for age and gender, no dimensions of IA predicted the amount of MV LTPA. However, Self-Regulation, Body Listening, and Trusting all predicted more minutes of mild intensity and total LTPA.

These results highlight the potential importance of IA in training and supporting individuals to develop in more body awareness to adopt and maintain LTPA, irrespective of intensity. Promoting aspects of IA might be an important modifiable factor, especially in young adults, to consider when trying to reduce sedentarism and support LTPA goals for individual and public health initiatives.

Keywords: Interoception, Physical activity

Authors:

Co-Author - Katherine E. Gnall, MS, MS,
University of Connecticut

Author - Crystal L. Park, PhD, FSBM, PhD, FSBM,
University of Connecticut

D49 - Barriers and facilitators for cascade genetic services: a qualitative study of tested and untested individuals with a family history of Lynch syndrome

Poster Number: D49
Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Cancer

Background: Lynch syndrome (LS) is a hereditary syndrome that significantly elevates risk for multiple cancers, including colorectal and endometrial cancer. Early detection of LS improves morbidity/mortality and is imperative for cancer prevention; however, pre-test genetic counseling and testing after learning of a family member’s LS diagnosis is under-utilized.

Purpose: To identify the facilitators and barriers to seeking genetic services among people at high risk for LS.

Methods: Participants included 27 adults (11 men, 16 women; 22 non-Hispanic White) with a known family history of LS. We conducted 7 focus groups and 1 interview based on the COM-B model (Capability-Opportunity-Motivation-Behavior), with the groups arranged by those who underwent genetic testing (n = 16) and those who have not (n = 11). Thematic analysis was conducted.

Results: Knowing family history and relevant information regarding LS (e.g., inheritance risk, cancer risk) is an important first step in one’s motivation to pursue genetic services. While both tested and untested groups said generally there is no harm in getting tested, they raised concerns about the impact of a positive result on non-health factors such as insurance and employment. Understanding how the results could impact cancer prevention and frequency of cancer screening would help the untested prioritize genetic testing. All participants discussed the importance of understanding the steps to get genetic testing and having a smooth referral process. Untested participants reported visiting medical providers who lacked knowledge about LS and not having access to useful educational materials. Free genetic testing was a motivator but not a determinator, while high perceived costs of testing was a barrier. In addition, family played an important role in decision-making (e.g., having a relative share their testing experiences or encourage testing). Participants discussed how knowing their LS status could help to inform and protect other family members. Strong emotional experiences, such as anxiety and fear could either motivate testing or serve as a barrier to getting tested.

Conclusion: Intervention opportunities include helping individuals at risk for LS understand the benefits of genetic counseling and testing, providing actionable steps for scheduling, and emphasizing the value of this information for their family.

Keywords: Decision making, Genetics

Authors:

Presenter - Haoyang Yan, PhD,
Northwestern University; University of Alabama at Birmingham

Co-Presenter - Jessica Powers, PhD,
Northwestern University

Co-Author - Karen Kaiser, PhD,
Northwestern University Feinberg School of Medicine

Co-Author - Marc D. Schwartz, PhD, FSBM,
Georgetown Lombardi Comprehensive Cancer Center

Co-Author - Brittany Szymaniak, PhD, LCGC,
Northwestern University

Co-Presenter - Carley Knudsen, MS, LCGC,
Northwestern Unviersity

Co-Author - Athena Nagel, MS,
Northwestern University

Co-Author - Christine Rini, PhD,
Northwestern University Feinberg School of Medicine

D50 - Relationships Between Physical Activity, Stress, Diabetes Distress, and Glucose Variability in Type 2 Diabetes: A Study Using Ecological Momentary Assessment and Continuous Glucose Monitoring

Poster Number: D50
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Physical Activity

Background. Physical activity (PA), psychological stress, and diabetes distress have been shown to be associated with glucose control. Glucose variability—fluctuations in blood glucose levels—is an important parameter of dynamic glycemic control and can be measured via real-time through continuous glucose monitoring (CGM). Ecological momentary assessment (EMA) captures real-time data on behavior and psychological stress in natural settings. This study aimed to examine the relationship among PA timing, daily PA, daily stress, daily diabetes distress, and glucose outcomes using EMA and CGM among individuals with type 2 diabetes (T2D).

Methods. Participants (n=67) with T2D responded to EMA surveys 4 times/day for 14 days. PA timing (morning, afternoon, evening) was recorded via EMA (yes/no), while daily PA (≥30 minutes, yes/no) was assessed in the final daily survey (at bedtime). Stressful events (yes/no) and stress levels (no stress [0] to extreme stress [10]) were measured 4x/day. Diabetes distress was assessed nightly using a 2-item Diabetes Distress Scale (DDS). Glucose variability (% coefficient of variation [CV] for glucose—stable CV is ≤33%) and mean glucose levels were tracked over 14 days via CGM. Multiple regressions with mixed effect models were performed for repeatedly measured daily glucose.

Results. The sample was predominantly female (70%), with a mean age of 61.96 years (SD=9.37) (Non-Hispanic [NH] White, 74.2 %; NH Black, 15.1%; NH Asian 1.5%). Mean CV was 23.31% (SD=6.44). Participants reported a mean of 1.0 daily stressful events (SD=2.22; range 0-8) and a mean stress level of 6.53 (SD=5.03; range 0-10). Mean DDS score was 2.11 (SD=1.19), indicating moderate level diabetes distress (2.0-2.9). Engaging in ≥30 minutes of daily PA was significantly associated with lower daily glucose levels (coefficient ± SE, -0.03±0.01, P<0.05). In another multiple regression model, higher stress level (coefficient ± SE, 0.31±0.14, P<0.05) and DDS scores (coefficient ± SE, 0.97±0.49, P<0.05) were associated with grater glucose variability. PA timing was not significantly associated with glucose variability.

Conclusion. Engaging in ≥30 minutes of daily PA was associated with lower daily glucose level, while higher daily stress and diabetes distress were linked to greater glucose variability in individuals with T2D. Future studies with large sample sizes are needed to further evaluate the relationship between PA timing and glucose variability.

Keywords: Physical activity, Diabetes

Authors:

Author - Soohyun Nam, PhD,
Yale University

Co-Author - Minjung Lee, PhD,
Yale University

Co-Author - Sangchoon Jeon, PhD,
Yale University

D51 - Exploring the Role of time in diabetes self-management and strategies to overcome time constraints: A scoping review

Poster Number: D51
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Multiple Health Behavior Change

Background: Type 2 diabetes (T2D) is a chronic condition that requires engagement in daily self-management behaviors (SMBs) such as medication use, glucose monitoring, physical activity, and dietary modifications to achieve optimal health outcomes. These SMBs can be time-consuming, necessitating effective time-management strategies. This scoping review synthesized evidence on the role of time in diabetes SMBs and explored potential strategies to improve time management for individuals with T2D.
Methods: We conducted a comprehensive search of PubMed, PSYCHINFO, CINAHL, and Cochrane Library databases for peer-reviewed articles published from inception to March 2024. The review was guided by Arksey and O’Malley’s framework and PRISMA guideline for a scoping review.
Results: The search yielded 3138 articles, with 47 meeting the inclusion criteria. These studies, published between 2013 and 2024, were mostly concentrated in the last five years (72%), spanning 26 countries. The average sample size and participants’ age were 206 and 56, respectively. Most studies utilized a qualitative approach (55%), and 21% used a quantitative descriptive design. All 47 studies reported time constraints due to family, work, social, and caregiving responsibilities as significant barriers to diabetes SMBs. These constraints particularly impacted the general management of diabetes (reported in 36% of studies), physical activity (30%), diabetes education (15%), dietary modifications (6%), self-monitoring (4%), and complications prevention (2%). About half of the studies (49%) suggested strategies to address time-related barriers, including establishing dedicated routines for SMBs, leveraging family/social networks, flexible work schedules and accommodations, virtual/SMS-based education, and automation of SMB tasks and data capturing. However, the five studies that adopted quasi-experimental and true experimental designs only tested telehealth-based strategies, and they demonstrated positive outcomes.
Conclusions: Our review highlights that time constraints from work, social, and family obligations are a prevalent global barrier to diabetes SMBs, with limited evidence on effective interventions to overcome this barrier. Addressing time-related barriers will likely require multilevel approaches, encompassing individual planning and role adjustments, interpersonal support from family and social networks, and broader structural changes in healthcare systems and workplace policies.

Keywords: Diabetes, Health behaviors

Authors:

Presenter - Eyitayo O. Owolabi, PhD, RN,
Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, USA

Co-Presenter - Michelle D.S. Boakye, PhD, RN,
Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, USA.

Co-Author - Oluwatosin Leshi, PhD,
College of Medicine, University of Kentucky, Lexington, USA

Co-Author - Shammah O. Omololu, MSc, RN,
College of Nursing, University of Cincinnati, Ohio, USA

D52 - Perceptions of acceptability, appropriateness, feasibility, and sustainability of clinic implementation strategies to increase patient referrals to diabetes self-management education and support

Poster Number: D52
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Dissemination and Implementation

Background: The prevalence of diabetes in Appalachian Kentucky is among the highest in the United States. Diabetes self-management education and support (DSMES) is a cost-effective, evidence-based intervention that improves patient outcomes, yet it is underutilized due to multilevel barriers. Throughout 2023–2024, we partnered with a statewide quality improvement advisory organization and two regional healthcare systems in Appalachian Kentucky to implement a 9-month DSMES learning collaborative, through which clinics developed and refined implementation strategies to increase DMSES referrals.

Methods: We first asked participants to describe implementation strategies they used during the collaborative, identify the intended outcomes of those strategies, and state any modifications to strategies; these data were collected via Qualtrics surveys administered to clinic practitioners and support staff (n = 13) in a group format over Zoom at two timepoints: midpoint and conclusion of the learning collaborative. Participants (n = 9) then individually completed online surveys assessing the acceptability, appropriateness, and feasibility of each strategy (12 total questions, 4 per domain), and the potential for sustainment of clinic DSMES activities across RE-AIM implementation outcomes (17 total questions). Questions used 5-point unidimensional Likert scales that were summed and averaged, with higher numbers indicating greater favorability.

Results: Clinic strategies for increasing DSMES referrals included creating a new referral system for their electronic health record, utilizing morning huddles to engage support staff and identify eligible patients, and creating patient face sheets for providers to review during visits. Modifications to these strategies were minimal and were intended primarily to increase provider and staff participation and to increase patient and provider acceptability of DSMES activities. Across the six reported implementation strategies, mean scores for acceptability (4.74), appropriateness (4.87), and feasibility (4.68) were high, as was likelihood for sustainability of activities (4.59).

Conclusion: Participation in a 9-month facilitated learning collaborative resulted in acceptable, appropriate, and feasible implementation strategies that were developed and modified to fit clinic context and perceived as having high likelihood for sustaining improvements in clinic DSMES referrals.

Keywords: Diabetes, Research to practice translation

Authors:

Presenter - Aaron Kruse-Diehr,
University of Kentucky College of Medicine

Co-Author - Borsika A. Rabin, PhD, MPH,
University of California San Diego

Co-Author - Jessica Elliott, CPHQ,
UK HealthCare, Kentucky Regional Extension Center

Co-Author - Brent McKune, MBA, CHPS, CPHIMS,
UK HealthCare, Kentucky Regional Extension Center

Co-Author - Vance Drakeford, MHI, PCMH CCE,
UK HealthCare, Kentucky Regional Extension Center

Co-Author - Laura Wright,
UK HealthCare, Kentucky Regional Extension Center

Co-Author - Key Douthitt, MD,
University of Kentucky College of Medicine

Co-Author - James Keck, MD, MPH,
Alaska Native Tribal Health Consortium

Co-Author - Mary Lacy, PhD,
University of Kentucky College of Public Health

D53 - Tengo miedo: Barriers to accessing diabetes preventive services among Latino individuals living in rural Indiana

Poster Number: D53
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Health of Marginalized Populations

Background: Latino individuals living in rural areas of the US face high diabetes risk but lack access to preventive services. The specific factors that hamper access in this population remain understudied.

Objectives: Identify the barriers that Latino individuals in rural Indiana encounter when accessing diabetes preventive services.

Methods: As part of a participatory design approach, we conducted one workshop in two rural counties in Indiana to identify barriers to accessing diabetes preventive services among Latino communities. Each workshop was conducted in Spanish and lasted two hours. Data were collected through a group story-building exercise, where participants identified the barriers they face when accessing diabetes preventive services, followed by journey mapping, where participants recorded the identified barriers along several steps. Two research team members independently coded the identified barriers and categorized them according to the National Institute on Minority Health and Health Disparities Research Framework.

Results: Twenty-two Latino individuals (82% women), over the age of 18 years, residing in two rural Indiana counties participated. Participants identified fear as the main barrier at the individual level of the sociocultural environment domain. Specifically, they cited fear of receiving a disease diagnosis, fear of immigration repercussions, fear of discrimination by healthcare personnel, fear of not being able to communicate in English, and fear of elevated healthcare costs. At the interpersonal and community levels of the Built/Physical Environment domain, the main barriers identified were lack of transportation and limited time for seeking healthcare due to work schedule. Finally, at the individual and community levels of the Healthcare System domain, barriers identified included lack of healthcare insurance, limited health literacy, and insufficient or unreliable resources/information in Spanish.

Conclusion: Latino individuals in rural Indiana face multi-level barriers that prevent them from accessing diabetes preventive services. Addressing these barriers will require interventions to reduce fear and improve health literacy at the individual level, as well as systemic changes to reduce the costs and improve access to diabetes preventive services.

Keywords: Disparities, Socioeconomic

Authors:

Presenter - María Montenegro,
Indiana University Bloomington

Co-Author - Karla I. Galaviz, MSc, PhD, MSc, PhD,
Indiana University Bloomington

Co-Author - Dayanna Moreno,
Indiana University

Co-Author - Rossina Sandoval,
Community Partner

Co-Author - María Sandoval,
Community Partner

Co-Author - Mary De Groot, Ph.D., Ph.D.,
Indiana University School of Medicine

Co-Author - Ines Gonzalez Casanova, PhD, PhD,
Indiana University Bloomington

D54 - The Impact of Participant and Group-Level Factors on Retention in the Diabetes Prevention Program

Poster Number: D54
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Multiple Health Behavior Change

Introduction:
The National Diabetes Prevention Program (DPP) is a yearlong lifestyle modification program designed to reduce the risk of type 2 diabetes through healthy eating, increased physical activity, and sustainable behavior change. Greater attendance and longer retention are strongly associated with successful achievement of the program’s 5% weight loss goal. Prior research has focused on participant-level factors influencing retention. However, few studies have examined how group-level factors influence retention, despite the widespread use of group-based formats for program delivery. The purpose of this study is to explore the association of baseline and time-varying participant and group characteristics with retention.
Methods:
We conducted a secondary analysis of data collected by a workplace DPP to summarize associations of baseline and time-varying participant and group characteristics including age, race, attendance, physical activity, and weight loss, with rates of dropping out of the DPP. We constructed Cox proportional hazards frailty models to acknowledge group to group variability in dropout times as follows: Model 1: baseline participant characteristics, Model 2: baseline participant and group characteristics; and Model 3: baseline and time-varying participant and group characteristics. A hazard ratio (HR) <1 was considered consistent with decreased dropout rate.
Results:
Between June 2014 and March 2020, 279 individuals were organized into 23 in-person DPP groups. Model 1 found no significant associations between baseline participant characteristics and dropout rates. After controlling for group-averaged age and BMI in Model 2, higher participant baseline BMI was associated with higher dropout rates (HR=1.24 per 6 kg/m2 change in baseline BMI, 95% CI: 1.02 - 1.51). After controlling for baseline and time-varying participant and group characteristics, Model 3 showed that time-varying, participant adherence and performance measures had the strongest associations with dropout rates from the DPP. A four percent increase in weight loss from enrollment was associated with a 44% decrease in the dropout rate (HR=0.56, 95% CI: 0.45 - 0.69), and a 30% increase in the proportion of visits attended at any time point was associated with a 48% decrease in the dropout rate (HR=0.52, 95% CI: 0.42 - 0.66).
Conclusion:
Efforts to improve DPP retention should account for both baseline and time-varying participant and group characteristics.

Keywords: Health behavior change, Diabetes

Authors:

Author - Lindsay Miller, MA,
Vanderbilt University Medical Center

Co-Author - Muktar Aliyu, MD/ DrPH,
Vanderbilt University Medical Center

Co-Author - Jonathan Shildcrout, PhD,
Vanderbilt University Medical Center

Co-Author - Yaping Shi, MS,
Vanderbilt University Medical Center

Co-Author - Carolyn Audet, PhD,
Vanderbilt University Medical Center

Co-Author - Mohammed Ali, MD,
Emory University

Co-Author - Lori Rolando, MD/MPH,
Vanderbilt University Medical Center

Co-Author - Rosette Chakkalakal, MD,
Emory Univeristy

D55 - The Impact of Coping Style on Symptoms of Anxiety and Depression in Maternal Caregivers of Adolescents with Type 1 Diabetes

Poster Number: D55
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Child and Family Health

Introduction
Previous research indicates that mothers of adolescents with type 1 diabetes (T1D) consistently report high levels of stress related to managing their child’s care. Additionally, diabetes-related stress in mothers is associated with increased risk of depression and anxiety. However, the relationship between strategies used by mothers to cope with T1D-related stressors and psychological outcomes has not been thoroughly investigated. We aimed to assess whether the use of coping strategies was linked to symptoms of depression and anxiety in mothers caring for adolescents with T1D.

Methods
Female caregivers of adolescents with T1D (N=151, mean child age = 14.0+2.0, 56% female, 83% non-Hispanic White, HbA1c = 9.0+2.1%) completed the Patient Health Questionnaire (PHQ-9) to assess depressive symptoms, and the Generalized Anxiety Disorder Scale (GADS) to assess symptoms of anxiety. A score of ≥ 10 on either screener indicated clinically significant symptoms. To determine the use of primary control engagement coping (e.g., problem solving), secondary control engagement coping (e.g., positive thinking, acceptance), and disengagement coping strategies (e.g., avoidance), caregivers completed the Responses to Stress Questionnaire – T1D version.

Results
Maternal caregivers with clinically significant depressive symptoms reported lower use of primary control coping strategies (M=.20±.03) than those with minimal or mild depressive symptoms (M=.21±.04, t=-2.1, p=.040). In a multivariable regression analysis adjusting for demographics (child age, parent age, race, marital status, total income), we found that primary control coping (β=-.25) and secondary control coping (β=-.21, both p<.01) were significant predictors of PHQ-9 scores. Additionally, maternal caregivers with clinically significant symptoms of anxiety reported using less secondary control coping strategies (M=.23±.04) than other caregivers (M=.26±.05, t=-4.2, p<.001). The multivariable regression model adjusted for demographics indicated the use of secondary control coping was a significant predictor of GADS scores (β=-.44, p<.001). Disengagement coping strategies were not significantly related to maternal symptoms of depression or anxiety in our sample.

Conclusions
Our findings suggest that the use of primary and secondary control coping strategies may help mitigate diabetes-related stress in caregivers, emphasizing the need for targeted interventions.

Keywords: Diabetes, Caregiving

Authors:

Author - Tabitha McCarty, BS,
Vanderbilt University Medical Center

Co-Author - Charity Davis, BA,
Vanderbilt University Medical Center

Co-Author - Sarah S. Jaser, PhD,
Vanderbilt University Medical Center

D56 - Exploring psychosocial influences on glycemic control among non-Hispanic Black and Hispanic adults with Type 2 Diabetes: A Scoping Review

Poster Number: D56
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Health of Marginalized Populations

Background: Non-Hispanic Black and Hispanic populations experience a higher prevalence of type 2 diabetes (T2D) and are more likely to have poor self-management outcomes than other ethnic groups. These disparities may be attributed to psychosocial challenges that negatively impact T2D self-management, leading to suboptimal glycemic control.

Aim This scoping review aimed to explore evidence of the intersection between psychosocial factors and glycemic control among Hispanic and non-Hispanic Black adults with T2D.
Methods: A comprehensive literature search was conducted using four electronic databases: PubMed, PsycINFO, CINAHL, and Web of Science. This review adhered to the PRISMA-ScR guidelines. Data were synthesized based on relevant outcome measures.

Results: Of the 1,130 identified articles, 10 met the inclusion criteria. The studies were predominantly conducted in the United States (9/10), with one in Australia, and most were cross-sectional in design (8/10). Studies examined psychosocial factors, such as social support, depression, anxiety, perceived stress, perceived discrimination, and diabetes distress, with HbA1c as the primary indicator of glycemic control. Depression was the most studied factor, with seven studies demonstrating a significant association between higher depression levels and poorer glycemic control. While perceived stress was also linked to increased HbA1c levels, social support and socioeconomic status were consistently associated with improved glycemic outcomes. Moreover, perceived ethnic discrimination and economic distress showed no significant correlation with glycemic control.

Conclusion: Culturally sensitive interventions that address depression, stress through enhanced social support, and strengthen coping mechanisms are crucial for improving glycemic outcomes in these populations. Future research should prioritize longitudinal studies and investigate the multifaceted intersections of psychosocial factors and sociodemographic on glycemic control in Hispanic and non-Hispanic Black adults with T2D.

Keywords: Diabetes, Minority health

Authors:

Co-Author - Memnun Seven, PhD, RN, PhD, RN,
University of Massachusetts

D57 - Co-crafting Type 1 Diabetes Screening Educational Materials with Health Care Professionals

Poster Number: D57
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Health Communication and Policy

Background: Type 1 Diabetes (T1D) is a chronic disease often diagnosed at the onset of symptoms, including life-threatening diabetic ketoacidosis (DKA). Screening For T1D is increasingly being evaluated in research due to the potential to identify patients early, enable screening, and provide access to therapies that delay onset of T1D. Currently, there is a gap in research on how to facilitate patient-centered communication about T1D screening to enable shared decision-making. Here, we explore perspectives of healthcare professionals (HCPs) on developing communication strategies to support pediatric T1D screening.

Methods: We reviewed existing patient-facing resources about T1D screening programs and, using these, created three patient-facing handouts. The focus of these handouts were 1) T1D in general, 2) screening for T1D, and 3) next steps after completing screening. HCPs were asked to review these materials prior to their participation in semi-structured interviews. These interviews were designed to gain an understanding of how to optimize these patient-facing resources and identify the communication strategies for effective implementation of T1D pediatric screening. The Extended Parallel Process Model (EPPM), a well-studied health communication model, was applied to interview data and interpretation.

Results: We conducted interviews with 15 HCPs, including 10 HCPs from general pediatrics and 5 certified diabetes educators. Overall, HCPs viewed the materials favorably but noted some key areas to change. Regarding threat appraisal, many HCPs desired more background education around T1D being an autoimmune disease, the associated health risks, and ages to consider screening. For efficacy appraisal, HCPs needed more information about how to facilitate screening and interpret and act upon the results (e.g., treatments). HCPs also wanted more resources and communication materials addressing response efficacy such as recommended ages to conduct screening. Overall, HCPs wanted multiple types of communication resources, including outreach, digital electronic health record materials, and options for directly sharing the information with patients and parents.

Discussion: Findings demonstrate key areas for intervention using communication strategies to improve T1D screening.

Keywords: Diabetes, Health communication

Authors:

Co-Author - Christie Gilbert Klaczko, PhD,
Geisinger

Presenter - Nicole Walters, BS,
Geisinger

Co-Author - Benjamin Keiser, BS,
Geisinger

Co-Author - Andrew Brangan, BS,
Geisinger

Co-Author - Katrina Romagnoli, MLIS, MS, PhD,
Geisinger

Co-Author - Jessica Goehringer, MS,
Geisinger

Co-Author - Laney Jones, PharmD, MPH,
Geisinger

Co-Author - Juliann Savatt, MS,
Geisinger

Co-Author - Gemme Campbell-Salome, PhD,
Geisinger

D58 - Familism, helpful and harmful involvement of a support person, and diabetes management in a diverse sample of young adults

Poster Number: D58
Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Child and Family Health

OBJECTIVES. Young adults (YAs) with type 1 diabetes (T1D) – especially those from minoritized groups - have sub-optimal self-care behaviors, and elevated A1c and distress. This may reflect the challenge of optimizing social support (i.e., high helpful and low harmful involvement) at a time of many social transitions. Familism, a cultural value emphasizing close family ties and interconnectedness, may provide an extended network of support that counters the effects of YAs engaging support partners who are not helpful or who are harmful for T1D management. We examined the independent and interactive effects of familism and helpful and harmful involvement of a support provider on diabetes outcomes in a diverse YA sample.
METHODS. YAs with T1D aged 18-24 (N=175, M age=21.2 years; 61% female; 28% Latinx, 56% non-Latinx White, 16% non-Latinx other races; 29% public or no insurance) completed baseline surveys as part of an ongoing clinical trial. Surveys measured familism, how often YAs experienced behaviors from a selected support person that were helpful and harmful for T1D management, as well as diabetes distress and self-care behaviors. A1c was collected via a home test kit.
RESULTS. Familism was correlated with selecting a support person (42% parent; 38% romantic partner) who performed both more helpful and more harmful behaviors specific to T1D management (ps < .003). Regressions were conducted with familism, helpful and harmful involvement, and their interactions predicting outcomes. Helpful and harmful involvement interacted to predict A1c (p=.027), self-care (p=.092), and distress (p=.072). In all cases, high helpful involvement buffered the association between harmful involvement and poorer outcomes. Familism was independently related to lower distress (p<.001) and higher self-care (p=.065), and buffered the association between low helpfulness and higher A1c (p=.005). Familism also moderated the helpful X harmful involvement interaction predicting distress (p=.013). Specifically, the helpful X harmful involvement interaction described above was present only among those low in familism. With high familism, neither low helpful nor high harmful involvement was associated with distress.
CONCLUSIONS. Familism may be protective for diverse YAs with T1D as they strive to develop sources of support for T1D. Enhancing helpful involvement from support partners may help YAs counter the adverse effects of harmful involvement at this high-risk time.

Keywords: Diabetes, Culture

Authors:

Co-Author - Cynthia A. Berg, PhD, FSBM, PhD, FSBM,
University of Utah

Co-Author - Emily B Ellis,
University of California, Merced

Co-Author - Charlie O Coward,
University of California, Merced

Co-Author - Jennifer K Raymond, MD,
Children's Hospital of Los Angeles

Co-Author - Lindsay S. Mayberry, PhD, FSBM, PhD, FSBM,
Vanderbilt University Medical Center

D59 - The Bidirectional Relationship between Glucose and Loss of Control Eating After Metabolic and Bariatric Surgery: Evidence from Naturalistic Assessment

Poster Number: D59
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Obesity

Evidence is accumulating that loss of control (LOC) eating, a disordered eating behavior characterized by the feeling that one cannot stop/control how much they are eating, is associated with poor weight outcomes following metabolic and bariatric surgery (MBS). However, to develop more effective interventions and promote better outcomes, greater insight into the antecedents and consequences of post-MBS LOC eating is needed. Blood glucose is one putative biological correlate of LOC eating that warrants closer inspection following MBS. Thus, naturalistic data was used to examine the bidirectional relationship between glucose and multiple types of post-MBS eating episodes. It was hypothesized that: 1) glucose would differentially predict engagement in eating episodes (vs. not eating) and LOC eating (vs. non-LOC eating), and 2) LOC eating would prompt significantly different patterns of glucose compared to non-LOC eating. Participants, who were 45 adults (84% female, 96% White) one-year post-MBS, completed 10 days of ecological momentary assessment (EMA) concurrent with wearing a continuous glucose monitor (CGM). Episodes of LOC eating, non-LOC eating, and periods of no eating (reported in semi-random EMA signals) were time-matched to CGM readings (collected every 5 minutes) during the three hours preceding and following episodes. Four metrics (mean, variability, % time spent in hyper- and hypo-glycemia) were calculated from CGM data and centered within-person to control for between-person confounds. Using multilevel modeling, analyses testing if glucose metrics predicted the likelihood of eating vs. not eating found that greater glucose mean and variability were significantly associated with an increased likelihood of eating (ꞵ=.12, SD=.06 and ꞵ=.20, SD=.06, respectively) while greater % time in hyperglycemia was linked with a decreased likelihood of eating (ꞵ=-.22, SD=.06). Analyses testing the relationship between eating and subsequent glucose metrics found that eating predicted significantly greater mean glucose (ꞵ=.06, SD=.02). While no statistically significant associations between prior glucose metrics and LOC eating vs. non-LOC eating emerged, engaging in LOC eating predicted significantly greater glucose variability (ꞵ=.06, SD=.03). Although glucose failed to predict when an individual was likely to engage in LOC eating, the unique post-prandial glucose effect may help elucidate how LOC eating promotes poorer weight outcomes following MBS.

Keywords: Binge eating, Technologies

Authors:

Author - Gail Kerver, PhD,
Sanford Research, Center for Biobehavioral Research

Co-Author - Scott Engel, PhD,
Sanford Research, Center for Biobehavioral Research

Co-Author - Glen Forester, PhD,
Sanford Research, Center for Biobehavioral Research

Co-Author - Kristine Steffen, PharmD, PhD,
North Dakota State University

Co-Author - David Sarwer, PhD,
Temple University

Co-Author - Stephen Wonderlich, PhD,
Sanford Research, Center for Biobehavioral Research

D60 - The Power of Community: Understanding the Association Between Community Connectedness and Weight Bias Internalization among Sexual Minority Women Who Binge Eat

Poster Number: D60
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Health of Marginalized Populations

Subclinical binge eating behaviors pose health risks similar in nature and severity to those of binge eating disorders, including high blood pressure, cardiovascular disease, diabetes, and gastrointestinal issues. The underlying mechanisms responsible for the onset and maintenance of disordered eating behaviors may differ for heterosexual women and sexual minority women (SMW; lesbians, bisexuals, pansexuals). One well-supported predictor of binge eating for women that may vary across sexualities is weight bias internalization, which involves applying society’s negative weight attitudes to oneself. Some studies suggest that sexual minority communities place less importance on the thin ideal, potentially acting as a protective factor against weight bias internalization, while others highlight similar levels of weight bias internalization between SMW and heterosexual women due to pressures for thinness from heteronormative culture. To further understand the unique impact of sexual minority communities on SMWs’ health, the present study aims to investigate the association between connectedness to the LGBTQIA+ community and SMWs’ weight bias internalization and their attitudes towards obesity among a sample of women who binge eat. Participants were 154 SMW (76% lesbian, 22.7% bisexual, Mage = 25.0; 68% White) who completed an online survey of eating behaviors and other health experiences. Regression analyses were conducted to examine associations between community connection variables and indicators of weight bias internalization, controlling for BMI. Results showed that SMW experiencing greater connection to the LGBTQIA+ community had less weight bias internalization (p<.001) and less negative attitudes towards obesity (p<.001). These findings suggest that feeling connected to LGBTQIA+ communities could be protective against the development of harmful weight-related beliefs and self-expectations among SMW. Incorporating community support into interventions may be beneficial for encouraging more neutral attitudes about weight or shifting attributions of self-worth away from one’s body when treating SMW for transdiagnostic eating disorder symptoms such as binge eating. However, further research is needed to understand the mechanisms by which connection to the LGBTQIA+ community is protective and its implications for interventions.

Keywords: Binge eating, Community intervention

Authors:

Co-Author - Meredith I. Turner, M.S.,
Virginia Consortium Program in Clinical Psychology

Co-Author - Kristin E. Heron, PhD, FSBM, PhD, FSBM,
Old Dominion University

D61 - Food Choice as a Function of Momentary Mood Clusters and Access to Greenspace: A Latent Profile Proof of Concept

Poster Number: D61
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Social and Environmental Context and Health

Background: Despite widespread awareness of the value of a healthy diet, many adolescents struggle to maintain patterns of healthy eating. Fluctuating psychological states such as affect, energy, and fatigue interact with environmental contexts to influence food choice.

Purpose: This study evaluated the effects of mood profiles on healthy eating habits using latent class analyses from data collected using ecological momentary assessment (EMA). Profiles were then used to predict consumption of a range of food types (e.g., fatty, starchy).

Methods: EMAs assessing mood states, greenspace, and food consumption were collected one to four times per day over a 20-day period in a sample of 100 adolescents, ages 13-18. Mood states were aggregated to the day level and food consumption was assessed at the day-level. Latent class analyses integrated EMA data collected on positive affect, negative affect, fatigue, energy, anger, friendliness, anxiety, and depression. The optimal number of latent classes was determined by comparing model fit indices. Once the latent classes were established, we evaluated the relationship between greenspace and participant food intake (i.e., intake of carbs, sweet foods, fatty foods, fast foods) for each class, while controlling for participant age.

Results: Profile analysis revealed five different latent profiles in the EMA data. Profiles were qualitatively labeled: 1) energetic-friendly, 2) introverted, 3) fatigued-friendly, 4) low-balanced, and 5) high-balanced. Participants reported consuming less carbohydrates (β=-.08, SE=.03) and sweet foods (β=-.06, SE=.03) when they were exposed to more greenspace except when they reported one of two profiles high in friendliness.

Conclusions: Measured over multiple EMA occasions, adolescents demonstrate a range of mood profiles. These profiles may interact with environmental factors to influence health behavior. As proof of concept, the current project establishes that mood profiles yield different information than multilevel models of individual mood variables as predictors of health behavior. Greenspace appears to serve as a protective factor for three of the mood profiles that emerged. However, for those who are feeling friendly (and perhaps engaging with friends), the protection appears to be lost. Adolescents may benefit from specific skills for healthy behavior when involved in the social activities implied by these ratings.

Keywords: Diet, Technology

Authors:

Co-Author - Calissa J. Leslie-Miller, MS, MS,
University of Kansas

Co-Author - Christopher C. Cushing, PhD, PhD,
University of Kansas

D62 - Self-reported hunger and food choice after acute use of cannabis: Effects of THC versus CBD

Poster Number: D62
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Substance Misuse

As cannabis legalization increases there are questions about the benefits and harms of such use, including how cannabis may affect health behaviors like eating and food choice. Some research suggests that cannabis may increase caloric intake or consumption of unhealthy foods, while other data demonstrate that cannabis use is negatively associated with body mass index and lower prevalence of having overweight or obesity. To explore these questions, the current study examined associations between blood levels of Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), and outcomes of self-reported hunger levels and observed snack choice after acute cannabis use among 110 individuals who infrequently use cannabis. Participants were mostly White (87.3%), most identified as women (56.4%), and were a mean age of 29.48 years (SD=5.37). These data came from a larger study investigating effects of acute cannabis use on obesogenic metabolic processes. Participants completed a baseline assessment at our campus laboratory and were visited a week later by our mobile pharmacology laboratory, which allowed for cannabis flower product use in their home ab libitum before returning to the mobile lab for post-use assessments. At the mobile lab visit post-cannabis use, participants were also allowed to take as much as they wanted among three snack foods: Lays potato chips, Oreos, or cashews. The number of bags taken was utilized as an objective assessment of hunger. Subjective hunger was evaluated in general and for sweet foods and salty foods immediately after cannabis use. Mixed effects models analyzed whether blood THC, blood CBD or their interaction was associated with hunger ratings while generalized linear regressions using Poisson distributions examined whether THC, CBD or their interaction influenced the number of snacks taken. There were no significant effects of THC, CBD, or their interaction on any measure of hunger nor on the number of potato chips or cashews taken (ps>0.09). In contrast, there was a significant CBD by THC blood level interaction for subjective hunger for sweet foods (F(1,76)=4.33, p=0.04); as THC levels increased, hunger for sweets decreased but only at higher levels of CBD (28 ng/ml and up). There was a main effect of THC on bags of Oreos taken (β=-0.01, SE=0.004, p<0.05); as THC levels increased, more Oreos were taken. These analyses the relationship of THC and CBD to hunger and dietary choices may be nuanced and dependent on food type.

Keywords: Eating behaviors, Substance abuse

Authors:

Author - Carillon J. Skrzynski, PhD, PhD,
University of Colorado Boulder

Author - Anika Sansgiry,
University of Colorado Boulder

Author - Irene De La Torre,
University of Colorado Boulder

D63 - Preliminary findings of the Food is Best Medicine program for food insecure postpartum women

Poster Number: D63
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Health of Marginalized Populations

The postpartum period presents significant challenges for many women, particularly those experiencing food insecurity. Food insecure mothers face the dual burdens of caring for a newborn while also struggling to maintain adequate nutrition, leading to higher rates of mental health disorders, including depression, greater weight retention, and lower breastfeeding rates compared to food-secure mothers. Food is the Best Medicine (FBM) is an intervention designed to alleviate some of the stress experienced by food-insecure new mothers. FBM delivers food boxes to postpartum women for an 8-week period, which include prepared meals, meal kits, organic fresh produce, and staple foods. To enhance sustainability after the initial intervention period, the research team developed a second version of the FBM program: FBM-CHW. In addition to the 8 weeks of home-delivered food, this version includes two home visits from community health workers (CHWs), who help families create and implement personalized plans. These plans may include referrals to local resources, assistance enrolling in food and financial assistance programs, and other supports designed to improve overall well-being. The purpose of this presentation is to provide preliminary results comparing the FBM and FBM-CHW interventions in terms of food security, fruit and vegetable (F&V) and whole grain consumption, postpartum depression, and breastfeeding rates, using a randomized controlled design with 100 women. Data were collected at baseline (T0) and immediately following the 8-week intervention (T1). Participants were predominantly Hispanic (71%), low income (84% earning less than $25,000 annually), and had relatively low levels of formal education (37% less than a high school education). Mixed-effects regression models showed significant reductions in food insecurity for both groups and increases in whole grain consumption from T0 to T1. Vegetable intake in the CHW group increased more than in the FBM group, although this difference was not statistically significant. Both groups experienced a significant decrease in breastfeeding rates. Future steps include conducting a comprehensive analysis of the final dataset and collecting qualitative data to refine both the food delivery and the CHW components of the intervention, ensuring they more effectively meet the needs of participants.

Keywords: Health disparities, Interventions

Authors:

Presenter - Alexandra van den Berg, PhD, MPH,
UTHealth

Co-Author - Elizabeth Polinard, PhD, RN,
Ascension Seton

Co-Author - Joi Chevalier,
The Cook's Nook

Co-Author - Andrea Abel,
Farmshare Austin

Co-Author - Chris Reyes,
UTHealth School of Public Health

Co-Author - Aida Nielsen, MPH,
UHealth School of Public Health

Co-Author - Nalini Ranjit, PhD,
UHealth School of Public Health

D64 - Improvements in glycosylated hemoglobin: Preliminary results from a worksite wellness micronutrient-dense plant-rich diet pilot intervention

Poster Number: D64
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Women's Health

Nearly one-third of the average person’s time is spent at work. Thus, worksites are locations that provide opportunities for intervening with a variety of employees over the course of the workday. Worksite wellness programs unite behavioral health counselors, nutrition and fitness experts, financial planners and health educators to support employees’ overall physical and mental health. This 13-week pilot study, conducted within a large southwestern university, evaluated a micronutrient-dense plant-rich dietary intervention through administering weekly facilitated small group sessions, allowing participants to pursue individual dietary goals while receiving social support from fellow group attendees. Facilitators of group sessions were current Master of Public Health graduate students trained in using motivational interviewing techniques. Sessions were conducted either at the worksite or remotely via Zoom and followed a plant-rich dietary curriculum focused on culturally relevant Indigenous dietary practices that honor the native peoples who have the called the area home for millennia. A total of 21 participants (Mage=47.8 ± 10.9 years, 100% female) were evaluated at baseline and post-intervention for fasting glycosylated hemoglobin (HbA1c) and anthropometric measures including waist circumference, weight, and BMI (kg/m2). Paired samples t-tests indicated a significant decrease in HbA1c (MT1=5.59% ± 0.5, MT2=5.49% ± 0.4, p=.005, Cohen’s d=0.62) and BMI (MT1=27.8 kg/m2 ±6.6, MT2=27.5 kg/m2 ± 6.7, p=.026, Cohen’s d=0.45). There were no significant changes in waist circumference or weight. These preliminary results suggest that micronutrient-dense plant-rich dietary patterns may improve metabolic health outcomes. Expanding recruitment and implementation of the current intervention to additional worksites is forthcoming. Providing opportunities for people to engage in dietary interventions at the workplace reduces barriers to implementation, can improve employee retention and reduce absenteeism and increase productivity. Future research will consider incorporating additional measures of cardiometabolic health and further explore the initial relationships found.

Keywords: Diet, Social support

Authors:

Presenter - Nanette V. Lopez, PhD, RDN,
Northern Arizona University

Co-Author - Julia C. Gardner, MPH, CHES,
Northern Arizona University

Co-Author - Chadleo Webb, RDH, MDH,
Northern Arizona University

Co-Author - Jay T. Sutliffe, PhD, RD,
Northern Arizona University

D65 - Characteristics of Dietary Lapses in Low-Income, Treatment-Seeking Families with Obesity

Poster Number: D65
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Digital Health

Objective: Socioeconomic disparities in childhood obesity prevalence and treatment response are well-documented. These disparities may be partially explained by experiences of dietary non-adherence in real-time (i.e., dietary lapses) triggered by poverty-related cues (e.g., presence of unhealthy foods) that thwart families' attempts to regulate eating. Few studies have characterized dietary lapses in the context of the family food environment, let alone among families from low-income households who may be particularly vulnerable to dietary lapses. The current study used ecological momentary assessment (EMA) to contextualize parent and child dietary lapses in real-time throughout 3-month family-based behavioral obesity treatment (FBT).
Method: 19 parent-child dyads (children aged 5-12) who receive Medicaid were recruited from a FBT trial at two Missouri primary care clinics. Parents completed separate one-week periods of EMA at baseline, month 2, and month 3 of FBT. At each study period, parents reported on their own and their child's dietary lapses at random daily intervals and provided information on the type of eating event (meal or snack), lapse location (fast-food chain, home, restaurant, work/school, social event, other), and perceived lapse severity (not at all more than planned to a lot more than planned). Child dietary lapses were categorized as having occurred at a separate eating event or shared eating event with the parent. Descriptive statistics were used to summarize dietary lapse characteristics.
Results: Across the three study periods, the majority of parent dietary lapses (M = 2.79, SD = 1.78) and child dietary lapses (M = 4.11, SD = 3.16) occurred during meals as opposed to snacks (72% of parent lapses, 76% of child lapses), at home (48% of parent lapses, 66% of child lapses), and were described as being a little more than planned (55% of parent lapses, 56% of child lapses). Over one-third (37%) of parent and child dietary lapses occurred when parent and child were eating together at the same eating event.
Discussion: Results highlight similarities in parent and child dietary lapse characteristics and underscore the importance of targeting the home food environment to bolster dietary adherence. Future research should identify real-time strategies to support family dietary adherence among low-income families and evaluate the bi-directional nature of parent-child dietary lapses.

Keywords: Children's health, Eating behaviors

Authors:

Author - Anne Claire Grammer, PhD,
Stanford University School of Medicine

Co-Author - Leslie Ligier, BA,
University of Pennsylvania

Co-Author - Allyson Feldman, LMSW,
Private Practice

Co-Author - Andrea Goldschmidt, PhD,
University of Pittsburgh

Co-Author - Jerica Berge, PhD, MPH, LMFT, CFLE,
University of Colorado School of Medicine

Co-Author - Bonnie Spring, PhD, ABPP, FSBM,
Northwestern Feinberg School of Medicine

Co-Author - Scott Engel, PhD,
Sanford Health Research Center for Biobehavioral Research

Co-Author - Ross Crosby, PhD,
Sanford Health Research Center for Biobehavioral Research

Co-Author - Ellen Fitzsimmons-Craft, PhD,
Washington University in St. Louis

Co-Author - Denise Wilfley, PhD,
Washington University School of Medicine

D66 - Changes in food addiction symptoms over time in a diverse sample of emerging adults with histories of heavy drinking

Poster Number: D66
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Substance Misuse

Emerging adulthood is a developmental period that spans the age-range of approximately 18-25-years. Substance and alcohol misuse are common during this time, and typically decline over time. Research has noted similarities between disordered overeating and substance use, resulting in the conceptualization of food addiction; however, there is a lack of longitudinal research on food addiction. The current study explored longitudinal changes in food addiction symptoms during emerging adulthood across 8 and 16-month follow-up assessments, and the influence of race and sex on these trajectories. Data were collected from a diverse sample of 595 emerging adults (mean age 22.64, 57.6% female, 45.2% white, 40.24% Black) recruited from the community on the basis of recent binge drinking. Food addiction was measured by the Yale Food Addiction Scale 2.0. Linear mixed-effects modeling was used to examine within-person changes in food addiction symptom count. The impact of race was examined using two separate models (primary: non-Black vs Black; secondary: non-white vs white). Main effects for time and sex on food addiction symptoms are reported from the primary model. Food addiction symptom count decreased significantly over time (F = 13.032, p < 0.001). There was a significant main effect of sex on food addiction symptoms, such that females had higher mean scores than males (F = 13.489, p < 0.001), though there was no significant interaction of sex with time or race. In the primary model, there was no significant effect of race on food addiction symptoms, though the secondary model indicated there was a significant main effect of race (F = 6.166, p = 0.013) such that white participants had lower mean symptom counts. The secondary model also indicated changes in food addiction symptoms over time differed by race; symptom count decreased among non-white participants at a steeper rate (race × time: F = 3.033, p = 0.049). Results add to the body of literature demonstrating that food addiction symptoms among emerging adults have similar declines over time as substance and alcohol use, and may be used to inform intervention and preventative measures. As symptoms decreased among emerging adults, early emerging adulthood may be a crucial period for intervention for food addiction. Further, preventative measures may be most needed for females and communities of color in particular, as these participants reported higher levels of food addiction.

Keywords: Eating behaviors, Longitudinal research

Authors:

Presenter - Mary Takgbajouah,
DePaul University

Co-Author - Ashley Dennhardt, PhD,
The University of Memphis

Co-Author - Kyla Belisario, MA,
Peter Boris Centre for Addictions Research, McMaster University

Co-Author - James MacKillop, PhD,
Peter Boris Centre for Addictions Research, McMaster University

Co-Author - James G. Murphy, PhD,
The University of Memphis

Co-Author - Joanna Buscemi, PhD, PhD,
DePaul University

D67 - Reducing HIV Health Disparities among African American Transgender Women: An mHealth Approach to Improving Prevention, Testing, and Treatment Outcomes

Poster Number: D67
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Health of Marginalized Populations

Background: Black transgender women who have sex with men (TWSM) face disproportionately high HIV rates and unique barriers to prevention and care. mHealth interventions show promise in addressing health disparities, but few have been developed specifically for this population. This study developed and evaluated Shine, a smartphone-based HIV behavioral intervention for Black TWSM.

Methods: To evaluate the efficacy of Shine, we recruited 38 Black TWSM who reported HIV transmission risk in the past 3 months. Forty-four percent reported living with HIV. Participants were randomly assigned to either Shine (n=18) or a control condition (n=20) consisting of CDC-developed HIV education videos. Shine integrated text messages, web-based assessments, and videos to provide tailored HIV education, address individual barriers, and offer gender-affirming content. Assessments were conducted at baseline and 6-months. The primary outcome was a composite HIV transmission risk score. Secondary outcomes included ART/PrEP adherence, condom use, and psychosocial factors.

Results: Preliminary analyses revealed no significant differences between conditions on the primary outcome or most secondary outcomes. However, ART adherence significantly increased across all participants from baseline to follow-up (p < .05). While not statistically significant, several outcomes showed trends in the expected direction for Shine participants, including increased social support and comfort with gender identity. Notably, Shine participants reported high satisfaction with the intervention (M=3.71, 0-4 scale), appreciating its accessibility, personalized feedback, and empowering content.

Conclusions: While quantitative results did not demonstrate Shine's efficacy in improving HIV-related outcomes compared to control, the intervention was well-received. The significant improvement in ART adherence across conditions and positive user feedback suggest potential benefits of mHealth approaches for this population. Importantly, nearly half of potential participants were ineligible due to lack of HIV risk behaviors, suggesting positive trends in HIV prevention practices within this community. Limited statistical power due to the small sample size likely contributed to the lack of significant between-group differences. Future research should refine Shine and evaluate it with a larger sample to better determine its efficacy in reducing HIV health disparities among Black TWSM.

Keywords: HIV, Health disparities

Authors:

Author - Samantha Leaf, Ph.D.,
ISA Associates, Inc.

Co-Author - Douglas Billings, Ph.D.,
ISA Associates, Inc.

Co-Author - Mary Morcos, MPH,
ISA Associates, Inc.

D68 - Technology Enhanced Mindfulness in Motion (MIM) Program: Does App-Augmented Care Improve Wellness Outcomes among Healthcare Workers?

Poster Number: D68
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Integrative Health and Spirituality

Evidence supporting the effectiveness of mindfulness-based interventions has grown significantly over the past 20+ years, with health and wellness benefits demonstrated across diverse populations in clinical and nonclinical settings. As the demand for mindfulness programming continues to expand, it will be essential to identify effective methods for scaling interventions while continuing to deliver on outcomes. Toward this end, we developed and tested the impact of a mobile wellness app designed to augment Mindfulness in Motion (MIM), an 8-week group program that teaches mindfulness, relaxation, gentle yoga and resilience-building skills to reduce burnout and improve wellness among helping professionals and other healthcare workers. In addition to testing the feasibility and impact of technology-enhanced MIM, we assessed whether including the app yields additional benefits above and beyond the traditional MIM program. Participants were 763 healthcare workers at a large health care system located in the United States or Australia. Using an open trial design, we compared changes in burnout and resiliency between two groups: one that participated in the traditional MIM program (n = 590) and another that participated in app-augmented MIM (n = 173). Wellness outcomes were assessed pre- and post-intervention using the Connor-Davidson Resilience Scale and Maslach Burnout Inventory. Results showed that participants in the app-augmented group experienced significantly greater improvements in wellness outcomes compared to those in the traditional program. Specifically, participants in the app-supported group exhibited greater improvements in total resilience (t = -2.134, p = 0.017), total burnout (t = 2.146, p = 0.016), depersonalization (t = 2.350, p = 0.010), personal accomplishment (t = -1.843, p = 0.033), and emotional exhaustion (t = 2.663, p = 0.004). Our findings highlight the potential of mobile technology to augment traditional mindfulness interventions and support the continued exploration of these models in skill-building wellness programs.

Keywords: Mindfulness, Technologies

Authors:

Presenter - Madison Voinovich, B.A.,
The Ohio State University Center for Integrative Health

Co-Author - Jacqueline Caputo, B.S.,
The Ohio State University Center for Integative Health

Co-Author - Slate Bretz, B.A.,
The Ohio State University Center for Integrative Health

Co-Author - Yulia Mulugeta, B.S.,
The Ohio State University Center for Integrative Health

Co-Author - Maryanna Klatt, PhD,
The Ohio State University Center for Integrative Health

D69 - A qualitative analysis of adolescent and young adult cancer survivors’ interview feedback on a depression self-management tool prototype

Poster Number: D69
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cancer

Introduction
Annually over 90,000 adolescents and young adults are diagnosed with cancer in the United States (AYACS, ages 15-49). In this population depressive symptoms are prevalent and problematic. While digital mental health tools may be helpful, they have not been tailored to AYACS needs or preferences. In this study we used individual interviews to obtain feedback from AYACS on a mid-fidelity prototype of a tailored digital depression self-management tool.

Methods
AYACS were identified via medical record review and asked to participate in individual interviews to provide feedback on a prototype of a depression self-management tool designed for AYACS. This prototype was co-designed with input from AYACS and providers with the aim of providing mood tracking, psychoeducation about depression and cancer, and adaptations of four evidence-based interventions for depression via a web-based app. The interviews entailed displaying the prototype and requesting targeted feedback. Qualitative analysis was conducted by two coders using the rigorous and accelerated data reduction (RADaR) technique.

Results
Fourteen AYACS (ages 15–38, 57% non-Hispanic white, 64% female) participated in individual interviews. Qualitative analysis resulted in four themes: Features to Promote User Engagement, Tailored Content Presentation, Perceived Usability, and Interface Design. To promote user engagement, AYACS suggested providing opportunities to connect with other AYACS and providers in the tool, having options as to how they engage in the content, and providing education on the value of the tool upfront. Regarding tailored content presentation, AYACS emphasized that content should be authentic, encouraging, and age appropriate. To enhance the perceived usability of the tool AYACS suggested delivering information via both video and easy-to-read text, ensuring clarity of wording and intuitive navigation, and providing multiple options for information input. Finally, AYACS indicated that the user interface could be improved by implementing a consistent and coherent theme, using brighter colors, allowing for color customization, and ensuring text is visually appealing.

Discussion
AYACS provided valuable feedback on the design of a digital depression self-management tool, identifying several features that are uniquely important to this population. These insights have guided the development of a working prototype of the tool that is tailored to the needs and preferences of AYACS.

Keywords: Cancer survivorship, Intervention

Authors:

Co-Author - Grace Westcott,
Virginia Commonwealth University

Co-Author - Antonija Augustinovic,
East Carolina University

Co-Author - Rachel Glock,
East Carolina University

Co-Author - AnneMarie Coffey,
East Carolina University

Co-Author - John Salsman, PhD,
Wake Forest University School of Medicine

Co-Author - David Victorson, PhD,
Northwestern University

Co-Author - Madhu Reddy, PhD, MS,
Northwestern University

Co-Author - Sarah Birken, PhD, MSPH,
Wake Forest University School of Medicine

Co-Author - Karly M. Murphy, PhD,
East Carolina University

D70 - Digital self-guided acceptance and commitment therapy for adults with chronic health conditions: Results from a waitlist-controlled trial

Poster Number: D70
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Mental Health

The challenges associated with chronic health conditions (CHCs) can contribute to impaired quality of life and mental health. CHCs are both prevalent and diverse among adults, raising challenges in developing, validating, and deploying mental health interventions for each condition. Previous research has found acceptance and commitment therapy (ACT) effective when tested with CHCs including chronic pain, cancer, epilepsy, diabetes, multiple sclerosis, and inflammatory bowel disease, among others, of which several studies used a digital intervention approach. This study extends prior research by evaluating a new digital self-guided program that targets transdiagnostic acceptance, mindfulness, and values-based psychological flexibility processes through ACT to improve quality of life and mental health for adults living with any CHC. If effective, such a program could offer a readily accessible resource for adults experiencing a wide range of CHCs, including more rare or comorbid conditions that otherwise might not have a targeted program available.

A sample of 100 adults reporting one or more CHCs were randomly assigned to digital ACT or a 10-week waitlist condition. ACT participants were asked to complete the 6 session program over 6 weeks. Online assessments were collected at baseline, 6-weeks, and 10-weeks. Participants reported a wide variety of CHCS (61 unique CHCs in total), and while 55% had a chronic pain condition, only 12% reported having only a pain condition. Participants completed an average of 4 (out of 6) digital ACT sessions, and reported high program satisfaction. Multilevel model results indicated participants assigned to ACT improved significantly more than waitlist condition from baseline to 10-week follow up on positive mental health (Mental Health Continuum; β = 0.38, 95%CI = 0.08, 0.68), CHC-related functional impairment (Work and Social Adjustment Scale; β = -0.33, 95%CI = -0.58, -0.07), and psychological flexibility (Comprehensive Assessment of ACT Processes; β = 0.29, 95%CI = 0.03, 0.55). However, there was no difference between conditions over time on the Depression, Anxiety, and Stress Scale (β = -0.26, 95%CI = -6.24, 0.10). In addition to discussing the significance of these results, we will discuss our unique approach to developing and deploying digital ACT through Qualtrics, including how this program will be made available as part of the ACT Guide service suite offered to the general public through our university.

Keywords: Chronic illness, e-Health

Authors:

Presenter - Michael Levin,
Utah State University

Author - Ty Aller,
Utah State University

Author - Korena Klimczak,
Utah State University

Author - Marissa Donahue, MA, MA,
Utah State University

Author - Francesca Knudsen,
Utah State University

D71 - Habit Strength and Medication Adherence: An Analysis Across Adherence Levels Using Objective Measures

Poster Number: D71
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Dissemination and Implementation

Nonadherence to blood pressure medications leads to poor outcomes in chronic conditions. Habit formation is key for behavior maintenance. Research indicates that greater habit strength improves medication adherence (MA), but few studies have followed individuals’ medication-taking behavior longitudinally with objective measures used to evaluate habit strength.

AIMS: 

This study aims to describe habit strength among individuals with high (>85%), moderate (71%-84%), and low (<70%) MA and determine if habit strength significantly differs among these MA levels. Multivariable and univariate models of demographic predictors are examined to identify correlates of habit strength.    

Methods: 

Medication implementation was electronically monitored for 8 weeks using the Medication Event Monitoring System (MEMS®) Cap (AARDEX Group, Belgium) to evaluate anti-hypertensive MA among 93 individuals with chronic kidney disease (CKD) recruited from two large health systems in the Midwestern United States. Habit strength was calculated from the MEMS® data as an objective measure of individual weekly consistency in pill timing.

Results:  

Mean age was 62.75 (SD 11.83) with 49% males. Medication adherence was significantly correlated with habit strength, r (85) = .70, p < .0001. The Kruskal-Wallis test for adherence levels was significant x2= 46.15 ([df (2)], N=86, p<.0001).   Race (p=0.0019) and marital status (p=0.0321) were significant predictors of habit strength in univariate models. Habit index was a significant predictor for MA score (p<0.0001) after adjusting for baseline covariates.

Discussion: 

For those with CKD, habit strength and MA were positively correlated, with significant differences between the low, moderate, and high adherence groups, with higher adherence linked to greater habit strength which is consistent with research on habit strength and medication adherence. Few studies have used objective measures of electronic monitoring medication taking behavior, and none have been studied specifically in the CKD population; However, these findings are consistent with the literature using both subjective and objective data. This is the first study to identify that race and marital status strongly predict habit strength.

Conclusion: 

Our findings suggest that individuals with well-established medication-taking habits are more likely to adhere to their prescribed regimens, highlighting the role of habit formation in consistent medication use.

Keywords: Ambulatory monitoring, Chronic illness

Authors:

Presenter - Sarah E. Zvonar, PhD, PhD,
Indiana University

Co-Author - Rebecca Bartlett Ellis, PhD, PhD,
Indiana University

Co-Author - Matthew Hays,
Indiana University Richard M. Fairbanks School of Public Health

Co-Author - Cynthia Russell, RN, RN,
University of Missouri-Kansas City

Co-Author - Antoine Pironet,
Aardex Group, Saraing, Belgium

Co-Author - Susan Perkins, PhD,
Indiana University School of Medicine

D72 - Perceptions of Personalized Glucose-based Biofeedback Messages to Promote Physical Activity in Cancer Survivors

Poster Number: D72
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Physical Activity

Introduction

Advances in mHealth and wearable technologies have enabled researchers to provide real-time personalized biofeedback from biosensors to motivate behavior change. This study examined how cancer survivors responded to personalized biofeedback messages from a continuous glucose monitor (CGM) in a physical activity intervention and identified feedback for optimization for future iterations.

Methods

The current study analyzed interviews from 10 insufficiently active cancer survivors at high risk for Type 2 diabetes and completed a 12-week physical activity intervention. During the first 4 weeks of the intervention, participants wore a Freestyle Libre 3 CGM and received personalized text messages based on their glucose data. Upon completion of the study, exit interviews were conducted to collect feedback on participants’ experience with the sensor. A total of 580 pages of interview transcripts were transcribed, cleaned and independently coded by three researchers. Thematic analysis was performed following Braun & Clarke’s (2006) process of identification, analysis, organization, description, and reports.

Results

Study participants were mostly female (n=9) and non-Hispanic white (n=9). Sixty percent (n=6) were obese, and 30% (n=3) were overweight. The mean age was 60.6 years (SD +/- 9.99), ranging from 44 to 80 years.

A majority of participants found the CGM sensor comfortable to wear during the 4-week period. Most participants wanted a longer CGM wearing period to monitor their glucose and behaviors, as they expressed that seeing data from the CGM kept them accountable in their movement and eating behaviors.

Most participants found their glucose information to be relevant and interesting, and became more conscious of how their glucose level was related to physical activity and/or diet. This connection led some to change their behavior. However, a few participants did not make the connection between their physical activity and glucose level, and a few were unclear on how to interpret their glucose when it fell in a normal range.

Conclusion

This study supports that glucose-based biofeedback using CGMs is well-received, and prompts participants to be more conscious of their physical activity and/or diet. More frequent glucose biofeedback may help participants understand their exercise and glucose, and interpretation of glucose in a healthy range may improve understanding of their health.

Keywords: Biofeedback, Physical activity

Authors:

Author - Anita On,
University of Texas at Arlington

Author - Grace Brannon, PhD,
University of Texas at Arlington

Author - Daniela Loya-Rivera,
University of Texas at Arlington

Author - Jannon Vu,
University of Texas at Arlington

Author - Sadia Ali, MD,
UT Southwestern Medical Center

Author - Zui Pan, PhD,
University of Texas at Arlington

Author - Karen Basen-Engquist, PhD, MPH,
The University of Texas MD Anderson Cancer Center

Author - Susan Schembre, PhD,
Georgetown University

Author - Yue Liao, MPH, PhD, CPH, MPH, PhD, CPH,
University of Texas at Arlington

D73 - Improvement in depression and anxiety symptoms among participants in a virtual cardiometabolic condition management program

Poster Number: D73
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Mental Health

Background: Supporting psychological wellness and using equitable approaches to care are integral parts of effective cardiometabolic (CMB) risk management. We evaluated change in depression and anxiety symptoms after enrolling in a virtual CMB program with integrated behavioral health support overall, among those with greater symptom burden, and within demographic subgroups.
Methods: Eligibility criteria included self-reported obesity, diabetes (DM), and/or hypertension (HTN), virtual CMB program enrollment between 10/2021 and 04/2024, and baseline and 16-week PHQ-4 values. The virtual programs offered condition-specific care with a lifestyle-behavior focused curriculum, including self-help cognitive behavioral and mindfulness tools, and a care team that included member-facing health coaches and CMB Specialists (for DM and/or HTN) and licensed clinical social workers available to consult with member-facing care teams on behavioral health needs. Change in PHQ-4 score was evaluated overall and by race/ethnicity and education using t-tests. Changes in PHQ-4 category (0-2=None; 3-5=Mild; 6-8=Moderate; 9-12=Severe) were evaluated with Stuart Maxwell and chi-squared tests. A subgroup analysis was conducted for those with baseline PHQ-4 scores ≥6.
Results: Among the eligible member sample (n=18,142), 73% were female, 81% identified as white, 8.4% Hispanic, and 6.6% Black, and 22% had a high-school or less education level. The percentage of members in each PHQ-4 category at baseline was 62% None, 26% Mild, 8% Moderate, and 2% Severe. Mean PHQ-4 score improved overall (-0.7, p<.01) and in the Moderate+ subgroup (n=2,202; -3.2, p<.01). There was a statistically significant difference in PHQ-4 category from baseline to follow-up overall (p<.01) and in the Moderate+ subgroup (p<.01), with 24% shifting into a lower severity category overall and 72% shifting into a lower severity category in the Moderate+ subgroup. Significant PHQ-4 improvements were observed across all race/ethnicity and education groups overall (PHQ-4 difference range: -0.6 to -0.9; all p<.01) and in the Moderate+ subgroup (PHQ-4 difference range: -3.1 to -3.6; all p<.01).
Discussion: Improvements in depression and anxiety symptoms were seen among members in virtual CMB programs overall and across demographic subgroups and were greatest among those with higher baseline symptom severity. Improved mental health support and well-being tools could help reduce CMB disease development and complications.

Keywords: Mental health, Intervention

Authors:

Co-Presenter - Jeanean B. Naqvi, PhD,
Omada Health

Co-Author - Jenna M. Napoleone, PhD, MPH,
Omada Health

Co-Presenter - Susan M. Devaraj, PhD, MS, RD,
Omada Health

Co-Author - Carmen Kaperick, LICSM, CDCES,
Omada Health

Co-Author - Sarah Linke, PhD, MPH, PhD, MPH,
Omada Health

D74 - The Effect of a Technology-Based Motivational Intervention on Asthma Control and Adherence

Poster Number: D74
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Health of Marginalized Populations

Background: Little is known about asthma self-management in Black American emerging adults, aged 18-29. Black Americans, however, have higher asthma-related morbidity and mortality rates than non-Hispanic White Americans. Emerging adults, especially those who identify with a racial/ ethnic minority group, have lower medication adherence and higher use of the emergency department for asthma care than older adult age groups.

Purpose: To examine the effect of a multicomponent, technology-delivered motivational intervention versus a technology-delivered asthma education control condition on asthma control and medication adherence both during the intervention and 12-month post-baseline, follow-up periods.

Methods: Using Computer Intervention Authoring Software, 143 Black American emerging adults with persistent, uncontrolled asthma completed either a motivational intervention or asthma education control at baseline and 1-month. Participants completed questionnaires at baseline, 1-, 3-, 6-, 9-, and 12-months assessing asthma control and medication adherence. Asthma control was assessed using the Asthma Control Test, behavioral medication adherence was assessed using the Brooks questionnaire, and percent adherence was assessed using the mean of three investigator-developed questions. Data were analyzed using piecewise latent growth curve modeling to model the intervention and follow-up periods separately in MPlus version 8.5. Models included a time-varying variable assessing the effect of COVID-19 on each time point.

Results: Compared to participants who received the asthma education control, participants in the motivational intervention had significant improvement in asthma control during the 1-month intervention period (βint=1.27, SE=0.57, p=0.03) that was sustained over the 12 months post-baseline follow-up (βf/u= -0.001, SE=0.06, p=0.99). The motivational intervention did not have significant effect on behavioral adherence (βint= 0.62, SE=0.38, p=0.11; βf/u= -0.03, SE=0.04, p=0.40) or percent adherence (βint= 6.42, SE=4.84, p=0.19; βf/u= -0.96, SE=0.50, p=0.06) during the intervention period or follow-up periods.

Conclusions: Compared to a time-matched asthma education control, a technology-delivered brief motivational intervention significantly improved asthma control, but not adherence, in Black American emerging adults during a 1-month intervention period. This improvement was sustained over the 12-month post-baseline follow-up period.

Keywords: Asthma, Randomized controlled trial

Authors:

Co-Author - Amy Hall, FNP-BC,
Florida State University

Co-Author - Bo Wang, PhD,
University of Massachusetts Chan Medical School

Co-Author - Jean-Marie Bruzzese, PhD,
Columbia University School of Nursing

Co-Author - Wanda Gibson-Scipio, PhD,
Wayne State University College of Nursing

Co-Author - Rhonda Dailey, MD,
Wayne State University School of Medicine

Co-Author - Alan Baptist, MD,
Henry Ford Health System

Co-Author - Karen MacDonell, PhD, PhD,
Florida State University

D75 - Beyond the Buzz: A Systematic Review of Generative AI’s Capabilities in Mental Health

Poster Number: D75
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Mental Health

This systematic review aims to evaluate the current capabilities of generative AI (genAI) models in the context of mental health applications A comprehensive search across five databases yielded 1,046 references, of which eight studies met the inclusion criteria. These criteria required original research with experimental designs (e.g., Turing tests, socio-cognitive tasks, trials, or qualitative methods), a focus on genAI models, and explicit measurement of socio-cognitive abilities (e.g., empathy, emotional awareness), mental health outcomes, and user experience (e.g., perceived trust, empathy). The studies, published between 2023 and 2024, primarily evaluated models like ChatGPT 3.5 and 4.0, Bard, and Claude in tasks such as psychoeducation, diagnosis, emotional awareness, and clinical interventions. Most studies employed zero-shot prompting and human evaluators to assess the AI responses, using standardized rating scales or qualitative analysis. However, these methods were often insufficient to fully capture the complexity of genAI capabilities. The reliance on single-shot evaluation techniques, limited comparisons, and task-based assessments isolated from a specific context may oversimplify genAI’s abilities and overlook the nuances of human-AI interaction, especially in areas requiring contextual reasoning or cultural sensitivity. The findings suggest that while genAI models demonstrate strengths in psychoeducation and emotional awareness, their diagnostic accuracy, cultural competence, and ability to engage users emotionally remain limited. Users frequently reported concerns about trustworthiness, accuracy, and the lack of emotional engagement.
Future research could use more sophisticated evaluation methods, such as few-shot and chain-of-thought prompting to fully uncover genAI’s potential. Future studies should also focus on longitudinal research, broader comparisons with human benchmarks, and exploring how AI can be better integrated into mental health care with improved socio-cognitive and ethical decision-making capabilities.

Keywords: Mental health, Informatics

Authors:

Author - Liying Wang,
Florida State University

Co-Author - Tanmay Bhanushali,
University of Washington, Seattle

Co-Author - Zhuoran Huang,
Northeastern University

Co-Author - Jingyi Yang,
Columbia University

D76 - Prevalence and characteristics of US adults in health-related Facebook groups.

Poster Number: D76
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Health Communication and Policy

A recent study has shown that over two-thirds of Facebook users have posted at least one health-related post on Facebook in the past year including health information or posts about a health condition or health-related behavior. Facebook allows users to create groups where users can discuss specific topics. Health-related groups abound on Facebook and studies have shown that patients benefit from sharing their experiences with other patients in these groups. Little is known about the prevalence of Facebook health-related group membership among Facebook users and the characteristics of users in health-related Facebook groups. We conducted a cross-sectional survey of 2,508 US adult Facebook users to determine the (a) proportion of users in Facebook groups who belong to health-related Facebook groups, (b) proportion of users whose most paid attention to Facebook group was a health group, and (c) user characteristics associated with health-related group membership including age, gender, race/ethnicity, education, income, and chronic disease status. Of the Facebook users surveyed (N=2,508; 74.7% female; mean age=40.89 SD=15.02), 74.5% belonged to at least one Facebook group. Of those, 34.2% belonged to a health-related Facebook group. About 9.1% of those who belonged to Facebook groups indicated that the Facebook group they paid the most attention to was a health-related group. Using multivariate logistic regression, we found that Facebook users with college degrees had higher odds of belonging to a health-related group compared to those with high school education or less. Facebook users who had chronic disease had higher odds of belonging to a health-related group on Facebook compared to those who did not. Age, gender, race/ethnicity, and household income were not associated with health-related Facebook group membership. Future research should investigate the psychosocial and health-related benefits of being a member of and/or engaging in health-related Facebook groups.

Keywords: e-Health, Health communication

Authors:

Presenter - Richard Bannor, MPH,
University of Connecticut

Co-Author - Christie I. Idiong, MS,
University of Connecticut

Co-Author - Jared Goetz, BA,
University of Connecticut

Co-Author - Sherry Pagoto, PhD,
University of Connecticut

D77 - Empowering caregivers of childhood cancer survivors: AI chatbots for equitable health information delivery

Poster Number: D77
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cancer

Caregivers of young childhood cancer survivors (YCCS) face significant barriers to accessing clear, actionable health and service information. Disparities in health literacy and access exacerbate such barriers in underserved communities (e.g., rural/Appalachian areas). To address these challenges and increase equitable access to information, we developed a prototype artificial intelligence-based chatbot to respond to pediatric oncology-related questions using evidence-based sources. The present study aimed to qualitatively evaluate the perceived utility of the chatbot to address caregivers of YCCS’ needs.

Qualitative data from semi-structured interviews and focus groups with YCCS caregivers (n=10) were analyzed using thematic analysis. Caregivers were recruited from rural, Appalachian, metropolitan areas of the Midwest USA. Caregivers were predominantly female (n=9), and their children ranged from 2-9 years old (M=5.97,SD=2.80) and were diagnosed with leukemia/lymphoma (n=3), non-central nervous system solid tumors (n=4), and brain tumors (n=3). During the interviews, caregivers used the chatbot to answer questions about cancer. The chatbot was built on large language models using evidence-based knowledge to improve accuracy and relevance.

Caregivers noted that engagement and design, personalized information access, trustworthiness and experience would be critical to them utilizing a health-related chatbot. Caregivers wanted the chatbot to support administrative tasks of caregiving such as scheduling or note-taking, particularly in rural and underserved settings. Some noted the benefits of multimodality during testing, suggesting more ways to interact with future iterations of our chatbot. Caregivers highlighted the chatbot’s ability to deliver timely, tailored, and easily understandable health information about local services, especially for addressing complex chronic topics needs like neurodevelopmental late effects. Caregivers noted that the chatbot could have provided more detailed survivorship guidance, such as how to resume education after treatment. The chatbot’s response readability was assessed using the Sydney Health Literacy Lab Editor, achieving high school grade reading score (M=10.1,SD=1.3). This study demonstrates the potential of chatbot use in health information communications and to empower caregivers in underserved populations. Future work will test chatbots longitudinally to understand its effectiveness and impact on health outcomes.

Keywords: Health disparities, Technologies

Authors:

Co-Author - Daniel I. Jackson, BSc.,
Nationwide Children's Hospital

Presenter - Emre Sezgin, BBA, MSc, PhD,
Nationwide Children's Hospital

Co-Author - Kate M. Kaufman, BSc.,
Nationwide Children's Hospital

Co-Author - Micah Skeens, PhD APRN FAAN,
Nationwide Childrens Research Institue

Co-Author - Cynthia A. Gerhardt, PhD,
Columbus Childrens Research Institute

Co-Author - Emily Moscato, PhD,
Nationwide Children's Hospital

D78 - Strengthening Data Integrity in Digital Adolescent Health Studies: A Layered Approach to Combating Fraud in Online Recruitment

Poster Number: D78
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, HIV/AIDS

Issue: Researchers’ increasing reliance on online recruitment, accelerated by the COVID-19 pandemic, has broadened reach, particularly for underrepresented groups like LGBTQ+ adolescents. However, online recruitment also introduces risks such as fraudulent participants. Motivated by financial incentives, some individuals falsify eligibility, compromising data integrity, straining resources, and creating ethical challenges. We present innovative strategies employed across several digital adolescent HIV prevention studies, spanning from one-time online surveys to a randomized control trial (RCT) of a remote texting intervention. Description: In June 2024, we launched a national campaign to recruit 360 U.S.-based adolescents (ages 13-18) for our RCT. Staff quickly observed patterns suggestive of fraud, including participants with unreliable internet, repeated demographic information, and difficulty with simple location-based questions. Initial preventative measures—such as captcha tests and mandatory video chat verifications—proved insufficient. In response, we implemented more robust strategies: updated video chat scripts including conversational prompts to assess U.S. residency and age, mandated photo ID submission prior to the video chat, and IP address analysis via the minFraud service. These strategies were also adapted for our survey studies in static formats, incorporating questions that AI typically cannot answer credibly, as well as video calls, photo ID submissions, and duplicate IP address screening. Lessons Learned: These enhanced strategies have deterred many fraudulent participants, as evinced by trends in recruitment data showing no new cases flagged for suspicion. Further, study staff note increased confidence in identifying fraudulent participants. While each measure alone may have limitations, combined they have strengthened our ability to verify participant eligibility and protect study integrity. Recommendations: Based on these experiences, we recommend adopting a layered approach to fraud prevention digital health research. Key strategies include: (1) using conversational eligibility prompts in video verifications, (2) requiring photo ID uploads, and (3) employing IP address analysis services like minFraud for real-time risk assessment. Continuous adaptation of screening methods is essential as fraud tactics evolve. These combined measures help ensure data quality, protect participant safety, and reduce burden on research staff.

Keywords: e-Health, HIV

Authors:

Presenter - Andrés Alvarado Avila,
Northwestern University - Feinberg School of Medicine

Co-Author - Bryant Norton,
Northwestern University - Feinberg School of Medicine

Co-Author - Eva Minahan,
Northwestern University - Feinberg School of Medicine

Co-Author - Zach Buehler,
Northwestern University - Feinberg School of Medicine

Co-Author - James Foran,
Northwestern University - Feinberg School of Medicine

Co-Author - Luis Rubio,
Northwestern University - Feinberg School of Medicine

Co-Author - William Wibowo Liem,
Northwestern University - Feinberg School of Medicine

Co-Author - Julianna Lorenzo,
Northwestern University - Feinberg School of Medicine

Co-Author - Kathryn Macapagal, PhD, PhD,
Northwestern University

D79 - Validation of Adapted Uses and Grats 2.0 Scale for New Media among Pregnant Individuals’ Use of mHealth

Poster Number: D79
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Women's Health

Since the emergence of the uses and gratifications (U&G) approach in the 1970s to understand media usage, communication technology has advanced significantly. This progress led to the modified U&G, incorporating diverse and novel features provided by new technologies. Sundar and Limperos proposed U&G 2.0, which includes new communication features to help understand people’s engagement with these technologies.
This study aims to evaluate the psychometric properties of the adapted U&G 2.0 scale for the pregnant population’s use of mHealth. Pregnant participants were recruited via CloudResearch and completed the survey using Qualtrics. After ensuring data integrity, the final sample size was 165. The psychometric evaluation includes content validity, reliability, and preliminary confirmatory factor analysis (CFA) conducted using Excel, SPSS Statistics, and SPSS Amos.
Of 165 pregnant participants, 99% identified as female and 1% as transgender. The participants had a mean age of 30.6 years (SD=6.4) and were 57% White, 22.4% African American, 6.7% Asian, and 4.8% Hispanic (8.4% included American Indian, Native Hawaiian, and multi-ethnic groups). Content validation was reviewed by seven experts. Out of 57 items, seven items failed to meet the item-level content validity index (.83) and were revised based on experts’ feedback. Reliability was assessed with Cronbach’s alpha (.97), indicating high internal consistency. Four preliminary measurement models were tested using first-order CFA to examine factor loadings of the 16 latent variables on 57 items based on the U&G 2.0. Given the multivariate nonnormality of the data, bootstrapping was employed to ensure the robustness of the results. All factor loadings were statistically significant. However, the baseline model fits were inadequate, leading to correlating error terms using modification indices and item content overlap. After model respecifications, the measurement models showed acceptable/marginal model fit values of CFI, RMSEA, and TLI.
This psychometric study confirms that adapted U&G 2.0 satisfies the validity and reliability criteria. However, further testing is needed of the second-order full measurement model to validate the hierarchical structure of the U&G 2.0 scale, which can provide a comprehensive understanding of mHealth use among the pregnant population. This scale is an important step in evaluating mHealth new media, offering valuable insights into user engagement and technology adoption.

Keywords: e-Health, Methodology

Authors:

Co-Author - Lorraine O. Walker, EdD, MPH, FSBM, EdD, MPH, FSBM,
University of Texas

D80 - Adapted Obesity Prevention Intervention in Under-Resourced Schools: A Pilot Study

Poster Number: D80
Time: 11:00 AM - 11:50 AM
Topics: Dissemination and Implementation, Child and Family Health

Background: The purpose of this study was to pilot-test an adapted obesity prevention intervention called Preventing Obesity Using Digital-Assisted Movement and Eating (ProudMe) in under-resourced schools. Method: Six schools were randomized to either ProudMe (n = 33 participants at three schools) or waitlist control (n = 46 participants at three schools) groups. ProudMe targeted students’ physical activity, diet, and screen time through interventions in school cafeterias (i.e., ProudMe Cafeteria) and physical education programs (i.e., ProudMe PE), and via artificial-intelligence-assisted behavioral counseling (ProudMe Tech) and staff professional development (ProudMe PD). Mixed methods data were collected to assess three implementation outcomes including penetration, fidelity, and sustainability. Trained observers evaluated the school cafeterias using the Smarter Lunchroom Scorecard before and after the intervention. Trained data collectors pre- and post-tested participants' anthropometrics (weight, height, waist circumference) and health behaviors. Results: ProudMe Cafeteria demonstrated outstanding implementation outcomes. The ProudMe Cafeteria intervention led to a 13.4% improvement (ΔM = 4.7) in scorecard scores across three schools, while control schools saw a 9.8% decline (ΔM = -3.0). ProudMe PE demonstrated only moderate penetration (50% to 67%) and fidelity (fidelity index ranged from 50% to 68.8% (M = 62.5%)) with low sustainability. ProudMe PD was well attended but ProudMe Tech was under-utilized. No significant time-by-condition interaction effects were observed for the student-level anthropometric and health behavior outcomes. Conclusion: This pilot trial generated mixed evidence on feasibility of the pilot ProudMe intervention. The lessons learned from this pilot study will inform our future intervention refinement for effectiveness evaluation. Childhood obesity prevention intervention efforts in under-resourced schools should consider influential factors such as intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the implementation process.

Keywords: Health education, Dissemination

Authors:

Author - Yuxin Nie, M.Ed.,
Louisiana State University

Co-Author - Qiaoyin Joy Tan, M.Ed.,
Louisiana State University

Co-Author - Paul Son, M.Ed.,
Louisiana State University

Co-Author - Amanda Staiano, Ph.D., M.P.P.,
Pennington Biomedical Research Center

Co-Author - Richard R. Rosenkranz, Ph.D.,
University of Nevada, Las Vegas

Co-Author - Katherine E. Spring, Ph.D.,
Pennington Biomedical Research Center

Co-Author - Monica Suarez Reyes, Ph.D.,
Pennington Biomedical Research Center

Co-Author - Jared N. Androzzi, Ph.D.,
Winthrop University

Co-Author - Senlin Chen, Ph.D.,
Louisiana State University

D81 - Translating the Behavior Change Technique Taxonomy Version 1 into Spanish: Methodology and Validation

Poster Number: D81
Time: 11:00 AM - 11:50 AM
Topics: Dissemination and Implementation, Methods and Measurement

Background: Precise and unequivocal specification of intervention content is key to facilitating the accumulation and implementation of knowledge. The Behavior Change Technique Taxonomy v1 (BCTTv1) is the most widely used classification of behavior change techniques (BCTs), providing a shared, standardized vocabulary to identify the active ingredients of behavioral interventions. However, the BCTTv1 is only available in English and this hampers its broad use and adoption. The aim of the present work is to report the process of translation of the BCTTv1 into Spanish.

Methods: A bilingual team led the translation of the BCTTv1, involving seven iterative steps: (i) establish a Committee, (ii) forward translation from English to Spanish, (iii) back translation from Spanish to English, (iv) comparison of original BCTTv1 and back translation, (v) opportunistic comparison against an independent BCTTv1 translation, (vi) empirical testing, and (vii) final Committee review.

Results: Changes as a result of the translation process included relabeling BCTs, amending definitions, and fixing conceptual and grammatical inconsistencies, yielding the final version. Very satisfactory inter-coder reliability in BCT identification was observed as part of the empirical testing (i.e., prevalence and bias-adjusted kappa scores > 0.8).

Conclusions: This study provides the Spanish-speaking population with a rigorous and validated BCTTv1 translation which can be used in both research and practice to provide a greater level of intervention detail for evidence synthesis, comparison, and replication of behavior change interventions. The translation process described here may prove helpful to guide future translation efforts in behavioral science and beyond.

Keywords: Dissemination, Research to practice translation

Authors:

Presenter - Oscar Castro,
Singapore-ETH Centre

Co-Author - Gabriela Fajardo,
Universidad de Santiago de Chile

Co-Author - Marie Johnston,
University of Aberdeen

Co-Author - Denise Laroze,
Universidad de Santiago de Chile

Co-Author - Eduardo Leiva-Pinto,
Universidad Bernardo O’Higgins

Co-Author - Oriana Figueroa,
Universidad del Desarrollo

Co-Author - Elizabeth,
University College London

Co-Author - Jeanette Chacón-Candia,
University of Granada

Co-Author - Giuliano Duarte,
University of Santiago of Chile

D83 - Framing Alcohol-Cancer Risk Messages for Young Female Drinkers: Evaluating the Drink Less For Your Breasts Campaign

Poster Number: D83
Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Cancer

Background
The breast cancer risk of alcohol consumption remains widely unknown among female drinkers. Drink Less For Your Breasts (DLFYB)—the first known breast cancer-alcohol risk campaign developed in the United States—leverages social media to raise awareness of a lesser-known health danger posed by alcohol.
Purpose
This multiphase exploratory study examined cancer message framing in DLFYB (Instagram @drinklessforyourbreasts; N=96). The role of visuals in communicating health priorities remains understudied. Therefore, this study applied integrative framing analysis (IFA) to conduct distinct text (i.e., post caption) and visual analyses. A semi-structured interview with the campaign’s lead investigator was conducted for insight on the framing strategies utilized in the campaign.
Method
A 9-item framework for cancer messages guided deductive analysis of post captions (n=77). A subsample (n=22) of images depicting female-presenting people was drawn for visual analysis. Images were digitally edited to separate words from image and deductively analyzed with a 4-level framework for visual framing analysis in accordance with IFA. de Vere Hunt and Linos’ principles for the development and effectiveness of social media health campaigns guided the development of the interview protocol.
Results
Post captions revealed the dominant alcohol-breast cancer risk frames were environmental (i.e., alcohol consumption causes cancer), epidemiologic (i.e., statistics on breast cancer incidence), and personal (i.e, focus on the individual's decision to consume alcohol). Visual frames aligned with photographic stylistic conventions (i.e., close-up of females' faces to convey intimacy) and denotative (i.e., mastectomy) and connotative (i.e., wine spilled on a breast) systems. The development of DLFYB reflected core campaign principles of tailored messaging and formative research. Due to focus group feedback the campaign avoided blame in its messaging.
Conclusion
Breast cancer is the second highest cancer killer of women in the United States. Drinking even small amounts of alcohol increases the risk of alcohol-related breast cancer. Framing of the cancer risk message may lead to curtailed drinking behaviors. These findings suggest that campaigns informed by health communication principles can raise awareness of risky cancer behaviors.

Keywords: Health communication, Cancer risk perceptions

Authors:

Author - Nadia A. Sesay, MA,
University of Kentucky

D84 - U.S. Vietnamese parents’ communication with their adolescents about sexual and reproductive health topics

Poster Number: D84
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Social and Environmental Context and Health

Background: Parent-child communication about sexual and reproductive health (SRH) can improve youth’s SRH outcomes and behaviors. Little research has focused on SRH communication in U.S. Vietnamese (i.e., those in the U.S. and self-identifying as Vietnamese) families. Furthermore, no study has examined how American and Vietnamese acculturation impact parent-child SRH communication in this population. We aim to 1) describe parent-child SRH communication in U.S. Vietnamese families; and 2) evaluate how parental acculturation influences SRH communication.

Methods: Data came from a cross-sectional survey conducted with 393 U.S. Vietnamese parents of adolescents aged 9-18. We assessed parent-child communication about (1) Birth control, (2) STDs, (3) HIV, (4) Pregnancy, (5) Resisting pressure to have sex, (6) Having a romantic relationship, and (7) Physical changes in puberty. American and Vietnamese acculturation were assessed by the Asian American Multidimensional Acculturation Scale, percentage of life in the U.S., and ability to understand medical information in English and Vietnamese. Descriptive statistics and multivariable logistic regressions were used to analyze data.

Results: Most participants were mothers (83.0%) and had completed a college degree (85.0%). Half of the children were female (50.6%) and born outside of the U.S. (51.7%). SRH topics, in descending order of ever discussed, were physical changes in puberty (87.3%), having a romantic relationship (77.1%), pregnancy (66.4%), HIV (53.4%), birth control (52.4%), STDs (51.7%), and resisting pressure to have sex (45.8%). Higher American acculturation was associated with discussions about each of the 7 topics (adjusted odd ratios ranged from 1.51 to 2.17). Furthermore, mothers were more likely to talk about physical changes in puberty. Those with a college degree or higher and those with female children were more likely to talk about pregnancy. Child’s age was also positively associated with communication on all SRH topics.

Discussion: Findings highlight low parent-child SRH communication among U.S. Vietnamese families, especially on critical topics like contraception, STDs, and resisting sexual pressure. Results point to a need for culturally-tailored SRH education emphasizing the importance of early and ongoing SRH communication that accounts for parental acculturation, parental education, as well as parental and child’s gender and age.

Keywords: Acculturation, Minority groups

Authors:

Co-Author - Miho Ujiie,
Emory University

Co-Author - Cari Jo Clark,
Emory University

Co-Author - Anna Newton-Levinson,
Emory University

Co-Author - Justine Liu,
Northwestern University

Presenter - Milkie Vu, PhD, PhD,
Northwestern University

D85 - The behaviour change content of commonwealth partnerships for antimicrobial stewardship

Poster Number: D85
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Dissemination and Implementation

Background:The Commonwealth Partnerships for Antimicrobial Stewardship were developed in 2019, funded by the UK Department of Health and Social Care, for groups of health professionals in UK, Ghana, Uganda, Zambia and Tanzania. The funding scheme included some training for partners in behavioural science and offered behavioural science volunteers to work with five of the twelve partnerships. We aimed to examine the behaviour change content of the interventions developed by the partners.
Methods: we conducted a behavioural content analysis of intervention materials. We asked for intervention materials from 12 partnerships and six submitted (50%). We compared partnerships with (n=2) and without (n=4) behaviour change volunteers.
Findings: we found that partnerships targeted 19 behaviours, most commonly hand hygiene and prescription of antibiotics. We found 23/93 (25%) behaviour change techniques in the interventions, with the most common being instruction on how to perform the behaviour. There was underreporting of specific behaviours, actor and target.
Discussion: interventions targeted multiple behaviours using a quarter of available behaviour change techniques. Intervention reporting did not lend itself to analysis or replication. In order to learn important lessons about antimicrobial stewardship projects, we need to increase the use of a shared language for reporting intervention targets and content.

Keywords: Infection, Research to practice translation

Authors:

Co-Author - Rachel Hawkins,
University of Manchester

Co-Author - Panayotis Michael,
University of Manchester

Co-Author - Eleanor Bull,
Derbyshire County Council

Co-Author - Richard Skone-James,
Tropical Health and Education Trust

Co-Author - Jo Hart, PhD, PhD,
University of Manchester

D86 - Culture Matters in Cardiovascular Responses to Cancer Caregiving Stress: Effects of Acculturation and Hispanic Ethnicity Among Caregivers of Adult Patients with Cancer

Poster Number: D86
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Stress

Caregiving for a family member with cancer can be challenging. Cultural factors such as acculturation and ethnicity may be contributory to differential stress responses and subsequent health outcomes, yet such inquiries remain understudied. This study examined the extent to which acculturation was associated with cardiovascular stress responses following an induced stressor, and the moderating role of Hispanic ethnicity, among caregivers of patients with cancer.

Participants were spousal caregivers (N = 138, M age = 58.9, 67.1% female, 60.1% Hispanic) of patients diagnosed with colorectal cancer. Participants completed questionnaires assessing their levels of acculturation and ethnicity. Cardiovascular responses, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), were measured at rest, upon stress induction, and after stress recovery from a relationship- and health-related experimental stressor. Age, body mass index (BMI), gender, and hypertension diagnosis were covariates.

Caregivers reported moderate levels of acculturation and displayed significant changes in cardiovascular responses (p < .001). General linear modeling revealed that Hispanic ethnicity was associated with greater recovery in SBP and DBP (b ≥ 6.85, p ≤ .032), and greater acculturation was associated with greater recovery in DBP (b = 3.07, p = .006). Additionally, among only Hispanic caregivers, greater acculturation was associated with lower SBP and DBP at rest (b ≥ -6.85, p ≤ .013) as well as greater DBP recovery following stress (b = 7.70, p < .001).

Findings suggest the independent, synergistic, and salutary roles of acculturation and Hispanic ethnicity in cardiovascular functioning, particularly in stress recovery. These results emphasize the need for culturally sensitive interventions to prevent premature cardiovascular diseases in caregivers of patients with cancer. Investigations of biopsychosocial mechanisms through which acculturation and Hispanic ethnicity are associated with cardiovascular health in culturally diverse caregiver populations are warranted.

Keywords: Acculturation, Cardiovascular reactivity

Authors:

Author - Thomas Aguilar Cortes,
University of Miami

Co-Author - Thomas C. Tsai,
University of Miami

Co-Author - Jiya Laxmi Arora,
University of Miami

Co-Author - Dominick Dennis,
University of Miami

Co-Author - Rachael Chandley,
University of Miami

Co-Author - Jake Falbo,
University of Miami

Co-Author - Youngmee Kim, PhD, FSBM, PhD, FSBM,
University of Miami

D87 - Strategies to increase Mpox Vaccination Uptake in San Antonio, Texas

Poster Number: D87
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Community Engagement

Background
Mpox was declared a public health emergency in 2022 & 2024. The virus can cause serious complications in those who have weakened immune systems, and can spread through close contact, including during sexual intercourse. The vaccine is recommended to individuals with higher risk of mpox contact, but uptake remains suboptimal. This study aimed to identify mpox vaccination barriers and identify potential interventions to increase mpox vaccination uptake in San Antonio, Texas.

Methods
Participants were recruited through community outreach, which included social media and flyer distribution in collaboration with the City of San Antonio Metropolitan Health District. Individuals eligible for the mpox vaccine were invited to participate in a 45-60 minute confidential, semi-structured, qualitative interview over Zoom, where they discussed sexual behaviors, experiences, beliefs, attitudes towards the healthcare system, and mpox vaccine services. Each interview transcript was analyzed using a framework analysis. Results of the analysis were discussed among team members with the goal of identifying potential vaccine interventions.

Results
Overall, of the 27 participants (age 18-64 years old), 100% were sexually active self-identified men, 81% identified as gay, 7% as heterosexual, and 11% as bisexual. By ethnoracial identity, 74% were Hispanic/Latino, 15% White Non-Hispanic, and 11% Black/African American. 48% had never received any doses of the mpox vaccine.

Analyses showed the following factors influencing mpox vaccine uptake: low awareness of the mpox vaccine, misconceptions/fear about mpox and the vaccine, challenges with transportation, out-of-pocket costs, and stigma surrounding mpox. Based on these findings,
four potential interventions were identified: dual branding of the mpox vaccine with smallpox to reduce stigma and lack of awareness, implementing a “pay-it-forward” community donation model to lower financial barriers, leveraging healthcare providers' recommendations to boost vaccine credibility and awareness, and offering vaccinations at local pharmacies to improve accessibility and reduce stigma.

Conclusion
Interviews with the mpox vaccine-eligible population were instructive for identification of mpox vaccine interventions that may be acceptable and appropriate for this population. Further studies are needed to optimize intervention implementation and to assess intervention effects on willingness and actual uptake of mpox vaccine.

Keywords: STDs, Latino

Authors:

Co-Author - Joann Vo,
University of Texas at San Antonio

Co-Author - Cheng Yu,
University of Texas at San Antonio

Co-Author - Leonardo Gamboa,
University of Texas at San Antonio

Co-Author - Etienne Jaime, MPH,
NYU Shanghai

Co-Author - Katelyn Sileo,
Boston College

Co-Author - Abram Wagner,
University of Michigan

Co-Author - Miguel Cervantes,
The City of San Antonio Metropolitan Health District

Co-Author - Rita Espinoza,
The City of San Antonio Metropolitan Health District

Co-Author - Shamshad Khan,
=University of Texas at San Antonio

Presenter - Stephen Pan,
University of Texas at San Antonio

D88 - Experiences of Binegativity and Physical Health Symptoms in Bisexual Asian and Latinx College Students

Poster Number: D88
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Social and Environmental Context and Health

INTRODUCTION: Experiences of Biphobia adversely impact the physical health of Bisexual persons (Doan Van et al, 2019). Yet, most research has focused on Lesbian and Gay (LG) populations while neglecting Bisexual experiences and perspectives (Barker & Langdridge, 2008). Bisexuals experience a unique form of discrimination, Binegativity, which includes identity invalidation and erasure, as well as sexual victimization from LG and heterosexual persons. As a result, the lack of support for the experiences of Bisexual persons may contribute to the development of health disparities for this population (Doan Van et al., 2018). This study explored the predictive relationship of experienced biphobia and physical health symptoms, namely headaches and gastrointestinal (GI) issues.

METHOD: Bisexual Asian and Latinx persons (N = 208) were recruited through social media posts, a psychology department participant pool, and flyers distributed at a public institution. Participation looked like completing the Physical Health Questionnaire-14 (PHQ-14) and the Anti-Bisexual Experiences Scale (ABES).

RESULTS: Greater experiences of Biphobia predicted more headaches, whether enacted by heterosexual (β = .046, p = .001), or gay or lesbian persons (β = .051, p = .012 ). The same pattern emerged for GI issues, where greater experiences of biphobia predicted more GI problems whether enacted by heterosexual (β = .062, p < .001) or gay/lesbian persons (β = .064, p = .008 ).

DISCUSSION: Findings highlight the systemic nature of Binegativity, suggesting that regardless of whether experiences of Biphobia are perpetuated by heterosexual or gay/lesbian individuals, Binegativity is consistently associated with greater physical health symptoms in this sample.

Keywords: Minority health, Sexual orientation

Authors:

Co-Author - Adina Corke, M.A.,
California State University Fullerton

Co-Author - Justin Baker,
California State University Fullerton

Co-Author - Emily Tearjen,
California State University Fullerton

Co-Author - James Tran,
California State University Fullerton

Co-Author - Tamara Tavira,
California State University Fullerton

Co-Author - Hanna Nguyen, M.A.,
California State University Fullerton

Author - James Garcia, Ph.D.,
California State University Fullerton

D89 - Examining the Relative Contributions of Modifiable Physical Fitness Variables to Cognition among Healthy Black and White Older Adults

Poster Number: D89
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Aging

Studies suggest physical fitness is positively associated with cognition among older adults, but Black/African Americans are underrepresented in the extant literature. The goal of the present study was to examine the relationships and relative contributions of physical fitness measures to cognitive performance among Black and White older adults. Healthy, cognitively normal participants aged 65+ from the Health and Retirement Study who completed the Harmonized Cognitive Assessment Protocol and who identified as “Black/African American” were selected (n = 76; mean age = 73.7 years; mean years of education = 13.4). A sample of participants who identified as “White/Caucasian” were matched based on demographics and health status (n = 76; mean age = 74.1 years; mean years of education = 13.7). Participants completed assessments of physical fitness (lung capacity, grip strength, timed walk) and a battery of neuropsychological tests. Composite scores for physical fitness, episodic memory, and executive function/processing speed performance were generated. Hierarchical multiple linear regression and analyses of relative importance were used to examine relationships between physical fitness and cognitive performance across and within racial groups. Across the full sample, higher composite physical fitness was associated with better executive function/processing speed (β=.42, p<.001), but not episodic memory (β = .10, p = .34). Although Race x Physical Fitness interactions were not observed (β’s < .03, p’s > .85), the relationship between composite fitness and executive function/processing speed among Black older adults was relatively weaker (β = .29, p = .08) compared to White older adults (β = .50, p < .001). Lung capacity had the strongest relative contribution to executive function/processing speed performance among the fitness variables for both racial groups. Performance on the timed walk had relatively important contributions to executive function/processing speed and episodic memory performance only for the White older adults. Overall, there appeared to be a weaker association between fitness and cognition among Black older adults relative to White older adults. These results suggest that components of physical fitness may have variable relationships with cognition depending on the cognitive domain assessed and racial composition of the study sample.

Keywords: Health disparities, Older adults

Authors:

Author - Matthew Stauder, M.S.,
The Ohio State University

Co-Author - Scott Hayes, Ph.D.,
The Ohio State University

D90 - Expanding the Diabetes Homelessness Medication Support program (D-HOMES) to Spanish-speaking Hispanic adults

Poster Number: D90
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Diabetes

Significance: Hispanic adults have significantly higher rates of diabetes with earlier, more severe complications and death than non-Hispanic whites. They also have higher rates of homelessness which exacerbates complications of diabetes. Furthermore, those who primarily speak Spanish have significantly lower medication adherence than English-speaking Hispanics.
Objective: Adapt the Diabetes Homeless Medication Support (D-HOMES) behavioral treatment manual using culturally appropriate guidance to enhance medication adherence of Spanish-speaking Hispanic adults living with type 2 diabetes.
Method: Our open trial pilot study enrolled 12 Spanish-speaking participants from 1) interested participants from previous qualitative interviews, 2) referrals from a community partner organization, and 3) eligible patients at our urban health system. Inclusion criteria were self-reported diagnosis of type 2 diabetes, preferred Spanish language, recent homelessness, and willingness to work on diabetes self-care. They were offered 10 one-on-one sessions over 3 months (approx. weekly) delivered in-person or by phone from a Spanish-speaking, Hispanic diabetes wellness coach. The coach used motivational interviewing and behavioral activation to improve medication adherence, provide diabetes education, and support resource/care coordination. Assessments were done at baseline and 3 months by Spanish-speaking, Hispanic staff. Participants self-reported measures of mood, quality of life, problem areas in diabetes, medication adherence, homelessness plus physical measurements like HbA1c.
Results: We engaged and retained 11 participants, with most completing all sessions. Diabetes self-management and medication adherence improved from baseline to 3 months (DSMQ increased 2.7 points from 24.5 to 27.2, p = 0.11; ASK-12 improved 3.2 points from 34.7 to 37.9, p = 0.21; ARMS-D decreased -0.4 points from 14.6 to 14.2, p = 0.32; PAID-5 decreased -0.4 points from 5.2 to 4.8, p = 0.80). Glycemic control (Hb A1c) also improved changing -0.9%, from 9.1% at baseline to 8.2% at 3-months (p = 0.15).
Conclusions: Combined in-person & telehealth options supported robust participation and high retention. Early results indicate potentially important improvements in diabetes self-care, medication adherence, and glycemic control. The results combine with other treatment development work in English and Spanish to develop a feasible behavioral trial for fully powered testing in a larger clinical trial.

Keywords: Hispanic, Health disparities

Authors:

Presenter - Oscar Oranday Perez,
Hennepin Healthcare Research Institute

Co-Author - Katherine Diaz Vickery, MD, MSc, MD, MSc,
Hennepin Healthcare Research Institute

Co-Author - Andrew M. Busch, PhD, PhD,
University of Minnesota/HCMC

Co-Author - Audrey R. Hyson, PhD, PhD,
Hennepin Healthcare Research Institute

Co-Author - Silvio Kavistan,
Hennepin Healthcare Research Institute

D91 - Mexican-origin Men’s Perceptions on a Culturally Tailored Intervention to Address NAFLD

Poster Number: D91
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Community Engagement

Background: Nonalcoholic Fatty Liver Disease (NAFLD), now termed Metabolic Dysfunction-Associated Steatotic Liver Disease, is prevalent in the U.S., particularly among Hispanic populations. Despite the high susceptibility of PNPLA3 that significantly increases the risk of NAFLD among Mexican-origin men, current guidelines lack specific recommendations for culturally tailored interventions. Purpose: This qualitative study aims to assess Mexican-origin men’s perceptions of a culturally tailored intervention for NAFLD, focusing on their priorities, preferences, and key motivators to develop more effective and engaging interventions that align with their values. Methods: Semi-structured interviews were conducted with 17 Mexican-origin men from a community-based sample who had NAFLD and a genetic predisposition, as identified in a previous cross-sectional study. The interview guide included questions and an activity where participants selected the top five cards representing their preferences and ranked them in order of importance for tailoring a program aimed at reducing NALFD risk and explored their motivators for engaging in these programs. Interviews were conducted and audio recorded in English (n = 6) and Spanish (n = 11) and uploaded in NVivo for data analysis and interpretation. Guided by the Health Belief Model, a thematic analysis approach was used to identify primary themes. Results: Men preferred understanding and interpreting medical tests to assess their genetic risk of NAFLD and its impact on their family’s health. Regarding program delivery, participants expressed the importance of receiving information in Spanish and having Mexican origin program staff to establish cultural relevance and trust. They shared the importance of involving family members to understand the health risks and disease progression. As primary motivators for implementing behavior changes (e.g., diet, physical activity) to prevent more severe liver conditions, participants expressed a desire to stay healthy and avoid illness for their families’ sake—to support and care for their family and to serve as role models. Conclusions: Our findings underscore the critical role of family and culturally tailored approaches in engaging Mexican-origin men in health interventions for NAFLD. Prioritizing family involvement, culturally relevant communication, and Spanish-language support is crucial for motivating behavior changes that can prevent the progression of liver conditions.

Keywords: Health behaviors, Minority health

Authors:

Presenter - Vanessa Torres, PhD, MPH,
Cedars Sinai

Co-Author - Edgar A. Villavicencio, MPH, MPH,
The University of Arizona

Co-Author - Adriana Maldonado, PhD, MA,
The University of Arizona

Co-Author - Jailene Cruz,
Cedars Sinai

Co-Author - David O. Garcia, PhD, PhD,
University of Arizona

D92 - The association of age at immigration on depression misperception among immigrant adults in the US: Data from National Health and Nutrition Examination Survey (NHANES) 2015-2018

Poster Number: D92
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Mental Health

Depression symptom recognition remains low among some racially/ethnically minoritized groups. Acculturation, the process of assimilating to a cultural environment, may impact depression symptom recognition through various mechanisms, such as English proficiency and concepts of mental health, leading to depression misperception. We investigate whether age at immigration is associated with depression misperception among immigrant adults in the US.
Methods: Using NHANES 2015-2018, we operationalized misperception as a mismatch between single-item depression severity and PHQ-9 (a validated measure of depression) scores. For the single-item, respondents were asked, “How often do you feel depressed?” (daily, weekly, monthly, a few times a year, never). For the PHQ-9, we used standard cutoffs (no, mild, moderate, moderately severe, severe). Respondents were considered overperceiving if their single-item depression severity was more severe than their PHQ-9 score, underperceiving if PHQ-9 was more severe than single-item, and correctly perceiving if scores matched. Age at immigration was calculated by subtracting the years in the U.S. from the current age. Separate logistic regression tested the association of age at immigration with depression misperception controlling for sociodemographics.
Results: Our sample of 932 Asian (36.03%), Black 183 (7.07%), Mexican American 728 (28.14%), Other Hispanic 612 (23.66%), White 132 (5.1%) adults (mean age: 49.91 yrs, 51.68% female) had a mean age at immigration of 29.67 years (ranging from 0-79). PHQ-9 scores were: 83.33% none, 13.26% mild, 3.71% moderate, 1.08% moderately severe, and 0.62% severe. For single-item severity, 8.4% endorsed at least weekly depression. Half (54.81%) correctly perceived, 39.08% overperceived, and 6.11% underperceived. Age at immigration was not associated with symptom overperception (OR=1.03, p=.19) but was associated with symptom underperception (OR=1.07, p=.04). Discussion: Age was significantly associated with depression misperception, with those who immigrated at an older age were more likely to underperceive their symptoms. Our crude depression misperception measure may not have fully captured the complexities of reporting discrepancies. Future work should include more comprehensive measures and methods to examine mechanisms of depression misperception in these and other minoritized communities.

Keywords: Health disparities, Mental health

Authors:

Presenter - Clare Wongwai,
University of Illinois at Chicago

Co-Author - Maya Lee,
University of Illinois Chicago

Co-Author - Lin Zhu, PhD, PhD,
Temple University

Co-Author - Loretta Hsueh, PhD, PhD,
University of Illinois at Chicago

D93 - Exploring drivers of binge eating in individuals with food insecurity

Poster Number: D93
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Diet, Nutrition, and Eating Disorders

Greater food insecurity is associated with more severe binge eating; however, little is known about what drives binge eating in populations with food insecurity. The use of narrow participant samples (e.g., underweight, White women from food secure households) in binge eating disorder research has resulted in theories of binge eating and interventions that may not sufficiently generalize to those with food insecurity and binge eating. This study explored the perceived drivers of binge eating in relation to food insecurity. We conducted individual interviews with 28 adults who report food insecurity and recurrent binge eating (Mean age = 46.22, SD = 11.94; 64.3% female; 39% Black, 53% White; 18% Hispanic). Although exploratory, we hypothesized that binge eating drivers would link to three proposed mechanisms: alleviating negative emotions, variable food access, and affordability of energy-dense foods. Interview data were audio-recorded, manually transcribed, independently coded by team members and analyzed using thematic analysis methods. Findings supported our hypotheses and suggest unique and common drivers of binge eating in food-insecure individuals. Fluctuating food access was identified as a unique driver with participants reporting increased binge eating during periods of greater food availability (e.g., “When I have a lot of money, I tend to binge eat because I can get whatever I'm craving at the time”). Drivers commonly observed in those who binge eat were also identified, such as negative experiences (e.g., stress) and binge-promoting narratives (e.g., rationalizing binges). Connections between themes of fluctuating access and negative experiences were also observed, with uncertainty about food availability leading to heightened stress which promoted binge eating. These qualitative data advance our understanding of the mechanisms involved in the association of food insecurity and binge eating. Future research should explore the impact of improving access to nutritious foods in combination with providing emotion regulation strategies to reduce binge eating in adults with food insecurity.

Keywords: Binge eating, Eating behaviors

Authors:

Author - Emilie Green, BA,
Rosalind Franklin University

Co-Author - Kristin Schneider, PhD,
Rosalind Franklin University

Co-Author - Angela Chang, MS,
Suffolk University

Co-Author - Brian Feinstein, PhD,
Rosalind Franklin University

Co-Author - Isabel Rooper, BA,
Northwestern University

Co-Author - Jennifer Wildes, PhD,
The University of Chicago

Co-Author - Andrea Graham, PhD,
Northwestern University

D94 - Experiences with Discrimination, Alcohol Use, and Anxiety Among Gay Men

Poster Number: D94
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Substance Misuse

Fifty percent of sexual minority men (SMM) report experiencing discrimination based on their sexual orientation (Bostwick et al., 2014). Additionally, many SMM reporting experiencing discrimination meet criteria for alcohol use disorder (Lee et al., 2016). Likewise, severe depression and anxiety is associated with discrimination experiences among SMM (Lamontagne et al., 2024). However, few studies examine the potential mediating role that alcohol use (AU) plays in explaining the relationship between discrimination and anxiety symptoms among SMM.

The goal of this study is to examine interrelationships among discrimination, AU, and anxiety severity in a sample of SMM. We hypothesize that discrimination experiences will be associated with problematic AU, which will lead to greater anxiety severity.

SMM participants (N = 310) were recruited in New York State. Participants completed a 30-minute survey; this study focuses on a subset of 293 White, Black, and Latine SMM who reported alcohol use. Experiences with discrimination were measured using the Everyday Discrimination Scale and alcohol use was measured using the Alcohol Use Disorders Identification Test. Anxiety severity was measured using the Generalized Anxiety Disorder-7 screener. Mediation analyses were conducted using the SPSS PROCESS macro, with age, socioeconomic status, and race/ethnicity included as control variables.

Results indicated that discrimination was a significant predictor of anxiety severity (B = .099, SE = .009, 95% CI[.08, .12], p < .001). Results also indicated that discrimination was a significant predictor of AU (B = .03, SE = .01, 95% CI[.01, .05], p = .001) and that AU was a significant predictor of anxiety severity (B = .35, SE = .05, 95% CI[.24, .45], p < .001). Approximately 46% of the variance in anxiety severity was accounted for by the predictors (r2 = .46). The mediation analysis also indicated that AU was statistically significant in mediating the relationship between discrimination and anxiety severity (95% Bootstrap CI: [.003, .02]).

This study contributes to our understanding of how discrimination experiences affect the mental health of SMM. Findings suggest that SMM who experience more discrimination are more likely to use alcohol and experience greater anxiety symptoms than SMM who report lesser instances of discrimination. These findings demonstrate the potentially negative impacts that experiencing discrimination can have on overall health among SMM.

Keywords: Anxiety, Alcoholism

Authors:

Author - Eric Cortez,
UCLA Department of Psychology

Co-Author - Patrick Wilson,
UCLA Department of Psychology

D95 - Utilization of and Satisfaction with Addiction Recovery Groups and Outpatient Substance Use Rehabilitation Programs Among Black Sexually Minoritized Men Living with HIV

Poster Number: D95
Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, HIV/AIDS

Introduction: Black Americans face significant inequities in substance use treatment. For young Black gay, bisexual, and other sexually minoritized men (BSMM) living with HIV, these barriers are exacerbated by stigma and discrimination related to their age, racial, sexual, and HIV-related identities. Additionally, substance use problems are prevalent among individuals living with HIV. Despite this, research on the experiences of young BSMM with substance use services, particularly in recovery groups and outpatient programs, is extremely limited. This study aims to address this gap by examining these issues among BSMM living with HIV in Atlanta, GA.

Methods: Participants were BSMM, age 18 to 29 years, and living with HIV. Recruitment occurred from April 2021-November 2022 via: (1) web-based forums, (2) community-based organization collaborations, and (3) a comprehensive HIV care center. Surveys were administered via REDCap (a HIPAA-compliant online database), and included measures of substance use treatment service utilization and satisfaction. We calculated frequencies to describe utilization of and satisfaction with addiction recovery groups and outpatient drug and/or alcohol rehabilitation programs. We ran logistic regression to identify predictors of utilization of both services.

Results: Of 200 BSMM, 27 had attended an addiction recovery group, and 19 had participated in an outpatient drug and/or alcohol rehabilitation program. Most participants who attended a recovery group reported being very satisfied (n=11) or satisfied (n=10), with only two expressing dissatisfaction. Similarly, those who participated in an outpatient rehabilitation program were mostly very satisfied (n=11) or satisfied (n=4), though one participant was very dissatisfied. Participants who were engaged in HIV care at the time of the survey were more likely to have utilized both types of services, compared to those who were not engaged in care (odds ratio: 0.075; 95% confidence interval: 0.006, 0.872).

Conclusions: Results show that while many BSMM were satisfied with their treatment, some were not. Engagement in HIV care appears to improve engagement with these services. Further qualitative research is needed to better understand barriers and facilitators of substance use treatment and service engagement from the perspective of BSMM. This is especially pertinent given the disproportionate impact of the ongoing drug overdose epidemic on Black Americans, including BSMM.

Keywords: Public health, Minority health

Authors:

Presenter - Daniel Alohan, MPH,
Emory University

Co-Author - Samuel C.O. Opara, MBBS, MPH,
Emory University

Co-Author - Darius M. Moore, MPH,
University of Michigan

Co-Author - Ryan Wade, PhD, MSW,
University of Illinois-Urbana Champaign

Co-Author - Gary W. Harper, PhD, MPH,
University of Michigan

Co-Author - Sophia A. Hussen, MD, MPH,
Emory University

D96 - Perceived stress associated with safe -sex discussions among vulnerable populations of young adults based on sexual orientation and gender

Poster Number: D96
Time: 11:00 AM - 11:50 AM
Topics: Health of Marginalized Populations , Decision Making

Previous research has indicated that emerging adults are more vulnerable to risky sexual behaviors, increasing the risk of STIs. Although clear communication with one’s sexual partner would promote more responsible sexual behaviors, there are obstacles to achieving this such as the stress, stigma, and social dynamics surrounding sexual conversations. Stress mediates physiological and psychological responses such as a disruption in attention and working memory which can ultimately alter one’s approach to participating in safe sex discussions. This study aims to examine the perceived stress response associated with safe sex discussions among young adults and potential barriers to such discussions, particularly among LGBTQIA+ individuals. We hypothesize that perceived stress regarding discussions of safe sex will be higher among vulnerable population groups including LGBTQIA+ participants and Women in comparison to non-LGBTQIA+ and Men participants. Although participants (N = 168; M age = 20.01, SD = 1.44; 68% female) who identified as LGBTQIA+ (27.5%) reported a higher perceived stress (M = 3.73, SD = 0.12) when discussing safe sex with a partner than non-LGBTQIA+ participants (M = 3.45, SD = 0.16), this was not a significant difference (t = 1.22, df = 150, p = 0.22). Moreover, women reported a significantly higher perceived stress associated with safe sex discussions (M = 4.22, SD = 0.92) than men (M = 3.47, SD = 1.17; t = 3.53, df = 146, p < .001). A clear understanding of the perceived stress response associated with discussions of safe sex can help better guide interventions strategies to increase these types of discussions among young adults, subsequently reducing sexual risk behaviors and their associated health outcomes.

Keywords: Risk factors, Sexual orientation

Authors:

Author - Sean Vargas,
Occidental College

Co-Author - Kylie Castro,
Occidental College

Co-Author - Zahra Noorani,
Occidental College

Co-Author - Disha Shah,
Occidental College

Co-Author - Joomi Park,
Occidental College

Co-Author - Martina Long,
Occidental College

Co-Author - Patricia Cabral, PhD, PhD,
Occidental College

D98 - Pre-Exposure Prophylaxis (PrEP) Care Engagement among Men Who Have Sex with Men (MSM) in the United States during the COVID-19 Pandemic: A Scoping Review

Poster Number: D98
Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Health of Marginalized Populations

Background: The COVID-19 pandemic has disproportionally impacted sexual minority men (SMM)'s engagement with the pre-exposure prophylaxis (PrEP) care continuum. While research has begun to explore PrEP use during the pandemic, the variability in pandemic response policies and PrEP regulations across different countries warrants a nuanced synthesis tailored to specific populations/regions. This scoping review evaluated empirical literature on the impact of COVID-19 on U.S. SMM’s engagement with the PrEP continuum of care.

Methods: A systematic search was performed on February 21, 2024, using PubMed, PsycINFO, and Embase. Inclusion criteria were a) English language, b) focus on U.S. SMM, c) academic articles with full text, d) inclusion of empirical data, e) assessment of PrEP care engagement, and f) evaluation of COVID-19’s impact on PrEP-related behaviors. Data were extracted using standardized forms, and study quality was appraised with validated scales. A synthesis of the literature was presented with descriptive statistics and narrative summaries. Study findings were categorized by the timing of data collection to delineate distinct temporal phases of the pandemic.

Results: This review included 22 studies (16 quantitative, 5 qualitative, and 1 mixed-method), with qualitative studies demonstrating better quality than quantitative studies. Most studies were conducted during the lockdown phase, with no studies spanning the initial outbreak, transition, or post-lockdown phases. Findings indicated a decline in PrEP usage, increased missed doses, and higher discontinuation rates during the pandemic, with only a minority of SMM continued PrEP use. Disruptions in PrEP care included difficulties in obtaining refills/lab tests, attending appointments, and navigating changes in clinic procedures. Youth returning home from college reported concerns about confidentiality around PrEP use. Further, model-estimation studies predicted worsening challenges with PrEP engagement over time. Qualitative evidence highlighted telehealth services and injectable PrEP as promising mitigators of the impact of COVID-19 on PrEP use.

Discussion: The findings reveal challenges in PrEP care engagement during COVID-19, a lack of post-lockdown research, and insufficient use of objective PrEP measures. These findings underline the need for proactive emergency preparedness for PrEP services and the expansion of telehealth and home-delivery PrEP services in future public health crises.

Keywords: HIV, Minority health

Authors:

Author - Junye Ma, MA, MA., M.S.,
SDSU-UC San Diego Joint Doctoral Program in Clinical Psychology

D99 - "Too Young for Sex, Too Young for PrEP": Healthcare Providers' Attitudes and Experiences on Prescribing Pre-exposure Prophylaxis to Adolescent Girls and Young Women in Eswatini

Poster Number: D99
Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Women's Health

Background
Adolescent girls and young women (AGYW) in sub-Saharan Africa are at high risk of acquiring HIV, making pre-exposure prophylaxis (PrEP) a crucial prevention tool. However, healthcare providers' attitudes significantly impact PrEP initiation, uptake, and adherence. In Eswatini, little is known about healthcare providers’ attitudes regarding prescribing PrEP to AGYW. This study aimed to explore healthcare providers' attitudes and experiences in prescribing PrEP to AGYW in Eswatini. 

Methods
A mixed methods study design was used to collect data from 108 healthcare providers across all four regions of Eswatini between June and July 2024. Inclusion criteria were age 18 years or older, doctor or nurse currently practicing in Eswatini, experience providing HIV prevention and treatment services, and having provided care to at least one patient in the last 6 months. A cross-sectional survey measured providers’ attitudes on a five-point Likert scale, with scores ranging from 0 to 60 (higher scores indicating a more positive attitude). Nineteen in-depth interviews were conducted with purposively selected survey participants experienced in providing PrEP services, and their responses were analyzed using thematic analysis in Dedoose.

Results
Participants were mostly nurses (83.3%), with a mean age of 38.8 (SD=8.6). Most (81.4%) participants had prescribed PrEP, and 86.1% were willing to continue prescribing it. The mean attitude score for prescribing PrEP was low (range: 0-60): 30.2 (SD= 3.7) for AG and 32.4.0 (SD=3.9) for YW. In interviews, healthcare providers expressed concerns about prescribing PrEP to AG, viewing them as too young or immature for having sex early and ideally waiting until marriage. Providers shared their experiences of challenges they encounter when prescribing PrEP to AG and YW, including inconsistent adherence, misunderstanding about PrEP use, and confusion with post-exposure prophylaxis (PEP). Similar challenges were mentioned for YW, particularly regarding follow-up, persistence, and adherence to PrEP.

Conclusion
Although healthcare providers in Eswatini are willing to prescribe PrEP to AGYW, their negative attitudes toward pre-marital sex may hinder effective PrEP provision. Updating PrEP training materials to promote non-judgmental care, educating AGYW on PrEP use, and emphasizing PrEP as a preventive tool regardless of marital status or age are essential steps to improve uptake and adherence within this high-risk group.

Keywords: HIV, Women's health

Authors:

Presenter - Sihlelelwe Sinenjabulo Dlamini,
University of Connecticut

Co-Author - Kamal Gautam,
University of Connecticut

Co-Author - Kiran Paudel, BPH, BPH,
University of Connecticut

Co-Author - Tengetile Mathunjwa,
University of Eswatini

Co-Author - Nkosazana Mkhonta,
University of Eswatini

Co-Author - Sindy Matse,
Eswatini Ministry of Health

Co-Author - Roman Shrestha, PhD, MPH, PhD, MPH,
University of Connecticut

D100 - Streamlining Stigma Measurement: Validation and Abridgment of the HIV Stigma Scale for Pregnant Women Living with HIV in South Africa

Poster Number: D100
Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Methods and Measurement

Background
Pregnant women living with HIV (WLHIV) in South Africa face significant HIV-related stigma, which is often overlooked in routine HIV care and can contribute to disengagement from healthcare services and heighten the risk of vertical transmission. The HIV Stigma Scale (HSS) is commonly used to measure perceived HIV-related stigma. However, this scale has not been validated among pregnant WLHIV in South Africa, and its length could be burdensome in such resource-limited settings. The current study aims to validate the HSS in pregnant WLHIV and develop an abridged version with comparable psychometrics properties to efficiently evaluate HIV stigma and recommend early and tailored interventions.

Methods
We leveraged baseline data from a sample of WLHIV (N = 472) in a prevention of mother-to-child transmission (PMTCT) program in Kwazulu-Natal (KZN). First, we conducted a confirmatory factor analysis (CFA) to validate the scale and determine if the four-factor structure from the original measure fit this sample. Next, we employed a data-driven item reduction process based on item factor loadings, inter-item correlations, and item difficulty and discrimination parameters. This 12-item abridged version was then subjected to a comprehensive psychometric evaluation that included internal consistency and construct validity.

Results
The CFA confirmed the four-factor structure of the original scale with excellent model fit (CFI=1.00, RMSEA=.03, SRMR=.04). To ensure model identification, each subscale should be represented by three items, and these 12 items were selected through the data-driven item reduction process. The abridged version of the scale also exhibited excellent model fit (CFI = 1.00, RMSEA = .01, SRMR = .03). All four subscales demonstrated strong internal consistency (Cronbach’s α > .80) and construct validity, showing significant correlations with measures of depression and coping styles.

Discussion
This study validated the HSS for pregnant WLHIV in KZN and established a reliable 12-item version that maintains the structure of the original measure. The abridged HSS offers an evidence-based tool for stigma screening, reducing patient burden and improving accessibility to behavioral interventions across diverse contexts. Its suitability for integration into routine care can foster greater engagement in HIV treatment and effectively address stigma, particularly within the evolving landscape of healthcare in resource-limited settings.

Keywords: HIV, Measurement

Authors:

Author - Yumei Chen, M.S.,
University of Miami

Co-Author - Steven A. Safren, PhD, PhD,
University of Miami

Co-Author - Maria M. Llabre, PhD, FSBM, PhD, FSBM,
University of Miami

Co-Author - Christina Psaros, PhD, PhD,
Massachusetts General Hospital

D101 - Systematic Review of Interventions to Improve HIV Medication Adherence among Individuals Using Substances

Poster Number: D101
Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Substance Misuse

Background: Medication adherence is essential to achieve sustained viral suppression for individuals living with human immunodeficiency virus (HIV). Use of alcohol and substances may interfere with medication adherence and lead to adverse outcomes. Thus, this review sought to examine the literature on behavioral interventions that improve medication adherence among individuals with HIV who are using alcohol or drugs.
Methods: Articles were included if they met the following criteria: (a) included individuals diagnosed with HIV (b) were published in English between January 1, 2000 and June 15, 2023, (c) evaluated a behavioral intervention to increase medication adherence, (d) reported at least one medication adherence outcome, (e) were randomized controlled trials (RCTs) or quantitative pre-post designs, and (f) were comprised primarily of individuals using alcohol or drugs.
Results: A total of 22 studies met the criteria and were included. Most were RCTs and focused on adults living in urban areas in the United States. The studies varied in their measurement of medication adherence, including biomarkers (e.g., HIV viral load, CD4+ T cell count) and self-report questionnaires. Findings supported intervention efficacy for cognitive behavioral-based interventions, directly observed antiretroviral therapy, and interventions to navigate barriers to care but support varied for other intervention approaches. Findings were also inconsistent regarding sustained improvement in medication adherence. Some interventions (n = 5) appeared to also reduce use of alcohol or drugs.
Discussion: This review indicated that there are multiple efficacious interventions for HIV medication adherence among populations using substances, although limitations remain. First, intervention research has focused primarily on samples that may not be representative of all individuals with HIV (e.g., recruited participants via referral or who were already engaged in care). Second, variation in the measurement of medication adherence makes comparison of interventions across studies difficult, especially in instances in which medication adherence outcomes are mixed (e.g., biomarkers indicate improvement, but self-report data do not). Recommendations for future trials include conducting interventions that are more readily accessible by rural populations, determining intervention efficacy among patients not already engaged in HIV care, and identifying methods to sustain improvement in adherence.

Keywords: HIV, Substance abuse

Authors:

Presenter - Chavez R. Rodriguez,
Purdue University

Co-Author - McKalaih E. Legault,
Purdue University

Co-Author - Stephen Beegle,
Purdue University

Co-Author - Jason T. Blackard,
University of Cincinnati College of Medicine

Co-Author - Bingfang Yan,
University of Cincinnati James L. Winkle College of Pharmacy

Co-Author - Jaime Robertson,
University of Cincinnati College of Medicine

Co-Author - Abby Atreya,
University of Cincinnati James L. Winkle College of Pharmacy

Co-Author - Linh Dinh,
University of Cincinnati James L. Winkle College of Pharmacy

Co-Author - Kevin T. Fedders,
University of Cincinnati College of Medicine

Co-Author - Luis A. Gomez,
Purdue University

Co-Author - Shaina Horner,
University of Cincinnati College of Medicine

Co-Author - William Liu,
University of Cincinnati James L. Winkle College of Pharmacy

Co-Author - Heidi L. Meeds,
University of Cincinnati College of Medicine

Co-Author - T. Dylanne Twitty,
University of Cincinnati

Co-Author - Jennifer L. Brown,
Purdue University

D102 - Exploring Digital Health Literacy and its Relationship to Cardiovascular Health, and Healthcare Access and Needs among Black and Latinx Adults in Maryland and Washington, D.C.

Poster Number: D102
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cardiovascular Disease

Background: Black and Hispanic populations face a higher risk of cardiovascular disease (CVD), compared to non-Hispanic Whites in the United States. Digital health literacy (DHL) may support CVD prevention and management, yet research examining DHL’s role within CVD contexts remains limited. This study evaluated associations between DHL and CVD status, healthcare access, unmet healthcare needs, and healthy lifestyle behaviors in Black and Hispanic adults. Methods: This study was a secondary analysis of survey data from a cross-sectional study on social determinants of health in underserved neighborhoods, conducted from March to June 2024. Participants (N=1,290) were recruited using convenience sampling from Maryland and Washington, D.C. DHL was measured using a validated DHL inventory, while CVD status was determined by self-reported diagnoses or CVD-related risks. Health insurance coverage was used as a proxy for healthcare access, and unmet healthcare needs were assessed based on missed medical appointments due to transportation issues and delayed care due to cost concerns. Healthy lifestyle behaviors were evaluated based on fruit, vegetable and sweetened beverage consumption, and exercise engagement. Logistic and linear regression analyses were conducted to explore hypothesized associations. Results: Participants had a mean age of 43 years; majority were female (63%), insured (87%), non-Hispanic (70%), and identified as Black/African American (64%). Only 35% had some high school education, a significant portion had low health literacy skills (85%), and annual household income below $50,000 (60.8%). DHL was not significantly associated with CVD status, but DHL levels differed between Hispanic and non-Hispanic adults (p<0.01), with Hispanic participants showing higher levels. Higher DHL scores were associated with better healthcare access (OR=1.05, 95% CI=1.03-1.07) and more frequent engagement in healthy behaviors, including weekly exercise and greater fruit and vegetable consumption (β=0.02, p<0.01). These relationships were, however, insignificant in multiple regression models. Conclusion: DHL positively correlated with health behaviors related to CVD prevention, highlighting the potential of targeted DHL interventions to reduce CVD risk among high-risk populations. Future research using experimental and longitudinal designs is needed to clarify causal pathways between DHL and CVD outcomes.

Keywords: Health behaviors, Health disparities

Authors:

Co-Author - Hailey Miller, PhD, RN, PhD, RN,
Johns Hopkins University

Co-Author - Diana Baptiste, DNP, MSN, RN, CNE, FAAN, FPCNA,
Johns Hopkins university

Co-Author - Elizabeth Andrade, DrPH, MPH,
Johns Hopkins university

Co-Author - Cheryl Himmelfarb, PhD, MSN, BS, RN,
Johns Hopkins university

D103 - Support for the Faith, Activity, and Nutrition (FAN) Logic Model in Predicting 12-Month Program Implementation of Healthy Eating and Physical Activity Changes in Churches

Poster Number: D103
Time: 11:00 AM - 11:50 AM
Topics: Integrative Health and Spirituality, Dissemination and Implementation

Background: Churches are important community settings for health behavior change. Faith, Activity, and Nutrition (FAN) trains committees to implement healthy eating (HE) and physical activity (PA) environmental changes within churches. To better understand drivers of HE and PA implementation (our outcome of interest), we tested support for our logical model in a US national implementation study. Our logic model states that churches will establish a committee that completes the 8-lesson online training, develops and submits a program plan, conducts regular meetings to plan implementation, and implements FAN HE and PA components.
Methods: We used data from study churches that met primarily in person at baseline (N=69 of 107 churches). Lesson completion was tracked by a learning management system, submission of program plans was documented by study staff, and church coordinators reported frequency of committee meetings and implementation of PA and HE components at baseline and 12 months. Using logistic and linear regression models, we examined whether committee training (two variables: committee size and average number of lessons completed by committee members) predicted program plan submission (yes/no) and frequency of FAN committee meetings at 12 months, controlling for baseline meetings. We then examined if plan submission and attending FAN committee meetings predicted 12-month implementation of HE and PA components (averaged across increasing opportunities, sharing messages, creating policies, and enlisting pastor support) at 12 months, controlling for baseline practices.
Results: The majority of the churches were primarily African American (70%), Methodist (46%) or Baptist (25%), and located in the Southeast (77%). Churches with larger committees (p=.01) and more lessons completed (p<.01) were more likely to submit a program plan. Neither committee size nor lessons completed were associated with frequency of committee meetings at 12 months (p>.05). Plan submission predicted greater HE implementation (p=.02) and trended in the same direction for PA implementation (p=.07). Further, more frequent committee meetings that planned HE activities and PA activities at 12 months were also associated with HE (p<.0001) and PA (p<.0001) implementation, respectively.
Conclusion: Overall, our data generally supported the FAN logic model and results underscore the importance of training, developing a

Keywords: Religion/Spirituality, Evidence based

Authors:

Presenter - Jasmin Parker-Brown, MS, MS,
University of South Carolina

Co-Author - Sara Wilcox, PhD, FSBM, PhD, FSBM,
University of South Carolina

Co-Author - Andrew Kaczynski, PhD,
University of South Carolina

Co-Author - Ruth Saunders, PhD,
Prevention Research Center, University of South Carolina

D104 - Reaching Veterans with Multiple Mental Health Diagnoses through the VA Whole Health System of Care

Poster Number: D104
Time: 11:00 AM - 11:50 AM
Topics: Integrative Health and Spirituality, Mental Health

The Veterans Health Administration’s Whole Health System (i.e., VA Whole Health) was developed to deliver “Whole Person” care, wherein the VA system and clinical providers integrate Veteran preferences and key services into care delivery to improve Veteran health and well-being. These services include core Whole Health services (i.e., Whole Health coaching and clinical care) and complementary and integrative health (CIH) interventions. Because VA Whole Health is a system-level transformation, it should reach all Veterans, including those with complex symptom constellations. However, the degree to which VA Whole Health is reaching those with multiple mental health diagnoses has yet to be determined. Therefore, the purpose of the current study was to determine whether core Whole Health and CIH use differed depending on the number of mental health diagnoses of an individual. As part of a large-scale evaluation of VA Whole Health, Veterans were recruited from the 18 VA Whole Health implementation sites. Electronic health record data were used to examine core Whole Health and CIH use among Veterans across four groups: those with zero, one, two, or three mental health diagnoses (i.e., anxiety, depression, and PTSD) in the past-year. Logistic regression was used to estimate the likelihood of core Whole Health and CIH use in each group, compared to each of the other groups, adjusting for covariates. Veterans (n=9,689; mean age=64.1 years) were mostly men (86.8%) and White (75.3%). Veterans with more mental health diagnoses had significantly higher odds of using core Whole Health services, with odds ratios ranging from 1.19 (95% CI: 1.02-1.39; two v. one diagnoses) to 2.49 (95% CI: 2.00-3.09; three v. zero diagnoses). Similarly, Veterans with more diagnoses had significantly higher odds of using any CIH therapy, with significant odds ratios ranging from 1.30 (95% CI: 1.04-1.62; three v. two diagnoses) to 2.21 (95% CI: 1.78-2.74; three v. zero diagnoses). VA Whole Health is designed to reach all Veterans seeking VA care, and the current evaluation suggests that Veterans with identified mental health conditions may perceive VA Whole Health as valuable and a part of their treatment plan. As the VA Whole Health transformation continues, understanding how best to bridge perspectives between VA leadership and clinical providers to ensure these services reach Veterans with multiple mental health conditions remains paramount.

Keywords: Co-morbidity, Complementary Medicine

Authors:

Presenter - David E. Reed, II, PhD, PhD,
University of Washington

Co-Author - Charles C. Engel, MD, MPH,
Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound

Co-Author - Bella Etingen, PhD,
Research and Development Service, Dallas VA Medical Center, Dallas, TX, USA

Co-Author - Justeen Hyde, PhD,
Center for Health Optimization and Implementation Research, VA Bedford Healthcare System

Co-Author - Barbara G. Bokhour, PhD,
Center for Health Optimization and Implementation Research, VA Bedford Healthcare System

Co-Author - Steven B. Zeliadt, PhD, MPH, PhD, MPH,
University of Washington

D105 - The spirit to push forward: The relationship between spirituality and physical fitness

Poster Number: D105
Time: 11:00 AM - 11:50 AM
Topics: Integrative Health and Spirituality, Physical Activity

Background: At the peak of the War on Terrorism, suicide rates, PTSD prevalence, and legal issues saw a marked increase in the military population. In response to this, a holistic framework and measure, Total Force Fitness, and the Global Assessment Tool (GAT), respectively, were created to bolster resilience to these outcomes. Each service personalized the framework to their branch; however, every branch focused on physical, spiritual, and social fitness- suggesting each of these constructs are perceived as highly important to resilience. The literature clearly demonstrates the value of each of these constructs but spirituality is the least understood and most controversial. This study examined how spiritual fitness impacts military readiness.

Methods: Utilizing the 2018 GAT data from 92,152 Army soldiers, this study examined the relationship between physical and spiritual fitness while controlling for demographic covariates (rank, race, gender, age, Military Occupational Specialty (MOS)) as well as conceptual covariates such as social fitness, exercise, pain, and sleep satisfaction.

Results: Spiritual fitness had a stronger relationship with physical fitness than reported exercise participation. Indeed, the relationship between spiritual and physical fitness remained significant, even when accounting for all covariates (F(1, 28960) = 15.6, p = <.0001, R2 = .0005). While the proportion of variance accounted for is small, it is greater than the proportion accounted for by exercise and sleep (R2= 0, R2=.0001 respectively).

Discussion: This study demonstrated spiritual fitness’s positive impact on physical fitness. While this impact was small, it was equivalent or greater than other well-established variables such as exercise and sleep satisfaction. It is clear spiritual fitness needs a better measure in the Army resiliency training, and may already have improvements in the new Azimuth check. Future research in resilience will benefit greatly from a better understanding of spiritual fitness, its mechanisms of action, and how to operationalize it into applicable interventions. Suggestions for future directions and applications will be discussed.

Keywords: Spirituality, Physical activity

Authors:

Author - Nicole Scarboro, Ph.D.,
CHAMPS

Author - Ryan Landoll, Ph.D.,
USUHS

Author - Gloria Park, Ph.D.,
CHAMPS

D106 - A monthly community-based contemplative practice program designed to combat stress and loneliness in older adults: preliminary findings

Poster Number: D106
Time: 11:00 AM - 11:50 AM
Topics: Integrative Health and Spirituality, Aging

Background: Since the COVID-19 pandemic, there has been a documented increase in stress and loneliness in older adults. This is problematic because both stress and social isolation have been linked to an increased risk of premature all-cause mortality and for several health conditions, including dementia, heart disease, stroke, depression, and anxiety. Yet, stress and social isolation are not adequately addressed in this population.

Methods: To address this serious public health issue, we created an integrative health program designed to teach older adults stress management and resiliency skills in a group community setting intended to foster social engagement and connectedness. The program was delivered in one-hour sessions monthly by content experts and the topics included mindfulness, meditation, self-compassion, Qi Gong, Tai Chi, breathwork, and Yoga. Participants were given a brief, written resource guide containing background information, the scientific evidence base, practical skill-building tips, and resources before each session. Participants responded to pre- (N=48) and post- (n=30) session surveys that assessed knowledge of the topics, use of the skills, and feedback about the program.

Results: The sample identified as primarily female (85%), >76 years of age (54%), and English-speaking (98%). On average, most participants rated their baseline knowledge about the topics as somewhat (38%) to moderately (38%) knowledgeable. Post-session participants reported being very (37%) or extremely (30%) likely to use the practice taught during the session and most (67%) reported being completely satisfied with the sessions. Most participants strongly agreed (53%) or agreed (27%) with the statement, “This session taught me about a potential stress management tool,” and strongly agreed (20%) or agreed (43%) with the statement, “I feel more connected after taking this class.”

Conclusions: While this preliminary study was observational, it serves as an example of bridging the gap in behavior medicine via a partnership between university-based integrative health experts and a community-based organization. Future research should leverage these findings to formally test the efficacy of integrative and contemplative practice programs to manage stress and loneliness in older adults in a community setting.

Keywords: Mindfulness, Mental health

Authors:

Author - sandra winter, PhD, MHA,
Senior Coastsiders, 925 Main Street, Half Moon Bay, CA 94019; 4. Stanford University, Stanford Prevention Research Center, 1265 Welch Road, MC 5411, Stanford CA 94305

Author - Grace D. Achepohl, BA and MS,
Senior Coastsiders, 925 Main Street, Half Moon Bay, CA 94019; Kaiser Permanent Medical School 98 S Los Robles Ave, Pasadena, CA 91101

D107 - A Cross-Sectional Association between Adiposity, Depression, and Physical Activity in U.S. Adults: Data from NHANES 2017-2020 (pre-pandemic)

Poster Number: D107
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Physical Activity

Evidence suggests that increased adiposity, as a proxy measure of obesity, is associated with clinical depression among U.S. adults and contributes to the national burden of diseases. This association seems to be stronger among women than men. Given that depression and adiposity are major contributors to morbidity, mortality, and disability in the U.S., it is important to find ways to protect against these adverse cardiovascular and mental health outcomes. Physical activity (PA), as a modifiable lifestyle factor, has been identified as a protective factor against adverse health outcomes, but little is known about possible gender differences in the relationship between adiposity, physical activity, and depressive symptoms. The goal of this study is to explore such gender differences using the 2017-2020 cycle of the National Health and Nutrition Examination Survey (NHANES) (N = 8,878). Variables analyzed included self-reported depressive symptoms, central adiposity (waist circumference), total adiposity (body mass index or BMI), and self-reported physical activity (moderate and vigorous). Analyses found that women aged 50 and older had significantly higher levels of central and total adiposity compared to those younger than 50. Further, women between the ages of 18-30 reported more depressive symptoms compared to other age groups across both genders. In examining the relationship between BMI and depressive symptoms, underweight adults and those with obesity reported more depressive symptoms compared to those classified as overweight or normal weight, with no differences between men and women. Regarding physical activity, men between the ages of 18-30 engaged in a greater number of minutes of recreational vigorous PA, compared to women and men across other age groups. There were no differences across age and gender for moderate PA. Results from mediation analyses revealed that for both males and females, waist circumference and BMI were independently associated with depressive symptoms, with higher BMI and larger waist circumferences being associated with more depressive symptoms. In both models, however, the indirect effect from waist circumference and BMI to physical activity was not significant. Results of the study are discussed in the context of depressive symptoms across different BMI groups, possible confounding influences in the relationship between PA, depressive symptoms, and adiposity; and the levels of PA reported by the sample.

Keywords: Mental health, Physical activity

Authors:

Co-Author - Laurie F. Donze, Ph.D., Ph.D.,
NIH

D108 - Exploration of Grit and Social Support as Predictors of the Development of Posttraumatic Growth in Healthcare Workers during the COVID-19 Pandemic

Poster Number: D108
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Stress

The COVID-19 pandemic presented significant challenges, both mental and physical, for the entire US population. Healthcare workers (HCWs) were particularly vulnerable as they faced a variety of struggles – including resource and staff shortages, increased hospital admissions, infection risks, and separation from loved ones - that increased their risk for a variety of negative psychological outcomes (e.g., Elhadi et al., 2020; Hammond et al., 2021; Shechter et al., 2020). While these negative outcomes, including anxiety, depression, and acute stress were well-studied in this population, less attention was paid to whether HCWs may have also demonstrated positive psychological outcomes, such as post-traumatic growth (PTG). This study aimed to examine the presence of PTG among HCWs, as well as relevant potential correlates, including social support and grit. All three of these variables have been previously found to be associated with psychological well-being (e.g., Barskova & Oesterreich, 2009; Salles et al., 2017; Calhoun, 2004). A total of 122 HCWs completed a survey between March and June 2022. Results revealed that PTG and grit were both present in the sample, but at lower levels than expected. PTG may have been lower than expected due to the timing of the study; specifically, PTG takes time to develop, and it is possible that insufficient time had elapsed between the height of the pandemic and the timing of data collection. Contrary to expectations, grit and PTG were not found to be associated in the multiple regression results. However, PTG was found to be positively associated with stress. These results echoed those from prior research, which indicate that a certain level of stress is needed for the development of PTG. Regression results also indicated a significant association between PTG and organizational support, highlighting the important role that organizations can play in facilitating positive outcomes among their workers. It is hoped that these findings can inform future research and contribute to a deeper understanding of PTG and grit, particularly within the HCW population.

Keywords: Mental health, Stress

Authors:

Author - Melissa Carlin, PsyD,
N/A

Co-Presenter - Elana Maurin, MHS, PhD, MHS, PhD,
The Chicago School

Co-Presenter - Lisa Lilenfeld, PhD,
The Chicago School

D109 - Characterizing Psychiatric Symptoms in Migraine Patients at High Risk of Sleep Apnea

Poster Number: D109
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Sleep

Objective: Sleep disorders are prevalent in patients with migraine, but little is known about how psychiatric presentations in patients with both migraine and sleep disorders differ from those with migraine alone. The present analysis aimed to characterize differences in headache and psychiatric characteristics of migraine patients with and without high risk of having sleep apnea at the time of measurement (HRSA).

Method: This sample is from the Clinical Decision Support Tool (CDST) trial, which aimed to improve patient adherence to acute migraine treatment. For the present analysis, only baseline data was used. 62 participants with migraine completed baseline questionnaires, including migraine frequency (headache days per 30 days) and severity (rated from 0-10) measured by the Migraine Disability, the Berlin Questionnaire (measuring sleep apnea risk), the Perceived Stress Scale (PSS, scored from 0-40 where 27+ indicates “high perceived stress”), PROMIS Anxiety, and PROMIS Depression measures (PROMIS scales are t-scored where M=50, SD=10).

Results: Of the sample of 62 participants, 38% (N=24) were screened as being at “high risk” of having sleep apnea at the time of measurement according to the Berlin sleep questionnaire. Tests of normality showed nonparametric distributions for headache frequency (MIDAS A), headache severity (MIDAS B), stress (PSS), anxiety (PROMIS-A), and depression (PROMIS-D) scores, justifying the use of Mann-Whitney U tests to compare nonparametric group means between those with and without HRSA. There was no difference in headache frequency by sleep apnea risk (overall M = 9.6, SD = 3.9), but headache severity was greater in the HRSA group (M=7.7, SD=1.5) than in the low-risk group (M=6.7, SD=1.7), p = 0.42. Additionally, the HRSA group’s stress (M=20.6, SD=7.5), anxiety (M=56.8, SD=10.4), and depression (M=52.6, SD=11.7) scores were significantly greater than the lower-risk group’s stress (M=14.1, SD=7.1), anxiety (M=50.0, SD=10.2), and depression (M=46.6, SD=8.8) scores, p < 0.05.

Conclusion: These findings suggest that being at HRSA is associated with increased headache severity and heightened psychiatric symptoms, including stress, anxiety, and depressive symptoms in patients with migraine, while headache frequency showed no difference between groups. These findings provide a more comprehensive understanding of how sleep apnea may interplay with a patient’s migraine presentation and psychiatric comorbidities.

Keywords: Headache, Sleep disorders

Authors:

Co-Author - Elizabeth K. Seng, PhD, FSBM, PhD, FSBM,
Yeshiva University

D110 - The collective influence of gender and socioeconomic status on the mental and physical health of Texas college students during the COVID-19 pandemic

Poster Number: D110
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Social and Environmental Context and Health

Background: In the first year of the COVID-19 pandemic, mental health (MH) concerns increased among US college students with 71% experiencing high levels of stress and anxiety. Given the rise in college students’ MH problems, it is vital to understand how social context impacted physical health (PH) and MH during this time. The current study examined how the intersections of socioeconomic status (SES) and gender identity jointly influenced the PH and MH of Texas college students during the pandemic.

Methods: Data were from a web-based study assessing PH, MH, and educational outcomes of undergraduate and graduate college students enrolled in Texas higher education institutions (n=884). Participants completed surveys in summer 2020 or 2021. Self-reported gender identity (66.2% Female, 31.4% Male, 2.4% Other) and household SES (59.4% <$60k income, 40.6% >$60k income) were used to construct 5 gender-SES intersections. Due to small sample sizes and similar results patterns, SES and Other gender intersections were not examined, only Other gender on its own. Participants reported serious psychological distress (SPD) using the Kessler 6 (0=No SPD, 1=SPD) and rated their overall PH and MH (0=Good, 1=Poor). Logistic regressions evaluated risk of poor PH and MH outcomes across gender-SES intersections, controlling for age, nativity, race, and survey year. All intersectional groups were compared to each other.

Results: Compared to high-income males, low-income females were twice as likely to suffer from SPD during the pandemic (p<.01). Additionally, low-income males (p=.001) and females (p<.001), high-income females (p<.01), and Other gender (p<.01) were more likely to rate their overall MH status as poor relative to high-income males. Low-income females also showed increased odds of poor MH than their high-income counterparts (p<.05). Low-income males and females, high-income females, and Other gender were over three times more likely to have poor PH compared to high-income males, respectively (all p<.05). Finally, low-income females and Other gender had increased odds of poor PH vs low-income males and high-income females (all p<.05).

Conclusion: The combination of gender discrimination and lack of socioeconomic resources may drive the poor outcomes observed among college students during the pandemic. The intersectionality of SES and gender shed light on the importance of prevention and intervention efforts that consider student context in higher education.

Keywords: Mental health, Health disparities

Authors:

Presenter - Cecelia Brown,
Department of Public Health at Santa Clara University

Co-Author - Alice Villatoro, PhD,
Santa Clara University

Co-Author - Vanessa Errisuriz, PhD,
Santa Clara University

D111 - Soul Food: A Physical Activity and Nutrition Program for Black Women by Black Women

Poster Number: D111
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Women's Health

Introduction: Eastern North Carolina (ENC) residents have higher rates of type 2 diabetes, lower life expectancy, less physical activity and higher food insecurity compared to the rest of North Carolina. Black individuals in ENC may face unique health disparities due to systemic and societal barriers to physical activity and a nutritious diet; modifiable behaviors that may improve overall health. Prior research has demonstrated tailored health interventions may be successful in minority populations. The purpose of this study was to examine the effect of a physical activity and nutrition program designed for Black women by Black women on Black women’s physical activity levels.

Methods: Participants were eligible if they identified as a Black woman, between the ages of 18-64 years of age, with a body mass index > 25 kg/m2, living in rural ENC. At baseline, participants completed a demographics questionnaire, questionnaires focused on diet quality and psychosocial factors, and were provided a Garmin to wear throughout the study. The 12-week online intervention focused on behavior change to increase physical activity and nutritious healthful diet through social support, cultural relativity, and an emphasis on holistic health and well-being. At the end of the intervention, participants completed questionnaires and returned their Garmin. Frequencies were completed for demographics and t-tests were used to compare pre and post intervention physical activity, as measured by steps and minutes of moderate-to-vigorous physical activity.

Results: Participants (N = 28) were 43.3 ± 8.7 years of age. Physical activity, as measured by steps and minutes of moderate-to-vigorous physical activity, increased significant (p < 0.05) from baseline to post-intervention. Process and outcome evaluations deemed the program acceptable and feasible for Black women living in rural Eastern North Carolina.

Discussion: This pilot intervention demonstrated a program designed for Black women by Black women integrating aspects of social support, cultural relativity, and a focus on holistic health may increase physical activity levels within Black women who meet overweight and obesity criteria and live in Eastern North Carolina. Future studies should replicate the program within other settings, including other rural communities along with urban and suburban ones, along with extending the length of the intervention to examine long-term impacts of the intervention.

Keywords: Women's health, Behavior Change

Authors:

Co-Author - Bhibha M. Das, PhD, MPH, PhD, MPH,
East Carolina University

Co-Author - Kelsey Simpson, MS,
Community Director

Co-Author - Lauren Sastre, PhD, RDN, LDN,
East Carolina University

D112 - Understanding Symptoms of Depression, Anxiety, and Trauma in Persons with Bleeding Disorders: Insights from a Pragmatic Analysis of Clinical Data

Poster Number: D112
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Social and Environmental Context and Health

Background: Screening for internalizing symptoms of anxiety and depression is recommended as standard of care for persons with bleeding disorders (PwBD). Internalizing symptoms have been connected to PwBD joint-related pain, adherence to bleeding disorder (BD) management, and higher utilization of medical system for BD-related events. Recent attention has also been paid to the impact of trauma on PwBD and the role social determinants of health have on impacting PwBD access to and engagement in their BD medical care. To examine the associations between PwBD psychological symptoms, BD-related markers of health, and social determinants of health, we present a pragmatic analysis of clinical data from a sample of patients using retrospective chart review and publicly available survey data (i.e., American Community Survey).
Methods and Analysis: Our sample includes 309 screenings of psychological symptoms (depression, anxiety, and trauma) taken from clinical records of 273 adult PwBD (42% female; 22% nonwhite; Mage = 40 (15.77), ages ranging from 18-86) attending appointments for multidisciplinary bleeding disorder management. Psychological screening was provided as part of standard of care.
Results: PHQ-9 scores were predicted from age, F(1) = 5.81 , p = .02 ; joint health F(1) = 6.30 , p = .01; and mental health history F(1) = 15.93, p = .0001.The squared multiple correlation for a regression that included all clinical and social variables of interest was .35, and yielded a significant prediction of PHQ-9, F(24, 93) = 2.07, p = .007 However, similar models did not significantly predict GAD-7 scores or trauma symptoms, although mental health history was a significant predictor of both (GAD-7, F(1) = 9.13, p = .003; trauma, F(1) = 10.34, p = .002).
Conclusions/Implications/Limitations: Results supported previous findings connecting joint health and depression for PwBD. Limitations include the use of retrospective and self-report methodologies. Further, we limited our analyses to adult participants. We anticipate earlier assessment of psychological symptoms and SDOH impacting barriers to accessing and engaging in healthcare in pediatric samples may provide opportunities to reduce their impact and lead to improved BD health outcomes and quality of life.

Keywords: Chronic illness, Mental health

Authors:

Author - Emily Wheat, PhD,
University of Colorado School of Medicine, Department of Pediatrics; Colorado School of Public Health

Co-Author - Vivian Thompson, MPH,
University of Colorado Anschutz Medical Campus, Department of Psychiatry

Co-Author - Yasmine Botto, PhD,
University of Colorado School of Medicine, Children's Hospital Colorado

Co-Author - Julie Smith, PhD, BS, CCRP,
Hemophilia and Thrombosis Center at the University of Colorado Anschutz Medical Campus

Co-Author - Richard Shearer, BA,
Hemophilia and Thrombosis Center at the University of Colorado Anschutz Medical Campus

Co-Author - Sydney Baker, MSc,
Hemophilia and Thrombosis Center at the University of Colorado Anschutz Medical Campus

Co-Author - Heather Smyth, PhD,
Center for Innovative Design and Analysis, Colorado School of Public Health

D113 - Patterns in Patient-Reported Outcome Scores Between Pediatric and Adolescents Athletes Participating in Individual vs Team Sports Undergoing Anterior Cruciate Ligament Reconstruction

Poster Number: D113
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Physical Activity

Introduction: Patient-athletes visiting the orthopaedic clinic are differentially affected by psychological factors including emotional support and depression. Studies have shown that in comparison to pediatric and adolescent athletes who participate in team sports, athletes who participate in individual sports suffer from increased risk of negative mental health outcomes. The purpose of this study is to compare mental and physical health patient-reported outcome domains among individual and team sport youth athletes recovering from Anterior Cruciate Ligament Reconstruction (ACLR).
Methods: Retrospective review at a single institution identified pediatric (<18yo) patients undergoing ACLR between 1/2019-7/2024 who had patient-reported-outcome-measurement-information-system (PROMIS) scores. We collected demographics, sport participation, and PROMIS Anxiety, Depressive Symptoms, Physical Function Mobility, Fatigue, Peer Relationships, and Pain Interference scores at pre-op, 4-6 weeks, 3 months, 6 months, 9 months, and 12 month post-operatively. PROMIS domain T-Scores were categorically cohorted and bivariate analyses were performed across sport groups at each postoperative timepoint.
Results: In our cohort of ACLR patients with a mean age 15 ± 2 years, 70 individual sport athletes and 556 team sport athletes were identified. No demographic differences were identified between sport groups (p>0.05). At 4-6 weeks, individual sport athletes demonstrated a higher proportion of moderate to severe Anxiety (24% vs. 12%, p=0.015) and Fatigue (34% vs. 21%, p=0.026) scores than team sport athletes. Individual sport athletes also had a higher proportion of moderate to
severely impaired Physical Function Mobility scores (44% vs. 25%, p=0.025) at 3 months post-op. No other significant differences in PROMIS scores domains were identified between individual and team sport athletes at later postoperative timepoints (p>0.05).
Conclusions: Athletes who participate in individual sports report higher anxiety and fatigue scores at the 4-6 week post-operative visit and lower mobility scores at the 3-month post-operative visits following ACLR compared to athletes who participate in team sports, though no difference was found at later follow-ups. This finding suggests that some aspects of team sports may increase coping ability in the first few weeks following ACL reconstruction. However, Peer Relationships PROMIS scores did not differ at these timepoints.

Keywords: Health outcomes, Musculoskeletal disorders

Authors:

Presenter - Caroline Kim, BS,
The Children's Hospital of Philadelphia

Co-Author - Morgan Swanson, BA,
The Children's Hospital of Philadelphia

Co-Author - Divya Talwar, PhD, MPH, PhD, MPH,
The Children's Hospital of Philadelphia

Co-Author - Brendan Williams, MD,
The Children's Hospital of Philadelphia

Co-Author - Theodore Ganley, MD,
The Children's Hospital of Philadelphia

D114 - Patterns in Patient-Reported Outcome Scores Among Pediatric and Adolescent Performance Athletes Undergoing Anterior Cruciate Ligament Reconstruction

Poster Number: D114
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Physical Activity

Introduction: Psychological factors play a significant role in the health and wellbeing of young athletes. Performance athletes, such as dancers, cheerleaders, and gymnasts, are at increased risk for developing eating disorders, anxiety, and depression, likely due in large part to the aesthetic component of competition and the tendency toward maladaptive perfectionism in this population. We aim to evaluate patient-reported outcomes among female youth performance athletes recovering from ACL reconstruction.
Methods: Retrospective review at one institution was conducted of female patients who underwent ACL reconstruction and had patient-reported-outcome-measurement-information-system (PROMIS) scores available between January 2019 and July 2024. We collected demographics, sport participation, and PROMIS Anxiety, Depressive Symptoms, Physical Function Mobility, Fatigue, Peer Relationships, and Pain Interference scores at pre-op, 4-6 weeks, 3 months, 6 months, 9 months, and 12 month post-operatively. Bivariate analyses were performed.
Results: In our cohort of female ACL reconstruction patients with mean age 15 ± 2 years, 33 performance athletes and 264 other athletes were identified, with no significant difference in age (p=0.315), race (p=0.069), or ethnicity (p>0.999) between the two groups. We found a significant association between Physical Function Mobility scores for performance athletes and other athletes, with performance athletes having a greater proportion of scores within normal limits or indicating mild mobility limitation (p=0.016). No significant difference in other PROMIS scores were found between performance athletes and other athletes at any time point (p>0.05).
Conclusions: Female performance athletes report similar anxiety, depression, mobility, fatigue, peer relationships, and pain interference scores as other female athletes surrounding ACL reconstruction surgery. This finding indicates that despite the high levels of anxiety and depression reported previously among performance athletes, they respond similarly psychosocially to ACL tears and have similar mental health outcomes following ACL reconstruction as other female athletes. Clinicians may direct mental and physical guidance to female patients regardless of sport participation.

Keywords: Surgery, Women's health

Authors:

Co-Author - Morgan Swanson, BA,
The Children's Hospital of Philadelphia

Presenter - Caroline Kim, BS,
The Children's Hospital of Philadelphia

Co-Author - Divya Talwar, PhD, MPH, PhD, MPH,
The Children's Hospital of Philadelphia

Co-Author - Grace Ganley,
The Children's Hospital of Philadelphia

Co-Author - Mary Daley, MD,
The Children's Hospital of Philadelphia

Co-Author - Theodore Ganley, MD,
The Children's Hospital of Philadelphia

Co-Author - Kathleen Maguire, MD,
The Children's Hospital of Philadelphia

D115 - Social Media Use, Symptoms of Social Media Addiction, and ADHD Among US Adults

Poster Number: D115
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Digital Health

Introduction. Social media use (SMU) and symptoms of addiction to social media (SASM) have been linked to mental health conditions including Attention Deficit Hyperactivity Disorder (ADHD). While prior studies have often focused on adolescent populations, associations among SMU, SASM, and ADHD in adults remains poorly understood. Therefore, we assessed associations among SMU, SASM, and ADHD among US adults.
Methods
We studied a national sample of 1512 US adults ages 30-70 years. Cross-sectional survey data were collected between July and August 2023, with a response rate of 61.4%. ADHD was assessed using the validated Adult ADHD Self-Report Scale for DSM-5 (ASRS-5). SASM was assessed using Bergen Social Media Addiction Scale (BSMAS) tailored to focus on social media, and sociodemographic data were self-reported. We used multivariable logistic regression to assess associations among SMU, SASM, and ADHD while adjusting for age, gender identity, race/ethnicity, sexual orientation, education, employment status, and marital status. We conducted multiple sensitivity analyses to assess the robustness of our findings.
Results
One-sixth (16.6%, n = 251) of participants screened positive for ADHD according to the ASRS-5. In Model 1, which included only SASM as an independent variable, compared to participants with low SASM, those with high SASM had over seven times the odds of screening positive for ADHD, even while controlling for all sociodemographic data (AOR = 7.14, 95% CI: 4.25, 12.00). In Model 2, which included only SMU as the independent variable, compared with those in the lowest quartile of SMU, those in the highest quartile had nearly four times the odds of ADHD (AOR = 3.61, 95% CI: 2.15, 6.04). Finally, in Model 3 that included both independent variables, SASM was significantly associated with ADHD, indicating SASM has stronger influence and acts as a mediator in the SMU-ADHD relationship. Results were robust to multiple sensitivity analyses.
Conclusion
Because both SASM and SMU were associated with ADHD, it may be valuable for interventions to address both factors; however, as SASM moderates the relationship between SMU and ADHD, it may be useful to particularly emphasize this construct. It would be useful for future research to assess these associations longitudinally. Qualitative research would also help understand possible reasons for these findings, particularly the strong association between SASM and ADHD.

Keywords: Social network analysis, Addictive behaviors Adherence

Authors:

Author - Memuna Aslam,
Oregon State University

Co-Author - Brian A. Primack,
Oregon State University

D116 - The Context of Trauma: Mental and Physical Health Effects Experienced by Children Exposed to Parental Incarceration and Home-Based Violence

Poster Number: D116
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Child and Family Health

Background: The US has one of the highest incarceration rates in the world and the impacts of this system reach beyond the person who is imprisoned. Children who have experienced parental incarceration (PI) experience more adverse childhood experiences and lack access to resources. Consequently, exposure to stressful home environments can increase their risk of mental and physical health outcomes. Existing research on PI and mental health is limited to anxiety, depression, and PTSD. The current study expands this area by examining how PI and exposure to violence in the home (EV) during childhood affect the physical and mental health of children.

Methods: Data were drawn from the Child National Health Interview Survey (2019), a cross-sectional household survey that collects information about the health of children and their families in the US (n=9193, Mage=8.98, SD=0.06). Parents and legal guardians completed surveys about their children. We examined how PI and EV were associated with physical health (i.e., self-rated health, doctor-diagnosed asthma) and mental health (i.e., emotional health, conduct issues, and hyperactivity symptoms; doctor-diagnosed ADHD) in children ages 4-17. Logistic regressions examined the role of PI and EV on physical/mental health, controlling for child age, gender, race, and poverty as well as parental education, mental health/substance use history.

Results: Overall, 6.5% of children ages 4-17 had an incarcerated parent and 6.8% were exposed to violence at home. After controlling for the covariates, children with EV were significantly more likely to have borderline to abnormal emotional problems (OR=2.09, p<.001), conduct issues (OR=2.49, p<.001), and hyperactivity symptoms (OR=1.98, p<.001) than children who were not exposed to EV. EV was also associated with decreased odds of having ADHD, net of the control variables (OR=.58, p<.001). PI was not significant for any outcome. Associations with physical health were limited to EV: children with EV had a higher risk of fair/poor self-perceived health (OR=1.84, p=.009) and a lower risk of asthma than children without EV (OR=.69, p=.005).

Discussion: Our findings underscore that EV within the home environment exert significant effects on children’s mental health in particular, beyond parental incarceration. These results highlight the need for interventions that address household violence to mitigate potential adverse outcomes and promote resilience and well-being among youth.

Keywords: Trauma, Children's health

Authors:

Author - Alexa Joy Andrews,
Santa Clara University

Co-Author - Allia Ida Griffin, PhD,
Santa Clara University

Co-Author - Alice P. Villatoro, PhD,
Santa Clara University

D117 - Exploring Youth Perspectives on Sexual Fluidity: Understanding Complexity and Facilitating Inclusive Environments

Poster Number: D117
Time: 11:00 AM - 11:50 AM
Topics: Methods and Measurement, Health of Marginalized Populations

Introduction. Sexual fluidity refers to one or more changes in an individual’s sexual orientation dimensions (identity, attractions, sex/gender of sexual partners). As more researchers and clinicians begin to examine sexual fluidity in adolescents and young adults (AYA), it is necessary to understand how youth themselves think about sexual fluidity.

Methods. Qualitative data were analyzed from the Sexual Orientation Fluidity in Youth Study, which recruited AYA ages 14-25 years in the US from an online survey panel. Participants were asked an open-ended question about how they understand sexual fluidity : “What does it mean for a person to be sexually fluid?” (with the option to write “I don’t know”). An inductive thematic analysis was conducted on responses from a random sample of participants (roughly 10% of total sample: N=368) stratified by past change in sexual orientation identity (yes, no) and age (ages 14-17, 18-21, 22-25 years).

Results. AYA shared particular levels of understanding and ways of conceptualizing sexual fluidity, which fell into three main themes: 1) Sexual fluidity as change(s) in attraction (e.g., “I would assume it means their attraction changes over time and isn’t fixed as one label”); 2) Sexual fluidity as changes in sexual orientation identity (e.g., “They could have multiple ways to identify their sexuality and it could change from time to time”); 3) Sexual fluidity as having varied sexual behaviors or interests (e.g., “to be interested in a lot of things sexually”). Beyond the three themes, 25% of the sub-sample reported not knowing what it means to be sexually fluid.

Conclusions. AYA can identify complexities in sexual orientation and fluidity, describing the three dimensions of sexual orientation. The varying ways in which AYA understand the complexities of sexual orientation change beyond identity highlight the need for researchers and clinicians to broaden how they measure and discuss changes in sexual orientation. Understanding youth perspectives on sexual fluidity can improve sexual fluidity measurement in research and foster more inclusive and affirming health environments.

Keywords: Adolescents, Measurement

Authors:

Author - R. Korkodilos,
Boston Children's Hospital

Co-Author - Frankie Greene,
Boston University School of Public Health

Co-Author - Samantha Haiken,
Boston University School of Public Health

Co-Author - Siddarth Seenivasa,
Boston University School of Public Health

Co-Author - Eli G. Godwin,
Boston Children's Hospital

Co-Author - Jennifer Conti,
Boston University School of Public Health

Co-Author - Lynsie Ranker, PhD, MPH, PhD, MPH,
Boston University School of Public Health

Co-Author - Ziming Xuan,
Boston University School of Public Health

Co-Author - Kimberly M. Nelson, PhD, MPH, PhD, MPH,
Boston University School of Public Health

Co-Author - Allegra R. Gordon,
Boston University

Co-Author - Sabra L. Katz-Wise, PhD, PhD,
Boston Children's Hospital

D118 - Development of the SWEET-BEAR Scale: A Comprehensive Tool for Assessing Burden, Enjoyment, and Rewarding Aspects of Self-Monitoring in Diet, Physical Activity, and Weight

Poster Number: D118
Time: 11:00 AM - 11:50 AM
Topics: Methods and Measurement, Multiple Health Behavior Change

Background: Comprehensive assessment of self-monitoring tools for physical activity (PA), diet, and weight often lacks detailed measurement of the associated burden, enjoyment, and reward. Existing scales have not fully addressed these dimensions, indicating a need for a more nuanced instrument.

Purpose: This study aimed to develop and pilot test the Scale for Weight, Eating, and Exercise Tracking - Burden, Enjoyment, And Reward (SWEET-BEAR), a novel tool designed to measure the burden, enjoyment, and rewarding aspects of self-monitoring tools for diet, PA, and weight.

Methods: The SWEET-BEAR scale was developed through focus groups and expert reviews, incorporating feedback on self-monitoring experiences and factors from a systematic review. The final scale includes 16 items per modality (diet, PA, weight) to comprehensively address three dimensions. Scores for burden ranged from 4 to 20 (with lower scores indicating greater burden), enjoyment from 5 to 25 (with higher scores indicating more enjoyment), and reward from 7 to 35 (with higher scores indicating greater reward). The scale was administered to the second cohort of the mLife study (n=137, mean age 45±11.3 y and BMI 35.5±16.2 kg.m2, 87% female, 71% White/21% Black), a one-year mobile health weight loss intervention where participants used Fitbit devices and the corresponding app to self-monitor weight, PA, and diet. Paired t-tests were used to analyze differences between diet, PA, and weight tracking with respect to burden, enjoyment, and reward.

Results: Results showed no differences (p’s all >0.05) in how rewarding participants found tracking diet (17.8±12.8), PA (18±13.1), and weight (17.4±13.1). However, PA tracking scored as significantly more enjoyable (12.7±9.3, p<0.001) than tracking diet (10.9±8.2, p<0.001) and weight (11.1±8.7, p<0.001), and significantly less burdensome (11.2±8.5) than both diet (9.6±7.6 p<0.001) and weight (10.6±7.8, p=0.01) tracking.

Conclusion: The SWEET-BEAR scale provides a measure of the multidimensional aspects of self-monitoring tools. As these findings indicate that PA tracking is perceived as more enjoyable and less burdensome and given the importance of diet and weight tracking for successful weight loss, future studies should aim to reduce the burden and increase the enjoyment of diet and weight tracking behaviors.

Keywords: self-monitoring, scale development, burden, enjoyment, reward, fitness tracking

Keywords: Health behaviors, Research methods

Authors:

Author - Halide Zeynep Aydin, MSc,
University of South Carolina

Co-Author - Brie Turner-McGrievy, PhD, MS, RD, PhD, MS, RD,
University of South Carolina

Co-Author - DIANA C. DELGADO-DIAZ, PhD, PhD,
UNIVERSITY OF SOUTH CAROLINA

Co-Author - Kelli DuBois, PhD,
University of South Carolina

Co-Author - Courtney Monroe, PhD ACSM EP-C, PhD ACSM EP-C,
University of South Carolina

Co-Author - Sara Wilcox, PhD, FSBM, PhD, FSBM,
University of South Carolina

Co-Author - Andrew T. Kaczynski, PhD, PhD,
University of South Carolina

D119 - Using Random Versus Fixed Prompts in Ecological Momentary Assessment: Does it Matter?

Poster Number: D119
Time: 11:00 AM - 11:50 AM
Topics: Methods and Measurement, Digital Health

Significance: Ecological momentary assessment (EMA) effectively measures dynamic changes in constructs such as affect. Affect variability has been linked to predicting health outcomes, such as substance use relapse. Successfully evaluating affect variability may depend on study design characteristics. For instance, while "random EMAs" (EMAs delivered at random intervals) are typically seen as more effective for capturing changes in affect than "fixed EMAs" (EMAs delivered at set timepoints), there has been limited experimental comparison of these methodologies.
Methods: The present study used data from a nationwide factorial experiment to identify best practices in EMA methods. Participants were randomized to 1 of 32 groups across five EMA study design factors: assessment prompting schedule (fixed or random EMAs), assessments per day (2 or 4), questions per assessment (15 or 25), assessment item response type (slider or Likert), and compensation strategy ($1 per EMA completed or total percentage of EMAs completed). EMAs assessed stress, affect (e.g., happy, sad), and previous days’ health behaviors (e.g., physical activity, cigarettes smoked) for 28 days. Affect variability was calculated for each day by taking the standard deviation for each affect item. Multilevel regressions were run to determine (1) if EMA prompt schedule (fixed vs. random) predicted affect variability and (2) if affect variability (assessed via fixed vs. random EMAs) could be used to predict next day health behaviors.
Results: Of the full sample (N=411), only those randomized to complete 25 questions per EMA were included in the present analyses (N=205) because the 25-question EMAs included addition affect items. This subsample was mostly female (72.7%), White (76.6%), lived in urban areas (83.4%), was 48.55 (SD=12.4) years old and had an approximately equal numbers of participants in the random (49.8%) and fixed (50.2%) prompt groups. Analyses indicated that effects of prompt schedule on affect variability were small with no significant differences in daily affect variability between the fixed and random EMAs (p’s>.05). Furthermore, prompt schedule did not significantly alter associations between daily affect and next day health behaviors in nearly all models.
Conclusions: These findings suggest that EMA prompt schedule may not bias the measurement of affect variability. Other factors, such as the measurement target, may be more important when deciding which prompt schedule to use.

Keywords: Research methods, Health behaviors

Authors:

Author - Jeremy Saul Langford, PhD,
University of Oklahoma Health Sciences Center

Co-Author - Jessica Becerra, PhD,
Federal Management Partners, Inc

Co-Author - Sarah Tonkin, PhD,
University of Oklahoma Health Sciences Center

Co-Author - Dusti R. Jones, PhD,
Center for HOPE, Huntsman Cancer Institute

Co-Author - Emily Hébert, DrPH,
University of Texas Health Science Center at Houston

Co-Author - Michael Businelle, PhD,
University of Oklahoma Health Sciences Center

D120 - Changes in objective physical activity and sleep efficiency among active-duty military personnel with overweight or obesity following a behavioral weight management intervention

Poster Number: D120
Time: 11:00 AM - 11:50 AM
Topics: Military and Veterans' Health, Sleep

The rise of overweight/obesity (OW/OB) in active-duty military personnel impacts physical performance and military readiness. Behavioral weight management programs within the military are designed to target behavioral components related to OW/OB, including increasing physical activity (PA) and optimizing sleep. Most studies use self-reported assessments of PA and sleep efficiency, which are known to suffer from bias. The aim of the present study was to determine the impact of a behavioral weight management program on objective measures of PA and sleep efficiency among active-duty military personnel with OW/OB. We hypothesized PA and sleep efficiency would improve significantly from baseline to 6 months post-intervention.
Participants with a minimum of 4 days of valid accelerometer data were included in analyses (n = 39). PA was measured as the average percent of time daily participants were recorded engaging in light or moderate/vigorous (MVPA) activities. Sleep efficiency scores, the ratio of total sleep time to total time in bed, were derived from wrist-worn accelerometer data. Paired samples t-tests were conducted to compare PA and sleep efficiency variables before and 6 months after the behavioral weight management intervention.
Participants were 30.6±6.9 years at the start of the intervention; 60% were female and 65% were White. Sleep efficiency significantly improved from baseline (M=80.4%; SD=6.9%) to 6 months post intervention (M=86.7%; SD=5.7%, T=5.64, p < .001); however, PA did not significantly change. At six months, the mean percent of time daily that participants engaged in light PA (M=14.1%; SD=4.7%) and MVPA (M=8.5%, SD=3.1%) did not significantly differ from participants’ mean percent of time engaged in light PA (M=14.7%, SD=4.0%) or MVPA (M=9.5%, SD=3.7%) at baseline.
Participants maintained relatively high levels of PA six months post-intervention, with no significant changes in daily time engaged in light or MVPA. Importantly, results support significant improvements in sleep efficiency six months post-intervention. Sleep efficiency scores of 90%+ are considered healthy in young adults and scores of 80%+ are considered healthy in older adults, thus participants in this young to middle-aged adult sample, on average, improved their scores to fall within the healthy range. Although improvements in sleep efficiency may or may not be related to the behavioral intervention, improving sleep is critical to supporting health and well-being.

Keywords: Physical activity, Weight control

Authors:

Author - Jessica Morse, PhD, PhD,
VA San Diego Healthcare System and UCSD

Co-Author - Natalie M. Yarish, PhD, PhD,
Old Dominion University

Co-Author - Jennalee S. Wooldridge, PhD, PhD,
VA San Diego/University of California San Diego

Co-Author - Matthew Herbert, PhD, PhD,
VA San Diego Healthcare System

Co-Author - Niloofar Afari, PhD, PhD,
VA San Diego Healthcare System & UC San Diego

D121 - Social (Self) Exclusion and Musculoskeletal Injuries in the U.S. Army: A sociocentric social network analysis

Poster Number: D121
Time: 11:00 AM - 11:50 AM
Topics: Military and Veterans' Health, Social and Environmental Context and Health

Musculoskeletal injuries (MSKI) are a highly prevalent and costly threat to U.S. Soldier health and medical readiness, affecting over half of all Soldiers. Most research and mitigation efforts have focused on identifying sociodemographic and physical factors contributing to MSKI. Yet emerging evidence underscores the importance of social relationships on health.
This research sought to empirically measure social relationships and MSKI patterns within military social networks by applying cross-sectional sociocentric social network analysis to two distinct combat-arms Army battalions (N=795; Cohort 1[C1] N=413, Cohort 2[C2] N=382). We measured self-reported social interaction networks by asking Soldiers to nominate up to 10 Soldiers from a unit roster with whom they socialized outside of duty hours. The networks were analyzed descriptively, including mean number of social ties nominated. A multivariate logistic regression with quadratic assignment procedure was used to examine dyadic similarity in injury status controlling for network dependence, sociodemographic variables, and known risk factors for MSKI (e.g., age, gender, body mass index).
The majority of participants were young (C1:26.6 ± 5.62 years; C2:26.96 ± 6.16 years), overweight (mean BMI C1:27.12 ± 3.88, C2:27.43 ± 19.45), male (C1:86.4% and C2:90.3%), White (C1:72.0%, C2:66.2 %), single (C1:48.8%, C2:51.3%), had a mean time in service of ~5-6 years (C1:67.66 ± 53.08 months and C2 :56.88 ± 56.88 months), and more than one-fourth of the sample reported being on a duty-limiting profile for a MSKI at the time of data collection (C1: 26.0%, C2: 27.7%). Injured Soldiers were significantly more likely to socialize with other injured Soldiers outside of duty hours compared to uninjured Soldiers (C1: OR= 1.255, p=.040, C2: OR=1.336, p=.008). High modularity scores (C1: .767; C2: .788) indicated that Soldiers with and without MSKI formed distinct, cohesive subgroups. Additionally, Soldiers with MSKI had 0.76-1.5 fewer social ties on average (C1: p=.025; C2: p=.003) compared to uninjured Soldiers.
Injured Soldiers had smaller networks than uninjured Soldiers, and formed distinct, cohesive subgroups, suggesting possible social (self) exclusion. Future studies should more directly test for peer selection dynamics based on MSKI status. Additionally, research should consider interventions aimed at enhancing social connectedness and unit cohesion to mitigate the negative effects of social exclusion on MSKI.

Keywords: Social network analysis, Musculoskeletal disorders

Authors:

Author - Kristen L. Zosel, PT, DPT, PhD,
U.S. Army Research Institute of Environmental Medicine

Co-Author - Diego F. Leal, PhD,
University of Arizona

Co-Author - Richard B. Westrick, PT, DPT, DSc,
U.S. Army Research Institute of Environmental Medicine

Co-Author - Brie Turner-McGrievy, PhD, MS, RD,
University of South Carolina

Co-Author - Chih-Hsiang Jason Yang, PhD,
University of South Carolina

Co-Author - Kirsten K. Daigle, MS,
U.S. Army Research Institute of Environmental Medicine

Co-Author - Courtney Monroe, PhD ACSM EP-C,
University of South Carolina

D122 - Exploring the interest of Veterans in Vascularized Composite Allotransplantation (VCA) treatment for traumatic hand and face injuries

Poster Number: D122
Time: 11:00 AM - 11:50 AM
Topics: Military and Veterans' Health, Decision Making

Background: Reconstructive surgical innovations have been crucial for injury survivors with severely reduced function and quality of life, such as military veterans. Vascularized composite allotransplantation (VCA) involves transplanting multiple tissues as a single unit, such as a hand or face. This procedure potentially restores function beyond the capabilities of current treatments. Understanding which factors influence veterans’ interest in pursuing VCA is essential to actualizing its therapeutic potential.

Methods: The sample consisted of veterans potentially eligible for a VCA, and cases were identified using the Department of Defense Joint Trauma Registry. Participants completed a semi-structured telephone interview about the nature of their experiences, impact of injury, and their knowledge of and receptivity to a VCA transplant. Scales measured satisfaction with surgical care post-injury, as well as comfort with and interest in the procedure. Interviews were qualitatively analyzed using the constant comparative method. Means, standard deviations, and tests of association were performed among the quantitative variables.

Results: The sample (n=60) had largely undergone upper extremity amputation (81.7%). On average, participants reported high satisfaction with their surgical care post-injury (M=4.5, range: 1-5). Most were exposed to VCA (65%) but were not interested in pursuing the procedure (66.7%). ANOVA revealed that reported comfort with VCA varied by interest: those interested reported highest mean comfort (M = 4.2, sd = .79), compared to those with potential interest (M= 3.7, sd = 1.2) and those with no interest (M = 2.0, sd = 1.3) (F (2, 57) = 17.3, p < .0001). Compared to those who were interested, uninterested participants were more likely to have had prior exposure to the procedure (X2 (2) = 5.5, p < .06). The most predominant reasons for not being interested in VCA included wanting to avoid immunosuppressants post-procedure (46.7%), and the belief that VCA yields limited function (25%). Participants who were interested in VCA cited wanting improved functional ability and independence.

Conclusion: Participants were generally satisfied with their surgical and rehabilitative care post-injury. The majority of the sample was not interested in pursuing VCA, despite being familiar with the procedure. Future research should investigate whether these findings are consistent among veterans who were less satisfied with their post-injury care.

Keywords: Organ transplant, Decision making

Authors:

Author - Laura A. Siminoff, PhD,
Temple University

Author - Maureen Wilson-Genderson, PhD,
Temple University

Co-Author - Diana Litsas, MPH,
Temple University

Author - Gerard P. Alolod, Ma, MPhil,
Temple University

Author - Heather M. Gardiner, PhD,
Temple University

D123 - Associations of Cannabis and Tobacco Use with Suicide and Death by Overdose Among Veterans Prescribed Opioid Analgesics

Poster Number: D123
Time: 11:00 AM - 11:50 AM
Topics: Military and Veterans' Health, Substance Misuse

Background: Little is known about whether cannabis and tobacco use are indicators of suicide and overdose risk. This longitudinal study aimed to examine associations between cannabis and tobacco use with risks of suicide attempt/death and overdose death over a 2-year follow-up in a large cohort of Veterans prescribed opioids.

Methods: We analyzed a national cohort of 923,291 Veterans receiving opioid analgesics in Veterans Health Administration clinics during 2014-2019. Cannabis and tobacco use were assessed at cohort entry. Outcomes (suicide attempts, suicide death, overdose death) were obtained at follow-up through 2021. We used cause-specific hazard models to examine associations between cannabis and tobacco use with each outcome adjusting for well-established risk factors for suicide/overdose (e.g., substance use disorders, mental health, socio-demographics).

Results: At baseline, 5.4% of the cohort used cannabis, and 39.4% used tobacco. At the end of follow-up (median follow-up time was 6.7-6.8 years), 2.2% of the sample had attempted suicide, 0.4% had died by suicide, and 0.5% had died by overdose. In adjusted models, cannabis use was associated with a higher risk of suicide attempt (hazard ratio [HR] 1.11, 95%CI: 1.06-1.15). Current use of tobacco (versus never use) was associated with higher risk of suicide attempts (HR 1.18, 95%CI: 1.13-1.22), suicide deaths (HR 1.19, 95%CI: 1.07-1.32), and overdose deaths (HR 1.67, 95%CI: 1.51-1.83).

Conclusions: Findings indicated cannabis and tobacco use were associated with suicide attempts/deaths and overdose deaths among Veterans prescribed opioid analgesics, underscoring a need for monitoring patients who use tobacco and cannabis in this population.

Keywords: Multiple risk factors, Multi-morbidity

Authors:

Presenter - Nhung Nguyen, PhD, PhD,
UCSF

Co-Author - Samuel Leonard,
San Francisco Veterans Affairs Health Care System

Co-Author - Amy Byers,
University of California San Francisco

Co-Author - Salomeh Keyhani,
San Francisco Veterans Affairs Health Care System

D124 - Changes in fruit and vegetable intake among low-income midlife and older adults: 12-month results from a health promotion randomized controlled trial

Poster Number: D124
Time: 11:00 AM - 11:50 AM
Topics: Multiple Health Behavior Change , Social and Environmental Context and Health

Background: While physical activity (PA) and fruit and vegetable (FV) intake are often linked, research on interventions targeting both behaviors is limited. Few trials have examined how PA interventions are associated with FV intake among midlife and older adults from lower-income communities. Additionally, existing studies often overlook local environmental factors that may impact both behaviors. To fill this gap, we conducted a secondary analysis of a PA cluster-randomized controlled trial to examine change in FV intake at 12 months (mos) according to two comparable PA intervention programs.
Methods: Participants (N=193) were a subset of midlife and older adults [mean (SD) age = 70.7 (9.8); 74% female] from the Steps for Change (SFC) trial, all residing in or near senior affordable housing in the San Francisco Bay Area, with complete data on key variables. Participants were randomized to receive either an evidence-based person-level PA behavioral intervention with a health education program or the same person-level PA behavioral intervention with a neighborhood-level citizen science intervention called Our Voice. The main outcome of the current study was FV servings per week measured via the validated Block Fruit/Vegetable/Fiber screener at baseline and 12 mos, with a higher score representing higher intake. Participants also reported neighborhood social cohesion (hereafter referred to as cohesion) at both time points, with higher scores reflecting greater cohesion. Three generalized estimate equation (GEE) models examined FV intake changes by study arm, adjusted for baseline FV intake, housing site to account for clustering, and cohesion. A fourth GEE model tested cohesion as an effect modifier.
Results: Adjusted GEE models revealed that the significant predictors of FV intake at 12 mos were baseline FV intake [0.5 servings/wk, 95% CI: 0.4, 0.7, p = <0.0001] and cohesion [1.6 servings/wk, 95% CI: 0.7, 2.6, p = 0.0007] with no between-arm differences in FV intake. Cohesion was a significant effect modifier of the association between study arm and FV weekly servings at 12 mos.
Conclusion: In this secondary analysis, we found that participants in both PA interventions increased their FV intake at
12 mos. The association between neighborhood social cohesion and FV intake highlights the importance of considering and promoting this factor in future health promotion trials targeting midlife and older adults from lower-income communities.

Keywords: Multilevel intervention, Low-income groups

Authors:

Presenter - Sofia A. Portillo, BA,
Stanford University School of Medicine

Co-Author - Abby C. King, PhD, FSBM, PhD, FSBM,
Stanford University Medical School

Co-Author - Maria I. Campero, BA,
Stanford University School of Medicine

Co-Author - Dulce M. Garcia, BA,
Stanford University School of Medicine

Co-Author - Astrid N. Zamora, PhD, MPH, PhD, MPH,
Stanford University School of Medicine

D126 - Predictors of Lifestyle Maintenance following Intensive Lifestyle Modification: Secondary Analyses from the TRIUMPH Trial

Poster Number: D126
Time: 11:00 AM - 11:50 AM
Topics: Multiple Health Behavior Change , Cardiovascular Disease

Background
Lifestyle modification and maintenance among individuals with treatment resistant hypertension (TRH) is critical to lowering their risk of cardiovascular disease and stroke. Few studies have examined predictors of lifestyle habit maintenance from successful randomized trials, although available evidence suggests that executive functioning, depression, older age, and greater medical comorbidities may all contribute to poor maintenance. We recently demonstrated that a 4-month comprehensive lifestyle modification can improve blood pressure, metabolic, cognitive, and mood outcomes among individuals with TRH. The present analyses examined cognitive and psychological predictors of lifestyle maintenance at a one-year naturalistic follow-up.
Methods
TRIUMPH was a 2:1 randomized controlled trial among individuals aged 35-80 with treatment resistant hypertension. Eligible participants qualified if they were sedentary, overweight, and taking three or more hypertensive medications, including it heretic, without adequate hypertension control. Cognitive functioning was assessed using a 45-minute test battery assessing executive functioning and memory. Psychological functioning was assessed using a psychometric battery assessing depression, anxiety, anger, and psychological distress. Lifestyle maintenance was examined using actigraphy-assessed physical activity, DASH dietary quality, and weight. Adjusted regression analyses examined residualized 4-month post-treatment levels as predictors of one-year outcomes, accounting for treatment assignment. Results
Among the 140 individuals initially randomized, 99 were available for one-year follow-up assessments due to assessment constraints associated with the COVID-19 pandemic lockdown. Results demonstrated that poorer psychological functioning, such as higher depressive symptoms and distress, were predictive of lower physical activity levels (B = -0.17, P = .036) and tended to be associated with higher weight levels (B = 0.07, P = .066). Psychological functioning was the most robust predictor of lifestyle maintenance, associating more strongly than demographic factors, clinical characteristics, or cognitive functioning. In contrast to physical activity and weight, psychological functioning did not predict one-year DASH dietary quality.
Discussion
Psychological functioning, including depressive symptoms, anxiety, and distress, represents an important predictor of lifestyle maintenance among individuals with TRH.

Keywords: Hypertension, Physical activity

Authors:

Presenter - Patrick J. Smith, PhD, MPH, PhD, MPH,
University of North Carolina at Chapel Hill

Co-Author - James Blumenthal,
Duke University Medical Center

Co-Author - Krista Ingle,
Duke University Medical Center

Co-Author - Crystal Tyson,
Duke University Medical Center

Co-Author - Stephanie Mabe,
Duke University Medical Center

Co-Author - Linda Craighead,
Emory University

Co-Author - Alan Hinderliter,
University of North Carolina at Chapel Hill

Co-Author - Andrew Sherwood, PhD, FSBM, PhD, FSBM,
Duke University Medical Center

D127 - Multiple Health Behavior Profile of Teenagers from a Rural Swiss School

Poster Number: D127
Time: 11:00 AM - 11:50 AM
Topics: Multiple Health Behavior Change , Substance Misuse

Background: Rural teenagers may be more likely inclined to engage in risky health behaviors compared to their urban counterparts for various reasons. In order to provide preventive health initiatives tailored to the needs of rural teenagers and for optimizing often limited resources, a multiple health behavior assessment should be conducted prior to planning or taking action. Thus, the purpose of this study was to assess the health behaviors of a rural Swiss secondary school (7th to 9th grade).
Methods: A cross-sectional survey conducted via LimeSurvey (LimeSurvey GmbH, n.d.) was implemented for the students of a Swiss secondary school (7th to 9th grade). The survey assessed demographics, physical activity, sedentary behavior, screen use, mental health, and substance use (alcohol, tobacco products, drugs). Of the 69 individuals providing survey responses 6 provided implausible replies and 2 completed < 70% of the questions. Thus, 61 participants (mean age=13.98, SD=1.00 years old; 59% female, 5% diverse) were included in the analyses.
Results: The mean of moderate to strenuous physical activity (MVPA) = 557.16 minutes per week (SD = 328.43). The mean sedentary behavior=467.02 minutes per day (SD = 181.65) and mean daily screen time = 379.24 minutes per day; SD = 261.33). The mean mental health index revealed that 95% experienced low to medium levels of psychological stress. Almost 40% (39.3%) had ever drunk alcohol, 75% of which reported drinking alcohol in the last 30 days. Prevalence of tobacco use = 37.7% and drug use = 3.3%.
Conclusion: The survey showed that overall students have relatively good levels of physical activity and mental health, but there are some concerning trends in sedentary behavior and addictive behavior. Problematic sedentary behavior is likely due to leisure time screen related behaviors although this needs to be confirmed. Substance use including alcohol use may have a cultural acceptance issue that should be addressed. The underlying reasons notwithstanding, resources should be focused on decreasing screen time and substance use for this Swiss secondary school.

Keywords: Multiple risk factors, Adolescents

Authors:

Author - Claudio Nigg, PhD,
University of Bern

Co-Author - Julia Hugo, MS,
University of Bern

Co-Author - Carolin Glauser, MS,
Entlebuch Secondary School

D128 - Self-compassion and mental health: Examining the mediational role of health behavior engagement

Poster Number: D128
Time: 11:00 AM - 11:50 AM
Topics: Multiple Health Behavior Change , Mental Health

Background: Over the past two decades, research demonstrating the benefits of self-compassion for mental health has proliferated. Self-compassion has also been shown to predict engagement in a range of health behaviors. Yet, it is not known whether self-compassion predicts better mental health in part via greater engagement in health behaviors. An improved understanding of this pathway has the potential to clarify how self-compassion leads to better mental health and may provide targets for the application of self-compassion strategies in clinical settings.

Objectives: The current study examines the extent to which engagement in health behaviors mediates the link between self-compassion and mental health among emerging adults, a group at heightened risk for decrements in both mental health and health behaviors.

Design/Method: Participants were 332 emerging adults (Mage = 19.0) who completed two surveys assessing self-compassion, depression and anxiety symptoms, comfort food snacking, sleep hygiene practices, and overall engagement in health behaviors. Participants completed the second survey 7-10 weeks after completing the first. The Hayes PROCESS macro was used to test the potential mediating role of health behaviors in the association between self-compassion and mental health over time (5,000 bootstrap samples).

Results: Baseline Self-compassion was significantly associated with all T2 health behaviors except for comfort food snacking. Engagement in sleep hygiene behaviors mediated the relationship between baseline self-compassion and both T2 depression and anxiety (95% CIs [-.082, -.028] and [-.068, -.016], respectively). Overall health behavior engagement mediated the relationship between baseline self-compassion and T2 depression (95% CI [-.042, -.006]).

Conclusions: Findings suggest that individuals with higher self-compassion engage more in overall health behaviors and sleep hygiene practices, and that health behavior engagement helps explain the associations between self-compassion and mental health symptoms over time. These findings highlight the multiple positive downstream effects of fostering self-compassion and have important implications for mental healthcare providers to encourage emerging adults to apply self-compassion to health behavior engagement to promote mental health.

Keywords: Health behaviors, Mental health

Authors:

Author - Camille L. Garnsey, MS,
University of Connecticut

Co-Author - Katherine E. Gnall, MS, MS,
University of Connecticut

Co-Author - Crystal L. Park, PhD, FSBM, PhD, FSBM,
University of Connecticut

D129 - Longitudinal Effects of a Digital Weight Management Program on Weight Loss and Maintenance: A Randomized Controlled Trial

Poster Number: D129
Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Obesity

Background:
The emergence of digital health technology offers a promising avenue for addressing the multifactorial challenge of weight management. However, the effects of these interventions are heterogeneous, and effects on long-term maintenance are still in question. As a result, there is a need for more rigorous evaluations utilizing randomized controlled trials (RCTs), larger samples, and extended follow-ups.

Methods:
We conducted a 2-arm RCT to investigate the long-term effects of a commercial digital weight management program, as compared to an educational do-it-yourself (DIY) approach, on weight loss, physical activity, and eating disorder risk among 412 adults seeking weight loss. Participants were randomized to the 16-week digital intervention or a 16-week educational control condition. Weight and physical activity were self-reported at baseline, 16, 29, 42, and 68 weeks. Multiple group latent growth curve analyses were employed to evaluate changes in weight, physical activity, and eating disorder risk.

Results:
At 16 weeks, participants in the digital intervention group exhibited significantly greater weight loss compared to the control group (-1.2% vs. 0.2%; p = .013). This trend continued at subsequent time points, with digital intervention participants showing successful weight maintenance at 68 weeks relative to the control group (-4.5% vs. 1.0%; p = .006). Additionally, digital intervention participants reported significantly higher levels of vigorous physical activity and greater improvements in weekly vigorous physical activity at 68 weeks compared to control participants. Both groups showed improvements in eating disorder risk over time, with intervention participants demonstrating a slightly greater improvement.

Conclusions:
Our findings indicate that a commercial digital weight management program can facilitate significant long-term weight loss and improvements in physical activity and eating disorder risk relative to an educational approach. These results underscore the potential of digital interventions in supporting sustained weight management, enhancing physical activity, and buffering against eating disorder risk. Further research is warranted to explore the mechanisms of action for optimizing weight loss and related behavioral change.

Keywords: Weight control, Behavior Change

Authors:

Co-Author - Sydney Earl,
Noom, Inc.

Co-Author - Robert Moulder, PhD,
Noom, Inc.

Co-Author - Kelly Blessing,
Noom, Inc.

Co-Author - Cole Ainsworth, PhD,
Noom, Inc.

Co-Author - Meaghan McCallum, PhD,
Noom, Inc.

D130 - “I wish they would have put it more on...a human level…”: A Qualitative Assessment of Pre-operative Educational Needs of Adolescents Undergoing Metabolic and Bariatric Surgery

Poster Number: D130
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Child and Family Health

Background: Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity. Prior to surgery, adolescents often receive structured educational materials detailing necessary behavioral changes, through teen-specific support groups, educational sessions, and/or printed materials. However, there is a paucity of literature detailing these resources for adolescents, making it difficult to assess their content, specificity, and perceived helpfulness. This study aimed to qualitatively assess the educational needs identified by post-operative patients and parents/guardians.
Methods: Patients who had undergone MBS as adolescents, and parents/guardians of post-operative adolescents, were recruited through a community-engaged program, social media, and in-clinic outreach. Eligible participants were invited to participate in semi-structured interviews via teleconferencing software. The interviews were transcribed and coded using MAXQDA. Themes and properties were generated inductively and deductively through a review of relevant literature and line-by-line analysis of transcripts. Interrater reliability was established at the theme level, and an adolescent citizen scientist was consulted to ensure the codebook themes and properties resonated with the target population.
Results: A racially and ethnically diverse group of adolescents (n=6, non-Hispanic White=3, Hispanic=3) aged 17.17+2.14, and parents/guardians (n=6, non-Hispanic White=3, Black=2, Hispanic=1) participated in the study. The majority of participants (91.6%) were female. Participants were recruited from 6 clinics across the United States. High interrater reliability (M=0.93) was achieved using the codebook. Interviewees identified five key themes regarding pre-surgery educational needs including: interactive materials, resources for psychosocial well-being, additional information on physical aspects of surgery, teen-specific materials, and specific resources for parents/guardians.
Discussion: This study highlights gaps in current educational resources offered to adolescents prior to MBS. Future studies should conduct a content analysis of resources from accredited MBS centers across the United States to determine if these gaps are widespread. Clinicians may consider addressing these educational gaps through direct conversations with adolescents and parents/guardians. Future research is needed on additional materials and the best format for delivery.

Keywords: Children's health, Obesity

Authors:

Co-Author - Carma L. Bylund, PhD, PhD,
University of Florida

Co-Author - David M. Janicke, PhD, PhD,
Department of Clinical and Health Psych

Co-Author - Sarada Menon,
University of Florida

Co-Author - Nehal Dwaram,
University of Florida

Co-Author - Ayzengart, MD,
Nevada Surgical

Co-Author - Dominick J Lemas, PhD,
University of Florida

Co-Author - Michelle Cardel, PhD, MS, RD, PhD, MS, RD,
WW International, Inc.; University of Florida

D131 - Why affect matters in weight management: Secondary outcomes from the WW3-country randomized trial

Poster Number: D131
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Mental Health

Research has shown that individuals living with comorbid mental health disorders and obesity benefit from weight management interventions that target both mental health and weight-related outcomes. However, understanding the role of affect (i.e., positive and negative) as a marker of mental health in long-term weight management has been limited. While the potential impact of affect on weight management was introduced over 3 decades ago with regard to initial weight loss efforts, little attention has focused on this mental health marker in predicting long-term weight change.

The present study (N = 339; BMI = 33.7±5.2) was a secondary analysis of a year-long two-armed, three-country, randomized weight management intervention examining the role of affect changes as predictors of weight change. General linear regression models were used to determine if initial changes in positive and negative affect assessed by the SPANE questionnaire from 0 to 3 months predicted weight change across 12 months.

Results from the present study show that all three affect changes (increases, decreases, no change) in either positive or negative affect were associated with weight loss at 3 months. However, increases in positive affect score from 0-3 months were not associated with weight loss at 12 months compared to those who had no change or decreases in positive affect (p=0.07). Increases in negative affect were related to significantly less weight loss compared to participants with no change (p=0.04) or decreases in negative affect (p=0.02). Therefore, it was only the trajectory of increases in negative affect that were linked to less weight loss across 12 months.

Results show that negative affect is significantly associated with less weight change across time. The full impact that affect had on physical health was not realized in the short term, but was observed across time as it predicted participants experiencing less than half the weight loss. Deterioration in affect and well-being can impact behaviour change - and ultimately weight loss maintenance. Future weight management interventions should measure and target increases in negative affect changes across time as it may adversely impact long-term weight change management. Ultimately, to develop effective and sustainable approaches to address global obesity and mental health challenges, our efforts should encompass all dimensions of a person’s health including biological, psychological, and social factors.

Keywords: Weight control, Mood

Authors:

Co-Presenter - Lesley D. Lutes, PhD, PhD,
University of British Columbia Okanagan

Co-Author - Tricia Tang, PhD,
University of British Columbia Vancouver

Co-Author - Kimberly Truesdale, PhD,
University of North Carolina

Co-Author - Maria Bryant, PhD,
University of York, United Kingdom

Co-Author - Michelle Cardel, PhD, MS, RD, PhD, MS, RD,
WW International, Inc.; University of Florida

Co-Author - Karen Hatley, MPH, RD,
UNC Chapel Hill

Co-Author - Lacey R. Dickson,
University of British Columbia Okanagan

Co-Author - Deborah Tate, PhD,
UNC Chapel Hill

Co-Author - Gary Foster, PhD,
WW, Berkshire; University of Pennsylvania

D132 - The moderating effects of child eating behavior traits on the association between maternal controlling feeding practices and child weight status

Poster Number: D132
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Child and Family Health

Background: Controlling feeding practices (e.g., pressuring or prompting a child to eat) are thought to influence child weight status. However, findings are not always consistent, and there is some evidence that child eating behavior traits (e.g., food approach and avoidant behaviors) could influence associations between parent feeding practices and child weight status. Thus, the present study examined whether child eating behavior traits moderated cross-sectional and prospective associations between maternal controlling feeding practices and toddler weight status.
Design: Participants were 72(54% female; 46% Hispanic; MBMIz=0.7(1.1)) toddlers and their mothers (Mage=30.2(4.4); MBMI=34.1(6.4)) who participated in a prenatal lifestyle intervention trial aimed at preventing excess gestational weight gain. Included participants also had data on parental child-feeding practices and child eating behavior at 18 months, and child body mass index (BMI) at 18 and 24 months of age. Maternal prompts to eat were coded from a video-recorded meal; pressure to eat was reported by mothers using the Child Feeding Questionnaire. The Children’s Eating Behavior Questionnaire for Toddlers was used to assess child eating behavior traits (i.e., food responsiveness, enjoyment of food, satiety responsiveness, and food fussiness). Weight and height were measured according to standardized procedures and toddlers’ BMIz were computed based on WHO growth references. Linear regression models, controlling for study site, were used for analyses.
Results: At 18 months, greater observed maternal prompts to eat, but not reported pressure to eat, was associated with lower child BMIz (b=-0.13, p<.05). Child eating behavior traits did not moderate this association. Assessed prospectively, greater maternal prompts to eat at 18 months were also negatively associated with child BMIz at 24 months, but only for children with low food responsiveness (blow=-0.16, p<.01; bhigh=0.04, p>.05). Greater reported pressure to eat at 18 months was associated with higher child BMIz at 24 months but only among children with high food enjoyment (b=0.22, p=.02). Satiety responsiveness and food fussiness were not significant moderators in any models.
Conclusion: Child food responsiveness and enjoyment moderated prospective associations between maternal prompts/pressure to eat and child weight. Further research is needed to understand associations between child traits, parental feeding practices and weight outcomes.

Keywords: Eating behaviors, Children

Authors:

Presenter - Azeb Gebre, PHD,
College of Public Health, Temple University

Co-Author - Suzanne Phelan, PhD,
Department of Kinesiology and Public Health, California Polytechnic State University

Co-Author - Rena Wing, PHD,
The Miriam Hospital and the Warren Alpert Medical School of Brown University

Co-Author - Alison K. Ventura, PhD,
Department of Kinesiology and Public Health, California Polytechnic State University

Co-Author - Jennifer Orlet Fisher, PHD,
Department of Social and Behavioral Sciences, Temple University

Co-Author - Elissa Jelalian, PhD,
The Miriam Hospital; Alpert Medical School of Brown University

Co-Author - Chantelle Hart, PhD,
Department of Social and Behavioral Sciences, Temple University

D133 - Eating Mindfully To Prevent Weight Regain: A Pilot Trial To Test The Effect Of A Mindfulness Intervention During Weight Loss Maintenance

Poster Number: D133
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Integrative Health and Spirituality

Long term weight loss success is a major challenge for obesity treatment. Effective behavioral treatments are needed to improve success. Mindfulness is an emerging clinical tool used to treat chronic conditions and has the potential to target energy balance behaviors in ways that potentially support successful weight loss maintenance. The purpose of this study was to examine changes in body weight, appetite ratings, and mindfulness metrics immediately following, and 4 months after, an 8-week mindfulness program (Mindfulness Oriented Recovery Enhancement [MORE]) vs. a contact-matched behavioral weight loss maintenance comparison intervention, both delivered virtually. Participants (Age: 42.5 +/- 9.8; BMI: 32.2 +/- 6.3 kg/m2; % initial weight loss: 28.6 +/- 15.9%; 80.5% female:) attended baseline, 8-week, and 24-week assessment visits. Assessments included body weight, appetite ratings in response to a laboratory-controlled meal test, and mindfulness-specific questionnaires. Results from linear mixed models show weight regain was not significantly different between the two groups at 8-weeks (B:1.96; p>0.05) however the MORE group had significantly higher metrics of mindfulness on the MAIA questionnaire (B: 4.00; p=0.007) including higher sub-scores on attention, self-regulation, body listening, and trusting (all p<0.05) and lower self-reported satiety ratings (B: -2154.06; p<0.05). At the 24-week follow up testing, participants in the MORE group had higher body weight compared to those in the comparison group (B:12.89; p=0.002), and there were no significant differences on all appetite and mindfulness related outcomes (all p>0.05). Our findings suggest mindfulness to be an intervention of interest to acutely prevent weight regain following significant weight loss in adults who previously had overweight/obesity, but effects were diminished once the intervention was removed. Future, larger randomized controlled trial are needed to replicate these results and test the mechanisms by which mindfulness can positively influence energy balance behaviors and contribute to successful long-term weight loss maintenance.

Keywords: Obesity, Mindfulness

Authors:

Author - Selene Tobin, PhD,
The Weight Control and Diabetes Research Center, The Warren Alpert Medical school at Brown University

Co-Author - Grace Zimmerman, MS,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Victoria Miranda, MS,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Jason Thomas, MS,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Michelle Kubicki, BS,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Issac Khong, BS,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Jackie Smith, BS,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Ryan Burns, PhD,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Christopher Depner, PhD,
The Department of Health and Kinesiology, The University of Utah

Co-Author - Jincheng Shen, PhD,
Department of Population Health Sciences, The University of Utah

Co-Author - Eric Garland, PhD,
Center on Mindfulness and Integrative Health Intervention Development, The University of Utah

Co-Author - Molly Conroy, MD,
Division of General Internal Medicine, The University of Utah

Co-Author - Tanya Halliday, PhD RD,
The Department of Health and Kinesiology, The University of Utah

D134 - The impact of early non-response among dyads in a couples-based weight loss intervention

Poster Number: D134
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Multiple Health Behavior Change

Background: This study extends research on early non-response in a weight loss intervention by evaluating the impact of early non-response on individual and couples’ weight loss outcomes. Additionally, this study examined whether types of support received from one’s partner differed between early non-response status of dyads.

Methods: Couples enrolled in a 6-month couples-based weight-loss program (Project TEAMS; 126 individuals, 63 dyads; Mean Age = 53.56 years, SD = 10.07; 50% female, Gorin et al., 2020) reported their weights weekly for the duration of the program. Early non-response (ENR) was defined as losing <2% at week 5 of treatment. The impact of early non-response on weight outcomes was tested using mixed models accounting for dyadic interdependence. Participants reported on autonomy and directive support (SDT Support) at baseline and the impact of this support on ENR was tested using independent samples t tests. Couples were grouped into 3 categories based on ENR status (both partners ENR, only 1 partner ENR, or both partners early responders). Group differences for support was tested using one-way ANOVA’s.

Results: Early non-response predicted significantly less weight loss at 6 (p<.001) and 12 months (p<.001). One partner’s early response status impacted their partner’s weight loss at 6 (p=.004) and 12 months (p<.001). However, there was no significant interaction at 6 (p=.798, ns) and 12 months (p=.762, ns) such that one’s weight loss at 6 and 12 months is not dependent on one’s partners early response status. Early weight loss status was shared within 56% of couples (8.5% both ENR and 47.5% both early responders) and 44% included couples with mixed responses. Autonomy support at baseline did not differ between the three groups (F(2,115)=1.030, p=.360, ns); however, directive support did (F(2,115)=3.770 p=.026). Directive support was higher in couples who were both early non responders vs. couples who were both early responders (p=.05) suggesting this form of support (i.e., reminding, “policing”) may not aid in early weight loss.

Conclusions: Partners within dyads in a couples weight loss intervention vary in early weight loss response. Coaching couples on how to best support their partner may be an important intervention target to achieve early weight loss success.

Keywords: Obesity, Weight loss

Authors:

Co-Author - Jeffrey D. Burke, PhD,
University of Connecticut

Co-Author - Tricia M. Leahey, PhD, FSBM, PhD, FSBM,
University of Connecticut

Co-Author - Amy A. Gorin, PhD, PhD,
University of Connecticut

D135 - The Relationship between Internalized Weight Stigma and Weight-Loss Treatment-Seeking Behavior

Poster Number: D135
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Social and Environmental Context and Health

Introduction:
Internalized weight stigma (IWS) is linked to healthcare avoidance, but it is unknown how IWS affects pursuit of obesity treatment. This study examined if IWS is associated with weight-loss treatment-seeking behavior. Exploratory analyses evaluated associations of IWS with weight-loss treatment preferences.

Methods:
Adults with obesity (N=157; Age: M(SD)=39.95(12.43); BMI: M(SD)=38.4(6.7) kg/m2; 93.6% women; 76.4% white, 8.3% Black or African American, 7.6% mixed race) were recruited via Prolific and completed validated measures of IWS. Desire to lose weight was rated from 1 (no desire) to 6 (strong desire). Those expressing desire to lose weight (rating ≥ 2) were asked to accept or decline weight-loss treatment resources during the survey as a proxy for weight-loss treatment-seeking behavior. Participants also reported on weight-loss treatment preferences. Hierarchical binary logistic regression examined if IWS was associated with acceptance/decline of weight-loss treatment resources, controlling for eating self-efficacy, body mass index, gender, self-rated health, and desire to lose weight. Partial correlations evaluated associations between IWS and weight-loss treatment preferences, controlling for desire to lose weight.

Results:
Higher IWS correlated with greater desire to lose weight (Spearman’s rho=.586, p<.001). Participants with higher (vs. lower) IWS had significantly greater odds of accepting weight-loss treatment resources, adjusting for all covariates (OR=1.52, p=.007, 95% CI=1.12-2.07). Exploratory analyses revealed that IWS was not associated with a preference for group or individual treatment, regardless of desire to lose weight. Higher IWS was associated with significantly greater comfort with online treatment (r=.16, p=.04), and with greater interest in seeing a nutritionist/dietitian (r=.25, p=.002) or a psychologist/counselor (r=.26, p=.001) (compared to a primary care provider or exercise specialist); however, these effects were not significant when controlling for desire to lose weight.

Conclusions:
Participants who accepted (vs. declined) weight-loss treatment resources had higher IWS, even after adjusting for all covariates. IWS was not associated with weight-loss treatment preferences when accounting for a general desire to lose weight. Further research is needed to clarify the role of IWS in weight-loss treatment-seeking behavior and preferences, and to determine how to best address IWS in weight-loss treatment.

Keywords: Obesity, Weight loss

Authors:

Presenter - Miriam Sheynblyum, M.S.,
University of Florida

Co-Author - Rebecca L. Pearl, PhD,
University of Florida

D136 - Sociodemographic Correlates of Internalized Weight Stigma: A Systematic Review

Poster Number: D136
Time: 11:00 AM - 11:50 AM
Topics: Obesity, Social and Environmental Context and Health

Individuals with a high weight (e.g., obesity) may apply negative societal attitudes about weight to the self, resulting in internalized weight stigma. Internalized weight stigma is strongly associated with adverse physical and mental health outcomes. However, questions remain about which groups are most vulnerable to internalizing weight stigma. This study systematically reviewed sociodemographic correlates of internalized weight stigma including sex/gender, age, race/ethnicity, income, education level, employment status, and marital status among adults with overweight and obesity.
A comprehensive literature search of five electronic databases was conducted in December 2023. Article eligibility was determined via title and abstract screening and full-text review by two independent reviewers. Eligible empirical studies were 1) available in English, 2) observational, 3) reported at least one quantitative association between a sociodemographic factor and a validated measure of internalized weight stigma, and 4) conducted either primary or subgroup analyses among adults with overweight or obesity.
Forty articles met inclusion criteria. Interrater reliability for title and abstract screening and full-text review was high, at 91.1% and 96.9%, respectively. Most studies examined sex/gender and age differences and primarily used cross-sectional designs. Overall, results were mixed across sociodemographic groups. Some studies identified significantly higher levels of internalized weight stigma among women, younger adults, White individuals, unemployed individuals, and those with lower educational attainment. However, most included studies found no significant differences across sociodemographic characteristics.
Additional research with representative samples and adequate power to detect sociodemographic variations in internalized weight stigma is needed. Such work is essential to identify those at the highest risk for internalizing weight stigma and to understand the factors that contribute to this process. Identifying high-risk groups is crucial for designing targeted interventions to prevent and mitigate the adverse psychological and physical health effects of internalized weight stigma.

Keywords: Obesity, Health disparities

Authors:

Presenter - Laurie C. Groshon, MS, MS,
University of Florida

Co-Author - Miriam Sheynblyum, MS,
University of Florida

Co-Author - Rebecca L. Pearl, PhD, PhD,
University of Florida

D137 - The Relationship Between Kinesiophobia and Religiosity in Patients with Sickle Cell Disease

Poster Number: D137
Time: 11:00 AM - 11:50 AM
Topics: Pain, Health of Marginalized Populations

Chronic illness manifests through a complex interplay of biological, social, and psychological factors that impact individuals’ daily lives. Sickle cell disease (SCD), a chronic hematological disorder, is characterized by red blood cells assuming a sickle shape, leading to obstructions in blood vessels. These obstructions often result in persistent vaso-occlusive pain and proportional decreases in physical activity. Anxiety associated with movement and anticipated pain is known as kinesiophobia. For patients with SCD, kinesiophobia can exacerbate mental suffering and promote physical deconditioning. In this study, 123 SCD patients were evaluated to understand the relationship between kinesiophobia (measured by the Tampa Kinesiophobia Scale), religiosity (measured by the Duke University Religion Index), and other relevant factors. Correlational analyses revealed that non-organizational religious activity was inversely related to kinesiophobia scores (p < .05). Furthermore, simple linear regression analyses demonstrated that religiosity explained approximately 13% of the variance in kinesiophobia among SCD patients. These findings suggest that religiosity, particularly non-organizational religious activity, may serve as a valuable coping mechanism for mitigating kinesiophobia in individuals with SCD through a combination of faith and faith-related behaviors.

Keywords: Disease, Spirituality

Authors:

Author - Brett P. Reid, BS,
North Carolina Central University

Co-Author - Cara L. Green, BS,
North Carolina Central University

Co-Author - John J. Sollers IV,
Thomas More University

Co-Author - Luca Mattassini,
Thomas More University

Co-Author - Malibongwe Mkosi,
Thomas More University

Presenter - Jenny L. Norris, BA,
North Carolina Central University

Co-Author - Ervin D. Whitley, BS,
North Carolina Central University

Co-Author - Beyonnshea N. Lucas, BS,
North Carolina Central University

Co-Author - Suquey-Amparo Castillo-Lopez, BS,
North Carolina Central University

Co-Author - Ashyia N. Williams, BS,
North Carolina Central University

Co-Author - Sadeja Goodman, BS,
North Carolina Central University

Co-Author - Camela S. Barker, PhD,
Fielding University

Co-Author - Mary Wood, MA,
Duke University Medical Center

Co-Author - Christopher L. Edwards, PhD, BCB, IABMCP,
North Carolina Central University

Co-Author - John J. Sollers III, PhD,
North Carolina Central University

D138 - Support Can Modify Hostility in Adults with Sickle Cell Disease (SCD)

Poster Number: D138
Time: 11:00 AM - 11:50 AM
Topics: Pain, Mental Health

Chronic pain is one of the primary symptoms of the genetic disease Sickle Cell Disease (SCD). SCD is characterized by abnormal hemoglobin with stiff and crescent-shaped red blood cells. These abnormalities result in various consequences, such as vaso-occlusive pain, anemia, and organ damage. Hostility emerges as a psychosocial factor that influences the experience of individuals with SCD. Sources of social support (spousal, familiar, civic, etc.) may also influence hostility in adults with SCD through paths that are not well understood. In this study, 84 patients with SCD were assessed on hostility and sources of social support. In a series of linear regressions, we found that older age predicted less hostility and fewer individuals in the support network. Only higher levels of support from family independently buffered the impact of hostility in patients with SCD. Interestingly, support from doctors and clinicians was not associated with clinical outcomes of interest. Our findings highlight the importance of addressing psychosocial factors in SCD management and to guide future research.

Keywords: Coping, Attitude(s)

Authors:

Author - Beyonnshea N, BS,
North Carolina Central University

Co-Author - Ashiya N. Williams, BS,
North Carolina Central University

Co-Author - Jenny L. Norris, BA,
North Carolina Central University

Co-Author - Cara L. Green, BS,
North Carolina Central University

Co-Author - Brett P. Reid, BS,
North Carolina Central University

Co-Author - Sadeja Goodman, BS,
North Carolina Central University

Co-Author - Ervin D. Whitley, BS,
North Carolina Central University

Co-Author - Mary Wood, MA,
Duke University Medical Center

Co-Author - Camela S. Barker, PhD,
Fielding University

Co-Author - Suquey- Amparo Castillo-Lopez, BS,
North Carolina Central University

D139 - Pain Experiences among Women in Midlife with CVD Risk: Daily Reports during an 8-Week Dyadic Physical Activity Intervention

Poster Number: D139
Time: 11:00 AM - 11:50 AM
Topics: Pain, Women's Health

Women in midlife (ages 40-65) experience pain in daily life due to biological factors (e.g., aging, menopausal transition causing poor sleep, estrogen decline) and the interplay of psychosocial factors (e.g., poor health behaviors due to caregiving responsibilities, body image changes). Women in midlife also tend to “push through” physical pain experiences to fulfill responsibilities during daily life (e.g., caregiving) and do not engage sufficiently in cardioprotective protective self-care behaviors (e.g., physical activity), increasing their susceptibility to pain, and the development of chronic pain and cardiovascular disease (CVD) risk factors (e.g., hypertension, type 2 diabetes). Fortunately, physical activity (PA) can delay the onset and decrease the severity of chronic pain. To increase PA and prevent worsening of pain symptoms, women in the present study completed an 8-week PA intervention that included weekly coaching sessions and social support from a partner (i.e., another woman in the program). Women in midlife with >1 risk factors for CVD (N=62, MAge=53, MBMI=33 kg/m2, 44% racial/ethnic minority identification) completed end-of-day surveys each day of the 8 week program. Surveys included questions about the occurrence of pain (yes/no), location(s) of pain, and pain severity (rated mild to very severe). Across 8 weeks, daily reports showed that women endorsed pain on 32% of days. Of these pain occurrences, 48% were rated as moderate level of pain, 10% were rated as severe pain, and 6% were rated as very severe. Pain was cited as the main barrier to engaging in PA on 9% of days. Women most commonly reported knees, feet, back, and “whole body” as the location of their pain. Overall, findings highlight the high prevalence, considerable severity, and wide range of pain locations among women in this group. Despite the frequency of moderate and severe pain experiences, pain was infrequently identified as the main barrier to PA engagement. Additional social support from PA partners and coaches may have alleviated some PA-related stress and increased overall well-being, enabling participation in PA. Future work is needed to clarify optimal methods to support PA among women in midlife with pain and CVD risk.

Keywords: Pain, Women's health

Authors:

Author - Iris Bercovitz, M.A., M.A.,
Rowan University

Co-Author - Gabrielle M. Salvatore, Ph.D.,
Rowan University

Co-Author - Kiri Baga, M.A.,
Rowan University

Co-Author - Emmanuel Lapitan, B.A.,
Rowan University

Co-Author - Anisha Satish, M.A.,
Rowan University

Co-Author - Amanda L. Folk, Ph.D.,
Rowan University

Co-Author - Danielle Arigo, Ph.D., LP,
Rowan University

D140 - Substance Use, Sex, and Depression as Predictors of Post-Surgical Opioid Use and Misuse

Poster Number: D140
Time: 11:00 AM - 11:50 AM
Topics: Pain, Substance Misuse

Intro: Previous literature has explored potential predictors of post-surgical opioid use and misuse, including a history of opioid use, mood,1,2 and smoking.3 The current study aims to examine potential predictors, including sex and mood, of opioid misuse in post-operative patients undergoing elective surgery.

Methods: We conducted a prospective cohort study of 718 adult patients undergoing elective surgical operations. Exclusion criteria included inability to complete assessments, cancer, and a positive preoperative COMM score ≥9. Study subjects completed preoperative assessments and postoperative assessments of mood, adverse child events? opioid use, pain (intensity, frequency, and duration), and substance use for 12 months after surgery. The primary outcome was a positive COMM score reported after surgery.

Results: Of 718 (Mage=58.2 years, 59.1% Female) patients enrolled in the prospective cohort study, 626 (87.2%) did not report a positive COMM score before surgery and were included in the analysis. 62 (9.9%) patients reported a positive postoperative COMM score. Comparing patients with and without a positive postoperative COMM score, there were significant differences in average preoperative pain interference scores (2.7 vs 1.8, p=0.001), preoperative pain intensity (3.0 vs 2.2, p=0.02), preoperative COMM scores (5.5 vs 3.2, p<0.0001), PROMIS depression scores (52.8 vs. 46.4, p<0.0001), preoperative opioid use (17.7% vs. 6.3%, p=0.003), and the percentage of positive TAPS-2 scores for cannabis (27.9% vs. 12.7%, p=0.003). In the final model, adjusted for surgery type, higher preoperative COMM scores (OR 1.52, 95% CI 1.31-1.76, p<0.0001) and higher preoperative PROMIS depression scores (OR 1.09, 95% CI 1.04-1.14, p=0.0005) were significant independent predictors of a positive postoperative COMM score.

Discussion: Depressive symptoms, preoperative pain intensity and interference, and cannabis use were associated with sub-positive COMM scores and findings suggest that these are potential predictors postoperative opioid misuse. In addition, depressive symptoms represent an important intervention target to prevent the development of postoperative opioid misuse after surgery.

Keywords: Opioids, Surgery

Authors:

Author - Gabrielle Hettie, BA, BA,
University of Connecticut

Co-Author - Luke Pirrotta,
Stanford University

Co-Author - Jennifer Hah, MD,
Stanford University

D141 - Unpacking the Role of Automatic Associations in Physical Activity Behavior: Insights from a Real-World Ecological Momentary Assessment Study

Poster Number: D141
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Multiple Health Behavior Change

Background: Maintaining recommended physical activity (PA) levels is essential for improving and maintaining good health. However, most U.S. adults are physically inactive. Previous research shows automatic evaluations (i.e., implicit, unconscious attitudes) toward PA behaviors may contribute to PA engagement. However, automatic evaluations have not been studied in real-world settings in natural daily life contexts. This study aims to explore whether day-to-day PA behavior is associated with individual differences and daily fluctuations in automatic evaluations. Methods: Adults (M age = 38.2, SD = 11.76, 64% female) completed up to 8 Implicit Association Tests (IATs) per day during daily life over a 14-day period to measure their momentary automatic evaluations of PA (2,108 IATs total). IATs used a novel mobile phone touchscreen browser-based tool with 2 blocks of 10 trials of categorizing PA word stimuli into categories containing ‘good’ or ‘bad’ attributes. On average, participants completed 3.17 (SD = 1.4) IATs per day. After aggregating at the daily level, there were 603 person-days of data from the data across 51 participants. Moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) min/day were assessed with waist-worn accelerometers. Multilevel Poisson models estimated the relationship between automatic evaluations and PA at the between-subject (BS, person) and within-subject (WS, day) levels, adjusting for age and accelerometer wear time. Results: For the VPA model, the BS-effect of automatic evaluations of physical activity were positively associated with VPA min/day (β = 3.31, p = .03). Conversely, the WS effect of the automatic evaluations was negatively associated with VPA minutes (beta = -0.63, p < .001). For the MVPA model, no significant association was found between MVPA and the BS-effect of automatic evaluations (beta = 0.36, p = .48). However, the WS-effect of the automatic evaluations was inversely associated with MVPA min/day (beta = -0.17, p < .001).
Discussion: At the person level, more favorable automatic evaluations toward PA were associated with higher VPA but not MVPA. An intriguing inverse relationship was observed between day-level automatic evaluations and both MVPA and VPA. Given the use of day-level aggregated data, it is challenging to establish a causal link. However, these results highlight the potential role of automatic evaluations momentary variability within subjects in driving behavior.

Keywords: Physical activity, Behavior Change

Authors:

Presenter - Max Samuelson,
USC Keck School of Medicine

Co-Author - Wei-Lin Wang, PhD, PhD,
University of Southern California

Co-Author - Bridgette Do, PhD, MPH, PhD, MPH,
Astellas

Co-Author - Amanda Rebar, PhD,
University of South Carolina

Co-Author - Genevieve F. Dunton, PhD, MPH, FSBM, PhD, MPH, FSBM,
University of Southern California

D142 - Effects of the Fit2Thrive Intervention Components on Social Cognitive Theory Constructs in Breast Cancer Survivors

Poster Number: D142
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Cancer

Background: Increased moderate to vigorous physical activity (MVPA) is associated with improved health outcomes in breast cancer survivors (BCS). Yet, 90% do not meet MVPA guidelines. Targeting social cognitive theory (SCT) constructs are associated with increased MVPA in BCS, but few studies have explored intervention effects on SCT constructs. This study tested the effect of five SCT-guided Fit2Thrive MVPA promotion intervention components on SCT constructs using the Multiphase Optimization Strategy (MOST) methodology.

Methods: All participants [n=269; Mage=52.5(SD=9.9)] received a core intervention (Fitbit+Fit2Thrive app) and were randomly assigned to “on” vs. “off” conditions for five intervention components: 1) support calls (CALLS); 2) deluxe app (DELUXE); 3) text messages (TEXT); 4) online gym (GYM); and 5) buddy. SCT constructs [barriers self-efficacy (SE); exercise SE; physical, social, and self-evaluative outcome expectations (OEs); social support for exercise from family, friends, and other cancer survivors; enjoyment; goal setting] were self-reported at baseline, post-intervention (12-weeks), and 24-week follow-up. Baseline to follow-up changes and effects of each component on each SCT construct at 12 and 24-weeks were estimated using generalized estimating equations (GEE) ordinal regression models.

Results: Overall, enjoyment, goal setting, and family social support increased, and physical OE decreased at 12-weeks; increases in enjoyment and goal setting were maintained while barriers SE decreased at 24-weeks (p’s<0.05 for all). At 12-weeks, changes in social OE favored “on” vs. “off” for DELUXE; friend social support favored “on” vs. “off” for GYM; other cancer survivors social support favored “off” vs. “on” for CALLS; and goal setting favored “on” vs. “off” for CALLS. At 24-weeks, changes in barriers SE favored “on” vs. “off” for CALLS and DELUXE; physical and self-evaluative OEs favored “off” vs. “on” for DELUXE; family social support favored “off” vs. “on” for GYM; and goal setting favored “on” vs. “off” for CALLS and favored “off” vs. “on” for DELUXE, GYM, and TEXT.

Conclusions: Changes in SCT constructs among Fit2Thrive participants by time and intervention component level were mixed, with some demonstrating improvements while others were unchanged or declined. Future studies should explore whether changes in these constructs mediate changes in MVPA to better understand how to effectively target SCT constructs and change MVPA in BCS.

Keywords: Physical activity, Cancer

Authors:

Presenter - Julia Frey, BS,
Northwestern University

Co-Author - Jing Song, MS,
Northwestern University

Co-Author - Juned Siddique, DrPH,
Northwestern University

Co-Author - Payton Solk,
Northwestern University Feinberg School of Medicine

Co-Author - Julia Starikovsky, MA, MA,
Northwestern University

Co-Author - Jean M. Reading, PhD, PhD,
Northwestern University Feinberg School of Medicine

Co-Author - Shirlene D. Wang, PhD, PhD,
Northwestern University

Co-Author - Kristina Hasanaj, PhD, PhD,
Northwestern University

Co-Author - Bonnie Spring, PhD, ABPP, FSBM, PhD, ABPP, FSBM,
Northwestern University

Co-Author - David Cella, PhD, PhD,
Northwestern University Feinberg School of Med

Co-Author - Frank J. Penedo, PhD, FSBM, PhD, FSBM,
University of Miami

Co-Author - Kerry S. Courneya, PhD, PhD,
University of Alberta

Co-Author - Ronald Ackerman, MD, MPH,
Northwestern University

Co-Author - Siobhan M. Phillips, PhD, MPH, FSBM, PhD, MPH, FSBM,
Northwestern University

D143 - The role of physical activity in the relationship between exposure to community violence and mental health: A systematic review

Poster Number: D143
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Social and Environmental Context and Health

Community violence is a global public health problem that is associated with mental health disorders. Physical activity can enhance mental health and may play an important role in the relationship between exposure to community violence and mental health. We systematically reviewed the literature to better understand the potential role of physical activity in this relationship. In this review, we searched the databases PubMed, Embase, Web of Science, Cochrane Central, PsycInfo, and SPORTdiscus, and conducted a grey literature search of one clinical trials registry and four organizations’ websites. The review included quantitative observational studies, intervention studies, and qualitative studies published by November 30, 2022 and that involved generally healthy individuals across the lifespan. Eligible studies included measures of community violence, mental health, and physical activity. Five studies met the inclusion criteria for the review. Four studies were conducted in high-income countries, only two minority populations were represented in the studies, and none of the studies included older adults or children. Studies defined and measured community violence, mental health, and physical activity in different ways. In most studies, physical activity was not a primary focus but assessed as one item within a larger construct. The role of physical activity was examined differently across the studies and only one study found a significant role (mediator) of physical activity. This review revealed that few studies have specifically examined physical activity’s role in the relationship between exposure to community violence and mental health. Further research is needed involving low-income countries, diverse minority populations, and children.

Keywords: Physical activity, Violence

Authors:

Presenter - Jeffrey Gehris, PhD,
Department of Health and Rehabilitation Sciences, College of Public Health, Temple University

Co-Author - Adewale Oyeyemi, PhD, PhD,
Arizona State University

Co-Author - Mona Baishya, MPH,
Department of Social and Behavioral Sciences, College of Public Health, Temple University

Co-Author - Stephanie Roth, MLIS,
Christiana Care Health System

Co-Author - Mark Stoutenberg, PhD, MSPH, PhD, MSPH,
Department of Sport and Exercise Sciences, Durham University

D144 - Social norms and physical activity among Chinese adult graduate students: the moderating role of group identification

Poster Number: D144
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Social and Environmental Context and Health

Introduction: Physical activity offers substantial health benefits, e.g. prevention of chronic diseases, improvement of mental health, and reduction in mortality risk. However, little attention has been paid to physical activity among Chinese adult graduate students. Two kinds of social norms, i.e. descriptive norms and injunctive norms, capture normative pressure from social environment. It has been widely argued that group identification, defined as perceived identification with a specific group, moderates the effects of social norms. The present study examined the associations between two kinds of social norms for typical graduate students on campus and physical activity among Chinese adult graduate students. The moderating role of group identification with typical graduate students on campus was also studied.

Methods: A cross-sectional web-based self-administered survey was conducted among 461 Chinese adult graduate students between May and June 2024. Demographic characteristics, e.g. gender, age, and family household income were collected. Physical activity level, descriptive norms, injunctive norms, and group identification were measured. Logistic regression analysis was performed to study the associations between two kinds of social norms and sufficient physical activity, defined as performing at least 150 minutes moderate to vigorous physical activity throughout the week. Interaction terms between social norms and group identification were further added in the models to test the moderating role of group identification. Data analysis was performed by STATA/SE 15.1.

Results: Both descriptive norms (aOR=1.01, p=0.012) and injunctive norms (aOR=1.48, p<0.001) positively predicted sufficient physical activity among Chinese adult graduate students after adjusting for demographic characteristics. Group identification significantly strengthened the association between injunctive norms and physical activity. However, there was no evidence that the relationship between descriptive norms and physical activity was moderated by group identification.

Conclusions: This study reveals how group identification moderates the associations between social norms and physical activity among Chinese adult graduate students. Findings of the present study suggest that injunctive norm interventions using typical graduate students on campus as the reference group to promote physical activity should especially target students who identify with this group.

Keywords: Physical activity, Beliefs

Authors:

Author - Xinchen Ye,
Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China

Co-Author - yuhan hu,
Department of Sociology, The Chinese University of Hong Kong, Hong Kong SAR, China

Co-Author - siwen huang,
Vanke School of Public Health, Tsinghua University, Beijing, China

Co-Author - Qingyu Li,
Vanke School of Public Health, Tsinghua University, Beijing, China

Co-Author - Sitong Luo,
Vanke School of Public Health, Tsinghua University, Beijing, China

Co-Author - Phoenix K. H. Mo,
Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China

D145 - Changes in self-efficacy for exercise following a home-based aerobic and muscle strengthening exercise intervention in endometrial cancer survivors

Poster Number: D145
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Cancer

Background: Guidelines recommend that endometrial cancer survivors (ECS) complete ≥150 minutes of aerobic exercise and ≥two days of muscle-strengthening exercise weekly, yet <10% of ECS meet guidelines. The Social Cognitive Theory posits environmental, behavioral, and cognitive factors influence exercise behavior, mediated in part by self-efficacy for exercise (SEE). We aimed to compare changes in SEE following a 10-week home-based aerobic and muscle-strengthening exercise intervention in ECS.

Methods: Ten ECS were recruited for a 10-week home-based aerobic exercise and muscle-strengthening exercise intervention from our Comprehensive Cancer Center’s Gynecologic Oncology Clinic. The intervention included 10 weeks of self-directed aerobic exercise with two days/week of muscle-strengthening exercise. Participants received exercise equipment (resistance bands, instructional session) and personalized support (tailored exercise logs, weekly study check-ins). Baseline measures included body mass index (BMI), age, and cancer characteristics. Exercise adherence was monitored weekly (% completed sessions). Participants completed the validated Self-Efficacy for Exercise scale (scored 0-90) for both aerobic exercise and muscle-strengthening exercise at baseline and follow-up. Demographics, SEE scores were reported as means and standard deviations (SD), with changes evaluated through Cohen’s d effect sizes in SAS 9.4 (Cary, NC).

Results: Participants were on average 63.7 (SD = 8.3) years old, BMI of 38.3 (SD = 7.6) kg/m2 and all having Stage 1 disease. High adherence rates were measured for aerobic exercise (89%) and muscle-strengthening exercise (82%). Baseline SEE for aerobic exercise was 58.7 (SD = 19) and muscle-strengthening SEE was 55.7 (SD = 20). Improvements were seen in SEE for aerobic exercise (d = 0.4) and SEE for muscle-strengthening exercise (d = 0.1), though these were not statistically significant.

Conclusion: Increases in SEE were observed, although not statistically significant, with larger improvements measured for aerobic exercise. ECS have high levels of inactivity, demonstrating a need for tailored exercise interventions using established behavior change theories. While our intervention was successful at increasing exercise behaviors, future research should focus on larger studies with diverse populations of ECS to further evaluate changes in SEE following intervention.

Keywords: Cancer survivorship, Exercise

Authors:

Co-Author - Andrea Babcock, MS,
University of Iowa

Co-Author - Michael Goodheart, MD,
University of Iowa

Co-Author - Alyssa Noble, BA,
University of Iowa

Co-Author - Susan Lutgendorf, PhD,
University of Iowa

Co-Author - Jessica Gorzelitz, PhD,
University of Iowa

D146 - Organizational and Policy Influences on Midwestern Firefighters’ On-duty Physical Activity

Poster Number: D146
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Health Communication and Policy

Purpose: Firefighters perform a variety of occupational tasks which require a high level of physical fitness yet exhibit high rates of physical inactivity and obesity. Fire departments are encouraged to have policies to maintain physical fitness and allow time to exercise while on-duty; however, little is known about how physical environment and policy components support firefighter physical activity (PA). This qualitative study aimed to explore organizational and policy level factors associated with occupational PA behaviors.

Methods: Career firefighters (N=32) from a mid-size, midwestern city participated in this study. Data from seven semi-structured focus group sessions were analyzed using inductive thematic analysis.

Results/Findings: At the organizational level, three key themes were identified: leadership priority, culture shift, and exercise barriers. Participants described the pivotal role of leadership in crew’s operations. A majority reported leadership prioritizes on-duty workouts and provides opportunities for job-related PA and exercise, while some felt that certain leaders were less concerned. Participants conveyed the department’s continued investment in quality equipment and establishing expectations in Fire Academy contribute to fostering a culture of health and wellness within the firehouse. However, running calls and training demands were seen as occupational barriers to on-duty exercise. As for policy, themes centered around opportunity for PA and awareness of health benefits. The department policies including designated time to exercise, annual health screenings, and performance assessments provide participants the opportunity to engage in PA. Moreover, participants found the health and performance assessments provided valuable information for discussions with healthcare providers and potential motivation for improving physical fitness. Based on self-reported data, participants were meeting or exceeding PA recommendations.

Conclusion: The current findings highlight the organizational and policy level barriers and facilitators to occupational PA. Many positive themes were identified that may contribute to firefighters prioritizing and valuing PA behavior, whereas job-related barriers present some challenges to on-duty exercise. These multifaceted efforts not only promote individual fitness, but also strengthen department culture and create a foundation for a healthier, more active work environment.

Keywords: Worksite health, Occupational health

Authors:

Co-Presenter - Emily Mailey, PhD,
Kansas State University

D147 - Exergaming Effects on Enjoyment and Self-Efficacy among Young Adults with Down Syndrome

Poster Number: D147
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Obesity

INTRODUCTION: Adults with Down Syndrome (DS) face unique barriers to moderate to vigourous physical activity (MVPA). Exergames present a home-based exercise option that has shown effectiveness for increasing MVPA in typically developed populations. Limited research exists investigating recent exergaming technology among populations with DS. Potential benefits found in typically developed populations were increases in physical activity enjoyment and self-efficacy. The purpose of this study was to investigate the effects of a 12-week exergaming intervention on physical activity enjoyment and self-efficacy among young adults with DS. METHODS: Adults with DS were given a Nintendo SwitchTM video gaming console and the exergame Ring-Fit AdventureTM. Ring-Fit AdventureTM is a novel exergame that uses both a resistance ring and body weight to perform numerous upper and lower body cardiovascular and resistance exercises. Participants were instructed to play the game for 120 minutes per week and attend weekly (15-minute) virtual health coaching sessions, during which an individual health coach promoted game usage and troubleshot problems with technology. Outcomes included physical activity enjoyment assessed via the Physical Activity Enjoyment Scale and self-efficacy assessed via Self-Efficacy for Activity for Persons with Intellectual Disabilities Scale. Paired sample t-tests were conducted to detail changes from pre to post. RESULTS: 20 adults with DS (M age = 24.28, 85% non-Hispanic white, 65% female) participated in the intervention. One participant ceased communication with the research team after completing pre-testing. Participants attended 93% of coaching sessions and 90% met the weekly gameplay goal. A significant increase in physical activity enjoyment (p <.001) and self-efficacy for activity was noted (p < .001). CONCLUSION: Physical activity enjoyment and self-efficacy for activity increased after this intervention. At-home exergaming interventions may present an effective option for enjoyable physical activity experiences among young adults with DS. Future studies that include a larger and more diverse sample as well as longer durations are warranted.

Keywords: Disability, Physical activity

Authors:

Presenter - Kameron Suire, PhD,
Berry College

Co-Author - Brian Helsel, PhD,
University of Kansas Medical Center

Co-Author - April Bowling, PhD,
Merrimack College

Co-Author - Amanda Staiano, PhD,
Pennington Biomedical Research Center

Co-Author - Joseph Sherman, M.S.,
University of Kansas Medical Center

Co-Author - Annie Rice, M.S.,
University of Kansas Medical Center

Co-Author - Lauren Ptomey, PhD, PhD,
University of Kansas Medical Center

D148 - Treadmill in the office to reduce sedentary time: A mixed-method daily diary case study

Poster Number: D148
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Mental Health

Background: Activity-permissive workstations (APWs) have gained popularity in the past few years to combat sedentary office work and improve office workers’ health condition. APW use has been shown to effectively decrease sedentary time while not compromising work productivity. However, there is limited evidence on office workers' subjective experiences with APWs, which is essential for understanding long-term feasibility and overall acceptability.
Methods: Four office workers who recently obtained treadmill desks were recruited for this daily diary study. Participants were not given guidelines or restrictions on their treadmill use or speed. Participants completed a baseline health survey and a one-week baseline assessment before using treadmill desks at their discretion for two months, along with daily diaries and two monthly surveys reporting physical and mental health and qualitative feedback (e.g., “What are some overall benefits and barriers of using a treadmill desk during your working hours?”).
Results: Participants used the treadmill desk on 54% of the days when they were in the office. On average, they walked 45.91 minutes (1.28 miles) daily. Participants mostly used the treadmills when they performed tasks including email, meeting preparation, and virtual meetings. They also reported using the treadmill desk to cope with anxiety or stress; however, there was no significant association between daily stress and treadmill usage. From the monthly report, perceived stress decreased over time for all participants; self-reported physical health and self-efficacy increased over time for three out of four participants. Participants identified mental and physical health benefits of using the treadmill desk, including that using a treadmill desk enhanced physical activity, increased energy, and reduced stress. Barriers for more frequent usage include inconsistent schedules in and out of the office, being unable to use the treadmill desk for in-person meetings and wanting to avoid being a distraction during online meetings.
Discussion: Treadmill desks show promise for improving employee well-being, with high feasibility and acceptability. However, barriers to consistent use were largely related to position-specific tasks, such as frequent in-person meetings in the office. Future research should explore strategies to integrate treadmill desks more seamlessly into diverse work roles and examine their long-term health benefits in larger office populations.

Keywords: Physical activity, Physical environment

Authors:

Presenter - Yiqing Skylar Yu,
Colorado State University

Co-Author - Chang Nie,
Colorado State University

Co-Author - Payge Grieve,
Colorado State University

Co-Author - Katie M. McMahon,
Colorado State University

Co-Author - Daniel J. Graham, PhD, PhD,
Colorado State University

D149 - Exploring the Impact of Social Media Fitness Influencers on Physical Activity: A Scoping Review

Poster Number: D149
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Digital Health

Background:
Fitness influencers, who share free physical activity (PA) information to motivate and inspire audiences, are a significant source of PA content online. Their easily accessible content offers a potential low-cost strategy for promoting PA, however, their content may contain misinformation and lead to negative social comparisons. Nevertheless, influencers could play a role in encouraging PA participation but it is unknown if their content can be a potentially effective tool for health promotion. Thus, this scoping review describes the published literature about the impact of social media fitness influencers on PA outcomes.

Methods:
Guided by the PCC (Participant, Concept, Context) framework, we conducted broad searches (e.g., no age limits) of 5 scientific databases to explore the evidence of influencers’ impact on PA behaviors. Studies were included if they focused on influencers’ impact on PA-related outcomes (e.g., intention, levels) and excluded if they focused on non-PA domains. Data were systematically extracted and coded for study details, key findings, and influencer qualities (e.g., content quality/misinformation).

Results:
Eleven studies were included—10 cross-sectional and one randomized experiment. The study samples were adults and majority female. Positive associations were observed between influencers (or certain influencer qualities, such as trustworthiness and content quality) and PA-related outcomes, including PA intention, inspiration, and motivation. The experimental study indicated that non-appearance-focused images resulted in higher PA intention. In terms of influencer qualities, positive associations were found between content quality and influencers who were perceived as credible and trustworthy. Misinformation was identified as a concern by study participants when viewing influencers' content and could impact the overall willingness to engage with such content. Notably, challenges included measuring PA levels (e.g., intensity, frequency, duration) using standardized methods.

Conclusions:
Fitness influencer content shows promise in supporting PA promotion but additional research is needed. Although findings suggest influencers have the potential to positively impact PA, further research is needed to explore the causality of these relationships and influencers’ effect on actual PA levels. Future behavioral interventions could leverage influencer content to target actual changes in PA.

Keywords: Physical activity, e-Health

Authors:

Presenter - Hannah A. Lavoie, MS CHES, ACSM-PAPHS,
University of Florida

Co-Author - Megan A. McVay, PhD,
University of Florida

Co-Author - Rebecca L. Pearl, PhD,
University of Florida

Co-Author - Carla L. Fisher, PhD,
University of Florida

Co-Author - Danielle E. Jake-Schoffman, PhD,
University of Florida

D150 - Church physical activity and healthy eating facilities in Virginia: availability and relationships to health promotion program offerings

Poster Number: D150
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Diet, Nutrition, and Eating Disorders

Background: Churches are important partners in health initiatives such as physical activity (PA) and healthy eating (HE) promotion. Despite evidence of the effectiveness of faith-based PA and HE programs, little is known about the availability of facilities within churches that could be leveraged for PA and HE promotion. The goal of this study was to report the availability of PA and HE facilities among Virginia churches and examine the relationship between PA and HE facility availability and pastor-reported PA and HE program offerings. We also aimed to examine differences in PA and HE facility prevalence by church rural/urban status.

Methods: Pastors of Christian churches in Virginia (n=213) were surveyed between January – July, 2024. They reported whether their church had indoor (fellowship hall, gym, track, exercise room) or outdoor (playground, open field, track) PA facilities. Additionally, pastors reported whether indoor (kitchen, classrooms) or outdoor (kitchen, garden) HE facilities were available. Pastors also indicated whether their church had ever offered health promotion programs focused on either PA or HE and provided their church’s zip code. Rural Urban Continuum Codes (RUCCs) were assigned based on the county in which the church was located; churches were categorized as either rural (36%) or urban (64%) according to their RUCC code. McNemar’s test was used to examine whether PA and HE facility presence was associated with church PA and HE program offerings as well as whether PA and HE facility availability and programs differed by rural/urban status.

Results: Most churches had indoor (92%) and outdoor (81%) PA space and indoor HE space (99%), while 56% had outdoor HE space. However, only 47% of churches reported offering PA programs while 40% reported offering HE programs. Rural churches were more likely to offer HE programs (r=.14; p=.04). There were no associations between PA and HE facility availability and whether churches had ever offered PA or HE programs, and there were no rural/urban differences in PA or HE facility availability.

Conclusions: Although most Virginia churches report having PA and HE facilities, less than half offer PA and HE programs. Further, PA and HE facilities are equally available among rural and urban churches. Therefore, there is great potential to partner with churches to deliver PA and HE programs, particularly in under-resourced rural areas where access to PA and HE facilities may be otherwise limited.

Keywords: Physical activity, Environment

Authors:

Author - Kelsey Day, PhD, MPH,
University of Virginia

Co-Author - Rebecca A. Krukowski, PhD, FSBM,
University of Virginia

Co-Author - Jamie Zoellner, PhD, RD,
University of Virginia

Co-Author - Jai Sethi,
University of Virginia

D151 - Physical Activity Outcomes from the Deep South IVR-supported Active Lifestyle (DIAL) Study

Poster Number: D151
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Obesity

Given high rates of physical inactivity and related chronic diseases in the Deep South, we developed and tested the Deep South Interactive Voice Response (IVR)-supported Active Lifestyle (DIAL) intervention. In a two-armed randomized controlled trial, 245 underactive adults residing in six rural Alabama Black Belt counties were randomly assigned to either the DIAL (automated telephone-based physical activity counseling) or wait-list control arm. Physical activity (PA) was assessed at baseline and 6 months via self-report data from the 7-Day Physical Activity Recall (PAR) interviews (primary outcome) and Godin Leisure-Time Exercise Questionnaire (GLTEQ), and accelerometers.

Participants were mostly non-Hispanic Black (97%) females (91%) with a mean age of 59.3 years (SD=13.4) and body mass index of 36.3 kg/m2 (SD=7.9). Education (60% <college degree), household income (83% <$50,000 annually) and employment levels (33.1% full-time) were low. Significant between-group differences were found in changes in moderate-to-vigorous PA (MVPA) from baseline to 6 months for both self-report measures: the 7-Day PAR (M=63.7 min/week, 95% CI: [33.8, 93.6], p<0.001) and GLTEQ (M=64.9 min/week, 95% CI: [32.4, 97.3], p<0.001), but not with accelerometry (M=10.9 min/week, 95% CI: [-29.3, 51.2], p=0.60). Accelerometer data also indicated no significant between-group differences for light PA (M=-29.0, 95% CI: [-188.7, 130.8], p=0.72); and sedentary behavior (M=16.4, 95% CI: [-334.3, 367.0], p=0.93).

These findings support the efficacy of the DIAL intervention for increasing MVPA among underactive, rural Black women with obesity. Low cost, scalable IVR technology shows promise for reaching underserved populations (rural, minority) and addressing PA-related health disparities in the Deep South.

Keywords: Physical activity, Obesity

Authors:

Presenter - Nashira I. Brown, PhD, PhD,
University of Alabama at Birmingham

Co-Author - Whitney Neal,
University of Alabama at Birmingham

Co-Author - Walker Cole,
University of Alabama at Birmingham

Co-Author - Kelsey Parrish,
University of Alabama Birmingham

Co-Author - Claudia Hardy,
University of Alabama at Birmingham

Co-Author - Monica Baskin,
University of Pittsburg

Co-Author - Maria Pisu, PhD, PhD,
University of Alabama at Birmingham

Co-Author - Robert Oster,
University of Alabama at Birmingham

Co-Author - Mohanraj Thirumalai,
University of Alabama at Birmingham

Co-Author - Soumya J. Niranjan, BPharm., MS, PhD, BPharm., MS, PhD,
University of Alabama at Birmingham

Co-Author - Wendy Demark-Wahnefried, PhD, RD, PhD, RD,
University of Alabama at Birmingham

Co-Author - Dori Pekmezi, PhD, FSBM, PhD, FSBM,
University of Alabama at Birmingham

D152 - Compositional data analysis of 24-hour movement behaviors as a predictor for cardiometabolic health outcomes among school-aged youth: A Systematic Review

Poster Number: D152
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Cardiovascular Disease

Physical activity (PA), sedentary behavior (SB) and sleep independently affect long-term cardiometabolic health in youth. However, these behaviors are interrelated components of a 24-hr day, where time spent in one behavior influences the time available for others. Compositional data analysis (CoDA) can be used to examine the combined effects of movement behaviors, offering a comprehensive understanding of how the co-dependent allocation of time in a 24-hr period affects health outcomes. The state of the evidence on 24-hr movement behaviors has yet to be synthesized for school-aged youth who will soon enter the age-related activity decline transition. The purpose is to review the associations between the 24-hr movement behaviors (e.g., daily proportion spent in light PA (LPA), moderate-to-vigorous PA (MVPA), SB, and sleep) with cardiometabolic health outcomes among youth (age 6-17 years). Two independent reviewers performed systematic literature searches in May 2024 across five search engines using the Cochrane criteria for systematic reviews. Studies were eligible based on these criteria: in English, peer-reviewed, age range 6-17 years old, used CoDA, and had a cardiometabolic health outcome. Data extraction and quality assessment procedures were registered and performed according to Prospero (CRD42024503270). A total of 1,021 titles and abstracts were screened, of which 25 articles underwent full-text review, and 10 met the inclusion criteria for this review. Nine out of the 10 articles included received a score of moderate or higher for the quality assessment. The proportion of the 24-hour day dedicated to each behavior was associated with adiposity and cardiovascular fitness. Time spent in MVPA, at the expense of other movement behaviors, was associated with favorable fitness, BMI, and cardiovascular health outcomes, while time spent in LPA and sleep showed mixed associations. Time in SB relative to the other movement behaviors was linked to deleterious cardiometabolic health outcomes. This review highlights the critical role of CoDA in understanding 24-h time use as a predictor of early cardiometabolic outcomes in youth. Standardizing CoDA techniques and reporting is essential for consistent and interpretable results. The findings can inform the development of integrated public health guidelines that specify the ideal proportion of the day dedicated to each movement behavior, helping to enhance child cardiometabolic health.

Keywords: Adolescents, Children

Authors:

Presenter - Kristen Moore, MS,
University of Southern California

Co-Author - Stephanie Castillo,
University of Southern California

Co-Author - Kelsey Mcalister, MS,
University of Southern California

Co-Author - Tiffany Chapman, MPH,
University of Southern California

Co-Author - Rachel Crosley-Lyons, MS, MS,
University of Southern California

Co-Author - Britni R. Belcher, PhD, MPH, PhD, MPH,
University of Southern California

D153 - Evaluating the Theory of Planned Behaviour's Prediction of Physical Activity in Newly Diagnosed Breast Cancer Patients

Poster Number: D153
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Cancer

Introduction
Despite benefits, physical activity levels (PA) remain low across the cancer continuum. The Theory of Planned Behaviour (TPB) suggests intention is the immediate determinant of PA. Previous studies have linked TPB components with PA in cancer populations but used hierarchical regression methods, which creates a gap in understanding TPB's predictive ability on PA by only evaluating independent TPB components. Therefore, the purpose of this analysis is to test TPB's predictive ability, measured at diagnosis, on objective PA 1-year post-diagnosis via structural equation modeling (SEM), which allows for testing an entire theoretical model with latent, mediating, and observed variables.
Methods
Women diagnosed in the Alberta Moving Beyond Breast Cancer (AMBER) cohort with early-stage breast cancer were eligible. The TPB was assessed at baseline via self-report. Participants were asked about their attitudes, subjective norm, perceived behavioural control, and intentions towards leisure PA in the next 6-months, which was defined as PA completed during free time. ActiGraph GT3X+® devices were worn on the right hip for 7-days to measure light, moderate, and vigorous PA (hours/day) 1-year after diagnosis. SEM was conducted with attitudes, subjective norm, and perceived behavioural control as latent variables, intentions as a mediating variable, and PA (light, moderate, and vigorous) as an observed variable.
Results
A total of 1,528 newly diagnosed early breast cancer patients were enrolled (55.4 years of age). Attitude, subjective norm, and perceived behavioural control accounted for ~52% (p<0.05) of the variance in intention at diagnosis for light, moderate, and vigorous PA. The TPB accounted for 2% of the variance in light ( = 0.15; R2=0.02; p<0.05) and moderate ( = 0.14; R2=0.02; p<0.05) PA and 5% in vigorous PA ( = 0.21; R2=0.05; p<0.05) at 1-year follow-up.
Implications
Results indicate the TPB performs well in predicting intentions at diagnosis but poorly predicts PA behaviour at 1-year follow-up. This finding highlights the ‘intention-behaviour gap’ that is commonly noted in the literature. The poor prediction of PA behaviour may be a result of intervening factors that changed intentions over a 1-year time period, most notably cancer treatments and subsequent negative side effects. Future studies should identify and address treatment-related barriers that may influence the ‘intention-behaviour gap’ and negatively impact PA levels.

Keywords: Physical activity, Cancer

Authors:

Presenter - Chad Wagoner, PhD,
University of Tennessee

Co-Author - Christine Friedenreich, PhD,
Alberta Health Services

Co-Author - Kerry Courneya, PhD,
University of Alberta

Co-Author - Qinggang Wang,
Alberta Health Services

Co-Author - Jeff Vallance, PhD,
Athabasca University

Co-Author - Charles Matthews, PhD,
National Cancer Institute

Co-Author - Lin Yang, PhD,
Alberta Health Services

Co-Author - Margaret McNeely, PhD,
University of Alberta

Co-Author - Nicole Culos-Reed, PhD,
University of Calgary

D154 - Daily Shifts in Incidental Affect and Exercise Dread Moderate the Intentions-Behavior Relationship Among Breast Cancer Survivors Enrolled in a Low-Touch Exercise Intervention

Poster Number: D154
Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Methods and Measurement

Background. Many breast cancer survivors do not meet guidelines for moderate-vigorous physical activity (MVPA), contributing to worse survivorship outcomes. Daily shifts in non-conscious, reflexive processing constructs may explain intention-behavior discordance but have rarely been considered as treatment moderators. This study predicted daily within-person shifts in two reflexive processing constructs, incidental affect (how good-bad one feels, unrelated to a target behavior) and exercise dread (automatic aversion towards exercise), would each moderate the strength of association between daily shifts in exercise intentions and MVPA.
Method. Data were collected for a single-arm trial (NCT04903249) with N = 36 inactive stage 0-III breast cancer survivors within 5 years of completing primary treatment. All participants received an exercise prescription and Fitbit. Ecological momentary assessment (EMA) was used to measure intentions (I intend to spend time exercising today; 1 = “disagree” to 7 = “strongly agree”), incidental affect (How good or bad do you feel right now? 0 = “very bad” to 10 = “very good”), and dread (When I think about exercising today, I experience a sense of dread; 1 = “disagree” to 7 = “strongly agree”) three times daily for 10 consecutive days in four measurement bursts over 12-weeks. ActiGraph wGT3X-BT accelerometers were used to measure total daily MVPA. Linear mixed effects models fit daily MVPA (log transformed) on each construct disaggregated into between and within person effects. Models adjusted for average levels of each construct, ActiGraph wear time, age, BMI, and time since completing treatment.
Results. More daily MVPA was associated with positive shifts in daily exercise intentions (β = 12.95%, 95% CI = 9.56, 16.53, p < 0.001) and daily incidental affect (β = 11.39%, 95% CI = 7.26, 15.62, p < 0.001). Reduced daily MVPA was associated with increases in exercise dread (β = -12.51%, 95% CI = -16.43, -8.44, p < 0.001). Interaction models showed dread attenuated the positive impact of daily exercise intentions on MVPA (β = -5.14%, 95% CI = -8.32, -1.83, p = 0.003), while incidental affect amplified it (β = 2.68%, 95% CI = 0.36, 5.13, p = 0.03).
Conclusions. Both incidental affect and exercise dread moderated the relationship between exercise intentions and MVPA in opposing directions. Future work should consider techniques for boosting incidental affect and reducing exercise dread as well as strengthening exercise intentions.

Keywords: Exercise, Biobehavioral mechanisms

Authors:

Presenter - Courtney J. Stevens, PhD,
Dartmouth-Hitchcock Medical Center | Dartmouth College

Co-Author - Hollin R. Hakimian, BA,
Dartmouth-Hitchcock Medical Center

Co-Author - Calie S. Sorenson, MSES,
Dartmouth-Hitchcock Medical Center

Co-Author - David E. Conroy, PhD, FSBM,
University of Michigan

Co-Author - David M. Williams, PhD, FSBM,
Brown University

Co-Author - Kathleen D. Lyons, ScD,
MGH Institute of Health Professions

Co-Author - Jennifer A. Emond, PhD,
Dartmouth College

Co-Author - Martha L. Bruce, PhD, MPH,
Dartmouth-Hitchcock Medical Center | Dartmouth College

Co-Author - Mary D. Chamberlin, MD,
Dartmouth-Hitchcock Medical Center | Dartmouth College

Co-Author - Carly A. Bobak, PhD,
Dartmouth College

D155 - Prevalence and Related Factors of Neck Pain in Turkey: A Population- Based Study

Poster Number: D155
Time: 11:00 AM - 11:50 AM
Topics: Pain, Quality of Life

Background: Recent population-based studies estimating the prevalence of neck pain and its associated factors in Turkey are lacking.

Objective: This study aims to determine the prevalence of neck pain in the Turkish population and its relationship with socio-demographic factors, work status, self-rated health, obesity, depression, physical activity level, and the use of nonprescription medications, vitamins, and nutritional supplements.

Methods: This cross-sectional study used data from the 2019 Turkey Health Survey by Turkstat, involving 17,084 participants aged 15 and over. The prevalence of neck pain and its associations with age, gender, education level, employment status, self-rated health, obesity, depression, nonprescription medication use, and vitamin and nutritional supplement intake were analyzed using descriptive and multivariate binary logistic regression.

Results: Gender, age, marital status, obesity, health status, and employment status were identified as factors associated with neck pain. Neck pain was found to increase between the ages of 35 and 65, decreasing in older age. Women had a 3.2 times greater risk of neck pain than men. Married individuals had a 1.3 times greater likelihood of neck pain, while divorcees had a 1.6 times higher likelihood compared to singles. Although an inverse relationship was found between neck pain, education level, and physical activity, it was not statistically significant. Those reporting good health had an 11 times higher risk of neck pain compared to those reporting very good health, while those reporting fair, poor, and very bad health had a 64, 145, and 387 times greater risk, respectively. House workers were 0.8 times less likely to experience neck pain compared to employees. The risk of neck pain was 1.2 times higher in the pre-obese and obese groups compared to those with normal weight. No significant relationship was found between neck pain and depressive disorder. Neck pain was twice as common among those using nonprescription drugs and 1.3 times more common among those taking vitamin or nutritional supplements.

Conclusion: Neck pain is prevalent in Turkey, with factors such as age, female gender, marital status, work status, health status, obesity, and the use of supplemental medications and vitamins associated with increased risks. This study serves as a reference for understanding, managing, and further researching neck pain.

Keywords: Pain, Depression

Authors:

Author - Nadire Gulcin Yildiz,
Bosphorus University

D156 - Sexually diverse, young adults in areas with greater socioeconomic deprivation are more likely to report frequent mental unhealthy days among commercially-insured adults engaging with a digital health application

Poster Number: D156
Time: 11:00 AM - 11:50 AM
Topics: Quality of Life, Digital Health

Research Objective: Determine the extent to which differences in self-reported frequent physical unhealthy days and mental unhealthy days by member characteristics exist among adults with employer-provided health insurance engaging with a digital health offering aimed at increasing access to care.

Methods: A cross-sectional study from a digital health application, Included Health. Members responded to an SMS-based survey that included the Centers for Disease Control and Prevention (CDC) Health-related Quality of Life (HRQoL)-4 survey, also known as ‘Healthy Days’. Members were defined as having frequent physical unhealthy days or frequent mental unhealthy days if they reported 14 or more unhealthy days during the past 30 days. Logistic regression was used to model the relationship between frequent unhealthy days and the variables of age, self-reported race, ethnicity, sexual orientation, gender identity, region, urbanicity, employer industry, chronic condition(s), and zip code social deprivation index (SDI) quartile.

Findings: Approximately 20.8% of the 6,682 respondents reported frequent mental unhealthy days and 13.7% of members reported frequent physical unhealthy days. Members with higher odds of frequent unhealthy days differed between physical and mental days. Members with chronic condition(s), who identified as queer, Asian, or a cisgender woman had higher odds of both physical and mental unhealthy days (ps<0.05). In addition, members who were younger, identified as bisexual or had multiple sexual orientations, lived in rural areas, and zip codes with higher SDI also had higher odds of frequent mental unhealthy days (ps<0.05), but these characteristics were not associated with odds of frequent physical unhealthy days.

Implications: This study found that even among adults with employer-provided insurance engaging with a digital health application, the odds of having frequent mental unhealthy days was highest for members who research has shown also have greater barriers to care. Specifically, members who were sexually diverse, lived in rural areas, and in zip codes with higher SDI. This highlights the continual need for employers to consider lowering barriers to care, specifically behavioral health resources, within their benefit strategy.

Keywords: Quality of life, Sexual orientation

Authors:

Presenter - OJ Bright, MS,
Included Health

Co-Author - Nicholas Leiby, PhD,
Included Health

Co-Author - Alexandra Yurkovic, MD,
Included Health

Co-Author - Jaclyn Marshall, MS,
Included Health

D158 - Behavioral Intervention for Comorbid Insomnia and Sleep Apnea Improves Symptoms of Posttraumatic Stress in Veterans

Poster Number: D158
Time: 11:00 AM - 11:50 AM
Topics: Sleep, Military and Veterans' Health

Background: Engaging Veterans with posttraumatic stress disorder (PTSD) in mental health treatment is challenging. Veterans who screen positive for mental health disorders endorse barriers to treatment and concerns about stigma at a far higher rate than those who screen negative. Furthermore, less than ten percent of Veterans attend a minimally recommended number of mental health appointments within the first year since PTSD diagnosis. Promoting engagement in healthcare in a different treatment context, such as sleep medicine, may ultimately bridge care for these Veterans. Estimates of sleep disorders among Veterans with PTSD are high, at around 70% for obstructive sleep apnea (OSA), and approximately 90% for insomnia. However, current treatments for OSA and insomnia have not been adapted to the needs of the many Veterans experiencing symptoms of PTSD. We developed a behavioral sleep treatment called Apnea and Insomnia Relief (AIR), which combines aspects of motivational enhancement, psychoeducation, positive airway pressure (PAP) desensitization, and cognitive behavioral therapy for insomnia.
Methods: We conducted a pilot randomized controlled trial (RCT) comparing AIR to Sleep Education (SE) control in Veterans with PTSD, insomnia, and OSA who were recommended for PAP therapy for OSA. PTSD symptom severity was measured at pre-treatment and post-treatment with the Clinician Administered PTSD Scale-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5).
Results: A total of 34 Veterans were randomized. Average age was 50 years (SD=12, range 26-76). The sample included 32 men (94%) and two women (6%), and 43% of the sample identified as a racial or ethnic minority. Participants randomized to AIR demonstrated greater decreases in PTSD symptom severity from pre- to post-treatment, with average reduction on the CAPS-5 being 10.1 (SD=10.0) points for AIR (t(16)=4.1, p<.01), versus 2.9 points (SD=9.6) for SE (t(15)=1.2, p=.25), and average reduction on the PCL-5 being 14.9 (SD=10.0) points for AIR (t(16)=6.1, p<.01) and 5.5 (SD=10.0) points for SE (t(14)=2.1, p=.05).
Discussion: Results demonstrate clinically significant reductions of PTSD symptom severity among participants randomized to AIR, highlighting that a sleep-focused intervention can impact PTSD symptoms in as few as six sessions, without a direct focus on trauma-related content. A fully-powered RCT with a larger, more diverse sample is needed to establish additional indicators of treatment efficacy.

Keywords: Sleep disorders, Trauma

Authors:

Presenter - Lizabeth Goldstein, PhD,
San Francisco VA Health Care System

Co-Author - Ali El-Solh, MD,
VA Western New York Health Care System

Co-Author - Thomas Neylan, MD,
San Francisco VA Health Care System

Co-Author - Kathleen Sarmiento, MD, MPHTM,
San Francisco VA Health Care System

Co-Author - Caitlin Haas, BS, BA,
San Francisco VA Health Care System

Co-Author - Shira Maguen, PhD,
San Francisco VA Medical Center

D159 - The influence of social factors on sleep and sleep hygiene in varsity athletes

Poster Number: D159
Time: 11:00 AM - 11:50 AM
Topics: Sleep, Social and Environmental Context and Health

The influence of social factors on sleep and sleep hygiene in varsity athletes
Bodner ME, Kampman K, Driller M, Hergott C, Cote AT, Fenuta AM

Background
The influence of social factors on sleep/sleep hygiene in university athletes is understudied.
Methods
We explored social factors (e.g. social relationship satisfaction, social groups, post-competition socialization) in varsity athletes in association with sleep/sleep hygiene using validated sleep questionnaires: Athlete Sleep Screening Questionnaire, Athlete Sleep Behaviour Questionnaire, and Sleep Regularity Questionnaire.
Results
Varsity athletes (N=90; 66.3% female) averaged 7.3±0.9 sleep hours/day. 51.7% reported being ‘somewhat’ to ‘very satisfied’ with their sleep quality, 34.8% reported ‘moderate’ to ‘severe’ sleep difficulty and 76.4% were characterized as having ‘poor’ sleep hygiene. Athletes ‘very’ satisfied with the quality of their social relationships (46.6%) had better sleep hygiene (44.0±5.8 vs 46.9±6.2, p=0.027), sleep regularity (25.4.0±5.7 vs 22.6±6.0, p = 0.028), and sleep difficulty (5.7±3.3 vs 7.5±3.3, p=0.013) scores compared to those ‘somewhat’ satisfied, respectively. Satisfaction with social relationships was positively associated with sleep quality χ²(4, N=88)=12.28, p=0.015. 69% identified a specific social group that negatively impacted sleep behaviors; 19.7% rated this impact ≥7 (scale: 1 ‘very little’ to 10 ‘quite a lot’). This rating was negatively associated with sleep hours (r= -0.361, p=0.006). On average, 91% of athletes socialized post-competition. Of these, 68% reported that socialization 'sometimes' or 'always’ delayed normal bedtime, with 51.6% reporting delays of ≥1 hour.
Conclusion
In varsity athletes, satisfying social connections may mitigate sleep difficulties (e.g., sleep hours/satisfaction, falling/staying asleep) and enhance sleep hygiene/regularity. However, certain social groups/activities might disrupt sleep-optimizing behaviours. Additional investigation of associations between social factors and sleep behaviours may inform counsel to help balance social engagement and sleep health.

Keywords: Health behaviors, Abnormal sleep

Authors:

Author - Michael E Bodner, PhD,
School of Human Kinetics, Trinity Western University

Co-Author - Kirsten Kampman, BHK,
School of Human Kinetics, Trinity Western University

Co-Author - Matt Driller, PhD,
Sport & Exercise Science, School of Allied Health, Human Services & Sport, La Trobe University

Co-Author - Cole Hergott, MHK,
School of Human Kinetics, Trinity Western University

Co-Author - Anita T Cote, PhD,
School of Human Kinetics, Trinity Western University

Co-Author - Alyssa M Fenuta, PhD,
School of Human Kinetics, Trinity Western University

D160 - Temporal Sequencing of Sleep Problems Following Sexual Assault

Poster Number: D160
Time: 11:00 AM - 11:50 AM
Topics: Sleep, Mental Health

It has been estimated that approximately 1 in 4 women (1 in 26 men) report a lifetime history of Sexual Assault Trauma (SAT) and 4 in 5 women who have been victims of SAT report that they were assaulted before the age of 25. Research shows a high rate of behavioral sleep problems including Posttrauma Nightmares (PTN) and Insomnia (INS) following SAT. However, less is known about the timing of sleep disturbance onset following SVT and whether early onset of sleep symptoms predict later Post Traumatic Stress Disorder Symptoms (PTSD). In order to examine we collected data from 137 emerging adult women college students from a large Midwest public university who reported a history of SAT (Life Event Checklist: LEC), current PTSD symptomatology (PTSD Checklist for the DSM-5: PCL), insomnia severity (Insomnia Severity Index: ISI) and nightmare symptoms (Nightmare Distress Index: NDI). Current symptomatology was as follows: ISI total (M=10.81, SD=6.04), NDI total (M=7.46, SD 4.94), PCL (50.76, SD=16.76). In a smaller sample (N=75), we asked about sleep quality in the week following SAT. In the week following SAT, 84% reported that either insomnia symptoms or PTN symptoms (or both) had begun or gotten worse. We then asked about insomnia and PTN symptom severity during that week (1-5 Likert Scale). Controlling for time since SAT, PTN symptom severity (b=3.68, t=2.39, p=.02) and Insomnia symptom severity (b=3.43, t=2.85, p<.05) predicted current PCL scores (with the nightmare item removed from the total). These data indicate that behavioral sleep problems may begin to present early following SAT and that early behavioral sleep disruption may predict later PTSD symptomatology. These are cross-sectional data that are potentially limited by retrospective recall bias. As such, these data point to a clear need for prospective longitudinal research investigating the role of behavioral sleep problems in the perpetuation of PTSD symptomatology.

Keywords: Sleep disorders, Trauma

Authors:

Author - Nancy Hamilton, PhD,
University of Kansas

Author - Garrett Baber, MA,
University of Kansas

Author - Matthew Gratton, MA,
University of Kansas

D161 - Use and satisfaction of food assistance interventions among patients receiving infusion treatments from a comprehensive cancer center clinic in an under-resourced neighborhood

Poster Number: D161
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Diet, Nutrition, and Eating Disorders

Background: The area surrounding the Simmons Comprehensive Cancer Center RedBird clinic in Dallas, TX has a greater proportion of people experiencing food insecurity than state and national averages. Food insecurity is associated with adverse cancer outcomes and long-term health consequences. This study aimed to assess how providing different food assistance interventions for three months may benefit patients receiving infusion treatments. This secondary analysis explored patients’ opinions on medically tailored meals (MTM) and monthly debit card payments to identify optimal strategies for improving diet and financial strain.
Method: Adults were screened using the 2-item Hunger Vital Sign to identify food insecurity. If patients answered ‘yes’ to either item, they were eligible. Patients (N=45) were randomized into one of three groups. All received a referral to a free community food market, group two (N=15) also received three months of 12 MTM, and group 3 (N=15) received $75 USD monthly on a debit card. Post intervention questionnaires included items on intervention fidelity and satisfaction.
Results: Among the group receiving twelve MTM per month, when asked how much was eaten each month, 36% ate a quarter, 36% ate half, and 27% ate all 12 provided. Just under half (46%) said they shared meals with others. A variety of entrees and cuisines were offered, but only 36% ate the meals as is with no substitutions or additions, while 64% added extra seasoning or condiments. When asked about the quantity, 90% said the breakfast (148g/meal) and 100% of the lunch/dinner entrees (269g/meal) provided the right amount of food. Among the group receiving payments, 77% stated they spent over $40 on food and less than $20 towards transportation to get food each month. The food items purchased the most were fruit, vegetables, meat, and dairy. Funds had no restrictions, but no patients reported using funds on alcohol or cigarettes. One patient used funds on transportation only and three patients used funds on bills. By study end, 96% of payments were used.
Conclusion: MTM were appropriately sized but may require more flavor to best serve infusion treatment patients. Nearly all spent all their funds by study end, with most spending some or all on groceries. Future programs focusing on similar populations could increase access to and flavor of MTM and provide extra meals for the household as well as provide financial resources for food, transportation, and bills.

Keywords: Low-income and minority groups, Interventions

Authors:

Presenter - Carolyn Haskins, M.S.,
University of Texas Southwestern Medical Center

Co-Author - Jessica Turcios, MPH,
UT Southwestern

Co-Author - Sandi L. Pruitt, PhD, PhD,
University of Texas Southwestern Medical Center

Co-Author - Kelseanna Hollis-Hansen, MPH, PHD, MPH, PHD,
UT Southwestern Medical Center

D162 - Food and housing security among SES and racially diverse college students: an intersectionality perspective

Poster Number: D162
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Mental Health

Background: Food insecurity (FI) is characterized by limited or uncertain access to nutritious foods in adequate amounts required for active and healthy living. FI has become a significant problem in the United States, particularly among college and university students, severely affecting their physical, mental health and academic performance. This study applied an intersectionality approach to study FI, and housing security among college students across the University of Connecticut’s campuses. Intersectionality with respect to FI studies how different forms of inequality (i.e., gender and race) contribute to an individual’s experience accessing food.
Methods: A survey-based cross-sectional study was put together using Qualtrics for participant recruitment during the fall of 2023. USDA’s 10-item tool was used as the FI screener along with a scale for housing security. Demographic variables included age, race, employment status, work hours, college major, number of dependents, first-generation student status, and Pell Grant eligibility.
Results: A total of 4135 female and 2403 male students completed the Qualtrics survey. About 31% of the female and 33% of the male students were food insecure. Comparatively, FI was significantly higher among female students than males. Among the UConn campuses, females in Waterbury and Stamford while male students in Hartford and Avery Point highly suffered from FI. For both male and female populations, students who were on a meal plan and earned more than $20,000 had higher FI while having dependents, first generation, and eligible for Pell Grant were in a comparatively better condition. For male and female groups, Black students had poor while Whites had better food security. Comparing race and gender, Black female students had the highest FI scores. Housing security was found to be correlated with FI with significantly higher FI among both genders facing housing security.
Conclusion: The data above provides evidence of FI disparities across students of diverse populations. Addressing FI among these particular students is crucial which requires a multifaceted and inclusive approach. Emergency financial assistance and increased aid might help those students fight short-term crises. Associated authorities should be equally mindful of dealing with those situations and improving accessibility while creating a more supportive environment for college students.

Keywords: Nutrition, Health disparities

Authors:

Presenter - Kritee Niroula, PhD,
Institute for Collaboration on Health, Intervention and Policy-University of Connecticut

Co-Author - Sajal Raja, BS,
Health Promotional Sciences - University of Connecticut

Co-Author - Summaya Abdul Razak, MS,
Allied Health Science-University of Connecticut

Author - Kristen Cooksey Stowers, PhD,
UConn Allied Health Sciences

D163 - Exploring Food Insecurity as a Predictor of Poor Mental Health Among Graduate Students & the Potential Moderating Effects of SES and Race/Ethnicity

Poster Number: D163
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Mental Health

Introduction:
Food insecurity (FI), defined as limited access to food among college students, exacerbates mental health challenges such as anxiety and depression. This study aims to investigate the relationship between FI and objective mental health among graduate students, examining the potential moderating influences of socioeconomic status (SES) and race/ethnicity.

Design: A cross-sectional study was conducted on the graduate students at the University of Connecticut (Storrs, medical, dental, and law). 6538 students logged into a Qualtrics survey site using their NetID. Data was collected in two ways: directly from students in the survey and by connecting to their administrative data through their student ID. The survey assessed the FI using the USDA 10-item screener; housing insecurity; and a range of other questions about food access and resources on campus. The administrative data included sex, race/ethnicity, first-generation status, Pell Grant eligibility, household size, number of dependents, level, credits completed, department, school, college, major, GPA, and expected graduation year.

Results: The study assessed the prevalence of FI among students at UConn, categorizing them into four levels: high, marginal, low, and very low. 48% of UConn students reported high Food Security (FS), 16% had marginal FS, 16% had low FS, and 20% had very low FS. At specific campuses like Storrs, UConn Health, and UConn Law, this percentage was slightly higher, ranging from 50%, 49%, and 49%. Examining FI by race revealed inequities, with minority students reporting lower rates of high FS compared to white peers. 35% of Latino students and 32% of Black students reported high FS compared to 51% and 56% among Asian and White students, respectively. FI was significantly higher among students who were single, employed, and had 3+ dependents, and lower among those earning >$20,000 annually and working 40+ hours/wk.

Conclusion: This study highlights inequities in FS among graduate students, with racial and ethnic minority students experiencing higher levels of FI compared to White students. Pell grant recipients also face notably higher levels of FI. Addressing these inequities is crucial and requires a comprehensive approach that addresses the barriers these groups face, including policy interventions. The approach should promote equitable access to adequate nutrition and support the overall well-being, social and academic success of all graduate students.

Keywords: Health disparities, Nutrition

Authors:

Presenter - Sajal Raja, BS,
University of Connecticut

Co-Author - Kritee Niroula, PhD,
University of Connecticut

Co-Author - Summaya Abdul Razak, MS,
University of Connecticut

Author - Kristen Cooksey Stowers, PhD,
UConn Allied Health Sciences

D164 - COVID-19 Vaccine Attitudes among College Students: Variation Across Sociodemographic Characteristics and Institutional Support

Poster Number: D164
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Decision Making

Background: Young adults display the highest rates of vaccine hesitancy in the U.S. Racial and ethnic minorities, along with those from lower socioeconomic backgrounds, are more vaccine-hesitant. Perceived organizational and government support is linked to more positive vaccine attitudes. Yet, little is known about how these factors are associated with vaccine attitudes in college students.

Methods: Data are from the 2021 COVID-19 Texas College Student Experiences Survey. Students (n=320) self-reported sociodemographics (i.e., gender, age, income, race/ethnicity, student status, nativity, living situation) and institutional supports (i.e., whether their university offered sufficient medical care support during the pandemic, receipt of a stimulus check from the federal government). Vaccine attitudes were measured by assessing students’ agreement on statements about the COVID-19 vaccine’s safety and effectiveness. Logistic regressions examined relationships between sociodemographic variables, institutional supports, and vaccine beliefs.

Results: Females were 2X more likely than males to believe the vaccine saves lives and benefits society (both p=0.01) and less likely to view it as harmful (p<.05), unnecessary (p<.01), and causing illness or death (p=0.06). High-income versus low-income students were less likely to believe the vaccine saves lives, provides societal benefits, or protects against the virus (p<.01), and 3.5X more likely to view it as unnecessary (p<.01). Graduate students were ~2.4X more likely than undergraduates to agree with positive vaccine statements (p<.05). Off-campus students living with friends were less likely than those living on campus to believe the vaccine saves lives, benefits society, and protects against the virus (p<.05). Stimulus check recipients were 2X and 1.7X more likely to think the vaccine causes harmful side effects (p<.05) and illness or death (p<.05). Race/ethnicity, nativity, age, and university support were not associated with vaccine attitudes.

Conclusion: Our findings suggest tailored and targeted interventions in higher education are imperative to encourage vaccination among undergraduates, males, high-income, and students who live off-campus. More research is needed to examine why recipients of stimulus checks were more likely to express negative views of the vaccine.

Keywords: Beliefs, Environment

Authors:

Presenter - Jill Morimoto,
Santa Clara University

Co-Author - Angela Dimaano,
Santa Clara University

Co-Author - Alice Villatoro,
Santa Clara University

Co-Author - Vanessa Errisuriz,
Santa Clara University

D165 - High Mental Health Need Areas Lag Decades Behind in Palliative Care Access and Quality

Poster Number: D165
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Health of Marginalized Populations

Significant disparities exist in access to palliative care, particularly in rural and underserved communities where individuals face personal and systemic barriers to mental health care. Individuals with serious and severe mental illness may be overrepresented in serious illness populations such as cancer, cardiovascular disease, and dementia, but face additional barriers receiving palliative care services. These disparities may be nested geographically due to state-to-state variation in economics, insurance, politics, and healthcare infrastructure.

This study utilized publicly available aggregate data from the Center to Advance Palliative Care Report Cards and state-level data from > 5,000,000 mental health screens conducted by Mental Health America. Nonparametric correlations relevant that states with higher prevalence of severe depression (rs = -.30, p = .033), PTSD (rs = -.32, p = .021), and psychosis (rs = -.32, p = .021) were all significantly associated with worse palliative care access (palliative care grades). Linear mixed effects models (e.g., HLM, MLM) indicated that disparities in palliative care access increased markedly between 2008 and 2019. Improvements in palliative care access (grades) were substantially lower in states with higher prevalence of depression (p =.024), PTSD (p<.001), trauma exposure (p<.001), and psychosis (p =.001). Similar findings emerged when using state-level data on self-reported mental illness, depression, and suicide rates drawn from the Kaiser Family Foundation. Furthermore, states with higher percentages of residents with untreated psychiatric concerns had consistently lower PC grades throughout 2008 to 2019 (ps <.050). We computed trajectories (i.e. simple slopes) for states with high and low prevalence of PTSD to compare when these regions would, on average, would reach “A” PC Grades (93%). Low prevalence PTSD states were estimated to already average “A” grades. In contrast High prevalence PTSD states were not predicted to achieve “A” Grades until 2051.

State-to-state variation in serious mental health needs and mental health access intersect with growing disparity in palliative care services. States with the highest mental health needs have populations at greater risk of serious illnesses, yet at current rates they will not achieve high quality palliative care access for decades. As a result, these populations stand to face both a greater incidence of illness and will have fewer resources to manage them.

Keywords: Palliative care, Mental health

Authors:

Author - Shriya Saxena,
Ohio University

Co-Author - Michael Hoerger, PhD MSCR, PhD MSCR,
Tulane Cancer Center

Co-Author - Sean O'Mahony, MD, BCh, BAO, MS, MD, BCh, BAO, MS,
University of Texas Medical Branch

Co-Author - Mukaila Raji, M.D., M.S (Pharm)., F.A.C.P.,
University of Texas Medical Branch

Co-Author - James Gerhart, PhD,
Ohio University

D166 - The Neighborhood Social Environment and Sleep Quality Among Black Women With and Without Systemic Lupus Erythematosus

Poster Number: D166
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Sleep

Background: Women with systemic lupus erythematosus (SLE), which disproportionally impacts Black women, commonly experience poor sleep. Poor sleep is associated with decreased quality of life, greater fatigue, and worse mental health for women with SLE. Thus, there is a critical need to understand factors that promote healthy sleep for Black women with SLE. The neighborhood social environment (e.g., social cohesion, safety) is an important determinant of sleep in Black women, but has not been examined in the context of SLE. Black women with SLE, who may spend more time at home due to pain and disability, might be uniquely impacted by their neighborhood. The current study investigated the associations of the neighborhood social environment and self-reported sleep quality among Black women with versus without SLE.

Method: The study used baseline data from an ongoing longitudinal study of social stressors and cardiovascular risk in 402 Black women (Mage=36.5) living with and without SLE (50% with SLE) in Atlanta, Georgia. The neighborhood social environment was measured using three scales: Social cohesion, Activities with Neighbors, and Safety. Sleep quality was measured via the Pittsburgh Sleep Quality Index (PSQI: higher scores indicative of poorer sleep). Multiple linear regression models stratified by SLE status tested associations between neighborhood factors and sleep while adjusting for age, socioeconomic factors, family size, smoking status, body mass index, and cognitive depressive symptoms. Additional analyses controlled for SLE disease activity in women with SLE.

Results: Approximately 75.6% of women with SLE reported poor sleep (PSQI > 5) compared to 59.7% of women without SLE. In adjusted models, greater social cohesion (β= -.21, SE= .46, [-2.22, -.41]) and more activities with neighbors (β= -.16, SE= .45, [-1.79, -.14]) were associated with better sleep quality among women with SLE only. These associations remained significant after adjusting for SLE disease activity (β= -.23, SE= .40, [-2.23, -.65]; β= -.21, SE= .37, [-1.96, -.50]). Safety was not associated with sleep quality for women with or without SLE.

Conclusion: For Black women with SLE, who may spend more time in their homes, connectedness and participating in activities with neighbors may be beneficial for better sleep. The findings have implications for sleep interventions that incorporate the social neighborhood environment to improve sleep health for Black women with SLE.

Keywords: Environmental, Abnormal sleep

Authors:

Author - Jelaina Shipman-Lacewell, PhD,
Emory University

Co-Author - Khadijah Abdallah, MPH,
Emory University

Co-Author - Shivika Udaipuria, MPH,
Emory University

Co-Author - Nicole Fields, PhD,
Northwestern University

Co-Author - Christy Erving, PhD,
Vanderbilt University

Co-Author - Lori Hoggard, PhD,
North Carolina State University

Co-Author - Zachary Martin, PhD,
Emory University

Co-Author - Rachel Parker, MPH,
Emory University

Co-Author - Jordan Parker, MA,
University of California, Los Angeles

Co-Author - Bianca Booker, MS,
Emory University

Co-Author - Reneé Moore, PhD,
Drexel University

Co-Author - Seegar Swanson,
Emory University

Co-Author - Jordan Wilson, MPH,
Drexel University

Co-Author - Charmayne Dunlop-Thomas, MS, MPH,
Emory University

Co-Author - Cristina Drenkard, MD, PHD,
Emory University

Co-Author - Viola Vaccarino, PhD,
Emory University

Co-Author - S. Sam Lim, MD,
Emory University

Co-Author - Dayna Johnson, PhD,
Emory University

Co-Author - Tené Lewis, PhD,
Emory University

D167 - A Public Health Framework for Generational Healing, Reparations, and Restitution in Haiti

Poster Number: D167
Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Health of Marginalized Populations

Objective: Amid severe political crises, Haiti faces significant health disparities compared to its former colonial power, France, including lower life expectancy (64.8 vs. 82.3 years) and higher infant and maternal mortality rates. These challenges are compounded by mental health issues, food insecurity (50% acute vs. 37% moderate), and high homicide rates (13.35 vs. 1.35 per 100,000 inhabitants). With rising demands for France to return Haiti's independence ransoms, limited data exists on how slavery reparations and restitutions could impact Haiti’s public health and community well-being or how healing programs might be effectively implemented.
Method: We conducted four focus group discussions between Spring and Fall 2023 with 28 Haitian women from Haiti and the U.S., exploring primary stressors and national healing strategies. This was followed by a comparative analysis of health data from Haiti and France, examining life expectancy, morbidity, and healthcare infrastructure. A return-on-investment model projected health improvements based on a $30 billion investment in healthcare, public health, and social services.
Results: Participants highlighted the urgent need for policies addressing Haiti's security crisis and improving access to resources. They stressed the importance of mental health education and stigma reduction. With a $30 billion restitution, Haiti could see life expectancy rise by 10–12 years, with infant and maternal mortality reduced by over 60%. Expanded mental health services could lower suicide rates to 4–5 per 100,000, while food insecurity could decrease by 20–25%, and homicide rates and violence against women could drop by 40–50% through targeted social welfare programs.
Conclusion: Haitian insights underscore the need to restore security, address social determinants of health, and implement community-based mental health programs. A biopsychosocial-ecological approach could guide reparations efforts, with a $30 billion investment promising substantial improvements in healthcare, mental health services, and security, leading to increased life expectancy, reduced mortality rates, and decreased violence.

Keywords: Community intervention, Economics

Authors:

Presenter - Judite Blanc, PhD, PhD,
University of Miami Miller School of Medicine

Co-Author - Candice A. Sternberg, MD, MD,
University of Miami Miller School of Medicine

Co-Author - Ernest J. Barthélemy,, MD, MPH, MA, FCNS,
SUNY Downstate Health Sciences University

D168 - An asset-based examination of the contextual factors influencing nutrition security in rural northern New England

Poster Number: D168
Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Health of Marginalized Populations

Background and Purpose: Rural communities face a disproportionate burden of diet-related health challenges and have been identified as a target for nutrition security initiatives. The purpose of this study is to examine characteristics that support nutrition security in rural northern New England using an asset-based approach.
Methods: We conducted focus groups and interviews with 32 food and nutrition professionals in Maine, New Hampshire, and Vermont in 2023 and 2024 to explore contextual factors that influence nutrition security in rural communities. We coded the data for community assets and mapped the identified assets into the dimensions of the Community Capitals Framework (CCF): built capital, cultural capital, financial capital, human capital, natural capital, political capital, and social capital.
Results: Participants described assets in all dimensions of the CCF except built capital. Specific assets discussed related to local food production (natural and cultural capital), coordination between food system stakeholders and strong social networks (human and social capital), regional political commitments to food security and nutrition (political capital), and the seasonal tourist economy (financial capital).
Conclusions: An asset-based approach was helpful for identifying existing resources that enhance rural nutrition security and may provide an opportunity to characterize and disseminate strategies to advance rural health equity.

Keywords: Nutrition, Prevention

Authors:

Presenter - Emily H. Belarmino, PhD, MPH,
University of Vermont

Co-Author - Claire Ryan, MS,
University of Vermont

Co-Author - Caitlin Morgan, PhD,
Agricultural Research Service, US Department of Agriculture

Co-Author - Jonathan Malacarne, PhD,
University of Maine

D169 - Promoting flourishing among college students: The relationship between contextual stressors, loneliness and psychological distress

Poster Number: D169
Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Health Communication and Policy

Background: There is mounting evidence that college students’ mental health is in crisis, with many college students meeting criteria for at least one mental-health problem. Contextual stressors (academics, career, finances, family, peers, and intimate relationships) and loneliness can cause or worsen psychological distress (PD). Studies have found flourishing, defined as individuals’ capability of experiencing positive emotions and functioning effectively in their personal and social lives, could be a protective factor for PD. However, almost no research has investigated a) the association between contextual stressors, loneliness and PD and b) whether flourishing can minimize the PD linked to stress and loneliness among college students. Methods: Data are survey responses (N=2,581) from a diverse sample of university students who participated in the 2024 National College Health Assessment (NCHA) at a public university in Southern California. Generalized linear models tested the hypothesized relationships between stressors (past 12 months stress across academics, career, finances, family, peers, and intimate relationships domains), loneliness (UCLA Loneliness Scale) and students’ PD (Kessler 6), adjusting for age, sex, ethnicity and food security, and whether flourishing (Diener Flourishing Score) moderated this relationship. Results: On average students were 25 (SD=8.1) years old, most were female (70% female), 45% Hispanic, 17% White, 16% Asian, 15% Multiethnic, and 4% Black. The vast majority of participants (81%) reported contextual stressors and half (49%) screened positive for loneliness. Contextual stressors (ß=2.1 p<0.001, 95%CI=1.66, 2.55) and loneliness (ß=2.7 p<0.001, 95%CI=2.30, 3.04) were associated with higher PD, while flourishing (ß=-0.2 p<0.001, 95%CI=-0.245, -0.202) was inversely associated with PD. Importantly, high levels of flourishing limited the negative effects of stressors and loneliness on PD (p<0.05). Discussion: These findings underscore the high percentage of college students experiencing contextual stressors, loneliness and PD. That flourishing can mitigate the effect of stressors and loneliness on PD has important implication for prevention programming. Individual and system level prevention approaches that encourage adaptive coping, compassionate self-care and peer-to-peer bonding may be promising foci of support services to improve students’ mental health and well-being.

Keywords: Mental health, Stress

Authors:

Co-Author - Myriam Forster, PhD, MPH, PhD, MPH,
California State University, Northridge

Co-Author - Christopher Rogers,
California State University, Northridge

Co-Author - Stephanie Benjamin,
California State University, Northridge

Co-Author - Abnous Shahverdi,
California State University, Northrodge

D170 - Using Hope to Cope: Examining the Impact of Religious Coping to address Chronic Stress and Masked Hypertension in African-Americans: The Jackson Heart Study

Poster Number: D170
Time: 11:00 AM - 11:50 AM
Topics: Stress, Cardiovascular Disease

Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP). Those with normal BP in the doctor’s office (office), but elevated BP when measured outside of the office may be diagnosed with masked hypertension (MHT). High levels of religious involvement and social support have been associated with lower systolic BP, when measured in the office setting, and lower awake and sleep systolic BP among African Americans (AA) adults. Religious coping and functional and structural social support may protect against high BP by promoting active coping behaviors and increasing emotional well-being. Yet, few data are available on the association of chronic stress, religious coping and BP measured outside of the office setting. This study utilized Jackson Heart Study (JHS) data from participants with office BP < 130/80 mm Hg and to examine the association between chronic stress and masked hypertension (MHT). Chronic stress was assessed by tertiles (low, medium and high) using the 8-item Global Perceived Stress Scale (GPSS). Religious coping and the Daily Spiritual Experience Scale (DSES) were assessed using the JHS Approach to Life A survey. Any MHT was defined using the 2017 American Heart Association/ American College of Cardiology. Analyses were stratified by antihypertensive medication use.

Among participants not taking and taking medication, the prevalence of any MHT was 61.8% and 77.9% for the upper levels of the GPSS score (GPSS score > 6), respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low levels of the chronic stress score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking medication, and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking medication. No association was present between chronic stress and MHT among the participants. Women and older participants had significantly higher levels of religiosity/spirituality involvement. Women also had higher mean DSES scores compared to men. Many participants attended religious services, participated in private prayer, and reported high use of religion in coping with daily stressors. These findings suggest the beneficial impact of cultural and religious practices in decreasing overall MHT risk and demonstrate the opportunities to target stress coping strategies along with lifestyle interventions.

Keywords: Stress, Social support

Authors:

Presenter - Miriam A. Miles, PhD, MSPH, PhD, MSPH,
University of Alabama at Birmingham

D171 - Social Support or Social Contagion? A Network Intervention on Physician Health and Well-Being

Poster Number: D171
Time: 11:00 AM - 11:50 AM
Topics: Stress, Mental Health

How do social relationships affect employee health and well-being? On one hand, social support from co-workers could directly improve health or indirectly buffer stress. On the other hand, social contagion was argued to spread mental health problems within organizations. We conducted a field experiment to examine the mechanisms linking social relationships to health and well-being. Physicians (n=880) were randomly selected to attend a resilience training alone, or with a randomly assigned co-worker. The training reduced burnout, anxiety, depression, and allostatic load biomarkers of chronic stress. Notably, mere presence of a co-worker increased the magnitude and duration of the training effect, and the increases were larger for longer social interactions. For mechanism, we evidenced that social support mediated the differences. For heterogeneity, we found a larger effect among the physicians who experienced stressful family and health events, but not economic or work events. We also found a smaller effect among the physicians whose training peers had lower baseline health and well-being; however, the apparent social contagion effects disappeared when we controlled for social support received from the peers. Overall, we integrated social support and social contagion theories and introduced a cost-effective “training in pairs” intervention to reduce employee stress and burnout.

Keywords: Occupational health, Social support

Authors:

Presenter - Lambert Zixin Li,
Stanford University

Co-Author - Jeffrey Pfeffer,
Stanford University

D172 - Effects of Trait Impulsivity on Alcohol Cue-Induced Heart Rate Variability and Drinking Behavior

Poster Number: D172
Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Cancer

Alcohol consumption is an important risk factor for a wide variety of health, social and interpersonal harms, making it critical to better understand the predictors of drinking behavior. Numerous studies have demonstrated that drinkers exposed to alcohol cues (e.g., the sight/smell of a preferred beverage) exhibit heightened levels of both self-reported craving and psychophysiological responses, including changes in heart rate (HR) and heart rate variability (HRV). These effects also tend to be more exaggerated among individuals with high levels of trait impulsivity. Whether or not psychophysiological responses to cues predict drinking behavior, especially among impulsive individuals, has not been well studied. In the present study, we hypothesized that impulsivity would predict higher levels of HR and HRV in drinkers exposed to alcohol cues, and that these responses would predict drinking behavior. Social drinkers from a New York City university (n = 32 Male, 42 Female, mean age = 21.5 + 2.0) completed measures of past-90-day drinking and trait impulsivity and participated in an experiment in which we measured cardiovascular responses during counterbalanced 90-second exposures to a glass of 1) alcohol and 2) water. Continuous HR and HRV were assessed using a Biopac MP150 system, and power spectral density analyses of HRV were performed using Acknowledge 3.1 software. Mediational analyses yielded partial support for the study hypotheses. We observed both direct effects of impulsivity on drinking behavior, as well as indirect effects through HRV. Significant effects were not observed for HR. This study highlights the importance of psychophysiological responses to alcohol cues as predictors of drinking behavior, but raises important questions about the potential complex mechanisms underlying the relationship between trait impulsivity and alcohol consumption.

Keywords: Alcohol, Alcoholism

Authors:

Co-Author - Joel Erblich, PhD, MPH, FSBM, PhD, MPH, FSBM,
Hunter College, City University of NY

D173 - Lessons Learned from An Opioid Overdose Medication Dissemination Program in Alaska.

Poster Number: D173
Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Dissemination and Implementation

Across the United States, state and local governments have enhanced their efforts to address the high rate of opioid misuse and overdose. Many state-sponsored programs have focused on increasing the accessibility and distribution of naloxone, an opioid-antagonist medication, in rural regions. Alaska has seen a rise in opioid overdose deaths, with nearly 345 Alaskans dying in 2023 compared with 247 deaths in 2022 (Alaska Department of Health, 2022). Project HOPE is a State of Alaska program that distributes naloxone to Alaska organizations to prevent opioid overdose deaths.

Project HOPE staff conducted key informant interviews with 32 individuals to explore ways Project HOPE could better serve the organizations they distributed naloxone to. The interview data was shared with a University of Alaska team evaluating the program. The interviews were coded by two researchers independently, who then came to consensus.

Most stakeholders (44%) interviewed were healthcare providers. The most respondents (41%) had been distributing naloxone for less than a year. A large percentage of respondents (41%) also expressed satisfaction with Project HOPE's distribution reporting process. In response to the question “What questions, suggestions, or feedback do you have about the [Project HOPE] distribution process”, the most common themes were: good as is (13 respondents), providing a comment on changing the distribution tracker (4 respondents), and asking a question about reordering naloxone kits (3 respondents). Analysis of qualitative data revealed four key recommendations for Project HOPE: 1) increase accessibility of online naloxone kit distribution forms (23% of respondents); 2) update reporting materials and forms to reflect the diverse methods of naloxone distribution (13%); 3) increase the number of fentanyl test strips in the naloxone kit due to high value and demand (48%); 4) more and consistent communication between OSMAP and ORPs (19%).

Findings suggest that stakeholders were generally supportive of Project HOPE but believe improvements in form accessibility, kit contents, and communication could enhance the program's effectiveness. The distribution of naloxone is a promising strategy in mitigating the harms of opioid overdose. However, continual monitoring and communication with served organizations to ensure that programs such as Project HOPE are most effectively disseminating opioid overdose reversal medication may improve the impact of such programs.

Keywords: Substance abuse, Opioids

Authors:

Co-Author - Lauren Kiker,
University of Alaska Anchorage

Co-Author - Deanna Dunn, PharmD,
State of Alaska Department of Health, Office of Substance Misuse and Addiction Prevention

Co-Author - Rebecca Van Wyck,
University of Alaska Anchorage

Co-Author - Kathryn Davis, MPH,
University of Alaska Anchorage

Co-Author - Tim Easterly,
State of Alaska Department of Health, Office of Substance Misuse and Addiction Prevention

Co-Author - Jessica Filley, MPH,
State of Alaska Department of Health, Office of Substance Misuse and Addiction Prevention

Co-Author - Nathan West, PhD,
University of Alaska Anchorage

Co-Author - Katie Cueva, ScD MAT MPH, ScD MAT MPH,
University of Alaska Anchorage

D174 - The Role of Alcohol-related Metacognition in Hazardous Drinking Among College Students

Poster Number: D174
Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Decision Making

Introduction: Metacognition is an active and reflective process directed at one’s own cognitive activity. Problem drinking is often sustained by maladaptive metacognitive beliefs, where both positive and negative beliefs on alcohol contribute to continued use. Alcohol-related metacognition has been shown to be related to alcohol use. However little is known about the patterns of associations between different dimensions of positive and negative metacognition beliefs on alcohol and multidimensional aspects of drinking behavior among college students.
Objective: The study examines the impact of positive and negative alcohol-related metacognition on hazardous drinking (alcohol-related problems and alcohol consumption) among college students.
Methods: 872 undergraduate students (Mage = 19.05 years, SD = 1.27) completed a series of self-reported measures including demographics, the Positive Alcohol Metacognition Scale (PAMS), Negative Alcohol Metacognition Scale (NAMS), the Rutgers Alcohol Problem Index (RAPI) and past 30 days alcohol use frequency. We first estimated exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) measurement models to evaluate the factor structures of each measure. We then used structural models to examine how PAMS and NAMS are associated with hazardous drinking (alcohol-related problems and alcohol frequency).
Results: Two-factor CFA measurement models of PAMS and NAMS and single-factor CFA measurement models of RAPI and frequency showed good model fit. Positive alcohol-related metacognition about emotional self-regulation and negative metacognition about uncontrollability showed positive association with both alcohol-related problems and alcohol frequency. Conversely, negative metacognition about cognitive harm showed a negative association with both alcohol outcomes. Positive metacognition about cognitive self-regulation was not associated with either alcohol outcome.
Conclusion: Different dimensions of positive and negative alcohol-related metacognitions showed different patterns of associations with college students’ hazardous drinking. Negative metacognitive beliefs about cognitive harm emerged as a protective factor for hazardous drinking while positive metacognition regarding emotional self-regulation and negative metacognition regarding uncontrollability emerged as risk factors for hazardous drinking.

Keywords: Addictive behaviors Adherence, Cognitive factors

Authors:

Presenter - Aparna Jain,
Claremont Graduate University, Claremont, CA

Author - Yusuke Shono,
Claremont Graduate University

D175 - Using Intervention Mapping to Design The Singularities, a Game-Based Intervention to Reduce Alcohol-Related Harms among Sexual and Gender Minority Youth

Poster Number: D175
Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Health of Marginalized Populations

Background
Sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, transgender, and queer youth) experience alcohol-related harms and mental health problems at higher rates compared to their cisgender, heterosexual peers. To address these health inequities in an engaging and affirming way, we created The Singularities, a web-based game intervention. The objective of this paper is to describe our collaborative and systematic process for designing The Singularities to enhance alcohol harm–reduction skills, healthy social media use, and adaptive coping strategies among SGMY.

Methods
In collaboration with SGMY (n=31) from across the US, we used Intervention Mapping (IM), a six-step health program planning framework that ensures programs are evidence-based, theory-driven, and designed to fit the needs of specific populations. Our IM process began with a comprehensive needs assessment focused on SGMY alcohol use and related harms, mental health, and social media conducted through literature reviews and interviews with SGMY. We created specific, measurable program objectives based on SGMY needs, selected evidence-based change methods, and partnered with a game development company to produce the game. SGMY participated in a total of 74 interviews, including think-aloud game play testing via Zoom at six different points throughout the development process.

Results
Through IM techniques, The Singularities was primarily designed to use interactive gameplay to teach SGMY alcohol harm-reduction strategies. Players move through the game by interacting with non-playable characters who provide information on alcohol harm-reduction and adaptive coping skills. To win the game, players must reteach these strategies to other non-playable characters, solidifying their understanding of the content and skills. Interactive resource pages on The Singularities website provide additional information on these topics and on healthy social media use.

Conclusions
In partnership with SGMY and game-developers, we successfully developed the first theory-based, community-informed online game intervention aimed at reducing alcohol-related harms and fostering health equity among SGMY.

Keywords: Alcohol, Intervention

Authors:

Presenter - Sam Egan,
University of Pittsburgh

Co-Author - Clarisse Lin,
University of Pittsburgh

Co-Author - Madelyn Rose,
University of Pittsburgh

Co-Author - Aaryn Mathias,
University of Pittsburgh

Co-Author - Emmett Henderson,
University of Pittsburgh

Co-Author - Jennifer Ta,
Schell Games

Co-Author - Brooke Morrill,
Schell Games

Co-Author - Ashley Godbold,
Schell Games

Co-Author - Rachel Grozanick,
Schell Games

Co-Author - Jesse Schell,
Schell Games, LLC

Co-Author - César Escobar-Viera, PhD, MD, MPH,
University of Pittsburgh

Co-Author - Elizabeth Miller,
University of Pittsburgh

Co-Author - Carla Chugani,
Mantra Health

Co-Author - Kimberly Hieftje,
Yale School of Medicine

Co-Author - Nyanda McBride,
Curtin University

Co-Author - Singularities Team,
University of Pittsburgh

Co-Author - James Egan,
University of Pittsburgh

Co-Author - Robert Coulter,
University of Pittsburgh

D176 - Preventing Opioid Overdose on a College Campus: Evaluation of a Naloxone Vending Machine

Poster Number: D176
Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Social and Environmental Context and Health

Background: Nonmedical use of prescription opiates is the second most commonly used substance among college students and adolescent opioid overdose deaths have tripled over the past two years in the US. In May 2023, a naloxone vending machine was installed at Santa Clara University as a harm reduction intervention to prevent opioid overdose. Methods: Between March - June 2024, we conducted a mixed methods research project to: 1) assess patterns, barriers and facilitators of student use of the vending machine; and 2) understand potential barriers to use of the vending machine and harm reduction practices. Students (N=320) completed a 36-question online survey. Follow up in-depth qualitative interviews were conducted with a subsample of N=15 respondents. Results: Survey findings indicate that most students have heard of naloxone (94.3%) and are aware of the vending machine (86.9%), while fewer students reported having a naloxone kit (38.9%), whether from the vending machine (29.6%), or from another source (24.3%). Three students reported using naloxone to reverse an opioid overdose. Students who used the vending machine did so because it is a useful public health tool (83.1%), because it is free (62.9%), because someone in their network uses opioids (20.2%), to give to someone (23.6%), or to take to parties (19.1%). Barriers to obtaining naloxone included not feeling the need to yet (33.3%), not doing drugs (29.2%), and stigma or feeling judged (16.5%). Although the majority of students who had heard of naloxone know that it can reverse an opioid overdose (94.3%), only 33.7% of students can recognize overdose signs. Students who currently have a naloxone kit reported feeling more confident using naloxone (p<0.001) and were more likely to be able to recognize the signs of an overdose (p<0.001) than those who do not have a kit. Qualitative findings underscore the role of cultural norms underlying stigma around substance use as a potential barrier to acquiring naloxone, and indicate the key role of formal and informal student leaders to support acquisition of naloxone and its use. Conclusions: Campus communities can - and must - play a key role in opioid overdose prevention among young adults in the US. With additional support to integrate training and awareness into key student leadership roles and across the campus community, naloxone vending machines can play an important role in shifting campus cultures to harm reduction approaches to overdose prevention.

Keywords: Opioids, Prevention

Authors:

Co-Author - Sonja Mackenzie,
Santa Clara University

Co-Author - Katherine Saxton, MPH PhD, MPH PhD,
Santa Clara University

Co-Author - Jamie Son,
Santa Clara University

Co-Author - Saron Asfaw,
Santa Clara University

D177 - Examining Tobacco Policy Coverage in California Before and After the Implementation of a $2 Tobacco Tax (Proposition 56)

Poster Number: D177
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Communication and Policy

Background: In 2016 California voters approved Proposition 56, a $2/pack increase in tobacco taxes to augment the California Tobacco Prevention Program and further reduce tobacco use in the state. We examined whether the passing of Proposition 56 was associated with increases in the state’s population being covered by policies related to tobacco retail sales, flavored tobacco products sales, secondhand smoke (SHS) restrictions, and smoking restrictions in multi-unit housing (MUH). We also examined whether the passing of Proposition 56 was associated with increases in the implementation of these policies across jurisdictions in California.
Methods: Using 2007-2023 data from the Policy Evaluation Tracking System in California, four key areas (tobacco retail sales, flavored tobacco, outdoor SHS, and MUH) were examined for changes in policy coverage at the population and jurisdiction levels across two time periods (pre-Proposition 56: January 2007-December 2017; post-Proposition 56: January 2018-January 2023 ) using flexible parametric and piecewise exponential models and log-linear models.
Results: By January 2023, roughly 80% of the California population was covered by SHS policies, while only about 50% were covered by tobacco retail sales and flavored tobacco policies. Less than 20% were covered by MUH policies. Although upward trajectories over time in both population and jurisdiction coverage were observed for each of the four policies, the rates of increase were significantly greater in the post-Proposition 56 period (vs. the pre-Proposition 56 period) for only tobacco retail sales policies and flavored tobacco policies (p<0.001), but not for SHS or MUH policies. Conclusions: Proposition 56 was associated with marked increases in the implementation of tobacco retail sales policies and flavored sales policies, but not SHS or MUH policies. With only about half of the California population covered by tobacco retail and flavored sales policies despite increased rates of adoption post-Proposition 56, continued efforts are needed to continue their upward trajectory. Additional efforts are particularly needed to increase population and jurisdiction coverage for MUH policies.

Keywords: Smoking, Policy

Authors:

Author - Dennis R. Trinidad, PhD,
University of California San Diego

Presenter - Matthew D. Stone,
University of California, San Diego

Co-Author - Brian Q. Dang, MS,
University of California San Diego

Co-Author - Thet Khin, MPH,
University of California San Diego

Co-Author - Sara B. McMenamin, PhD,
University of California San Diego

Co-Author - Yuyan Shi, PhD, PhD,
University of California San Diego

Co-Author - Karen Messer, PhD,
University of California San Diego

Co-Author - John P. Pierce, PhD, FSBM, PhD,
University of California San Diego

D178 - Perceptions of Tobacco Product Risks: Insights from a MaxDiff Analysis

Poster Number: D178
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Methods and Measurement

The perceived risk of tobacco products plays a crucial role in an individual use behavior and as a guide in public health decision-making. Misconceptions about the dangers of tobacco products are common, and this research sought to directly compare perceived risk perceptions across 18 different tobacco products. This study leverages the online research panel Prolific to explore the perceived risks associated with each of the tobacco products. Using a relevant items Maximum Difference (MaxDiff) task, participants (n=830) assessed the perceived risks of tobacco products they were familiar with. A multinomial hierarchical Bayesian analysis ranked risk perceptions using probability scaled scores that allow for direct comparability across products. Overall, combustible cigarettes had the highest probability of being perceived as the most dangerous (11.24%). Comparatively, e-cigarettes were considered three times less risky (3.54%), while heated tobacco products such as IQOS were perceived as 11 times less dangerous than cigarettes. Despite a risk profile akin to cigarettes, little cigars, and cigarillos were perceived to carry about half the risk (7.64%). Nicotine Replacement Therapies (NRTs) were believed to carry the least risk (0.29%). These findings bring to light the importance of raising consumer awareness about tobacco-related risks. Targeted public health interventions are warranted to address these misconceptions and better inform the public. The insights from this study can be instrumental in developing more effective tobacco control strategies, especially as new products continue to emerge in the market.

Keywords: Tobacco use, Tobacco control

Authors:

Author - Troy Tektonopoulos,
California State University San Marcos

Co-Author - Teresa DeAtley, PhD,
University of Utah

Co-Author - Janet Audrian-McGovern, PhD,
University of Pennsylvania

Co-Author - Andrew Strasser, PhD,
University of Pennsylvania

Author - Matthew D. Stone, PhD,
University of California, San Diego

D179 - Reasons for a menthol cigarette ban and its perceived impact: A focus group study

Poster Number: D179
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Communication and Policy

Background: The FDA has proposed to end the sale of menthol cigarettes (i.e., a “menthol ban”), which has prompted the tobacco industry to spread misinformation. This study aimed to understand perceptions of the ban among adults who smoke menthol cigarettes. 

Methods: We conducted 6 semi-structured online focus groups, each with 7-9 US adults age 21+ years, who smoked menthol cigarettes (n = 50 total). Four of the focus groups were with priority populations (i.e., Black and lesbian, gay and bisexual adults). The focus groups explored perceived reasons for banning menthol cigarettes and the perceived impact of such a policy on adults who smoke menthol cigarettes. We transcribed each session verbatim and conducted qualitative thematic analyses.  

Results: Most participants believed that the goal of the proposed menthol ban was to protect future generations from smoking menthol cigarettes, which they saw as appealing to younger age groups and more addictive than non-menthol cigarettes. Some viewed the ban as a means for the government to limit individual freedom of choice, and a few thought it unfairly targeted Black people who smoke. Most expressed that they would seek to obtain menthol cigarettes through illicit markets that might emerge post-ban. Some considered switching to non-menthol cigarettes, vapes, or other substances such as heated tobacco devices and marijuana. However, several participants also felt the ban could help them smoke less and eventually quit smoking altogether, as they found cigarettes without menthol flavoring less enjoyable and were deterred from vaping due to its high addictiveness and health risks. Additionally, individuals who were Black expressed concerns that the ban could lead to over-policing, increased targeting of Black communities, feelings of insecurity, and a rise in crime as people sought ways to access menthol cigarettes.

Conclusions: The proposed ban is viewed as both a protective measure and as a source of concern. Many concerns about a menthol ban echoed themes that the tobacco industry has propagated, illustrating the reach of industry messaging. Findings highlight the need for greater and more nuanced health communication about a menthol ban, including messages to quell concerns about policing and remind people who smoke about the public health goals of the ban.

Keywords: Health policy, Smoking

Authors:

Presenter - Mayank Sakhuja, PhD,
University of North Carolina at Chapel Hill

Co-Author - Shayna Farris, BS,
University of North Carolina at Chapel Hill

Co-Author - Rhyan N. Vereen, PhD,
University of North Carolina at Chapel Hill

Co-Author - Jennifer M. Sheldon, MPH,
University of North Carolina at Chapel Hill

Co-Author - Chisom Ojukwu, MPH,
University of North Carolina at Chapel Hill

Co-Author - Emmanuel Saint-Phard, MPH,
University of North Carolina at Chapel Hill

Co-Author - Sarah D. Mills, PhD,
University of North Carolina at Chapel Hill

Co-Author - Carrie Rosario, PhD,
University of North Carolina at Greensboro

Co-Author - Kurt M. Ribisl, PhD,
University of North Carolina at Chapel Hill

Co-Author - Allison J. Lazard, PhD,
University of North Carolina at Chapel Hill

Co-Author - Paschal Sheeran, PhD,
University of North Carolina at Chapel Hill

Co-Author - Noel T. Brewer, PhD,
University of North Carolina at Chapel Hill

Co-Author - Marissa G. Hall, PhD,
University of North Carolina at Chapel Hill

D180 - Understanding the Contexts, Factors, and Perspectives Influencing Smoking Behavior among Low-Income Communities: A Qualitative Analysis

Poster Number: D180
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Health of Marginalized Populations

Background and Purpose: Low-income smokers are disproportionately impacted by smoking-related morbidity and mortality. Smokers who identify as having low-income have higher rates of tobacco use, have a more difficult time quitting, and are less likely to successfully quit. The health inequities among low-income smokers are due in large part to smoking cessation recommendations and interventions that have not been adequately tailored to address the specific needs of low-income communities. This study aims to explore the contexts, factors, behaviors, and perspectives regarding smoking and quitting among a sample of low-income smokers.

Methods: Participants were recruited from the San Francisco Health Network that primarily serve low-income individuals. Researchers completed targeted recruitment using a combination of advertising (e.g., flyers) and snowball (e.g., chain referral) sampling strategies. Participants completed an individual semi-structured interview in which they shared their experiences, attitudes, and behaviors related to smoking and quitting. The semi-structured interview was iteratively refined during research team meetings by research psychologists and study team members with expertise in smoking cessation treatment. Interviews were conducted by two trained research staff, lasted approximately 60-minutes, and were audio recorded. Data analysis was guided by thematic analysis, informed by Social Cognitive Theory.

Results: The sample consisted of 25 participants. Analyses generated several insights related to smoking and quitting within a low-income context. We identified several themes: Socioenvironmental factors that reinforce smoking; smoking as a coping mechanism for psychological distress; deliberate avoidance and denial of known personal health, financial, and social consequences caused by smoking; and cigarettes acting as a security blanket. Participants also identified barriers to quitting (e.g., cravings) and provided peer advice (e.g., self-help) related to smoking cessation.

Conclusions: The interplay between socioeconomic factors, smoking, and cessation efforts is highly complex. However, findings from this study underscore the importance of developing culturally responsive interventions for low-income populations. In an effort to reduce tobacco-related disparities, future studies are needed to determine the most effective and culturally responsive strategies for addressing smoking cessation in this vulnerable population.

Keywords: Smoking, Low-income groups

Authors:

Author - Monique T. Cano, Ph.D.,
Yale School of Medicine

Co-Author - Oscar F. Rojas Perez, Ph.D.,
Yale School of Medicine

Co-Author - Sara Reyes, MPH,
The University of Nebraska Medical Center

Co-Author - Edith Harris, Psy.D.,
San Francisco VA Health Care System

Co-Author - Ricardo Muñoz, Ph.D.,
University of California San Francisco

Co-Author - Alexis Ramirez-Hardy,
Yale University

Co-Author - Stephanie Montealegre,
Yale University

D181 - Peer influence and selection effects on e-cigarette initiation among youth and young adults

Poster Number: D181
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Social and Environmental Context and Health

Significance: Peer influence and selection effects are linked to e-cigarette use and initiation among young adults. However, few studies include a longitudinal research design investigating how peer norms impact e-cigarette initiation, especially among young adults. We aim to elucidate the effects of peer influence and peer selection on e-cigarette initiation over time.

Methods: We used data in the Truth Longitudinal Survey (TLC), a nationally representative longitudinal dataset of youth and young adults. Our analytic sample included 2,029 individuals aged 15-25, who were e-cigarette naïve in Fall/Winter 2020, and who also reported whether they used e-cigarettes in the Fall/Winter 2022 survey. We used repeated measures mixed effects models to examine changes in peer norms of e-cigarette use (acceptance for social e-cigarette use, likelihood of accepting an e-cigarette from a friend, friend disapproval of e-cigarette use, number of close friends using e-cigarettes, and estimated proportion of people my age using e-cigarettes).

Results: At Fall/Winter 2020, future e-cigarette initiators showed higher levels of social e-cigarette acceptance (z=3.7, p < .001), reported a greater likelihood of accepting an e-cigarette if offered (z=7.6, p < .001), reported their friends were less likely to disapprove of e-cigarette usage (z=-3.5, p < .001), and had more close friends who currently use e-cigarettes (z=4.1, p < .001) compared to non-initiators (suggesting peer influence prior to initiation). Additionally, e-cigarette initiators showed a greater increase in their acceptance of social e-cigarette use (β=0.64, p<0.001), likelihood of accepting an e-cigarette from a friend (β=0.63, p<0.001), the number of 4 closest friends using e-cigarettes (β=0.56, p<0.001) and a greater decrease in friends’ disapproval of using e-cigarettes (β=-0.41, p<0.001) by Fall/Winter 2022 compared to those who did not initiate (suggesting peer selection towards more e-cigarette-friendly environments). Interestingly, those who did not initiate actually decreased in their estimated proportion of people their age using e-cigarettes in Fall/Winter 2022 from Fall/Winter 2020, compared to e-cigarette initiators (β=0.47, p=0.001).

Conclusion: We find evidence for both peer influence and peer selection effects in e-cigarette use initiation. At baseline, initiators had already exhibited elevated peer acceptance of e-cigarettes, and these effects were amplified after initiation.

Keywords: Adolescents, Tobacco use

Authors:

Author - Linda Q. Yu, PhD,
Truth Initiative

Author - Alexander D'Esterre, PhD,
Truth Initiative

Author - Kristiann Koris, MPP,
Truth Initiative

Author - Michael Liu, MS,
Truth Initiative

Author - Elizabeth C. Hair, PhD,
Truth Initiative

Presenter - Elizabeth K. Do, PhD, MPH,
Truth Initiative

D182 - Awareness of a cessation-focused media campaign is linked to more subsequent attempts to quit e-cigarettes among youth and young adults

Poster Number: D182
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Communication and Policy

Significance: To effectively decrease tobacco usage rates among youths and young adults, it is important to encourage current users of e-cigarettes to quit. This study uses a longitudinal design to evaluate awareness of a media campaign with cessation-focused messaging on subsequent intentions and attempts to quit among current e-cigarette users.

Methods: Data were obtained from participants of the Truth Longitudinal Cohort (TLC), a probability-based sample of youth and young adults (aged 15-29 years) residing in the United States. The analytic sample (N=471) included respondents who were current users of e-cigarettes and reported on awareness of cessation-focused messaging belonging to the national truth® campaign at Wave 12 (collected in January 2022). Respondents were assessed for intentions to quit (including those who indicated they have already quit) and attempts to quit e-cigarettes in the past 30 days at Wave 14 (Dec 2023). Cessation-focused messaging was defined as advertisements that focused on the quitting journey, and called for signing up for a text-message-based quitting resource.

Results: At Wave 14, 34.6% of the sample reported that they had already quit. Those reporting awareness of cessation-focused messaging at Wave 12 were more likely to make any attempt at quitting or have quit intentions at Wave 14 (Pearson chi square = 7.56, p = 0.023). Specifically, of those who reported awareness of the cessation content at Wave 12, 61.1% of respondents made any attempts to quit within the past 30 days, compared to 51.4% who were not aware. In contrast, only 11.1% of participants who were aware of cessation-focused content reported no attempt to quit and no intentions to quit, compared to 21.4% of those who reported no awareness.

Conclusion: Awareness of cessation-focused messaging is associated with an increase in later attempts or intentions to quit e-cigarettes.

Keywords: Tobacco control, Health communication

Authors:

Author - Linda Q. Yu, PhD,
Truth Initiative

Presenter - Elizabeth K. Do, PhD, MPH,
Truth Initiative

Author - Kristiann Koris, MPP,
Truth Initiative

Author - Tyler Minter, MS,
Truth Initiative

Author - Elizabeth C. Hair, PhD,
Truth Initiative

D184 - Perceived Health Concerns of Child Hand Nicotine Levels among Parental Smokers

Poster Number: D184
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Child and Family Health

Thirdhand smoke pollution results from persistent tobacco smoke residue that remains in indoor environments. Pollutants from secondhand smoke collect on carpets, walls, and indoor surfaces. Due to normal developmental behaviors such as crawling, young children are at an increased risk for thirdhand smoke exposure. Hand nicotine has been shown to be a promising marker of thirdhand smoke pollution found in children’s environments. The influence of child’s hand nicotine levels on parental smoking behaviors and perceptions remains unknown. This study assessed parental smokers’ perceived health concerns of child thirdhand smoke exposure based on high and low hypothetical child hand nicotine levels. This study included 92 parents who used tobacco, lived with 0-11-year-olds, and were participating in a thirdhand smoke observational trial. Parents were presented with hypothetical child hand wipe nicotine levels: low result of <10ng/wipe and high result of >200ng/wipe. After being presented with each result, parents reported their readiness to quit smoking (range=0-10) and general concern about the results, concern that smoking would affect their child’s health, and perception on how often their child would get sick (ranges=0-3). T-tests were performed to compare sample means. Parents had higher readiness to quit (7.0, SD=3.1, p=0.002) and higher general concern about the results (2.3, SD=0.9, p<0.001) when presented with the high result compared to the low result (6.4, SD=3.1; and 2.0, SD=1.0, respectively). Parents had higher concern that smoking would affect their child’s health (2.4, SD=0.9, p<0.001) and how often their child would get sick (2.0, SD=1.1, p=0.005) when presented with the high result compared to the low result (2.0, SD=1.0; and 1.8, SD=1.1, respectively). Higher hypothetical child hand nicotine levels influenced parents’ concerns about their child’s health and chances of getting sick. Future tobacco cessation interventions should consider providing parents with their child’s actual hand wipe nicotine levels to potentially increase their readiness to quit tobacco use.

Keywords: Tobacco use, Family

Authors:

Presenter - Madelyn J. Hill, MPH,
University of Cincinnati

Co-Author - E. Melinda Mahabee-Gittens, Ph.D., M.D.,
Cincinnati Children's Hospital

Co-Author - Georg E. Matt, PhD,
San Diego State University

Co-Author - Lara Stone, MA,
Cincinnati Children's Hospital

Co-Author - Ashley L. Merianos, Ph.D.,
University of Cincinnati

D185 - Youth and young adult neutral perceptions of tobacco imagery on-screens

Poster Number: D185
Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Substance Misuse

Tobacco depictions in on-screen entertainment can influence youth tobacco initiation. Research demonstrates that social environments plays a crucial role in influencing tobacco use by establishing and reinforcing social norms. Young people now have access to a plethora of content and are no longer limited by traditional television programming and movies aired only in theaters. This study investigates perceptions of tobacco depictions in media among young people in the current digital landscape. Young people (15–24-year-olds; N=1,495) were surveyed in a cross-sectional, online panel in April 2023. Participants were asked 19 questions focused on their perceptions of tobacco imagery/use on-screens, using a 5-point Likert scale (Strongly Disagree to Strongly Agree). Example items include 1) Streamed media that is popular with young people shouldn’t show tobacco products, and 2) There should be no tobacco imagery in on-screen content that is appealing to youth. Current (past 30-day) tobacco use was dichotomized. Those who reported having used at least one tobacco product in the past 30-days were classified as current tobacco users. Self-reported perceptions were analyzed by current tobacco user status (users vs non) and age (15-17, 18-20, 21-24).Many participants are ambivalent to each perception with neutral responses ranging from 23% to 40%. The perception with the highest neutral response among all respondents was, “parental ratings are accurate in warning about tobacco on screens.” Overall, 30% of all respondents were neutral to the impacts of tobacco on-screens. Respondents who are under 21 years old have higher neutral responses to perceptions on the effectiveness of ratings and the impacts of tobacco imagery on-screens. Over 30% of 15-20 year olds were ambivalent to the perception, “watching streamed media in which someone vapes doesn’t impact whether young people start vaping” compared to 27% of 21-24 year olds. Non-users had higher neutral responses compared to current users. For example, 42% of non-users were neutral to the perception, “parental ratings are accurate in warning about tobacco on screens” compared to 36% of current users. Young people are not knowledgeable about the harmfulness of tobacco imagery on screens and neutral responses can indicate even more room for education. Understanding young people’s perceptions is critical for the development of public health prevention strategies and policies surrounding tobacco presence in media.

Keywords: Tobacco use, Adolescents

Authors:

Author - Jessica M. Rath, PhD, MPH, CHES,
Truth Initiative

Co-Author - Brenda Dimaya, MPH,
Truth Initiative

Co-Author - Jodie Briggs, MPP, MA,
Truth Initiative

Co-Author - Tyler Minter, MA,
Truth Initiative

Co-Author - Simon Page, BA,
NORC at the University of Chicago

Co-Author - Nada Adibah, MPH,
NORC at the University of Chicago

D186 - Lesbian and Queer Women's Health Care in the Coachella Valley Region

Poster Number: D186
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Health of Marginalized Populations

Lesbian and Queer-identified women face significant health disparities compared to their heterosexual counterparts. McKetta et al. (2024) found that lesbian and bisexual women report more alcohol and tobacco use and have an increased risk of breast cancer and cardiovascular disease compared with heterosexual counterparts. Due to the large number of lesbian and queer-identified women residing in the Coachella Valley Region, a study was conducted regarding their healthcare experiences.
Of the 221 participants, most identified as White, middle class, and middle-aged. When asked about their gender presentation, 59.7% considered themselves feminine presenting. The survey consisted of 17 items. Four questions were open-ended, addressing attitudes towards lesbian healthcare providers, healthcare experiences, ignoring symptoms of illness, and delaying care.
Results indicated 57% of participants regularly seek preventative medical care. When asked about the factors contributing to delays in seeking medical attention, 27.6% of respondents cited comfort level with physicians, followed by a lack of trust in medical professionals (24.4%) and concerns about costs (20.8%). Forty-one percent cited other reasons, such as inaccessibility to healthcare and time constraints. Most emphasized the importance of having an out-lesbian doctor, citing three main themes: relational empathy, comfort, and inclusivity.
When reporting why they delayed seeking medical attention or ignored symptoms, participants noted factors such as inaccessibility of healthcare, concerns of mistreatment, avoidance, urgency of symptoms, and inconvenience. Three main themes identified among participants relating to healthcare experiences included inaccessibility of healthcare, negative experiences with doctors, and belief that they would benefit from having a lesbian doctor.
These findings highlight the need for inclusive healthcare professionals. Lesbian and queer-identified women expressed a preference for having a lesbian doctor, as it fosters relational empathy, comfort, and inclusivity. Ultimately, they are more likely to seek care from providers and environments where they feel comfortable. Due to the WEIRD sample representation, efforts are underway to collect data from Spanish-speaking populations to ensure findings can be generalized to a broader group of women. The ultimate goal is to provide comprehensive care by removing barriers and fostering healthcare environments where women feel at ease.

Keywords: Women's health, Health promotion

Authors:

Presenter - Adina Corke, MA, MA,
California State University Fullerton

Co-Author - Noah Devore,
California State University, Fullerton

Co-Author - Kristin Beals, Ph.D.,
California State University, Fullerton

Co-Author - Karyl Ketchum, Ph.D.,
California State University

D187 - Associations between Women Wellness Visits and the context of communication about women wellness visits among Latina Women.

Poster Number: D187
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Health of Marginalized Populations

Research has demonstrated that family can influence an individual’s engagement in health behaviors (Marks, 1999; Umberson, 1987). Discussions with family members about preventative health screenings may be one mechanism through which individuals are influenced to engage in recommended health screenings. However, it remains unclear what type of information is disseminated between parents and their children when discussing women wellness screenings, nor whether these discussions are related to the utilization of screenings among women. The purpose of this mixed-method study was to examine the prevalence of parent-child discussions of women wellness exams among women and the association with utilization of women wellness exams. Three hypotheses were proposed: (H1) The majority of women will report a lack of discussion regarding women’s wellness visit with their parent; (H2) Informative parent-child discussions of women wellness exams will be associated with a higher prevalence of recent women wellness exams; and (H3) Latina Women will report a significantly higher use of euphemisms in these discussions which will subsequently be related to utilization of women wellness exams. Qualitative coding was used to identify themes in retrospective parent-child discussions of women wellness exams reported by women. The sample (M age = 27.91, SD = 12.86) consisted of 92 women, and most of the women identified as Latina (60%). Over 66% of the whole sample reported having had a discussion about women wellness exams with their parent(s). Additionally, about 67% of women reported having a recent wellness visit. Foreign-born Latina Women reported the lowest prevalence of discussions with a parent about wellness visits as well as the lowest prevalence of recent wellness visits. Data was collected on socioeconomic status and health insurance status amongst all participants. Interventions that provide parents guidance in addressing women wellness exams early in childhood may reduce misinformation and discouragement of timely women wellness exams.

Keywords: Latino, Health communication

Authors:

Author - Grace Fernandez,
Occidental College

Co-Author - Julia Hutchinson,
Occidental College

Co-Author - Martina Long,
Occidental College

Co-Author - Kylie Castro,
Occidental College

Co-Author - Disha Shah,
Occidental College

Co-Author - Angelica Ortiz,
Occidental College

D188 - Understanding Perinatal Women’s Preferences in a Mental Health App

Poster Number: D188
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Digital Health

Purpose: Depression affects 10-20% of perinatal women in the U.S., posing significant risks to both mothers and children. Addressing inequities in care requires accessible, acceptable, and effective interventions. Digital mental health apps may help mitigate these challenges by providing easily accessible resources to support mental health. However, research on perinatal women’s interest in such apps is limited. This study aimed to explore their interest and preferences for app features. A secondary goal was to examine differences in preferences between women in two geographic locations.

Methods: This explanatory sequential mixed-methods study included an online survey and semi-structured interviews with perinatal women in Nebraska and Florida. Recruitment primarily occurred through approved Facebook groups of mothers. The study included 159 participants from Nebraska and 35 from Florida. Interviews were completed by 29 women from Nebraska and 7 from Florida. Descriptive statistics were used to analyze demographics and survey variables, with means to compare states. Interview data were analyzed using directed content analysis.

Results/Findings: Of the 194 women surveyed, 78.8% were interested in downloading a mental health app, yet only 40.4% had previously downloaded one, and just 10.9% were actively using one. Preferred app features included postpartum education, mood tracking, baby care guidance, and mental health education. Minimal differences were found between states, though some notable ones included higher midwife use in Florida (37.1% vs. 13.8%, p=0.001) and greater privacy concerns among Floridians (65.7% vs. 47.2%, p=0.047). Florida women also reported more birth care information from midwives (37.1% vs. 11.9%, p<0.001) and books (40.0% vs. 20.8%, p=0.018), with additional information on birth care (74.3% vs. 54.1%, p=0.029) and bottle feeding (37.1% vs. 20.8%, p=0.039) than Nebraska women. Interviews revealed that women valued the idea of a dedicated app, emphasizing the importance of credible information.

Conclusions: Perinatal women show substantial interest in a mobile app tailored to their mental health needs, highlighting a market gap. Developing such an app will require a focus on credible information and collaboration with healthcare providers to address specific health concerns.

Keywords: e-Health, Pregnancy

Authors:

Co-Author - Danae M. Dinkel, PhD, PhD,
University of Nebraska at Omaha

Co-Author - Maggie R. Emerson, DNP, PMHNP-BC, DNP, PMHNP-BC,
UNMC

Co-Author - David Johnson,
Wake Forrest

D189 - Prevalence and Perceptions: Experiences of Perinatal Trauma in a Diverse Sample

Poster Number: D189
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Health of Marginalized Populations

Background: Approximately 50% of birthing people describe their birth as “traumatic,” with racially/ethnically minoritized individuals exhibiting stark disparities in childbirth related post traumatic stress disorder (CB-PTSD). Despite these inequities and the family-wide consequences of CB-PTSD, there is a lack of research on risk factors and the experiences of racially and ethnically minoritized individuals. To address this gap, we surveyed a diverse sample of individuals with prior perinatal experiences. This poster will examine perinatal complications, a leading risk factor for the development of CB-PTSD.

Methods: Participants were recruited from a completed observational study (Diebold et al., 2021). Eligible participants were ≥18 years old, spoke English or Spanish, lived in the U.S., and were pregnant at least once. Surveys were completed online or by phone and included demographic and perinatal experience questionnaires developed by the research team and informed by the literature. Participants were asked to endorse 14 predefined complications in three periods: prenatal (e.g., preeclampsia), labor/delivery (e.g., emergency surgery), and postpartum (e.g., NICU stay). Participants were also provided a free response option. If a participant endorsed a complication, they were asked whether they perceived it as traumatic.

Results: Of the 166 individuals who completed the demographics survey, 70% reported a household income <$50,000, 28% identified as Hispanic, and 60% identified as a racial minority. Of the 157 who completed the perinatal experience questionnaire, 140 (89%) endorsed ≥1 perinatal complication (range = 1–11). On average, participants endorsed 4 perinatal complications. Of individuals who endorsed ≥1 perinatal complication, 69% reported feeling traumatized by one or more of the complications.

Conclusions: This research fills a gap in the literature on the prevalence and often traumatic impact of perinatal complications in a diverse U.S. sample. Limitations of this study include the generalizability of this sample to other racial and ethnic groups. We are currently conducting qualitative interviews with a subset of participants. Future work will explore other risk factors and their correlations with PTSD symptoms. These findings will guide an adaptation of Mothers and Babies (MB), an evidence-based perinatal depression intervention, aimed at preventing the onset or worsening of symptoms associated with CB-PTSD.

Keywords: Pregnancy, Trauma

Authors:

Co-Author - Ada Moses, BA,
Northwestern University Feinberg School of Medicine

Co-Author - Alicia Diebold, MSW,
Northwestern University Feinberg School of Medicine

Co-Author - Aiko Lovejoy, BA,
Northwestern University Feinberg School of Medicine

Co-Author - Ella Swenson,
Northwestern University Feinberg School of Medicine

Co-Author - Darius Tandon, PhD,
Northwestern University Feinberg School of Medicine

D190 - Development and Feasibility of a Conversation Tool to Garner Mental Health and Intimate Partner Violence History from Patients Seeking Pelvic Healthcare: A Trauma Informed Approach

Poster Number: D190
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Education, Training, and Career Development

Introduction: 1 in 4 women suffer from pelvic floor dysfunction in their lifetime. The incidence and severity of pelvic floor dysfunction can be influenced by trauma histories. Specifically, delay in pelvic healthcare has been associated with a history of intimate partner violence and there is a significant association between women with a history of sexual abuse and chronic pelvic pain. In our research team’s previous investigations, we identified high rates of mental health distress among postpartum women with moderate pelvic floor dysfunction. Women also reported shame and embarrassment related to their pelvic health and avoided seeking healthcare until severe symptoms occurred. Due to the influence of trauma histories on accessing pelvic healthcare and high rates of mental health distress among women with pelvic floor dysfunction, providers require more support to engage with patients seeking pelvic healthcare in a trauma informed way. Therefore, a research team comprised of clinical experts (e.g., pelvic health physical therapists) and victim service experts have developed a conversation tool for healthcare providers to use when discussing patient’s experiences with intimate partner violence and mental health symptomology prior to the patient’s receipt of pelvic healthcare. Methods: This tool was developed via a three-stage process. Stage 1 focused on instrument design including content domain determination, content item generation, and instrument construction. Stage II involved healthcare practitioners and community health advocates with sexual violence expertise (n = 17) reviewing the conversation tool and completing a mixed- measures Qualtrics survey regarding the tool’s feasibility and content validity. Stage 3 comprised semi-structured telephonic interviews with healthcare professionals (n = 13) to discuss the tool’s utility and feasibility. The tool was then re-reviewed, further revised, and finalized by the research team. Results: The finalized conversation tool was found to have satisfactory face and content validity as well as to be feasible to implement in clinical settings based on constructs related to acceptability, practicality, demand and implementation. Discussion: Next steps will focus on pilot testing the tool through workshops targeting health professional students interested in providing pelvic healthcare.

Keywords: Trauma, Violence

Authors:

Co-Presenter - Kailey Snyder, PhD, MS, PhD, MS,
University of Nebraska at Omaha

Co-Presenter - Tara Richards, PhD,
University of Nebraska at Omaha

Author - Kari Bargstadt-Wilson, MPT,
Creighton University

Author - Julie Peterson, DPT, EdD,
Creighton University

Author - Madeline Jelacic, DPT,
Creighton University

D191 - Applying the North Carolina Maternal and Child Health Dashboard to examine smoking during pregnancy and related social determinants of health

Poster Number: D191
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Social and Environmental Context and Health

Background: There is no safe level of smoking during pregnancy. Rates are higher among women with low socioeconomic status and those experiencing social isolation. In the United States (US), the rate of smoking during pregnancy was 4.6% in 2021, with North Carolina (NC) ranked 24th (5.6%) nationwide.
Aim: To examine underlying factors of smoking rates during pregnancy across five social determinants of health (SDOH) domains – economic stability, education access, healthcare access, neighborhood/built environment and social/community context – using the NC Maternal and Child Health Geographic Information System Dashboard.
Methods: We analyzed secondary data at the county level (2018-2022) from the NC State Center for Health Statistics, Health Resources and Services Administration and the US Census. Each county was classified as rural or urban based on the 2023 Rural-Urban Continuum Codes. We applied an independent t-test to examine differences between rural and urban counties and conducted a Pearson’s correlation to assess relationships between SDOH factors and smoking during pregnancy, the outcome.
Results: Of the 100 counties in NC, 55 are rural (55%). Rates of smoking during pregnancy were significantly higher among rural counties (13.9%) versus urban (9.9%)(p=.001). Within all SDOH domains, most indicators were significantly different between rural and urban counties. Notably, median household income was $51,963 in rural counties compared to $65,960 in urban (p<.001). Rural counties had higher rates of adults with no high school diploma (14.2%) versus urban (10.9%)(p<.001). Across NC, median household income (r=-0.45,p<.001) and having a bachelor’s degree or higher (r=-0.36,p=.001) were significantly negatively correlated with smoking during pregnancy. As for healthcare access, the rate of obstetricians/gynecologists was significantly negatively correlated with smoking during pregnancy (r=-0.28,p=.005). Regarding social/community context, rates of reproductive-age women were significantly negatively correlated with smoking during pregnancy (r=-0.42,p<.001).
Conclusion: Across SDOH domains, rural counties in NC fare worse compared to urban counties and have significantly higher rates of smoking during pregnancy. Increasing access to education in rural areas is imperative to prevent smoking during pregnancy. Similarly, behavioral health interventions to support smoking cessation throughout the perinatal period must consider geography and social context.

Keywords: Women's health, Population health

Authors:

Presenter - Liane M. Ventura, MPH,
University of North Carolina at Charlotte

Co-Author - Qian Huang, PhD, MA, MPA,
East Tennessee State University

Co-Author - Alicia A. Dahl, PhD,
University of North Carolina at Charlotte

Co-Author - Hadii Mamudu, PhD, MPA,
East Tennessee State University

Co-Author - Kate E. Beatty, PhD, MPH,
East Tennessee State University

D192 - Depressive symptoms mediate the relationship between dispositional mindfulness and diet quality on weekends but not weekdays among pregnant individuals with pre-pregnancy BMI≥25

Poster Number: D192
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Diet, Nutrition, and Eating Disorders

Poor diet quality and weekday-weekend differences in eating patterns during pregnancy are linked to adverse pregnancy outcomes and cardiometabolic health indicators. Mindfulness, a practice of non-judgmental awareness of present experience, is associated with higher diet quality and reduced emotion-driven eating among non-pregnant individuals, and this relationship may be mediated by depressive symptoms. The purpose of this study was to examine whether dispositional mindfulness is related to weekday and weekend diet quality in pregnant individuals with pre-pregnancy body mass index (BMI)≥25 and to explore whether depressive symptoms mediate this relationship. Participants (N=245; Mage±SD=31.6±4.7; MBMI=32.0 kg/m2±6.4; Mweeks gestation=13.7±2.7weeks) were recruited for a perinatal lifestyle intervention trial. At baseline, participants self-reported mindfulness (Mindful Attention Awareness Scale [MAAS]) and depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS]). The Healthy Eating Index (HEI)-2020 was derived from two 24-hour dietary recalls (one weekday, one weekend day). Direct and mediating effects of MAAS and EPDS scores on HEI scores were analyzed in three separate models (HEI weekday, weekend, and average) using the mediation package in R with bias-corrected bootstrapped confidence intervals (BootCI; k=1,000). Models covaried for age, racial identity, education, income, pre-pregnancy BMI, and typical work start time. HEI scores were higher on weekdays than weekends (t(244)=2.8, p<.01; Mweekday=47.9±14.5; Mweekend=44.9±13.5), and scores were in the poor quality range. Higher MAAS scores were related to higher weekend HEI scores (β=0.2, p<.01) but not weekday (β=0.02, p=.76) or average (β=0.1, p=.06) HEI scores. EPDS scores mediated the relationship between MAAS and weekend HEI scores (average causal mediation effect=0.2, BootCI=0.03-0.35, p=.02), such that greater mindfulness was associated with higher weekend diet quality through lower depressive symptoms. These cross-sectional data suggest dispositional mindfulness relates to diet quality on weekends in pregnant individuals with pre-pregnancy BMI≥25, an effect explained in part by lower depressive symptoms. Mindfulness is linked with improved self-regulation, which may facilitate consistent dietary patterns across weekends and weekdays. Additional research assessing the impact of mindfulness interventions on prenatal diet quality is warranted.

Keywords: Pregnancy, Mindfulness

Authors:

Author - Shannon D. Donofry, PhD, PhD,
RAND

Co-Author - Riley J. Jouppi, M.S., M.S.,
University of Pittsburgh

Co-Author - Rachel P. Kolko Conlon, PhD, PhD,
University of Pittsburgh School of Medicine

Co-Author - Christine C. Call, PhD, PhD,
University of Pittsburgh

Co-Author - Diva Kothari,
University of Pittsburgh

Co-Author - Michele D. Levine, PhD, FSBM, PhD, FSBM,
University of Pittsburgh Medical Center

D193 - Elevated high sensitivity c-reactive protein is associated with poorer cardiovascular health during early pregnancy among individuals with pre-pregnancy BMI≥25

Poster Number: D193
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Cardiovascular Disease

Pro-inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), have been associated with cardiovascular disease risk in the general population, as well as with adverse pregnancy outcomes (e.g., preterm birth) among pregnant individuals. Individuals who begin their pregnancies with body mass index (BMI)≥25 kg/m2 may be more likely to experience systemic inflammation and therefore at higher risk of poor cardiovascular outcomes. The purpose of this study was to evaluate the relationship between hs-CRP and cardiovascular health (CVH) early in pregnancy among individuals with pre-pregnancy BMI≥25. Identifying this association early on may allow for early interventions to mitigate cardiovascular risk, improving both maternal and fetal outcomes in this high-risk population. Participants (N=285; Mage=31.05±4.95) with pre-pregnancy BMI≥25 (M=31.93±5.93) were recruited at 12-20 weeks' gestation (M=13.59±2.7) for a randomized trial of a lifestyle intervention during the perinatal period. Data for the current study were drawn from the baseline assessment prior to randomization, during which participants underwent a fasting blood draw to obtain concentrations of hs-CRP and completed measures of CVH. Hemoglobin A1c, non-high density lipoprotein cholesterol, and current BMI were coded according to the American Heart Association’s Life’s Essential 8 guidelines to calculate a composite CVH score (range: 0-100, higher scores = better CVH). Robust linear regression was performed using the MASS package in R to test the relationship between hs-CRP and CVH score while accounting for potential outliers. Age, racial identity, education, and gestational age at baseline were included as covariates. Mean CVH scores were 73.41 (SD=13.39, range: 33-90), considered to be in the intermediate range. Higher hs-CRP concentrations were associated with lower CVH scores (β=-0.23, p<.01). Individuals with hs-CRP >1SD above the mean had CVH scores 9.45 points lower than those with hs-CRP concentrations <1SD below the mean (MCVH=70.36±10.72 vs. 79.81±10.95). These cross-sectional findings suggest that elevated hs-CRP is associated with poorer CVH during pregnancy among individuals with pre-pregnancy BMI≥25. Additional longitudinal research is needed to evaluate the direction of this effect and whether the relationship between inflammation and CVH changes across pregnancy and postpartum period, particularly among this high-risk population.

Keywords: Pregnancy, Cardiovascular disease

Authors:

Co-Author - Shannon D. Donofry, PhD, PhD,
RAND Corporation

Co-Author - Riley J. Jouppi, M.S., M.S.,
University of Pittsburgh

Co-Author - Michele D. Levine, PhD, FSBM, PhD, FSBM,
University of Pittsburgh Medical Center

D194 - Loneliness in midlife women: The role of EMA-captured relationship stress and social support

Poster Number: D194
Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Digital Health

Background: Loneliness in midlife is linked to adverse health outcomes including cognitive decline and dementia. It can be influenced by relationships, social support, or stress. Since the causes of loneliness vary across populations and life stages, more detailed studies on specific groups are needed. Midlife women (aged 50-64), who are particularly under-studied, often face more relationship-related stress than men, yet no studies have specifically examined how this stress affects their loneliness. We aim to fill this gap by considering both dynamic interpersonal stressors and perceptions of social support as factors influencing loneliness in midlife women.
Methods: We used a custom-built ecological momentary assessment (EMA) app that captured daily stressors in real time for two weeks. At the start of this period, participants reported on loneliness and social support using the 3-item UCLA Loneliness Scale and the Social Provisions Scale. A total of 95 women completed the data collection. The frequency of thematically analyzed relationship stressors (including family relationship stress, colleague relationships stress at work and other social interactions stress), social support, and marital status were used as variables in a regression analysis to predict loneliness.
Results:The regression model significantly explained 24.6% of the variance in loneliness (R2=0.246; F(5,89)=5.808, p<.05). Higher levels of social support were associated with lower loneliness (β=0.317, p<.05). Single women were found to be lonelier (β=−0.241, p<.05). Stress from family relationships also contributed to increased loneliness (β=−0.025, p<.05). Stressors of colleague relationships and other social interactions were not significantly related to loneliness.
Conclusions:This study developed an approach to understand how real-time relationship-related stressors interact with broader social support perceptions to influence loneliness in midlife women. We found that while married women generally report less loneliness than single women, frequent family stress is linked to higher loneliness. This suggests that merely having family relationships, including being married, does not guarantee reduced loneliness; rather, the supportiveness or stressfulness of these relationships is crucial. Additionally, social support significantly reduces loneliness. These findings highlight the importance of addressing family stress and enhancing social support to reduce loneliness in midlife women.

Keywords: Gender, Mental health

Authors:

Author - Xing Yao,
Indiana University Bloomington

Co-Author - Betsey Z. Nuseibeh,
Indiana University Bloomington

Co-Author - Patrick C. Shih, PhD,
Indiana University Bloomington

Co-Author - Erik J. Nelson, PhD,
Brigham Young University

Co-Author - Aric A. Prather, PhD, PhD,
University of California, San Francisco

Co-Author - Mario Schootman, PhD,
University of Arkansas for Medical Sciences

Co-Author - Stephen J. Carter, PhD,
Indiana University Bloomington

Chair - Evan J. Jordan, PhD,
Indiana University Bloomington

D195 - "Find sunshine wherever you can": Perspectives on psychosocial wellness from individuals with multiple sclerosis

Poster Number: D195
Time: 11:00 AM - 11:50 AM
Topics: Quality of Life, Mental Health

Psychosocial wellness has been identified as a top priority in multiple sclerosis (MS) research. Unfortunately, research progress in this area is thwarted by a lack of a clear, comprehensive understanding of psychosocial wellness as experienced by those living with MS. To address this critical gap, we conducted a qualitative study to develop a conceptual model that reflects how psychosocial wellness is experienced and defined by people with MS and identifies common facilitators and barriers to psychosocial wellness in MS. Five 90-minute focus groups were conducted via videoconference with N=45 adults with MS. Most were female (71%) and White (85%). The mean age was 51.29 ± 11.14 years (range = 34 - 74 years). The sample represented a wide range of disability severity (Patient Determined Disease Steps range = 0-7). An experienced qualitative researcher used a structured focus group guide to query participants’ definitions of psychosocial wellness, experiences of wellness, and facilitators/barriers to wellness. Focus group recordings were transcribed and analyzed by a team of four coders using the thematic analysis method. Thematic analyses of the focus group transcripts suggest that psychosocial wellness is commonly experienced by people with MS, with many MS-specific facets and individual-level contributors to wellness. Salient major themes (with minor themes) that were identified included: Psychological contributors (silver linings, flexibility and acceptance), Behavioral contributors (creative outlets and hobbies, symptom management), Social contributors (supporters/partners, contribution/responsibility, finding community, setting boundaries), Spirituality, Barriers, and Temporal factors (daily variability, change over time, grieving process). Implications for how professionals (e.g. psychologists, occupational therapists, recreational therapists) can support psychosocial wellness in MS were also identified. These themes informed the development of a comprehensive conceptual model of psychosocial wellness in MS. Qualitative findings suggest that psychosocial wellness is commonly experienced in people with MS and that many psychological, social, and behavioral strategies can support wellness in MS. Findings provide a person-centered perspective on the experience of living with MS, which encapsulates both challenges and positive experiences. Future research to identify ways to promote psychosocial wellness in MS is warranted.

Keywords: Quality of life, Mental health

Authors:

Presenter - Jade Treder, B.S.,
Michigan Medicine

Co-Author - Dawn Ehde, Ph.D.,
University of Washington

Co-Author - Evan Smith, Ph.D.,
Michigan Medicine

Co-Author - Josiah Goga, B.S.,
Michigan Medicine

Co-Author - Anna Kratz, Ph.D.,
Michigan Medicine

D196 - Social isolation in a national sample of caregivers of patients with chronic and serious conditions: Risk and associations with health and healthcare utilization

Poster Number: D196
Time: 11:00 AM - 11:50 AM
Topics: Quality of Life, Social and Environmental Context and Health

Background: Social isolation is associated with worse health outcomes in the general population, but little is known about these relationships among caregivers, especially since the COVID-19 pandemic. This study determined social isolation’s prevalence and associations with risk factors and health outcomes among family caregivers of patients with serious and chronic conditions using the NIH-sponsored Health Information and National Trends Survey (HINTS).
Methods: Self-identified caregivers completed a single-session, postal/online survey in March-November 2022, reporting their demographic information, social isolation (PROMIS Social Isolation Scale), mental health (PHQ-4), physical health (SF-1), and healthcare utilization (frequency and delay of care). Using jackknife replication and sampling weights, analyses characterized the sample; identified those most at risk of social isolation via ANOVA, chi-square, and t-tests; and examined the relationship between isolation and mental health, physical health, frequency of care, and delay of care via linear, ordinal, and multinomial logistic regression, while controlling for age, sex, education, marital status, rurality of residence, relationship to the patient, and caregiver and patient health conditions.
Results: Family caregivers (N=796; 57% female; 62% Non-Hispanic White; mean age 52 years) most commonly provided care to individuals with musculoskeletal issues (35%), chronic illnesses (e.g., heart or lung disease, 34%), and neurocognitive conditions (31%; not mutually exclusive). Overall, 23% of caregivers were socially isolated (T-score ≥55), with higher estimates among those who were aged 18-34 (50%, p=.007), unmarried (37%, p<.001), and financially strained (32%, p<.001). Being female (p=.023), a spousal caregiver (p=.032), diagnosed with multiple health conditions (p<.001), or diagnosed with depression/anxiety (p=.002) were also associated with higher isolation scores. In regression analyses, higher isolation scores were significantly associated with worse mental (B=0.609, p<.001) and physical health (OR=1.051, p=.003), and increased risk of delaying necessary medical care (RRR=1.055, p=.003), but not frequency of care (OR = 1.008, p=.527).
Conclusion: Over 20% of caregivers are socially isolated and at risk for worse health and care utilization outcomes. The results demonstrate the need for interventions that address isolation and policies supporting family-centered care and caregiver quality of life.

Keywords: Caregiving, Social support

Authors:

Author - Brenna Mossman, PhD, MA,
Georgetown Lombardi Comprehensive Cancer Center

Co-Author - Nina Kadan-Lottick, MD, MPH,
Georgetown Lombardi Comprehensive Cancer Center

Co-Author - Claire C. Conley, PhD,
Georgetown Lombardi Comprehensive Cancer Center

Co-Author - Tristen Peyser, MS,
Tulane University

Co-Author - Michael Hoerger, PhD MSCR,
Tulane Cancer Center

D197 - “Is he gonna live? Is he not gonna live? And if he does get to transplant, what’s it gonna be like after?”: The Experiences and Wellness Needs of Caregivers of Patients on the Solid Organ Transplant Journey.

Poster Number: D197
Time: 11:00 AM - 11:50 AM
Topics: Quality of Life, Physical Activity

Background: Caregivers play a critical role for individuals experiencing chronic disease or illness. Despite this, they are rarely supported and as a result often report high levels of negative physical and mental outcomes. The Transplant Wellness Program is an exercise behaviour change study designed to target patient wellness needs, but has not yet addressed the gap in caregiver wellness. Thus, the purpose of this study was to explore caregivers’ perspectives on the experience of providing care, and their own wellness needs, during the transplant journey.
Methods: A qualitative descriptive design was used for this study. Purposive sampling was used to recruit self-identified primary caregivers of patients in evaluation for or who had undergone kidney or liver transplant and were involved in the Transplant Wellness Program. Data was collected through semi-structured Zoom interviews. Interviews were recorded, transcribed verbatim, and analyzed using conventional content analysis. Rigour was maintained through the use of an audit trail, reflexivity journaling, and peer debriefing.
Results: Eight participants were recruited, with four caregivers of post-transplant patients and four caregivers of pre-transplant patients. Four themes that emerged included: 1) Caregiver Strain, 2) Life Changes, 3) Individual Wellness Needs, and 4) Caregiving Needs. Within the themes, eight categories further described caregivers’ experiences and wellness needs. Categories included the impact of added responsibilities, emotional strain, changed relationships and priorities. Identified opportunities to support caregivers in their role included flexible wellness supports such as physical activity programming, social support from others in similar circumstances, and more structured support and communication from the health care system.
Discussion: Caregivers prioritized their loved one’s needs over their own, and experienced enormous stress due to the added responsibilities and constant uncertainty associated with their role. There is a need for comprehensive services to support caregivers in looking after their own wellness, while continuing to provide care to patients before and after transplantation. Results from this study will be used to address this critical need by informing the development of caregiver wellness resources for the Transplant Wellness Program, including delivery of social support groups and physical activity programming.

Keywords: Caregiving, Organ transplant

Authors:

Presenter - Jenna A.P. Sim, MSc,
Faculty of Kinesiology, The University of Calgary, Calgary, Alberta, Canada

Co-Author - Ashley L. Exall,
Faculty of Kinesiology, The University of Calgary, Calgary, Alberta, Canada

Co-Author - Maneka A. Perinpanayagam, PhD,
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Co-Author - Vanessa Bahry, BKin, CSEP-CEP,
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Co-Author - Debra L. Isaac, MD,
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Co-Author - Kelly W. Burak, MD, MSc (Epi),
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Co-Author - Stefan Mustata, MD,
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Co-Author - S. Nicole Culos-Reed, PhD,
Faculty of Kinesiology, The University of Calgary, Calgary, Alberta, Canada

D198 - Chronic Overlapping Pain Conditions and Reproductive Health Symptoms in Veterans: Insights from the Million Veteran Program

Poster Number: D198
Time: 11:00 AM - 11:50 AM
Topics: Pain, Military and Veterans' Health

Chronic overlapping pain conditions (COPCs) encompass a range of persistent pain disorders, including migraine, tension headache, irritable bowel syndrome, chronic back pain, temporomandibular disorder, chronic fatigue syndrome, chronic prostatitis/chronic pelvic pain syndrome, and fibromyalgia. COPCs account for half of all chronic pain cases and are characterized by persistence, co-occurrence, and impairment. Despite their prevalence and impact on overall health, little is known about the relationship between COPCs and reproductive health. In this cohort study (N=334,379), using data from men (n=304,602) and women (n=29,777) Veterans in the Million Veteran Program, we evaluated the association between COPCs and self-reported “fertility problems” and reproductive health history – including sexual problems (e.g., pain with intercourse), erectile dysfunction (ED), pregnancy history (including miscarriage and stillbirth), and gynecological surgery. The number of lifetime COPCs was derived from electronic health record diagnoses (possible range 0-8). Analyses were conducted separately for men and women, including all ages and within specified age groups (≤ 40 and >40 years). Fertility issues were reported by 4% of men and 12% of women with no COPCs and by 11% of men and 23% of women with three or more COPCs. In all ages, each additional COPC (over none) was associated with a 16% increase in the likelihood of fertility problems (p < .001), with the greatest association during peak reproductive years (≤40 years; ORmen = 1.27 (95%CI 1.17, 1.37), ORwomen = 1.15 (95% CI 1.081, 1.22), both p <.001). Both men and women under 40 were increasingly more likely to report reproductive health issues with each additional COPC compared to individuals without COPCs. The largest difference was between three or more COPCs and none. Men reported more ED (35% v 15%, p < .001), sexual problems (20% v. 5%, p < .001), and difficulty urinating (20% v. 6%, p < .001) than men without COPCs. Women reported more sexual problems (46% v. 23%, p < .001), oophorectomy (4% v. 1%, p < .001), hysterectomy (10% v. 3%, p < .001) and miscarriage (41% v. 32%, p = .002) than women without COPCs. Our findings showed a positive association between COPC and fertility and related reproductive health issues in both men and women Veterans. Further research is needed to explore the biological and psychosocial mechanisms that underlie the association between COPCs, fertility, and reproductive health.

Keywords: Pain, Sexual functioning

Authors:

Author - Armand Gerstenberger,
VA PUGET SOUND HEALTHCARE SYSTEM

Co-Author - Marianna Gasperi, PhD, PhD,
Unviersity of Washington

D199 - Associations Between Religiosity and Using Prayer to Cope with Pain in an In-Patient Setting

Poster Number: D199
Time: 11:00 AM - 11:50 AM
Topics: Integrative Health and Spirituality, Pain

Prayer is one way individuals cope with acute and chronic pain, but a better understanding of this behavior within in-patient settings is needed. This study examined associations between the Duke University Religion Index (DUREL), which examines three dimensions of religious engagement, and participants' use of prayer to cope with pain during a hospital stay. Participants were recruited from two hospitals in a large system in Memphis, TN. A cross-sectional survey asked demographics, the DUREL, if patients used prayer or other practices to cope with pain during their stay, and what types of practices they used. Participants were categorized as not using prayer if they said no to using prayer/other practices during their stay or did not report prayer as a practice type. A logistic regression examined DUREL total scores (continuous, possible range: 5-27) and use of prayer (yes/no). The model included rating of pain (continuous, possible range: 1-6), age (continuous), sex (male/female), and race (African American/Other). On average, participants (n=482) were 61.7 (SD=14.4) years old and reported their pain as moderate to severe (M=4.4, SD=1.5)). Most participants identified as female (59.5%) and African American (71%). Total DUREL scores were high (M=21.6, SD=4.1) and most participants reported using prayer during their stay (59%). Patients with higher DUREL scores and pain levels had higher odds of reporting the use of prayer (1.12 (1.06, 1.18), p<0.001; 1.45 (1.26, 1.68), p<0.001, respectively). Patients who were African American were more likely than those of other racial groups to report using prayer during their stay (1.65 (1.02, 2.67), p=0.04). As the total score was statistically significant, the three DUREL subscales were examined. Engaging in activities such as prayer at home and having a personal religious commitment were associated with using prayer (1.26 (1.10, 1.44), p<.001; 1.95 (1.42, 2.67, p<0.001), respectively), but attending religious services was not. In all subscale models, patients who were African American and those with higher pain levels had higher odds of using prayer. When only religious affiliation is used to understand patients' religiosity in hospitals, the multidimensional relationship between religious engagement and health can be lost. The study’s findings reinforce the importance of spiritual care teams within hospitals as well as training healthcare professionals in caring for patients' spiritual and physical health needs.

Keywords: Pain, Religion/Spirituality

Authors:

Co-Author - Jonathan Lewis,
Methodist Le Bonheur Healthcare

Co-Author - Jamaica Ivery-Glover,
Methodist Le Bonheur Healthcare

Co-Author - Briana Baptist,
Methodist Le Bonheur Healthcare

Co-Author - Jenna Warnock,
Appalachian State University

Co-Author - Rachel Lowry,
Appalachian State University

Co-Author - Sherrhoda Townsend,
Methodist Le Bonheur Healthcare

Co-Author - Stacy Smith,
Methodist Le Bonheur Healthcare

Co-Author - Sandra Madubuonwu,
Methodist Le Bonheur Healthcare

D200 - An Experiential Training Program to Promote Engagement with Social Determinants of Health among Clinical Psychology Graduate Students in an Integrated Primary Care Setting

Poster Number: D200
Time: 11:00 AM - 11:50 AM
Topics: Education, Training, and Career Development, Integrated Primary Care

Negative social determinants of health (SDOH) are linked to a myriad of physical and mental health dilemmas, including obesity, depression, and substance use disorders. While evidence suggests that training medical learners (i.e., medical residents, medical students) in this area has led to increased knowledge of, and willingness to engage in, discussions of SDOH with patients, to date no work has examined whether engaging in training in this area for mental health professionals, specifically clinical psychology doctoral students, can elicit similar benefit.

This project examined the efficacy of an experiential training program to facilitate increased understanding of, and clinical engagement with, SDOH for clinical psychology doctoral trainees enrolled in an integrated behavioral medicine practicum training program. Students (n=8) were enrolled in a 3-part training program at the start of their practicum year. Part 1: A one-hour seminar introducing SDOH, its relevance to psychotherapy and how to screen for SDOH. Part 2: A 3-hour experiential activity including researching census data on the local zip-code, a self-guided Walking Survey of the surrounding community, and a written reflection. Part 3: A one-hour debrief of their experience and sharing of SDOH related community resources and clinical services that they could connect their patients to. Students completed a self-report assessment immediately prior to, immediately after, and one year after the training.

Students reported gains in knowledge of SDOH, comfort in discussing SDOH with patients and incorporating them into treatment planning, and awareness of community resources from pre- to post-training that were maintained at one-year follow-up. Results were also compared to a control cohort of students (n=9) who were in a similar stage of practicum training but without this SDOH training. Compared to this control cohort, at one-year follow up students who completed the training reported stronger beliefs about the importance of incorporating SDOH into regular assessment, that knowledge of SDOH would change their medical decision-making, and greater comfort in engaging with SDOH challenges with individuals demographically different from themselves. Findings suggest that low intensity training such as this can have durable effects on students’ engagement with SDOH in their clinical care and speak to the utility of broader dissemination of such experiential SDOH training among psychology trainees.

Keywords: Training, Education

Authors:

Co-Author - Betsy Mathew, MD,
Rutgers - Robert Wood Johnson Medical School

D201 - Co-creating behaviour change technique activities with people who will deliver them: The Cards for Change

Poster Number: D201
Time: 11:00 AM - 11:50 AM
Topics: Education, Training, and Career Development, Dissemination and Implementation

Background: The Behaviour Change Technique Taxonomy v1 describes 93 discrete
behaviour change techniques. The smoking cessation behaviour change technique
taxonomy, describes 43 discrete techniques for behaviour change support in smoking
cessation.
Objectives: We aimed to develop two packs of cards with a description of a behaviour
change technique on one side and a feasible, enjoyable suggestion for using that technique
in health professional training or smoking cessation conversations.
Methods: With a group of experts in a) behaviour change (N=2), b) health professional
training or smoking cessation (N=28) and c) both (N=6), we ran co-creation workshops to
propose, discuss and refine behaviour change techniques and ways of using them in
practice. The smoking cessation workshops included bilingual experts so that the cards
could be produced in English and Welsh. The other set of cards has been directly translated
into French.
Results: We created suggestions for a proportion of techniques: 34 education and training
cards and 43 smoking cessation cards. Experts thought that some techniques could not be
carried out independently or at all. Experts had advice about how to deliver techniques and
how to make playing with the cards engaging, making learning about behaviour change
techniques more enjoyable and effective.
Conclusion: The Cards for Change illustrate a co-creation method of developing feasible
behaviour change technique examples. Further, they demonstrate using game approaches
to learn about behaviour change techniques. Future research will concentrate on exploring
the feasibility and discriminant content validity of the activities and the efficacy of the game
approach in learning about behaviour change techniques.

Keywords: Behavior Change, Education

Authors:

Presenter - Jo Hart, PhD, PhD,
University of Manchester

Co-Author - Eleanor Bull,
University of Manchester and Derbyshire county council

Co-Author - Lucie Byrne-Davis,
University of Manchester

D202 - Persuasiveness of Narrative versus Informational Videos Depends on Perceived Risk

Poster Number: D202
Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Cancer

Background. Narrative messages are believed to be more persuasive and elicit less message rejection than informational messages. We explored whether perceived risk moderates this relationship among people viewing brief video messages promoting colorectal cancer (CRC) screening. Methods. Participants (N=422, 45-75 years, not adherent to CRC screening, no history of CRC) were recruited from Prolific. Participants were randomly assigned to view one of 6 versions of a narrative video (n=362) or an informational video (n=60). Next, they completed assessments of CRC screening intentions, perceived absolute risk for CRC, and multiple indicators of message rejection (effectiveness, derogation, counterarguing, and source credibility). We tested if interactions between video condition and perceived risk were associated with each message rejection variable and whether perceived risk moderated a mediated pathway from video condition to message rejection to CRC screening intentions (moderated mediation). Results. In bivariate analysis, video condition was not associated with screening intentions, perceived risk or indicators of message rejection, ps>.422). However, the interaction between video condition (narrative vs. informational) and perceived risk was associated with each indicator of message rejection (ps<.02). Participants with higher perceived risk had more negative perceptions of the narrative than informational video, with the opposite trend for those with lower perceived risk. There was evidence of the predicted moderated mediation for effectiveness, derogation, and source credibility, but not counterarguing: the mediational pathway from video condition to screening intentions through message rejection was only significant for participants with higher perceived risk. People with higher perceived risk rejected the informational video less than the narrative videos and had stronger intentions to be screened after watching the informational than narrative video. Discussion. The majority of people have low perceptions of risk for CRC and other cancers and for these individuals, narrative messages may elicit less message rejection than informational messages. However, for those with high perceived risk, informational messages may elicit less rejection, perhaps because the facts-based approach is consistent with their perceptions of CRC as a significant and serious threat. Findings could inform other tailored communication such as provider-patient conversations.

Keywords: Risk perception, Health communication

Authors:

Presenter - Heather Orom, PhD, PhD,
University at Buffalo

Co-Author - Natasha C. Allard, MBA, MBA,
University at Buffalo School of Public Health and Health Professions

Co-Author - Amy McQueen, PhD, PhD,
Washington Universityint St. Louis

Co-Author - Marc Kiviniemi, PhD,
University of Kentucky

Co-Author - Erika Waters, PhD,
Washington University in St. Louis

Co-Author - Jennifer Hay, PhD,
Memorial Sloan Kettering Cancer Center

D203 - APOL1 Genetic Testing Preferences among Potential Living Kidney Donors using Best-Worst Scaling

Poster Number: D203
Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Health Communication and Policy

Purpose: This study explores Black American (BA) potential living donors’ genetic testing preferences for high-risk APOL1 variants as part of the medical evaluation process for potential living kidney donors.
Methods: An online survey was administered to a Qualtrics panel (n=517) to assess the level of importance potential living donors placed on the risks and benefits associated with APOL1 genetic testing. The survey included a best-worst scaling experiment with an experimental design of 18 profiles, each with 6 attribute/level combinations. Respondents were randomized to one of three groups and each respondent viewed six profiles. A mean score was calculated to represent the number of times an attribute/level combination was selected as best minus the number of times it was selected as worst divided by the total number of times it was shown.
Results: All participants identified as BA; 5% identified as Afro-Latinx. 67.1% of the sample were female, with a mean age of 38 years (SD= 12.2). Most participants had equivalent to a high school education or greater (89.2%), and a household income of < $75,000 per year (74.7%). Nearly all participants (97.5%) reported awareness of organ donation, and 35.2% were registered organ donors. The most preferred attributes were $0 cost for genetic testing (Mean score (M)= 0.5), followed by an 8-year gain in recipient life (0.3), and a 5-year gain in recipient life (M= 0.2). The least preferred attributes were $100 for the cost of genetic testing (-0.4), employer access to genetic test results (-0.3), and a 35% chance of having APOL1 risk variants (M= -0.3). Additionally, participants indicated a preference for offering all potential donors the option of APOL1 genetic testing (M=0.2), rather than offering testing based on race (-0.1) or ancestry (-0.1).
Conclusion: Results indicate which attributes of APOL1 genetic testing may drive the decision of whether to test and provide important information that will be used to build a decisional support tool for BA potential living donors. Findings can also be used to design policy and communication about APOL1 testing.

Keywords: Decision making, Genetics

Authors:

Author - Ilene Hollin, PhD,
Health Services, Administration and Policy Department, Temple University

Co-Author - Heather Marie Gardiner, PhD,
Social and Behavioral Sciences Department, Temple University

Co-Author - Ryan Blunt, MPH,
Social and Behavioral Sciences Department, Temple University

Co-Author - Sarah Bass, PhD,
Social and Behavioral Sciences Department, Temple University

Co-Author - Melody Slashinski, PhD,
Social and Behavioral Sciences Department, Temple University

Co-Author - Avrum Gillespie, Nephrologist ,
Lewis Katz School of Medicine, Temple University

Co-Author - Joie Cooper,
Social and Behavioral Sciences Department, Temple University

D204 - Explanations for one's illness risk: Lessons learned from COVID-19

Poster Number: D204
Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Social and Environmental Context and Health

BACKGROUND
Explanations for illness risks provide critical insights into how risk perceptions are formed, shaping behavioral responses. Yet, there is scant research examining the attributions people make when judging their risk for contracting a novel disease. In this study we explore people’s attributions for their perceived risk of contracting COVID-19 in order to anticipate effective risk messaging for future disease outbreaks.

METHODS
We collected qualitative responses (N=2271) between June and July 2020 in the U.S. Research questions included (1) What were the attributions people made to explain their perceived risk for COVID-19? (2) How did the attributions differ as a function of perceived risk levels (high, low, uncertain about risk)?

RESULTS
Participants’ attributions generally related to internal characteristics, compromised agency and control, environmental factors, and pandemic unpredictability. Respondents with low or high perceived risk (53.9% and 18.5% of the sample, respectively) often attributed their risk to internal characteristics, with individuals perceiving low risk citing protective behaviors like social distancing, while those perceiving high risk citing their vulnerable health. Environmental factors were another common attribution; those perceiving low risk described safe environments, such as remote work, while those perceiving high risk cited unsafe work environments. Those who perceived themselves to be at higher or uncertain about their risk reported lower agency, citing concerns over contagiousness and others' noncompliance with safety measures. Those who reported uncertainty also cited pandemic unpredictability, highlighting the unknown nature of the virus. Religious beliefs or the perception of the pandemic as a hoax were also mentioned, albeit less frequently across all risk levels.

CONCLUSIONS AND IMPLICATIONS
These findings can help anticipate responses to other contagious disease outbreaks and increase preparedness for future pandemics, where rising incidence is a formidable challenge for public health. Tailored messaging that reinforces protective behaviors while acknowledging the challenges of unpredictability of contagious disease outbreaks could improve adherence to safety measures. Additionally, understanding the role of religious beliefs and trust in shaping risk perceptions may help in developing more nuanced and targeted risk messaging.

Keywords: Risk perception, Illness behavior

Authors:

Presenter - Malwina Maja Lewicka, PhD, PhD,
Cornell Tech

Co-Author - Jada G. Hamilton, PhD, MPH, PhD, MPH,
Memorial Sloan Kettering Cancer Center

Co-Author - Heather Orom, PhD, PhD,
University at Buffalo

Co-Author - Erika A. Waters, PhD, MPH, FSBM, PhD, MPH, FSBM,
Washington University School of Medicine

Co-Author - Natasha C. Allard, MBA, MBA,
University at Buffalo School of Public Health and Health Professions

Co-Author - Florence Lui, PhD, PhD,
Memorial Sloan Kettering Cancer Center

Co-Author - Sukruthi Yerramreddy,
University of Kentucky

Co-Author - Peter Kanetsky, PhD ,
Lee Moffitt Cancer Center

Co-Author - Marc T. Kiviniemi, PhD, FSBM, PhD, FSBM,
University of Kentucky

Co-Author - Jennifer L. Hay, PhD, FSBM, PhD, FSBM,
Memorial Sloan Kettering Cancer Center

D205 - Physical activity and nutrition in soft tissue sarcoma patients: Needs assessment for a prehabilitation program

Poster Number: D205
Time: 11:00 AM - 11:50 AM
Topics: Cancer, Multiple Health Behavior Change

Introduction: Soft tissue sarcomas (STS) are rare, malignant tumors mainly found in the extremities and trunk. Treatment of STS includes salvage surgery and possibly chemotherapy and/or radiation. Despite treatment advances, patients may experience side effects including functional decline, fatigue, and reduced quality of life. In other cancers, prehabilitation (preoperative exercise and diet interventions) has been associated with increased postoperative physical function, enhanced recovery, and increased quality of life; however, prehabilitation in STS patients remains understudied. This study assessed STS patients’ needs and preferences for lifestyle prehabilitation programs.

Methods: STS patients completed an online questionnaire including cancer and treatment history and current physical activity and diet. They also participated in a semi-structured interview including questions about their treatment and symptoms, lifestyle behaviors, and feedback and preferences for prehabilitation physical activity and nutrition programming. Data from interviews were analyzed by 5 research team members using an inductive approach through thematic text analysis.

Results: Participants (N = 20) were 50% female, ages 22 to 77 years. Patients who received chemotherapy before surgery (83%) felt fatigue and loss of appetite. Patients who received radiation (63%) felt fatigue and loss of physical function. Five themes emerged from the interviews for patients’ needs and preferences towards prehabilitation: (1) Prehabilitation lifestyle resources to allow ownership over recovery; (2) Consistent reinforcement and feedback; (3) Tracking external factors that influence lifestyle habits; (4) Social support from other STS survivors; and (5) Remote access to support and resources.

Discussion: Participants emphasized the need for prehabilitation resources like physical activity and nutrition recommendations before surgery, as early access would empower them to take ownership of their recovery. They expressed interest in regular reinforcement and utilizing tools like wearables or apps. Participants suggested future lifestyle interventions should consider external factors like mental health, symptoms, side effects, and family stressors when designing programs. Lastly, support from other STS survivors was seen as valuable for accountability and encouragement. Overall, participants viewed a prehabilitation program as beneficial to improve postoperative outcomes and quality of life.

Keywords: Cancer, Behavior Change

Authors:

Author - Jacqueline Guzman, PhD,
Medical College of Wisconsin

Co-Author - John Charlson, MD,
Medical College of Wisconsin

Co-Author - Jessica Liu, BS,
Medical College of Wisconsin

Co-Author - Kelly Clohesey, MOT,
Medical College of Wisconsin

Co-Author - Zechariah Cummings,
University of Wisconsin-Milwaukee

Co-Author - Johnathan Bedolla,
University of Wisconsin-Parkside

Co-Author - Whitney A. Morelli, PhD,
Medical College of Wisconsin

Poster Session D

Description

Date: 3/28/2025
Start: 11:00 AM
End: 11:50 AM
Location: Grand Ballroom A-B