Times are displayed in (UTC-05:00) Central Time (US & Canada) Change
Poster Session E
Housing as a Social Determinant of Health: Older Adults' Experiences in Rural Government-Assisted Housing
Poster Number: E1Time: 05:00 PM - 05:50 PM
Topics: Aging, Social and Environmental Context and Health
Background/Purpose: Older adults in rural government-assisted housing face complex challenges related to housing quality, social isolation, and health management. Limited research has explored their lived experiences, particularly in rural settings where resource constraints and geographic isolation may intensify health disparities.
Theoretical Framework: The study employed the Socioecological Model to examine multilevel influences on health and well-being among older adults in rural housing environments.
Methods: A qualitative descriptive study was conducted in Walker County, Alabama. Sixteen older adults (ages 60-85, average age 66.4 years) participated, including 11 Black/African American and 5 Non-Hispanic White residents. Semi-structured interviews were used to capture participants' experiences. Thematic analysis guided by the socioecological model was applied to analyze the data.
Results: Four primary themes emerged from the analysis. Housing as Foundation for Stability revealed how affordable housing provides relief and a sense of safety for older adults. The Double-Edged Sword of Living Alone captured the complex experiences of independence and isolation. Social Connections and Community Dynamics explored the nuanced patterns of social relationships and intentional distancing. Health Challenges and Housing Adaptation demonstrated how chronic conditions shape housing needs and coping strategies.
Conclusions and Implications: The study highlights the remarkable resilience of older adults navigating the tensions between independence and isolation in rural government-assisted housing. The findings suggest opportunities for nursing interventions targeting social isolation, community programming, and housing-health integration to support aging in place in rural settings. The research provides critical insights into the social determinants of health for vulnerable older adult populations.
Keywords: Aging, Health promotionTheoretical Framework: The study employed the Socioecological Model to examine multilevel influences on health and well-being among older adults in rural housing environments.
Methods: A qualitative descriptive study was conducted in Walker County, Alabama. Sixteen older adults (ages 60-85, average age 66.4 years) participated, including 11 Black/African American and 5 Non-Hispanic White residents. Semi-structured interviews were used to capture participants' experiences. Thematic analysis guided by the socioecological model was applied to analyze the data.
Results: Four primary themes emerged from the analysis. Housing as Foundation for Stability revealed how affordable housing provides relief and a sense of safety for older adults. The Double-Edged Sword of Living Alone captured the complex experiences of independence and isolation. Social Connections and Community Dynamics explored the nuanced patterns of social relationships and intentional distancing. Health Challenges and Housing Adaptation demonstrated how chronic conditions shape housing needs and coping strategies.
Conclusions and Implications: The study highlights the remarkable resilience of older adults navigating the tensions between independence and isolation in rural government-assisted housing. The findings suggest opportunities for nursing interventions targeting social isolation, community programming, and housing-health integration to support aging in place in rural settings. The research provides critical insights into the social determinants of health for vulnerable older adult populations.
Authors:
Author - Evans Kyei, PhD MSc. RN, The University of Alabama, Capstone College of Nursing
Co-Author - Mercy Mumba, PhD RN FAAN, The University of Alabama Capstone College of Nursing
A qualitative exploration of social connectedness among adolescents and young adults with cancer
Poster Number: E10Time: 05:00 PM - 05:50 PM
Topics: Cancer, Social and Environmental Context and Health
Background: Diminished social connectedness (connections/relations with others) is a major risk factor for poorer health and well-being among individuals with cancer. Given their age and developmental period, adolescents and young adults (AYAs; ages 15-39) coping with cancer often experience abrupt changes in their social relationships. While previous research has examined the types of supportive and unsupportive social relationships among AYA with cancer, limited work has focused on identifying how AYAs perceive their social networks to be changing over time and desired needs associated with those changes. The aim of this qualitative study was to explore the experiences of social connectedness over time among AYAs with cancer.
Methods: Participants were 24 AYAs with cancer (Mage=28.5, SD=6.0, Range=17-38; 58% female) enrolled in a larger longitudinal study focused on social networks and well-being. AYAs were offered participation in a brief qualitative interview after their last survey (at 6 months post baseline) to understand their felt experiences of changes in social connectedness among members of their social networks (e.g., family, friends). Relevant themes identified in the literature and through social cognitive processing theory and stress buffering frameworks guided the development and use of semi-structured interview guides. Content-structuring qualitative analysis was used to identify themes using ATLAS.ti software.
Results: Across AYAs, four main themes emerged: Relationship Shifts: strengthening and/or weakening of relationship dynamics and communication over time; Adapting to a New Social Lifestyle: difficulty adjusting back to pre-cancer social life and expectations post-treatment; Resource Needs: desire for felt connection to cancer peers to navigate social challenges; Cancer Survivor Identity: navigating the integration of the cancer experience into establishing and/or maintaining social connections.
Conclusion: Social challenges are a major issue for AYA cancer patients. Our findings shed light on how AYAs perceive their social networks to be changing over time. Our results additionally highlight areas of social connectedness that can be leveraged to better deliver targeted psychosocial and evidence-based interventions that enhance the long-term health and well-being among AYAs with cancer.
Keywords: Social support, Cancer survivorshipMethods: Participants were 24 AYAs with cancer (Mage=28.5, SD=6.0, Range=17-38; 58% female) enrolled in a larger longitudinal study focused on social networks and well-being. AYAs were offered participation in a brief qualitative interview after their last survey (at 6 months post baseline) to understand their felt experiences of changes in social connectedness among members of their social networks (e.g., family, friends). Relevant themes identified in the literature and through social cognitive processing theory and stress buffering frameworks guided the development and use of semi-structured interview guides. Content-structuring qualitative analysis was used to identify themes using ATLAS.ti software.
Results: Across AYAs, four main themes emerged: Relationship Shifts: strengthening and/or weakening of relationship dynamics and communication over time; Adapting to a New Social Lifestyle: difficulty adjusting back to pre-cancer social life and expectations post-treatment; Resource Needs: desire for felt connection to cancer peers to navigate social challenges; Cancer Survivor Identity: navigating the integration of the cancer experience into establishing and/or maintaining social connections.
Conclusion: Social challenges are a major issue for AYA cancer patients. Our findings shed light on how AYAs perceive their social networks to be changing over time. Our results additionally highlight areas of social connectedness that can be leveraged to better deliver targeted psychosocial and evidence-based interventions that enhance the long-term health and well-being among AYAs with cancer.
Authors:
Presenter - Katie Darabos, PhD, Rutgers School of Public Health/Rutgers Cancer Institute
Co-Author - Shannon Desbiens, BA, Rutgers School of Public Health
Co-Author - Sean McHugh, BS, Rutgers School of Public Health
Co-Author - Katie Devine, PhD, FSBM, Rutgers Cancer Institute
Assessing Implementation Readiness of Key Stakeholders for Universal School-Based Depression Screening
Poster Number: E100Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Child and Family Health
Despite estimates that nearly 20% of adolescents in the U.S. have a diagnosable psychiatric disorder, depression screening rates remain extremely low. Given their broad access to youth, schools are considered an optimal setting for improving screening rates. However, significant barriers continue to impede widespread implementation of school-based depression screening. We report findings from a comprehensive mixed-methods research project designed to evaluate the feasibility and acceptability of implementing a policy mandated screening program for adolescent depression in schools. Key implementation stakeholders were identified in collaboration with a community advisory board. Interviews with samples of school administrators and health professionals (N=15 key-informant interviews and N=70 school psychologists and social workers surveyed) assessed school personnel’s implementation readiness. Inputs from prominent mental health advocacy organizations and professional associations active on this policy were derived from content analyses of state legislative hearings, reports and testimonials (N=99), local news stories (N=213), and official statements (N=27). A state representative sample of parents of adolescents (N=678) was also surveyed to assess their views and concerns regarding implementation. All stakeholder groups recognized the preventive utility of screening adolescents for depression but raised distinct concerns. School personnel were mostly concerned about feasibility in the absence of adequate resources, support and training. Mental health advocates/professionals expressed significant concerns about the suitability of a standard screening instrument for diverse student populations and the lack of explicit provisions connecting screening to follow-up diagnosis and treatment. Parents were primarily concerned about potential adverse effects on privacy, treatment, and stigma; parents from underserved groups additionally noted concerns about affording further evaluation and services. Addressing these concerns during the legislative process can reduce ambiguity and strengthen the foundation for successful, widespread implementation.
Keywords: Adolescents, DepressionAuthors:
Co-Author - Cynthia Blitz, Rutgers University
Co-Author - David Amiel, Rutgers University
Co-Author - Itzhak Yanovitzky, Rutgers University
Association between autism spectrum disorder diagnosis and depression among children aged 5–17 years: a cross-sectional study using National Health Interview Survey data
Poster Number: E101Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Child and Family Health
Background: Depression is increasingly prevalent among children, particularly those
diagnosed with autism spectrum disorder (ASD). While previous research has established that
depressive symptoms are common in children with ASD, few studies have examined whether
an ASD diagnosis independently predicts depression on a national scale. Additionally, the
role of sex differences in this relationship remains unclear. This study examined (1) whether
an ASD diagnosis is associated with depression among U.S. children aged 5–17, and (2)
whether this association varies by sex.
Method: Data were drawn from the 2023 National Health Interview Survey (NHIS),
comprising adult-reported information on 5,650 children. Descriptive statistics, bivariate
tests, and multiple linear regression were used to assess the association between ASD
diagnosis and depression. A sex interaction term was included to test for moderation effects.
Results: Children with ASD had significantly higher depression scores compared to their
peers, even after adjusting for sociodemographic and clinical factors (adjusted β = 0.056;
95% CI = 0.006, 0.106; p = .02). Sex did not significantly moderate this association (p = .11).
Conclusion: These findings highlight a heightened risk of depression among children with
ASD. To reduce this burden, routine mental health screening in pediatric care and early,
ASD-specific interventions should be prioritized.
Keywords: Depression, Children's healthdiagnosed with autism spectrum disorder (ASD). While previous research has established that
depressive symptoms are common in children with ASD, few studies have examined whether
an ASD diagnosis independently predicts depression on a national scale. Additionally, the
role of sex differences in this relationship remains unclear. This study examined (1) whether
an ASD diagnosis is associated with depression among U.S. children aged 5–17, and (2)
whether this association varies by sex.
Method: Data were drawn from the 2023 National Health Interview Survey (NHIS),
comprising adult-reported information on 5,650 children. Descriptive statistics, bivariate
tests, and multiple linear regression were used to assess the association between ASD
diagnosis and depression. A sex interaction term was included to test for moderation effects.
Results: Children with ASD had significantly higher depression scores compared to their
peers, even after adjusting for sociodemographic and clinical factors (adjusted β = 0.056;
95% CI = 0.006, 0.106; p = .02). Sex did not significantly moderate this association (p = .11).
Conclusion: These findings highlight a heightened risk of depression among children with
ASD. To reduce this burden, routine mental health screening in pediatric care and early,
ASD-specific interventions should be prioritized.
Authors:
Presenter - Chia-Shuan Chang, University of Maryland, College Park
Co-Author - Ebbie Kalan, PhD, University of Maryland, College Park
Correlates of Depression Among Men with HIV in India: Secondary Analysis of Endline Data from a Randomized Controlled Trial
Poster Number: E102Time: 05:00 PM - 05:50 PM
Topics: Mental Health, HIV/AIDS
Background: Depression is a common mental health issue among people with HIV (PWH), particularly in low- and middle-income countries. In India, men living with HIV who consume alcohol face elevated risks due to the intersecting challenges of substance use, stigma, and limited access to mental health care. However, research on factors associated with depression in this population remains limited.
Objective: This study aimed to identify factors associated with depressive symptoms among Indian men living with HIV.
Methods: We analyzed endline survey data from a randomized controlled trial (2014–2018) conducted at four government antiretroviral therapy (ART) centers in Mumbai, India. Three ART centers implemented a multi-level intervention (individual counseling, group intervention, and collective advocacy), while one provided standard care per national guidelines. Of 752 baseline participants, 565 completed the final survey. Depression was measured using the 10-item Center for Epidemiologic Studies-Depression (CES-D) scale. Multivariable linear regression was used to assess factors associated with depression, including alcohol use, family support, quality of life, ART adherence, CD4 count, HIV-related symptoms, and intervention group status, adjusting for sociodemographic factors (age, education, marital status, employment, and income).
Results: Approximately 24% of participants screened positive for depression. Higher QOL (β = -0.15, p < 0.05), stronger family support (β = -0.13, p < 0.05), and participation in the multi-level intervention (β = -0.12, p < 0.05) were associated with fewer depressive symptoms. Conversely, greater HIV-related symptom burden was linked to higher depressive symptoms (β = 0.21, p < 0.05). The model explained 23% of the variance in depression (R² = 0.23).
Conclusion: Our findings highlight the potential of multi-level interventions, improved quality of life, and strong family support to reduce depressive symptoms among men living with HIV in India. Integrated approaches addressing mental health, quality of life, and social support may mitigate depression and enhance overall health outcomes in this population.
Keywords: Depression, HIVObjective: This study aimed to identify factors associated with depressive symptoms among Indian men living with HIV.
Methods: We analyzed endline survey data from a randomized controlled trial (2014–2018) conducted at four government antiretroviral therapy (ART) centers in Mumbai, India. Three ART centers implemented a multi-level intervention (individual counseling, group intervention, and collective advocacy), while one provided standard care per national guidelines. Of 752 baseline participants, 565 completed the final survey. Depression was measured using the 10-item Center for Epidemiologic Studies-Depression (CES-D) scale. Multivariable linear regression was used to assess factors associated with depression, including alcohol use, family support, quality of life, ART adherence, CD4 count, HIV-related symptoms, and intervention group status, adjusting for sociodemographic factors (age, education, marital status, employment, and income).
Results: Approximately 24% of participants screened positive for depression. Higher QOL (β = -0.15, p < 0.05), stronger family support (β = -0.13, p < 0.05), and participation in the multi-level intervention (β = -0.12, p < 0.05) were associated with fewer depressive symptoms. Conversely, greater HIV-related symptom burden was linked to higher depressive symptoms (β = 0.21, p < 0.05). The model explained 23% of the variance in depression (R² = 0.23).
Conclusion: Our findings highlight the potential of multi-level interventions, improved quality of life, and strong family support to reduce depressive symptoms among men living with HIV in India. Integrated approaches addressing mental health, quality of life, and social support may mitigate depression and enhance overall health outcomes in this population.
Authors:
Presenter - Toan Ha, University of Pittsburgh School of Public Health
Co-Author - Thien Pham, University of Pittsburgh School of Public Health
Co-Author - Roopal Sign, Population Council Institute, India
Co-Author - Stephen Schensul, UConn Health School of Medicine
Prioritizing Participant Protection: Lessons Learned from the Foster TALES Study
Poster Number: E103Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Methods and Measurement
Experiences of trauma and violence are pervasive among populations affected by structural inequities, shaping mental health trajectories across the lifespan. Advancing behavioral medicine requires rigorous research on trauma-related processes, including risk and resilience pathways, yet such inquiry often entails asking participants to revisit distressing life events. While essential for developing trauma- and violence-informed (TVI) interventions, these research practices can inadvertently heighten participant burden, evoke acute distress, or trigger re-traumatization. This tension raises critical ethical and methodological questions: How can researchers generate new knowledge about trauma while safeguarding the wellbeing of those who participate?
This presentation synthesizes contemporary scholarship on TVI research methods and procedures, highlighting their promise as well as their limitations. I appraise strategies designed to reduce harm, manage risk, and foster trust when engaging with participants who hold complex trauma histories. To ground these considerations, I draw on lessons from Foster TALES, a mixed-methods study of emerging adults transitioning out of foster care. This exemplar illustrates evidence-informed strategies used at multiple points in the research process—from study design and recruitment to data collection, debriefing, and follow-up—to mitigate potential harms and enhance participant safety.
Findings underscore both opportunities and gaps in current approaches. Specifically, they point to the need for greater integration of ethical safeguards with methodological innovation, as well as the importance of embedding TVI principles into the research ecosystem itself. By centering participant safety as a scientific priority, behavioral medicine can more effectively generate actionable insights while also modeling equity-oriented, ethically sound approaches to inquiry. Such innovations are essential to advancing discovery at the intersection of trauma science, mental health research, and social justice.
Keywords: Methods, TraumaThis presentation synthesizes contemporary scholarship on TVI research methods and procedures, highlighting their promise as well as their limitations. I appraise strategies designed to reduce harm, manage risk, and foster trust when engaging with participants who hold complex trauma histories. To ground these considerations, I draw on lessons from Foster TALES, a mixed-methods study of emerging adults transitioning out of foster care. This exemplar illustrates evidence-informed strategies used at multiple points in the research process—from study design and recruitment to data collection, debriefing, and follow-up—to mitigate potential harms and enhance participant safety.
Findings underscore both opportunities and gaps in current approaches. Specifically, they point to the need for greater integration of ethical safeguards with methodological innovation, as well as the importance of embedding TVI principles into the research ecosystem itself. By centering participant safety as a scientific priority, behavioral medicine can more effectively generate actionable insights while also modeling equity-oriented, ethically sound approaches to inquiry. Such innovations are essential to advancing discovery at the intersection of trauma science, mental health research, and social justice.
Authors:
Author - Brianna Jackson, PhD, MScN, RN, University of Wisconsin-Madison
Post-Traumatic Growth in Substance Use Recovery: Impact of Stigma-Reduction Campaign Exposure
Poster Number: E104Time: 05:00 PM - 05:50 PM
Topics: Mental Health
Background: Post-traumatic growth (PTG) refers to positive psychological change that emerges following trauma or major life crises. PTG is particularly relevant to individuals in recovery, as many have endured trauma before or during substance use, and recovery itself can catalyze growth. The Live Tampa Bay Stories Ending Stigma campaign is a large-scale, contact-based storytelling initiative aimed at reducing addiction-related stigma in the Tampa Bay region. By highlighting recovery narratives and growth experiences, the campaign worked to normalize treatment and recovery, challenge stereotypes, and foster connection. This study examined whether PTG scores differed between adults in recovery who were exposed to the Stories Ending Stigma campaign and those who were not.
Methods: Data were collected from 318 adults in recovery. PTG was assessed using a modified inventory that included five established domains (Relating to Others, New Possibilities, Personal Strength, Spiritual and Existential Change, and Appreciation of Life) along with an additional domain focused on physical and mental health to reflect recovery-specific growth. To examine differences in PTG between campaign-exposed and non-exposed participants, an independent samples t-tests was conducted, and effect sizes were calculated using Cohen’s d.
Results: Participants were predominantly male (69%), White (67%), with an average age of 36.73 (SD = 11.84). Significant group differences were found for Relating to Others (t = -2.48, p < .05, d = .35) and Spiritual and Existential Change (t = -3.00, p < .01, d = .36). Campaign-exposed individuals reported higher scores. No significant differences were found for the remaining 4 domains.
Conclusion: Campaign exposure may be linked to greater interpersonal and existential growth. By promoting connection and reframing recovery as a strength-based process, the Stories Ending Stigma campaign may support PTG among individuals in recovery. Future research should identify which PTG domains are most responsive to stigma-reduction messaging and further examine the roles of relationships, existential change, and spirituality in recovery. These findings highlight the broader potential of narrative-based interventions to enhance growth-related outcomes and reduce internalized stigma, underscoring the need for scalable, community-driven approaches to support recovery.
Keywords: Substance abuse, TraumaMethods: Data were collected from 318 adults in recovery. PTG was assessed using a modified inventory that included five established domains (Relating to Others, New Possibilities, Personal Strength, Spiritual and Existential Change, and Appreciation of Life) along with an additional domain focused on physical and mental health to reflect recovery-specific growth. To examine differences in PTG between campaign-exposed and non-exposed participants, an independent samples t-tests was conducted, and effect sizes were calculated using Cohen’s d.
Results: Participants were predominantly male (69%), White (67%), with an average age of 36.73 (SD = 11.84). Significant group differences were found for Relating to Others (t = -2.48, p < .05, d = .35) and Spiritual and Existential Change (t = -3.00, p < .01, d = .36). Campaign-exposed individuals reported higher scores. No significant differences were found for the remaining 4 domains.
Conclusion: Campaign exposure may be linked to greater interpersonal and existential growth. By promoting connection and reframing recovery as a strength-based process, the Stories Ending Stigma campaign may support PTG among individuals in recovery. Future research should identify which PTG domains are most responsive to stigma-reduction messaging and further examine the roles of relationships, existential change, and spirituality in recovery. These findings highlight the broader potential of narrative-based interventions to enhance growth-related outcomes and reduce internalized stigma, underscoring the need for scalable, community-driven approaches to support recovery.
Authors:
Presenter - Jocelyn Jarvis, BS, University of South Florida
Co-Author - Sierra Tentis, MPH, University of South Florida
Co-Author - Ciara Spivey, BA, University of South Florida - Tampa, FL
Co-Author - Estefania Simon, MA, CRC, CVE, University of South Florida - Tampa, FL
Co-Author - B. Michelle Wilks-Otto, PhD, University of South Florida - Tampa, FL
Co-Author - Kristin Kosyluk, PhD, University of South Florida - Tampa, FL
Implementing Evidence-Based Mental Health Interventions for Vulnerable Youth: A Randomized Trial in Colombia
Poster Number: E106Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Health Disparities
Background: Implementing evidence-based mental health programs in community settings poses challenges for ensuring both cost-effectiveness and long-term sustainability. These challenges are particularly relevant in low- and middle-income countries where mental health needs are high and resources are limited.
Purpose: This study evaluated the impact of a government-sponsored mental health program in Medellín, Colombia, targeting youth not in employment or education (NEET) who reported symptoms of anxiety or depression.
Method: We used a randomized controlled design with 1,950 participants assigned to one of four groups: (1) eight individual sessions of cognitive-behavioral therapy (CBT), (2) four group-based experiential sessions, (3) a combined intervention, or (4) a control group. Data were collected at baseline and follow-up on mental health (PHQ-4), educational aspirations, and employment outcomes. Fourteen community-based psychologists received two weeks of structured training in CBT. Fidelity strategies were implemented to ensure adherence and inform a sustainable implementation protocol.
Results: The CBT-only group showed a 14% reduction in anxiety and depression symptoms compared to the control group. Participants also demonstrated an 8% increase in willingness to pursue formal education, particularly among those with severe baseline symptoms, suggesting improved self-regulation. No significant effects were observed for employment outcomes, possibly due to structural labor market barriers. Group-based experiential sessions had no average effect and worsened symptoms in some subgroups.
Conclusion: Structured, evidence-based approaches like CBT can improve mental health and educational engagement among vulnerable youth. Its high cost-effectiveness and adaptability highlight its potential for scale-up through implementation strategies in similar contexts.
Keywords: CBT, Public healthPurpose: This study evaluated the impact of a government-sponsored mental health program in Medellín, Colombia, targeting youth not in employment or education (NEET) who reported symptoms of anxiety or depression.
Method: We used a randomized controlled design with 1,950 participants assigned to one of four groups: (1) eight individual sessions of cognitive-behavioral therapy (CBT), (2) four group-based experiential sessions, (3) a combined intervention, or (4) a control group. Data were collected at baseline and follow-up on mental health (PHQ-4), educational aspirations, and employment outcomes. Fourteen community-based psychologists received two weeks of structured training in CBT. Fidelity strategies were implemented to ensure adherence and inform a sustainable implementation protocol.
Results: The CBT-only group showed a 14% reduction in anxiety and depression symptoms compared to the control group. Participants also demonstrated an 8% increase in willingness to pursue formal education, particularly among those with severe baseline symptoms, suggesting improved self-regulation. No significant effects were observed for employment outcomes, possibly due to structural labor market barriers. Group-based experiential sessions had no average effect and worsened symptoms in some subgroups.
Conclusion: Structured, evidence-based approaches like CBT can improve mental health and educational engagement among vulnerable youth. Its high cost-effectiveness and adaptability highlight its potential for scale-up through implementation strategies in similar contexts.
Authors:
Presenter - Mariantonia Lemos, PhD, Universidad EAFIT
Co-Author - Martin Vanegas-Arias, Universidad EAFIT
Co-Author - Santiago Tobon, PhD, Universidad EAFIT
Pregnancy Brain? Examining the Influence of Mood and Physical Activity on Cognitive Impairment in Pregnancy and Postpartum
Poster Number: E108Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Women's Health
Background: Perinatal cognitive failures (e.g., memory lapses) are frequently reported and associated with adverse maternal (e.g., increased dementia risk) and infant (e.g., fetal brain development changes) outcomes. Thus, identifying modifiable factors protecting against cognitive failures is critical. Mood (i.e., depressive/anxiety symptoms) and physical activity (PA) are two modifiable targets that may buffer against cognitive failures; however, their interactive effects in the perinatal period are not well understood. This study examined perinatal mood and PA on cognitive failures. Methods: Pregnant persons (N=56) from a longitudinal cohort study completed mood (Center for Epidemiologic Studies Depression Scale, State Trait Anxiety Inventory), PA (Leisure Time Exercise Questionnaire), and cognitive measures (Cognitive Failures Questionnaire) at 28-30 weeks gestation and 6-weeks postpartum. Participants were grouped based on mood (lower-or higher-than-average anxiety/depressive symptoms) and meeting PA guidelines (150 min/week moderate PA) at one, both, or neither timepoint. General linear models assessed mood and PA effects on cognitive failures. Moderation analyses examined mood and PA’s influence on cognitive failure relationships. Results: Higher-than-average anxiety at both timepoints was associated with greater prenatal cognitive failures (p<0.001). Higher-than-average depressive symptoms was associated with greater postpartum cognitive failures (p=0.015). PA moderated the impact of prenatal depressive (p=0.009) and postpartum anxiety symptoms (p=0.026) such that cognitive failures increased with mood symptoms at a lower rate for those who met PA guidelines in pregnancy and a higher rate for those who met PA guidelines in postpartum. Prenatal depressive symptoms (p=0.013) was a moderator such that among women with higher prenatal depressive symptoms, higher prenatal PA was associated with fewer prenatal cognitive failures. Postpartum anxiety symptoms (p=0.032) moderated the PA-cognition relationship such that among those with lower postpartum anxiety symptoms, higher postpartum PA was associated with fewer cognitive failures. Conclusion: PA and mood may be modifiable targets protecting against perinatal cognitive failures. Interventions promoting increased PA and mood regulation may offer a novel strategy to reduce perinatal cognitive failures. Future research is needed to explore novel and scalable strategies to support maternal cognitive health.
Keywords: Mental health, Women's healthAuthors:
Author - Victoria Suhy, M.S., The Pennsylvania State University
Co-Author - Abigail Pauley, PhD, The Pennsylvania State University
Co-Author - Owen Griffith, PhD, The Pennsylvania State University
Co-Author - Jamie Whitney, M.S., The Pennsylvania State University
Co-Author - Danielle Downs, PhD, The Pennsylvania State University
Healing Our Intergenerational Wounds: A Praxis of Community Healing Envisioned by Refugee Young Adults Engaging in Participatory Avatar-Based Community Circles
Poster Number: E109Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Community Engagement
About one out of three refugees experiences high rates of depression, anxiety, and post-traumatic stress disorders, which persist for many years after displacement (Blackmore et al., 2020). In mainstream Western, Educated, Industrialised, Rich, Democratic (WEIRD) psychologies, the dominant approach to trauma and healing is embedded within an individualist perspective, where they are often explored without understanding the social causes or engaging communities with lived experiences (Adams et al., 2019). This risks the generation of siloed and unrelatable findings with limited applicability to refugee healing (Schultz et al., 2016). To address this gap in refugee healing literature, this paper reports on the third phase of a Decolonizing Participatory Action Research (PAR) study focused on historical trauma and community healing with 2nd-generation Toronto Tamil refugees. This study presents community-driven research, where we make visible a praxis of community healing envisioned with, by, and for refugees. Two core questions were addressed: a) What elements are important to Tamil young adults for community healing? b) What do community healing practices and therapeutic interventions look like for Tamil young adults? Employing storytelling and in-depth perspective sharing through participatory avatar-based community circles with 12 refugee young adults, reflexive data analysis revealed seven thematic elements that encompassed a praxis of community healing. These include: 1)Agency and Self-determination; 2)Historical Trauma-Informed; 3)Cultural Safety; 4)Intergenerational Connectedness and Belonging; 5)Destigmatized Access & Delivery; 6)Holistic & Authentic Approaches to Healing; and 7)Truth Telling as Justice. The findings also necessitated a broader contextualization of community healing as actively existing in a dialectic, where communities are required to live in both spaces of recognition and resistance to interlocking systems of oppression and hate, as well as pursue radical hope for justice and liberation. Our findings add perspective and inspire action for interested practitioners and policymakers serving refugee mental health needs. Notably, this study takes an inventive approach using participatory avatar-based community circles, a method new to the health sciences. Overall, this project pushes beyond a Western-centric psychology and towards a community-driven liberatory psychology that centres the knowledge and capacities of refugee communities.
Keywords: Community intervention, Minority healthAuthors:
Author - Vivetha Thambinathan, PhD, University of Michigan Medical School
Co-Author - Lloy Wylie, Western University
Co-Author - Deluxna Ganesh, peer researcher
Co-Author - Luxana Ramesh, peer researcher
Co-Author - Elizabeth Anne Kinsella, McGill University
Understanding the Social Networks of Adolescents and Young Adults with Cancer: Longitudinal relationships of health behaviors and psychological well-being
Poster Number: E11Time: 05:00 PM - 05:50 PM
Topics: Cancer, Social and Environmental Context and Health
Background
Approximately 90,000 AYAs (Adolescents and Young Adults; ages 15-39) are diagnosed with cancer yearly in the United States. Health-promoting behaviors (e.g., exercise, healthy diet, no substances) are key during diagnosis and survivorship to mitigate progression, recurrence, and promote well-being. AYAs often increase such behaviors after diagnosis to optimize outcomes. Social networks (SN), comprised of supportive interpersonal relationships (e.g., family, friends, co-workers), often reflect healthy lifestyles of AYAs after cancer. Peers are a notable part of AYA’s SNs but may be less attuned to the health needs of a cancer diagnosis and therefore less likely to change their health behaviors. While research suggests overall positive concordance between AYA and SN health environments, less is known about the longitudinal and psychological implications of this relationship.
Methods
40 AYAs enrolled in a larger longitudinal study completed online measures of psychological well-being (depression and anxiety) and perceived health behaviors of SN members [i.e., substance use (alcohol, smoking), and diet and exercise habits] at baseline and 6 months later. A health composite change score captured SN changes in health-compromising behaviors over time. Repeated measures ANOVA tested SN health behavior change over time. Hierarchical linear regression examined associations between the health composite change score and depression and anxiety at 6 months.
Results
A change in SN health behaviors was found, with a decrease in the number of SN members who engaged in health-compromising behaviors over time [F(1,39)=6.4, p=0.02, ƞ2p=0.14]. Controlling for sociodemographic, cancer status, and baseline depression and anxiety, results revealed a positive association between constricting SN members engaging in health-compromising behaviors and depression (β=0.27, p<.003) and anxiety (β =0.24, p<0.04) at 6 months.
Conclusions
Findings indicate that over time, AYA’s prune unhealthy SN members and that network pruning is associated with depression and anxiety over time. This may suggest that the misalignment of health values among AYAs and their SNs yields incongruent lifestyles over time, likely causing SN members to disengage. The loss of important social support may increase psychological distress among AYAs. Future work would benefit from examining support-related characteristics of pruned SN members to understand their association with well-being over time.
Keywords: Cancer, Social network analysisApproximately 90,000 AYAs (Adolescents and Young Adults; ages 15-39) are diagnosed with cancer yearly in the United States. Health-promoting behaviors (e.g., exercise, healthy diet, no substances) are key during diagnosis and survivorship to mitigate progression, recurrence, and promote well-being. AYAs often increase such behaviors after diagnosis to optimize outcomes. Social networks (SN), comprised of supportive interpersonal relationships (e.g., family, friends, co-workers), often reflect healthy lifestyles of AYAs after cancer. Peers are a notable part of AYA’s SNs but may be less attuned to the health needs of a cancer diagnosis and therefore less likely to change their health behaviors. While research suggests overall positive concordance between AYA and SN health environments, less is known about the longitudinal and psychological implications of this relationship.
Methods
40 AYAs enrolled in a larger longitudinal study completed online measures of psychological well-being (depression and anxiety) and perceived health behaviors of SN members [i.e., substance use (alcohol, smoking), and diet and exercise habits] at baseline and 6 months later. A health composite change score captured SN changes in health-compromising behaviors over time. Repeated measures ANOVA tested SN health behavior change over time. Hierarchical linear regression examined associations between the health composite change score and depression and anxiety at 6 months.
Results
A change in SN health behaviors was found, with a decrease in the number of SN members who engaged in health-compromising behaviors over time [F(1,39)=6.4, p=0.02, ƞ2p=0.14]. Controlling for sociodemographic, cancer status, and baseline depression and anxiety, results revealed a positive association between constricting SN members engaging in health-compromising behaviors and depression (β=0.27, p<.003) and anxiety (β =0.24, p<0.04) at 6 months.
Conclusions
Findings indicate that over time, AYA’s prune unhealthy SN members and that network pruning is associated with depression and anxiety over time. This may suggest that the misalignment of health values among AYAs and their SNs yields incongruent lifestyles over time, likely causing SN members to disengage. The loss of important social support may increase psychological distress among AYAs. Future work would benefit from examining support-related characteristics of pruned SN members to understand their association with well-being over time.
Authors:
Presenter - Shannon Desbiens, B.A., Rutgers University
Co-Author - Katie Darabos, PhD, Rutgers University
Co-Author - Sean McHugh, Rutgers University
Co-Author - Katie Devine, PhD, FSBM, Rutgers Cancer Institute
Comprehensive Review of Screening Tools for Postpartum Depression Using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Guideline
Poster Number: E111Time: 05:00 PM - 05:50 PM
Topics: Methods and Measurement, Mental Health
Abstract
Background: Postpartum depression (PPD) significantly affects mothers, families, and child development, yet disagreement remains about the most suitable screening tool. Patient-reported outcome measures (PROMs) are commonly used, but systematic evaluation of their measurement properties in postpartum populations is limited.
Objective: To systematically review and assess the quality of evidence on depression screening tools for postpartum populations using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology.
Methods: APA PsycINFO, CINAHL, and PubMed were searched for validation studies (2001–2025). Eligible studies validated depression screening tools in postpartum populations, addressed ≥3 of 4 domains (affective, behavioral, somatic, interference), and reported at least one psychometric property. COSMIN criteria were applied to evaluate methodological quality, structural validity, reliability, responsiveness, and other properties. Evidence was graded as Level A (recommended), Level B (promising but needs further study), or Level C (not recommended).
Results: Nine studies met inclusion criteria (sample sizes 106–1,390). Tools examined included the Edinburgh Postnatal Depression Scale (EPDS, n=8), Beck Depression Inventory I/II (BDI-I, n=1; BDI-II, n=2), Postpartum Depression Screening Scale (PDSS, n=3), Center for Epidemiologic Studies Depression Scale (CES-D, n=1), and Patient Health Questionnaire-9 (PHQ-9, n=1). The EPDS demonstrated sufficient evidence for structural validity, internal consistency, criterion validity, hypothesis testing, and responsiveness, earning the only Level A rating. All other instruments were rated Level B, limited by indeterminate validity, insufficient evidence, or gaps in psychometric assessment.
Conclusions: The EPDS is currently the most robust screening tool for PPD, supported by consistent psychometric evidence. Nonetheless, concerns remain regarding cross-cultural validity and variable cut-point thresholds. Other instruments, though rated lower, may provide context-specific advantages. Future research should prioritize addressing measurement gaps, improving cultural adaptation, and evaluating implementation in diverse postpartum populations.
Keywords: Measurement, Mental healthBackground: Postpartum depression (PPD) significantly affects mothers, families, and child development, yet disagreement remains about the most suitable screening tool. Patient-reported outcome measures (PROMs) are commonly used, but systematic evaluation of their measurement properties in postpartum populations is limited.
Objective: To systematically review and assess the quality of evidence on depression screening tools for postpartum populations using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology.
Methods: APA PsycINFO, CINAHL, and PubMed were searched for validation studies (2001–2025). Eligible studies validated depression screening tools in postpartum populations, addressed ≥3 of 4 domains (affective, behavioral, somatic, interference), and reported at least one psychometric property. COSMIN criteria were applied to evaluate methodological quality, structural validity, reliability, responsiveness, and other properties. Evidence was graded as Level A (recommended), Level B (promising but needs further study), or Level C (not recommended).
Results: Nine studies met inclusion criteria (sample sizes 106–1,390). Tools examined included the Edinburgh Postnatal Depression Scale (EPDS, n=8), Beck Depression Inventory I/II (BDI-I, n=1; BDI-II, n=2), Postpartum Depression Screening Scale (PDSS, n=3), Center for Epidemiologic Studies Depression Scale (CES-D, n=1), and Patient Health Questionnaire-9 (PHQ-9, n=1). The EPDS demonstrated sufficient evidence for structural validity, internal consistency, criterion validity, hypothesis testing, and responsiveness, earning the only Level A rating. All other instruments were rated Level B, limited by indeterminate validity, insufficient evidence, or gaps in psychometric assessment.
Conclusions: The EPDS is currently the most robust screening tool for PPD, supported by consistent psychometric evidence. Nonetheless, concerns remain regarding cross-cultural validity and variable cut-point thresholds. Other instruments, though rated lower, may provide context-specific advantages. Future research should prioritize addressing measurement gaps, improving cultural adaptation, and evaluating implementation in diverse postpartum populations.
Authors:
Author - Saisuree Namluck, PhD candidate, University of Massachusetts Boston
A photo-elicitation study of factors affecting family caregiver distress and well-being during the early stages of a Veteran’s intensive care hospitalization
Poster Number: E112Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Stress
Research Objective: Family caregivers often experience distress when a patient is admitted to critical care. We sought to understand the timing and nature of family caregivers’ experiences during the early phases of a patient’s intensive care unit (ICU) hospitalization.
Study Design: Qualitative study using photo-elicitation interviews, a visual participatory approach. Caregivers were asked to take photos representing their experiences during the early stages of the patient’s critical care hospitalization. Caregivers then completed semi-structured interviews by phone or videoconference, using their photos to understand what experiences were most important to them. We conducted an inductive content analysis, focused on caregiver emotions of distress and well-being throughout the ICU hospitalization.
Population Studied: Nineteen family caregivers of medical ICU patients admitted to a medical-surgical critical care unit within a mid-western Veterans Affairs (VA) hospital. Family caregivers were recruited to participate within 72 hours of ICU admission.
Principal Findings: Participants were primarily female spouses, average age 62 years (12 SD) and 12 years (9 SD) of caring for the patient. Caregivers described anxiety and fear related to unexpected or worsening symptoms and incomplete information during the ICU admission [one caregiver took a photo of a QR code on a pop machine to show how easy it was to get information for help with a vending machine compared to the ICU]. However, caregivers also noted feelings of well-being related to staff care during the hand-off to the ICU. While patients receiving new treatments or procedures, such as mechanical ventilation [depicted by a photo of a vital sign monitor on night patient was intubated] was distressing, seeing the patient in the private ICU room, along with the high level of care, expertise, and empathy from staff was comforting [represented by photo of nurse-drawn get-well card]. Early on during the ICU hospitalization, caregivers experienced distress around not knowing patient medical trajectory or survival while also noting feelings of trust associated with skilled patient care.
Conclusions: Caregivers faced distress in the earliest moments of ICU admission around uncertainty, yet experienced mixed emotions during ICU admission and early ICU hospitalization due to staff engagement and care. Modifiable factors related to both feelings of distress and well-being were identified.
Keywords: Caregiving, AnxietyStudy Design: Qualitative study using photo-elicitation interviews, a visual participatory approach. Caregivers were asked to take photos representing their experiences during the early stages of the patient’s critical care hospitalization. Caregivers then completed semi-structured interviews by phone or videoconference, using their photos to understand what experiences were most important to them. We conducted an inductive content analysis, focused on caregiver emotions of distress and well-being throughout the ICU hospitalization.
Population Studied: Nineteen family caregivers of medical ICU patients admitted to a medical-surgical critical care unit within a mid-western Veterans Affairs (VA) hospital. Family caregivers were recruited to participate within 72 hours of ICU admission.
Principal Findings: Participants were primarily female spouses, average age 62 years (12 SD) and 12 years (9 SD) of caring for the patient. Caregivers described anxiety and fear related to unexpected or worsening symptoms and incomplete information during the ICU admission [one caregiver took a photo of a QR code on a pop machine to show how easy it was to get information for help with a vending machine compared to the ICU]. However, caregivers also noted feelings of well-being related to staff care during the hand-off to the ICU. While patients receiving new treatments or procedures, such as mechanical ventilation [depicted by a photo of a vital sign monitor on night patient was intubated] was distressing, seeing the patient in the private ICU room, along with the high level of care, expertise, and empathy from staff was comforting [represented by photo of nurse-drawn get-well card]. Early on during the ICU hospitalization, caregivers experienced distress around not knowing patient medical trajectory or survival while also noting feelings of trust associated with skilled patient care.
Conclusions: Caregivers faced distress in the earliest moments of ICU admission around uncertainty, yet experienced mixed emotions during ICU admission and early ICU hospitalization due to staff engagement and care. Modifiable factors related to both feelings of distress and well-being were identified.
Authors:
Author - Amanda Blok, PhD MSN RN PHCNS-BC, Department of Veterans Affairs
Co-Author - Lauren Gauntlett, VA Center for Clinical Management Research
Co-Author - Allison Ranusch, VA Center for Clinical Management Research
Co-Author - Molly Harrod, VA Center for Clinical Management Research
Co-Author - Sarah Krein, VA Center for Clinical Management Research
Evaluation of a Single-Session Sleep Health Intervention for U.S. Air Force Trainees
Poster Number: E113Time: 05:00 PM - 05:50 PM
Topics: Military and Veterans' Health, Sleep
Background: Chronic insufficient sleep appears to develop early in the military career, with around half of Active Duty U.S. Air Force (USAF) personnel reporting suboptimal sleep during military training. Often the solution for health behavior change in large organizations such as the USAF is providing information through written materials (e.g., infographic), which may be suboptimal. The need to better address sleep health in military training led to the collaborative development of a video-facilitated, leader-led, brief single session group intervention that is now provided to >30,000 Airmen in training per year. The aim of the current study was to conduct a post-implementation study of the effectiveness using an ABAB design.
Method: Participants were 483 USAF personnel in training for law enforcement careers. Four alternating week-group cohorts received either the intervention (a video-based sleep health primer; n = 259) or the control (a paper infographic; n = 224), both of which emphasized the same sleep health best practices. At 2.5-week follow-up participants reported on sleep duration, sleep quality, and weekday-weekend waketime consistency using paper surveys. Each outcome was dichotomized, and odds ratios were calculated to convey the relative probability of sleep health outcomes at follow-up, by group.
Results: At follow-up, the intervention group evinced 63% greater odds of adequate sleep (>6 hours per night) relative to the control group (OR = 1.63, 95% CI [1.09, 2.42]). The intervention group likewise demonstrated 61% greater odds of reporting ‘good’ or ‘excellent’ past week sleep quality (OR = 1.61, 95% CI [1.08, 2.24]. The intervention group’s odds of deviating weekend wake-time more than 1 hour relative to weekday wake-time were commensurate with those for the control group (OR = 1.08, 95% CI (0.69, 1.67]).
Discussion: Early career USAF personnel in training for law enforcement careers who received a single-session sleep intervention reported better sleep health compared to an infographic only control group with the same evidence-based information. Further research with larger samples is needed to examine the long-term impact on sleep health and occupational performance. Results suggest that military trainees are more likely to modify health behaviors in response to interventions that utilized brief multi-media content and leader-led discussions compared to written graphic materials.
Keywords: Abnormal sleep, Health promotionMethod: Participants were 483 USAF personnel in training for law enforcement careers. Four alternating week-group cohorts received either the intervention (a video-based sleep health primer; n = 259) or the control (a paper infographic; n = 224), both of which emphasized the same sleep health best practices. At 2.5-week follow-up participants reported on sleep duration, sleep quality, and weekday-weekend waketime consistency using paper surveys. Each outcome was dichotomized, and odds ratios were calculated to convey the relative probability of sleep health outcomes at follow-up, by group.
Results: At follow-up, the intervention group evinced 63% greater odds of adequate sleep (>6 hours per night) relative to the control group (OR = 1.63, 95% CI [1.09, 2.42]). The intervention group likewise demonstrated 61% greater odds of reporting ‘good’ or ‘excellent’ past week sleep quality (OR = 1.61, 95% CI [1.08, 2.24]. The intervention group’s odds of deviating weekend wake-time more than 1 hour relative to weekday wake-time were commensurate with those for the control group (OR = 1.08, 95% CI (0.69, 1.67]).
Discussion: Early career USAF personnel in training for law enforcement careers who received a single-session sleep intervention reported better sleep health compared to an infographic only control group with the same evidence-based information. Further research with larger samples is needed to examine the long-term impact on sleep health and occupational performance. Results suggest that military trainees are more likely to modify health behaviors in response to interventions that utilized brief multi-media content and leader-led discussions compared to written graphic materials.
Authors:
Presenter - Jordan Ellis, PhD, United States Air Force
Co-Author - Daniel Cassidy, PhD, Psychological Health Center of Excellence
Co-Author - Chase Aycock, PsyD, United States Air Force
Co-Author - Kara Wiseman, MPH, PhD, University of Virginia
Co-Author - Trevin Glasgow, University of Virginia
Association of Chronic Overlapping Pain Conditions and Frailty in the Million Veteran Program: A Matched Case–Control Analysis
Poster Number: E114Time: 05:00 PM - 05:50 PM
Topics: Pain, Quality of Life
Background: Chronic overlapping pain conditions (COPCs) – including migraine (MIG), tension headache (TH), fibromyalgia (FM), chronic fatigue syndrome (CFS), temporomandibular disorder (TMD), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), irritable bowel syndrome (IBS), and chronic back pain (CBP) – have been associated with substantial functional impairment and disability. Little is known about the relationship of COPCs with frailty, a multidomain state of physical vulnerability. We evaluated the association between COPCs and frailty in the Million Veteran Program (MVP).
Methods: Frailty status, classified as robust, pre-frail, or frail, at MVP enrollment, was derived from the MVP Baseline Survey and electronic health record (EHR) data, and pre-frail individuals were excluded from the primary analysis. COPC were defined by EHR ICD9/10 codes preceding the index date. Using 1:1 nearest neighbor propensity matching of frail to robust individuals across age, sex, race, education, income, healthcare utilization, and EHR length, we evaluated covariate balance using standardized mean differences (all achieving SMDs <0.10). Conditional logistic regression (stratified by pair) estimated adjusted odds ratios (AORs) for COPC count and for each COPC. Estimates reported as AOR (95%CI). For individual logistic regression models, the reference group was restricted to Veterans with no COPCs.
Results: Among 570,954 Veterans (mean age 67 years, 90% male, 81% white), we matched 52,249 frail individuals to 52,249 individuals identified as robust. COPC prevalence ranged from 0.4% (FM) to 43% (CBP), with 55% having ≥ 1 COPC. The number of COPCs was strongly associated with higher odds of frailty per additional COPC: 1.95 (1.91 – 1.97). Individual COPCs showed significant positive associations with frailty reported as AOR (95%CI): FM 7.78 (5.68 – 10.67), CFS 4.76 (4.51 – 5.01), TH 4.18 (3.71 – 4.73), IBS 3.91 (3.59 – 4.26), MIG 3.12 (2.94 – 3.31), TMD 3.81 (3.41 – 4.24), CP/CPPS 2.95 (2.63 – 3.29), and CBP 2.78 (2.70 – 2.87).
Conclusions: We observed a dose-response association between the number of COPCs and frailty in Veterans, as well as positive associations between specific COPCs and frailty. Our findings indicate a relationship between chronic pain and frailty and lay the foundation for future efforts to understand the environmental and genetic mechanisms underlying these associations.
Keywords: Pain, Health outcomesMethods: Frailty status, classified as robust, pre-frail, or frail, at MVP enrollment, was derived from the MVP Baseline Survey and electronic health record (EHR) data, and pre-frail individuals were excluded from the primary analysis. COPC were defined by EHR ICD9/10 codes preceding the index date. Using 1:1 nearest neighbor propensity matching of frail to robust individuals across age, sex, race, education, income, healthcare utilization, and EHR length, we evaluated covariate balance using standardized mean differences (all achieving SMDs <0.10). Conditional logistic regression (stratified by pair) estimated adjusted odds ratios (AORs) for COPC count and for each COPC. Estimates reported as AOR (95%CI). For individual logistic regression models, the reference group was restricted to Veterans with no COPCs.
Results: Among 570,954 Veterans (mean age 67 years, 90% male, 81% white), we matched 52,249 frail individuals to 52,249 individuals identified as robust. COPC prevalence ranged from 0.4% (FM) to 43% (CBP), with 55% having ≥ 1 COPC. The number of COPCs was strongly associated with higher odds of frailty per additional COPC: 1.95 (1.91 – 1.97). Individual COPCs showed significant positive associations with frailty reported as AOR (95%CI): FM 7.78 (5.68 – 10.67), CFS 4.76 (4.51 – 5.01), TH 4.18 (3.71 – 4.73), IBS 3.91 (3.59 – 4.26), MIG 3.12 (2.94 – 3.31), TMD 3.81 (3.41 – 4.24), CP/CPPS 2.95 (2.63 – 3.29), and CBP 2.78 (2.70 – 2.87).
Conclusions: We observed a dose-response association between the number of COPCs and frailty in Veterans, as well as positive associations between specific COPCs and frailty. Our findings indicate a relationship between chronic pain and frailty and lay the foundation for future efforts to understand the environmental and genetic mechanisms underlying these associations.
Authors:
Author - Jennalee Wooldridge, PhD, VA San Diego/University of California San Diego
Co-Author - Armand Gerstenberger, VA PUGET SOUND HEALTHCARE SYSTEM
Co-Author - Marianna Gasperi, PhD, Unviersity of Washington
Emotion-Focused Pain-Coping Moderates the Relationship Between Discrimination and Health-Related Quality of Life Among Emerging Adults
Poster Number: E115Time: 05:00 PM - 05:50 PM
Topics: Pain, Quality of Life
In individuals with chronic pain, experiences of discrimination are associated with worse health-related quality of life (HRQoL), (Molina et al., 2019). Previous research suggests that pain-coping strategies may be effective in mitigating the negative impacts of discrimination (Terry et al., 2020). However, there is limited research analyzing whether various pain-coping strategies are associated with improvements in HRQoL. This study sought to examine whether pain-coping strategies buffer the relationship between perceived discrimination and HRQoL in emerging adults living with pain. We hypothesized that individuals living with pain who experience higher levels of discrimination would report poorer HRQoL. We also hypothesized that individuals who frequently use coping strategies would report better HRQoL, buffering the negative effects of discrimination. Our study included 631 undergraduate students with chronic and acute pain, who completed the Adolescent Discrimination Distress Index, the Brief COPE and Pain Coping Questionnaire (PCQ), and the RAND SF-36 Health Survey. Pain-specific emotion-focused coping (PCQ) moderated the relationship between discrimination and general health. At lower levels of discrimination, less emotion-focused coping was associated with better health; however, at higher levels of discrimination, there was generally worse health regardless of emotion-focused coping (b = 4.01, SE = 1.24, p = 0.0014). Interestingly, emotion-focused coping for general stressors seemed to buffer the negative effects of discrimination, while lower coping was related to steeper declines in general health with discrimination (b = 5.12, SE = 2.57, p = 0.0473). Avoidance-coping moderated the relationship between discrimination and emotional and social functioning, where more avoidance coping was related to worse emotional and social functioning, and less avoidance coping seemed to buffer the effect of discrimination (b = 3.65, SE = 1.72, p = 0.0342 and b = 3.95, SE = 2.15, p = 0.067, respectively). Emotion-focused coping moderates the impact of discrimination on HRQoL, whereas avoidance coping is associated with worse emotional and social functioning. Our findings highlight that the use of coping strategies can mitigate the negative impacts of discrimination, but there is a complex relationship between discrimination, coping strategies, and HRQoL in this population. More work is needed to further unravel this association to better support improved HRQoL.
Keywords: Pain, Quality of lifeAuthors:
Co-Author - Autumn Rajcevich Schwer, DePaul University
Co-Author - Giselle McPherson-Isbell, DePaul University
Co-Author - Kayla McCracken, DePaul University
Co-Author - Jacquelyn Raftery-Helmer, Worcester State University
Co-Author - Alison Stoner, Assumption University
Co-Author - Susan Tran, DePaul University
Prevalence and impact of post-traumatic symptoms for youth attending an intensive pediatric chronic pain program.
Poster Number: E116Time: 05:00 PM - 05:50 PM
Topics: Pain, Child and Family Health
Introduction. Research indicates a high prevalence of adverse childhood events (ACEs) and post-traumatic stress symptoms (PTSS) in youth with chronic pain (Nelson et al., 2021). In addition, PTSS mediate the relationship between ACEs and pain (Nania et al., 2024). A few studies have examined the role of ACEs and PTSS in treatment outcomes for youth with chronic pain. Nelson et al. (2019) found that ACEs do not impact treatment outcomes of an interdisciplinary intensive pain program (IIPT). Alternatively, for youth with functional abdominal pain, those with post-traumatic stress disorder (PTSD) did not respond as well to cognitive behavioral therapy (Nelson & Cunningham, 2020). Additional research is warranted to investigate the impact of PTSS on pediatric chronic pain treatment. The current study examines the relationship of PTSS with treatment outcomes among youth participating in an IIPT. Methods. Participants were 289 youth with chronic pain (ages 13-23, 70.6% female) enrolled in a 3-week outpatient IIPT located in a midwestern academic medical center between 2022-2025. Youth completed demographic information and a validated measure of PTSS at admission (baseline). Youth also completed validated self-report measures of pain intensity, pain catastrophizing, anxiety, depression, and functional disability at baseline and at discharge (post-treatment). Results. Forty-nine youth (17.0%) endorsed a clinically significant level of PTSS on the Child PTSD Symptom Scale for DSM-5 (CPSS-5; Foa et al., 2017), which is slightly higher than national norms. Correlational analyses indicated that greater baseline levels of PTSS was significantly related to greater baseline pain intensity (r=0.13, p<.05), pain catastrophizing (r=0.48, p<.001), depression (r=0.60, p<.001), anxiety (r=0.59, p<.001), and functional disability (r=0.36, p<.001). Greater PTSS at baseline was also associated with more pain catastrophizing (r=0.22, p<.001), depression (r=0.31, p<.001), anxiety (r=0.43, p<.001), and functional disability (r=0.14, p<.05) at discharge. Regression analyses indicated PTSS was a significant predictor of less change in pain catastrophizing (β =0.323, p <.001) and explained 16% of the variance [R2 = 0.157, F(1, 253) = 47.28 , p<.001]. Conclusions. PTSS are related to pain and mental health variables for youth with debilitating chronic pain and influence treatment outcomes. Future research should focus on tailoring treatment to address PTSS to optimize outcomes.
Keywords: Trauma, AdolescentsAuthors:
Author - Karen Weiss, Ph.D., Mayo Clinic
Co-Author - Caitlin Murray, PhD, Seattle Children's Research Institute
Co-Author - Jasmine Berry, Ph.D., Mayo Clinic
Co-Author - Cynthia Harbeck-Weber, Ph.D., Mayo Clinic
Co-Author - Andrea Eickhoff, RN, Mayo Clinic
Co-Author - Amy Rabatin, MD, Mayo Clinic
Co-Author - Leslie Sim, Ph.D., Mayo Clinic
Short Physical Activity Breaks and Children’s Mental Health: A Systematic Review and Meta-Analysis
Poster Number: E117Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Mental Health
Objective: Mental health problems among youth are a national public health concern. Current efforts to address rising mental health challenges for youth focus on treatment and access to care, but preventative approaches are also needed to promote well-being. Physical activity (PA) breaks, or short bouts of physical activity used to break up sedentary activity, may be a potential scalable approach to promote mental well-being. The purpose of this study was to synthesize the effects of PA breaks on mental health outcomes among children.
Methods: Using the PRISMA protocol, we systematically searched the APA PsychInfo, ERIC, SportDiscus, ProQuest Dissertations & Theses, PubMed, and Web of Science electronic databases, and the ClinicalTrials.gov and WHO International Clinical Trials Registry Platform Portal registries. Studies were included if they examined PA breaks (≤ 20 minutes) compared to an inactive control group, measured at least one mental health outcome, and included children under 18 years. The Risk of Bias 2 tool was used to assess potential bias among studies. Separate random effects models were used to pool standardized mean differences (SMD) for mental well-being and mental difficulties. We analyzed intervention dose (total minutes) as a subgroup synthesis using meta-regression.
Results: Seventeen reports representing 16 different studies were identified for inclusion in this review. Of these, 13 were included in the meta-analysis. The total sample size across studies was N = 7,025. The overall effect for mental well-being was small, yet significant (g = .27, p = .04, SE = .13, 95% CI = .010 to .52). The effect for mental difficulties was not significant (g = -.23, p = .05, SE = .12, 95% CI = -.47 to -.00). Heterogeneity was high for both meta-analyses (mental well-being I2 = 90.8%; Q(10) = 71.3%, p < .001; mental difficulties I2 = 91%; Q(7) = 56.8%, p < .001) and the meta-regression tests were significant (mental well-being β=19.5, p = .002; mental difficulties β=23.3, p <.001).
Conclusions: Short bouts of PA may promote positive mental health, although the outcomes may be dose dependent. Although more high-quality studies are needed to better understand the mechanisms that contribute to changes in mental health outcomes, relevant parties could consider policies and appropriate training to promote the use of PA breaks to support mental health, as they offer a low-risk approach and may provide some benefits.
Keywords: Children, Mental healthMethods: Using the PRISMA protocol, we systematically searched the APA PsychInfo, ERIC, SportDiscus, ProQuest Dissertations & Theses, PubMed, and Web of Science electronic databases, and the ClinicalTrials.gov and WHO International Clinical Trials Registry Platform Portal registries. Studies were included if they examined PA breaks (≤ 20 minutes) compared to an inactive control group, measured at least one mental health outcome, and included children under 18 years. The Risk of Bias 2 tool was used to assess potential bias among studies. Separate random effects models were used to pool standardized mean differences (SMD) for mental well-being and mental difficulties. We analyzed intervention dose (total minutes) as a subgroup synthesis using meta-regression.
Results: Seventeen reports representing 16 different studies were identified for inclusion in this review. Of these, 13 were included in the meta-analysis. The total sample size across studies was N = 7,025. The overall effect for mental well-being was small, yet significant (g = .27, p = .04, SE = .13, 95% CI = .010 to .52). The effect for mental difficulties was not significant (g = -.23, p = .05, SE = .12, 95% CI = -.47 to -.00). Heterogeneity was high for both meta-analyses (mental well-being I2 = 90.8%; Q(10) = 71.3%, p < .001; mental difficulties I2 = 91%; Q(7) = 56.8%, p < .001) and the meta-regression tests were significant (mental well-being β=19.5, p = .002; mental difficulties β=23.3, p <.001).
Conclusions: Short bouts of PA may promote positive mental health, although the outcomes may be dose dependent. Although more high-quality studies are needed to better understand the mechanisms that contribute to changes in mental health outcomes, relevant parties could consider policies and appropriate training to promote the use of PA breaks to support mental health, as they offer a low-risk approach and may provide some benefits.
Authors:
Co-Author - Ashlee Davis, PhD, Georgia Health Policy Center
Co-Author - Christianna Jarvis, MPA, Georgia Health Policy Center
Co-Author - Savita Nguyen, MPH, Georgia Health Policy Center
Co-Author - Anjulyn Ballard, PhD, Ballard & Associates Community Partnership
Effects of a Multi-site Electronic Health Record-Integrated Physical Activity Intervention (MyActivity) on Sedentary Time and Light Activity in Breast & Endometrial Cancer Survivors at 48-Week Follow-up
Poster Number: E118Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Cancer
Background: Reducing sedentary time (ST) and increasing light physical activity (LPA) is associated with health benefits in cancer survivors (CS). Since time is finite, engaging in moderate-vigorous physical activity (MVPA) may influence these behaviors. MyActivity used a singly randomized trial to test a stepped approach to promote MVPA in cancer care. Participants received a minimal intervention (study website+Fitbit linked to electronic health record). Non-responders (≤80% MVPA goal in past 4 weeks) in the initial 24-weeks were randomized to one of two step-up conditions: online gym (GYM) or bi-weekly coaching calls (COACH). At 24-weeks, ST and LPA did not significantly change overall. ST and LPA differences between responders and all non-responders and non-responders in COACH or GYM were significant (ps<0.001). Responders’ ST and LPA did not change but non-responders, overall, and across conditions increased ST and decreased LPA (ps<0.05). ST and LPA changes did not differ by step-up condition. This study examined ST and LPA effects at 48-weeks.
Methods: Inactive CS (n=323; Mage=57.4(SD=11.0); 73.7% breast; 25.4% endometrial) received the minimal MyActivity intervention. MVPA adherence was evaluated at 4, 8, 12, 16, and 20 weeks, and non-responders (n=116) were randomized to GYM or COACH for the remaining 24-weeks. Responders continued with the minimal intervention. From weeks 24 to 48, only the minimal intervention continued; step-up conditions ended. Mixed effects models examined intervention condition effects on daily hours of accelerometer-assessed ST and LPA from baseline (T1) to 48 weeks (T3), accounting for 24-week (T2) changes and wear time.
Results: Similar to T2, overall minutes of ST (M∆=0.05; 95%CI=[-0.05,0.14];p=0.37) and LPA (M∆=-0.09; 95%CI=[-0.18,0.01];p=0.08) did not significantly change from T1 to T3. Significant differences in ST and LPA between responders and non-responders and responders and non-responders allocated to COACH or GYM were not maintained at T3. Consistent with T2, ST and LPA did not differ significantly for non-responders allocated to GYM vs COACH.
Conclusions: MyActivity did not result in ST or LPA changes during follow-up, indicating T2 compensatory effects (increased ST, decreased LPA) for non-responders were not sustained. Future work should explore response heterogeneity to MVPA interventions across time and test other step-up strategies to effectively initiate and maintain increased MVPA and LPA and reduced ST.
Keywords: Physical activity, Cancer survivorshipMethods: Inactive CS (n=323; Mage=57.4(SD=11.0); 73.7% breast; 25.4% endometrial) received the minimal MyActivity intervention. MVPA adherence was evaluated at 4, 8, 12, 16, and 20 weeks, and non-responders (n=116) were randomized to GYM or COACH for the remaining 24-weeks. Responders continued with the minimal intervention. From weeks 24 to 48, only the minimal intervention continued; step-up conditions ended. Mixed effects models examined intervention condition effects on daily hours of accelerometer-assessed ST and LPA from baseline (T1) to 48 weeks (T3), accounting for 24-week (T2) changes and wear time.
Results: Similar to T2, overall minutes of ST (M∆=0.05; 95%CI=[-0.05,0.14];p=0.37) and LPA (M∆=-0.09; 95%CI=[-0.18,0.01];p=0.08) did not significantly change from T1 to T3. Significant differences in ST and LPA between responders and non-responders and responders and non-responders allocated to COACH or GYM were not maintained at T3. Consistent with T2, ST and LPA did not differ significantly for non-responders allocated to GYM vs COACH.
Conclusions: MyActivity did not result in ST or LPA changes during follow-up, indicating T2 compensatory effects (increased ST, decreased LPA) for non-responders were not sustained. Future work should explore response heterogeneity to MVPA interventions across time and test other step-up strategies to effectively initiate and maintain increased MVPA and LPA and reduced ST.
Authors:
Author - Kristina Hasanaj, PhD, Northwestern University Feinberg School of Medicine
Co-Author - Payton Solk, MS, Northwestern University Feinberg School of Medicine
Co-Author - Hannah Freeman, BS, Northwestern University Feinberg School of Medicine
Co-Author - Julia Pincever, MA, Northwestern University Feinberg School of Medicine
Co-Author - Jing Song, MS, Northwestern University Feinberg School of Medicine
Co-Author - Lauren Wang, BS, Northwestern University Feinberg School of Medicine
Co-Author - Megan Agnew, PhD, MPH, University of Wisconsin-Madison
Co-Author - Christian W. Schmidt, PhD, University of Wisconsin-Madison
Co-Author - Shirlene Wang, PhD, Northwestern University Feinberg School of Medicine
Co-Author - Julia Frey, BS, Northwestern University Feinberg School of Medicine
Co-Author - Fiona Webb, BA, Northwestern University Feinberg School of Medicine
Co-Author - Emma Barber, MD, Northwestern University Feinberg School of Medicine
Co-Author - Mary E. Sesto, PT, PHD, University of Wisconsin-Madison
Co-Author - William Gradishar, MD, Northwestern University Feinberg School of Medicine
Co-Author - Amye J. Tevaarwerk, MD, Mayo Clinic Cancer Center
Co-Author - Bonnie Spring, PhD, ABPP, FSBM, Florida State University College of Medicine
Co-Author - Ryan Spencer, MD, MS, FACOG, University of Wisconsin-Madison
Co-Author - Ron Gangnon, PhD, University of Wisconsin-Madison
Co-Author - Inbal Nahum-Shani, PhD, University of Michigan
Co-Author - Lisa Cadmus-Bertram, PhD, University of Wisconsin - Madison
Co-Author - Kristen A. Pickett, PhD, University of Wisconsin-Madison
Co-Author - Siobhan Phillips, PhD, MPH, FSBM, Northwestern University Feinberg School of Medicine
Optimizing social media advertisements to enroll men in a physical activity intervention trial for insufficiently-active young adults
Poster Number: E119Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Cardiovascular Disease
In physical activity intervention trials, men are underrepresented relative to women and are perceived as less willing to volunteer for clinical trials. Although young men are at a higher risk of cardiovascular diseases than their counterparts, it has been challenging to recruit men for physical activity intervention trials. Developing social media advertisements that connect more authentically with potential participants’ interests and values may help to improve recruitment by increasing trust and familiarity. To evaluate that hypothesis, we manipulated the types of language used, images shown, and the level of detail about compensation in advertisements and conducted a factorial-design experiment to evaluate differences in response rates. Generative artificial intelligence was used to create the desired language and images for these advertisements. Tracking pixels were embedded in each ad to track performance (i.e., number of clicks for each ad and respondent demographics). The 19-day campaign cost $1347.90 and yielded 456,934 impressions, 4267 ad clicks (0.93%), and 589 completed screening surveys (13.8%). Men were more responsive to ads using gamer/brain-rot language (52.4%) than ads using Joe Rogan-style “bro talk” (26.1%) or plain English (29.2%). Likewise, men were more likely to respond to ads showing anime images (63.1%) than ads showing aliens (52.3%) or real people (21.8%). Finally, men responded more to ads that provided detailed (61.9%) compared to bland (36.5%) details about compensation. After adjusting for reach, anime image ads received significantly more clicks than both alien and real person ads. Specifically, anime ads had higher click counts compared to alien ads (β = 0.71, SE = 0.06, p < .001; exp(β) = 2.03) and compared to real ads (β = 0.74, SE = 0.06, p < .001; exp(β) = 2.10). There was no significant difference between alien and real person ads (p = 0.78). Superficial tailoring to appeal to sub-populations can increase response rates and enhance enrollment. This work suggests that a thoughtful and intentionally-diverse social media advertising strategy can identify the optimal tailoring process for attracting interest from specific sub-populations. Future work should consider other advertising features that can be tailored to broaden participation in research among traditionally-understudied and hard-to-recruit groups.
Keywords: Physical activity, Research methodsAuthors:
Author - Crystal Lim, MS, University of Michigan
Co-Author - Shea Boyer, BS, University of Michigan
Co-Author - Yingjia Liu, MS, University of Michigan
Author - David Conroy, PhD, FSBM, University of Michigan
Innovations in Cancer Rehabilitation: Evolving Frontiers in Survivorship Care- A Scoping Review
Poster Number: E12Time: 05:00 PM - 05:50 PM
Topics: Cancer, Digital Health
Introduction: Cancer rehabilitation has emerged as a cornerstone of survivorship care, addressing long-term physical, cognitive, and psychosocial sequelae among over 43 million cancer survivors worldwide. Innovations such as tele-rehabilitation, wearable technology, and structured survivorship models are redefining care delivery. This scoping review synthesizes emerging evidence on these modalities and examines systemic factors influencing their adoption.
Methods: Following Arksey and O’Malley’s framework and Joanna Briggs Institute guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, and CINAHL for studies published between January 2010 and March 2024. Eligible studies focused on cancer rehabilitation interventions for adults (≥18 years), excluding pediatric, palliative-only, or non-English articles. Data extraction was performed using a standardized charting tool and was analyzed thematically.
Results: A total of 218 studies were included, categorized into six innovation domains: tele-rehabilitation, wearable technologies, exercise oncology, psychosocial interventions, cognitive/vocational rehabilitation, and survivorship care models. Tele-rehabilitation programs demonstrated parity with in-person care, especially in remote settings. Exercise oncology yielded consistent improvements in fatigue, VO2 max, and emotional well-being. Wearables enabled real-time monitoring, though adherence varied. Psychosocial interventions—including CBT and mindfulness—enhanced coping and resilience. Vocational rehabilitation improved cognitive recovery and return-to-work rates. Structured care plans improved continuity, particularly in LMICs, through community-led delivery.
Discussion and Conclusion: While innovations show strong promise, disparities persist due to digital divides and system readiness. The Chronic Care Model, RE-AIM, and Andersen’s Behavioral Model provide frameworks for scalable, equitable integration. Future efforts must focus on inclusive design, policy support, and cross-sectoral collaboration to embed cancer rehabilitation into global survivorship care.
Keywords: Cancer, Tele-healthMethods: Following Arksey and O’Malley’s framework and Joanna Briggs Institute guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, and CINAHL for studies published between January 2010 and March 2024. Eligible studies focused on cancer rehabilitation interventions for adults (≥18 years), excluding pediatric, palliative-only, or non-English articles. Data extraction was performed using a standardized charting tool and was analyzed thematically.
Results: A total of 218 studies were included, categorized into six innovation domains: tele-rehabilitation, wearable technologies, exercise oncology, psychosocial interventions, cognitive/vocational rehabilitation, and survivorship care models. Tele-rehabilitation programs demonstrated parity with in-person care, especially in remote settings. Exercise oncology yielded consistent improvements in fatigue, VO2 max, and emotional well-being. Wearables enabled real-time monitoring, though adherence varied. Psychosocial interventions—including CBT and mindfulness—enhanced coping and resilience. Vocational rehabilitation improved cognitive recovery and return-to-work rates. Structured care plans improved continuity, particularly in LMICs, through community-led delivery.
Discussion and Conclusion: While innovations show strong promise, disparities persist due to digital divides and system readiness. The Chronic Care Model, RE-AIM, and Andersen’s Behavioral Model provide frameworks for scalable, equitable integration. Future efforts must focus on inclusive design, policy support, and cross-sectoral collaboration to embed cancer rehabilitation into global survivorship care.
Authors:
Chair - Biswadeep Dhar, PhD, M.Ed., MS, James Madison University
Author - Sudip Bhattacharya, MD, AIIMS, Deoghar, India
Co-Author - Alok Singh, PhD, Department of Community Medicine, Faculty of Medicine and Health Sciences, SGT University, Gurugram, India
Transitions in Motivational Profiles among Mid-life Adults in the Context of an RCT Designed to Increase Exercise Self-Regulation
Poster Number: E120Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Decision Making
Motivational profiles capture distinct patterns of reasons for exercising and may shift with intervention, with consequences for adherence. We tested whether motivational profiles transition—and whether transitions forecast adherence—in a randomized controlled trial to increase exercise self-regulation among low-active, midlife adults (N = 233; Mage = 46.7 years). Participants completed the Exercise Motivation Inventory–2 at baseline and 1 month post-intervention. Latent profile analysis at each time point and tests of longitudinal similarity supported a four-profile solution with good separation (entropy≈0.87–0.90). Latent transition analysis then estimated transition probabilities and intervention effects. Baseline prevalences were: Weakly Motivated 25.6%, Moderately Motivated with a Fitness orientation 14.7%, Moderately Motivated with a Psychological Well-Being orientation 47.0%, and Strongly Motivated 12.7%. One-month stability differed by profile: Well-Being 67.4%, Weakly 54.8%, Fitness 45.0%, Strongly 37.9%. Transitions were directionally concentrated toward Well-Being. From Weakly, 30.0% moved to Well-Being; from Fitness, 34.4% moved to Well-Being; from Strongly, 42.7% moved to Well-Being and only 4.7% reverted to Weakly. Trial-arm effects favored the cognitive regulation training program: among participants starting in the Fitness-oriented profile, the intervention markedly increased the odds of transitioning to Strongly Motivated rather than to other profiles (odds ratio >10, p<.01). Demographics showed no detectable associations with profile membership, and baseline steps and cardiorespiratory fitness showed minimal associations. Profiles were behaviorally relevant. At one month, estimated proportions meeting the moderate-or-vigorous activity guideline were 39% [26–52%] for Weakly, 17% [0–35%] for Fitness, 79% [66–93%] for Strongly, and 91% [88–95%] for Well-Being; across 12 months, Weakly and Fitness accrued fewer months meeting guidelines, whereas Well-Being and Strongly accrued more. These findings demonstrate that motivational profiles are replicable, that short-term transitions occur and favor psychologically oriented motivation, and that an intervention targeting self-regulation can shift profiles in ways that anticipate longer-term adherence.
Keywords: Cognitive factors, MotivationAuthors:
Presenter - Xuan Lin, University of Illinois,Urbana-Champaign
Co-Author - Reilly Ruzella, university of illinois urbana-champaign
Co-Author - William Gilbert, Université du Québec à Rimouski
Co-Author - Yan Luo, PhD, Shanghai Jiao Tong University
Co-Author - Kelly Ryono, university of illinois urbana-champaign
Co-Author - David Thomas, PhD Candidate (ABD), UIUC
Co-Author - Adam Taggart, PhD, University of Michigan Ann Arbor
Co-Author - Madhura Phansikar, PhD, The Ohio State University
Co-Author - Youngjoon Kim, PhD, university of illinois urbana-champaign
Co-Author - Alexandre J. S. Morin, PhD, Concordia University
Co-Author - Arthur Kramer, PhD, University of Illinois
Co-Author - Edward McAuley, PhD, University of Illinois
Co-Author - Sean Mullen, PhD, University of Illinois at Urbana-Champaign
Social Support and Physical Activity Among Teens and Young Adults with Congenital Heart Disease: The Mediating Role of Perceived Control
Poster Number: E121Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Cardiovascular Disease
Importance: The American Heart Association recommends teens and young adults with congenital heart disease (CHD) participate in regular moderate-to-vigorous activity (MVPA), which has been suggested to improve vascular and immune functioning. However, some research shows individuals with CHD display lower levels of daily physical activity compared to the general population. It may be that perceived control contributes to the relationship between social support and MVPA, but this has yet to be explored. Therefore, this study aimed to examine relationships between social support, perceived control, and MVPA in teens and young adults with CHD.
Methods/Design: Teens and young adults with CHD (N = 245; Mage=19.82, SD=3.21; 56% male, 83% white, 74% Moderate CHD, 26% Complex CHD) completed self-report measures assessing social support and perceived control for physical activity as part of a larger ongoing randomized controlled trial. MVPA daily averages were determined from one week of waist-worn accelerometry. Whether perceived control contributes unique variance to the relationship between social support and MPVA was explored.
Results/Findings: Males had significantly higher daily MVPA minutes (M = 26.62) than females (M = 14.89, t = 4.740, p ≤ .001). However, age and CHD complexity were not significantly related to MVPA. Social support and perceived control for physical activity were positively associated with daily MVPA, r = .191, p = .003, r = .231, p ≤ .001, respectfully. Further, there was a significant indirect effect of social support on daily MVPA through perceived control for physical activity, b = .0433, SE = .0192, CI [.0113, .2430].
Conclusions: Our findings suggest that having greater perceived control for engaging in physical activity may help explain the relationship between greater social support from family and friends and higher levels of MVPA. When counseling teens and young adults on being more physically active, it may be important to consider whether they perceive themselves as having control of engaging in MVPA. Considering future research, the current ongoing trial will examine whether the intervention changes perceptions of self-control.
Keywords: Cardiovascular disease, Social supportMethods/Design: Teens and young adults with CHD (N = 245; Mage=19.82, SD=3.21; 56% male, 83% white, 74% Moderate CHD, 26% Complex CHD) completed self-report measures assessing social support and perceived control for physical activity as part of a larger ongoing randomized controlled trial. MVPA daily averages were determined from one week of waist-worn accelerometry. Whether perceived control contributes unique variance to the relationship between social support and MPVA was explored.
Results/Findings: Males had significantly higher daily MVPA minutes (M = 26.62) than females (M = 14.89, t = 4.740, p ≤ .001). However, age and CHD complexity were not significantly related to MVPA. Social support and perceived control for physical activity were positively associated with daily MVPA, r = .191, p = .003, r = .231, p ≤ .001, respectfully. Further, there was a significant indirect effect of social support on daily MVPA through perceived control for physical activity, b = .0433, SE = .0192, CI [.0113, .2430].
Conclusions: Our findings suggest that having greater perceived control for engaging in physical activity may help explain the relationship between greater social support from family and friends and higher levels of MVPA. When counseling teens and young adults on being more physically active, it may be important to consider whether they perceive themselves as having control of engaging in MVPA. Considering future research, the current ongoing trial will examine whether the intervention changes perceptions of self-control.
Authors:
Author - Marlee Rakouskas, B.S., Nationwide Childrens Hospital
Co-Author - Taylor Dattilo, Ph.D., Nationwide Children's Hospital
Co-Author - Ruri Famelia, PhD, Nationwide Children's Hospital
Co-Author - Naina Manocha, B.S., Nationwide Childrens
Co-Author - Jamie Jackson, Ph.D., Nationwide Childrens Hospital
Exploring the role of visual attention in the photosurvey procedure of built environmental physical activity research
Poster Number: E122Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Social and Environmental Context and Health
Asking participants to judge environments based on static photographs is one experimental approach used to identify built environmental factors that may increase physical activity. In these studies, results can be difficult to interpret: is a particular factor ineffective, or did participants not notice it? This exploratory study uses eye-tracking data to assess the relationship between visual attention to microscale environmental modifications and physical activity intentions based on static photographs. Participants were 141 college students who viewed photographs of parks with or without an intervention (i.e., a pavilion and trashcan, a lightpost, a park bench). Participants then rated their intention to be physically active in the depicted environment while their eye fixations were recorded. Based on a multilevel structural equation model, fixating on the intervention was not significantly associated with activity intention on the between- (b=0.25, p= 0.065, 95%CI [-0.15, 1.06]) nor within-subjects levels (b=-0.08, p=0.052, 95% CI[-0.19, 0.02]). Follow-up path analysis models stratified by intervention were conducted with a false discovery rate (FDR) correction. Those who viewed a park with a pavilion and trashcan were more likely to report higher activity intentions, but fixating on the intervention was not significant after FDR adjustment (b=-0.10, p= 0.02, 95%CI[-0.23, -0.02]). For the remaining interventions which did not affect activity intention, there was no evidence for the role of fixating on the intervention (Lightpost: b=0.00, p=0.46, 95%CI[-0.19, 0.20]; Bench: b=0.14, p=0.10, 95%CI[-0.05,0.31]). Advanced statistical techniques that decompose within- and between-subjects effects can provide deeper understanding of experimental investigations into the effects of manipulated environmental factors. For two interventions, eye-tracking analyses contradicted the null results explanation that participants did not notice the modification, providing support for the conclusion that these interventions do not improve activity intentions. Between-subjects findings can address questions of participant motivation: Participants who tended to fixate on the interventions responded similarly to those who did not. Future researchers using primarily-visual media (e.g., photographs, videos, virtual reality) to experimentally assess built environments may consider using eye-tracking data as a predictor to explore potential explanations for their results.
Keywords: Built environment, Physical activityAuthors:
Presenter - Amanda Spitzer, MS, Colorado State University
Co-Author - Reagan Miller-Chagnon, PhD, Colorado State University
Co-Author - Daniel Graham, PhD, Colorado State University
Study enrollment and protocol adherence in a dyadic behavioral intervention trial among racially, ethnically, and socioeconomically diverse women
Poster Number: E123Time: 05:00 PM - 05:50 PM
Topics: Physical Activity
Background: Within behavioral intervention trials, adherence to study procedures and trial retention are critical to ensure internal validity. In a trial designed to test the effectiveness of a dyadic intervention to increase physical activity in inactive women, we implemented brief orientation sessions prior to enrollment to enhance women’s understanding of the study, adherence to study procedures, and ultimately, retention. This presentation will describe the orientation sessions and enrollment and adherence outcomes in racially, ethnically, and socioeconomically diverse women.
Methos: Women on the Move is an ongoing trial in which women enrolled with a study partner (e.g., family, friend) and were randomized to a dyadic health coaching intervention, an individual health coaching intervention, or a health education control. Women were recruited through community channels and from work sites. Dyads in which both women were eligible were invited to participate in a virtual, 30-minute orientation session. Orientation sessions highlighted the health benefits of physical activity, provided study details, described underlying research principles (e.g., randomization), and engaged women in interactive discussions with Motivational Interviewing techniques to inform women’s decision-making regarding trial participation. Chi-square tests assessed associations of demographic characteristics with study enrollment.
Results: In total, 1,008 women were screened for eligibility, 736 (73%) were eligible as individuals, and 571 (78% of eligible) completed orientation. Of those who completed the orientation, 460 women (81%; 230 dyads) attended a baseline visit. Participants were racially/ethnically diverse (64% Hispanic, 23% Black, 7% White, 5% Asian), and 33% reported a high school education or less. Nearly all women (99%) completed study procedures at baseline which included sufficient wear of an accelerometer for physical activity assessment. Although enrollment rates post-orientation varied by Hispanic ethnicity and education level (e.g., 74% for those reporting less than high school education compared to 82% for those with more), these differences were not statistically significant.
Conclusions: Women enrolled in the study at similar rates post-orientation. Orientation sessions were easily incorporated into the enrollment process and were designed to provide women with the information and tools needed to decide whether they could commit to study participation.
Keywords: Physical activity, Randomized controlled trialMethos: Women on the Move is an ongoing trial in which women enrolled with a study partner (e.g., family, friend) and were randomized to a dyadic health coaching intervention, an individual health coaching intervention, or a health education control. Women were recruited through community channels and from work sites. Dyads in which both women were eligible were invited to participate in a virtual, 30-minute orientation session. Orientation sessions highlighted the health benefits of physical activity, provided study details, described underlying research principles (e.g., randomization), and engaged women in interactive discussions with Motivational Interviewing techniques to inform women’s decision-making regarding trial participation. Chi-square tests assessed associations of demographic characteristics with study enrollment.
Results: In total, 1,008 women were screened for eligibility, 736 (73%) were eligible as individuals, and 571 (78% of eligible) completed orientation. Of those who completed the orientation, 460 women (81%; 230 dyads) attended a baseline visit. Participants were racially/ethnically diverse (64% Hispanic, 23% Black, 7% White, 5% Asian), and 33% reported a high school education or less. Nearly all women (99%) completed study procedures at baseline which included sufficient wear of an accelerometer for physical activity assessment. Although enrollment rates post-orientation varied by Hispanic ethnicity and education level (e.g., 74% for those reporting less than high school education compared to 82% for those with more), these differences were not statistically significant.
Conclusions: Women enrolled in the study at similar rates post-orientation. Orientation sessions were easily incorporated into the enrollment process and were designed to provide women with the information and tools needed to decide whether they could commit to study participation.
Authors:
Author - Larkin Strong, PhD, MPH, University of Texas MD Anderson Cancer Center
Co-Author - Lorna McNeill, MPH, PhD, FSBM, University of Texas MD Anderson Cancer Center
Co-Author - Lorraine Reitzel, PhD, University of Texas MD Anderson Cancer Center
Co-Author - Yisheng Li, PhD, University of Texas MD Anderson Cancer Center
Co-Author - Jian Wang, PhD, University of Texas MD Anderson Cancer Center
Co-Author - Karen Basen-Engquist, PhD, MPH, FSBM, UT - M.D. Anderson Cancer Center
Social Cognitive Predictors of Muscle Strengthening Activity Behavior Among Cancer Survivors
Poster Number: E124Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Cancer
Background: Increased muscle strengthening activities (MSA) are associated with improved health outcomes in cancer survivors. Guidelines recommend cancer survivors engage in ≥2 days/week of MSA, but most cancer survivors do not meet these guidelines. A better understanding of theory-driven determinants of MSA is needed to optimize future interventions.
Methods: This study examined social cognitive theory (SCT) correlates of cancer survivors’ beliefs, preferences, and engagement in MSA. Cross-sectional survey data were analyzed from post-treatment cancer survivors (N=553, Mean age=56.5 (SD=14.7); 53.6% female). Participants self-reported frequency and duration of weekly MSA engagement via the Muscle Strengthening Exercise Questionnaire. They also completed well-validated SCT-construct questionnaires modified to focus on MSA, including the Exercise Identity and Planning Scale (motivation and planning), Self-Efficacy for Exercise Scale, Multidimensional Outcome Expectations for Exercise Scale, and Social Support for Exercise Scale. SCT correlates of MSA were examined using logistic regressions (meet MSA guidelines yes/no) and linear regressions (weekly MSA minutes)
Results: Approximately half of the participants met the MSA guidelines (273, 49.3%), with a mean weekly MSA minutes of 40.45 min (SD = 32.98) for those participating in MSA. Higher motivation and planning, and stronger self-efficacy beliefs and physical, self-evaluative, and cancer-specific outcome expectations were associated with meeting MSA guidelines and higher weekly MSA minutes. Social support from family and friends was correlated with adherence to MSA guidelines, but not with the number of weekly MSA minutes.
Conclusions: Our findings suggest that SCT constructs may be associated with meeting MSA guidelines and engaging in weekly MSA minutes in cancer survivors. MSA intervention in cancer survivors should incorporate strategies to support planning, build self-efficacy, strengthen positive outcome expectations, and leverage family and friend social support networks to help increase MSA participation and improve health outcomes.
Keywords: Physical activity, Cancer survivorshipMethods: This study examined social cognitive theory (SCT) correlates of cancer survivors’ beliefs, preferences, and engagement in MSA. Cross-sectional survey data were analyzed from post-treatment cancer survivors (N=553, Mean age=56.5 (SD=14.7); 53.6% female). Participants self-reported frequency and duration of weekly MSA engagement via the Muscle Strengthening Exercise Questionnaire. They also completed well-validated SCT-construct questionnaires modified to focus on MSA, including the Exercise Identity and Planning Scale (motivation and planning), Self-Efficacy for Exercise Scale, Multidimensional Outcome Expectations for Exercise Scale, and Social Support for Exercise Scale. SCT correlates of MSA were examined using logistic regressions (meet MSA guidelines yes/no) and linear regressions (weekly MSA minutes)
Results: Approximately half of the participants met the MSA guidelines (273, 49.3%), with a mean weekly MSA minutes of 40.45 min (SD = 32.98) for those participating in MSA. Higher motivation and planning, and stronger self-efficacy beliefs and physical, self-evaluative, and cancer-specific outcome expectations were associated with meeting MSA guidelines and higher weekly MSA minutes. Social support from family and friends was correlated with adherence to MSA guidelines, but not with the number of weekly MSA minutes.
Conclusions: Our findings suggest that SCT constructs may be associated with meeting MSA guidelines and engaging in weekly MSA minutes in cancer survivors. MSA intervention in cancer survivors should incorporate strategies to support planning, build self-efficacy, strengthen positive outcome expectations, and leverage family and friend social support networks to help increase MSA participation and improve health outcomes.
Authors:
Presenter - Shirlene Wang, PhD, Northwestern University
Co-Author - Julia Pincever, MA, Northwestern University
Co-Author - Julia Frey, Northwestern University
Co-Author - Payton Solk, MS, Northwestern University Feinberg School of Medicine
Co-Author - Kristina Hasanaj, PhD, Northwestern University
Co-Author - Melanie Wolter, Northwestern University
Co-Author - Hannah Freeman, Northwestern University
Co-Author - Lauren Wang, Northwestern University
Co-Author - Fiona Webb, Northwestern University
Co-Author - Siobhan Phillips, PhD, MPH, Northwestern University
Predictors of Response to a 24-Week, Multi-site Electronic Health Record-Integrated Physical Activity Intervention (MyActivity) Among Breast and Endometrial Cancer Survivors
Poster Number: E125Time: 05:00 PM - 05:50 PM
Topics: Physical Activity, Cancer
Purpose: Moderate to vigorous physical activity (MVPA) is associated with improved health outcomes among breast and endometrial cancer survivors; however, many remain insufficiently active. While many physical activity interventions have demonstrated efficacy, the increase in MVPA (i.e. response) is often heterogeneous. This study explored demographic and disease correlates of response to the 24-week MyActivity MVPA promotion intervention.
Methods: Inactive post-treatment survivors (n=323; Mage=57.4 (SD=11.0); 73.7% breast; 25.4% endometrial) received the minimal MyActivity intervention (study website + Fitbit integrated into the electronic health-record) as part of a singly randomized trial. MVPA goal adherence was evaluated every 4 weeks over the 24-week intervention. At each evaluation timepoint, intervention response was assessed. Participants were classified as non-responders if they met ≤80% of the MVPA goals over the previous 4 weeks and were randomized for the remainder of 24-weeks to one of two “step-up” conditions: online gym or bi-weekly coaching calls. Responders continued with the website + Fitbit minimal intervention. Participants self-reported demographic (age, body mass index, race, ethnicity, employment, rurality, education, income) and health (cancer type, stage, and treatment; chronic conditions; health status) characteristics and wore an accelerometer for 7 consecutive days to assess MVPA at baseline. T-tests and Chi-Square tests were used to examine potential correlates (p<0.10 due to exploratory nature) of non-response.
Results: A total of 116 (36%) participants were classified as non-responders. Higher BMI, working full- or part-time, lower income, poorer health rating, diagnoses of arthritis, degenerative disc disease, or visual impairment, and lower baseline accelerometer MVPA were associated (p<0.10) with non-response to MyActivity. Individuals who had osteoporosis were more likely to be responders (p=0.05). No other associations were observed.
Conclusions: Health status, presence of coexisting health conditions, employment status, and income level may be associated with cancer survivors’ ability to effectively engage in MVPA interventions. Identifying predictors of response to MVPA interventions may inform more effective tailoring of MVPA promotion strategies and resources to reduce non-response, enhance intervention efficacy, and improve health outcomes.
Keywords: Physical activity, Cancer survivorshipMethods: Inactive post-treatment survivors (n=323; Mage=57.4 (SD=11.0); 73.7% breast; 25.4% endometrial) received the minimal MyActivity intervention (study website + Fitbit integrated into the electronic health-record) as part of a singly randomized trial. MVPA goal adherence was evaluated every 4 weeks over the 24-week intervention. At each evaluation timepoint, intervention response was assessed. Participants were classified as non-responders if they met ≤80% of the MVPA goals over the previous 4 weeks and were randomized for the remainder of 24-weeks to one of two “step-up” conditions: online gym or bi-weekly coaching calls. Responders continued with the website + Fitbit minimal intervention. Participants self-reported demographic (age, body mass index, race, ethnicity, employment, rurality, education, income) and health (cancer type, stage, and treatment; chronic conditions; health status) characteristics and wore an accelerometer for 7 consecutive days to assess MVPA at baseline. T-tests and Chi-Square tests were used to examine potential correlates (p<0.10 due to exploratory nature) of non-response.
Results: A total of 116 (36%) participants were classified as non-responders. Higher BMI, working full- or part-time, lower income, poorer health rating, diagnoses of arthritis, degenerative disc disease, or visual impairment, and lower baseline accelerometer MVPA were associated (p<0.10) with non-response to MyActivity. Individuals who had osteoporosis were more likely to be responders (p=0.05). No other associations were observed.
Conclusions: Health status, presence of coexisting health conditions, employment status, and income level may be associated with cancer survivors’ ability to effectively engage in MVPA interventions. Identifying predictors of response to MVPA interventions may inform more effective tailoring of MVPA promotion strategies and resources to reduce non-response, enhance intervention efficacy, and improve health outcomes.
Authors:
Presenter - Lauren Wang, BA, Northwestern University Feinberg School of Medicine
Co-Author - Julia Pincever, MA, Northwestern University Feinberg School of Medicine
Co-Author - Payton Solk, MS, Northwestern University Feinberg School of Medicine
Co-Author - Jing Song, MS, Northwestern University Feinberg School of Medicine
Co-Author - Hannah Freeman, BA, Northwestern University Feinberg School of Medicine
Co-Author - Julia Frey, BS, Northwestern University Feinberg School of Medicine
Co-Author - Fiona Webb, BA, Northwestern University Feinberg School of Medicine
Co-Author - Megan Agnew, PhD, MPH, University of Wisconsin-Madison
Co-Author - Christian Schmidt, PhD, University of Wisconsin-Madison
Co-Author - Shirlene Wang, PhD, Northwestern University Feinberg School of Medicine
Co-Author - Kristina Hasanaj, PhD, Northwestern University Feinberg School of Medicine
Co-Author - Amye Tevaarwerk, MD, Mayo Clinic Cancer Center
Co-Author - Emma Barber, MD, Northwestern University Feinberg School of Medicine
Co-Author - Bonnie Spring, PhD, Northwestern University Feinberg School of Medicine
Co-Author - Mary Sesto, PT, PhD, University of Wisconsin-Madison
Co-Author - William Gradishar, MD, Northwestern University Feinberg School of Medicine
Co-Author - Ryan Spencer, MD, MS, FACOG, University of Wisconsin-Madison
Co-Author - Ron Gangnon, PhD, University of Wisconsin-Madison
Co-Author - Inbal Nahum-Shani, PhD, University of Michigan
Co-Author - Lisa Cadmus-Bertam, PhD, University of Wisconsin-Madison
Co-Author - Kristen Pickett, PhD, University of Wisconsin-Madison
Co-Author - Siobhan Phillips, PhD, MPH, Northwestern University Feinberg School of Medicine
Associations Between Muscle Strengthening Activities Characteristics and Patient Reported Physical Health, Mental Health, and Fatigue in Cancer Survivors
Poster Number: E126Time: 05:00 PM - 05:50 PM
Topics: Physical Activity
Background: Cancer survivors (CS) experience elevated symptom burden and side effects post-treatment. Muscle-strengthening activities (MSA) may improve CS’s health outcomes, but the relationship between MSA FITT (i.e. frequency, intensity, time, and type) characteristics and health outcomes are unclear. This study examined associations between MSA FITT characteristics and patient reported outcomes (PROs).
Methods: Post-treatment CS [N=553,Mage=56.5 (SD=14.7);53.6% female] within 5 years of diagnosis completed the Patient-Reported Outcomes Measurement Information System Global 10 (Short Form) to assess physical and mental health and Fatigue (Short Form) v8. CS self-reported MSA FITT characteristics via the Muscle-Strengthening Exercise Questionnaire: frequency, session intensity (from 0=extremely easy to 10=extremely hard), time, and type [weight machines (WM); resistance exercise (RE); bodyweight exercise (BE), and holistic exercise (HE)]. Separate linear regression models examined associations between meeting MSA (i.e.≥ 2 days/week) guidelines and FITT characteristics with PROs scores.
Results: Over half (n=302; 54.6%) of CS reported any MSA; 49.4% reported meeting MSA guidelines. On average, CS reported 22.0 (SD=31.6) MSA minutes/week MSA; average intensity was 5.9 (SD=2.1). Meeting MSA guidelines was associated with higher physical (β=1.12,SE=.13,p<.001) and mental (β=1.44SE=.21,p<.001) health and lower fatigue (β=-4.24,SE=.70,p<.001). Every 10-minute increase in weekly MSA was significantly (ps<.001) associated with better physical (β=0.14; 95%CI=0.10,0.18) and mental (β=0.17;95%CI=0.11,0.24) health and lower fatigue (β=-0.44; 95%CI=-0.66,-0.22). For CS who did any MSA, higher session intensity rating (β=0.17, SE=.04,p<.001) and doing WM (β=0.49,SE=.16,p<.005) and BW (β=0.88,SE=.17,p<.001) exercises were associated with higher physical health. BW exercise was also associated with lower fatigue (β=-2.45,SE=.98,p<.02). No other associations between MSA type and PROs were significant.
Conclusions: Meeting MSA guidelines and higher MSA minutes were associated with improved physical and mental health and lower fatigue ratings. Associations with PROs for MSA type and intensity were more heterogenous. Fatigue differences for MSA guidelines and BW exercise were clinically meaningful. Future work should further explore how MSA characteristics influence health outcomes to inform MSA intervention development and testing to maximize health outcomes for CS.
Keywords: Physical activity, Cancer survivorshipMethods: Post-treatment CS [N=553,Mage=56.5 (SD=14.7);53.6% female] within 5 years of diagnosis completed the Patient-Reported Outcomes Measurement Information System Global 10 (Short Form) to assess physical and mental health and Fatigue (Short Form) v8. CS self-reported MSA FITT characteristics via the Muscle-Strengthening Exercise Questionnaire: frequency, session intensity (from 0=extremely easy to 10=extremely hard), time, and type [weight machines (WM); resistance exercise (RE); bodyweight exercise (BE), and holistic exercise (HE)]. Separate linear regression models examined associations between meeting MSA (i.e.≥ 2 days/week) guidelines and FITT characteristics with PROs scores.
Results: Over half (n=302; 54.6%) of CS reported any MSA; 49.4% reported meeting MSA guidelines. On average, CS reported 22.0 (SD=31.6) MSA minutes/week MSA; average intensity was 5.9 (SD=2.1). Meeting MSA guidelines was associated with higher physical (β=1.12,SE=.13,p<.001) and mental (β=1.44SE=.21,p<.001) health and lower fatigue (β=-4.24,SE=.70,p<.001). Every 10-minute increase in weekly MSA was significantly (ps<.001) associated with better physical (β=0.14; 95%CI=0.10,0.18) and mental (β=0.17;95%CI=0.11,0.24) health and lower fatigue (β=-0.44; 95%CI=-0.66,-0.22). For CS who did any MSA, higher session intensity rating (β=0.17, SE=.04,p<.001) and doing WM (β=0.49,SE=.16,p<.005) and BW (β=0.88,SE=.17,p<.001) exercises were associated with higher physical health. BW exercise was also associated with lower fatigue (β=-2.45,SE=.98,p<.02). No other associations between MSA type and PROs were significant.
Conclusions: Meeting MSA guidelines and higher MSA minutes were associated with improved physical and mental health and lower fatigue ratings. Associations with PROs for MSA type and intensity were more heterogenous. Fatigue differences for MSA guidelines and BW exercise were clinically meaningful. Future work should further explore how MSA characteristics influence health outcomes to inform MSA intervention development and testing to maximize health outcomes for CS.
Authors:
Author - Melanie Wolter, BA, Northwestern University
Co-Author - Shirlene Wang, PhD, Northwestern University
Co-Author - Julia Pincever, MA, Northwestern University
Co-Author - Julia Frey, BS, Northwestern University
Co-Author - Payton Solk, MS, Northwestern University Feinberg School of Medicine
Co-Author - Jean Reading, PhD, University of Illinois at Chicago
Co-Author - Kristina Hasanaj, PhD, Northwestern University
Co-Author - Hannah Freeman, BA, Northwestern University
Co-Author - Lauren Wang, BS, Northwestern University
Co-Author - Fiona Webb, BA, Northwestern University
Co-Author - Siobhan Phillips, PhD, MPH, FSBM, Northwestern University
Funding Freezes Affecting Research Training and Career Development Training Grants and Recommendations for Future Advocacy
Poster Number: E127Time: 05:00 PM - 05:50 PM
Topics: Professional Development, Health Communication and Policy
Background: In 2022, a panel of the National Academies of Science, Engineering, and Medicine (NASEM) recommended federal investment in expanding the scientific workforce with an emphasis on increasing workforce diversity. NIH-funded Research Training and Career Development awards for doctoral students and early career researchers are key mechanisms for workforce development. Changes in federal priorities in early 2025 led to terminations and funding freezes for training awards, which will disrupt degree attainment, research training, and foundational scholarship of emerging scientists.
Purpose: In this study, we explored the potential impact of funding freezes on the scientific workforce by describing the types of training awards affected by funding changes in 2025.
Methods: We analyzed data from Grant Witness to determine the scope of affected training awards. We included awards which: 1) had funds terminated, frozen, or paused and possibly reinstated; 2) were in the Research Training and Career Development category; 3) were focused on career or workforce training of individuals versus curriculum.
Results: As of August 30th, 2025, 5,114 NIH awards had been terminated or subject to funding freezes. Approximately 25% (n=1240) of all affected awards supported research training and career development. Training awards were largely F31s (n=408, 32.90%), followed by T32s (n=224, 18.06%), and K99s (n=142, 11.45%). The total expenses for all training awards that were terminated or frozen was $1.2 billion, with each F31 award averaging $75,000. Two Funding Opportunity Announcements for predoctoral fellowships, the Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research (n=192, 15.48%) and the NRSA Individual Predoctoral Fellowship (n=98, 7.90%) had the greatest number of affected awards.
Conclusion: One quarter of the NIH awards affected by funding freezes supported the expansion of the scientific workforce. Predoctoral fellowships, especially for students from diverse backgrounds, were substantially affected. The cost of these awards is small relative to their impact on the workforce. Their termination runs counter to NASEM recommendations and will undoubtedly have a long-reaching impact on scientific innovation. Advocacy to help policymakers understand the value and impact of such training awards is critically important to prevent disruptions in workforce expansion.
Keywords: Policy, AdvocacyPurpose: In this study, we explored the potential impact of funding freezes on the scientific workforce by describing the types of training awards affected by funding changes in 2025.
Methods: We analyzed data from Grant Witness to determine the scope of affected training awards. We included awards which: 1) had funds terminated, frozen, or paused and possibly reinstated; 2) were in the Research Training and Career Development category; 3) were focused on career or workforce training of individuals versus curriculum.
Results: As of August 30th, 2025, 5,114 NIH awards had been terminated or subject to funding freezes. Approximately 25% (n=1240) of all affected awards supported research training and career development. Training awards were largely F31s (n=408, 32.90%), followed by T32s (n=224, 18.06%), and K99s (n=142, 11.45%). The total expenses for all training awards that were terminated or frozen was $1.2 billion, with each F31 award averaging $75,000. Two Funding Opportunity Announcements for predoctoral fellowships, the Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research (n=192, 15.48%) and the NRSA Individual Predoctoral Fellowship (n=98, 7.90%) had the greatest number of affected awards.
Conclusion: One quarter of the NIH awards affected by funding freezes supported the expansion of the scientific workforce. Predoctoral fellowships, especially for students from diverse backgrounds, were substantially affected. The cost of these awards is small relative to their impact on the workforce. Their termination runs counter to NASEM recommendations and will undoubtedly have a long-reaching impact on scientific innovation. Advocacy to help policymakers understand the value and impact of such training awards is critically important to prevent disruptions in workforce expansion.
Authors:
Co-Author - Amelia Knopf, PhD, Indiana University
Managing Anger for Patients and Providers (MAPP): Refining an Anger Communication Training Program for Remote Delivery to Palliative Care Clinicians
Poster Number: E128Time: 05:00 PM - 05:50 PM
Topics: Professional Development, Health Communication and Policy
Anger can be a common and reasonable response to painful and serious illnesses treated in palliative care. Dysregulated anger is associated with poorer pain and symptom management and can erode the patient-clinician alliance. Clinician training can enhance emotion regulation and communication skills providers need to assist patients with addressing, expressing, and regulating their anger effectively. Given barriers in the palliative care training pipeline, online training options are needed to enhance clinicians access to training.
The aim of this study was to assess if a remotely delivered hybrid synchronous/asynchronous version of the Managing Anger for Patients and Providers (MAPP) program is a feasible method for strengthening provider self-efficacy and communication skills in responding to patient anger.
Participants completed pre-training questionnaires and then engaged with activities in a self-paced learning module consisting of readings, pre-recorded videos, and reflection questions before attending the virtual workshop. During the virtual workshop, participants were able to test the skills they learned in a case-based scripted role play on Zoom with trained graduate students, and preceptors experienced in palliative care service and training. Afterwards, post-training questionnaires were completed.
Thirteen of seventeen participants completed the program (eight returning trainees, nine new trainees). There was a significant increase in anger communication self-efficacy (B = 17.3, p < .001), a significant decrease in emotional suppression (B = -3.05, p = .026), and a non-significant increase in reappraisal (B = 1.77, p = .067). Post-training anger communication self-efficacy was strongly associated with higher skill use (r = .65, p = .022). New trainees reported greater improvements in anger communication self-efficacy and reappraisal compared to the returning trainees, however, the returning trainees marked larger improvements in emotional suppression.
Participants found the virtual hybrid version of the MAPP program to be useful and feasible to frequently use in their clinical practice. MAPP skills appear to have a stronger impact on new trainees, who recorded greater improvements. The findings show useful takeaways for how the MAPP program can be effectively delivered in a remote design with live and self-paced components. The poster will discuss implications for further anger communication research including controlled trials.
Keywords: Anger, Palliative careThe aim of this study was to assess if a remotely delivered hybrid synchronous/asynchronous version of the Managing Anger for Patients and Providers (MAPP) program is a feasible method for strengthening provider self-efficacy and communication skills in responding to patient anger.
Participants completed pre-training questionnaires and then engaged with activities in a self-paced learning module consisting of readings, pre-recorded videos, and reflection questions before attending the virtual workshop. During the virtual workshop, participants were able to test the skills they learned in a case-based scripted role play on Zoom with trained graduate students, and preceptors experienced in palliative care service and training. Afterwards, post-training questionnaires were completed.
Thirteen of seventeen participants completed the program (eight returning trainees, nine new trainees). There was a significant increase in anger communication self-efficacy (B = 17.3, p < .001), a significant decrease in emotional suppression (B = -3.05, p = .026), and a non-significant increase in reappraisal (B = 1.77, p = .067). Post-training anger communication self-efficacy was strongly associated with higher skill use (r = .65, p = .022). New trainees reported greater improvements in anger communication self-efficacy and reappraisal compared to the returning trainees, however, the returning trainees marked larger improvements in emotional suppression.
Participants found the virtual hybrid version of the MAPP program to be useful and feasible to frequently use in their clinical practice. MAPP skills appear to have a stronger impact on new trainees, who recorded greater improvements. The findings show useful takeaways for how the MAPP program can be effectively delivered in a remote design with live and self-paced components. The poster will discuss implications for further anger communication research including controlled trials.
Authors:
Presenter - Mia Schmittenberg, Ohio University
Co-Presenter - Shriya Saxena, Ohio University
Co-Author - James Gerhart, PhD, Ohio University
Patient Experiences from Medical Student Training with Motivational Interviewing
Poster Number: E129Time: 05:00 PM - 05:50 PM
Topics: Professional Development, Multiple Health Behavior Change
Background: Motivational interviewing is becoming increasingly popular in medical school training, but there is limited information on patients’ experiences with students’ implementation of MI strategies. The aim of this study was to analyze the impact of medical students’ use of motivational interviewing on patient care and patient experiences.
Methods: The motivational interviewing education regimen consisted of a three-day program. On day one, students attended didactic lectures on the foundational principles and strategies of motivational interviewing, in addition to engaging in supervised role-playing to practice these strategies. The next two days largely consisted of students practicing the strategies they had learned with patients in a supervised emergency room setting. Afterwards, patients filled out a Communicational Assessment Tool (CAT) which scored students’ performance and their own experiences with the encounters.
Results: The descriptive statistics for the CAT total score was n = 28, M = 4.87, SD = 0.41, with a range of 1-5. Of note, the variability in range was only found in three items on the CAT and the remainder of the items ranged from 4 to 5. When examining differences by gender Chi-square analyses were completed by item, and no significant differences were found. Interestingly, women universally rated motivational interviewing communication on the CAT 5/5.
Conclusions: This study found that a brief educational intervention on the topic of motivational interviewing had a positive impact on first-year medical students’ abilities to use motivational interviewing to facilitate high levels of patient satisfaction in an emergency room setting.
Keywords: Education, MotivationMethods: The motivational interviewing education regimen consisted of a three-day program. On day one, students attended didactic lectures on the foundational principles and strategies of motivational interviewing, in addition to engaging in supervised role-playing to practice these strategies. The next two days largely consisted of students practicing the strategies they had learned with patients in a supervised emergency room setting. Afterwards, patients filled out a Communicational Assessment Tool (CAT) which scored students’ performance and their own experiences with the encounters.
Results: The descriptive statistics for the CAT total score was n = 28, M = 4.87, SD = 0.41, with a range of 1-5. Of note, the variability in range was only found in three items on the CAT and the remainder of the items ranged from 4 to 5. When examining differences by gender Chi-square analyses were completed by item, and no significant differences were found. Interestingly, women universally rated motivational interviewing communication on the CAT 5/5.
Conclusions: This study found that a brief educational intervention on the topic of motivational interviewing had a positive impact on first-year medical students’ abilities to use motivational interviewing to facilitate high levels of patient satisfaction in an emergency room setting.
Authors:
Author - Caleb Wunder, BS, University of Kansas Medical Center
Co-Author - Brad Barth, MD, University of Kansas Medical Center
Co-Author - Courtney Marlin, LSCSW, ACM, CCM, University of Kansas Medical Center
Co-Author - Jessica Hamilton, PhD, University of Kansas Medical Center
CRIS (Cancer Resource and Information Support) Software improves QOL 1-month post Cystectomy among Bladder Cancer Patients: Results from a RCT
Poster Number: E13Time: 05:00 PM - 05:50 PM
Topics: Cancer, Quality of Life
Background: Bladder cancer (BC) survivors and their partners and caregivers experience both practical and psychosocial challenges following cystectomy (bladder removal). The CRIS (Cancer Resource Information Support) software is a new, web-based health and lifestyle management tool for patients recovering from cystectomy and their caregivers. CRIS features expert and patient/caregiver testimonies and medically approved information.
Purpose: To report on the results of a two-site RCT, comparing CRIS vs an enhanced standard of care (eSOC) consisting of a take-home brochure (NCI’s Facing Forward) on patient and caregiver quality of life (QOL) after cystectomy.
Method: We collected data at baseline and 1-month post-intervention: QOL with the FACT- Bladder for patients and the Caregiver QOL scale, and on anxiety and depression with the GAD7 and CESD.
Results: Patients (N=109) were mostly male (n=77), White (n=95), married/partnered (n=75); mean age=66.93 (±9.66 years). Diversion types were illeal conduit (n=71;65%) and neobladder (n=29; 27%). Caregivers (N=65) were mostly female (n=57), White (n=56), married/partnered (n=56); mean age=59.91 (±12.41 years). No significant differences between the two study arms by demographics or site exist.
One-month post-surgery, QOL scores of patients randomized to CRIS were 10 points higher than those of patients in the comparison arm [CRIS QOL=116.34±22.94; Brochure QOL=106.87 ±22.75; p = 0.028]. This is a clinically meaningful difference.
Baseline caregivers mean QOL score randomized to CRIS was 34.76±8.51 and for eSOC 33.24±8.27. At one month caregiver QOL for CRIS was 31.70±9.47 and for eSOC 34.62±5.97; p=0.023. Although statistically significant the difference is not clinically meaningful. Usage data suggested that caregivers did not use the program as much as patients.
Patients and caregivers in both groups were not clinically depressed/anxious at baseline or 1-month follow-up.
Conclusions: Access to a web-based support tool post-surgery has resulted in clinically significantly better patient QOL at one month. The post-surgical time is especially taxing to patients making underscoring the clinical importance of the present results. The same effect did not hold for caregivers, likely due to a lack of assigned program usage. Future implementation might include consistent electronic reminders about the value of the information contained in CRIS, which will further increase the effectiveness of the program.
Keywords: Cancer survivorship, Quality of lifePurpose: To report on the results of a two-site RCT, comparing CRIS vs an enhanced standard of care (eSOC) consisting of a take-home brochure (NCI’s Facing Forward) on patient and caregiver quality of life (QOL) after cystectomy.
Method: We collected data at baseline and 1-month post-intervention: QOL with the FACT- Bladder for patients and the Caregiver QOL scale, and on anxiety and depression with the GAD7 and CESD.
Results: Patients (N=109) were mostly male (n=77), White (n=95), married/partnered (n=75); mean age=66.93 (±9.66 years). Diversion types were illeal conduit (n=71;65%) and neobladder (n=29; 27%). Caregivers (N=65) were mostly female (n=57), White (n=56), married/partnered (n=56); mean age=59.91 (±12.41 years). No significant differences between the two study arms by demographics or site exist.
One-month post-surgery, QOL scores of patients randomized to CRIS were 10 points higher than those of patients in the comparison arm [CRIS QOL=116.34±22.94; Brochure QOL=106.87 ±22.75; p = 0.028]. This is a clinically meaningful difference.
Baseline caregivers mean QOL score randomized to CRIS was 34.76±8.51 and for eSOC 33.24±8.27. At one month caregiver QOL for CRIS was 31.70±9.47 and for eSOC 34.62±5.97; p=0.023. Although statistically significant the difference is not clinically meaningful. Usage data suggested that caregivers did not use the program as much as patients.
Patients and caregivers in both groups were not clinically depressed/anxious at baseline or 1-month follow-up.
Conclusions: Access to a web-based support tool post-surgery has resulted in clinically significantly better patient QOL at one month. The post-surgical time is especially taxing to patients making underscoring the clinical importance of the present results. The same effect did not hold for caregivers, likely due to a lack of assigned program usage. Future implementation might include consistent electronic reminders about the value of the information contained in CRIS, which will further increase the effectiveness of the program.
Authors:
Presenter - Michael Diefenbach, PhD, FSBM, Northwell Health
Co-Author - Allison Marziliano, PhD, Northwell Health
Co-Author - Erin Tagai, Ph.D., Fox Chase Cancer Center
Co-Author - Stephanie Izard, MS, Northwell Health
Co-Author - Lauryn Hall, BS, Fox Chase Cancer Center
Co-Author - Jennifer Itty, MS, Northwell Health
Co-Author - Sherene Lambert, BS, Northwell Health
Co-Author - Mahdia Parker, BS, Northwell Health
Co-Author - Jazmarie Vega, BS, Fox Chase Cancer Center
Co-Author - Simon Hall, MD, Northwell Health
Co-Author - Manish Vira, MD, Northwell Health
Co-Author - Alexander Kutikof, MD, Fox Chase Cancer Center
Co-Author - Suzanne Miller, PhD, FSBM, Fox Chase Cancer Center/Temple University Health System
Liver Transplantation Rapidly Improves Health Related Quality of Life for those Patients with Higher MELD-3.0 Scores
Poster Number: E130Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Methods and Measurement
Introduction
End-stage liver disease (ESLD) impairs health-related quality of life (HRQOL). However, HRQOL after liver transplantation (LT) has not been adequately measured using robust tools. The National Institutes of Health Patient-Reported Outcomes Measurement Information System 29-item Profile (PROMIS-29) is considered the “standard HRQOL instrument” and assesses seven health domains and pain intensity. We hypothesized that HRQOL domains will improve rapidly post-LT and that magnitude of improvement would vary by Model for End-Stage Liver Disease (MELD) 3.0 scores.
Methods
Participants with ESLD were enrolled at time of LT evaluation. PROMIS-29 profiles were administered at baseline, then monthly pre-LT and weekly post-LT. Patients were grouped by MELD-3.0 scores: MELD>15, MELD<15. Mean T-scores were compared at baseline. Of those transplanted, the mean T-score difference (∆T-score) for each domain was calculated between pre-LT and three months post-LT. Minimal important change (MIC) was defined as a change in mean T-score of ≥2.
Results
A total of 190 LT evaluation patients were enrolled. At their baseline visit, evaluation patients with MELD>15 (56.3%) reported significantly worse health in three of eight domains: physical function (p<0.01), sleep quality (p=0.03), and satisfaction with social roles and activities (p=0.04). Of those enrolled, 51 patients underwent LT and were followed for three months. LT recipients had a mean age of 54 years (SD 11), 57% were male, 73% were white, and the most common disease etiology was alcohol-related liver disease (43%). LT recipients with MELD>15 (58.8%) showed meaningful improvements in seven HRQOL domains (|∆T-score| range 4.2-9.27). Although improvements were observed in patients with MELD<15 in the same seven domains, the magnitude of change was comparatively less (|∆T-score| range 0.09-3.65). Domains associated with largest improvements for those with higher MELD scores were fatigue (∆T-score=-9.27), social roles and activities (∆T-score=6.47), and anxiety (∆T-score=-5.66). Regardless of MELD, pain intensity remained similar to baseline.
Conclusions
Large, meaningful improvements were observed in HRQOL soon after LT for those with higher MELD scores. Notable changes yielded as early as three months after LT suggest that symptomology drives HRQOL. Future studies are needed to better understand the interaction between different symptoms of disease and ESLD etiology in terms of effects on long-term HRQOL.
Keywords: Quality of life, Health outcomesEnd-stage liver disease (ESLD) impairs health-related quality of life (HRQOL). However, HRQOL after liver transplantation (LT) has not been adequately measured using robust tools. The National Institutes of Health Patient-Reported Outcomes Measurement Information System 29-item Profile (PROMIS-29) is considered the “standard HRQOL instrument” and assesses seven health domains and pain intensity. We hypothesized that HRQOL domains will improve rapidly post-LT and that magnitude of improvement would vary by Model for End-Stage Liver Disease (MELD) 3.0 scores.
Methods
Participants with ESLD were enrolled at time of LT evaluation. PROMIS-29 profiles were administered at baseline, then monthly pre-LT and weekly post-LT. Patients were grouped by MELD-3.0 scores: MELD>15, MELD<15. Mean T-scores were compared at baseline. Of those transplanted, the mean T-score difference (∆T-score) for each domain was calculated between pre-LT and three months post-LT. Minimal important change (MIC) was defined as a change in mean T-score of ≥2.
Results
A total of 190 LT evaluation patients were enrolled. At their baseline visit, evaluation patients with MELD>15 (56.3%) reported significantly worse health in three of eight domains: physical function (p<0.01), sleep quality (p=0.03), and satisfaction with social roles and activities (p=0.04). Of those enrolled, 51 patients underwent LT and were followed for three months. LT recipients had a mean age of 54 years (SD 11), 57% were male, 73% were white, and the most common disease etiology was alcohol-related liver disease (43%). LT recipients with MELD>15 (58.8%) showed meaningful improvements in seven HRQOL domains (|∆T-score| range 4.2-9.27). Although improvements were observed in patients with MELD<15 in the same seven domains, the magnitude of change was comparatively less (|∆T-score| range 0.09-3.65). Domains associated with largest improvements for those with higher MELD scores were fatigue (∆T-score=-9.27), social roles and activities (∆T-score=6.47), and anxiety (∆T-score=-5.66). Regardless of MELD, pain intensity remained similar to baseline.
Conclusions
Large, meaningful improvements were observed in HRQOL soon after LT for those with higher MELD scores. Notable changes yielded as early as three months after LT suggest that symptomology drives HRQOL. Future studies are needed to better understand the interaction between different symptoms of disease and ESLD etiology in terms of effects on long-term HRQOL.
Authors:
Author - Michelle Callegari, MS, Northwestern University Feinberg School of Medicine
Author - Kenny Chen, MS, Northwestern University Feinberg School of Medicine
Author - Jessica Kasperek, Northwestern University Feinberg School of Medicine
Author - John Devin Peipert, PhD, University of Birmingham
Author - Zachary Dietch, MD, Northwestern University Feinberg School of Medicine
Exploring New Teacher Wellness Using Poetic Representation
Poster Number: E131Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Social and Environmental Context and Health
Abstract: Teacher attrition remains a global concern, with numerous organizations, including the United Nations Educational, Scientific and Cultural Organization (UNESCO), highlighting the importance of raising the awareness around teacher well-being.
Purpose: The objective of this research was to examine the perceptions of wellness among new teachers with five and fewer years of teaching experience, and to identify programs that effectively supported their well-being.
Methods: Hermeneutical phenomenology and poetic representation were selected for this study as they allowed participant experiences to be considered, interpreted, and represented at a deep and meaningful level. Hermeneutical phenomenology is a qualitative tradition in which researchers explore the deeper meanings and essences of individual experiences (Miles, et al., 2013). Poetry uses words, meaning, and rhythm to create imagery, raise awareness, and evoke emotional responses (Woods & Sikes, 2022). Found poetry provides the researcher with an effective technique to express the everyday reality of people (Sjollema et al., 2012).
Participant sampling and recruitment: This research utilized purposeful and chain sampling, promoted by Patton in 1990. Prior to beginning recruitment, ethical approval was obtained from the University of Victoria Human Research Ethics Board.
Data collection: Data for the study was collected using one-to-one interviews following a standard open-ended interview guide (Patton, 2002). This approach allowed the questions and topics to be predetermined and sequenced in a logical flow (Patton, 2002). During the one-to-one interviews audio recording was conducted to later create full verbatim or denaturalized transcriptions. To properly conduct and use the transcriptions, McMullin’s (2023) framework of undertaking and reporting transcription was used.
Results: Through the interview process, four themes emerged: “wellness as dimensions”, “wellness as balance”, “wellness from programs”, and “wellness as change.” One theme, “wellness as programs”, was revealed to be a cluster where sub-themes surfaced. These included, “wellness as programs for teacher support”, “wellness as program awareness for new teachers”, and “wellness as programs for community”. The emergence of these themes, sub-themes, and teacher comments revealed new teachers’ desire for programs, support, community, and change. From this, further sharing, research, and action is inspired.
Keywords: Worksite health, Career developmentPurpose: The objective of this research was to examine the perceptions of wellness among new teachers with five and fewer years of teaching experience, and to identify programs that effectively supported their well-being.
Methods: Hermeneutical phenomenology and poetic representation were selected for this study as they allowed participant experiences to be considered, interpreted, and represented at a deep and meaningful level. Hermeneutical phenomenology is a qualitative tradition in which researchers explore the deeper meanings and essences of individual experiences (Miles, et al., 2013). Poetry uses words, meaning, and rhythm to create imagery, raise awareness, and evoke emotional responses (Woods & Sikes, 2022). Found poetry provides the researcher with an effective technique to express the everyday reality of people (Sjollema et al., 2012).
Participant sampling and recruitment: This research utilized purposeful and chain sampling, promoted by Patton in 1990. Prior to beginning recruitment, ethical approval was obtained from the University of Victoria Human Research Ethics Board.
Data collection: Data for the study was collected using one-to-one interviews following a standard open-ended interview guide (Patton, 2002). This approach allowed the questions and topics to be predetermined and sequenced in a logical flow (Patton, 2002). During the one-to-one interviews audio recording was conducted to later create full verbatim or denaturalized transcriptions. To properly conduct and use the transcriptions, McMullin’s (2023) framework of undertaking and reporting transcription was used.
Results: Through the interview process, four themes emerged: “wellness as dimensions”, “wellness as balance”, “wellness from programs”, and “wellness as change.” One theme, “wellness as programs”, was revealed to be a cluster where sub-themes surfaced. These included, “wellness as programs for teacher support”, “wellness as program awareness for new teachers”, and “wellness as programs for community”. The emergence of these themes, sub-themes, and teacher comments revealed new teachers’ desire for programs, support, community, and change. From this, further sharing, research, and action is inspired.
Authors:
Author - Linnea Leist, M.A., University of Victoria
Perceived Stigma and Depression among Young Adults with Visible Skin Disease
Poster Number: E132Time: 05:00 PM - 05:50 PM
Topics: Quality of Life, Mental Health
Background: Approximately 2–5 million young adults in the US have a visible skin disease (VSD).
A VSD can be stigmatizing, particularly for this age group, who desire to be “the same” as peers.
Among populations with other stigmatized identities (e.g., weight, racial discrimination,) stigma
– particularly internalized stigma – has been linked to poorer mental health outcomes.
Objectives: This study examines the effects of social and internalized stigma on depressive
symptoms, anxiety, and loneliness among young adults with VSD. As obesity and being a
member of a racial minority group can also be stigmatizing, we covaried those variables.
Methods: Survey data were collected through NIH’s Research Match from 171 young adults
(18-25; 64.7% women) with psoriasis, dermatitis/eczema, or hidradenitis suppurativa. Almost
half (49%) identified as a racial minority, and 60% were overweight/obese according to BMI
criteria. The survey included a Likert scale of perceived visibility of one’s skin disease, and
standardized scales of social stigma (Perceived Stigma Questionnaire), internalized stigma
(adaptation of the Weight Bias Internalization Scale), depressive symptoms (PHQ-9), anxiety
(GAD-7), and loneliness (UCLA short form). Hierarchical multiple regression analyses examined
the contributions of perceived visibility, social stigma, and internalized stigma (entered as a set)
on the three outcomes after controlling for BMI and racial minority status.
Results: The full models explained significant amounts of variance in depressive symptoms,
anxiety, and loneliness (R 2 = .19, .18, and .16, respectively, p’s<.001). Internalized stigma was
related to greater depressive symptoms (β = .43, p<.001) and anxiety (β = .57, p<.001), with
large associations. Social stigma was related to greater loneliness (β = .36, p<.05) but
surprisingly to lower anxiety (β = -.29, p<.05). Visibility of the skin disease was related only to
less loneliness (β = -.24, p<.05). Except in one case (BMI and depressive symptoms), the
covariates were non-significant.
Conclusion: For young adults with a visible skin disease, both social stigma and internalized
stigma clearly affect mental health. Healthcare professionals must be cognizant of the stigma
that young adults with a VSD experience. Interventions may target the reduction of social or
internalized stigma in an effort to improve well-being for this population.
Keywords: Chronic illness, Quality of lifeA VSD can be stigmatizing, particularly for this age group, who desire to be “the same” as peers.
Among populations with other stigmatized identities (e.g., weight, racial discrimination,) stigma
– particularly internalized stigma – has been linked to poorer mental health outcomes.
Objectives: This study examines the effects of social and internalized stigma on depressive
symptoms, anxiety, and loneliness among young adults with VSD. As obesity and being a
member of a racial minority group can also be stigmatizing, we covaried those variables.
Methods: Survey data were collected through NIH’s Research Match from 171 young adults
(18-25; 64.7% women) with psoriasis, dermatitis/eczema, or hidradenitis suppurativa. Almost
half (49%) identified as a racial minority, and 60% were overweight/obese according to BMI
criteria. The survey included a Likert scale of perceived visibility of one’s skin disease, and
standardized scales of social stigma (Perceived Stigma Questionnaire), internalized stigma
(adaptation of the Weight Bias Internalization Scale), depressive symptoms (PHQ-9), anxiety
(GAD-7), and loneliness (UCLA short form). Hierarchical multiple regression analyses examined
the contributions of perceived visibility, social stigma, and internalized stigma (entered as a set)
on the three outcomes after controlling for BMI and racial minority status.
Results: The full models explained significant amounts of variance in depressive symptoms,
anxiety, and loneliness (R 2 = .19, .18, and .16, respectively, p’s<.001). Internalized stigma was
related to greater depressive symptoms (β = .43, p<.001) and anxiety (β = .57, p<.001), with
large associations. Social stigma was related to greater loneliness (β = .36, p<.05) but
surprisingly to lower anxiety (β = -.29, p<.05). Visibility of the skin disease was related only to
less loneliness (β = -.24, p<.05). Except in one case (BMI and depressive symptoms), the
covariates were non-significant.
Conclusion: For young adults with a visible skin disease, both social stigma and internalized
stigma clearly affect mental health. Healthcare professionals must be cognizant of the stigma
that young adults with a VSD experience. Interventions may target the reduction of social or
internalized stigma in an effort to improve well-being for this population.
Authors:
Author - Avery Mak, N/A, Hunter College Campus Schools, Hunter College
Co-Author - Caroline Stuhlmann, PhD, University Medical Center Hamburg Eppendorf
Co-Author - Eszter Bolcz, BA, Hunter College
Co-Author - Julia Sochacki, BA, Silberman School of Social Work
Co-Author - Tracey Revenson, PhD, FSBM, Hunter College & The Graduate Center - CUNY
Evening Moderate-to-Vigorous Physical Activity and Same-Night Sleep in Adolescent Girls
Poster Number: E133Time: 05:00 PM - 05:50 PM
Topics: Sleep, Physical Activity
Background: The majority of adolescents do not meet the recommended 8-10 hours of sleep required to support healthy functioning. This deficit may be due in part to engagement in evening moderate-to-vigorous physical activity (MVPA), as athletic participation and practices often run occur late on weeknights. This current study utilized actigraphs to examine within- and between-person associations between evening MVPA and same-night sleep health in a sample of adolescent girls.
Methods: Participants include 146 premenarchal girls assigned female at birth (Mage=11.13, SDage=0.93) monitored across 7 consecutive evenings. Actigraph devices were worn for 7 days to quantify evening MVPA (18:00–24:00) and measure dimensions of sleep health such as sleep onset latency, efficiency, total sleep time, and wake after sleep onset. Multilevel linear models estimated within- and between-person effects, with days (Level 1) nested within participants (Level 2). MLM analyses were conducted in R using the lme4 package.
Results: Across 1,003 observed evenings, adolescents engaged in MVPA on 66.1% of evenings (663 evenings). Average MVPA duration was 6.74 minutes (SD = 10.6). Person-level descriptive patterns indicated that 97.63% of adolescents engaged in evening MVPA at least once over the 7 observed evenings. Significant within-person effects were found for efficiency and wake after sleep onset (WASO) parameters of sleep health. On evenings when a girl engaged in 10 extra minutes of MVPA, sleep efficiency improved by 0.60% (SE = 0.02, p = 0.0058) and individuals spent 1.81 fewer minutes awake after sleep onset (SE = 0.09, p = 0.037). No significant associations were found for total sleep time and sleep onset latency parameters.
Conclusion: Findings suggest that female adolescents engage in very few minutes of evening MVPA although it may support same-night sleep continuity (higher efficiency, lower WASO). Contrasting adult population findings of evening MVPA sleep disruption, these patterns could reflect adolescent-specific circadian timing that lend to evening MVPA helping regulate restlessness or stress’ effects on sleep health. Future work will incorporate covariates, pubertal timing, and physical activity intensity effects on this relationship.
Keywords: Physical activity, AdolescentsMethods: Participants include 146 premenarchal girls assigned female at birth (Mage=11.13, SDage=0.93) monitored across 7 consecutive evenings. Actigraph devices were worn for 7 days to quantify evening MVPA (18:00–24:00) and measure dimensions of sleep health such as sleep onset latency, efficiency, total sleep time, and wake after sleep onset. Multilevel linear models estimated within- and between-person effects, with days (Level 1) nested within participants (Level 2). MLM analyses were conducted in R using the lme4 package.
Results: Across 1,003 observed evenings, adolescents engaged in MVPA on 66.1% of evenings (663 evenings). Average MVPA duration was 6.74 minutes (SD = 10.6). Person-level descriptive patterns indicated that 97.63% of adolescents engaged in evening MVPA at least once over the 7 observed evenings. Significant within-person effects were found for efficiency and wake after sleep onset (WASO) parameters of sleep health. On evenings when a girl engaged in 10 extra minutes of MVPA, sleep efficiency improved by 0.60% (SE = 0.02, p = 0.0058) and individuals spent 1.81 fewer minutes awake after sleep onset (SE = 0.09, p = 0.037). No significant associations were found for total sleep time and sleep onset latency parameters.
Conclusion: Findings suggest that female adolescents engage in very few minutes of evening MVPA although it may support same-night sleep continuity (higher efficiency, lower WASO). Contrasting adult population findings of evening MVPA sleep disruption, these patterns could reflect adolescent-specific circadian timing that lend to evening MVPA helping regulate restlessness or stress’ effects on sleep health. Future work will incorporate covariates, pubertal timing, and physical activity intensity effects on this relationship.
Authors:
Co-Author - Aidan Crawford, Loyola University Chicago
Co-Author - Julianna Adornetti, Loyola University Chicago
Co-Author - Kirby Knapp, Loyola University Chicago
Co-Author - Josie Peterburs, Loyola University Chicago
Co-Author - Stephanie Crowley, PhD, Rush University Medical Center
Co-Author - Amy Bohnert, PhD, Loyola University Chicago
Large Language Models and the Identification of Behavior Change Technique Codes: A Case Study using Pediatric Sleep Interventions
Poster Number: E134Time: 05:00 PM - 05:50 PM
Topics: Sleep, Methods and Measurement
Introduction
The Behavior Change Technique Taxonomy includes 96 behavior change techniques (BCT) and provides a standardized framework for identifying, categorizing, and describing behavior change interventions. We recently applied BCT codes to pediatric sleep interventions in a systematic review; this was a labor- and cost-intensive months long process, involving multiple trained reviewers. Recent advances in natural language processing, particularly Large Language Models (LLM), present an opportunity to alleviate some of this burden. We aimed to determine the performance of six LLMs to correctly assign BCTs to pediatric sleep intervention, using our human-coded data as the ground truth.
Methods
We leveraged six LLMs with a user-friendly chat interface (ChatGPT, Claude, DeepSeek, Gemini, Grok, and Mistral). We individually entered the intervention descriptions from 38 pediatric sleep intervention articles, asking the LLM to assign BCTs. We assessed the performance of each LLM against human coded data by assessing the level of agreement using Kappa statistics. We also calculated sensitivities, specificities, and area under the curves (AUC). These analyses were performed using Stata 19.0.
Results
A total of 3,533 ratings (38 articles x 93 BCTs) were used to compare the levels of agreement between each of the six LLMs with the human-scored ground-truth codes. All were determined to have moderate levels of agreement (average kappa=0.40). The specificities of the LLMs averaged 93.1, the sensitivities averaged 51.9, and the AUCs averaged 0.7. ChatGPT 5 and Claude-Sonnet had the highest Kappa’s (0.46 and 0.45), specificities (93.0 and 88.6), sensitivities (60.5 and 66.2), and AUCs (0.77 and 0.77).
Conclusion
Assigning BCT codes as part of a systematic review is labor- and cost-intensive. Our data suggest that LLMs could have utility in assisting with this process but should not be used exclusively. We found that the LLMs had moderate agreement with human-scoring, with a low rate of false positives but high rate of false negatives. This approach needs to be replicated and applied to other behavioral interventions.
Keywords: Behavior Change, MethodologyThe Behavior Change Technique Taxonomy includes 96 behavior change techniques (BCT) and provides a standardized framework for identifying, categorizing, and describing behavior change interventions. We recently applied BCT codes to pediatric sleep interventions in a systematic review; this was a labor- and cost-intensive months long process, involving multiple trained reviewers. Recent advances in natural language processing, particularly Large Language Models (LLM), present an opportunity to alleviate some of this burden. We aimed to determine the performance of six LLMs to correctly assign BCTs to pediatric sleep intervention, using our human-coded data as the ground truth.
Methods
We leveraged six LLMs with a user-friendly chat interface (ChatGPT, Claude, DeepSeek, Gemini, Grok, and Mistral). We individually entered the intervention descriptions from 38 pediatric sleep intervention articles, asking the LLM to assign BCTs. We assessed the performance of each LLM against human coded data by assessing the level of agreement using Kappa statistics. We also calculated sensitivities, specificities, and area under the curves (AUC). These analyses were performed using Stata 19.0.
Results
A total of 3,533 ratings (38 articles x 93 BCTs) were used to compare the levels of agreement between each of the six LLMs with the human-scored ground-truth codes. All were determined to have moderate levels of agreement (average kappa=0.40). The specificities of the LLMs averaged 93.1, the sensitivities averaged 51.9, and the AUCs averaged 0.7. ChatGPT 5 and Claude-Sonnet had the highest Kappa’s (0.46 and 0.45), specificities (93.0 and 88.6), sensitivities (60.5 and 66.2), and AUCs (0.77 and 0.77).
Conclusion
Assigning BCT codes as part of a systematic review is labor- and cost-intensive. Our data suggest that LLMs could have utility in assisting with this process but should not be used exclusively. We found that the LLMs had moderate agreement with human-scoring, with a low rate of false positives but high rate of false negatives. This approach needs to be replicated and applied to other behavioral interventions.
Authors:
Co-Author - Christian Estrada, Children's Hospital of Philadelphia
Co-Author - Carol Li, Children's Hospital of Philadelphia
Co-Author - Olivia Elliott, MS, Children's Hospital of Philadelphia
Co-Author - Knashawn Morales, ScD, University of Pennsylvania
Presenter - Jonathan Mitchell, PhD, MSc , Children's Hospital of Philadelphia
Let yourself SHINE: A study investigating the sleep health of military-affiliated pregnant mothers
Poster Number: E135Time: 05:00 PM - 05:50 PM
Topics: Sleep, Military and Veterans' Health
Sleep disturbances are common in adulthood, particularly in pregnant and new mothers, and are a major source of stress. Unfortunately, postpartum sleep disturbances are linked to increased risk for developing depressive and anxiety symptoms. Postpartum depression (PPD) is the most common complication of childbearing, and yet is commonly underdiagnosed and undertreated. PPD can seriously impact the mother, baby, and the family system (e.g., marital stress, mother-child interactions). PPD and its consequences can persist for years after childbirth, with lingering impacts on physical/psychological functioning even after recovery from depressive episodes marking it as a major public health concern.
While sleep disturbances and associated adverse consequences are greater among pregnant women, they are further amplified among military-affiliated women (active-duty and spouses), particularly following deployment of the active- duty member. Rates of PPD in active-duty women range from 20-26% and 12.2% in military spouses, both of which are much higher than the civilian population (10-15%). Women with spouses who are deployed have more frequent diagnoses of depressive disorders (50%), sleep disorders, anxiety, acute stress reaction, and adjustment disorders compared to women with no spouse deployment. To decrease PPD among pregnant military-affiliated women, we contend that sleep (in infant and mother) may be an important and accessible target. We are currently assessing the effectiveness of a smart bassinet to 1) enable optimal infant sleep; 2) improve maternal sleep by reducing nocturnal awakenings and improving sleep quality; and 3) reduce the risk of PPD in military-affiliated women. We present baseline data on demographics, sleep, and health behaviors for n=60 participants in this ongoing study. Findings from the ongoing study will demonstrate the utility of targeting infant sleep to subsequently improve maternal sleep quality and depression outcomes. The use of a smart bassinet represents an innovative feature that facilitates potential health benefits to military-affiliated women and their infants.
Table 1. Demographics at baseline
Variables Mean (SD)
Edinburgh Postnatal Depression Scale 20.67 (2.70)
General Anxiety Disorder -7 scale 9.26 (2.22)
Perinatal Anxiety Screening Scale 39.76 (7.59
Epworth Sleepiness Scale 4.19 (3.56)
Social Support Survey 86.03 (9.86)
*SCID-5-CV diagnosis of Depressive Disorder Present (2%), Past (18.4%), No History (79.6%)
Keywords: Abnormal sleep, Women's healthWhile sleep disturbances and associated adverse consequences are greater among pregnant women, they are further amplified among military-affiliated women (active-duty and spouses), particularly following deployment of the active- duty member. Rates of PPD in active-duty women range from 20-26% and 12.2% in military spouses, both of which are much higher than the civilian population (10-15%). Women with spouses who are deployed have more frequent diagnoses of depressive disorders (50%), sleep disorders, anxiety, acute stress reaction, and adjustment disorders compared to women with no spouse deployment. To decrease PPD among pregnant military-affiliated women, we contend that sleep (in infant and mother) may be an important and accessible target. We are currently assessing the effectiveness of a smart bassinet to 1) enable optimal infant sleep; 2) improve maternal sleep by reducing nocturnal awakenings and improving sleep quality; and 3) reduce the risk of PPD in military-affiliated women. We present baseline data on demographics, sleep, and health behaviors for n=60 participants in this ongoing study. Findings from the ongoing study will demonstrate the utility of targeting infant sleep to subsequently improve maternal sleep quality and depression outcomes. The use of a smart bassinet represents an innovative feature that facilitates potential health benefits to military-affiliated women and their infants.
Table 1. Demographics at baseline
Variables Mean (SD)
Edinburgh Postnatal Depression Scale 20.67 (2.70)
General Anxiety Disorder -7 scale 9.26 (2.22)
Perinatal Anxiety Screening Scale 39.76 (7.59
Epworth Sleepiness Scale 4.19 (3.56)
Social Support Survey 86.03 (9.86)
*SCID-5-CV diagnosis of Depressive Disorder Present (2%), Past (18.4%), No History (79.6%)
Authors:
Presenter - Leilani Feliciano, PhD, University of Colorado, Colorado Springs
Co-Author - Jonathan Sundby, MA, University of Colorado Colorado Springs
Co-Author - Christopher Griffith, MA, University of Colorado Colorado Springs
Co-Presenter - Michele Okun, PhD, University of Colorado at Colorado Springs
Discrepancies Between Subjective and Objective Sleep in Daily Life: The Role of Stress and Affect
Poster Number: E136Time: 05:00 PM - 05:50 PM
Topics: Sleep, Stress
Subjective reports of sleep are robust predictors of well-being, yet self-reported subjective sleep often does not strongly correspond to objective measures of sleep. This study aimed to identify factors that may influence concordance between objective and self-report sleep, particularly in naturalistic contexts. We examined if prior day’s stress or affect influenced the correspondence between subjective sleep ratings and objective sleep duration and quality. Community adults (n=126) completed 14 days of ambulatory assessment during which participants wore an Actiwatch Spectrum Plus to capture objective sleep actigraphy and completed ecological momentary assessment reports. Daily summary ratings of stress, positive affect (PA), and negative affect (NA) were assessed by an end of day survey, whereas daily subjective sleep quality and duration were assessed in a morning survey. Linear mixed models examined if prior day’s stress, PA, or NA moderated the association between subjective sleep (quality or duration) and objective sleep (quality or duration). Between-person main effects of subjective sleep duration were consistently observed; those who reported longer average subjective sleep duration also exhibited longer objective sleep duration. There were not reliable within-person (person mean-centered; PMC) associations between subjective and objective sleep duration. Subjective sleep quality was consistently unrelated to objective sleep quality at both the between- and within-person levels. Individuals with lower average NA had higher objective sleep quality, whereas those with lower average PA had higher objective sleep quantity. Stress moderated the concordance of subjective and objective sleep indicators, but in complex ways. Between-person stress interacted with PMC subjective sleep duration such that for higher stress individuals on days they reported longer than typical subjective sleep duration, objective sleep duration was longer (b = 0.066, p = 0.021). In contrast, for higher stress individuals on days they reported higher than typical subjective sleep quality, objective sleep quality was lower (b = -0.136, p = 0.036). These findings suggest daily reports of subjective sleep duration are more accurate than are daily reports of sleep quality. Additionally, this work highlights the utility of probing the complex influence of affect and, particularly, stress on the concordance between subjective and objective sleep measures in the natural environment.
Keywords: Ambulatory monitoring, StressAuthors:
Author - Jacob Stork, BS, The Ohio State University
Co-Author - Joshua Smyth, PhD, FSBM, The Ohio State University
Rural State of Mind: rurality, stress, and emotional wellbeing in people who are Transgender and Gender Non-Conforming in the upper Midwest
Poster Number: E137Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Stress
People who identify as Transgender or Gender Non-Conforming (TGNC) experience higher rates of stress, depression, and anxiety than people who are cisgender. Living or growing up TGNC in a rural environment may affect the amount and types of stress experienced due to limited access to gender affirming resources such as healthcare or social support. This study of 52 TGNC individuals used standardized measures to examine how rurality was associated with current perceived general and gender minority stress, emotional wellbeing, and family, friend, and online social support. Early life and current rurality was assessed subjectively (self-reported rural identity) and objectively (zipcode). Interestingly, feeling rural and actually being rural while growing up or currently led to different self-reports of gender minority stress and general well-being. Participants who felt they had a rural childhood reported lower internalized transphobia (t(48)=2.08, p<.05, d=.58). However, objectively having a rural childhood was linked to less emotional wellbeing (t(47)=2.43, p<.01, d=.69), and more emotional limitations (t(48)=2.38,p =.01, d=.68). Currently feeling rural was associated with worse emotional wellbeing (t(49)=2.22, p=.01, d=.78) and more limited social function (t(49)=4.28, p<.001, d=1.5). Objective current rurality was similarly associated with worse emotional wellbeing (t(50)=2.07, p<.03, d=.647) in addition to more family support (t(49)=-2.03, p<.05, d=-.63) and more online support (t(48)=-1.87, p<.05, d=-.59). The results of this exploratory study reveal complexities in how rurality is associated with TGNC health, specifically in how people experience it. Growing up in a rural environment was objectively associated with emotional well-being deficits, possibly due to a lack of resources such as a community of support. Current rurality was associated with negative emotional and social processes regardless of whether rurality was subjective or objective, suggesting an exacerbation of adverse well-being in TGNC individuals in rural environments. However, actually being rural at the time of the study was associated with stronger ratings of family and online support, possibly reflecting the interdependence among family members and reliance on online communities in rural environments. Rurality may enhance adverse developmental outcomes, but it may also facilitate salubrious factors like family support and self-actualization in TGNC persons.
Keywords: Stress, Health disparitiesAuthors:
Author - Garrett Byron, BS, BA, MS, North Dakota State University
Co-Author - Clayton Hilmert, PhD, North Dakota State University
Interpersonal risk perception in romantic relationships
Poster Number: E138Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Decision Making
Romantic partners influence each other on many different outcomes, including health behaviors. Research suggests that risk perceptions may be an important motivator of whether individuals try to influence a close other’s health behavior, but how people perceive their romantic partner’s health risk remains unclear. Prior studies show that individuals tend to be optimistic regarding their own risk for diseases, but it is not clear if they are similarly optimistic in their perception of a romantic partner’s health risk. On the one hand, romantic partners may be motivated to avoid thinking of each other as unhealthy, leading to an underestimation of risk. On the other hand, romantic partners might be motivated to worry about their partner’s health and therefore overestimate their risk. Using data collected in 2021 by the National Cancer Institute, the goal of this project was to determine how individuals perceive their romantic partner’s health risks compared to: 1) the individual’s self risk perceptions, and 2) the partner’s own risk perceptions. Participants were 223 dyads (478 individuals) in cohabiting romantic relationships. Participants were asked to report their perceptions of risk and worry for cancer and COVID-19 for themselves and for their partner. Individuals and their partners who have ever had cancer were excluded from cancer analyses (n=9). Those who had COVID-19 and those who have never had COVID-19 were combined. Controlling for the dyadic structure of the data, dependent measures t-tests were used to compare individual’s perceptions of risk and of worry for themselves and their partner. On average, participants perceived their own risk for developing cancer and for getting COVID-19 as greater than their perception of their partner’s risk for both diseases. However, participants were more worried about their partner’s risk of cancer and COVID-19 than about their own (all p’s < .05). Using an actor-partner interdependence model framework, we observed a similar pattern comparing perceptions of one’s partner’s risk/worry to the partner’s own perceptions. Perceptions of one’s partner’s risk/worry were predicted by perceptions of one’s own risk/worry. Describing how risk is perceived within interpersonal relationships will provide insight into when individuals may be motivated to influence their partner’s health behaviors. Future research will examine the implication of these findings for health promotion strategies targeting romantic couples.
Keywords: Risk perception, Couple-focusedAuthors:
Author - Emily Chan, University of Minnesota
Co-Author - Jeffry Simpson, PhD, University of Minnesota
Co-Author - Alex Rothman, PhD, FSBM, University of Minnesota
Educational, Clinical, and Lived Experiences in Medical Students' Identification of Medication Adherence Barriers
Poster Number: E139Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health
Background: Physicians are well-positioned to address medication nonadherence, yet their skill in identifying medication adherence barriers varies. Educational and clinical experiences in medical school could improve these skills. Yet, it is unclear if all students would benefit equally from these experiences. Based on experiential learning theory, we hypothesized that students with lived experiences taking long-term medication would be more skilled in identifying patient medication barriers, even after accounting for prior educational and clinical experiences with medication nonadherence.
Methods: 409 medical students (69% women, 42% non-White) from accredited MD or DO programs participated. Participants completed an online survey in which they read a clinical vignette depicting a patient with medication nonadherence. Students answered an open-ended prompt to identify potential barriers to the patient’s medication adherence. Responses were coded into subcategories of practical (e.g., forgetting), perceptual (e.g., medication concerns), or other barriers. Counts of total, practical, and perceptual barriers identified were computed for each participant. Participants also reported their educational or clinical experiences with medication nonadherence and experience taking medication long-term (> 3 months).
Results: Regressions examined if medication-adherence related clinical or educational experiences (block 1) were associated with adherence barrier identification, and if lived experience (block 2) contributed additional variance. Educational or clinical experiences failed to contribute significant variance to the total number of adherence barriers or number of perceptual barriers identified (βs = -.09 to .06, ps = .10 to .71). Clinical (but not educational) experience with nonadherence was associated with identification of more practical barriers (β=.12, p=.02). Contrary to expectation, lived experience did not contribute additional variance (ΔR²s=.00-.01, ps=.10-.71).
Conclusions: Clinical experiences focused on medication nonadherence may be useful in improving student skill in identifying practical adherence barriers. However, additional work is needed to replicate and expand findings to other domains of nonadherence assessment. A more nuanced assessment of lived experiences with medication taking and the impact on one’s clinical approach may also be valuable.
Keywords: Compliance, Clinical applicationsMethods: 409 medical students (69% women, 42% non-White) from accredited MD or DO programs participated. Participants completed an online survey in which they read a clinical vignette depicting a patient with medication nonadherence. Students answered an open-ended prompt to identify potential barriers to the patient’s medication adherence. Responses were coded into subcategories of practical (e.g., forgetting), perceptual (e.g., medication concerns), or other barriers. Counts of total, practical, and perceptual barriers identified were computed for each participant. Participants also reported their educational or clinical experiences with medication nonadherence and experience taking medication long-term (> 3 months).
Results: Regressions examined if medication-adherence related clinical or educational experiences (block 1) were associated with adherence barrier identification, and if lived experience (block 2) contributed additional variance. Educational or clinical experiences failed to contribute significant variance to the total number of adherence barriers or number of perceptual barriers identified (βs = -.09 to .06, ps = .10 to .71). Clinical (but not educational) experience with nonadherence was associated with identification of more practical barriers (β=.12, p=.02). Contrary to expectation, lived experience did not contribute additional variance (ΔR²s=.00-.01, ps=.10-.71).
Conclusions: Clinical experiences focused on medication nonadherence may be useful in improving student skill in identifying practical adherence barriers. However, additional work is needed to replicate and expand findings to other domains of nonadherence assessment. A more nuanced assessment of lived experiences with medication taking and the impact on one’s clinical approach may also be valuable.
Authors:
Author - Erin Flynn, BA, Rosalind Franklin University of Medicine and Science
Co-Author - Hunter Crowton, BS, Rosalind Franklin University of Medicine and Science
Co-Author - Emma Gaydos, BA, Rosalind Franklin University of Medicine and Science
Co-Author - L. Sophia Rintell, MS, Rosalind Franklin University of Medicine and Science
Co-Author - Sara Lampert-Okin, MS, Cincinnati Children's Hospital Medical Center
Co-Author - Petula Walsh-Grant, BA, Rosalind Franklin University of Medicine and Science
Co-Author - Nicole Ofer, University of Wisconsin - Madison
Co-Author - Jeanette Morrison, MD, Rosalind Franklin University of Medicine and Science
Co-Author - Rachel Greenley, PhD, Rosalind Franklin University of Medicine and Science
Ethnic Identity Development Protects Against Impacts of Discrimination on College Students’ Physical Health
Poster Number: E140Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Mental Health
INTRODUCTION. Social stress theory posits that experiences of racism are social stressors that negatively impact the health of individuals with marginalized racial identities (Anderson, 2012). Past research indicates that identity-based discrimination is related to worse health outcomes, but that positive ethnic identity may promote increased psychosocial functioning in individuals with marginalized racial and ethnic identities (Umaña-Taylor, 2011; Williams et al., 2019). The college period often represents a critical stage for ethnic identity development, and many college students of marginalized racial identities face discrimination on campus that is detrimental to their health (Zhou et al., 2019; Tsai & Fuligni, 2012; Jochman et al., 2019; Hwang et al., 2009; Gamba et al., 2024). Research investigating whether ethnic identity mitigates the impacts of discrimination on mental health has yielded mixed results, and there has been little research investigating the interactive effect of discrimination and ethnic identity on physical health (Yip, 2018). This study aimed to explore how experiences of discrimination impact mental and physical health in a sample of undergraduate students and to investigate how ethnic identity development may mitigate these impacts.
METHOD. Collete students (n=670) completed surveys assessing ethnic identity development (Ethnic Identity Scale, Umaña-Taylor, 2004), experienced discrimination (Everyday Discrimination Scale (Short Version); Sternthal, et al., 2011), and global health (PROMIS Global Health, Hays et al., 2004).
RESULTS. Linear regression revealed that experienced discrimination predicted worse physical health, b=.23, p = .005, and that ethnic identity moderated this relationship, b= -.01, p = .02. Experienced discrimination predicted worse mental health, b = .11, p < .001, but ethnic identity did not significantly moderate this relationship, b = -.003, p= .40.
CONCLUSIONS. These results add to existing evidence that discrimination has detrimental impacts on both physical and mental health. Further, our findings indicate that ethnic identity development buffers the impacts of discrimination on physical health, but not necessarily on mental health. Future research should examine whether discrimination impacts physical and mental health through distinct mechanisms, which may, in turn, shape ethnic identity’s role as a protective factor.
Keywords: Social stress, Minority healthMETHOD. Collete students (n=670) completed surveys assessing ethnic identity development (Ethnic Identity Scale, Umaña-Taylor, 2004), experienced discrimination (Everyday Discrimination Scale (Short Version); Sternthal, et al., 2011), and global health (PROMIS Global Health, Hays et al., 2004).
RESULTS. Linear regression revealed that experienced discrimination predicted worse physical health, b=.23, p = .005, and that ethnic identity moderated this relationship, b= -.01, p = .02. Experienced discrimination predicted worse mental health, b = .11, p < .001, but ethnic identity did not significantly moderate this relationship, b = -.003, p= .40.
CONCLUSIONS. These results add to existing evidence that discrimination has detrimental impacts on both physical and mental health. Further, our findings indicate that ethnic identity development buffers the impacts of discrimination on physical health, but not necessarily on mental health. Future research should examine whether discrimination impacts physical and mental health through distinct mechanisms, which may, in turn, shape ethnic identity’s role as a protective factor.
Authors:
Author - Anna Grace Kelly, George Mason University
Co-Presenter - Griffin Perry, George Mason University
Co-Author - Natasha Tonge, PhD, George Mason University
Adverse Childhood Experiences and Problematic Drug Use in Low-Income Mothers: Amplification by Social Constraints
Poster Number: E141Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Substance Misuse
Background: Adverse childhood experiences (ACEs) are robust predictors of substance use risk, yet not all exposed individuals develop problematic drug use habits. This study tests whether the association between ACEs and problematic drug use in low-income mothers is attenuated by positive social attachments and exacerbated by social constraints when they disclose stressful experiences to significant others. Method: We analyzed cross-sectional survey responses from low-income mothers (>185% below the federal poverty level) recruited into an intervention to reduce children’s tobacco smoke exposure (n=347; 72% African American). Reliable and validated measures included the Drug Abuse Screening Test (DAST; Skinner, 1982), ACEs (Felitti et al., 1998), Social Constraints (SC; Lepore & Ituarte, 1989), and the Attachment (AT) social support scale (Cutrona & Russell, 1987). Results: Reported substance use included alcohol (48%), cannabis (27.7%), opiates (6.1%), and stimulants (0.3%). Results from the primary OLS regression analyses showed a significant positive relation between ACEs and DAST scores (p<.01), no main effect of SC, and a significant ACEs × SC interaction (p<.05). To evaluate robustness, we re-estimated the model using negative binomial regression with a log link to account for the skewed, count-like nature of the DAST scores (women generally had low levels of problematic drug use). Results were nearly identical, with ACEs a significant predictor of DAST (p=.003), no main effect of SC, and a significant ACEs × SC interaction (p=.033). This convergence supports the robustness of the moderation effect. Graphs and simple slope analyses showed that the ACEs-DAST relation steepened under higher levels of SC. AT did not have a significant main or moderating effect on DAST, and the SC models held when statistically controlling for AT. Conclusions: Although women reported generally low levels of problematic drug use, social constraints significantly intensified the association between early childhood adversity and problematic drug use, whereas positive attachments did not moderate this relationship. Social constraints may limit adaptive coping, particularly in the areas of disclosure and help-seeking, thereby exacerbating the ACE-DAST link. Interventions targeting social constraints on disclosure could potentially reduce problematic substance use among women with histories of childhood adversity.
Keywords: Substance abuse, StressAuthors:
Presenter - Stephen Lepore, PhD, FSBM, Temple University
Co-Author - Bradley Collins, PhD, FSBM, Temple University
Co-Author - Övgü Kaynak, PhD, Penn State Harrisburg
“For those that are not educated, trans comes in a box”: Black Transgender Women’s Experiences with Transmisogynoir When Using Behavioral Health Services
Poster Number: E142Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Health Disparities
Transmisogynoir describes intersecting marginalization faced by Black transgender women (BTW), often linked to mental health and substance use inequities impacting the community. These inequities underscore the importance of affirming behavioral health services that address BTW’s needs. Yet, literature documenting service use experiences of BTW remains scant. Healthcare and Healing at the Margins project explored BTW’s experiences contributing to their behavioral health service needs and their experiences during service use.
This phenomenological study consisted of interviews with 12 US-based BTW (ages 18+) who previously used behavioral health services. Participants were recruited in 2023 via collaborations with community-based organizations. Data analysis was guided by the six-step reflexive thematic analysis (i.e., Familiarizing yourself with the dataset; Coding; Generating initial themes; Developing and reviewing themes; Refining, defining, and naming themes; Writing up). Three team members reviewed transcripts and pulled “power quotes”, a technique used in the “Sort and Sift, Think and Shift” method.
Average BTW was 39 years-old with most living in Baltimore (50%). Findings were grouped under the themes of “Need” and “Services.” Need encompassed BTW’s early life family trauma upon being outed or coming out. Having to run away, BTW linked subsequent housing instability, incarceration, and survival sex work to their mental health and substance use challenges. When using Services, BTW faced mistreatment, including violence and stigmatization that led to suicidal ideation and relapse. Residential facilities stood out as particularly stigmatizing, with some having to leave facilities upon rumors being circulated about their genitals. Providers were often perceived as stereotyping and inadequately trained to be working with marginalized communities. BTW recalled later finding providers who fostered a therapeutic environment for them to explore their identities and recover.
Findings elucidate the prevalent nature of transmisogynoir that follows BTW into the therapeutic setting, acting as a barrier to recovery and contributing to further vulnerability. BTW’s experiences highlight the need for provider and staff training that instills gender affirming approaches, provides exposure to diverse set of life experiences, and demonstrates cultural humility and active listening when working with clients whose experiences transcend their previous understanding.
Keywords: Minority health, TreatmentThis phenomenological study consisted of interviews with 12 US-based BTW (ages 18+) who previously used behavioral health services. Participants were recruited in 2023 via collaborations with community-based organizations. Data analysis was guided by the six-step reflexive thematic analysis (i.e., Familiarizing yourself with the dataset; Coding; Generating initial themes; Developing and reviewing themes; Refining, defining, and naming themes; Writing up). Three team members reviewed transcripts and pulled “power quotes”, a technique used in the “Sort and Sift, Think and Shift” method.
Average BTW was 39 years-old with most living in Baltimore (50%). Findings were grouped under the themes of “Need” and “Services.” Need encompassed BTW’s early life family trauma upon being outed or coming out. Having to run away, BTW linked subsequent housing instability, incarceration, and survival sex work to their mental health and substance use challenges. When using Services, BTW faced mistreatment, including violence and stigmatization that led to suicidal ideation and relapse. Residential facilities stood out as particularly stigmatizing, with some having to leave facilities upon rumors being circulated about their genitals. Providers were often perceived as stereotyping and inadequately trained to be working with marginalized communities. BTW recalled later finding providers who fostered a therapeutic environment for them to explore their identities and recover.
Findings elucidate the prevalent nature of transmisogynoir that follows BTW into the therapeutic setting, acting as a barrier to recovery and contributing to further vulnerability. BTW’s experiences highlight the need for provider and staff training that instills gender affirming approaches, provides exposure to diverse set of life experiences, and demonstrates cultural humility and active listening when working with clients whose experiences transcend their previous understanding.
Authors:
Presenter - Tural Mammadli, BA, MSW, University of Maryland Baltimore
Co-Author - Linda-Jeanne M. Mack, MSW, University of Maryland School of Social Work
Co-Author - Tharyn Giovanni, LMSW, University of Maryland School of Social Work
Co-Author - Zachary Runge, MA, Harford Community College
Co-Author - Darren L. Whitfield, PhD, MSW, University of Maryland School of Social Work
Associations between health-related social needs and physical inactivity in Alaska: A secondary data analysis
Poster Number: E143Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Physical Activity
Background: Regular physical activity is associated with a reduced risk for excess weight gain, preventable chronic diseases and improved mental health, yet the prevalence of physical inactivity (i.e., no physical activity outside of work) in the US continues to rise. While individual-level factors (e.g., motivation, knowledge) play a role in physical activity engagement, many individuals also point to upstream factors such as the social drivers of health (SDOH), or health-related social needs (HRSNs) (e.g., food insecurity). Few studies, however, have documented the connection between population-level HRSNs and physical inactivity, particularly in Alaska. Methods: The purpose of this preliminary study was to examine associations between HRSNs and physical inactivity using 2022-2023 Alaska Behavioral Risk Factor Surveillance System (BRFSS) data (N=11,390 Alaskan adults). Multivariate logistic regressions were used to examine associations between the SDOH/HRSN summary measure (0 to 4+), top reported individual HRSN (≥10%) and physical inactivity. Results: Participants were: 18-44 years of age (50%), white (63%), male (52%) with a household income of 185% above the poverty guidelines (72%), and with an education level of some college or higher (66%). Many participants reported no disability (70%) and good to excellent health (83%). Twenty-one percent of the sample was physically inactive, and roughly 63% reported one or more unmet HRSN, with the highest reported HRSNs being mental distress (35%), social isolation (33%), a lack of emotional and social support (25%), and food insecurity (13%), housing insecurity (12%), lost employment (12%) and receiving food stamps (10%). Participants reporting at least three HRSNs, when compared to those reporting no HRSNs, were more likely to be physically inactive (OR: 1.37; 95% CI: 1.01-1.86). Further examination of the highest reported HRSNs revealed that a lack of social and emotional support was associated with a greater likelihood of being physically inactive (OR:1.27; 95% CI: 1.04-1.55). Discussion: Findings from this preliminary analysis provide evidence for multi-level health promotion programs to account for upstream factors such as social support when targeting physical activity behavior. Future research should continue examining differences across demographic factors (e.g., age, race/ethnicity, sex) to better understand the associations between HRSNs and physical inactivity.
Keywords: Public health, Physical activityAuthors:
Author - Nathan West, PhD, University of Alaska Anchorage
Co-Author - Diane King, PhD, University of Alaska Anchorage
Co-Author - Jodi Barnett, MA, Alaska Department of Health, Behavioral Risk Factor Surveillance System Program
Co-Author - Katie Reilly, MPH, Alaska Department of Health, Physical Activity and Nutrition Program
Co-Author - Lauren Kelsey, MPH, Alaska Department of Health, Physical Activity and Nutrition Program
Stress impacts on habit formation for water and flavored drink consumption during a fluid intake intervention
Poster Number: E144Time: 05:00 PM - 05:50 PM
Topics: Stress, Diet, Nutrition, and Eating Disorders
Background: Increasing fluid intake reduces the risk of recurrence for kidney stones but patients struggle to develop fluid intake habits. This trial tested the hypothesis that stress adversely impacts changes in habit strength for consuming water and flavored drinks.
Method: Adults with a history of kidney stones (n=149, 77% women, 88% White) received education about fluid intake and a connected water bottle with a mobile app for tracking fluid intake. For 12 weeks, participants who did not meet hourly intake goals received text message reminders to drink (temporally-cued negative reinforcement). Participants completed baseline and weekly measures of habit strength (experienced automaticity) for drinking water (tap or bottled) and flavored beverages (juice, soda, tea, coffee, milk, alcohol) along with weekly measures of perceived stress.
Results: Habit strength for drinking water and drinking flavored drinks had a weak positive between-person association (b=0.16,p=.049) but were not associated within-person. Water drinking habit strength had significant linear (b=0.02,p<.001) and quadratic (b=-0.01,p<.001) slopes. Habit strength was weaker during weeks when participants reported greater stress (b=-0.13,p=.009) but not associated with average levels of stress. In contrast, flavored drink consumption habit strength decreased over the 12-week period (b=-0.03, p<.001) but decreased less for participants with greater stress on average (b=0.03,p=.005). Habit strength for flavored drinks did not fluctuate as a function of weekly stress.
Conclusion: Habit dynamics are specific and generalize little between similar behaviors. Stress management interventions may be useful for supporting both the formation of desired health behavior habits as well as modifying established competing habits.
Keywords: Motivation, Health behavior changeMethod: Adults with a history of kidney stones (n=149, 77% women, 88% White) received education about fluid intake and a connected water bottle with a mobile app for tracking fluid intake. For 12 weeks, participants who did not meet hourly intake goals received text message reminders to drink (temporally-cued negative reinforcement). Participants completed baseline and weekly measures of habit strength (experienced automaticity) for drinking water (tap or bottled) and flavored beverages (juice, soda, tea, coffee, milk, alcohol) along with weekly measures of perceived stress.
Results: Habit strength for drinking water and drinking flavored drinks had a weak positive between-person association (b=0.16,p=.049) but were not associated within-person. Water drinking habit strength had significant linear (b=0.02,p<.001) and quadratic (b=-0.01,p<.001) slopes. Habit strength was weaker during weeks when participants reported greater stress (b=-0.13,p=.009) but not associated with average levels of stress. In contrast, flavored drink consumption habit strength decreased over the 12-week period (b=-0.03, p<.001) but decreased less for participants with greater stress on average (b=0.03,p=.005). Habit strength for flavored drinks did not fluctuate as a function of weekly stress.
Conclusion: Habit dynamics are specific and generalize little between similar behaviors. Stress management interventions may be useful for supporting both the formation of desired health behavior habits as well as modifying established competing habits.
Authors:
Presenter - David Conroy, PhD, FSBM, University of Michigan
Co-Author - Shiyu Li, Louisiana State University
Co-Author - Nilam Ram, PhD, Stanford University
Co-Author - Necole Streeper, MD, Medical College of Wisconsin
Relationship between Perceived Stress and Meanings of Eating among Ethnic Minoritized Children
Poster Number: E145Time: 05:00 PM - 05:50 PM
Topics: Stress, Diet, Nutrition, and Eating Disorders
Background: Among youth, eating for reasons unrelated to physical hunger (e.g., physiological, cognitive, and emotional transitions) contribute to overeating. Stress may impair emotional regulation which can increase affect-driven eating as a coping mechanism. Affective influences on eating, such as meanings of eating, may be exacerbated by stress. Despite ample studies on stress-induced eating, the underlying mechanisms remain unclear, especially among ethnic minority youth; further, research indicates that sex differences in eating behaviors emerge during childhood.
Purpose: This study examined the relationship between perceived stress and meanings of eating by sex and race/ethnic group among children.
Methods: A secondary analysis of cross-sectional data from 302 children (Mage=10±1.14; 43% Latinx, 19% Asian, 22% African-American, 16% Other) assessed the association between perceived stress and meanings of eating by sex and race/ethnic group. Data was collected via self-report surveys. Independent t-tests and linear regressions were performed.
Results: T-test results indicate males had higher scores on personal negative emotions (p=.007), pleasure eating (p<.001), and eating on behalf of others (p<.001) than females. Regression models showed that, overall, perceived stress was significantly associated with personal negative emotions (Std =.191, p=.002), disturbed eating (Std =.170, p=.007), and eating on behalf of others (Std =.177, p=.003). By race/ethnicity, higher perceived stress was significantly associated with higher disturbed eating among Latinx children (Std =.222, p=.026). Sex stratified analyses revealed that among females, perceived stress was associated with disturbed eating (Std = .234, p=.005). Perceived stress was related to negative personal emotions (Std =.172, p=.041) among females and among males (Std =.220, p=.019). Among males, perceived stress was positively associated with eating on behalf of others (Std =.238, p=.012).
Conclusion: A potential explanation for these findings is that eating styles may be influenced by stressors related to cultural contexts and associated gender roles established during childhood. This indicates a need for better understanding how cultural messages and beliefs are related to stress and coping, which may impact eating behaviors. This could elucidate potential strategies to prevent overeating among racial/ethnic minority children, such as intervening on negative meanings of eating.
Keywords: Stress, Eating behaviorsPurpose: This study examined the relationship between perceived stress and meanings of eating by sex and race/ethnic group among children.
Methods: A secondary analysis of cross-sectional data from 302 children (Mage=10±1.14; 43% Latinx, 19% Asian, 22% African-American, 16% Other) assessed the association between perceived stress and meanings of eating by sex and race/ethnic group. Data was collected via self-report surveys. Independent t-tests and linear regressions were performed.
Results: T-test results indicate males had higher scores on personal negative emotions (p=.007), pleasure eating (p<.001), and eating on behalf of others (p<.001) than females. Regression models showed that, overall, perceived stress was significantly associated with personal negative emotions (Std =.191, p=.002), disturbed eating (Std =.170, p=.007), and eating on behalf of others (Std =.177, p=.003). By race/ethnicity, higher perceived stress was significantly associated with higher disturbed eating among Latinx children (Std =.222, p=.026). Sex stratified analyses revealed that among females, perceived stress was associated with disturbed eating (Std = .234, p=.005). Perceived stress was related to negative personal emotions (Std =.172, p=.041) among females and among males (Std =.220, p=.019). Among males, perceived stress was positively associated with eating on behalf of others (Std =.238, p=.012).
Conclusion: A potential explanation for these findings is that eating styles may be influenced by stressors related to cultural contexts and associated gender roles established during childhood. This indicates a need for better understanding how cultural messages and beliefs are related to stress and coping, which may impact eating behaviors. This could elucidate potential strategies to prevent overeating among racial/ethnic minority children, such as intervening on negative meanings of eating.
Authors:
Co-Author - Pamela Martinez, MPH, California State University, Long Beach
Co-Author - Selena Nguyen-Rodriguez, PhD, MPH, California State University, Long Beach
Differences in perinatal hormones by opioid use disorder: Implications for postpartum relapse prevention
Poster Number: E146Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Women's Health
Aims: Hormones related to reproductive functioning (e.g., estrogens) and stress response (e.g., cortisol) have been implicated in a variety of drug-taking behaviors. For example, prior research has identified an inverse relationship between estradiol and cue response, well as links between diurnal cortisol patterns and risk of relapse. These hormones vary dramatically from pregnancy to the postpartum, a unique transitional period that is also linked to heightened risk for return to opioid misuse. Within this context, we sought to examine the hormonal differences in those with and without opioid use disorder (OUD+ versus OUD-, respectively) in the perinatal period.
Methods: Participants were enrolled during late pregnancy (>36 weeks gestation) and followed through postpartum week 12. Weekly saliva and blood samples were collected to measure cortisol (30 minutes after waking, late morning, and at 8pm), oxytocin, estrogens (e.g., estradiol, estriol), androgens (e.g., testosterone, DHEA-S), and progesterone. Assays were done by enzyme immunoassay in the Laboratory for the Evolutionary Endocrinology of Primates for oxytocin and cortisol, and by liquid chromatography-mass spectroscopy by ZRT Laboratory for the remaining hormones.
Results: The OUD+ (n=43) and OUD- (n=18) groups were comparable on age (29.4±5.1), race/ethnicity (White=41%, Hispanic=51%), and parity (multiparous=72%). During late pregnancy, compared to OUD-, OUD+ had significantly lower estriol (23,329.3 v. 13,932.4 pg/mL, p<0.01), 17-OH progesterone (630.3 v. 390.0 ng/dL, p<0.01), 11-deoxycortisol (168.9 v. 106.3 ng/dL, p<0.01), cortisone (6.1 v. 4.8 ug/dL, p<0.01), and diurnal change in cortisol (2184.1 v. 1221.7 ug/dL, p=0.03). Additionally, during postpartum, OUD+ had significantly lower cortisone (2.1 vs. 1.2 ug/dL, p<0.01). Lastly, trends were noted suggesting OUD+ may also have lower awakening cortisol (3412.0 vs 2676.0 ug/dL, p=0.06) during late pregnancy and lower androstenedione (136.8 vs. 106.7 ng/dL, p=0.08), DHEA-S (174.2 vs. 112.3 ug/dL, p=0.09) and late morning cortisol (38.4 vs. 32.6 ug/dL, p=0.06) postpartum.
Conclusions: These observations suggest that perinatal hormones may vary between individuals with and without OUD. This has potential implications for relapse risk during the transitional postpartum period. Thus, additional research is needed to explore how these hormones may contribute to the heightened risk of postpartum return to opioid misuse.
Keywords: Opioids, PregnancyMethods: Participants were enrolled during late pregnancy (>36 weeks gestation) and followed through postpartum week 12. Weekly saliva and blood samples were collected to measure cortisol (30 minutes after waking, late morning, and at 8pm), oxytocin, estrogens (e.g., estradiol, estriol), androgens (e.g., testosterone, DHEA-S), and progesterone. Assays were done by enzyme immunoassay in the Laboratory for the Evolutionary Endocrinology of Primates for oxytocin and cortisol, and by liquid chromatography-mass spectroscopy by ZRT Laboratory for the remaining hormones.
Results: The OUD+ (n=43) and OUD- (n=18) groups were comparable on age (29.4±5.1), race/ethnicity (White=41%, Hispanic=51%), and parity (multiparous=72%). During late pregnancy, compared to OUD-, OUD+ had significantly lower estriol (23,329.3 v. 13,932.4 pg/mL, p<0.01), 17-OH progesterone (630.3 v. 390.0 ng/dL, p<0.01), 11-deoxycortisol (168.9 v. 106.3 ng/dL, p<0.01), cortisone (6.1 v. 4.8 ug/dL, p<0.01), and diurnal change in cortisol (2184.1 v. 1221.7 ug/dL, p=0.03). Additionally, during postpartum, OUD+ had significantly lower cortisone (2.1 vs. 1.2 ug/dL, p<0.01). Lastly, trends were noted suggesting OUD+ may also have lower awakening cortisol (3412.0 vs 2676.0 ug/dL, p=0.06) during late pregnancy and lower androstenedione (136.8 vs. 106.7 ng/dL, p=0.08), DHEA-S (174.2 vs. 112.3 ug/dL, p=0.09) and late morning cortisol (38.4 vs. 32.6 ug/dL, p=0.06) postpartum.
Conclusions: These observations suggest that perinatal hormones may vary between individuals with and without OUD. This has potential implications for relapse risk during the transitional postpartum period. Thus, additional research is needed to explore how these hormones may contribute to the heightened risk of postpartum return to opioid misuse.
Authors:
Presenter - Alicia Allen, University of Arkansas for Medical Sciences
Co-Author - Linnea Linde-Krieger, Arizona State University
Co-Author - James Baurley, Biorealm, LLC
Co-Author - Stephanie Mallahan, University of Arizona
Co-Author - Arushi Chalke, University of Arizona
Co-Author - Lela Rankin, Arizona State University
Co-Author - Stacey Tecot, University of Arizona
Modes of cannabis administration, co-use with tobacco, and associations with cannabis use and health outcomes
Poster Number: E147Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Tobacco Control and Nicotine-Related Behavior
Objective: Co-use of tobacco with cannabis is increasingly prevalent and is linked to a range of physical and mental health problems. In the ever-evolving cannabis marketplace, it is critical to understand cannabis modes of administration (MOAs) and their health-related correlates across those with exclusive cannabis use vs. dual cannabis-tobacco use. In a sample of adults in Oklahoma, a state with both loose cannabis regulations and high tobacco use prevalence, this study assessed differences in the prevalence and correlates of different cannabis MOAs between adults reporting past 30-day tobacco and cannabis use (co-use) and those reporting cannabis-only use.
Method: Participants were adults reporting past 30-day cannabis use (n=3,488; 53% female, 68% non-Hispanic White) living in Oklahoma who participated in a repeated cross-sectional online study (September 2020–September 2024). Relative prevalence, rankings, and odds of past 30-day use of 9 different cannabis MOAs (including blunts) were examined across those reporting co-use vs. past 30-day cannabis-only use. ANCOVA tests examined associations of co-use (vs, cannabis-only use) and type of past 30-day cannabis use (combustible-only, non-combustible-only, both) with respiratory problems and past 30-day frequency of medical and recreational cannabis use.
Results: In this sample of adults reporting current cannabis use, 76.2% reported past 30-day tobacco use. Smoking cannabis was the most popular MOA across cannabis-only (72%) and cannabis-tobacco co-use (83.1%). Among those reporting co-use, blunt use was the second most popular MOA (64.8%), followed by vaping (44%), and edibles (36.5%). Among those reporting cannabis-only use, edibles were the second most popular MOA (47.8%), followed by blunt smoking (36.1%), and vaping (33.4%). Co-use (vs. cannabis-only use) was significantly associated with higher odds of smoking (aOR=1.81), vaping (aOR=1.24), dabbing (aOR=1.89), and blunt use (aOR=2.44), and lower odds of edible (aOR=0.45) and dissolvable use (aOR=0.68). Using combustible forms of cannabis use and engaging in co-use (vs. cannabis-only use) were associated with more severe respiratory problems and more frequent past 30-day recreational and medical cannabis use.
In a sample of Oklahoma adults who report cannabis use, those who engage in co-use with tobacco (vs only use cannabis) are more likely to use higher-risk MOAs, experience more respiratory problems and use cannabis more frequently.
Keywords: Tobacco use, Co-morbiditiesMethod: Participants were adults reporting past 30-day cannabis use (n=3,488; 53% female, 68% non-Hispanic White) living in Oklahoma who participated in a repeated cross-sectional online study (September 2020–September 2024). Relative prevalence, rankings, and odds of past 30-day use of 9 different cannabis MOAs (including blunts) were examined across those reporting co-use vs. past 30-day cannabis-only use. ANCOVA tests examined associations of co-use (vs, cannabis-only use) and type of past 30-day cannabis use (combustible-only, non-combustible-only, both) with respiratory problems and past 30-day frequency of medical and recreational cannabis use.
Results: In this sample of adults reporting current cannabis use, 76.2% reported past 30-day tobacco use. Smoking cannabis was the most popular MOA across cannabis-only (72%) and cannabis-tobacco co-use (83.1%). Among those reporting co-use, blunt use was the second most popular MOA (64.8%), followed by vaping (44%), and edibles (36.5%). Among those reporting cannabis-only use, edibles were the second most popular MOA (47.8%), followed by blunt smoking (36.1%), and vaping (33.4%). Co-use (vs. cannabis-only use) was significantly associated with higher odds of smoking (aOR=1.81), vaping (aOR=1.24), dabbing (aOR=1.89), and blunt use (aOR=2.44), and lower odds of edible (aOR=0.45) and dissolvable use (aOR=0.68). Using combustible forms of cannabis use and engaging in co-use (vs. cannabis-only use) were associated with more severe respiratory problems and more frequent past 30-day recreational and medical cannabis use.
In a sample of Oklahoma adults who report cannabis use, those who engage in co-use with tobacco (vs only use cannabis) are more likely to use higher-risk MOAs, experience more respiratory problems and use cannabis more frequently.
Authors:
Presenter - Amy Cohn, PhD, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Katelyn Romm, PhD, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Erin Vogel, PhD, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Steven Pan, MS, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Summer Frank-Pearce, PhD, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Michael Smith, MS, MPH, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Hannah Appleseth, Oklahoma State University
Author - Laili Boozary, PhD, University of Oklahoma Health Sciences, TSET Health Promotion Research Center
Author - Munjireen Sifat, PhD, Sidney Kimmel Cancer Center, Thomas Jefferson University
Author - Darla Kendzor, PhD, The University of Oklahoma Health Sciences Center
Implementation of Universal Screening in a Student Health Setting: Initial Findings
Poster Number: E148Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Integrated Primary Care
For many young adults, college represents their first experience of independence; a time that often results in early experimentation with alcohol and other illicit substances. While most young adults will not go on to develop an alcohol or substance use disorder, misuse of alcohol and other substances has been shown to lead to a variety of problematic outcomes in this population, including driving fatalities, mental health difficulties, and interpersonal challenges. Recognizing that early identification of, and intervention for risky behaviors, can yield positive behavioral change and better health outcomes, it has been suggested that evidence-based practices such as Screening, Brief Intervention and Referral to Treatment (SBIRT) be employed with young adults.
In response, as part of a large implementation project funded by SAMHSA, universal screening practices were introduced into our university’s student health service on January 6, 2025. The tools administered include the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST-10). The AUDIT is a screening tool used to assess alcohol consumption, behaviors, and problems associated with alcohol use (World Health Organization) while the DAST, is brief, standardized self-report instrument used to screen for possible involvement with drugs (not including alcohol or tobacco). Of the 1,291 young adults aged 18-44 (Mean = 23.81, SD = 4.48) screened through 06/30/2025 (64 % female), 4.9% reported alcohol and/or substance use indicating a need for Brief Intervention services. With respect to the individual measures, we observed scores on the AUDIT ranging between 0 and 28 (M = 2.23, SD = 2.62), with scores on the DAST ranging between 0 and 8 (M = .53, SD = .88). While the overall positivity rate was surprisingly low, the nature of the screening environment (a university student health where respondents may have had concerns about confidentiality) could have contributed to student underreporting problematic behavior. Furthermore, while to the best of our knowledge, this effort represents one of the earliest efforts at introducing universal screening into a collegiate health service system, we do not know if the sample obtained is representative of the general population of young adults in an academic setting. Follow-up interviews, which are part of the ongoing data collection process, will all allow us to assess the efficacy of SBIRT with this unique population.
Keywords: Substance abuse, ScreeningIn response, as part of a large implementation project funded by SAMHSA, universal screening practices were introduced into our university’s student health service on January 6, 2025. The tools administered include the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST-10). The AUDIT is a screening tool used to assess alcohol consumption, behaviors, and problems associated with alcohol use (World Health Organization) while the DAST, is brief, standardized self-report instrument used to screen for possible involvement with drugs (not including alcohol or tobacco). Of the 1,291 young adults aged 18-44 (Mean = 23.81, SD = 4.48) screened through 06/30/2025 (64 % female), 4.9% reported alcohol and/or substance use indicating a need for Brief Intervention services. With respect to the individual measures, we observed scores on the AUDIT ranging between 0 and 28 (M = 2.23, SD = 2.62), with scores on the DAST ranging between 0 and 8 (M = .53, SD = .88). While the overall positivity rate was surprisingly low, the nature of the screening environment (a university student health where respondents may have had concerns about confidentiality) could have contributed to student underreporting problematic behavior. Furthermore, while to the best of our knowledge, this effort represents one of the earliest efforts at introducing universal screening into a collegiate health service system, we do not know if the sample obtained is representative of the general population of young adults in an academic setting. Follow-up interviews, which are part of the ongoing data collection process, will all allow us to assess the efficacy of SBIRT with this unique population.
Authors:
Presenter - Troi Rutherford, Drexel University
Co-Presenter - Lauren Kairys, MS, LAPC, Drexel University
Co-Author - Robert Sterling, PhD, Drexel University
Co-Author - Margaret Dickinson, MS, LAPC, Drexel University
Co-Author - Jessica Chou, PhD, LPC, LMFT, Drexel University
Co-Author - Rikki Patton, PhD, MFT, Drexel University
Co-Author - Kristen Pedersen, MS, Western Michigan University
Co-Author - Zahrah Surrat, Drexel University
Co-Author - Sharra Wile, Drexel University
Co-Author - Gary Davis, MD, Drexel University
Co-Author - Emily Hudash, Drexel University
Framing Matters: A Choice Experiment on Gain-Loss Messages in Digital Alcohol Interventions
Poster Number: E149Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Aging
Background:
Mobile messaging is a cost-effective and scalable digital intervention to support health behavior change, particularly for older adults. However, little is known about how message framing influences user engagement in alcohol reduction interventions. Behavioral science research suggests framing—emphasizing benefits (gain) versus costs (loss)—can shape motivation, but evidence among aging populations remains limited.
Purpose:
This study aimed to optimize mobile health messaging by examining older adults’ preferences for gain- versus loss-framed text messages in the context of alcohol reduction. Guided by the Multiphase Optimization Strategy (MOST), we sought to identify both framing effects and message-level attributes that influence engagement.
Methods:
Adults aged ≥50 who reported drinking alcohol (N=1,348; 52% female) were recruited from Prolific. Participants completed a discrete choice experiment, evaluating 174 messages (86 gain-framed, 86 loss-framed) across five randomized paired comparisons (6,740 total choices; 3,434 direct gain–loss contrasts). Outcomes included message preference proportion and variability across items. A one-sample proportions test assessed overall gain vs. loss preference, with exploratory analyses by demographics and message characteristics.
Results:
Participants preferred gain-framed over loss-framed messages in 57.8% of direct comparisons (95% CI: 0.561–0.594; χ²(1)=83.66, p<.001). Preferences remained consistent across repetitions and message placement. Substantial item-level variability was observed (range: 19%–74%), with the most preferred messages emphasizing positive outcomes (e.g., sleep, cognition, reduced disease risk) and future orientation. Least preferred messages often employed a judgmental tone, regardless of frame. No significant differences in gain preference emerged by gender.
Conclusions:
Older adults demonstrated a clear preference for gain-framed mobile messages to support alcohol reduction, but framing alone did not fully predict engagement. Content emphasizing positive outcomes and supportive tone was most effective, while judgmental messages were least appealing. Findings underscore the importance of user-centered optimization within MOST to refine mobile interventions. For behavioral medicine, results highlight that framing and content design should be adaptive, inclusive, and tailored to older adults’ motivational needs to enhance digital intervention effectiveness.
Keywords: Alcohol, Health behavior changeMobile messaging is a cost-effective and scalable digital intervention to support health behavior change, particularly for older adults. However, little is known about how message framing influences user engagement in alcohol reduction interventions. Behavioral science research suggests framing—emphasizing benefits (gain) versus costs (loss)—can shape motivation, but evidence among aging populations remains limited.
Purpose:
This study aimed to optimize mobile health messaging by examining older adults’ preferences for gain- versus loss-framed text messages in the context of alcohol reduction. Guided by the Multiphase Optimization Strategy (MOST), we sought to identify both framing effects and message-level attributes that influence engagement.
Methods:
Adults aged ≥50 who reported drinking alcohol (N=1,348; 52% female) were recruited from Prolific. Participants completed a discrete choice experiment, evaluating 174 messages (86 gain-framed, 86 loss-framed) across five randomized paired comparisons (6,740 total choices; 3,434 direct gain–loss contrasts). Outcomes included message preference proportion and variability across items. A one-sample proportions test assessed overall gain vs. loss preference, with exploratory analyses by demographics and message characteristics.
Results:
Participants preferred gain-framed over loss-framed messages in 57.8% of direct comparisons (95% CI: 0.561–0.594; χ²(1)=83.66, p<.001). Preferences remained consistent across repetitions and message placement. Substantial item-level variability was observed (range: 19%–74%), with the most preferred messages emphasizing positive outcomes (e.g., sleep, cognition, reduced disease risk) and future orientation. Least preferred messages often employed a judgmental tone, regardless of frame. No significant differences in gain preference emerged by gender.
Conclusions:
Older adults demonstrated a clear preference for gain-framed mobile messages to support alcohol reduction, but framing alone did not fully predict engagement. Content emphasizing positive outcomes and supportive tone was most effective, while judgmental messages were least appealing. Findings underscore the importance of user-centered optimization within MOST to refine mobile interventions. For behavioral medicine, results highlight that framing and content design should be adaptive, inclusive, and tailored to older adults’ motivational needs to enhance digital intervention effectiveness.
Authors:
Presenter - Michael Sobolev, PhD, University of Southern California
Co-Author - Patrycja Sleboda, PhD, Baruch College, City University of New York
Co-Author - Frederick Muench, PhD, North Shore Health System
Co-Author - Alexis Kuerbis, PhD, Hunter College, City Univeristy of New York
Exploring effects of a patient-directed psychosocial intervention on parents of adolescents and young adults (AYAs) with cancer
Poster Number: E15Time: 05:00 PM - 05:50 PM
Topics: Cancer, Child and Family Health
Background: Adolescents and young adults (AYAs) with cancer and their parents are at risk for poor psychosocial outcomes. Despite known reciprocal associations between parent and child adjustment, links between patient-directed interventions and parent outcomes are not well understood.
Objective: We aimed to explore effects of the Promoting Resilience in Stress Management (PRISM) psychosocial intervention for AYAs with cancer on parent distress and health-related quality of life.
Method: This exploratory descriptive analysis included parent cohorts from 2 multi-site Phase III randomized trials of PRISM for AYAs with advanced cancer (PRISM-AC) and receiving hematopoietic cell transplant (PRISM-HCT). AYAs were 12-24 years-old and diagnosed with advanced cancer or <30 days of HCT, respectively; parents were the parent or guardian of an enrolled AYA and English- or Spanish-speaking. AYAs were randomized to receive PRISM or psychosocial usual care (UC); PRISM consisted of 4 sessions delivered 1:1, 1-2 weeks apart, teaching behavioral skills associated with wellbeing plus an optional family meeting. PRISM-AC AYAs also received a 5th session on advance care planning. Parents self-reported anxiety [Generalized Anxiety Disorder-7], depression [Patient Health Questionnaire-8], health-related quality of life [HRQoL; Short Form Health Survey-36], and demographics at baseline and 3-month follow-up. This analysis was not powered to detect efficacy; we used descriptive statistics and effect sizes (Cohen’s d) to explore change in parent outcomes in response to PRISM for each trial and the combined cohort.
Results: Across both studies, 95 parents enrolled and completed baseline and follow-up surveys [N=73 (77%) PRISM-AC; N=22 (23%) PRISM-HCT]. The majority were female (80%); Asian (7%), Black/African American (7%), or White (67%); and spoke English as a first language (82%). Median age was 46 (IQR 41-50). Direction and magnitude of effects were similar for each trial and the combined cohort; for the latter, on average PRISM-arm parents showed greater reductions in anxiety [-1.4 (SD=5.1) vs. -0.9 (SD=4.6), d=-0.1] and depression [-1.4 (SD=5.5) vs. -0.6 (SD=3.1), d=-0.2] and greater improvements in HRQoL [4.1 (SD=16.5) vs. -0.2 (SD=14.5), d=0.3] at 3-month follow-up compared to UC-arm parents.
Conclusion: Patient-directed psychosocial interventions show promise for improving parent outcomes. These exploratory findings warrant further examination via fully powered trials.
Keywords: Intervention, Parent-child transactionsObjective: We aimed to explore effects of the Promoting Resilience in Stress Management (PRISM) psychosocial intervention for AYAs with cancer on parent distress and health-related quality of life.
Method: This exploratory descriptive analysis included parent cohorts from 2 multi-site Phase III randomized trials of PRISM for AYAs with advanced cancer (PRISM-AC) and receiving hematopoietic cell transplant (PRISM-HCT). AYAs were 12-24 years-old and diagnosed with advanced cancer or <30 days of HCT, respectively; parents were the parent or guardian of an enrolled AYA and English- or Spanish-speaking. AYAs were randomized to receive PRISM or psychosocial usual care (UC); PRISM consisted of 4 sessions delivered 1:1, 1-2 weeks apart, teaching behavioral skills associated with wellbeing plus an optional family meeting. PRISM-AC AYAs also received a 5th session on advance care planning. Parents self-reported anxiety [Generalized Anxiety Disorder-7], depression [Patient Health Questionnaire-8], health-related quality of life [HRQoL; Short Form Health Survey-36], and demographics at baseline and 3-month follow-up. This analysis was not powered to detect efficacy; we used descriptive statistics and effect sizes (Cohen’s d) to explore change in parent outcomes in response to PRISM for each trial and the combined cohort.
Results: Across both studies, 95 parents enrolled and completed baseline and follow-up surveys [N=73 (77%) PRISM-AC; N=22 (23%) PRISM-HCT]. The majority were female (80%); Asian (7%), Black/African American (7%), or White (67%); and spoke English as a first language (82%). Median age was 46 (IQR 41-50). Direction and magnitude of effects were similar for each trial and the combined cohort; for the latter, on average PRISM-arm parents showed greater reductions in anxiety [-1.4 (SD=5.1) vs. -0.9 (SD=4.6), d=-0.1] and depression [-1.4 (SD=5.5) vs. -0.6 (SD=3.1), d=-0.2] and greater improvements in HRQoL [4.1 (SD=16.5) vs. -0.2 (SD=14.5), d=0.3] at 3-month follow-up compared to UC-arm parents.
Conclusion: Patient-directed psychosocial interventions show promise for improving parent outcomes. These exploratory findings warrant further examination via fully powered trials.
Authors:
Presenter - Katy Fladeboe, PhD, University of Washington/Seattle Children's
Author - Li Chen, MS, Dana Farber Cancer Institute
Author - Emanuele Mazzola, PhD, Dana Farber Cancer Institute
Author - Joyce Yi-Frazier, PhD, Dana Farber Cancer Institute
Author - Abby Rosenberg, MD, MA, MS, Dana Farber Cancer Institute/Harvard Medical School
Post-Traumatic Growth and Self-Stigma: Evidence from Adults in Substance Use Recovery
Poster Number: E150Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Mental Health
Background: Post-Traumatic Growth (PTG) is the positive psychological change following trauma. For people in recovery, PTG holds particular importance; not only do many face trauma linked to substance use, but the journey of recovery can also open pathways to personal growth. Self-stigma can reinforce shame and hinder recovery among individuals with substance use histories. This study examines the relationship between the six domains of PTG and self-stigma.
Methods: Data from 102 adults in substance use recovery were analyzed. PTG was measured with an adapted scale assessing six domains (Relating to Others, New Possibilities, Personal Strength, Spiritual/Existential Change, Appreciation of Life, and Mental/Physical Health). Self-stigma was measured with a validated scale including two subscales (self-devaluation and fear of enacted stigma). Four linear regressions examined relations of self-stigma with Domains 1 and 4 (Relating to Others; Spiritual/Existential Change) after a correlation matrix of all six factors.
Results: Participants were predominantly male (58.8%) and White (65.9%), with a mean age of 43 (SD = 15.70). Model one predicted total self-stigma from Domain 1 [F(1,99) = 4.63, p = .016], and model two predicted total self-stigma from Domain 4 [F(1,99) = 4.21, p = .043]. Model three predicted Self-Devaluation from Domain 1 [F(1,99) = 4.28, p = .041], and model four predicted Fear of Enacted Stigma from Domain 4 [F(1,99) = 4.05, p = .047]. Domain 1 explained 4.6% (R² = .046) of total self-stigma variation and 4.1% (R² = .041) of Self-Devaluation. Domain 4 explained 4.1% (R² = .041) of total self-stigma and 3.9% (R² = .039) of Fear of Enacted Stigma. Domain 1 positively predicted total self-stigma (β = .215, p = .016) and Self-Devaluation (β = .204, p = .041). Domain 4 positively predicted total self-stigma (β = .202, p = .043) and Fear of Enacted Stigma (β = .198, p = .047).
Conclusion: Individuals reporting greater growth in Domain 1 also reported higher self-stigma and self-devaluation, suggesting that increased interpersonal sensitivity may heighten internalized stigma. Likewise, those experiencing growth in Domain 4 reported higher self-stigma and fear of enacted stigma, suggesting this domain may be linked to increased reflection and sensitivity to stigma. Interventions to reduce self-stigma may benefit from addressing relational and existential aspects of recovery.
Keywords: Substance abuse, TraumaMethods: Data from 102 adults in substance use recovery were analyzed. PTG was measured with an adapted scale assessing six domains (Relating to Others, New Possibilities, Personal Strength, Spiritual/Existential Change, Appreciation of Life, and Mental/Physical Health). Self-stigma was measured with a validated scale including two subscales (self-devaluation and fear of enacted stigma). Four linear regressions examined relations of self-stigma with Domains 1 and 4 (Relating to Others; Spiritual/Existential Change) after a correlation matrix of all six factors.
Results: Participants were predominantly male (58.8%) and White (65.9%), with a mean age of 43 (SD = 15.70). Model one predicted total self-stigma from Domain 1 [F(1,99) = 4.63, p = .016], and model two predicted total self-stigma from Domain 4 [F(1,99) = 4.21, p = .043]. Model three predicted Self-Devaluation from Domain 1 [F(1,99) = 4.28, p = .041], and model four predicted Fear of Enacted Stigma from Domain 4 [F(1,99) = 4.05, p = .047]. Domain 1 explained 4.6% (R² = .046) of total self-stigma variation and 4.1% (R² = .041) of Self-Devaluation. Domain 4 explained 4.1% (R² = .041) of total self-stigma and 3.9% (R² = .039) of Fear of Enacted Stigma. Domain 1 positively predicted total self-stigma (β = .215, p = .016) and Self-Devaluation (β = .204, p = .041). Domain 4 positively predicted total self-stigma (β = .202, p = .043) and Fear of Enacted Stigma (β = .198, p = .047).
Conclusion: Individuals reporting greater growth in Domain 1 also reported higher self-stigma and self-devaluation, suggesting that increased interpersonal sensitivity may heighten internalized stigma. Likewise, those experiencing growth in Domain 4 reported higher self-stigma and fear of enacted stigma, suggesting this domain may be linked to increased reflection and sensitivity to stigma. Interventions to reduce self-stigma may benefit from addressing relational and existential aspects of recovery.
Authors:
Author - Sierra Tentis, MPH, University of South Florida
Co-Author - Jocelyn Jarvis, BS, University of South Florida
Co-Author - Ciara Spivey, BA, University of South Florida
Co-Author - Estefania Simon, MA, CRC, CVE , University of South Florida
Co-Author - B. Michelle Wilks-Otto, PhD, University of South Florida
Co-Author - Kristin Kosyluk, PhD, University of South Florida
Substance Use Among Latino Men: The Role of Ethnic Identity
Poster Number: E151Time: 05:00 PM - 05:50 PM
Topics: Substance Misuse, Social and Environmental Context and Health
Background: Latinos exhibit higher rates of substance use and dependence compared to non-Latino Whites, and Latino men report higher substance use compared to Latina women. Latino cultural values such as familismo have been linked to lower risk of substance use in Latinos, yet evidence on whether ethnic identity (EI) serves as a protective factor is mixed, particularly among men. Grounded in Social Identity Theory, the Multigroup Ethnic Identity Measure (MEIM) assesses feelings about one’s ethnic group. Using this framework, we examined how EI influences substance use (illegal drug use, daily alcohol consumption >2 drinks, and cigarette smoking). We hypothesized that stronger EI would be negatively associated with lower substance use.
Methods: This is a secondary analysis of the NIH-funded Latino Men’s Health Initiative (R21-CA143636), which examined cultural variables underlying race and ethnicity and their relationship to diet, physical activity, and body image among 203 Puerto Rican and Mexican men aged 18-65 (M = 39.41, SD = 13.17). Measures included the MEIM, a composite measure of three substance use behaviors, and demographic variables, which were included as covariates in the analysis (age, preferred language, and SES). The hypothesis was tested using multinomial logistic regression in R.
Results: Composite substance use patterns showed 53% reported no use, 35% reported using one substance, 11% two substances, and 1% three. Stronger EI was significantly associated with lower odds of using one substance (OR=0.44, 95% CI [0.21, 0.93], p=.003), but not with using two substances (OR = 0.56, 95% CI [0.19, 1.63], p = .287). For three substances, the estimate was unstable due to the very small sample size (n = 24; 12%), and a valid confidence interval could not be calculated (OR = 0.00, p = 0.765). Among the covariates, higher SES was associated with lower odds of reporting one substance (OR=0.44, 95% CI [0.21, 0.33], p=.033) compared to none. Age and preferred language were not significantly associated with substance use.
Discussion: Stronger EI was protective against the use of one substance, suggesting a strong sense of belonging to one’s ethnic group may reduce the likelihood of single-substance use. SES was consistently associated with substance use, highlighting socioeconomic disadvantage as a key risk factor. Future studies should examine how SES interacts with EI to better understand substance use among Latino men of diverse backgrounds.
Keywords: Substance abuse, LatinoMethods: This is a secondary analysis of the NIH-funded Latino Men’s Health Initiative (R21-CA143636), which examined cultural variables underlying race and ethnicity and their relationship to diet, physical activity, and body image among 203 Puerto Rican and Mexican men aged 18-65 (M = 39.41, SD = 13.17). Measures included the MEIM, a composite measure of three substance use behaviors, and demographic variables, which were included as covariates in the analysis (age, preferred language, and SES). The hypothesis was tested using multinomial logistic regression in R.
Results: Composite substance use patterns showed 53% reported no use, 35% reported using one substance, 11% two substances, and 1% three. Stronger EI was significantly associated with lower odds of using one substance (OR=0.44, 95% CI [0.21, 0.93], p=.003), but not with using two substances (OR = 0.56, 95% CI [0.19, 1.63], p = .287). For three substances, the estimate was unstable due to the very small sample size (n = 24; 12%), and a valid confidence interval could not be calculated (OR = 0.00, p = 0.765). Among the covariates, higher SES was associated with lower odds of reporting one substance (OR=0.44, 95% CI [0.21, 0.33], p=.033) compared to none. Age and preferred language were not significantly associated with substance use.
Discussion: Stronger EI was protective against the use of one substance, suggesting a strong sense of belonging to one’s ethnic group may reduce the likelihood of single-substance use. SES was consistently associated with substance use, highlighting socioeconomic disadvantage as a key risk factor. Future studies should examine how SES interacts with EI to better understand substance use among Latino men of diverse backgrounds.
Authors:
Author - Jessica Yunez, Rosalind Franklin University of Medicine and Science
Co-Author - Catherine Kelly, Rosalind Franklin University of Medicine and Science
Co-Author - Kristin Schneider, PhD, FSBM, Rosalind Franklin University of Medicine & Science
Co-Author - Lisa Sanchez-Johnsen, Ph.D., M.S., B.A., Medical College of Wisconsin
Everyday Discrimination and Smoking Behavior in the U.S.: Evidence from the 2023 National Health Interview Survey
Poster Number: E152Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Disparities
Despite decades of health education, regulatory measures, and policy initiatives, tobacco use remains highly prevalent in the United States and continues to drive the burden of noncommunicable diseases. Understanding the broader social determinants of smoking behavior, beyond individual factors, is essential for designing effective public health interventions. This study examines the relationship between socioeconomic factors (e.g., age, race/ethnicity, region, poverty level) and smoking behavior, with a particular focus on everyday discrimination as the primary variable of interest. Data were drawn from the 2023 cross-sectional U.S.-based National Health Interview Survey (NHIS). Smoking behavior patterns were analyzed across different types and degrees of perceived everyday discrimination. Chi-square tests and multivariable logistic regression models were employed to estimate associations while controlling for key demographic and socioeconomic covariates, including age, sex, race/ethnicity, education, income, and region. Individuals reporting experiences of everyday discrimination, such as being treated less courteously, feared, threatened, or harassed, were significantly more likely to smoke compared to those without such experiences (chi-square, p < 0.001). After adjusting for covariates, individuals with high levels of perceived discrimination had 39% greater odds of smoking (OR = 1.39, 95% CI: 1.24–1.47) than those reporting no discrimination. Everyday discrimination is significantly associated with increased smoking risk, underscoring the role of psychosocial stressors in shaping health behaviors. Smoking prevention and cessation programs that address discrimination and related social determinants may yield more impactful and equitable public health outcomes.
Keywords: Discrimination, Smoking, Tobacco, Psychosocial Stressors, Social determinants
Keywords: Tobacco use, Health disparitiesKeywords: Discrimination, Smoking, Tobacco, Psychosocial Stressors, Social determinants
Authors:
Presenter - Sharmila Acharya, Master's in Health Promotion and Education (MHPE), University of Memphis
Author - Satish Kedia , PhD in Behavioral sciences , University Of Memphis
Co-Author - Abid Hasan Khan , Master's in Public health(MPH), University Of Memphis
Co-Author - Xichen Mou, PhD , MS, University Of Memphis
Measurement Invariance Evaluation of a Generalized Nicotine Dependence Scale
Poster Number: E153Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior
Introduction. A shortened, generalized nicotine dependence scale is needed, given changes to the tobacco landscape and patterns of these products across youth and young adults.
Methods. The four-item E-cigarette Dependence Scale (EDS) was modified to reference use of any nicotine product, rather than e-cigarettes specifically. Data were obtained from a continuous, cross-sectional sample of youth and young adults (aged 15-24 years), collected between April 2025 to June 2025 (N = 1094). A one-factor, confirmatory factor model fit the data (CFI = 0.99). Measurement invariance by age (15-20 vs. 21-24 years), product type (e-cigarette; cigarette; oral nicotine product; little cigar, cigar, cigarillo), and number of products used (single product vs. multiple products) was preliminarily assessed using Chi-square difference testing (p-value<0.05 indicating poor model fit). Relationships between the generalized nicotine scale and use frequency (1-19 days vs. 20+ days in the past 30 days), quit intentions (none vs. any intention), and quitting stage (precontemplation vs. contemplation, preparation, and action stages) were assessed via logistic regression analyses, controlling for age, sex at birth, sexual orientation, financial situation, race and ethnicity.
Results. The generalized nicotine dependence scale was scalar invariant by age (15-20 years vs. 21-24 years) across all products. Additionally, higher nicotine dependence was associated with greater use frequency (on at least 20 days of the past 30 days). Although higher nicotine dependence was not associated with quit intentions, it was associated with lower odds of being in later stages of quitting (i.e., action stage vs. precontemplation stage).
Discussion. A generalized nicotine dependence scale, based on the four-item EDS, can be used to assess nicotine dependence across different age groups and is associated with use frequency and stage of quitting.
Keywords: Adolescents, CessationMethods. The four-item E-cigarette Dependence Scale (EDS) was modified to reference use of any nicotine product, rather than e-cigarettes specifically. Data were obtained from a continuous, cross-sectional sample of youth and young adults (aged 15-24 years), collected between April 2025 to June 2025 (N = 1094). A one-factor, confirmatory factor model fit the data (CFI = 0.99). Measurement invariance by age (15-20 vs. 21-24 years), product type (e-cigarette; cigarette; oral nicotine product; little cigar, cigar, cigarillo), and number of products used (single product vs. multiple products) was preliminarily assessed using Chi-square difference testing (p-value<0.05 indicating poor model fit). Relationships between the generalized nicotine scale and use frequency (1-19 days vs. 20+ days in the past 30 days), quit intentions (none vs. any intention), and quitting stage (precontemplation vs. contemplation, preparation, and action stages) were assessed via logistic regression analyses, controlling for age, sex at birth, sexual orientation, financial situation, race and ethnicity.
Results. The generalized nicotine dependence scale was scalar invariant by age (15-20 years vs. 21-24 years) across all products. Additionally, higher nicotine dependence was associated with greater use frequency (on at least 20 days of the past 30 days). Although higher nicotine dependence was not associated with quit intentions, it was associated with lower odds of being in later stages of quitting (i.e., action stage vs. precontemplation stage).
Discussion. A generalized nicotine dependence scale, based on the four-item EDS, can be used to assess nicotine dependence across different age groups and is associated with use frequency and stage of quitting.
Authors:
Co-Author - Elizabeth Do, PhD, MPH, Truth Initiative
Co-Author - Kristiann Koris, MPP, Truth Initiative
Co-Author - Tyler Minter, MA, Truth Initiative
Co-Author - Meghan E. Morean, PhD, Yale University
Anxiety and Depression Severity Predicts Early Engagement in Clinical Trial-Based Smoking Cessation Treatment for Persons with HIV (PWH)
Poster Number: E154Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, HIV/AIDS
Background: PWH who smoke lose more life-years due to smoking than HIV. Understanding desire to engage in smoking cessation treatment can lead to interventions to increase uptake. We aimed to identify baseline predictors of early treatment engagement among a sample of PWH enrolled in a smoking cessation trial.
Methods: We used baseline data from a randomized trial comparing a pharmacogenetic and adherence optimized treatment vs. standard treatment for PWH (NCT04176172). Evaluation of eligible participants included DSM-5 disorders, depression/anxiety severity, and cigarette dependence were assessed with the Mini-International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale (HADS), and Fagerstrom Test for Cigarette Dependence (FTCD), respectively. The first treatment session occurred <60 days after intake. Early treatment engagement was defined as completing the first session. In a series of logistic regression models, we tested sociodemographic (e.g., age, sex, race), smoking (e.g., FTCD, nicotine metabolite ratio, preference for menthol vs. regular cigarettes), and clinical factors (e.g., HIV medication adherence past 30 days, HADS total, alcohol/substance use disorder past 12 months) as predictors of early engagement. Medication assignment served as a covariate: varenicline or nicotine patch for personalized treatment and varenicline for standard treatment.
Results: 362 participants were enrolled by 08/18/2025. Mean age was 53.0 (SD=10.1), 74.6% were male, and 78.2% were a racial/ethnic minority. Mean cigarettes/day was 11.5 (SD=7.2) and mean FTCD score was 4.2 (SD=2.1). The mean HADS total score was 7.3 (SD=5.8). 51.8% of participants had an alcohol/substance use disorder in the past 12 months and 42.5% had a current/past mental health disorder. 283 (79.2%) participants engaged in treatment. In the final model, only lower HADS total scores predicted treatment engagement (OR=0.91, 95% CI=0.87-0.96). Among participants with normal HADS scores (<11, n=263), 81.7% engaged in treatment whereas only 67.1% of those with moderate/severe anxiety and depression scores (≥11, n=79) engaged, χ2(1, 342)=7.7, p=006).
Conclusions: Anxiety/depression severity, but not other clinical factors, such as alcohol/substance use disorder, may undermine early treatment engagement. Further advancements in treatment for PWH may require integration of behavioral strategies to address anxiety/depression immediately after enrollment.
Keywords: Cessation, Co-morbiditiesMethods: We used baseline data from a randomized trial comparing a pharmacogenetic and adherence optimized treatment vs. standard treatment for PWH (NCT04176172). Evaluation of eligible participants included DSM-5 disorders, depression/anxiety severity, and cigarette dependence were assessed with the Mini-International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale (HADS), and Fagerstrom Test for Cigarette Dependence (FTCD), respectively. The first treatment session occurred <60 days after intake. Early treatment engagement was defined as completing the first session. In a series of logistic regression models, we tested sociodemographic (e.g., age, sex, race), smoking (e.g., FTCD, nicotine metabolite ratio, preference for menthol vs. regular cigarettes), and clinical factors (e.g., HIV medication adherence past 30 days, HADS total, alcohol/substance use disorder past 12 months) as predictors of early engagement. Medication assignment served as a covariate: varenicline or nicotine patch for personalized treatment and varenicline for standard treatment.
Results: 362 participants were enrolled by 08/18/2025. Mean age was 53.0 (SD=10.1), 74.6% were male, and 78.2% were a racial/ethnic minority. Mean cigarettes/day was 11.5 (SD=7.2) and mean FTCD score was 4.2 (SD=2.1). The mean HADS total score was 7.3 (SD=5.8). 51.8% of participants had an alcohol/substance use disorder in the past 12 months and 42.5% had a current/past mental health disorder. 283 (79.2%) participants engaged in treatment. In the final model, only lower HADS total scores predicted treatment engagement (OR=0.91, 95% CI=0.87-0.96). Among participants with normal HADS scores (<11, n=263), 81.7% engaged in treatment whereas only 67.1% of those with moderate/severe anxiety and depression scores (≥11, n=79) engaged, χ2(1, 342)=7.7, p=006).
Conclusions: Anxiety/depression severity, but not other clinical factors, such as alcohol/substance use disorder, may undermine early treatment engagement. Further advancements in treatment for PWH may require integration of behavioral strategies to address anxiety/depression immediately after enrollment.
Authors:
Presenter - Annie Lee, BA, Northwestern University
Co-Author - Jessica Santos, Northwestern University
Co-Author - Casey Foster, BA, University of Pennsylvania
Co-Author - Kyleigh Burke, BS, University of Pennsylvania
Co-Author - Blake Max, PharmD, AAHIVP, University of Illinois at Chicago
Co-Author - Sarah Assian, MS, AAHIVP, PA-C, Cook County Health
Co-Author - Jacqueline Gollan, PhD, Northwestern University
Co-Author - Chad Auchenbach, MD, MPH, Northwestern University
Co-Author - Frank Leone, MD, MS, University of Pennsylvania
Co-Author - Robert Gross, MD, MSCE, University of Pennsylvania
Co-Author - Robert Schnoll, PhD, University of Pennsylvania
Co-Author - Brian Hitsman, PhD, Northwestern University
Rural-Urban Disparities in Perceived Loneliness and Current Tobacco Use
Poster Number: E155Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Social and Environmental Context and Health
Background: Loneliness is a growing public health concern linked to higher risk of substance use, including tobacco products. Rural-urban disparities may shape both perceived loneliness and tobacco product use, yet few studies have examined their intersection. Understanding these patterns can inform interventions tailored to community contexts.
Methods: We used data from the 2024 National Health Interview Survey on adults aged 18+ years (n=30,760). Respondents were asked, “How often do you feel lonely?” with response options ranging from (0) never to (4) always. This measure was modeled as an ordinal continuous variable. Respondents also indicated current use (defined as using “every day” or “some days”) of cigarettes, e-cigarettes, and cigars. We estimated whether loneliness was associated with current use of each tobacco product using logistic regression, adjusted for sociodemographic characteristics. We then tested two-way interactions between loneliness and rural-urban status, and we ran additional models stratified by rural-urban status for statistically significant interactions (p<0.05) to examine effect modification.
Results: Among the sample, mean loneliness was 0.80 (SD=0.99), and 9.9% reported current cigarette use, 7.0% reported e-cigarette use, and 3.7% reported cigar use. In adjusted models, each unit-increase in loneliness was associated with current cigarette (OR=1.13, 95% CI=1.08-1.18) and e-cigarette (OR=1.22, 95% CI=1.15-1.30) but not cigar (OR=1.08, 95% CI=1.00-1.16) use. However, two-way interactions between loneliness and rural-urban status were not statistically significant for models corresponding to current cigarette (p=0.72) and e-cigarette (p=0.22) use but were for the model corresponding to cigar use (p=0.033). In the model stratified by rural-urban status, each unit-increase in loneliness was associated with current cigar use among adults who lived in urban areas (OR=1.11, 95% CI=1.02-1.21) but not for adults who lived in rural areas (OR=0.90, 95% CI=0.76-1.06).
Conclusions: Loneliness was associated with higher odds of cigarette and e-cigarette use overall, and with cigar use among urban adults. These findings highlight loneliness as a modifiable risk factor for tobacco use with product- and context-specific patterns. Community-based interventions that improve social connection and integrate tailored cessation support could help reduce tobacco use and advance health equity, with attention to cigar use in urban communities.
Keywords: Tobacco use, Health disparitiesMethods: We used data from the 2024 National Health Interview Survey on adults aged 18+ years (n=30,760). Respondents were asked, “How often do you feel lonely?” with response options ranging from (0) never to (4) always. This measure was modeled as an ordinal continuous variable. Respondents also indicated current use (defined as using “every day” or “some days”) of cigarettes, e-cigarettes, and cigars. We estimated whether loneliness was associated with current use of each tobacco product using logistic regression, adjusted for sociodemographic characteristics. We then tested two-way interactions between loneliness and rural-urban status, and we ran additional models stratified by rural-urban status for statistically significant interactions (p<0.05) to examine effect modification.
Results: Among the sample, mean loneliness was 0.80 (SD=0.99), and 9.9% reported current cigarette use, 7.0% reported e-cigarette use, and 3.7% reported cigar use. In adjusted models, each unit-increase in loneliness was associated with current cigarette (OR=1.13, 95% CI=1.08-1.18) and e-cigarette (OR=1.22, 95% CI=1.15-1.30) but not cigar (OR=1.08, 95% CI=1.00-1.16) use. However, two-way interactions between loneliness and rural-urban status were not statistically significant for models corresponding to current cigarette (p=0.72) and e-cigarette (p=0.22) use but were for the model corresponding to cigar use (p=0.033). In the model stratified by rural-urban status, each unit-increase in loneliness was associated with current cigar use among adults who lived in urban areas (OR=1.11, 95% CI=1.02-1.21) but not for adults who lived in rural areas (OR=0.90, 95% CI=0.76-1.06).
Conclusions: Loneliness was associated with higher odds of cigarette and e-cigarette use overall, and with cigar use among urban adults. These findings highlight loneliness as a modifiable risk factor for tobacco use with product- and context-specific patterns. Community-based interventions that improve social connection and integrate tailored cessation support could help reduce tobacco use and advance health equity, with attention to cigar use in urban communities.
Authors:
Author - Delvon Mattingly, PhD, MS, University of Kentucky College of Medicine
Co-Author - Osayande Agbonlahor, MD, PhD, University of Mississippi Medical Center
Co-Author - Meman Diaby, MS, University of Kentucky College of Medicine
Co-Author - Joy L. Hart, PhD, University of Louisville
Daily Concordance Between Self-Reported and Sensor-Measured Sleep and Smoking Cessation Outcomes in a mHealth Study
Poster Number: E156Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Sleep
Background:
Non-biased, real-time measurement of sleep and smoking cessation outcomes is critical for advancing mHealth interventions targeting smoking cessation. While smartphone-based ecological momentary assessments (EMAs) are commonly used, they remain vulnerable to recall bias and inaccuracy.
Purpose:
The current study evaluated day-level agreement between self-reported and sensor-derived measures of sleep and smoking in a fully remote, six-week mHealth trial.
Methods:
Participants completed daily EMAs, used a wrist-worn sleep sensor, and a portable carbon monoxide (iCO) monitor for 42 days. We compared self-reported vs. sensor-based sleep onset, wake-up time, sleep duration, and smoking abstinence each day. We also compared self-reported and biochemically confirmed smoking status using a 6 ppm CO threshold. Analyses included descriptive statistics, within-person correlations, Bland–Altman plots, intraclass correlations (ICC), and sensitivity/specificity analyses.
Results:
Participants were 65% White, 35% Black, 29% Male, 55.2 years old on average (SD=11.5). Within-person correlations of daily self-reports and sensor data were moderate to strong for sleep onset (r = 0.41), wake-up time (r = 0.49), and sleep duration (r = 0.30). Bland–Altman plots showed a mean bias of –11.1 minutes for sleep duration with self-reports tending to underestimate sensor-measured values, though individual errors ranged widely (–229.1 to +206.9 minutes). For smoking, self-reported cigarettes per day correlated with iCO levels (r = 0.64). Daily self-reported smoking status had sensitivity of 84.7% and specificity of 89.4% using a 6 ppm cutoff.
Conclusions:
Findings indicate that self-reported and sensor-based measures show good overall convergence in mHealth studies, supporting their complementary use for capturing day-level sleep and smoking outcomes. However, substantial individual variability underscores the need for caution when interpreting single-subject estimates and highlights the value of combining multiple measurement approaches.
Keywords: Tobacco use, TechnologiesNon-biased, real-time measurement of sleep and smoking cessation outcomes is critical for advancing mHealth interventions targeting smoking cessation. While smartphone-based ecological momentary assessments (EMAs) are commonly used, they remain vulnerable to recall bias and inaccuracy.
Purpose:
The current study evaluated day-level agreement between self-reported and sensor-derived measures of sleep and smoking in a fully remote, six-week mHealth trial.
Methods:
Participants completed daily EMAs, used a wrist-worn sleep sensor, and a portable carbon monoxide (iCO) monitor for 42 days. We compared self-reported vs. sensor-based sleep onset, wake-up time, sleep duration, and smoking abstinence each day. We also compared self-reported and biochemically confirmed smoking status using a 6 ppm CO threshold. Analyses included descriptive statistics, within-person correlations, Bland–Altman plots, intraclass correlations (ICC), and sensitivity/specificity analyses.
Results:
Participants were 65% White, 35% Black, 29% Male, 55.2 years old on average (SD=11.5). Within-person correlations of daily self-reports and sensor data were moderate to strong for sleep onset (r = 0.41), wake-up time (r = 0.49), and sleep duration (r = 0.30). Bland–Altman plots showed a mean bias of –11.1 minutes for sleep duration with self-reports tending to underestimate sensor-measured values, though individual errors ranged widely (–229.1 to +206.9 minutes). For smoking, self-reported cigarettes per day correlated with iCO levels (r = 0.64). Daily self-reported smoking status had sensitivity of 84.7% and specificity of 89.4% using a 6 ppm cutoff.
Conclusions:
Findings indicate that self-reported and sensor-based measures show good overall convergence in mHealth studies, supporting their complementary use for capturing day-level sleep and smoking outcomes. However, substantial individual variability underscores the need for caution when interpreting single-subject estimates and highlights the value of combining multiple measurement approaches.
Authors:
Co-Author - Nazife Pehlivan, Rutgers Cancer Institute
Co-Author - Prianca Nardkani, RWJ Medical School
Co-Author - Anushri Mahabir, Princeton University
Co-Author - Donald Hedeker, PhD, University of Chicago
Co-Author - Michael Businelle, PhD, FSBM, University of Oklahoma Health Sciences Center
Co-Author - Michael Steinberg, RWJ Medical School
Co-Author - Andrea Spaeth, Rutgers University
Co-Author - andrea villanti, Rutgers University
Racial and Ethnic Disparities in Attitudes towards the Tobacco Industry and its Tactics
Poster Number: E157Time: 05:00 PM - 05:50 PM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Disparities
Introduction: Tobacco companies have historically targeted racial and ethnic minority populations to promote and market tobacco products, contributing to racial and ethnic tobacco-related health disparities. The current study examines the relationship between race/ethnicity and attitudes towards the tobacco industry.
Methods: We recruited a convenience sample of 4,017 adults aged 25+ years old to complete an online survey between March 20 and April 24, 2025. Awareness of tobacco industry tactics was measured using a 4-point scale; participants indicated how much they agreed or disagreed that the tobacco industry engaged in specific tactics. Logistic regressions were used to examine the relationship between race/ethnicity and awareness of tobacco industry tactics, controlling for sociodemographics and past 30-day cigarette or e-cigarette use.
Results: Non-Hispanic (NH) Black and Hispanic respondents had higher odds of agreeing that tobacco companies tell the truth about their products’ addictiveness (OR=1.55, 95% CI: 1.28, 1.88 and OR=1.71, 95% CI: 1.40, 2.09, respectively) and have developed new products that are less harmful than cigarettes (OR=1.37, 95% CI: 1.13,1.66 and OR=1.56, 95% CI: 1.27, 1.90, respectively) compared to NH white respondents. NH Black respondents had lower odds of agreeing that tobacco companies target young people with their advertising and products (OR=0.72, 95% CI: 0.58, 0.90) and use flavors to get young people to use their products (OR=0.71, 95% CI: 0.56, 0.91), that children can see tobacco products and their advertisements on display in stores in their community (OR=0.69, 95% CI: 0.55, 0.86), and that influencers on social media are known to use tobacco products in their posts (OR=0.82, 95% CI: 0.67, 1.00) compared to NH white respondents.
Conclusion: The tobacco industry has historically targeted Black and Hispanic communities through marketing. Meanwhile, awareness of such tactics among Black or Hispanic populations is lower than their white non-Hispanic counterparts. Culturally tailored and community-engaged communication efforts are needed to ensure awareness of tobacco industry tactics across all racial and ethnic groups, which in turn could diminish racial and ethnic tobacco-related disparities.
Keywords: Tobacco control, DisparitiesMethods: We recruited a convenience sample of 4,017 adults aged 25+ years old to complete an online survey between March 20 and April 24, 2025. Awareness of tobacco industry tactics was measured using a 4-point scale; participants indicated how much they agreed or disagreed that the tobacco industry engaged in specific tactics. Logistic regressions were used to examine the relationship between race/ethnicity and awareness of tobacco industry tactics, controlling for sociodemographics and past 30-day cigarette or e-cigarette use.
Results: Non-Hispanic (NH) Black and Hispanic respondents had higher odds of agreeing that tobacco companies tell the truth about their products’ addictiveness (OR=1.55, 95% CI: 1.28, 1.88 and OR=1.71, 95% CI: 1.40, 2.09, respectively) and have developed new products that are less harmful than cigarettes (OR=1.37, 95% CI: 1.13,1.66 and OR=1.56, 95% CI: 1.27, 1.90, respectively) compared to NH white respondents. NH Black respondents had lower odds of agreeing that tobacco companies target young people with their advertising and products (OR=0.72, 95% CI: 0.58, 0.90) and use flavors to get young people to use their products (OR=0.71, 95% CI: 0.56, 0.91), that children can see tobacco products and their advertisements on display in stores in their community (OR=0.69, 95% CI: 0.55, 0.86), and that influencers on social media are known to use tobacco products in their posts (OR=0.82, 95% CI: 0.67, 1.00) compared to NH white respondents.
Conclusion: The tobacco industry has historically targeted Black and Hispanic communities through marketing. Meanwhile, awareness of such tactics among Black or Hispanic populations is lower than their white non-Hispanic counterparts. Culturally tailored and community-engaged communication efforts are needed to ensure awareness of tobacco industry tactics across all racial and ethnic groups, which in turn could diminish racial and ethnic tobacco-related disparities.
Authors:
Presenter - Stephanie Yoon, MPP, Truth Initiative
Author - Emily Donovan, MPH, Truth Initiative
Author - Madison Iskra, MPH, Truth Initiative
Author - Jennifer Kreslake, PhD, MPH, Truth Initiative
Appetitive traits and associations with gestational weight gain during early pregnancy among birthing individuals with a body mass index ≥25kg/m2
Poster Number: E158Time: 05:00 PM - 05:50 PM
Topics: Weight Related Health , Women's Health
Introduction: Appetitive traits reflect individuals’ predispositions toward food, are related to weight status and weight gain over time, and are potentially modifiable. Individuals with pre-pregnancy body mass index (BMI)≥25kg/m2 often exceed guidelines for gestational weight gain (GWG), which increases risk for negative postpartum outcomes and cardiovascular disease across the lifespan. However, appetitive traits have not been characterized in pregnancy, and data are needed to understand links between appetitive traits and weight in the context of pregnancy. Thus, we examined appetitive traits in early pregnancy and their associations with pre-pregnancy BMI and early GWG among individuals with pre-pregnancy BMI≥25.
Methods: Pregnant individuals (N=312; 12-20 weeks gestation) with pre-pregnancy BMI≥25 completed the Adult Eating Behavior Questionnaire (AEBQ) in early pregnancy (M weeks gestation=13.6±2.7). The AEBQ includes eight subscales (ratings range from 1–5), four of which describe “food approach” traits: Hunger, Food Responsiveness, Emotional Over-Eating, and Enjoyment of Food. The remaining four AEBQ subscales describe “food avoidance” traits: Satiety Responsiveness, Emotional Under-Eating, Food Fussiness, and Slowness in Eating. Correlation and linear regression analyses were used to evaluate each AEBQ subscale in relation to pre-pregnancy BMI and early GWG (difference between pre-pregnancy weight and weight gain to date during early pregnancy).
Results: During early pregnancy, participants reported the highest average score for Enjoyment of Food (4.31±0.67) and the lowest average score for Food Fussiness (2.22±0.97). The four food approach subscales were all significantly positively associated with one another, as were the four food avoidance subscales. Satiety Responsiveness, Food Fussiness, and Slowness in Eating were the only subscales significantly related to pre-pregnancy BMI (rho’s≥0.12, p’s≤.04). After adjusting for pre-pregnancy BMI and gestational age, only Food Responsiveness significantly related to early GWG (B=1.39, p=.04).
Conclusions: This is the first study to characterize appetitive traits using the AEBQ during pregnancy and document that Food Responsiveness, an appetitive trait linked to higher weight in non-pregnant adults, is associated with higher weight gain during early pregnancy. Further research is needed to understand changes in appetitive traits across pregnancy and their impact on end-of-pregnancy and birth outcomes.
Keywords: Eating behaviors, PregnancyMethods: Pregnant individuals (N=312; 12-20 weeks gestation) with pre-pregnancy BMI≥25 completed the Adult Eating Behavior Questionnaire (AEBQ) in early pregnancy (M weeks gestation=13.6±2.7). The AEBQ includes eight subscales (ratings range from 1–5), four of which describe “food approach” traits: Hunger, Food Responsiveness, Emotional Over-Eating, and Enjoyment of Food. The remaining four AEBQ subscales describe “food avoidance” traits: Satiety Responsiveness, Emotional Under-Eating, Food Fussiness, and Slowness in Eating. Correlation and linear regression analyses were used to evaluate each AEBQ subscale in relation to pre-pregnancy BMI and early GWG (difference between pre-pregnancy weight and weight gain to date during early pregnancy).
Results: During early pregnancy, participants reported the highest average score for Enjoyment of Food (4.31±0.67) and the lowest average score for Food Fussiness (2.22±0.97). The four food approach subscales were all significantly positively associated with one another, as were the four food avoidance subscales. Satiety Responsiveness, Food Fussiness, and Slowness in Eating were the only subscales significantly related to pre-pregnancy BMI (rho’s≥0.12, p’s≤.04). After adjusting for pre-pregnancy BMI and gestational age, only Food Responsiveness significantly related to early GWG (B=1.39, p=.04).
Conclusions: This is the first study to characterize appetitive traits using the AEBQ during pregnancy and document that Food Responsiveness, an appetitive trait linked to higher weight in non-pregnant adults, is associated with higher weight gain during early pregnancy. Further research is needed to understand changes in appetitive traits across pregnancy and their impact on end-of-pregnancy and birth outcomes.
Authors:
Presenter - Rachel Conlon, PhD, University of Pittsburgh School of Medicine
Co-Author - Luke Giannetta, MD, University Pittsburgh School of Medicine
Co-Author - Zijing Zhang, MS, Western Psychiatric Hospital, University of Pittsburgh Medical Center
Co-Author - Christine Call, PhD, University of Pittsburgh School of Medicine
Co-Author - Riley Jouppi, MS, University of Pittsburgh
Co-Author - Abigale Regal, BS, Western Psychiatric Hospital, University of Pittsburgh Medical Center
Co-Author - Shannon Donofry, PhD, RAND Corporation
Co-Author - Britny Hildebrandt, PhD, University of Pittsburgh School of Medicine
Co-Author - Marquis Hawkins, PhD, University of Pittsburgh
Co-Author - Michele Levine, PhD, University of Pittsburgh School of Medicine
Associations of sleep and meal timing with caloric intake and weight status in school-aged children
Poster Number: E159Time: 05:00 PM - 05:50 PM
Topics: Weight Related Health , Sleep
Background: Emerging research suggests that later meals and bedtimes may increase obesity risk, with some indication that later bedtimes affect such risk through delaying the timing of eating. However, few studies have explored how these behaviors, together, affect obesity risk in children. The current study investigated whether later bedtimes and meals are associated with increased energy intake and body mass index z-scores (BMIz) in school-aged children.
Methods: Eighty-six children (8-11 years, 67.4% female, BMIz: 0.86 ± 1.0) who presented for a study focused on enhancing children’s sleep duration were categorized into four sleep-meal timing behavior groups based on median splits of mean bedtimes and time of last meal (EBEM – early bedtime/early meal time (n=27); LBLM-late bedtime/late meal time (n=29); EBLM-early bedtime/late meal time (n=15); LBEM-late bedtime/early meal time (n=15). Mean bedtime and sleep duration were assessed using standard procedures for scoring wrist actigraphy over seven days. Dietary intake and time of last meal (time of last eating episode) were assessed using the mean of three 24-h dietary recalls. Pearson correlation and ANCOVA were used for statistical analyses.
Results: Mean bedtime was 10:31 PM (±58.03 min), with an average sleep duration of 521 minutes (±40 min), and a mean last meal time of 7:30 PM (±70.82 min). Later bedtimes were significantly correlated with later mealtimes (r = .49, p < .01). There were no significant differences in BMIz across sleep-meal timing groups (F (3,79) = 1.78, p = .16). However, controlling for sleep duration, significant differences were observed for mean caloric intake (F (3,80) = 6.08, p <.01). Children with EBEM were reported to consume 334 (± 120) fewer calories on average than those with EBLM (p = .04). Moreover, children with LBLM were reported to consume 394 (± 123) more calories than those with LBEM (p = .01).
Conclusion: These findings suggest that later meals and bedtimes are associated with increased caloric intake, which can place children at increased risk for excess weight gain over time. Future work should particularly consider late meal timing as a novel target for obesity prevention.
Keywords: Obesity, ChildrenMethods: Eighty-six children (8-11 years, 67.4% female, BMIz: 0.86 ± 1.0) who presented for a study focused on enhancing children’s sleep duration were categorized into four sleep-meal timing behavior groups based on median splits of mean bedtimes and time of last meal (EBEM – early bedtime/early meal time (n=27); LBLM-late bedtime/late meal time (n=29); EBLM-early bedtime/late meal time (n=15); LBEM-late bedtime/early meal time (n=15). Mean bedtime and sleep duration were assessed using standard procedures for scoring wrist actigraphy over seven days. Dietary intake and time of last meal (time of last eating episode) were assessed using the mean of three 24-h dietary recalls. Pearson correlation and ANCOVA were used for statistical analyses.
Results: Mean bedtime was 10:31 PM (±58.03 min), with an average sleep duration of 521 minutes (±40 min), and a mean last meal time of 7:30 PM (±70.82 min). Later bedtimes were significantly correlated with later mealtimes (r = .49, p < .01). There were no significant differences in BMIz across sleep-meal timing groups (F (3,79) = 1.78, p = .16). However, controlling for sleep duration, significant differences were observed for mean caloric intake (F (3,80) = 6.08, p <.01). Children with EBEM were reported to consume 334 (± 120) fewer calories on average than those with EBLM (p = .04). Moreover, children with LBLM were reported to consume 394 (± 123) more calories than those with LBEM (p = .01).
Conclusion: These findings suggest that later meals and bedtimes are associated with increased caloric intake, which can place children at increased risk for excess weight gain over time. Future work should particularly consider late meal timing as a novel target for obesity prevention.
Authors:
Co-Author - Nicola Hawley, PhD, Yale University
Co-Author - Hollie A. Raynor, PhD RD, University of Tennessee
Co-Author - Elissa Jelalian, PhD, Alpert Medical School of Brown University
Co-Author - Rena R. Wing, PhD, FSBM, Alpert Medical School of Brown University
Co-Author - Chantelle N. Hart, PhD, Temple University, College of Public Health
Supportive care intervention effects on patient-reported outcomes in patients undergoing hematopoietic stem cell transplantation: A systematic review and meta-analysis
Poster Number: E16Time: 05:00 PM - 05:50 PM
Topics: Cancer, Quality of Life
Background: Psychosocial interventions have been tested in patients with hematologic malignancies receiving hematopoietic stem cell transplantation (HSCT). Yet, no comprehensive synthesis of these trials exists. This systematic review and meta-analysis characterized randomized controlled trials (RCTs) of psychosocial interventions for adult HSCT recipients and examined intervention effects on patient-reported outcomes (PROs).
Methods: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and CENTRAL for RCTs of psychosocial interventions of adult HSCT recipients with psychosocial PRO measures. We used the Cochrane Risk of Bias 2.0 protocol, grouped findings by intervention and PRO types, and synthesized results narratively. Where sufficient data were available, we conducted exploratory random-effects meta-analyses to estimate pooled intervention effects on anxiety and depressive symptoms and quality of life (QOL).
Results: Fifty unique RCTs met criteria, including quasi-experimental, pilot, single-site, and multi-site RCTs published from 1992 to 2025 with a broad range of sample sizes (11-711), participant demographics (mean age 33-63; 22-64% female), and PRO measures. Interventions fit into eight categories: cognitive behavioral (n=3), exercise only (n=18), expressive helping (n=2), mind-body/stress management (n=7), multimodal (exercise plus another modality; n=6), music/art (n=12), palliative care (n=2), positive psychology (n=1), and self-management/self-efficacy (n=4). Most studies had moderate-to-high risk of bias, with at least “some concern” regarding missing outcome data (77%) and outcome measures (85%). Although synthesis was limited by heterogeneity of PRO measures and intervention characteristics, interventions were mostly feasible and acceptable with promising improvements in psychological distress, QOL, and physical functioning and symptoms. Meta-analysis of exercise interventions showed a potential trend toward improved QOL (MD=3.63; 95% CI: -0.56,7.83) but not anxiety or depressive symptoms. Music/art interventions showed potential for reducing acute depressive symptoms based on standardized mean differences (SMD=-0.26; 95% CI: -0.52,0).
Conclusion: Among patients undergoing HSCT for hematologic malignancies, psychosocial interventions show promise for improving PROs, including psychological distress and QOL, but larger, rigorously designed trials with standardized PRO measures are needed to establish efficacy.
Keywords: Intervention, CancerMethods: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and CENTRAL for RCTs of psychosocial interventions of adult HSCT recipients with psychosocial PRO measures. We used the Cochrane Risk of Bias 2.0 protocol, grouped findings by intervention and PRO types, and synthesized results narratively. Where sufficient data were available, we conducted exploratory random-effects meta-analyses to estimate pooled intervention effects on anxiety and depressive symptoms and quality of life (QOL).
Results: Fifty unique RCTs met criteria, including quasi-experimental, pilot, single-site, and multi-site RCTs published from 1992 to 2025 with a broad range of sample sizes (11-711), participant demographics (mean age 33-63; 22-64% female), and PRO measures. Interventions fit into eight categories: cognitive behavioral (n=3), exercise only (n=18), expressive helping (n=2), mind-body/stress management (n=7), multimodal (exercise plus another modality; n=6), music/art (n=12), palliative care (n=2), positive psychology (n=1), and self-management/self-efficacy (n=4). Most studies had moderate-to-high risk of bias, with at least “some concern” regarding missing outcome data (77%) and outcome measures (85%). Although synthesis was limited by heterogeneity of PRO measures and intervention characteristics, interventions were mostly feasible and acceptable with promising improvements in psychological distress, QOL, and physical functioning and symptoms. Meta-analysis of exercise interventions showed a potential trend toward improved QOL (MD=3.63; 95% CI: -0.56,7.83) but not anxiety or depressive symptoms. Music/art interventions showed potential for reducing acute depressive symptoms based on standardized mean differences (SMD=-0.26; 95% CI: -0.52,0).
Conclusion: Among patients undergoing HSCT for hematologic malignancies, psychosocial interventions show promise for improving PROs, including psychological distress and QOL, but larger, rigorously designed trials with standardized PRO measures are needed to establish efficacy.
Authors:
Presenter - Lisa Gudenkauf, PhD, MPH, Brigham and Women's Hospital
Author - Daniel Schaefer, MD, Dana-Farber Cancer Institute
Co-Author - Emma Keane, BA, Brigham and Women's Hospital
Co-Author - M. Tim Song, BA, Brigham and Women’s Hospital
Co-Author - Isabella Larizza, BS, Brigham and Women's Hospital
Co-Author - Fabian Adri, Brigham and Women's Hospital
Co-Author - Josephine Monahan, BA, Brigham and Women's Hospital
Co-Author - Alexandria Cronin, MLIS, Countway Medical Library
Co-Author - Michael Stoto, PhD, Harvard T.H. Chan School of Public Health
Co-Author - Hermioni Amonoo, MD, MPP, MPH, Brigham and Women's Hospital
Prevalence and Correlates of Perceived Weight Discrimination in Older Adult Women: A Women’s Health Initiative Study
Poster Number: E160Time: 05:00 PM - 05:50 PM
Topics: Weight Related Health , Aging
Aim: Perceived weight discrimination (PWD) is associated with adverse health outcomes such as weight gain and poor lifestyle health behaviors. PWD persists into middle-to-late adulthood (i.e., >50 years), but whether PWD is a concern in older populations (e.g., >70 years) is unknown. We aimed to describe the prevalence and correlates of PWD in older adult women.
Method: This cross-sectional analysis included participants in the Women’s Health Initiative (WHI) Extension Study 2. PWD, other everyday discrimination (e.g., based on race, age, etc.), and lifestyle health behaviors (i.e., physical activity, alcohol use, tobacco use) were self-reported. Body mass index (BMI) was calculated from measured height and weight. The most recent assessment of all variables was used. Associations of PWD with BMI category and lifestyle health behaviors were examined descriptively then analyzed with Firth’s logistic regression, which reduces bias due to rare events. The reported model is adjusted for sociodemographic factors.
Results: Participants (N=32,172) were 84.1±5.1 years old and 88% non-Hispanic White. PWD prevalence was low (0.67%, n=213). Descriptively, participants reporting PWD were younger (Mage=81.2±4.7 years) and more often had low household income (47.9% <$49,999) than those not reporting PWD (Mage=84.1±5.1 years, 40.3% <$49,999). Nearly all participants reporting PWD reported another form of discrimination (93%). Most participants reporting PWD had obesity (69.4%), engaged in any physical activity (65.7%), and did not smoke (91.1%) or drink alcohol (52.1%). Across BMI categories, PWD was most frequently reported in obesity (1.5%, n=148), followed by underweight (1.0%, n=2), overweight (0.4%, n=41), and normal weight (0.2%, n=22). In the adjusted model, underweight (OR=6.0, 95% CI=1.6-22.2), overweight (OR=2.0, 95% CI=1.2-3.3), and obesity (OR=6.9, 95% CI=4.4-10.8) were all associated with greater odds of PWD vs. normal BMI. Physical activity (any vs. none) was associated with lower odds of PWD (OR=0.7, 95% CI=0.52-0.97). Alcohol use and smoking were not associated with PWD.
Conclusions: Although the prevalence of PWD in older adult women in the WHI was low, unique patterns emerged. PWD in older adulthood may overlap significantly with other forms of discrimination and may be more strongly associated with underweight status than in younger groups. These findings are limited due to the small sample size of PWD and should be confirmed in future studies.
Keywords: Obesity, Older adultsMethod: This cross-sectional analysis included participants in the Women’s Health Initiative (WHI) Extension Study 2. PWD, other everyday discrimination (e.g., based on race, age, etc.), and lifestyle health behaviors (i.e., physical activity, alcohol use, tobacco use) were self-reported. Body mass index (BMI) was calculated from measured height and weight. The most recent assessment of all variables was used. Associations of PWD with BMI category and lifestyle health behaviors were examined descriptively then analyzed with Firth’s logistic regression, which reduces bias due to rare events. The reported model is adjusted for sociodemographic factors.
Results: Participants (N=32,172) were 84.1±5.1 years old and 88% non-Hispanic White. PWD prevalence was low (0.67%, n=213). Descriptively, participants reporting PWD were younger (Mage=81.2±4.7 years) and more often had low household income (47.9% <$49,999) than those not reporting PWD (Mage=84.1±5.1 years, 40.3% <$49,999). Nearly all participants reporting PWD reported another form of discrimination (93%). Most participants reporting PWD had obesity (69.4%), engaged in any physical activity (65.7%), and did not smoke (91.1%) or drink alcohol (52.1%). Across BMI categories, PWD was most frequently reported in obesity (1.5%, n=148), followed by underweight (1.0%, n=2), overweight (0.4%, n=41), and normal weight (0.2%, n=22). In the adjusted model, underweight (OR=6.0, 95% CI=1.6-22.2), overweight (OR=2.0, 95% CI=1.2-3.3), and obesity (OR=6.9, 95% CI=4.4-10.8) were all associated with greater odds of PWD vs. normal BMI. Physical activity (any vs. none) was associated with lower odds of PWD (OR=0.7, 95% CI=0.52-0.97). Alcohol use and smoking were not associated with PWD.
Conclusions: Although the prevalence of PWD in older adult women in the WHI was low, unique patterns emerged. PWD in older adulthood may overlap significantly with other forms of discrimination and may be more strongly associated with underweight status than in younger groups. These findings are limited due to the small sample size of PWD and should be confirmed in future studies.
Authors:
Presenter - Natalie Keirns, PhD, Ball State University
Co-Author - Nimish Valvi, MPH, DrPH, Ball State University
Co-Author - Madison Stout, PhD, University of Evansville
Co-Author - Bryant Keirns, PhD, Ball State University
Co-Author - Elena Salmoirago-Blotcher, MD, PhD, FSBM, Cardiovascular Institute, The Miriam Hospital
Co-Author - Patrick Montine, MPH, PhD, University of California, Davis
Co-Author - Julie Weitlauf, PhD, Stanford University
Co-Author - Lesley Tinker, PhD, RD, Fred Hutch Cancer Center
Do Teens Want Parents Involved in Their Weight Management Treatment? A Qualitative Examination
Poster Number: E161Time: 05:00 PM - 05:50 PM
Topics: Weight Related Health , Child and Family Health
As overweight/obesity in youth has been associated with health risks including cardiovascular disease, the need to develop acceptable and effective weight management (WM) interventions for this group is pronounced. The literature surrounding parental involvement in adolescent WM programs is mixed and lacks qualitative approaches to understand teens’ perspectives on parental involvement in their WM treatment. The present study analyzes qualitative interview responses from teens who recently underwent a teen-only group WM program. Adolescent (ages 14-19, BMI ≥ 85th percentile) females completed feedback interviews following completion of a group acceptance-based WM program or a psychoeducational WM program in a randomized trial. Participants (n = 24, 62.5% Black or African American, 12.5% Asian, 20.8% White, 4.2% more than one race) responded to the following question: “We chose not to involve parents or other support people [in this program]. How do you feel about that? Would you make any changes?” Responses were analyzed through inductive thematic analysis. Following Braun and Clarke’s six-phase framework for thematic analyses, three themes emerged from participants’ responses: 1) Not involving parents ensures the highest possible comfort in the group space; 2) Without parental presence, teens are more invested in the program; and 3) Future programs could have a method for including parents in a limited capacity. Notably, almost all participants (95.8%) reported that they would not change the design of the WM program and enjoyed that their parents were uninvolved. One teen (i.e., 4.2%) mentioned that not involving parents was a good decision, but she thought including parents in the program should be optional. Overall, teens discussed how a teen-only group space facilitated honesty and vulnerability and promoted engagement in the program. Teens also outlined ideas for minimizing involvement of parents in WM programs (e.g., WM programs could provide descriptions of their content to ease parents’ concerns). Findings from this study are consistent with results from a past study exploring what teens would hope to see in a WM program, where teens also suggested that parents should have limited involvement. Future research must continue to examine the effectiveness of WM interventions by comparing weight loss outcomes with and without parents present, especially among groups of diverse teens.
Keywords: Children's health, Weight controlAuthors:
Author - Isabella Pruscino, BA, Nemours Children's Health
Co-Author - Ross Sonnenblick, M.S., Drexel University
Co-Author - Jannah Moussaoui, BS, Washington University in St. Louis
Co-Author - Stephanie Manasse, PhD, Nemours Children's Health
Reducing Dietary Variety During a Family-Based Obesity Treatment Intervention (Families Becoming Healthy Together): A Randomized Clinical Trial
Poster Number: E162Time: 05:00 PM - 05:50 PM
Topics: Weight Related Health , Diet, Nutrition, and Eating Disorders
Reducing long-term intake of energy-dense, low-nutrient-dense foods (e.g., cookies, chips) is an area in which better strategies are needed to help children with overweight and obesity. Decreasing the number of different types (variety) of these foods eaten may help reduce long-term intake of these foods and overall energy intake. This trial tested if additional goals to limit variety of energy-dense foods enhanced decreases in energy intake and improved body mass index (BMI) in children receiving an 18-month, family-based childhood obesity treatment. Children aged 8-12 y, ≥ 85th BMI%ile, with one adult caregiver with a BMI ≥ 25 kg/m2, were randomized to one of two 18-month interventions: standard family-based obesity treatment, with daily goals for energy intake and RED food (energy-dense, low-nutrient-dense) servings (FBT); or FBT combined with goals to limit variety of RED foods (identify 2 RED foods, an entrée and a snack food, and regularly eat these foods and limit other RED food intake). Measures of diet, via 3, 24-hr dietary recalls supported by pre- and post-intake photos, and anthropometrics were taken at 0, 6, 12, and 18 months. This trial occurred from 2019-2025, and due to the COVID-19 pandemic, assessments and intervention transitioned from being in person to remote. Eighty-three families (child: 10.8±1.5 y; 29.1±5.2 kg/m2; 51.8% female; 72.3% White; 92.8% non-Hispanic) were randomized. Children significantly reduced energy intake (-100±846 kcal/d) and number of different RED foods (-2.4±4.9/3d) consumed from 0-6 months, with energy intake significantly increasing from 6-12 months (99±952 kcal/d). There was no significant change in child BMI from 0-6 months (-0.3±1.6 kg/m2), with a corresponding significant reduction in standardized BMI (ZBMI [-0.11±0.19]) when intervention was >1 contact/mos. BMI significantly increased from 6-12 months (0.9±1.6 kg/m2), and significantly increased again from 12-18 months (0.6±1.7 kg/m2), as intervention contact decreased to monthly, and bimonthly contact, respectively. No effect of randomization was found on child dietary intake or BMI. Reducing RED food variety was achieved, but goals for decreasing variety did not enhance this reduction or further reduce energy intake. Child BMI was maintained, with a corresponding decrease in ZBMI, when intervention was > 1 contact/mos, but increased as intervention contact decreased, during a time frame when child weight gain was occurring in the US (COVID-19 pandemic).
Keywords: Obesity, DietAuthors:
Author - Hollie Raynor, PhD, RD, LDN, University of Tennessee
Co-Author - Kristoffer Berlin, PhD, University of Memphis
Co-Author - Chelsi Cardoso, MS, RD, University of Tennessee, Knoxville
Co-Author - Scott Crouter, PhD, University of Tennessee
Co-Author - Leonard Epstein, PhD, FSBM, University At Buffalo
Co-Author - J. Graham Thomas, PhD, Brown University School of Medicine & The Miriam Hospital
HbA1c Links BMI to Brain Structure and Cognition Beyond Age-Related Changes
Poster Number: E163Time: 05:00 PM - 05:50 PM
Topics: Weight Related Health
Background: Obesity is associated with structural brain changes, particularly in regions supporting executive function (EF), and may contribute to accelerated cognitive aging. Likewise, poor glycemic control, common in individuals with obesity, is associated with brain atrophy. Given overlapping neural consequences, glycemic dysregulation may partially mediate the impact of obesity on structural brain changes and cognition, implicated in age-related cognitive decline.
Methods: Ninety-three adults aged 22-74, recruited for bariatric surgery (mean ± SD; age = 44.6 ± 12.2 years; BMI = 46.0 ± 8.0 kg/m²; 68.8% White; 79.6% female), completed fasting blood draws and MRI scans. Regression analyses examined associations between BMI, HbA1c, brain-wide gray matter volume, cortical thickness in the frontal cortex associated with EF, EF (i.e., balanced integration scores for Trails B and Stroop) and covariates (age, sex, education). Causal mediation analyses using nonparametric bootstrapping (1,000 simulations) tested whether HbA1c mediated the effect of BMI on gray matter, cortical volume and EF.
Results: Older age was associated with reductions in both brain-wide gray matter volume (r = -0.57, p<.001) and EF-related cortical thickness (r = -0.30, p<.001). Higher BMI was significantly associated with elevated HbA1c levels (β=0.22, p=.0385). HbA1c was negatively associated with EF-related cortical thickness (β=-0.31, p=.0027) and at trend-level reduced gray matter volume (β=-0.19, p=.055). Mediation analyses showed significant indirect effects of BMI via HbA1c on reduced gray matter volume (ACME= -0.04, p=.020) and EF-related cortical thickness (ACME=-0.07, p=.014), despite nonsignificant total effects. For Trails B, BMI had a significant direct effect on performance (ADE=0.25, p=.024), yet non-significant mediation with HbA1c (all ps>.05). BMI and HbA1c were both not significantly associated with Stroop performance (all p>.05).
Conclusion: Findings suggest that glycemic control may act as a potential mechanism through which obesity impacts cognitive function in a sample of bariatric surgery candidates, highlighting the need for interventions addressing both weight reduction and glycemic regulation to mitigate cardiometabolic risk and support long-term brain health. Future studies should include health controls and consider premorbid cognitive ability or duration of metabolic dysfunction to clarify how obesity and glycemic dysregulation impact brain aging.
Keywords: Obesity, Cognitive factorsMethods: Ninety-three adults aged 22-74, recruited for bariatric surgery (mean ± SD; age = 44.6 ± 12.2 years; BMI = 46.0 ± 8.0 kg/m²; 68.8% White; 79.6% female), completed fasting blood draws and MRI scans. Regression analyses examined associations between BMI, HbA1c, brain-wide gray matter volume, cortical thickness in the frontal cortex associated with EF, EF (i.e., balanced integration scores for Trails B and Stroop) and covariates (age, sex, education). Causal mediation analyses using nonparametric bootstrapping (1,000 simulations) tested whether HbA1c mediated the effect of BMI on gray matter, cortical volume and EF.
Results: Older age was associated with reductions in both brain-wide gray matter volume (r = -0.57, p<.001) and EF-related cortical thickness (r = -0.30, p<.001). Higher BMI was significantly associated with elevated HbA1c levels (β=0.22, p=.0385). HbA1c was negatively associated with EF-related cortical thickness (β=-0.31, p=.0027) and at trend-level reduced gray matter volume (β=-0.19, p=.055). Mediation analyses showed significant indirect effects of BMI via HbA1c on reduced gray matter volume (ACME= -0.04, p=.020) and EF-related cortical thickness (ACME=-0.07, p=.014), despite nonsignificant total effects. For Trails B, BMI had a significant direct effect on performance (ADE=0.25, p=.024), yet non-significant mediation with HbA1c (all ps>.05). BMI and HbA1c were both not significantly associated with Stroop performance (all p>.05).
Conclusion: Findings suggest that glycemic control may act as a potential mechanism through which obesity impacts cognitive function in a sample of bariatric surgery candidates, highlighting the need for interventions addressing both weight reduction and glycemic regulation to mitigate cardiometabolic risk and support long-term brain health. Future studies should include health controls and consider premorbid cognitive ability or duration of metabolic dysfunction to clarify how obesity and glycemic dysregulation impact brain aging.
Authors:
Author - Kate Worwag, MS, University of Florida
Co-Author - Tyler Busch, BS, University of Florida
Co-Author - Hannah Hoogerwoerd, BA, University of Florida
Co-Author - Joshua Juhasz, University of Florida
Co-Author - Ron Cohen, PhD, University of Florida
Co-Author - Eric Porges, PhD, University of Florida
Co-Author - Aprinda Queen, PhD, University of Florida
Predicting daily sleep outcomes from continuous HRV in female chronic pelvic pain disorders
Poster Number: E164Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Pain
Background
Female chronic pelvic pain disorders (CPPDs) negatively affect sleep in 72% of patients and are linked to autonomic nervous system (ANS) dysregulation. Heart rate variability (HRV), a marker of ANS function, is associated with sleep quality and offers an objective and reliable alternative to self-reported measures. Wearable devices enable continuous HRV monitoring, providing a scalable approach for assessing sleep health in this population.
Objective
This study examined whether daily HRV metrics could predict self-reported sleep quality among individuals with CPPDs compared to healthy controls.
Methods
A retrospective observational study was conducted using 90 days of data from a mobile health (mHealth) research App. The sample included 128 women with CPPDs and 62 demographically matched controls. Participants used the App to track daily sleep outcomes and disease symptoms, and wore Fitbits to collect continuous HRV data. The sleep periods were determined by FitBit, which estimates using a combination of movement and heart rate patterns [1]. The outcome was a composite sleep score (CSS) based on the PROMIS 3-item sleep quality questionnaire. The primary predictors were HRV metrics (high frequency; HF, low frequency; LF, root mean square of successive differences; RMSSD) and group (CPPD vs control). Covariates included daily pain and menstrual cycle status. In 3 separate models, we regressed CSS on each HRV metric as a smooth function using generalized additive regression, including its interaction with group, and covariates.
Results
There was a significant interaction of HRV with group where, increases in HF, LF, RMSSD were associated with worsened daily sleep scores for those with CPPD (vs controls), independent of covariates (B=-1.59 t=-8.103 for HF; B=-2.23e-04, t=-13.05 for LF; B=-0.56, t=-8.352, for RMSSD, p<0.0001 for all). The smooth terms of HRV were statistically significant, suggesting improved predictive estimates.
Discussion
Findings support the use of HRV as an objective physiological indicator of sleep quality in individuals with chronic pelvic pain. The integration of wearable HRV data with daily symptom tracking may offer a scalable and low-burden method for advancing behavioral sleep research in this population. These digital health tools have the potential to reduce diagnostic delays and support personalized care strategies. This can improve personalized health monitoring efforts and care for CPPDs.
Keywords: Pain, Abnormal sleepFemale chronic pelvic pain disorders (CPPDs) negatively affect sleep in 72% of patients and are linked to autonomic nervous system (ANS) dysregulation. Heart rate variability (HRV), a marker of ANS function, is associated with sleep quality and offers an objective and reliable alternative to self-reported measures. Wearable devices enable continuous HRV monitoring, providing a scalable approach for assessing sleep health in this population.
Objective
This study examined whether daily HRV metrics could predict self-reported sleep quality among individuals with CPPDs compared to healthy controls.
Methods
A retrospective observational study was conducted using 90 days of data from a mobile health (mHealth) research App. The sample included 128 women with CPPDs and 62 demographically matched controls. Participants used the App to track daily sleep outcomes and disease symptoms, and wore Fitbits to collect continuous HRV data. The sleep periods were determined by FitBit, which estimates using a combination of movement and heart rate patterns [1]. The outcome was a composite sleep score (CSS) based on the PROMIS 3-item sleep quality questionnaire. The primary predictors were HRV metrics (high frequency; HF, low frequency; LF, root mean square of successive differences; RMSSD) and group (CPPD vs control). Covariates included daily pain and menstrual cycle status. In 3 separate models, we regressed CSS on each HRV metric as a smooth function using generalized additive regression, including its interaction with group, and covariates.
Results
There was a significant interaction of HRV with group where, increases in HF, LF, RMSSD were associated with worsened daily sleep scores for those with CPPD (vs controls), independent of covariates (B=-1.59 t=-8.103 for HF; B=-2.23e-04, t=-13.05 for LF; B=-0.56, t=-8.352, for RMSSD, p<0.0001 for all). The smooth terms of HRV were statistically significant, suggesting improved predictive estimates.
Discussion
Findings support the use of HRV as an objective physiological indicator of sleep quality in individuals with chronic pelvic pain. The integration of wearable HRV data with daily symptom tracking may offer a scalable and low-burden method for advancing behavioral sleep research in this population. These digital health tools have the potential to reduce diagnostic delays and support personalized care strategies. This can improve personalized health monitoring efforts and care for CPPDs.
Authors:
Author - Rhyann Clarke, BS, Icahn School of Medicine at Mount Sinai
Co-Author - Samia Shahnawaz, MPH, Icahn School of Medicine at Mount Sinai
Co-Author - Jovita Rodrigues, MS, CCRC, Icahn School of Medicine at Mount Sinai
Co-Author - Kyle Landell, BS, Icahn School of Medicine at Mount Sinai
Co-Author - Matteo Danieletto, PhD, Icahn School of Medicine at Mount Sinai
Co-Author - Robert Hirten, MD, Icahn School of Medicine at Mount Sinai
Co-Author - Ipek Ensari, PhD, Icahn School of Medicine at Mount Sinai
Understanding Racial and Ethnic Minority Women's Experiences with Group Prenatal Care
Poster Number: E165Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Health Disparities
Background: Innovative strategies are needed to improve perinatal care for racial and ethnic minority women. Group Prenatal Care (Group PNC), a patient-centered model where women of similar gestational age receive care in a group setting, has shown promise in enhancing the birthing experience by fostering social support, trust, and reducing power hierarchies through engaged health assessments and interactive learning. This mixed-methods systematic review explores minority women’s perspectives, experiences, and health outcomes associated with Group PNC to document benefits of participation and inform strategies for expanding access.
Methods: A comprehensive search of PubMed, CINAHL Complete, APA PsycInfo, Web of Science, and ProQuest identified U.S.-based studies on Group PNC focused on racial/ethnic minority populations or with outcomes disaggregated by race/ethnicity. Using Covidence, two researchers independently screened 6,173 abstracts, reviewed 287 full texts, and extracted data from 51 eligible studies. Discrepancies were resolved through discussion or third-party adjudication. Extracted data included study design, intervention details, demographics, and outcomes specific to minority participants.
Results: Of the 51 studies, only 2 found no significant differences in outcomes for minority populations. The rest reported improved outcomes with Group PNC, including reduced rates of preterm birth, low birthweight, and NICU admissions, along with better nutritional adherence and prenatal visit attendance. Across 5 studies, 80-100% of Black and Hispanic women indicated they would participate in group care again and/or recommend it to a friend. Culturally adapted, community-based Group PNC models received highly positive feedback, with participants citing benefits such as stress reduction, goal setting, and stronger social ties. However, 3 studies noted Black women were less likely than White and Hispanic women to choose Group PNC over individual care, indicating a need to explore perceived barriers to participation. Additional data on outcomes and study quality will be presented.
Discussion: These results will be used to advocate for the scale-up of Group PNC to improve birthing experiences for minority communities and reduce health disparities. Findings will inform future community-engaged projects aimed at improving access to Group PNC across racial and ethnic minority communities, with the goal of enhancing health behaviors and clinical outcomes.
Keywords: Pregnancy, Minority groupsMethods: A comprehensive search of PubMed, CINAHL Complete, APA PsycInfo, Web of Science, and ProQuest identified U.S.-based studies on Group PNC focused on racial/ethnic minority populations or with outcomes disaggregated by race/ethnicity. Using Covidence, two researchers independently screened 6,173 abstracts, reviewed 287 full texts, and extracted data from 51 eligible studies. Discrepancies were resolved through discussion or third-party adjudication. Extracted data included study design, intervention details, demographics, and outcomes specific to minority participants.
Results: Of the 51 studies, only 2 found no significant differences in outcomes for minority populations. The rest reported improved outcomes with Group PNC, including reduced rates of preterm birth, low birthweight, and NICU admissions, along with better nutritional adherence and prenatal visit attendance. Across 5 studies, 80-100% of Black and Hispanic women indicated they would participate in group care again and/or recommend it to a friend. Culturally adapted, community-based Group PNC models received highly positive feedback, with participants citing benefits such as stress reduction, goal setting, and stronger social ties. However, 3 studies noted Black women were less likely than White and Hispanic women to choose Group PNC over individual care, indicating a need to explore perceived barriers to participation. Additional data on outcomes and study quality will be presented.
Discussion: These results will be used to advocate for the scale-up of Group PNC to improve birthing experiences for minority communities and reduce health disparities. Findings will inform future community-engaged projects aimed at improving access to Group PNC across racial and ethnic minority communities, with the goal of enhancing health behaviors and clinical outcomes.
Authors:
Presenter - Allissa Desloge, PhD, University of North Carolina at Charlotte
Co-Author - Alydia Monahan, University of North Carolina at Charlotte
Co-Author - Brianna Gardner, University of North Carolina at Charlotte
Co-Author - Hasina Ndeketa, University of North Carolina at Charlotte
Co-Author - Navjot Khinda, University of North Carolina at Charlotte
Co-Author - Ryan Harris, MLIS, University of North Carolina at Charlotte
Co-Author - Lorenzo Hopper, PhD, University of North Carolina at Charlotte
Exploring the immediate impact of microaggression experience on affective states and stress coping in Black women using ecological momentary assessment
Poster Number: E166Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Health Disparities
Introduction: There is growing recognition that lived personal experience of racial discrimination increases risks of chronic diseases. One plausible mechanism underlying this link could be increased psychological stress. Most previous studies have focused on the cumulative effects of lifetime exposures to racial discrimination. Using ecological momentary assessment (EMA), this study aims to examine daily experiences of microaggressions among Black women and their immediate impact on affective states and perceived ability in stress coping. Methods: This pilot study included data from 40 Black women (18-50 years old) over a 10-day monitoring period. Four EMA surveys were prompted at random intervals during waking hours through a smartphone app. Each EMA survey included questions assessing current affective states (positive affect [3 items], negative affect [4 items], and fatigue [3 items]) and stress coping (i.e., outcomes), as well as experience of microaggression since the last prompt using 7 randomized items from the Gender Racial Microaggressions Scale and Racial Microaggressions Scale. Frequency of microaggression experiences (i.e., total number of endorsed items) and level of stress from each endorsed item were calculated at each EMA prompt level (i.e., predictors). Mixed-effects linear regression models and mixed-effects location-scale linear regression models were used to estimate the effects of predictors on subject-level means and within-subject variance of the outcomes. Results: At the prompt level, the average microaggression frequency was 0.5 (ranged 0-3.6) and stress from microaggression was 0.75 (ranged 0-4). More frequent microaggression than one’s usual experience was associated with greater fatigue (β coef=0.03, p=.03), less ability to manage stress (β coef=-0.13, p<.01), and greater variability in negative affect (tau coef=0.19, p<.01). Greater stress from microaggression than one’s usual level was associated with greater negative affect (β coef= 0.11, p=<.01). No other significant associations were found at the within-subject level. Conclusion: This study used EMA to assess microaggression experiences and responses in real-time with a novel modeling approach. Results suggest that daily experiences of microaggression have an immediate impact on Black women’s negative affect and their perceived ability to manage stress in the moment, highlighting the opportunity for future just-in-time interventions to assist with stress coping strategies.
Keywords: Social stress, Minority healthAuthors:
Presenter - Yue Liao, MPH, PhD, CPH, University of Texas at Arlington
Co-Author - Anita On, University of Texas at Arlington
Co-Author - Wei-Lin Wang, PhD, University of Southern California
Co-Author - Chih-Hsiang Yang, University of South Carolina
Co-Author - Najmeh Ghalamsiah, University of Texas at Arlington
Co-Author - John Kolade, University of Texas at Arlington
Co-Author - Mahira Titly, University of Texas at Arlington
Co-Author - Keng-Yu Chang, University of Texas at Arlington
Co-Author - Salene Jones, PhD, MA, Fred Hutchinson Cancer Center
Co-Author - Kyrah Brown, PhD, University of Texas at Arlington
Co-Author - R. Matthew Brothers, University of Texas at Arlington
Sexual Negotiation and Mental Health: A Study of Perinatal Women in Mozambique
Poster Number: E167Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Mental Health
Few studies have explored the impact of sexual negotiation on autonomy and mental health, particularly among women in Southeast Africa. Using the 2022-2023 Mozambique Demographic and Health Survey (DHS), this study aimed to examine the differential associations between sex negotiation and reported depression and anxiety symptoms using the PHQ-9 and GAD-7, respectively, between female respondents in Mozambique aged 15-49 who had given birth and experienced an obstetric fistula and those who had given birth without experiencing fistula.
Participants meeting inclusion criteria were matched 1:1 using Propensity Score Matching (PSM), allowing for a more robust analysis by balancing characteristics between the two groups. The probability of ever having a fistula (the propensity score) was estimated using the propensity score function in SPSS, which employed a logistic regression model that used age, education, religious membership, marital status, type of residence, and wealth index as covariates. Matching was conducted with a maximum propensity score difference of 0.1 within each pair. PSM matched 37 participants with obstetric fistula history with 37 participants with no obstetric fistula history by the time of the survey (N = 74).
T-tests revealed no significant group differences in reported depression and anxiety were found, but anxiety scores were higher among female respondents with a history of obstetric fistula. Moderation analyses using general linear models were also performed. Fistula status did not moderate the relation between sexual negotiation and depression or anxiety scores. Notably, individual test results for the estimated marginal means (EMM) of sexual negotiation revealed significantly higher depression scores for those who endorsed being able to negotiate for sex compared to individuals who did not have the ability to negotiate for sex. EMM comparing anxiety scores between the two groups did not find significant differences.
This was one of the first studies using DHS data to examine the differential associations between sexual negotiation and mental health among women in Mozambique who have given birth. Gaining a deeper understanding of the psychological factors that influence health and wellness, alongside physical and social factors, will help highlight the critical role of mental health in assessing perinatal health outcomes among healthcare providers and community members.
Keywords: Women's health, Sexual behaviorParticipants meeting inclusion criteria were matched 1:1 using Propensity Score Matching (PSM), allowing for a more robust analysis by balancing characteristics between the two groups. The probability of ever having a fistula (the propensity score) was estimated using the propensity score function in SPSS, which employed a logistic regression model that used age, education, religious membership, marital status, type of residence, and wealth index as covariates. Matching was conducted with a maximum propensity score difference of 0.1 within each pair. PSM matched 37 participants with obstetric fistula history with 37 participants with no obstetric fistula history by the time of the survey (N = 74).
T-tests revealed no significant group differences in reported depression and anxiety were found, but anxiety scores were higher among female respondents with a history of obstetric fistula. Moderation analyses using general linear models were also performed. Fistula status did not moderate the relation between sexual negotiation and depression or anxiety scores. Notably, individual test results for the estimated marginal means (EMM) of sexual negotiation revealed significantly higher depression scores for those who endorsed being able to negotiate for sex compared to individuals who did not have the ability to negotiate for sex. EMM comparing anxiety scores between the two groups did not find significant differences.
This was one of the first studies using DHS data to examine the differential associations between sexual negotiation and mental health among women in Mozambique who have given birth. Gaining a deeper understanding of the psychological factors that influence health and wellness, alongside physical and social factors, will help highlight the critical role of mental health in assessing perinatal health outcomes among healthcare providers and community members.
Authors:
Author - Lukonde Mulenga, MPH, The Graduate Center, City University of New York (CUNY)
Co-Author - Adriana Espinosa, PhD, City College of New York & The Graduate Center, City University of New York (CUNY)
Co-Author - Adeyinka Akinsulure-Smith, PhD, City College of New York
Co-Author - Laura Reigada, PhD, City University of New York at Brooklyn College
Examining the Preliminary Impact of Light Therapy on Gestational Weight Gain
Poster Number: E168Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Weight Related Health
Background: Poor prenatal sleep behaviors can elevate adverse health risks such as excessive gestational weight gain (GWG). There is an important need for non-pharmacological interventions that promote healthy behaviors such as good sleep hygiene and exposure to more circadian-effective daytime light (>350 lux) to improve GWG and other prenatal outcomes. Limited research, however, has directly examined the impact of light therapy on GWG. The purpose of this study was to examine the initial impact of a behavioral intervention incorporating light therapy on GWG. Methods: Pregnant women (N=8, M age=31.9 years; M BMI= 22.0; 30% non-white) participated in a 35–39-day pilot intervention study. They wore green light glasses each morning for 60 minutes within 2 hours of waking and participated in a weekly 60-min education session targeting sleep hygiene, and other healthy behaviors (physical activity, energy intake), and importance of managing GWG. Each day, women weighed themselves (Wi-Fit weight scale) and wore the light glasses and a Daysimeter (a monitor that measures light exposure). Descriptive statistics and Pearson correlations were used to describe and examine the relationship between light exposure and GWG. Results: From pre- to post-intervention, women gained an average of 0.20 lb. (SD=1.41). At pre-intervention, 25% (2/8) of women had GWG above the IOM recommendations and low circadian-effective light exposure values. At post-intervention, 62.5% (5/8) of the participants with high circadian-effective light exposure values (range: 0.3 to 0.5; increased light exposure) had lower GWG values (range: -0.2 to 0.5); all 5 participants (100%) were within the IOM GWG recommendations. Among the remaining 37.5% (3/8) with lower circadian-effective light exposure values (range: 0.3 to 0.4), all exceeded GWG guidelines (range 1.2 to 3.1). Although not significant (p’s>.05), pre and post morning circadian-effective light exposures had a positive association with post GWG (r’s= pre-light/post-GWG=-.05, post-light/post-GWG=-.06). Conclusions: These preliminary findings illustrate that a prenatal behavioral intervention incorporating light therapy has the potential to impact and possibly regulate GWG within guidelines. Future research is needed to test efficacy of this approach over the entire course of the pregnancy to confirm these effects.
Keywords: Weight control, TechnologyAuthors:
Author - Danielle Downs, PhD, The Pennsylvania State University
Co-Author - Abigail Pauley, PhD, The Pennsylvania State University
Co-Author - Jamie Whitney, MS, The Pennsylvania State University
Co-Author - Victoria Suhy, MS, The Pennsylvania State University
Co-Author - Allen Kunselman, MA, Pennsylvania State University - College of Medicine
Co-Author - Dahlia Mukherjee, PhD, Pennsylvania State University - College of Medicine
Co-Author - Jennifer S. Savage, PhD, The Pennsylvania State University
Co-Author - Daniel Rivera, PhD, FSBM, Arizona State University
Co-Author - Mariana Figueiro, PhD, Icahn School of Medicine at Mount Sinai
Do Psychological Factors Predict Prenatal Meal-Delivery Intervention Engagement?
Poster Number: E169Time: 05:00 PM - 05:50 PM
Topics: Women's Health, Diet, Nutrition, and Eating Disorders
Background: Psychological factors, such as perceived social support, self-efficacy, and stress, are highly influential in individuals’ responses to behavioral weight management interventions. These constructs also impact pregnant women’s behavioral health changes as they work towards medically recommended gestational weight gain (GWG). However, the role these factors may have on pregnant women’s participation and engagement in a weight management intervention remains unknown. Therefore, this study aimed to determine if pregnant women’s perceived social support, self-efficacy, and stress are predictive of engagement in the meal delivery intervention. Methods: Her Home is a weekly meal delivery intervention, focused on preventing excessive GWG in pregnant women residing in central Alabama. A total of 35 pregnant women were enrolled in the Her Home pilot study. This secondary analysis study examined pregnant women's perceived social support, self-efficacy, and stress reported at baseline in relation to meal-delivery treatment adherence. Social support was measured using the Multidimensional Scale of Perceived Social Support, while self-efficacy was measured using a subscale of the Canadian Electronic Maternal (EMat) health survey. The Perceived Stress Scale-10 was used to measure perceived stress. Treatment adherence was measured by calculating the reported proportion of meals consumed compared to the total number of meals received throughout the treatment. Results: The pregnant women in this study predominantly identified as Black or African American (45.7%) and White (45.7%). On average, the participants were 31 years old (SD=5.42) and nearly 60% had an annual household income of > $59,999. Our findings indicated that social support did not predict women’s treatment adherence [F (1,27) = .152, p=.699, R2=.006]. Similarly, self-efficacy did not predict women’s treatment adherence [F (1,27) = 2.499, p=.126, R2=.085]. While nearly significant, perceived stress did not predict women’s treatment adherence [F (1, 27) = 3.014, p=.094, R2=.100]. Discussion: Despite previous studies suggesting a relationship between psychological factors and engagement in weight management interventions, the findings from this study were not statistically significant. To our knowledge, this is the first study focusing on the role of psychological factors in a meal delivery intervention, and it would benefit from further examination.
Keywords: Health behavior change, Women's healthAuthors:
Author - Demetria Pizano, MA, University of Alabama in Birmingham
Co-Author - Alanis Stansberry, University of Alabama at Birmingham
Chair - Gareth Dutton, PhD, FSBM, University of Alabama at Birmingham
Chair - Camille Schneider-Worthington, PhD, RDN, The University of Alabama at Birmingham
From Knowledge to Coping: Understanding Cancer-Related Cognitive Impairment in Latina Breast Cancer Survivors
Poster Number: E17Time: 05:00 PM - 05:50 PM
Topics: Cancer, Quality of Life
Introduction: About 75% of breast cancer patients experience cancer-related cognitive impairment (CRCI). These cognitive changes can be attributed to cancer and its treatment and can significantly reduce the quality of life of survivors. In the general population, Latinos are at higher risk for cognitive impairment, including an earlier onset of mild cognitive impairment and dementia. However, CRCI among Latina cancer survivors remains poorly understood. This study aimed to explore Latina breast cancer survivors’ experiences with CRCI and to identify strategies they use to manage cognitive changes.
Methods: This preliminary analysis is part of an ongoing mixed-methods study of Latina breast cancer survivors. Participants completed a data collection visit that included participant characteristics, self-reported cognition, physical activity, and diet. Survivors also participated in a focus group. Data from focus groups were analyzed using an inductive approach through content analysis.
Results: Participants (N = 9) were Latina breast cancer survivors, ages 38 to 73, MFACT-Cog = 38.6±15.6. Most were foreign-born (67%), had at least a high school diploma (78%), and reported low income (44%). Cancer treatment included radiation (78%), chemotherapy (56%), and surgery (100%). Participants reported limited awareness about CRCI. While most reported experiencing cognitive problems, they were not aware that these symptoms were related to CRCI. Only two participants recalled their oncologists discussing CRCI, and only one reported being provided with strategies to manage it. Commonly reported difficulties included memory problems, challenges processing language and information, and struggling with English as a second language after treatment. CRCI symptoms negatively affected participants’ family relationships and work abilities. To cope, participants reported using strategies such as lists, calendars, keeping items in designated places, and reminders from family members.
Conclusion: Findings highlight a critical gap in awareness of CRCI among both Latina breast cancer survivors and their physicians. Survivors often experience cognitive challenges that affect their daily lives, yet receive little guidance on how to manage them. Increasing education for patients and providers about CRCI, alongside culturally tailored interventions that promote effective coping strategies, may improve quality of life of Latina breast cancer survivors experiencing CRCI.
Keywords: Cancer survivorship, DisparitiesMethods: This preliminary analysis is part of an ongoing mixed-methods study of Latina breast cancer survivors. Participants completed a data collection visit that included participant characteristics, self-reported cognition, physical activity, and diet. Survivors also participated in a focus group. Data from focus groups were analyzed using an inductive approach through content analysis.
Results: Participants (N = 9) were Latina breast cancer survivors, ages 38 to 73, MFACT-Cog = 38.6±15.6. Most were foreign-born (67%), had at least a high school diploma (78%), and reported low income (44%). Cancer treatment included radiation (78%), chemotherapy (56%), and surgery (100%). Participants reported limited awareness about CRCI. While most reported experiencing cognitive problems, they were not aware that these symptoms were related to CRCI. Only two participants recalled their oncologists discussing CRCI, and only one reported being provided with strategies to manage it. Commonly reported difficulties included memory problems, challenges processing language and information, and struggling with English as a second language after treatment. CRCI symptoms negatively affected participants’ family relationships and work abilities. To cope, participants reported using strategies such as lists, calendars, keeping items in designated places, and reminders from family members.
Conclusion: Findings highlight a critical gap in awareness of CRCI among both Latina breast cancer survivors and their physicians. Survivors often experience cognitive challenges that affect their daily lives, yet receive little guidance on how to manage them. Increasing education for patients and providers about CRCI, alongside culturally tailored interventions that promote effective coping strategies, may improve quality of life of Latina breast cancer survivors experiencing CRCI.
Authors:
Presenter - Jacqueline Guzman, PhD, Medical College of Wisconsin
Co-Author - Whitney Morelli, PhD, Medical College of Wisconsin
Impact of physical activity on treatment-related outcomes among adolescents and young adults with cancer
Poster Number: E18Time: 05:00 PM - 05:50 PM
Topics: Cancer, Physical Activity
Background
In adult oncology, there is growing evidence that physical activity (PA) during cancer treatment can reduce the risk of treatment-related adverse events and disease recurrence and improve cancer survival. However, there is a paucity of evidence on the benefits of PA on cancer treatment-related outcomes in pediatric oncology, particularly among adolescents and young adults (AYA). This study aimed to examine if device-measured PA is associated with negative treatment-related outcomes among AYA across 3 months of active cancer treatment.
Methods
Participants were AYA ages 14-24 receiving cancer treatment at the Children’s Hospital of Philadelphia [N=80, mean age (SD)=17.6 (2.2) years, 55% male, 56% non-Hispanic white, 51% leukemia/lymphoma]. Participants wore an accelerometer (ActiGraph GT9X) on their non-dominant wrist for 2 weeks to estimate daily minutes of moderate-to-vigorous PA (MVPA). Treatment-related outcomes including unplanned hospitalizations, dose reductions (<85% of planned dose), and treatment delays (> 5 days) were extracted from the electronic medical record across the following 3 months. A combined outcome variable was also generated using cutoffs 0 or ≥1. Logistic regression models associated MVPA with the binary outcomes separately and combined.
Results
Seventy-five (94%) AYA wore the monitor for at least 7 days and were included in the analysis. Average daily MVPA was 24.5 min (SD=28.0). Thirty-four (45%) AYA had one or more negative treatment-related outcomes during the 3-month monitoring period [dose reductions: n=17(23%); treatment delays n=17(23%); unplanned hospitalizations n=19(25%)]. MVPA was not associated with the individual treatment outcomes [dose reductions: odds ratio (OR)=.97, 95% CI (.93,1.00), p=.08; treatment delays: OR (95% CI) =.97 (.94,1.01), p=.10; unplanned hospitalizations: OR (95% CI)=.96 (.93, 1.00), p=.06)]. However, each additional minute of MVPA was associated with a 3% reduced likelihood of combined negative treatment-related outcomes [OR (95% CI)=.97 (.95,.99), p=.02].
Discussion
We report preliminary observational evidence that AYA who engage in more MVPA during treatment have a lower likelihood of having one or more negative treatment-related outcomes. Further work is needed to understand optimal levels of MVPA to positively impact treatment-related outcomes and examine outcomes across a longer period to understand the impact of PA on survival and disease recurrence in this age group.
Keywords: Cancer, Physical activityIn adult oncology, there is growing evidence that physical activity (PA) during cancer treatment can reduce the risk of treatment-related adverse events and disease recurrence and improve cancer survival. However, there is a paucity of evidence on the benefits of PA on cancer treatment-related outcomes in pediatric oncology, particularly among adolescents and young adults (AYA). This study aimed to examine if device-measured PA is associated with negative treatment-related outcomes among AYA across 3 months of active cancer treatment.
Methods
Participants were AYA ages 14-24 receiving cancer treatment at the Children’s Hospital of Philadelphia [N=80, mean age (SD)=17.6 (2.2) years, 55% male, 56% non-Hispanic white, 51% leukemia/lymphoma]. Participants wore an accelerometer (ActiGraph GT9X) on their non-dominant wrist for 2 weeks to estimate daily minutes of moderate-to-vigorous PA (MVPA). Treatment-related outcomes including unplanned hospitalizations, dose reductions (<85% of planned dose), and treatment delays (> 5 days) were extracted from the electronic medical record across the following 3 months. A combined outcome variable was also generated using cutoffs 0 or ≥1. Logistic regression models associated MVPA with the binary outcomes separately and combined.
Results
Seventy-five (94%) AYA wore the monitor for at least 7 days and were included in the analysis. Average daily MVPA was 24.5 min (SD=28.0). Thirty-four (45%) AYA had one or more negative treatment-related outcomes during the 3-month monitoring period [dose reductions: n=17(23%); treatment delays n=17(23%); unplanned hospitalizations n=19(25%)]. MVPA was not associated with the individual treatment outcomes [dose reductions: odds ratio (OR)=.97, 95% CI (.93,1.00), p=.08; treatment delays: OR (95% CI) =.97 (.94,1.01), p=.10; unplanned hospitalizations: OR (95% CI)=.96 (.93, 1.00), p=.06)]. However, each additional minute of MVPA was associated with a 3% reduced likelihood of combined negative treatment-related outcomes [OR (95% CI)=.97 (.95,.99), p=.02].
Discussion
We report preliminary observational evidence that AYA who engage in more MVPA during treatment have a lower likelihood of having one or more negative treatment-related outcomes. Further work is needed to understand optimal levels of MVPA to positively impact treatment-related outcomes and examine outcomes across a longer period to understand the impact of PA on survival and disease recurrence in this age group.
Authors:
Author - Sara King-Dowling, PhD, Children's Hospital of Philadelphia
Co-Author - Polina Poliakova, MA, Children's Hospital of Philadelphia
Co-Author - Margaret Jankowski, BA, Children's Hospital of Philadelphia
Co-Author - Brielle Pennente-Fantauzzi, BA, Children's Hospital of Philadelphia
Co-Author - Reba Manicheril, Children's Hospital of Philadelphia
Co-Author - Kethan Shirodkar, Children's Hospital of Philadelphia
Co-Author - Joyce Obeid, PhD, McMaster University
Co-Author - Alexandra Psihogios, Ph.D., Northwestern University Feinberg School of Medicine
Co-Author - Jonathan Mitchell, PhD, Children's Hospital of Philadelphia
Co-Author - Tracey Jubelirer, MD, Children's Hospital of Philadelphia
Co-Author - Lisa Schwartz, PhD, Children's Hospital of Philadelphia
Informing the VA-ACCERT Center’s Colon Health Champion Program: Community Perspectives and Influences on CRC Screening
Poster Number: E19Time: 05:00 PM - 05:50 PM
Topics: Cancer, Social and Environmental Context and Health
Background: Colorectal cancer (CRC) screening remains underutilized in underserved communities despite its effectiveness in reducing mortality. The Colon Health Champion Program (CHCP) is a novel, community-based intervention in development designed to improve CRC screening uptake through peer-led communication among income-based housing residents. This formative study, supported by the NCI-funded Virginia Advancing Cancer Control Engaged Research through Transformative Solutions (VA-ACCERT) Center, aimed to assess community needs, resources, and perspectives to inform the intervention’s development.
Methods: Semi-structured interviews were conducted with 16 participants (11 income-based housing community residents (ages 45-75) and 5 staff (public housing authority (PHA) staff and community health workers)), between May and August 2025. Interviews explored CRC screening awareness, screening barriers, social and environmental influences, access to community health resources, and existing health-related social support. Participant also shared insights on effective recruitment strategies.
Results: CRC screening awareness was low; many residents unfamiliar with guidelines or screening options. While some noted a family history of cancer and all endorsed the importance of screening, not all had been screened. Negative colonoscopy experiences were reported, and many were unaware of at-home stool tests. Key barriers included fear of diagnosis, lack of insurance, and transportation. Social influence was important; peer discussions and involving both genders were seen as helpful. Perceived interest of the community in a screening intervention was mixed, with some residents perceived as being interested while others as disengaged due to stress, competing priorities, or substance use. Both residents and staff endorsed the PHA as a for outreach and recruitment assistance. Other suggested recruitment strategies included flyers, letters, trusted messengers, and incentives (e.g., food, trinkets, money). Participants emphasized messaging focused on prevention and community benefit.
Conclusions: Engaging community partners through discussions early in the research process provides critical insights that can strengthen intervention design and implementation. The CHCP will incorporate these insights to enhance community relevance and feasibility in its next development phase.
*This submission was reviewed using ChatGPT to assist with wording and character reduction.
Keywords: Screening, Community interventionMethods: Semi-structured interviews were conducted with 16 participants (11 income-based housing community residents (ages 45-75) and 5 staff (public housing authority (PHA) staff and community health workers)), between May and August 2025. Interviews explored CRC screening awareness, screening barriers, social and environmental influences, access to community health resources, and existing health-related social support. Participant also shared insights on effective recruitment strategies.
Results: CRC screening awareness was low; many residents unfamiliar with guidelines or screening options. While some noted a family history of cancer and all endorsed the importance of screening, not all had been screened. Negative colonoscopy experiences were reported, and many were unaware of at-home stool tests. Key barriers included fear of diagnosis, lack of insurance, and transportation. Social influence was important; peer discussions and involving both genders were seen as helpful. Perceived interest of the community in a screening intervention was mixed, with some residents perceived as being interested while others as disengaged due to stress, competing priorities, or substance use. Both residents and staff endorsed the PHA as a for outreach and recruitment assistance. Other suggested recruitment strategies included flyers, letters, trusted messengers, and incentives (e.g., food, trinkets, money). Participants emphasized messaging focused on prevention and community benefit.
Conclusions: Engaging community partners through discussions early in the research process provides critical insights that can strengthen intervention design and implementation. The CHCP will incorporate these insights to enhance community relevance and feasibility in its next development phase.
*This submission was reviewed using ChatGPT to assist with wording and character reduction.
Authors:
Presenter - Carrie Miller, PhD, MPH, Virginia Commonwealth University
Co-Author - E. Marshall Brooks, PhD, Virginia Commonwealth University
Co-Author - Latoya Wright, n/a
Co-Author - London Williams, Virginia Commonwealth University
Co-Author - Bernard Fuemmeler, PhD, MPH, FSBM, Virginia Commonwealth University
Co-Author - Scott Strayer, MD, Virginia Commonwealth University
Co-Author - Duc-Thi Barsell, B.S., Virginia Commonwealth University
Co-Author - Kassandra Prassana, MPH, Old Dominion University
Co-Author - Brynn Sheehan, PhD, Old Dominion University
Activity Priorities and Experiences in Providing Care: Perspectives of Care Partners of Latinos with Parkinson Disease
Poster Number: E2Time: 05:00 PM - 05:50 PM
Topics: Aging, Health Disparities
Care partners (CPs) provide critical support for people with Parkinson disease (PD). Latinos rely more frequently on informal CPs to help with daily activities. Yet, due to the underrepresentation of Latinos in PD research, little is known about the experience of CPs of Latinos with PD. The purpose of this study was to describe Latino CPs’ experience providing care and their impacted occupational priorities in the categories of self-care, leisure, and productivity. This study used a qualitative study design, where participants completed a demographic questionnaire, semi-structured interview on the PD diagnostic process and care responsibilities, and the Canadian Occupational Performance Measure (COPM). Interviews were thematically analyzed using NVIVO 15. Eligibility criteria included being an adult that provides unpaid care for a person with PD, being Latino or caring for a Latino person with PD, able to communicate in English or Spanish, and lives in the US including Puerto Rico. We identified 29 interested participants via PD community organizations and electronic health records; 15 participated (60.7 + 11.7 years old; 13 females, 2 male). Most participants identified as Mexican (n=8). CPs assisted with a variety of care tasks such as helping with medication, transportation, and housework. Participants reported language as a barrier to receiving adequate healthcare for the person with PD. CPs often worried about the uncertainty of the prognosis of PD, but some expressed relief after their loved one received the diagnosis because they could now act. CPs accessed resources on the internet and in Latino-specific PD groups to learn about symptom management; however, they often faced challenges in negotiating time for their own self-care, professional goals, and care tasks. The top occupational categories identified by the CPs using the COPM were leisure (active recreation and socialization) and productivity (learning about caregiving, volunteering). Describing the care experiences and occupational priorities of CPs in the Latino PD community provides information on what is meaningful and important to these individuals. As CPs are an otherwise understudied population, these data offer insights which can further inform current and future health interventions tailored for this population.
Keywords: Caregiving, HispanicAuthors:
Presenter - Laura Prieto, PhD, University of Wisconsin-Madison
Co-Author - Jori Gasser, Denver University
Co-Author - Maria Mora Pinzon, University of Wisconsin-Madison
Co-Author - Luis Columna, University of Wisconsin-Madison
Co-Author - Kristen Pickett, University of Wisconsin - Madison
From Survival to Survivorship: Advancing Patient-Reported Quality of Life and Equity in Cancer Immunotherapy
Poster Number: E20Time: 05:00 PM - 05:50 PM
Topics: Cancer, Quality of Life
From Survival to Survivorship: Advancing Patient-Reported Quality of Life and Equity in Cancer Immunotherapy
Authors: Zeinab A. Mohamed, Charles S. Kamen
Abstract (249 words)
Background:
Immune checkpoint inhibitors (ICIs) have transformed cancer care, extending survival across malignancies. Yet quality-of-life (QoL) outcomes remain underreported and inconsistently integrated into research and practice. Standard QoL tools inadequately capture delayed immune-related adverse events (irAEs) and miss culturally and socially relevant domains, producing evidence that does not fully reflect patients’ lived experiences.
Purpose:
This review examines how methodological limitations and systemic inequities constrain QoL assessment in immunotherapy. It evaluates existing frameworks guiding patient-reported outcomes (PROs) and highlights opportunities to advance equity-centered, patient-informed, digitally inclusive approaches.
Methods:
A structured narrative synthesis was conducted, consistent with accepted approaches to scoping reviews. Evidence was organized across oncology, behavioral medicine, regulatory science, digital health, health equity, and community-engaged research. Domains analyzed included trial methodology, survivorship, digital integration, intersectionality, literacy, and social determinants of health.
Results:
QoL reporting in ICI trials remains sparse, with fewer than 12% of studies publishing PRO findings. Existing tools inadequately capture chronic and delayed irAEs, and trial designs often neglect survivorship and diverse populations. Widely used frameworks such as SPIRIT-PRO, CONSORT-PRO, RE-AIM, and the Digital Health Equity Framework enhance rigor but insufficiently address equity, cultural adaptation, or caregiver perspectives. Structural barriers, including digital exclusion, linguistic gaps, and underrepresentation of racial and age groups, further bias QoL evidence.
Conclusions:
QoL can serve as a structural measure of equity and a core endpoint in immunotherapy. Future research should integrate culturally validated tools, equity audits, inclusive digital strategies, and community-engaged methods to ensure outcomes reflect the lived experience of all patients, while also guiding policy, informing clinical practice, and strengthening survivorship care planning.
Keywords:
Quality of Life (QoL); Patient-Reported Outcomes (PROs); Cancer Immunotherapy; Survivorship; Health Equity; Digital Health; Behavioral Medicine.
Keywords: Cancer survivorship, Quality of lifeAuthors: Zeinab A. Mohamed, Charles S. Kamen
Abstract (249 words)
Background:
Immune checkpoint inhibitors (ICIs) have transformed cancer care, extending survival across malignancies. Yet quality-of-life (QoL) outcomes remain underreported and inconsistently integrated into research and practice. Standard QoL tools inadequately capture delayed immune-related adverse events (irAEs) and miss culturally and socially relevant domains, producing evidence that does not fully reflect patients’ lived experiences.
Purpose:
This review examines how methodological limitations and systemic inequities constrain QoL assessment in immunotherapy. It evaluates existing frameworks guiding patient-reported outcomes (PROs) and highlights opportunities to advance equity-centered, patient-informed, digitally inclusive approaches.
Methods:
A structured narrative synthesis was conducted, consistent with accepted approaches to scoping reviews. Evidence was organized across oncology, behavioral medicine, regulatory science, digital health, health equity, and community-engaged research. Domains analyzed included trial methodology, survivorship, digital integration, intersectionality, literacy, and social determinants of health.
Results:
QoL reporting in ICI trials remains sparse, with fewer than 12% of studies publishing PRO findings. Existing tools inadequately capture chronic and delayed irAEs, and trial designs often neglect survivorship and diverse populations. Widely used frameworks such as SPIRIT-PRO, CONSORT-PRO, RE-AIM, and the Digital Health Equity Framework enhance rigor but insufficiently address equity, cultural adaptation, or caregiver perspectives. Structural barriers, including digital exclusion, linguistic gaps, and underrepresentation of racial and age groups, further bias QoL evidence.
Conclusions:
QoL can serve as a structural measure of equity and a core endpoint in immunotherapy. Future research should integrate culturally validated tools, equity audits, inclusive digital strategies, and community-engaged methods to ensure outcomes reflect the lived experience of all patients, while also guiding policy, informing clinical practice, and strengthening survivorship care planning.
Keywords:
Quality of Life (QoL); Patient-Reported Outcomes (PROs); Cancer Immunotherapy; Survivorship; Health Equity; Digital Health; Behavioral Medicine.
Authors:
Author - Zeinab Mohamed, MS, Ph.D. Student, University of Rochester
Co-Author - Charles Kamen, PhD, MPH, University of Rochester Medical Center
Increasing Community Health Workers' Palliative Care Knowledge and Advance Care Planning Self-Efficacy to Support Quality of Life in People with Cancer: The CHWs CARE Project
Poster Number: E21Time: 05:00 PM - 05:50 PM
Topics: Cancer, Community Engagement
Background: Community health workers (CHWs) serve as a link between communities and health services and play a crucial role in bridging gaps in care. Although there is growing interest in partnering with CHWs to support advance care planning (ACP), CHW training in palliative care and ACP is often limited. This study examined changes in CHWs’ palliative care knowledge and ACP self-efficacy after a training to support quality of life among people with cancer. Methods: CHWs (N=34) participated in a half-day, in-person training. The CHWs CARE curriculum covered: 1. Cancer Fundamentals (epidemiology, staging systems, treatments, clinical trials, common psychosocial challenges), 2. ACP - Values and Preferences about Cancer Care (ACP, advance directives, skills building to elicit values and preferences, case examples), and 3. Palliative Care (palliative care as specialist care for serious illness, debunking myths, hospice, national guidelines). CHWs completed the Palliative Care Knowledge Scale and an adapted Advance Care Planning Engagement Survey pre- and post-training. Paired t-tests were used to assess change. Results: CHWs predominately identified as cis female (68%) and Black/African American (68%) or Hispanic/Latino (29%). CHWs rated the training as ‘very’ to ‘extremely’ relevant (M=4.4 out of 5) and helpful (M=4.6) and were ‘very’ to ‘extremely’ satisfied with the training (M=4.7). There was a significant increase in CHWs’ self-perceived knowledge of palliative care (4.9 to 8.1 out of 10, p<.05) and hospice (6.3 to 7.8, p<.05). In the knowledge test, the proportion of CHWs who correctly responded ‘false’ to the following items also significantly increased: “When people receive palliative care, they must give up their other doctors” (63% to 84%, p<.05) and “Palliative care is exclusively for people who are in the last six months of life” (63% to 95%, p<.05). For each of the 10 items of the adapted Advance Care Planning Engagement Survey, CHWs significantly increased their confidence in facilitating patient-provider communication and discussing surrogate medical decision-makers and end-of-life care from ‘somewhat’ to ‘fairly’ confident (2.59-2.91 out of 4) to ‘fairly’ to ‘extremely’ confident (3.58-3.79, ps<.05). Conclusions: CHWs had misconceptions about palliative care that were successfully addressed and their self-efficacy across ACP domains increased. Findings support the acceptability and preliminary efficacy of the CHWs CARE curriculum.
Keywords: Palliative care, Cancer survivorshipAuthors:
Presenter - Patricia I. Moreno, PhD, University of Miami
Co-Author - Ashley Hatch, MPH, University of Miami
Co-Author - Mariana Khawand-Azoulai, MD, University of Miami
Co-Author - Magela Pons, MSPH, University of Miami
Co-Author - Heidy N. Medina, PhD, MPH, University of Miami
Co-Author - Julia Meguro, MD, MPH, University of Miami
Co-Author - Marcia M. Tan, PhD, MPH, University of Chicago
Promoting equitable uptake of genetic testing for inherited breast cancer: Insights from a qualitative study with at-risk Black women identified through the Breast Health Assessment
Poster Number: E22Time: 05:00 PM - 05:50 PM
Topics: Cancer, Implementation Science
Background: Black women remain less likely than White women to undergo guideline-recommended genetic testing (GT) for inherited breast cancer (IBC), perpetuating racial disparities in early detection and cancer mortality. This qualitative study integrated implementation science, behavioral theory, and community-based participatory research (CBPR) to explore unique factors shaping GT decision-making among at-risk Black women identified through the Breast Health Assessment (BHA), an electronic health record-integrated family health history (FHH) tool implemented before screening mammograms at a community health system. Methods: Qualitative interviews were conducted via WebEx between January and March 2025 with 12 self-identified Black women who screened high-risk for IBC on the BHA and consented to GT. Guided by the Integrated Model of Behavioral Prediction, semi-structured interviews elucidated psychosocial and contextual influences on GT decisions. Data were analyzed using hybrid thematic analysis. A CBPR advisory team of 8 Black women informed all aspects of the study to ensure cultural validity and relevance. Results: Participants perceived the FHH tool as routine and low burden but did not recall the BHA specifically. Most demonstrated basic understanding of GT and endorsed its clinical utility. Strong instrumental attitudes, namely the desire for actionable information for self and family, emerged as the primary motivator for GT consent, while trust in the healthcare system and family support reinforced decision-making. Participants recognized community skepticism toward GT but emphasized making autonomous decisions. Many reported sharing GT information with family and peers following BHA completion, suggesting a pathway for peer-driven knowledge diffusion. Discussion: Findings indicate that innovative implementation of FHH risk assessment tools into routine clinical workflows may facilitate equitable GT uptake with minimal patient burden. The GT decision-making process among Black women in this study centered on instrumental attitudes, system trust, and social support rather than normative or sociocultural beliefs. Embedding behavioral strategies, such as culturally tailored, family-centered messaging, throughout the BHA process may further enhance informed decision-making in this population. Continued use of CBPR approaches will be critical for sustaining trust and ensuring that novel interventions resonate with historically underserved communities.
Keywords: Participatory research, GeneticsAuthors:
Author - Sanjana Ramesh, PhD, MPH, Endeavor Health
Co-Author - Sarah Choi, MGCS, CGC, Endeavor Health
Co-Author - Shanequa Reed, MS, Endeavor Health
Co-Author - Georgina Menyah, In the Know, Inc.
Co-Author - Vida Henderson, PhD, PharmD, MPH, Fred Hutchinson Cancer Research Center
Co-Author - Pamela Ganschow, MD, Internal Medicine, University of Illinois Cancer Center
Co-Author - Henry Dunnenberger, PharmD, Endeavor Health
Co-Author - Peter Hulick, MD, Endeavor Health
Post-cancer treatment and sociodemographic factors affect how pediatric cancer survivors and their parents participate in a healthy lifestyle behavioral intervention.
Poster Number: E23Time: 05:00 PM - 05:50 PM
Topics: Cancer, Child and Family Health
Background: Pediatric cancer survivors remain at risk for poor health outcomes post-treatment (e.g., chronic conditions) related to adaptation of poor lifestyle behaviors. Despite existing interventions, adherence to behavioral interventions may be influenced by participants’ stress, digital fatigue, time demands, treatment intensity, individual risk for late effects, and other factors. However, these have not been systematically studied in the context of interventions for PCS and their parents. This project aims to evaluate the association between treatment intensity, long-term treatment risk complications, demographic variables, and completion of a healthy lifestyle behavioral intervention.
Methods: PCS, aged 5-15 years, and their parents participated in and completed a randomized lifestyle behavioral intervention (Nourish-T+ vs. EUC). Clinical providers reported on the type of cancer treatment, treatment intensity, and risk level of treatment complications for each PCS. Additional data were collected from demographic surveys, and intervention completion was assessed as a binary variable by a research coordinator post 6-week sessions or a control session. Chi-square analyses were conducted to evaluate the relationship between treatment intensity and demographic variables on intervention completion.
Results: Preliminary data from 282 parent-child dyads that completed a randomized lifestyle behavioral intervention were used in this analysis. Most parents identified as female (n=262; 93%), 39% were Hispanic/Latino (n=109), and the average age (SD) was 43.2 (7.6) years. 61% of PCS identified as female (n=171), with an average age (SD) of 12 (3), and 33% were Hispanic/Latino (n=92). Parents’ race, identifying as white (p=0.005), and income (>$70K per year; p=0.021) had a significant association with intervention completion. Parents of PCS with a low risk were significantly associated with completing the intervention (p=0.006). Child’s race, gender, treatment intensity, and treatment type were not associated with intervention completion. Completion did not vary due to the assigned intervention conditions.
Conclusion: Our main findings indicate that parental race, income, and PCS risk of treatment complications or late effects were significant factors influencing intervention completion. This is crucial for understanding how future interventions can be tailored to enhance adherence and motivation among diverse sociodemographic groups of participants.
Keywords: Cancer survivorship, Health behavior changeMethods: PCS, aged 5-15 years, and their parents participated in and completed a randomized lifestyle behavioral intervention (Nourish-T+ vs. EUC). Clinical providers reported on the type of cancer treatment, treatment intensity, and risk level of treatment complications for each PCS. Additional data were collected from demographic surveys, and intervention completion was assessed as a binary variable by a research coordinator post 6-week sessions or a control session. Chi-square analyses were conducted to evaluate the relationship between treatment intensity and demographic variables on intervention completion.
Results: Preliminary data from 282 parent-child dyads that completed a randomized lifestyle behavioral intervention were used in this analysis. Most parents identified as female (n=262; 93%), 39% were Hispanic/Latino (n=109), and the average age (SD) was 43.2 (7.6) years. 61% of PCS identified as female (n=171), with an average age (SD) of 12 (3), and 33% were Hispanic/Latino (n=92). Parents’ race, identifying as white (p=0.005), and income (>$70K per year; p=0.021) had a significant association with intervention completion. Parents of PCS with a low risk were significantly associated with completing the intervention (p=0.006). Child’s race, gender, treatment intensity, and treatment type were not associated with intervention completion. Completion did not vary due to the assigned intervention conditions.
Conclusion: Our main findings indicate that parental race, income, and PCS risk of treatment complications or late effects were significant factors influencing intervention completion. This is crucial for understanding how future interventions can be tailored to enhance adherence and motivation among diverse sociodemographic groups of participants.
Authors:
Author - Rachel Sauls, MPH, University of North Carolina at Chapel Hill
Co-Author - Jocelyn Jarvis, BS, University of South Florida
Co-Author - Sahar Heydari, University of South Florida
Co-Author - Ana Paula Rodrigues, PhD, University of South Florida
Co-Author - Heewon Gray, PhD, University of South Florida
Co-Author - Marilyn Stern, PhD, University of South Florida
Supporting plant-forward eating for women enrolled in the Every Day Counts lifestyle intervention – program planning and evolution
Poster Number: E24Time: 05:00 PM - 05:50 PM
Topics: Cancer, Diet, Nutrition, and Eating Disorders
Background: Framed by the American Cancer Society (ACS) survivorship guidelines, Every Day Counts (EDC) is an on-going multisite, randomized trial. It is designed to test the impact of a 16-week nutrition and physical activity intervention on patient reported outcomes for women with clinically stable metastatic breast cancer. The ACS advocates plant-based eating for all cancer survivors, encouraging high intakes of fruit, vegetables, and whole grains and decreased consumption of red and processed meats, sugar sweetened beverages and alcohol. However, operationalizing plant-based eating for patient populations requires considerable resources to improve ACS guideline adherence. Data supports the positive effect of cooking classes on health outcomes. Herein we describe the EDC cooking classes, providing experiential details on the creation, implementation, and evolution required.
Methods: Based on the successful EDC pilot trial, monthly in-person cooking classes for women in the intervention are were proposed. Classes would provide hands-on demonstrations of plant-based, budget-friendly recipes, one cooking skill, and social support for attendees at a location closest to their recruiting site. Trained professionals were to lead these classes, and women were expected to attend 1 class/month for 4 months. Eligible participants (~10/month) would receive class details and reminders in advance.
Results: Owing to funding reductions, logistics, and COVID concerns, virtual EDC cooking classes were implemented. Classes (60 minutes) were live streamed twice monthly and offered simple, seasonal (summer and winter) recipes that required novice culinary skills. Despite sending class links via email and text, mean attendance was only 1.2 women/month (range 0-4 over 20 months), reflecting poor uptake. Evolutionary efforts included: variable class times (AM and PM) and days, shorter class duration (30 minutes), promotional brochures, class preregistration, a name change to plant-forward (vs. plant-based), posting recorded classes on YouTube, and reminders from health coaches. No changes in class attendance or views were observed.
Conclusions: After substantial efforts, the virtual EDC cooking classes were discontinued. A static on-line platform was adopted offering easy recipes, existing cooking reels, and other cooking resources. Future efforts are needed to identify low resource, high yield methods to adapt healthy dietary patterns in vulnerable cancer survivors.
Keywords: Nutrition, Behavior ChangeMethods: Based on the successful EDC pilot trial, monthly in-person cooking classes for women in the intervention are were proposed. Classes would provide hands-on demonstrations of plant-based, budget-friendly recipes, one cooking skill, and social support for attendees at a location closest to their recruiting site. Trained professionals were to lead these classes, and women were expected to attend 1 class/month for 4 months. Eligible participants (~10/month) would receive class details and reminders in advance.
Results: Owing to funding reductions, logistics, and COVID concerns, virtual EDC cooking classes were implemented. Classes (60 minutes) were live streamed twice monthly and offered simple, seasonal (summer and winter) recipes that required novice culinary skills. Despite sending class links via email and text, mean attendance was only 1.2 women/month (range 0-4 over 20 months), reflecting poor uptake. Evolutionary efforts included: variable class times (AM and PM) and days, shorter class duration (30 minutes), promotional brochures, class preregistration, a name change to plant-forward (vs. plant-based), posting recorded classes on YouTube, and reminders from health coaches. No changes in class attendance or views were observed.
Conclusions: After substantial efforts, the virtual EDC cooking classes were discontinued. A static on-line platform was adopted offering easy recipes, existing cooking reels, and other cooking resources. Future efforts are needed to identify low resource, high yield methods to adapt healthy dietary patterns in vulnerable cancer survivors.
Authors:
Presenter - Sandra Contreras, Medical College of Wisconsin
Co-Author - Shruthi Turaga, MPH, Loyola University Chicago
Author - Mary Mora D'Anza, MS, RDN, Real Foods Collective
Author - Ame Proietti, MA, RDN, Loyola University Chicago
Author - Margaret Tovar, MPH, Medical College of Wisconsin
Author - Melinda Stolley, PhD, Medical College of Wisconsin
Author - Paula O'Connor, MbChB, Loyola University Chicago
Author - Kathleen O'Connell, PhD, Medical College of Wisconsin
Presenter - Patricia Sheean, PhD, RD, Loyola University Chicago
Helping Ovarian Cancer Patients Cope with Their Disease (HOPE): Development of a Narrative-Based Intervention to Improve Patient Flourishing
Poster Number: E25Time: 05:00 PM - 05:50 PM
Topics: Cancer, Quality of Life
Background: Patients with recurrent ovarian cancer are at high risk of mortality and suffer high rates of depression and anxiety. To address the need to improve their mental outcomes and reduce suffering, we developed Helping Ovarian Cancer Patients Cope with Their Disease (HOPE) – a 3-session workshop-based group intervention grounded in hope theory and the science of narrative to improve patients’ psychosocial outcomes. The goal of this study was to develop the HOPE intervention and examine its feasibility, acceptability, and satisfaction among patients with recurrent ovarian cancer.
Methods: In Phase 1, n=10 patients and n=10 gynecologic oncology clinicians provided feedback through semi-structured interviews on the original HOPE intervention. In Phase 2, the optimized version of HOPE was pilot tested in four workshop groups (n=15 patients) delivered in person (n=2) and virtually (n=2) to assess feasibility, acceptability, and satisfaction. Depression (PHQ-8) and anxiety (GAD-7) were measured as exploratory outcomes.
Results: Phase 1 results indicate patients rated HOPE with high acceptability (M=4.1) and patients and clinicians indicated high satisfaction (M= 4.2 and 4.3) and high degrees of helpfulness (M=4.0 and 3.9) (on 1-to-5 Likert items). Qualitative feedback indicates participants like the use of storytelling and moving through negative emotions. Suggestions for improvement include clarifying content and providing more relevant case studies. Phase 2 results demonstrate high levels of feasibility, acceptability, and satisfaction. A total of 83.3% of screened patients participated in the study and 86.7% (n=13 out of 15) completed all three sessions. Remaining participants completed 2 out of 3 sessions. On 1-to-5 Likert items, patients reported strongly liking the workshop (M=4.6) and finding it acceptable (M=4.9). On 1-to-10 Likert items, patients reported high levels of satisfaction (M=8.6) and indicated they would be highly likely to recommend it to others (M=9.0) and participate again (M=8.9). Finally, both depression (M= 4.3 to 3.5, p=0.10) and anxiety scores (M = 3.7 to 3.4, p=0.26) showed a trend towards decreasing post-intervention.
Conclusion: Preliminary data indicate that the HOPE intervention, which was developed using patient and clinician feedback, had high levels of feasibility, acceptability, and satisfaction. Preliminary results also indicate potential for efficacy, which should be tested in future large-scale trials.
Keywords: Cancer, Quality of lifeMethods: In Phase 1, n=10 patients and n=10 gynecologic oncology clinicians provided feedback through semi-structured interviews on the original HOPE intervention. In Phase 2, the optimized version of HOPE was pilot tested in four workshop groups (n=15 patients) delivered in person (n=2) and virtually (n=2) to assess feasibility, acceptability, and satisfaction. Depression (PHQ-8) and anxiety (GAD-7) were measured as exploratory outcomes.
Results: Phase 1 results indicate patients rated HOPE with high acceptability (M=4.1) and patients and clinicians indicated high satisfaction (M= 4.2 and 4.3) and high degrees of helpfulness (M=4.0 and 3.9) (on 1-to-5 Likert items). Qualitative feedback indicates participants like the use of storytelling and moving through negative emotions. Suggestions for improvement include clarifying content and providing more relevant case studies. Phase 2 results demonstrate high levels of feasibility, acceptability, and satisfaction. A total of 83.3% of screened patients participated in the study and 86.7% (n=13 out of 15) completed all three sessions. Remaining participants completed 2 out of 3 sessions. On 1-to-5 Likert items, patients reported strongly liking the workshop (M=4.6) and finding it acceptable (M=4.9). On 1-to-10 Likert items, patients reported high levels of satisfaction (M=8.6) and indicated they would be highly likely to recommend it to others (M=9.0) and participate again (M=8.9). Finally, both depression (M= 4.3 to 3.5, p=0.10) and anxiety scores (M = 3.7 to 3.4, p=0.26) showed a trend towards decreasing post-intervention.
Conclusion: Preliminary data indicate that the HOPE intervention, which was developed using patient and clinician feedback, had high levels of feasibility, acceptability, and satisfaction. Preliminary results also indicate potential for efficacy, which should be tested in future large-scale trials.
Authors:
Co-Author - Robyn Castellani, BA, Castle and Spark
Co-Author - Maya Pande, BS, Fred Hutchinson Cancer Center
Co-Author - Anneke Loggers, Fred Hutchinson Cancer Center
Co-Author - Sarah Yarborough, MPH, Fred Hutchinson Cancer Center
Co-Author - Barbara Goff, MD, Fred Hutchinson Cancer Center
Co-Author - Heidi Gray, MD, University of Washington
Sun Protection and Tanning Awareness in Rural Schools (STARS): Mixed-method analysis of a Pilot Intervention
Poster Number: E26Time: 05:00 PM - 05:50 PM
Topics: Cancer, Community Engagement
Background: High school classrooms are an ideal setting for providing education about skin cancer and its prevention to adolescents. This education can be particularly impactful among rural communities, which often experience worse skin cancer outcomes due to later diagnoses, limited access to resources, and insufficient education about the risks of skin cancer. The Sun Protection and Tanning Awareness in Rural Schools (STARS) project aimed to understand how best to tailor a skin cancer prevention intervention and its implementation to meet the needs of rural high schools and their students. In this mixed-methods analyses, we present findings from interviews with high school teachers in rural Utah and from a pilot intervention.
Methods: Interviews were conducted using a structured interview guide to determine perspectives on skin cancer prevention education within the local community and high school. Using a qualitative coding scheme based on the Consolidated Framework for Implementation Research (CFIR), each interview was coded by two coders. Interview findings guided refinements to an in-class intervention, which included a lecture, a risk assessment worksheet, and a sun protection action planning exercise. This intervention was delivered within a single-arm pilot trial to two Utah high schools.
Results: Within interviews (n=9), teachers noted that their rural students commonly participated in outdoor activities without sun protection and held misconceptions about sun protection (e.g., not needed for winter sports). Teachers believed that skin cancer education was important and supported by school leaders; however, they noted barriers, including a lack of time and curriculum resources. Within the STARS pilot intervention (n=38 students), analyses revealed statistically significant (p<.05), or marginally significant (p<.10) improvements to skin cancer knowledge, overall weekday sun protection, and to the specific behaviors of wearing brimmed hats and avoiding peak exposure times.
Conclusions: Classroom-based interventions can be a feasible and effective method of improving skin cancer prevention knowledge and behaviors among rural adolescents. These findings highlight the importance of skin cancer education programs tailored for rural high schools.
Keywords: Cancer, Children's healthMethods: Interviews were conducted using a structured interview guide to determine perspectives on skin cancer prevention education within the local community and high school. Using a qualitative coding scheme based on the Consolidated Framework for Implementation Research (CFIR), each interview was coded by two coders. Interview findings guided refinements to an in-class intervention, which included a lecture, a risk assessment worksheet, and a sun protection action planning exercise. This intervention was delivered within a single-arm pilot trial to two Utah high schools.
Results: Within interviews (n=9), teachers noted that their rural students commonly participated in outdoor activities without sun protection and held misconceptions about sun protection (e.g., not needed for winter sports). Teachers believed that skin cancer education was important and supported by school leaders; however, they noted barriers, including a lack of time and curriculum resources. Within the STARS pilot intervention (n=38 students), analyses revealed statistically significant (p<.05), or marginally significant (p<.10) improvements to skin cancer knowledge, overall weekday sun protection, and to the specific behaviors of wearing brimmed hats and avoiding peak exposure times.
Conclusions: Classroom-based interventions can be a feasible and effective method of improving skin cancer prevention knowledge and behaviors among rural adolescents. These findings highlight the importance of skin cancer education programs tailored for rural high schools.
Authors:
Author - Tammy Stump, PhD, University of Utah
Co-Author - Kayla Clinger, University of Nevada - Reno
Co-Author - Jacey Jones, Huntsman Cancer Center, University of Utah
Co-Author - Kendra Nelson, Huntsman Cancer Institute, University of Utah
Co-Author - Douglas Grossman, Huntsman Cancer Institute, University of Utah
Co-Author - Yelena Wu, PhD, FSBM, Huntsman Cancer Institute, University of Utah
Resilience and Adverse Childhood Experiences in patients with recent Myocardial Infarction
Poster Number: E27Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Child and Family Health
Introduction: Psychological resilience, the ability to adapt and overcome adversity, has been associated with lower rates of stress and depressive symptoms after myocardial infarction (MI). Adverse childhood experiences (ACEs), a set of early life stressors linked to long-term physical and mental health risks, may shape resilience later in life. However, the relationship between ACEs and resilience in the context of MI recovery remains poorly understood. Examining this association could help identify MI patients who may benefit from interventions to improve resilience.
Methods: We analyzed baseline data from an ongoing longitudinal cohort study of adults recently hospitalized for MI. ACE exposure before age 18 was assessed using five dichotomous indicators: living in a household with mental illness, substance use, or chronic illness or disability; parental separation or divorce; and prolonged financial hardship. Resilience was assessed using the Brief Resilience Scale (BRS); a score of <3 indicates low resilience. Participants also completed the Seattle Angina Questionnaire (SAQ-7) to assess disease-specific health status. We used Mann-Whitney U tests and chi-square tests for descriptive analyses, and linear and logistic regression to test bivariate and multivariate associations between ACEs and resilience, overall and by sex.
Results: The 314 participants (63% women, 26.6% non-White race, 8.3% Hispanic ethnicity, median age 62.1 years [IQR=52.9-70.8]) completed questionnaires at median 61 days post-MI (IQR=29.75-100.25). The mean SAQ-7 score was 77.4 (SD=19.2). At least one ACE was reported by 58.3% of participants (63.8% women vs. 48.7% men, p=0.009) and 22.1% of participants reported low resilience (25.1% women vs. 17.4% men, p<0.001). Overall, greater exposure to ACEs was associated with lower resilience (OR per ACE=1.26 [95% CI, 1.01, 1.58], p=0.04); this association was similar in women (OR per ACE=1.27 [95% CI, 0.97, 1.65], p=0.08) and men (OR per ACE=1.16 [95% CI, 0.72, 1.79], p=0.53). Adjusting for age, race, ethnicity, time since MI, education, marital status and SAQ-7 score did not meaningfully change the associations. Findings were similar when analyzing resilience as a continuous outcome.
Conclusion: ACEs may be an important determinant of resilience during recovery from MI in women. Assessing ACE exposure may help guide the development of targeted interventions to enhance resilience and improve psychological outcomes in this population.
Keywords: Cardiovascular disease, ResilienceMethods: We analyzed baseline data from an ongoing longitudinal cohort study of adults recently hospitalized for MI. ACE exposure before age 18 was assessed using five dichotomous indicators: living in a household with mental illness, substance use, or chronic illness or disability; parental separation or divorce; and prolonged financial hardship. Resilience was assessed using the Brief Resilience Scale (BRS); a score of <3 indicates low resilience. Participants also completed the Seattle Angina Questionnaire (SAQ-7) to assess disease-specific health status. We used Mann-Whitney U tests and chi-square tests for descriptive analyses, and linear and logistic regression to test bivariate and multivariate associations between ACEs and resilience, overall and by sex.
Results: The 314 participants (63% women, 26.6% non-White race, 8.3% Hispanic ethnicity, median age 62.1 years [IQR=52.9-70.8]) completed questionnaires at median 61 days post-MI (IQR=29.75-100.25). The mean SAQ-7 score was 77.4 (SD=19.2). At least one ACE was reported by 58.3% of participants (63.8% women vs. 48.7% men, p=0.009) and 22.1% of participants reported low resilience (25.1% women vs. 17.4% men, p<0.001). Overall, greater exposure to ACEs was associated with lower resilience (OR per ACE=1.26 [95% CI, 1.01, 1.58], p=0.04); this association was similar in women (OR per ACE=1.27 [95% CI, 0.97, 1.65], p=0.08) and men (OR per ACE=1.16 [95% CI, 0.72, 1.79], p=0.53). Adjusting for age, race, ethnicity, time since MI, education, marital status and SAQ-7 score did not meaningfully change the associations. Findings were similar when analyzing resilience as a continuous outcome.
Conclusion: ACEs may be an important determinant of resilience during recovery from MI in women. Assessing ACE exposure may help guide the development of targeted interventions to enhance resilience and improve psychological outcomes in this population.
Authors:
Author - Alexis Bartelloni, MSPH, CHES , NYU Langone Health
Co-Author - Stefany De Brito, NYU Langone
Co-Author - Milla Arabadjian, PhD, FNP-BC, RN, NYU Grossman Long Island School of Medicine
Co-Author - Yuhe Xia , NYU Langone Health
Co-Author - Harmony Reynolds , MD, NYU Langone Health
Co-Author - Tanya Spruill, PhD, NYU Langone Health
Associations between Cognitive Function with Functional Capacity and Health-Related Quality of Life among Patients with Heart Failure and Mild Cognitive Impairment
Poster Number: E29Time: 05:00 PM - 05:50 PM
Topics: Cardiovascular Disease, Quality of Life
Significance: Individuals with heart failure (HF) generally have poor functional capacity and health-related quality of life (HRQoL). More than half of these individuals experience cognitive impairment. Better cognitive function is linked with better quality of life, including better functional capacity. We hypothesized that, among individuals with HF, better cognitive functioning would be associated with better functional capacity and HRQoL.
Methods: This was a secondary analysis using baseline pre-randomization data from an ongoing RCT conducted in adults with HF and mild cognitive impairment (MCI; scores 15-26 on MoCA). Participants completed measures from the NIH Toolbox Fluid Cognition Battery: 1) Flanker Inhibitory Control and Attention Test (attention and inhibitory control), 2) Pattern Comparison Test (processing speed), 3) List Sorting Working Memory Test (working memory), 4) Picture Sequence Memory Test (episodic memory), 5) Dimensional Change Card Sort Test (attention and cognitive flexibility). Functional capacity was measured with the 6-minute walk test (6MWT). HRQoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). We conducted six separate linear regression models with age-adjusted Fluid Composition Cognitive score and age-adjusted scores from each cognitive test as predictors, and KCCQ as the outcome, adjusting for sex and education. We repeated the analyses using 6MWT as the outcome.
Results: The average age of participants (n=114) was 71.9 years (SD = 12.2). Most (78.9%) were White and 39.5% were female. Higher Fluid Cognition Composite scores (β = 0.38, 95% CI = 0.08, 0.68, p = .02), higher Flanker Inhibitory Control and Attention Test scores (β = 0.67, 95% CI = 0.28, 1.05, p < .001), and higher Dimensional Change Card Sort Test scores (β = 0.45, 95% CI = 0.16, 0.74, p = .003), but not the other cognitive measures tests, were associated with higher KCCQ scores. While male participants had higher functional capacity (M=337.6 meters) than female participants (M=281.9 meters), (β = -55.7, 95% CI = -100.5, -10.8, p = .02), there were no associations between cognitive function or education with functional capacity.
Conclusions: In this cross-sectional analysis, better cognitive function was associated with better HRQoL. While cognitive impairment is highly prevalent among patients with HF, better attention, inhibitory control, and cognitive flexibility are beneficial for HRQoL.
Keywords: Cardiovascular disease, Cognitive factorsMethods: This was a secondary analysis using baseline pre-randomization data from an ongoing RCT conducted in adults with HF and mild cognitive impairment (MCI; scores 15-26 on MoCA). Participants completed measures from the NIH Toolbox Fluid Cognition Battery: 1) Flanker Inhibitory Control and Attention Test (attention and inhibitory control), 2) Pattern Comparison Test (processing speed), 3) List Sorting Working Memory Test (working memory), 4) Picture Sequence Memory Test (episodic memory), 5) Dimensional Change Card Sort Test (attention and cognitive flexibility). Functional capacity was measured with the 6-minute walk test (6MWT). HRQoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). We conducted six separate linear regression models with age-adjusted Fluid Composition Cognitive score and age-adjusted scores from each cognitive test as predictors, and KCCQ as the outcome, adjusting for sex and education. We repeated the analyses using 6MWT as the outcome.
Results: The average age of participants (n=114) was 71.9 years (SD = 12.2). Most (78.9%) were White and 39.5% were female. Higher Fluid Cognition Composite scores (β = 0.38, 95% CI = 0.08, 0.68, p = .02), higher Flanker Inhibitory Control and Attention Test scores (β = 0.67, 95% CI = 0.28, 1.05, p < .001), and higher Dimensional Change Card Sort Test scores (β = 0.45, 95% CI = 0.16, 0.74, p = .003), but not the other cognitive measures tests, were associated with higher KCCQ scores. While male participants had higher functional capacity (M=337.6 meters) than female participants (M=281.9 meters), (β = -55.7, 95% CI = -100.5, -10.8, p = .02), there were no associations between cognitive function or education with functional capacity.
Conclusions: In this cross-sectional analysis, better cognitive function was associated with better HRQoL. While cognitive impairment is highly prevalent among patients with HF, better attention, inhibitory control, and cognitive flexibility are beneficial for HRQoL.
Authors:
Author - Danusha Selva Kumar, PhD, Alpert Medical School at Brown University
Co-Author - Barbara Riegel, PhD, University of PA School of Nursing
Co-Author - Hila Pond, BS, Brown University Health
Co-Author - Christopher Liu, Brown University
Co-Author - Vanessa Serrano, MS, MPH, SDSU/UC San Diego, Alpert Medical School at Brown University
Co-Author - Janice Tripolone, MS, MAT, Brown University Health
Co-Author - Christopher Breault, BS, Brown University
Co-Author - Ronald Cohen, PhD, University of Florida
Co-Author - Elena Salmoirago-Blotcher, MD, PhD, FSBM, Cardiovascular Institute, The Miriam Hospital
Everyday Mindfulness and Well-Being Across Daily Activities among African American Older Adults
Poster Number: E3Time: 05:00 PM - 05:50 PM
Topics: Aging, Physical Activity
Background: Older adults at risk of Alzheimer’s disease and related dementias (ADRD) often show early difficulties in daily living activities. While early prevention strategies emphasize slowing cognitive decline, less is known about how daily states, such as mindfulness, perceived cognition, and mood, relate to different types of activities. Mindful walking has been linked to improved well-being, but its effects across activity contexts remain unclear. Understanding these influences may guide targeted strategies to support independence. Objective: This study aims to examine whether a mindfulness walking intervention influences daily living activities in older adults. Methods: We conducted a secondary analysis of data from 63 African American older adults (≥60 years) with at least one ADRD risk factor (family history, BMI ≥25, or self-reported cognitive decline) and no history of mood or neurological disorders. Participants were randomized to a mindful walking intervention (twice weekly, 30 minutes; 24 sessions) or a waitlist control group. Both groups completed a 14-day ecological momentary assessment with daily surveys on mindfulness, perceived cognition, affect (positive/negative mood), and daily living activities, which were categorized as basic self-care, practical self-care, social, leisure, or other. Linear mixed models with pairwise comparisons tested group differences in mindfulness and well-being across activity types. Results: The intervention group showed higher mindfulness (β=0.8, p=0.03) and perceived cognition (β=0.9, p=0.02), but not negative or positive affect (β=0.5, p=0.21, β=0.2, p=0.41) across all daily activity types. Pairwise comparisons suggested that mindfulness, perceived cognition, and positive affect, not negative affect, were higher during practical self-care, social, and leisure activities compared with basic self-care (p<0.001). Conclusions: Both the intervention and control group showed higher states of mindfulness, perceived cognition, and positive affect when participating in activities beyond basic self-care, demonstrating that inclusion of mindfulness into everyday routines as a promising strategy to promote healthy aging and resilience against cognitive decline. Future studies may investigate whether providing a short bout of mind-body intervention in daily living conditions may improve psychological well-being and affective states.
Keywords: Physical activity, MindfulnessAuthors:
Presenter - Alina Tofiqul, University of South Carolina
Co-Author - Jongwon Lee, M.P.H, University of South Carolina
Co-Author - Halle Prine, BS, MS, Exercise Science
Co-Author - Chih-Liang Wang, BS, MS, Institution of Gerontology, National Cheng Kung University
Co-Author - Chih-Hsiang Yang, PhD, University of South Carolina
Using social network analysis to identify roles in food-related tasks and nutrition advice seeking sources of Black mothers
Poster Number: E30Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Diet, Nutrition, and Eating Disorders
Background: Obesity disparities in Black youth are linked to dietary behaviors that may increase their risk. Parents, especially mothers, are key influences of children’s dietary behaviors. Understanding how social networks influence parents’ dietary-related behaviors is essential to developing more effective health promotion strategies. This study explores the nutrition advice seeking sources and roles in food-related tasks among Black mothers of pre-adolescent children.
Methods: This is a secondary analysis of a community-engaged, multi-methods study (online surveys, telephone interviews) with a community advisory board (CAB) consisting of Black mothers with children aged 9-12 years. Participants completed an online survey that asked: “who or where you would go to for food or nutrition advice,” “who usually does the food shopping in your home,” and “who usually does the food preparation in your home.” Descriptive statistics were used to summarize demographic characteristics and responses. An advice seeking network was generated using UCINET 6.80 to assess seeking pattern. Network maps were generated in NetDraw 2.190 to visualize advice-seeking behavior by participant characteristics such as age and marital status.
Results: The CAB (n=15) included 14 mothers and 1 grandmother, 30-39 years old (60%), married (53%), and described their family structure as nuclear (53%). A majority were the primary food shoppers (60%) while some identified food shopping as a shared responsibility (33%) or performed by another adult (7%). Some mothers were the primary food preparers (47%), while some identified it as shared responsibility (33%), or performed by another adult (20%). Mothers reported a variety of advice seeking sources: self (60%), coach (53%), doctor (53%), YouTube (53%), and websites (47%). The degree centrality was highest for mothers who selected a greater number of nutrition advice sources and those who selected shared responsibility for both food shopping and preparation. This indicates greater connectivity and potential influence.
Conclusion: Using social network analysis to identify nutrition advice seeking sources and roles in food-related tasks among Black mothers can provide insight into how parental behaviors influence children’s dietary choices. Understanding these networks can provide a foundation for designing more culturally relevant and effective nutrition and obesity prevention interventions.
Keywords: Family, NutritionMethods: This is a secondary analysis of a community-engaged, multi-methods study (online surveys, telephone interviews) with a community advisory board (CAB) consisting of Black mothers with children aged 9-12 years. Participants completed an online survey that asked: “who or where you would go to for food or nutrition advice,” “who usually does the food shopping in your home,” and “who usually does the food preparation in your home.” Descriptive statistics were used to summarize demographic characteristics and responses. An advice seeking network was generated using UCINET 6.80 to assess seeking pattern. Network maps were generated in NetDraw 2.190 to visualize advice-seeking behavior by participant characteristics such as age and marital status.
Results: The CAB (n=15) included 14 mothers and 1 grandmother, 30-39 years old (60%), married (53%), and described their family structure as nuclear (53%). A majority were the primary food shoppers (60%) while some identified food shopping as a shared responsibility (33%) or performed by another adult (7%). Some mothers were the primary food preparers (47%), while some identified it as shared responsibility (33%), or performed by another adult (20%). Mothers reported a variety of advice seeking sources: self (60%), coach (53%), doctor (53%), YouTube (53%), and websites (47%). The degree centrality was highest for mothers who selected a greater number of nutrition advice sources and those who selected shared responsibility for both food shopping and preparation. This indicates greater connectivity and potential influence.
Conclusion: Using social network analysis to identify nutrition advice seeking sources and roles in food-related tasks among Black mothers can provide insight into how parental behaviors influence children’s dietary choices. Understanding these networks can provide a foundation for designing more culturally relevant and effective nutrition and obesity prevention interventions.
Authors:
Author - Chishinga Callender , MS, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center; UTHealth Houston School of Public Health
Co-Author - Kayo Fujimoto , PhD , UTHealth Houston School of Public Health
Co-Author - Jayna Dave, PhD, Baylor College of Medicine - USDA/ARS Children's Nutrition Research Center
Co-Author - Maria Jibaja-Weiss, EdD, Baylor College of Medicine, Dan L. Duncan Comprehensive Cancer Center
Co-Author - Jane Richards Montealegre, PhD, The University of Texas M.D. Anderson Cancer Center, Department of Behavioral Science
Co-Author - Debbe Thompson, PhD, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine
Exploring Hispanic families’ experiences with dog-facilitated physical activity: results from qualitative research to inform a culturally tailored intervention program
Poster Number: E31Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Physical Activity
Background: Hispanic families in the United States face persistent inequities in access to supportive environments for physical activity. Family dogs may offer opportunities for shared activity that reflect family values and daily routines, informing the design of culturally tailored interventions to promote active living.
Purpose: To explore how Hispanic caregivers and their children perceive the role of the family dog in daily life and physical activity, and identify considerations for a culturally tailored dog-facilitated physical activity intervention.
Methods: Fifteen Hispanic caregiver–child dyads (n = 30) from Central Florida who owned a dog and did not meet physical activity guidelines completed a brief screening survey followed by semi-structured bilingual interviews, conducted via videoconference by trained bilingual research assistants. The interview guide explored 1) daily family routines, 2) dog-related activities, 3) barriers and motivators for dog walking and play, and 4) preferences for mobile health interventions. Interviews were audio-recorded, transcribed verbatim, translated when conducted in Spanish, and analyzed thematically. Two researchers independently coded transcripts, discussed discrepancies, and refined a shared codebook to identify emerging themes supported by representative quotations.
Results: Families consistently described dogs as family members who fostered emotional connection, shared enjoyment and responsibility. Dogs encouraged family-based walking and play, which families perceived as opportunities to spend time together and reduce sedentary behaviors. Some families incorporated dog care into their existing routines. Reported barriers included caregivers’ shift work, children’s homework demands, Florida heat, and concerns about neighborhood safety. Participants emphasized the need for a supportive, family-oriented intervention with reminders, progress tracking, and interactive challenges that encourage shared participation across generations, as well as community efforts to create safer and dog-friendly spaces that reflect cultural values of togetherness.
Conclusions: Findings indicated that Hispanic families perceive dog care as a source of joy and a practical way to be active together. Future interventions should build on these strengths by integrating cultural values, flexible scheduling, and community engagement to support sustained, family-centered physical activity.
Keywords: Children's health, Health behavior changePurpose: To explore how Hispanic caregivers and their children perceive the role of the family dog in daily life and physical activity, and identify considerations for a culturally tailored dog-facilitated physical activity intervention.
Methods: Fifteen Hispanic caregiver–child dyads (n = 30) from Central Florida who owned a dog and did not meet physical activity guidelines completed a brief screening survey followed by semi-structured bilingual interviews, conducted via videoconference by trained bilingual research assistants. The interview guide explored 1) daily family routines, 2) dog-related activities, 3) barriers and motivators for dog walking and play, and 4) preferences for mobile health interventions. Interviews were audio-recorded, transcribed verbatim, translated when conducted in Spanish, and analyzed thematically. Two researchers independently coded transcripts, discussed discrepancies, and refined a shared codebook to identify emerging themes supported by representative quotations.
Results: Families consistently described dogs as family members who fostered emotional connection, shared enjoyment and responsibility. Dogs encouraged family-based walking and play, which families perceived as opportunities to spend time together and reduce sedentary behaviors. Some families incorporated dog care into their existing routines. Reported barriers included caregivers’ shift work, children’s homework demands, Florida heat, and concerns about neighborhood safety. Participants emphasized the need for a supportive, family-oriented intervention with reminders, progress tracking, and interactive challenges that encourage shared participation across generations, as well as community efforts to create safer and dog-friendly spaces that reflect cultural values of togetherness.
Conclusions: Findings indicated that Hispanic families perceive dog care as a source of joy and a practical way to be active together. Future interventions should build on these strengths by integrating cultural values, flexible scheduling, and community engagement to support sustained, family-centered physical activity.
Authors:
Presenter - Qianxia Jiang, PhD, University of Central Florida
Co-Author - Sualba Alejandro, University of Central Florida
Co-Author - Manuela Reyes, University of Central Florida
Co-Author - Emilia Nina, University of Central Florida
Co-Author - Susanny Beltran, University of Central Florida
Co-Author - Keith Brazendale, PhD, University of Central Florida
Co-Author - Denisse Lamas, Hispanic Family Counseling Inc
Active Play and Screen Time and Their Associations with Social-Emotional Development in Toddlerhood
Poster Number: E32Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health
Background: Moderate- and vigorous-intensity physical activity (MVPA) and screen use behaviors are key health behaviors for early childhood social-emotional development. Within a 24-hour movement framework, these behaviors may theoretically displace one another and are often assumed to cluster (e.g., higher physical activity with lower sedentary time). However, little is known about whether active play and screen media use develop interdependently or how these behaviors jointly influence social-emotional development in early childhood. This study examined (1) correlations between changes in daily MVPA and daily screen time and (2) the joint associations of changes in daily MVPA and daily screen time with social-emotional development from age 1.5 to 2.5 years.Methods: Participants were mother-toddler dyads from the longitudinal Child and Mother Physical Activity Study (CAMPAS) in the Chicago area. At children’s approximate ages of 1.5 and 2.5 years, physical activity was measured using ActiGraph accelerometers and screen time was parent-reported. Social-emotional functioning at age 2.5 years was assessed using the Strengths and Difficulties Questionnaire (SDQ). The correlation between 1-year changes in daily time spent in MVPA (minutes/day) and screen media use (minutes/day) was calculated. Multivariable linear regression models predicted SDQ scores at age 2.5 years, including annualized changes in screen time and MVPA as primary predictors, adjusting for age, sex, neighborhood resources, and baseline SDQ scores.Results: Analyses included 116 children (53% female) who completed the SDQ at age 2.5 years. From age 1.5 to 2.5 years, mean daily screen time increased from 43 (SD=46) to 69 minutes (SD=60), and mean daily MVPA increased from 72 (SD=22) to 90 minutes (SD=22). Longitudinal changes in daily screen time were not correlated with changes in daily MVPA (r=-0.08; p=0.42). A multivariable regression model estimated that a 30-minute annualized increase in daily screen time was associated with a 0.5-point higher SDQ total difficulty score (p=0.04), whereas a 30-minute annualized increase in daily MVPA was associated with a 1.0-point lower SDQ total difficulty score (p=0.04). Conclusion: These findings suggest that changes in physical activity are not necessarily displaced by increases in screen use during toddlerhood. Rather, increasing physical activity and minimizing screen exposure may exert independent and beneficial effects on social-emotional development. Toddlerhood may represent a sensitive developmental window for interventions that promote active play and reduce screen time to support healthy social-emotional functioning.
Keywords: Physical activity, Children's healthAuthors:
Presenter - Soyang Kwon, PhD, Northwestern University
Co-Author - Nidhi Gopagani, Northwestern University
Co-Author - Isabella Zylka, Northwestern University
Co-Author - Sarah Welch, Northwestern University
Playful Reframing and Engagement in Parenting (PREP): A Randomized Trial of a Novel Playful Parenting Intervention
Poster Number: E34Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Multiple Health Behavior Change
Background. Research over the past decade has documented playful parenting's positive effects on child social-cognitive development, emotional regulation, secure attachment, and reduced negativity and problem behaviors. Despite growth in caregiver-mediated interventions that coach caregivers in play facilitation, this field remains fragmented, with existing research focusing on isolated aspects, overlooking caregiver outcomes, and emphasizing play activities and contexts rather than transferable principles of playful engagement. This study introduces a novel intervention based on the Playful Reframing and Engagement in Parenting (PREP) framework, a new theoretical model integrating previously disparate perspectives into a unified multidimensional approach. The intervention provides targeted training across all PREP dimensions to equip caregivers with foundational competencies in playful parenting across everyday caregiving contexts.
Methods. Thirty-five caregiver-child dyads (children aged 3-5 years) were recruited through a community college parenting program and randomized to immediate intervention (two 2-hour workshops on consecutive Saturdays) or waitlist control. Data was collected at baseline, post-intervention (Week 3), and follow-up periods (Weeks 6 and 9), then analyzed using mixed-effects modeling controlling for baseline scores.
Results. Significant time×group interactions indicated sustained improvement on key outcomes. Notably, effect sizes revealed progressively increasing between-group differences in playful reframing skills, with groups beginning at similar levels and reaching large effect sizes by follow-up (Cohen's d = -.08, .42, 1.04, and 1.07 at weeks 0, 3, 6, and 9), favoring the experimental group. For parenting competence, the experimental group began below control levels but showed consistent improvement, ultimately exceeding controls by week-9 follow-up (Cohen's d = -1.41, -.93, -.29, and .34 at weeks 0, 3, 6, and 9).
Discussion. Findings support feasibility and early efficacy of the PREP-based intervention, demonstrating that playful parenting skills can be effectively cultivated through brief, targeted training. Progressive improvements in key outcomes suggest the intervention's potential for lasting behavioral change, providing a compelling model for comprehensive playful parenting training while demonstrating how integrating scientific perspectives drives innovation in family science.
Keywords: Parent-child transactions, InterventionsMethods. Thirty-five caregiver-child dyads (children aged 3-5 years) were recruited through a community college parenting program and randomized to immediate intervention (two 2-hour workshops on consecutive Saturdays) or waitlist control. Data was collected at baseline, post-intervention (Week 3), and follow-up periods (Weeks 6 and 9), then analyzed using mixed-effects modeling controlling for baseline scores.
Results. Significant time×group interactions indicated sustained improvement on key outcomes. Notably, effect sizes revealed progressively increasing between-group differences in playful reframing skills, with groups beginning at similar levels and reaching large effect sizes by follow-up (Cohen's d = -.08, .42, 1.04, and 1.07 at weeks 0, 3, 6, and 9), favoring the experimental group. For parenting competence, the experimental group began below control levels but showed consistent improvement, ultimately exceeding controls by week-9 follow-up (Cohen's d = -1.41, -.93, -.29, and .34 at weeks 0, 3, 6, and 9).
Discussion. Findings support feasibility and early efficacy of the PREP-based intervention, demonstrating that playful parenting skills can be effectively cultivated through brief, targeted training. Progressive improvements in key outcomes suggest the intervention's potential for lasting behavioral change, providing a compelling model for comprehensive playful parenting training while demonstrating how integrating scientific perspectives drives innovation in family science.
Authors:
Author - Xiangyou Shen, Oregon State University
Co-Author - Shauna Tominey, Oregon State University
Co-Author - Lawrence Cohen, Lawrence J. Cohen Psychological Services
Co-Author - Maayan Shorer, Ruppin Academic Center
Co-Author - Nazli Ozkoca, Oregon State University
Identifying Body Fat Percentage Thresholds for Cardiometabolic Risk in Adolescents
Poster Number: E35Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Cardiovascular Disease
Background: Childhood obesity is associated with a higher likelihood of several chronic diseases including heart disease and diabetes. Body Mass Index (BMI) is commonly used as a tool for determining obesity. However, BMI does not differentiate between fat mass and lean mass. Furthermore, the recent diagnostic criteria of clinical obesity state that excess adiposity should be confirmed by direct measurement.
Objective: The purpose of this study was to evaluate the predictive value of body fat percentage and fat mass index for cardiometabolic risk factors in adolescents.
Methods: A cross-sectional study was conducted on 335 participants (10-16 years). Measurements included body composition and cardiometabolic risk factors (triglycerides; high-density lipoprotein cholesterol; systolic/diastolic blood pressure; fasting glucose). Body composition was assessed using DEXA Scans. Body fat percentage and fat mass index (fat mass/height(m)2) were used in the analysis. Elevated risk was defined as having two or more abnormal cardiometabolic risk factors: triglycerides ≥110 mg/dL; high-density lipoprotein cholesterol < 40 mg/dL; systolic or diastolic blood pressure ≥ 90th percentile for age, sex, and height; and fasting glucose ≥ 100 mg/dL. Receiver operating characteristic analysis was used to examine the utility of body fat percentage and fat mass index to determine elevated cardiometabolic risk. Models were adjusted for age, sex, puberty status, and race.
Results: The mean age of the participants was 13.1 ±1.9 years. Eighteen percent of the sample had elevated cardiometabolic risk. ROC analyses indicated that body fat percentage and fat mass index had moderate accuracy to predict increased risk for a clustering of cardiometabolic risk factors (AUCs range from 0.77 to 0.86). Optimal cut points for identifying elevated cardiometabolic risk in girls were body fat percentage of 45.8% (<13 years) and 43.3% (≥13 years) and fat mass index of 10.5 kg/m2 (<13 years) and 7.9 kg/m2 (≥13 years). Optimal cut points for identifying elevated cardiometabolic risk in boys were body fat percentage of 28.4% (<13 years) and 26.9% (≥13 years) and fat mass index of 6.1 kg/m2 (<13 years) and 10.7 kg/m2 (≥13 years).
Conclusions: Thresholds identified in the current study allow clinicians to use body fat as an indicator of risk for chronic disease in adolescents.
Keywords: Cardiovascular disease, Children's healthObjective: The purpose of this study was to evaluate the predictive value of body fat percentage and fat mass index for cardiometabolic risk factors in adolescents.
Methods: A cross-sectional study was conducted on 335 participants (10-16 years). Measurements included body composition and cardiometabolic risk factors (triglycerides; high-density lipoprotein cholesterol; systolic/diastolic blood pressure; fasting glucose). Body composition was assessed using DEXA Scans. Body fat percentage and fat mass index (fat mass/height(m)2) were used in the analysis. Elevated risk was defined as having two or more abnormal cardiometabolic risk factors: triglycerides ≥110 mg/dL; high-density lipoprotein cholesterol < 40 mg/dL; systolic or diastolic blood pressure ≥ 90th percentile for age, sex, and height; and fasting glucose ≥ 100 mg/dL. Receiver operating characteristic analysis was used to examine the utility of body fat percentage and fat mass index to determine elevated cardiometabolic risk. Models were adjusted for age, sex, puberty status, and race.
Results: The mean age of the participants was 13.1 ±1.9 years. Eighteen percent of the sample had elevated cardiometabolic risk. ROC analyses indicated that body fat percentage and fat mass index had moderate accuracy to predict increased risk for a clustering of cardiometabolic risk factors (AUCs range from 0.77 to 0.86). Optimal cut points for identifying elevated cardiometabolic risk in girls were body fat percentage of 45.8% (<13 years) and 43.3% (≥13 years) and fat mass index of 10.5 kg/m2 (<13 years) and 7.9 kg/m2 (≥13 years). Optimal cut points for identifying elevated cardiometabolic risk in boys were body fat percentage of 28.4% (<13 years) and 26.9% (≥13 years) and fat mass index of 6.1 kg/m2 (<13 years) and 10.7 kg/m2 (≥13 years).
Conclusions: Thresholds identified in the current study allow clinicians to use body fat as an indicator of risk for chronic disease in adolescents.
Authors:
Author - Katherine Spring, PhD, Pennington Biomedical Research Center
Co-Author - Robbie Beyl, PhD, Pennington Biomedical Research Center
Co-Author - Stephanie Broyles, PhD, Pennington Biomedical Research Center
Co-Author - Catherine Champagne, PhD, RDN, LDN, FADA, Pennington Biomedical Research Center
Co-Author - Peter Katzmarzyk, PhD, Pennington Biomedical Research Center
Co-Author - Robert Newton, PhD, FSBM, Pennington Biomedical Research Center
Co-Author - Corby Martin, PhD, FTOS, Pennington Biomedical Research Center
Co-Author - Amanda Staiano, PhD, Pennington Biomedical Research Center
Distinct but Connected: Mental Health Trajectories among Latina Mother-Daughter Dyads
Poster Number: E36Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Mental Health
Background: Latino families in the U.S. experience psychosocial stressors linked to sociopolitical tensions, immigration-related fear, and anti-immigrant policies. These challenges elevate anxiety and depression in both adults and children, often resulting in emotional distress, behavioral issues, and school disengagement. Family Systems Theory highlights the connection between parent and child well-being. Examining bidirectional influences among Latina mother–daughter dyads provides an important lens for understanding cross-generational patterns of psychological functioning. Mental health symptoms affect key health behaviors such as physical activity, diet, and sleep, yet few studies have examined bidirectional associations in depression and anxiety among dyads in pre-adolescence.
Methods: This study analyzed data from Conmigo, a two-armed randomized controlled trial promoting physical activity and wellness in Latina mothers and daughters (N = 79 dyads, daughters aged 8–11 years). Dyads were randomly assigned to a 12-week intervention or delayed-control. Depression (PHQ-8) and anxiety (GAD-2) symptoms were assessed at baseline (M1) and post-intervention, 12 weeks later (M2). Actor-partner interdependence models were estimated with full information maximum likelihood for missing data and robust estimators for model assumptions. Each M2 outcome was regressed on individual and partner M1 scores and intervention status.
Results: Analyses included both intervention and control groups. Depressive symptoms were minimal (<5) to mild (5-9). Anxiety symptoms fell below the clinical cut-point of 3, indicating minimal anxiety. Significant actor effects emerged, with baseline depression and anxiety symptoms predicting an individual's own 12-week outcomes. No partner effects were detected, indicating that maternal symptoms did not significantly predict daughters’ mental health symptoms over time, or vice versa. Intervention status had no effect on these associations.
Conclusion: Findings suggest persistent individual symptom patterns and minimal cross-dyad effects at this developmental stage. Since psychological distress often persists within individuals over time, addressing individual psychological needs may reduce symptoms that could persist throughout the lifespan and within family systems. Integrating mental health support into health behavior and wellness programs may improve outcomes for Latina families facing ongoing psychosocial stress.
Keywords: Mental health, FamilyMethods: This study analyzed data from Conmigo, a two-armed randomized controlled trial promoting physical activity and wellness in Latina mothers and daughters (N = 79 dyads, daughters aged 8–11 years). Dyads were randomly assigned to a 12-week intervention or delayed-control. Depression (PHQ-8) and anxiety (GAD-2) symptoms were assessed at baseline (M1) and post-intervention, 12 weeks later (M2). Actor-partner interdependence models were estimated with full information maximum likelihood for missing data and robust estimators for model assumptions. Each M2 outcome was regressed on individual and partner M1 scores and intervention status.
Results: Analyses included both intervention and control groups. Depressive symptoms were minimal (<5) to mild (5-9). Anxiety symptoms fell below the clinical cut-point of 3, indicating minimal anxiety. Significant actor effects emerged, with baseline depression and anxiety symptoms predicting an individual's own 12-week outcomes. No partner effects were detected, indicating that maternal symptoms did not significantly predict daughters’ mental health symptoms over time, or vice versa. Intervention status had no effect on these associations.
Conclusion: Findings suggest persistent individual symptom patterns and minimal cross-dyad effects at this developmental stage. Since psychological distress often persists within individuals over time, addressing individual psychological needs may reduce symptoms that could persist throughout the lifespan and within family systems. Integrating mental health support into health behavior and wellness programs may improve outcomes for Latina families facing ongoing psychosocial stress.
Authors:
Author - Marisa Torres, San Diego State University/University of California San Diego
Co-Author - Diana Chagolla, MA, San Diego State University, Institute for Behavioral and Community Health
Co-Author - Jennifer Schneider, MPH, MA, San Diego State University Research Foundation - IBACH
Co-Author - Gretchen Bandoli, PhD, MPH, MBA , University of California San Diego
Co-Author - Scott Roesch, San Diego State University
Co-Author - Kathryn Derose, University of Massachusetts Amherst
Co-Author - Becky Marquez, PhD MPH, University of California San Diego
Co-Author - Guadalupe Ayala, PhD, MPH, San Diego State University
Co-Author - Elva Arredondo, PhD, FSBM, San Diego State University
Access to Foods in the Home and Dietary Motivation Predict Dietary Intake in Black Adolescents in the Families Improving Together (FIT) for Weight Loss Trial
Poster Number: E37Time: 05:00 PM - 05:50 PM
Topics: Child and Family Health, Social and Environmental Context and Health
Healthful eating habits (e.g., increased fruits/vegetables, decreased junk food and sugar sweetened beverages) are important for preventing chronic disease risk (e.g., obesity, Type 2 diabetes) and improving health in Black adolescents. This study uses a multi-system framework to examine intrapersonal, interpersonal, and macrolevel factors associated with daily dietary intake in Black adolescents with overweight and obesity. Baseline data was used from 241 Black adolescents who participated in the Families Improving Together (FIT) for Weight Loss trial (Mage=12.8 years, SD=1.8; 63% female; MBMI%=96.6, SD=4.3). Multi-system predictors were measured using validated adolescent self-reported surveys and included dietary motivation (intrapersonal), social support for diet from family (interpersonal), and access to food in the home (macrolevel). Dietary outcomes were measured using validated adolescent self-reported surveys (fruits, vegetables, junk food, sweetened beverages). Separate multiple linear regressions revealed several associations between multi-system factors and daily food intake. Results demonstrated that greater access to healthy foods was associated with increased vegetable intake (β=0.17, SE=0.79, p<0.05), whereas greater access to unhealthy foods was associated with increased fruit intake (β=0.30, SE=0.13, p<0.05). Greater access to unhealthy foods was associated with increased junk food intake (β=0.76, SE=0.09, p<.001), whereas increased self-reported dietary motivation was associated with decreased junk food intake (β=-0.24, SE=0.09, p<.05). Greater access to unhealthy foods (β=1.47, SE=0.23, p<.001) and higher adolescent BMI (β=0.79, SE=0.40, p<.05) was also associated with increased sugar-sweetened beverage consumption. These findings suggest that greater access to healthy foods in the home are associated with greater consumption of vegetables, while restricting access to unhealthy foods and increased motivation towards healthier eating were associated with reductions in unhealthy eating in Black adolescents. Interestingly, greater access to unhealthy foods in the home was associated with greater fruit intake, which may suggest greater access to less healthy fruit options, such as more sweetened and sugary fruit drinks. These findings may inform future health promotion programs across multiple-systems of dietary behaviors in Black youth with an emphasis on understanding the role of dietary motivation and access to foods in the home.
Keywords: Eating behaviors, Social ecologyAuthors:
Presenter - Taylor White, University of South Carolina
Co-Author - Sonali Tucker, University of South Carolina
Co-Author - Allison Sweeney, PhD, University of South Carolina
Co-Author - Dawn Wilson, PhD, University of South Carolina
Understanding Native Hawaiian and Pacific Islander Perspectives of a Community Resource for Diabetes Prevention
Poster Number: E38Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Diabetes
Diabetes affects Native Hawaiian and Pacific Islanders (NHPIs) at higher rates (~12-19% prevalence) than the general U.S. population (~9%). Utah's Salt Lake Valley is home to an estimated 29,500 NHPIs and could benefit from resources that address the community health needs of this population.
The Wellness Bus ('Bus') is a component of the Driving Out Diabetes Initiative at the University of Utah, providing diabetes-related screenings and referrals to community resources for health promotion and disease prevention. The Bus is intended to provide services for populations that experience disparities in metabolic health outcomes. However, there has been little research on NHPI use and perceptions of the Bus.
The purpose of this study was to determine the use of the Bus among NHPI community members over a 6-year period and determine potential facilitators and barriers to utilization.
A mixed-methods approach was used to track NHPI utilization, and perceptions, of the Bus as a local resource to address health promotion. Pragmatic Bus data, qualitative interviews with NHPI community leaders (n=8), and visits to the Bus by the first author to allow for an ethnographic experience were used to achieve the study purpose.
Between 2018 to 2024, annual NHPI visits ranged from 3 to 118, with 2021 recording the highest visit count. Notably, this peak coincided with the Embrace Project—a program focused on the health of minority women, particularly NHPI women—implemented in partnership with the Utah Department of Health and Human Services Office of Health Equity, the Bus, and several community-based organizations.
Comparative and thematic analysis of interviews and Bus visits resulted in 4 themes—Awareness and Accessibility, Communication and Outreach, Cultural Perceptions and Trust, and Past Experiences and Recommendations. Awareness, communications, mistrust, and negative experiences with health care underly the lack of engagement from NHPIs. Ethnographic perspectives identified needs such as strengthening connections with NHPI community-based organizations, increased use of community-based channels and integration of the Bus into community events, and enhancement of cultural competency.
These findings suggest that when the Bus engages NHPI communities through culturally-tailored initiatives, engagement from NHPI community members considerably increases.
Keywords: Diabetes, CultureThe Wellness Bus ('Bus') is a component of the Driving Out Diabetes Initiative at the University of Utah, providing diabetes-related screenings and referrals to community resources for health promotion and disease prevention. The Bus is intended to provide services for populations that experience disparities in metabolic health outcomes. However, there has been little research on NHPI use and perceptions of the Bus.
The purpose of this study was to determine the use of the Bus among NHPI community members over a 6-year period and determine potential facilitators and barriers to utilization.
A mixed-methods approach was used to track NHPI utilization, and perceptions, of the Bus as a local resource to address health promotion. Pragmatic Bus data, qualitative interviews with NHPI community leaders (n=8), and visits to the Bus by the first author to allow for an ethnographic experience were used to achieve the study purpose.
Between 2018 to 2024, annual NHPI visits ranged from 3 to 118, with 2021 recording the highest visit count. Notably, this peak coincided with the Embrace Project—a program focused on the health of minority women, particularly NHPI women—implemented in partnership with the Utah Department of Health and Human Services Office of Health Equity, the Bus, and several community-based organizations.
Comparative and thematic analysis of interviews and Bus visits resulted in 4 themes—Awareness and Accessibility, Communication and Outreach, Cultural Perceptions and Trust, and Past Experiences and Recommendations. Awareness, communications, mistrust, and negative experiences with health care underly the lack of engagement from NHPIs. Ethnographic perspectives identified needs such as strengthening connections with NHPI community-based organizations, increased use of community-based channels and integration of the Bus into community events, and enhancement of cultural competency.
These findings suggest that when the Bus engages NHPI communities through culturally-tailored initiatives, engagement from NHPI community members considerably increases.
Authors:
Author - Onosai Fonoti, University of Utah
Author - Paul Estabrooks, PhD, University of Utah
Culturally Relevant Community Connections (C3) to Increase COVID-19 Testing in Black Communities: Findings from the RADx-UP CDCC Rapid Research Pilot Program
Poster Number: E39Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Decision Making
COVID-19 has disproportionately impacted Black communities where structural inequities and medical mistrust limit engagement in prevention strategies. Trusted venues such as salons and barbershops offer opportunities to deliver culturally grounded interventions. To evaluate the effectiveness of the Culturally Relevant Community Connections (C3) intervention in increasing COVID-19 testing among Black/African American adult participants (N=327) were recruited from two salons and three barbershops in North Carolina. All participants engaged with community opinion leaders who received a 2-hr training on COVID-19 testing, treatments, and community impact. Participants viewed culturally tailored edutainment videos focused on COVID-19’s impact and visualizing testing instructions. Participants were then offered an on-site COVID-19 test (Test 1) and, if completed, received a take-home test to complete within 48 hours (Test 2). Surveys included the validated COVID-19 Testing Decision-Making Scale (CTDMS) and Video Feedback Scale (VFS). Logistic regression models examined associations between scale scores and testing uptake. Primary models tested unadjusted associations consistent with study aims; secondary models adjusted for age and gender to assess robustness. Overall, 22.3% (n=73) completed Test 1 and 2.7% (n=9) completed Test 2. In unadjusted models, higher CTDMS General Sentiment (OR=1.81, 95% CI [1.35-2.41], p<.001) and Practical Support scores (OR=1.69, 95% CI [1.19-2.40], p=.003) predicted initial test uptake. Higher VFS total scores also predicted Test 1 uptake (OR=3.54, 95% CI [2.01-6.21], p<.001) and Test 2 completion (OR=11.01, 95% CI [1.27-95.17], p=.029), though the Test 2 model was unstable given the small sample (n=9). In age- and gender-adjusted models, General Sentiment and VFS remained significant predictors, while Practical Support attenuated to non-significance. The C3 intervention, grounded in community trust and cultural tailoring, demonstrated effectiveness in promoting COVID-19 testing uptake. Validated measures (CTDMS, VFS) provided critical insights into individual- and community-level predictors of engagement. Reporting both unadjusted and minimally adjusted models underscores the robustness of General Sentiment and VFS as predictors while balancing clarity and rigor. Findings highlight the potential for sustainable, community-driven approaches to advance health equity beyond COVID-19.
Keywords: Community intervention, CultureAuthors:
Co-Author - Schenita Randolph, PhD, MPH, RN, FAAN, Duke University School of Nursing
Co-Author - Elizabeth Jeter, PHD, Duke University School of Nursing
Co-Author - Ragan Johnson, DNP, FNP-BC, CNE, Duke University School of Nursing
Co-Author - Maralis Emerson, MPH, Duke University School of Nursing
Beyond 24 Hours: Day-to-Day Links Between Affect and Movement Activities in Older Adults
Poster Number: E4Time: 05:00 PM - 05:50 PM
Topics: Aging, Digital Health
Background. Many studies emphasize between-person associations of affect and movement activities in older adults to inform active lifestyle promotion, while ecological momentary assessment (EMA) offers additional insight into within-person and reciprocal associations using repeated measured data. This study explores the temporal and reciprocal associations between affective and movement activity dynamics in older adults’ daily life.
Methods. This EMA study included 103 participants (aged 60 years or older). Participants wore an activPAL for 14 consecutive days to objectively measure time spent in sedentary behavior, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and steps. Smartphone-based EMA surveys assessed affective valance & activation, and various domains of affect (loneliness, pain, tiredness, anxiety, or composite negative affects). The Random Intercept Cross-Lagged Panel Model (RI-CLPM) examined the dynamic associations, adjusting for age, sex, and BMI.
Results. The results showed that higher-than-usual affect activation (β=0.001, p=0.044) was associated
with more sedentary time the same day, whereas with more-than-usual sedentary time was associated with higher activation the same day (β=5.008, p =0.022). Moreover, higher-than-usual prior-day pain (β= −0.005, p =0.024), tiredness (β= −0.003, p=0.040), and negative affect (β= −0.005, p=0.037) were associated with lower steps next day. Conversely, more-than-usual prior-day sedentary time was associated with lower tiredness (β= −4.909, p=0.045) and loneliness (β= −4.398, p=0.031) next day. Lastly, more-than-usual prior-day MVPA time was associated with higher anxiety next day (β=10.14, p<0.001). The only significant positive between-person association was loneliness and next-day sedentary time (β=1.10, p=0.018).
Conclusion. The observed within-person temporal associations between sedentary time and affect activation are bidirectional across days, but the within-person temporal associations between negative affect and activities are asymmetric. Given that older adults engage in varied structured and unstructured activities from day-to-day, the mixed directionality of associations reflects the inherent complexity of studying everyday health behaviors and outcomes. Future EMA research is needed to better characterize the dynamic associations of lifestyle behaviors and mental health outcomes in older adults.
Keywords: Tele-health, AgingMethods. This EMA study included 103 participants (aged 60 years or older). Participants wore an activPAL for 14 consecutive days to objectively measure time spent in sedentary behavior, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and steps. Smartphone-based EMA surveys assessed affective valance & activation, and various domains of affect (loneliness, pain, tiredness, anxiety, or composite negative affects). The Random Intercept Cross-Lagged Panel Model (RI-CLPM) examined the dynamic associations, adjusting for age, sex, and BMI.
Results. The results showed that higher-than-usual affect activation (β=0.001, p=0.044) was associated
with more sedentary time the same day, whereas with more-than-usual sedentary time was associated with higher activation the same day (β=5.008, p =0.022). Moreover, higher-than-usual prior-day pain (β= −0.005, p =0.024), tiredness (β= −0.003, p=0.040), and negative affect (β= −0.005, p=0.037) were associated with lower steps next day. Conversely, more-than-usual prior-day sedentary time was associated with lower tiredness (β= −4.909, p=0.045) and loneliness (β= −4.398, p=0.031) next day. Lastly, more-than-usual prior-day MVPA time was associated with higher anxiety next day (β=10.14, p<0.001). The only significant positive between-person association was loneliness and next-day sedentary time (β=1.10, p=0.018).
Conclusion. The observed within-person temporal associations between sedentary time and affect activation are bidirectional across days, but the within-person temporal associations between negative affect and activities are asymmetric. Given that older adults engage in varied structured and unstructured activities from day-to-day, the mixed directionality of associations reflects the inherent complexity of studying everyday health behaviors and outcomes. Future EMA research is needed to better characterize the dynamic associations of lifestyle behaviors and mental health outcomes in older adults.
Authors:
Author - Chih-Liang Wang, Exercise Science, University of South Carolina
Author - Jongwon Lee, M.P.H, University of South Carolina
Author - Halle Prine, University of South Carolina
Author - Kailyn Horn, DPT, University of South Carolina
Author - Scott Jamieson, The University of South Carolina
Author - Christine Pellegrini, PhD, FSBM, University of South Carolina
Author - Chih-Hsiang Yang, University of South Carolina
Assessing health outcomes for women participating in a farm-based job training program for women facing homelessness.
Poster Number: E40Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Multiple Health Behavior Change
Introduction: Homelessness is a complex issue with significant health equity implications. Experiences of homelessness are gendered and racialized and those with intersecting marginalized identities are particularly likely to experience homelessness and to develop significant comorbidities. One innovative method to address the needs of people facing homelessness is farm-based programs, though research on outcomes is lacking. One of these innovative programs is The Green Team (GT), which is a 16-week organic farm-based job training program with case management, that is designed exclusively for female-identifying individuals. The primary purpose of this study is to determine health, behavioral, and social outcomes for women participating in the GT. This is done by assessing changes in behavioral and psychosocial outcomes, healthful food consumption, and understanding changes in participants' perceptions of and capacity to obtain basic needs. Methods: This is a mixed-method community engaged study using an Integrated Research Practice Partnership approach comprised of researchers from the University of Utah and its mobile health unit, The Wellness Bus (WB), and practice partners from GT staff. This abstract presents initial results from semi-structured interviews and focus groups conducted near the start and end of GT cohorts to descriptively examine participants’ self-defined health-related barriers and facilitators. Results: Initial themes highlight the salience of individuals’ health-related barriers, such as contextual circumstances and experiences that impact their access to resources, sense of self, and self-efficacy. Health-related facilitators include GT strategies to promote resource access, social support, and individualized adaptive self-management strategies such as and goal setting. A 63-year-old participant had an exemplary statement, “They make sure that we eat good and feel good about ourselves….That makes a big difference….Because I was told negative things my entire life,” and “I rode my bike three times this week, because that was one of my goals….I hadn't been on a bike in 45 years.” Homeless service systems are generally not informed by the self-defined needs and priorities of service users. Findings may provide practice-relevant evidence regarding female-identifying individuals’ perspectives of how person-centered approaches and practices influence health behaviors and health equity as they navigate homeless and -adjacent services.
Keywords: Health disparities, Women's healthAuthors:
Presenter - Shannon Jones, Assistant Professor (Clinical), University of Utah
Co-Author - Alexandra Hernandez, Program Manager, The Wellness Bus, University of Utah
Co-Author - Jackie Rodabaugh, Green Team Progam Director, Wasatch Community Gardens
Co-Author - Jenifer Cornish, Green Team Case Manager, Wasatch Community Gardens
Co-Author - Amber Alvey, Green Team Farm Manager, Wasatch Community Gardens
Co-Author - James Loomis, Director of Agricultural Operations, Wasatch Community Gardens
Co-Author - Paul Estabrooks, Professor, University of Utah
Engagement Strategies for Non-White Populations in Genomic Research: Barriers and Lessons Learned – A Scoping Review
Poster Number: E41Time: 05:00 PM - 05:50 PM
Topics: Community Engagement, Health Disparities
Background: The underrepresentation of non-white populations in genomic research has contributed to a limited understanding of genetic differences among diverse ethnic and racial groups. Strategies that address the concerns of these communities are essential for enhancing participation and diversity in genomic research. This review explores the barriers and facilitators of effective engagement of non-white populations in genomic research.
Methods: A systematic search was conducted across multiple databases to identify empirical studies, encompassing qualitative, quantitative, and mixed-methods research, as well as reviews published in the English language. Studies were included if they focused on strategies for engaging non-white populations in genomic research settings, which included community-based, clinical, or academic environments. Articles were excluded if they did not discuss engagement strategies, did not emphasize recruiting non-white populations, or were not empirical studies. Results: A total of 55 studies were included in the review, with sample sizes ranging from 11 to over 13,000 participants. The review summarized various strategies employed in the studies, the barriers encountered, and the strategies and solutions recommended by study participants. Most studies reported that personalized outreach, such as using family connectors and community champions and establishing community-based partnerships, was considered the most effective and well-received approach. Barriers faced by researchers and those raised by participants were also presented. The obstacles that participants reported most frequently included cultural mistrust, a lack of awareness, and historical concerns related to medical research. Furthermore, lessons learned were presented, focusing on practical approaches to enhance engagement in genomic research with non-white populations and how these strategies can be refined.
Conclusion: This review highlights key strategies and challenges for engaging underrepresented populations in genomic research, providing approaches that consider the unique cultural experiences and values of diverse communities. The findings provide valuable insights for enhancing inclusivity in genomic research and can inform researchers’ future efforts to overcome participation barriers.
Keywords: Genetics, DiversityMethods: A systematic search was conducted across multiple databases to identify empirical studies, encompassing qualitative, quantitative, and mixed-methods research, as well as reviews published in the English language. Studies were included if they focused on strategies for engaging non-white populations in genomic research settings, which included community-based, clinical, or academic environments. Articles were excluded if they did not discuss engagement strategies, did not emphasize recruiting non-white populations, or were not empirical studies. Results: A total of 55 studies were included in the review, with sample sizes ranging from 11 to over 13,000 participants. The review summarized various strategies employed in the studies, the barriers encountered, and the strategies and solutions recommended by study participants. Most studies reported that personalized outreach, such as using family connectors and community champions and establishing community-based partnerships, was considered the most effective and well-received approach. Barriers faced by researchers and those raised by participants were also presented. The obstacles that participants reported most frequently included cultural mistrust, a lack of awareness, and historical concerns related to medical research. Furthermore, lessons learned were presented, focusing on practical approaches to enhance engagement in genomic research with non-white populations and how these strategies can be refined.
Conclusion: This review highlights key strategies and challenges for engaging underrepresented populations in genomic research, providing approaches that consider the unique cultural experiences and values of diverse communities. The findings provide valuable insights for enhancing inclusivity in genomic research and can inform researchers’ future efforts to overcome participation barriers.
Authors:
Author - Judith Mwobobia, Washington University in St Louis
Co-Author - Ashley Nurse, Yale University
Co-Author - Michelle Doering, Washington University in St Louis
Co-Author - Maame-Owusua Boateng, Yale University
Co-Author - Imani Myton, Washington University in St Louis
Co-Author - Omar Guerrero, Yale University
Co-Author - Nautica Alexander, Washington University in St Louis
Co-Author - Chelsey Carter, PhD, Yale University
Co-Author - Brett Maricque, PhD, Washington University in St Louis
Understanding healthcare professional perspectives around supporting decision-making in patients with amyotrophic lateral sclerosis
Poster Number: E42Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Aging
Background: Decision-making in amyotrophic lateral sclerosis (ALS) is complex as patients must make multiple preference-sensitive decisions quickly throughout the disease trajectory. While early intervention is encouraged, management of bulbar (speech and swallowing) problems is often delayed. Previous studies examining healthcare professional (HCP) perspectives for decision-making has focused on identifying perceived barriers and facilitators, including lack of comprehensive access to information, lack of time, and patients’ difficulties with accepting their disease. However, literature is limited regarding how HCPs are supporting patients with decision-making within the context of bulbar symptom management at a multidisciplinary ALS clinic, and their needs in this area.
Methods: We conducted an interpretive, descriptive qualitative study to understand healthcare professionals’ experiences and needs with supporting patients with ALS with making decisions for bulbar symptom management at a multidisciplinary ALS clinic. We interviewed HCPs (i.e., neurologists and Speech-Language Pathologists) who were involved with bulbar symptom management. Participants were eligible if they had at least 2 years of experience working with patients with ALS in a multidisciplinary ALS clinic. Reflexive thematic analysis was used to analyze study data. Recruitment ceased when information power was reached.
Results: Seven interviews were completed (4 neurologists and 3 Speech-Language Pathologists). We identified three themes regarding HCPs’ approach to supporting patients with decision-making: (1) Decision approach changed depending on perceived difficulty across [continuum of difficulty for bulbar-related decisions; (2) Informational support based on patient’s perception of bulbar management needs; and (3) Decision support focused on supporting informed decisions. We also identified two themes for HCPs’ needs: (1) providing educational resources about bulbar symptom management in advance and (2) streamlining the decision-making process.
Conclusion: HCPs had difficulty supporting patients who were not ready to engage in decision-making conversations, emphasizing the need for informational and practical supports with decision-making. There is a need to provide HCPs in the multidisciplinary ALS clinic with decision supports that can facilitate early and timely decision-making for patients with ALS.
Keywords: Decision making, Clinical applicationsMethods: We conducted an interpretive, descriptive qualitative study to understand healthcare professionals’ experiences and needs with supporting patients with ALS with making decisions for bulbar symptom management at a multidisciplinary ALS clinic. We interviewed HCPs (i.e., neurologists and Speech-Language Pathologists) who were involved with bulbar symptom management. Participants were eligible if they had at least 2 years of experience working with patients with ALS in a multidisciplinary ALS clinic. Reflexive thematic analysis was used to analyze study data. Recruitment ceased when information power was reached.
Results: Seven interviews were completed (4 neurologists and 3 Speech-Language Pathologists). We identified three themes regarding HCPs’ approach to supporting patients with decision-making: (1) Decision approach changed depending on perceived difficulty across [continuum of difficulty for bulbar-related decisions; (2) Informational support based on patient’s perception of bulbar management needs; and (3) Decision support focused on supporting informed decisions. We also identified two themes for HCPs’ needs: (1) providing educational resources about bulbar symptom management in advance and (2) streamlining the decision-making process.
Conclusion: HCPs had difficulty supporting patients who were not ready to engage in decision-making conversations, emphasizing the need for informational and practical supports with decision-making. There is a need to provide HCPs in the multidisciplinary ALS clinic with decision supports that can facilitate early and timely decision-making for patients with ALS.
Authors:
Author - Anna Huynh, MHSc, University of Toronto
Co-Author - Lisa Cranley, RN, PhD, University of Toronto
Co-Author - Carolina Barnett-Tapia, MD, PhD, University of Toronto
Co-Author - Lorne Zinman, MD, MSc, University of Toronto
Co-Author - Yana Yunusova, PhD, University of Toronto
Women want to be informed about the harms and benefits of screening even after learning that the 2024 USPSTF recommends breast cancer screening for all women in their 40s.
Poster Number: E43Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Cancer
Introduction: In 2024 the United States Preventive Services Task Force (USPSTF) revised its breast cancer screening (BCS) guidelines to recommend that all women screen biennially from age 40-74. This contrasted with the USPSTF’s prior recommendation that women ages 40-49 engage in informed decision-making to determine when to begin BCS prior to age 50. We investigated how communicating information about the new guideline affected women’s screening preferences and their beliefs about what information women should be told before screening.
Methods: This study included 301 women, ages 39-49, who were previously enrolled in an ongoing longitudinal study in which they were exposed to a decision aid informing them about BCS harms and benefits and the 2009 Task Force recommendation. Participants completed an online survey during which they received an informational intervention about the 2024 Task Force recommendation. Outcomes included screening preferences pre- and post-intervention and beliefs about what information is important to receive prior to getting screened assessed on a 1=not at all important to 4=very important scale.
Results: Information about the new guideline influenced participants’ screening preferences. At post-intervention (compared with pre-intervention) participants were more likely to want to screen at their current age (86% vs 81%; p <0.001) and biennially thereafter (45% vs 33%; p<0.001). Participants believed it was important for women to be informed about the benefits of screening (M=3.77), their personal risk of breast cancer (M=3.75), and how often screening benefits occur (M=3.74). Participants also believed it was important to be informed about overdiagnosis (M=3.48) and false positives (M=3.61).
Conclusions: Being informed about the 2024 USPSTF mammography guidelines shifted screening preferences to be consistent with the new guideline. Even though the new guideline deemphasizes informed decision-making, women still wanted to be informed about BCS harms and benefits, as well as their personal cancer risk. Ensuring that women are provided with complete and comprehensive screening information may foster an environment for adherence to screening recommendations, while also leaving space for individual autonomy.
Keywords: Cancer screening, CancerMethods: This study included 301 women, ages 39-49, who were previously enrolled in an ongoing longitudinal study in which they were exposed to a decision aid informing them about BCS harms and benefits and the 2009 Task Force recommendation. Participants completed an online survey during which they received an informational intervention about the 2024 Task Force recommendation. Outcomes included screening preferences pre- and post-intervention and beliefs about what information is important to receive prior to getting screened assessed on a 1=not at all important to 4=very important scale.
Results: Information about the new guideline influenced participants’ screening preferences. At post-intervention (compared with pre-intervention) participants were more likely to want to screen at their current age (86% vs 81%; p <0.001) and biennially thereafter (45% vs 33%; p<0.001). Participants believed it was important for women to be informed about the benefits of screening (M=3.77), their personal risk of breast cancer (M=3.75), and how often screening benefits occur (M=3.74). Participants also believed it was important to be informed about overdiagnosis (M=3.48) and false positives (M=3.61).
Conclusions: Being informed about the 2024 USPSTF mammography guidelines shifted screening preferences to be consistent with the new guideline. Even though the new guideline deemphasizes informed decision-making, women still wanted to be informed about BCS harms and benefits, as well as their personal cancer risk. Ensuring that women are provided with complete and comprehensive screening information may foster an environment for adherence to screening recommendations, while also leaving space for individual autonomy.
Authors:
Author - Tamar Parmet, MSW, University of Colorado Denver
Author - Grant Yoder, MEd, Universtity of Colorado Anschutz Medical Campus
Author - Kirsten McCaffery, PhD, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Author - Jolyn Hersch, PhD, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Author - Marilyn M. Schapira, MD, Department of Medicine University of Pennsylvania, Philadelphia PA, USA
Author - Carmen L. Lewis, MD, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
Author - Joseph Cappella, PhD, University of Pennsylvania
Author - Channing Tate, PhD, MPH, University of Colorado Anschutz
Author - Brad Morse, PhD, University of Colorado Anschutz Medical Campus
Author - Laura Scherer, PhD, University of Colorado, Anschutz Medical Campus
Evaluating Medical Students’ Skill in Assessment of Medication Adherence
Poster Number: E44Time: 05:00 PM - 05:50 PM
Topics: Decision Making, Social and Environmental Context and Health
Background: Medication nonadherence contributes to increased morbidity, mortality, and costs. Physicians play a vital role in addressing nonadherence, yet discussions about adherence in clinical practice are often inadequate. Little is known about medical students' skill in identifying nonadherence. Aims: To examine medical students’ intention to assess patient medication nonadherence and skill in recognizing nonadherence. Secondarily, guided by social cognitive models, we examined whether self-efficacy (SE) and outcome expectancy (OE) were associated with behavioral intention (BI) to assess for nonadherence, and whether SE and BI were linked to nonadherence assessment skill. We hypothesized that SE and OE would be associated with BI to assess for nonadherence, and that SE and BI would be associated with skill in nonadherence assessment. Method: 409 medical students from 51 institutions (69% Women; 42% non-White) participated. Participants were recruited via emails distributed to all accredited MD and DO medical schools in the U.S. Participants responded to questions about a standardized patient vignette depicting a medical follow-up appointment for a patient recently diagnosed with hypertension. Participants also rated their SE, OE, and BI related to their own medication nonadherence assessment skills. Results: Despite 66% of participants reporting high intention to assess for nonadherence clinically, only 33% actually identified medication adherence as a relevant domain for follow-up in the vignette. Rates of nonadherence assessment among students were comparable to those of physicians documented in past research, z = 1.50, p = .133]. OE (β = 0.29, 95% CI [0.236, 0.487]) and SE (β = 0.45, 95% CI [0.381, 0.651]) were associated with intention to routinely assess adherence in clinical practice. Although SE was modestly associated with student skill in identifying nonadherence (OR = 1.07, 95% CI [1.01, 1.14]), BI was not (OR = 1.004, 95% CI [0.96, 1.06]). Discussion: Two-thirds of students did not identify adherence as a domain warranting clinical follow-up, highlighting the importance of education on routine screening for nonadherence. SE was correlated with both BI and skill in identifying nonadherence as a relevant follow-up domain, and may be a useful target for educational interventions aimed at improving adherence assessment skills.
Keywords: Compliance, Outcome expectationsAuthors:
Presenter - L. Sophia Rintell, MS, Rosalind Franklin University of Medicine and Science
Co-Author - Erin Flynn, BA, Rosalind Franklin University of Medicine and Science
Co-Author - Sara Lampert-Okin, MS, Cincinnati Children's Hospital
Co-Author - Petula Walsh-Grant, BA, Rosalind Franklin University of Medicine and Science
Co-Author - Emma Gaydos, BA, Rosalind Franklin University of Medicine and Science
Co-Author - Jeanette Morrison, MD, Rosalind Franklin University of Medicine and Science
Co-Author - Rachel Greenley, PhD, Rosalind Franklin University of Medicine & Science
Preliminary Analysis of Eating-Based Protective Behavioral Strategies Specifically Designed for Diabetes
Poster Number: E45Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Multiple Health Behavior Change
Background: Diabetes and prediabetes are a chronic health crisis among U.S. adults, and studies have shown their strong links with mortality. Studies suggest the number of cases will continue to increase in the next couple of decades. Healthy eating is an important behavior for the self-management of diabetes. However, despite the known positive health benefits of these behaviors, many adults continue to engage in poor eating habits. Protective behavioral strategies (PBS) are specific actions that may be taken to reduce harm from risky behaviors. They have proven effective when used to manage alcohol and substance use but have not been studied in populations with diabetes. One of the aims of this study was to develop and test the psychometric properties of a measure of protective behavioral strategies designed specifically for diabetes.
Method: Individuals with diabetes were invited to complete a survey asking various questions regarding their eating habits, behaviors, attitudes, and intentions. A total of 272 participants completed a survey containing the Eating-Based PBS Use & Intentions measure, Perceived Diabetes Self-Management Scale, Food Cravings Questionnaire, and Eating Behavior Pattern Questionnaire. The associations between these measures were explored through Pearson correlations.
Findings: Participants were on average 51.7 years old (SD = 13.548). Most identified as female (N = 167) and 71% identified as White. 79.5% had been diagnosed with type 2 diabetes and 47.6% had been living with their diabetes for over 10 years. The Eating-Based PBS Use & Intentions measure was significantly correlated with the Perceived Diabetes Self-Management Scale (r = 0.34; p <.001 and r = 0.21; p <.001). There were no significant correlations found between the Eating PBS measure and other measures. This finding demonstrates the importance of interventions and assessments being developed with specific consideration of the different eating behaviors of this population.
Conclusion: Overall, protective behavioral strategies designed specifically for diabetes may be an effective way of looking at health behaviors in this population. The validity and reliability of this newly developed measure will need to be ascertained through future studies that can assess its overall performance.
Keywords: Eating behaviors, Health behaviorsMethod: Individuals with diabetes were invited to complete a survey asking various questions regarding their eating habits, behaviors, attitudes, and intentions. A total of 272 participants completed a survey containing the Eating-Based PBS Use & Intentions measure, Perceived Diabetes Self-Management Scale, Food Cravings Questionnaire, and Eating Behavior Pattern Questionnaire. The associations between these measures were explored through Pearson correlations.
Findings: Participants were on average 51.7 years old (SD = 13.548). Most identified as female (N = 167) and 71% identified as White. 79.5% had been diagnosed with type 2 diabetes and 47.6% had been living with their diabetes for over 10 years. The Eating-Based PBS Use & Intentions measure was significantly correlated with the Perceived Diabetes Self-Management Scale (r = 0.34; p <.001 and r = 0.21; p <.001). There were no significant correlations found between the Eating PBS measure and other measures. This finding demonstrates the importance of interventions and assessments being developed with specific consideration of the different eating behaviors of this population.
Conclusion: Overall, protective behavioral strategies designed specifically for diabetes may be an effective way of looking at health behaviors in this population. The validity and reliability of this newly developed measure will need to be ascertained through future studies that can assess its overall performance.
Authors:
Author - Nicte Donis, B.S., Texas A&M University
Co-Author - Vishaka Kalra, MPH, Texas A&M University
Co-Author - Valentina Foinquinos, B.S., Texas A&M University
Co-Author - Jiulin Dai, B.S., Texas A&M University
Co-Author - Sherecce Fields, PhD, Texas A&M University
Co-Author - Rachel Smallman, PhD, Texas A&M University
Ethnic Differences in Continuous Glucose Monitoring among Emerging Adults with Type 1 Diabetes: Use, User Behaviors and Attitudes
Poster Number: E46Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Health Disparities
Objectives: Continuous glucose monitoring (CGM) is associated with improved diabetes outcomes among people with type 1 diabetes (PWD), but CGM use is low among Hispanic vs non-Hispanic White (NHW) and emerging adult PWDs. Ethnic differences are often attributed to differential access, with limited research on disparities once on CGM. We examined if there are ethnic differences in CGM use, as well as user behavior and attitudes once on CGM, in a diverse sample of emerging adults. We also examined if ethnicity moderates relationships of CGM use, user attitudes and behaviors with diabetes outcomes.
Methods: PWDs (ages 18-24; N=219; 64.8% NHW; 53.4% female) completed baseline surveys and HbA1c kits during an ongoing clinical trial. PWDs reported CGM use, use duration, CGM breaks, days worn in past month, checking and responding to out-of-range alarms, user satisfaction, and CGM barriers (glucose monitoring and social complications). Outcomes included self-care behaviors, HbA1c, and diabetes distress. Health insurance status (public or no insurance vs private) was covaried in all analyses.
Results: Hispanic PWDs were less likely than NHW PWDs to be using CGM (p<.005) and had been for a shorter time (p<.001; 11.7% of Hispanic PWDs duration of use > 4 years vs. 41.5% for NHW PWDs), but they did not differ on CGM user behaviors, satisfaction or barriers (p values>.05). Replicating an earlier report from the same study, CGM use and more frequent/consistent user behaviors were related to lower HbA1c, higher satisfaction and fewer barriers were related to lower distress, and more frequent checking/responding was related to higher self-care (p values<.05). Ethnicity did not moderate these links. Ethnicity only moderated the relationship of CGM use duration with diabetes distress (p=.05); Hispanic PWDs had a non-significant positive association of CGM duration with distress, while NHW PWDs had a non-significant negative association between these variables.
Conclusion: Ethnic disparities exist in who is using CGM and for how long, but not in how emerging adults use, perceive, or benefit from CGM once they initiate use. Ethnic differences in how CGM duration is linked to distress needs to be replicated and explored to identify potential sources of distress. Understanding and addressing factors that limit or delay CGM use across ethnicity remains a high priority.
Keywords: Diabetes, Ethnic differencesMethods: PWDs (ages 18-24; N=219; 64.8% NHW; 53.4% female) completed baseline surveys and HbA1c kits during an ongoing clinical trial. PWDs reported CGM use, use duration, CGM breaks, days worn in past month, checking and responding to out-of-range alarms, user satisfaction, and CGM barriers (glucose monitoring and social complications). Outcomes included self-care behaviors, HbA1c, and diabetes distress. Health insurance status (public or no insurance vs private) was covaried in all analyses.
Results: Hispanic PWDs were less likely than NHW PWDs to be using CGM (p<.005) and had been for a shorter time (p<.001; 11.7% of Hispanic PWDs duration of use > 4 years vs. 41.5% for NHW PWDs), but they did not differ on CGM user behaviors, satisfaction or barriers (p values>.05). Replicating an earlier report from the same study, CGM use and more frequent/consistent user behaviors were related to lower HbA1c, higher satisfaction and fewer barriers were related to lower distress, and more frequent checking/responding was related to higher self-care (p values<.05). Ethnicity did not moderate these links. Ethnicity only moderated the relationship of CGM use duration with diabetes distress (p=.05); Hispanic PWDs had a non-significant positive association of CGM duration with distress, while NHW PWDs had a non-significant negative association between these variables.
Conclusion: Ethnic disparities exist in who is using CGM and for how long, but not in how emerging adults use, perceive, or benefit from CGM once they initiate use. Ethnic differences in how CGM duration is linked to distress needs to be replicated and explored to identify potential sources of distress. Understanding and addressing factors that limit or delay CGM use across ethnicity remains a high priority.
Authors:
Author - Emily Ellis, University of California, Merced
Co-Author - Deborah Wiebe, PhD, MPH, FSBM, University of California, Merced
Co-Author - Charlie Coward, University of California, Merced
Co-Author - Cynthia Berg, PhD, FSBM, University of Utah
Co-Author - Jennifer Raymond, MD, Children's Hospital of Los Angeles
Co-Author - Lindsay Mayberry, PhD, FSBM, Vanderbilt University Medical Center
Effectiveness of mHealth Interventions Incorporating Behavioral Change Techniques: A Systematic Review
Poster Number: E47Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Digital Health
Introduction: Diabetes is one of the most prevalent chronic diseases worldwide. People with diabetes face numerous challenges, as self-management requires a series of daily behaviors to control their blood sugar. Diabetes mHealth or “Mobile health” interventions may help alleviate some self-management burdens. These interventions provide individuals with diabetes a more personalized and cost-effective experience, making it important to understand the most effective behavioral change techniques. Behavior Change Techniques (BCT’s) include techniques such as goal setting, tracking one's progress, personalized feedback, social support, receiving reminders and rewards. Methods: This review synthesized data from 29 studies between the years of 2020 and 2024. These use a variety of mobile health programs for patients with Type 1, 2, or gestational diabetes. Inclusion criteria included randomized controlled trials with a mobile application and HbA1c as an outcome variable. Overall, the studies revealed that use of mobile health apps led to lowered HbA1c. The most effective programs were ones that combined several strategies into one intervention. Results: Across the interventions, there was a consistent decrease in HbA1c, with some improvements in weight, blood pressure, and psychological well-being. The interventions that emphasized goal setting and planning showed greater improvement than interventions focused on diet and physical activity. The interventions that incorporated device-based feedback and self-monitoring showed the most improvement in HbA1c. Social support through family and coaching enhanced engagement and reduced diabetes distress. Studies that applied reinforcement and rewards saw improvements in engaged behavior and glucose outcomes. Shaping knowledge alone was not very impactful, but when paired with planning and feedback effects were notable. Strengthening self-belief and identity reframing helped one's self-efficacy and engagement. Overall interventions that combined more than one of the behavior-change techniques resulted in substantial improvements, specifically in HbA1c . Discussion: Overall, there is evidence that mHealth tools improve diabetes by incorporating numerous behavior-change techniques. These tools have shown improvement in HbA1c, weight, and psychosocial outcomes. While overall the changes are small, the personalization and accessibility that mHealth provides make it a valuable complimentary tool to traditional care.
Keywords: Diabetes, e-HealthAuthors:
Author - Valentina Foinquinos, Texas A&M University
Co-Author - Sherecce Fields, PhD, Texas A&M University
Co-Author - Rachel Smallman, Texas A&M University
Co-Author - Juilin Dai, Texas A&M University
Co-Author - Vishaka Kalra, Texas A&M University
Co-Author - Nicte Donis, Texas A&M University - College Station
What If? A Tailored Counterfactual Thinking Intervention to Promote Healthy Eating in Individuals with Diabetes
Poster Number: E48Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Health Disparities
Abstract
Background: Diabetes is a chronic metabolic disease in which the body’s ability to use or produce insulin is impaired leading to elevated blood sugar levels. Diabetes self-management remains an integral pillar of diabetes treatment; however, these changes are difficult to maintain in the long-term. Further, research examining the role of SES and ethnicity/race in diabetes self-management remains limited, highlighting the importance of examining these factors in individuals from diverse backgrounds. Behavioral lifestyle interventions can aid the self-management of diabetes, especially when said interventions are motivating and personalized. The present study utilizes counterfactual thinking (i.e. mental simulations of how a past outcome could have been different) to develop a personalized and adaptable intervention to increase motivation and intentions to eat healthily.
Method: Individuals with diabetes (N = 199) were randomly assigned to either a control condition (N=98) or a counterfactual thinking intervention (N=101). In the counterfactual condition, participants were prompted to generate three counterfactuals about a past negative eating event and complete a Counterfactual Transference Task. Participants in the control condition listed three factual statements about a past glucose spike. Data on intentions to use protective behavioral strategies, healthy eating motivation and eating disorder symptoms were collected post intervention. Finally, all participants also completed a demographics questionnaire.
Findings: Differences in motivation were found across types of diabetes. Participants in the counterfactual condition reported higher intentions for perceived behavioral control with respect to healthy eating motivation and higher intentions to use protective behavioral strategies to eat healthier in the upcoming week than the control group. Main effects for ethnicity were found for self-efficacy, perceived behavioral control, intentions for healthy eating, motivation, and protective behavioral strategies. Moderation analyses showed interaction effects between condition and diabetes type, and race/ethnicity and socio-economic status on use of protective behavioral strategies.
Conclusion: Results indicate that the counterfactual intervention is effective in influencing factors that promote healthier eating patterns in individuals with diabetes. These effects were found to vary across diabetes type, race/ethnicity and socioeconomic status.
Keywords: Diabetes, DisparitiesBackground: Diabetes is a chronic metabolic disease in which the body’s ability to use or produce insulin is impaired leading to elevated blood sugar levels. Diabetes self-management remains an integral pillar of diabetes treatment; however, these changes are difficult to maintain in the long-term. Further, research examining the role of SES and ethnicity/race in diabetes self-management remains limited, highlighting the importance of examining these factors in individuals from diverse backgrounds. Behavioral lifestyle interventions can aid the self-management of diabetes, especially when said interventions are motivating and personalized. The present study utilizes counterfactual thinking (i.e. mental simulations of how a past outcome could have been different) to develop a personalized and adaptable intervention to increase motivation and intentions to eat healthily.
Method: Individuals with diabetes (N = 199) were randomly assigned to either a control condition (N=98) or a counterfactual thinking intervention (N=101). In the counterfactual condition, participants were prompted to generate three counterfactuals about a past negative eating event and complete a Counterfactual Transference Task. Participants in the control condition listed three factual statements about a past glucose spike. Data on intentions to use protective behavioral strategies, healthy eating motivation and eating disorder symptoms were collected post intervention. Finally, all participants also completed a demographics questionnaire.
Findings: Differences in motivation were found across types of diabetes. Participants in the counterfactual condition reported higher intentions for perceived behavioral control with respect to healthy eating motivation and higher intentions to use protective behavioral strategies to eat healthier in the upcoming week than the control group. Main effects for ethnicity were found for self-efficacy, perceived behavioral control, intentions for healthy eating, motivation, and protective behavioral strategies. Moderation analyses showed interaction effects between condition and diabetes type, and race/ethnicity and socio-economic status on use of protective behavioral strategies.
Conclusion: Results indicate that the counterfactual intervention is effective in influencing factors that promote healthier eating patterns in individuals with diabetes. These effects were found to vary across diabetes type, race/ethnicity and socioeconomic status.
Authors:
Author - Vishaka Kalra, MPH, Texas A&M University
Co-Author - Nicte Donis, B.S., Texas A&M University
Co-Author - Valentina Foinquinos, B.S., Texas A&M University
Co-Author - Juilin Dai, B.S., Texas A&M University
Co-Author - Sherecce Fields, PhD, Texas A&M University
Co-Author - Rachel Smallman, PhD, Texas A&M University
A Mixed Methods Analysis of Implementation Factors within a Pharmacist and Community Health Worker-Led Intervention for Black and Hispanic Adults with Diabetes
Poster Number: E49Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Implementation Science
Background
Black and Hispanic adults experience disproportionately high rates of diabetes complications, partly due to poor medication adherence influenced by health misbeliefs and social determinants of health (SDOH) such as transportation, food insecurity, and medication costs. Pharmacist-led Medication Therapy Management (MTM) combined with Community Health Worker (CHW) support offers a promising approach to improve adherence and address SDOH challenges. This study assessed feasibility, implementation, and sustainability barriers and facilitators in community pharmacies.
Methods
Using the Health Equity Implementation Framework, we conducted a convergent mixed-methods study of pharmacist-led MTM with CHW support. Three theoretical domains (1) innovation characteristics, (2) clinical encounter, and (3) recipients guided the analysis. Pharmacists and CHWs working with 86 Black and Hispanic adults with uncontrolled type 2 diabetes completed brief 10-minute surveys and semi-structured 60-minute interviews on feasibility, integration, and implementation barriers. Qualitative content analysis was conducted, and emerging themes were merged with survey data to form meta-inferences.
Results
Interventionists (3 pharmacists, 5 CHWs) reported the collaboration model as feasible, though time demands and workflow integration were key barriers. Related to integrating the intervention into workflows, mean scores on a 5-point Likert scale were 2.24 (± 0.19) for the CHWs, and 2.44 (± 0.59) for the pharmacists (1 = Strongly agree, and 5 = Strongly Disagree). Both pharmacists and CHWs agreed on the potential scalability of the intervention to other pharmacies but reported qualitatively that this was dependent on funding, partnerships, and adaptability across settings. Other implementation barriers included organizational challenges, scheduling conflicts, and competing priorities, while training, team support, and peer collaboration were facilitators. Cultural alignment, trust, and communication promoted engagement, and tangible support (transportation, food, home-delivered medicines) reduced access barriers.
Conclusion
Pharmacist-CHW collaboration shows promise for diabetes management in community pharmacies but requires better workflow integration and reduced time burden to ensure sustainability. These findings can guide efforts to implement and sustain pharmacy-based interventions addressing medication adherence, health misbeliefs and diabetes control.
Keywords: Diabetes, Evidence basedBlack and Hispanic adults experience disproportionately high rates of diabetes complications, partly due to poor medication adherence influenced by health misbeliefs and social determinants of health (SDOH) such as transportation, food insecurity, and medication costs. Pharmacist-led Medication Therapy Management (MTM) combined with Community Health Worker (CHW) support offers a promising approach to improve adherence and address SDOH challenges. This study assessed feasibility, implementation, and sustainability barriers and facilitators in community pharmacies.
Methods
Using the Health Equity Implementation Framework, we conducted a convergent mixed-methods study of pharmacist-led MTM with CHW support. Three theoretical domains (1) innovation characteristics, (2) clinical encounter, and (3) recipients guided the analysis. Pharmacists and CHWs working with 86 Black and Hispanic adults with uncontrolled type 2 diabetes completed brief 10-minute surveys and semi-structured 60-minute interviews on feasibility, integration, and implementation barriers. Qualitative content analysis was conducted, and emerging themes were merged with survey data to form meta-inferences.
Results
Interventionists (3 pharmacists, 5 CHWs) reported the collaboration model as feasible, though time demands and workflow integration were key barriers. Related to integrating the intervention into workflows, mean scores on a 5-point Likert scale were 2.24 (± 0.19) for the CHWs, and 2.44 (± 0.59) for the pharmacists (1 = Strongly agree, and 5 = Strongly Disagree). Both pharmacists and CHWs agreed on the potential scalability of the intervention to other pharmacies but reported qualitatively that this was dependent on funding, partnerships, and adaptability across settings. Other implementation barriers included organizational challenges, scheduling conflicts, and competing priorities, while training, team support, and peer collaboration were facilitators. Cultural alignment, trust, and communication promoted engagement, and tangible support (transportation, food, home-delivered medicines) reduced access barriers.
Conclusion
Pharmacist-CHW collaboration shows promise for diabetes management in community pharmacies but requires better workflow integration and reduced time burden to ensure sustainability. These findings can guide efforts to implement and sustain pharmacy-based interventions addressing medication adherence, health misbeliefs and diabetes control.
Authors:
Co-Presenter - Olubukola Tikare, MSc, BPharm, University of Michigan Ann Arbor
Co-Author - Janiya Pouncy, BS, University of Michigan Ann Arbor
Co-Presenter - Martha Maurer, PhD MSSW, University of Wisconsin-Madison
Co-Presenter - Olayinka Shiyanbola, PhD BPharm, University of Michigan Department of Clinical Pharmacy, Ann Arbor
Combining biographical narratives and implementation intentions to promote seasonal influenza vaccination among community-dwelling older adults: the SILVER RCT study
Poster Number: E5Time: 05:00 PM - 05:50 PM
Topics: Aging, Digital Health
Background: The uptake of seasonal influenza vaccination (SIV) remained suboptimal among community-dwelling older adults ≥65 years in Hong Kong. Effective and sustainable behavioral interventions are urgently needed.
Objective: To conduct a three-arm randomized controlled trial (RCT) to compare the efficacy of an intervention combining biographical narratives with implementation intentions (BNII) in improving SIV behaviors and related perceptions, compared to two control conditions involving only biographical narratives (BN) or only topic-matched didactic messages (DD).
Methods: A WhatsApp Chatbot-based, self-guided intervention was developed. (1) Video-based biographical narrative component: four intervention videos with firsthand experiential stories elicited from peer narrators with diverse backgrounds and SIV-related experiences. (2) Complementary implementation intention component: an interactive help sheet for personalized SIV planning. An RCT was then conducted among 423 older adults in Hong Kong. All groups received intervention videos with narrative or didactic messages. The BNII group further received the implementation intention intervention. Assessments were conducted before (T1), immediately after (T2), and three months after (T3) the intervention. Between-group differences in SIV behaviors were examined using Chi-square tests. Between-group and within-group differences in SIV-related perceptions were examined using paired t-tests and ANCOVA analyses.
Results: At T2, BNII led to significantly higher early SIV uptake than BN, which in turn led to higher uptake than DD. A similar trend was observed at T3 for cumulative SIV uptake. All conditions produced significant improvements in intentions to SIV, cognitive risk perceptions regarding influenza infection, attitudes toward SIV, and perceptions regarding the response efficacy, side effects, and life impact of SIV at T2 and/or T3. Only BNII and BN produced significant improvements in affective risk perceptions and perceived ineligibility for SIV. BNII produced significantly greater improvements than DD in perceived susceptibility and affective risk perceptions, attitudes, and self-efficacy regarding SIV. BN produced significantly greater improvements than DD in attitudes, perceived ineligibility, perceived side effects, and self-efficacy regarding SIV.
Conclusion: This study has important implications for utilizing narrative persuasion and implementation intentions to promote SIV behavior.
Keywords: Health behavior change, InterventionObjective: To conduct a three-arm randomized controlled trial (RCT) to compare the efficacy of an intervention combining biographical narratives with implementation intentions (BNII) in improving SIV behaviors and related perceptions, compared to two control conditions involving only biographical narratives (BN) or only topic-matched didactic messages (DD).
Methods: A WhatsApp Chatbot-based, self-guided intervention was developed. (1) Video-based biographical narrative component: four intervention videos with firsthand experiential stories elicited from peer narrators with diverse backgrounds and SIV-related experiences. (2) Complementary implementation intention component: an interactive help sheet for personalized SIV planning. An RCT was then conducted among 423 older adults in Hong Kong. All groups received intervention videos with narrative or didactic messages. The BNII group further received the implementation intention intervention. Assessments were conducted before (T1), immediately after (T2), and three months after (T3) the intervention. Between-group differences in SIV behaviors were examined using Chi-square tests. Between-group and within-group differences in SIV-related perceptions were examined using paired t-tests and ANCOVA analyses.
Results: At T2, BNII led to significantly higher early SIV uptake than BN, which in turn led to higher uptake than DD. A similar trend was observed at T3 for cumulative SIV uptake. All conditions produced significant improvements in intentions to SIV, cognitive risk perceptions regarding influenza infection, attitudes toward SIV, and perceptions regarding the response efficacy, side effects, and life impact of SIV at T2 and/or T3. Only BNII and BN produced significant improvements in affective risk perceptions and perceived ineligibility for SIV. BNII produced significantly greater improvements than DD in perceived susceptibility and affective risk perceptions, attitudes, and self-efficacy regarding SIV. BN produced significantly greater improvements than DD in attitudes, perceived ineligibility, perceived side effects, and self-efficacy regarding SIV.
Conclusion: This study has important implications for utilizing narrative persuasion and implementation intentions to promote SIV behavior.
Authors:
Presenter - Meiqi XIN, The Hong Kong Polytechnic University
Co-Author - Huiqi WANG, The Hong Kong Polytechnic University
Co-Author - Leiyi RAO, The Hong Kong Polytechnic University
Author - Phoenix Kit-han MO, The Chinese University of Hong Kong
Co-Author - K. Viswanath, PhD, FSBM, Harvard University
Co-Author - Zixin WANG, The Chinese University of Hong Kong
Co-Author - Kenneth N.K. FONG, The Hong Kong Polytechnic University
Temporal Dynamics of Habit Strength and Sugar-Sweetened Beverage Intake: Exploratory Analysis of a Randomized Controlled Trial
Poster Number: E50Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Digital Health
Habit plays a critical role in both initiating and sustaining health behavior change, yet little is known about how sugar-sweetened beverage (SSB) habits evolve over time or impact the effectiveness of interventions.
This study examined exploratory aims from a randomized controlled trial comparing iSIPsmarter, an interactive digital SSB reduction program, with a static patient education (PE) website. We explored (1) changes in SSB-related habit strength at post-intervention (9-week) and 18-month follow-up, and (2) SSB intake trajectories among participants with high vs. low baseline habit strength.
SSB habit strength (1-5 scale; 1=weak, 5=strong) and intake (BEV-Q, ounces) were assessed with validated measures. Analyses included completers only. Linear regression estimated changes in habit strength, adjusting for age, sex, race, income, education, and health literacy. Longitudinal models tested main and interaction effects of time, baseline habit, and intervention on SSB intake with the same covariates.
Of 249 participants, 211 (85%) were included in the analyses (mean age=42; 89% White; 83% female; 50% annual income <$55,000; 86% rural; 82% overweight/obese). Habit strength scores declined (indicating weaker SSB habits) at 9-week (iSIPsmarter: -1.19 vs PE comparison: -0.75, both p<0.001) and 18-month (iSIPsmarter: -1.63, vs PE comparison: -1.23, both p<0.001), with greater reductions for iSIPsmarter at both time points (9-week: –0.35, p=0.018, d=0.33; 18-month: –0.40, p=0.017, d=0.34). Subgroup analyses included 56 high and 96 low baseline habit strength participants. At 9-week, SSB intake decreased for both low (iSIPsmarter: –25.42 vs. PE comparison: –24.62, both p<0.001) and high habit strength groups (iSIPsmarter: –24.35, p<0.001 vs. PE comparison: –10.21, p=0.019), with a significant between-group difference only for high habit strength group (–14.14, p=0.019). At 18-month, intake declined in both low (iSIPsmarter: –26.94 vs. PE comparison: –23.28, both p<0.001) and high habit strength groups (iSIPsmarter: –25.21 vs. PE comparison: –21.04, both p<0.001), but between-group differences were not significant.
Relative to the PE comparison, iSIPsmarter produced greater improvements in SSB habit strength both short- and long-term. Participants with stronger baseline habits achieved larger short-term SSB intake reductions, underscoring the importance of targeting habit mechanisms to enhance intervention impact.
Keywords: Health behavior change, Eating behaviorsThis study examined exploratory aims from a randomized controlled trial comparing iSIPsmarter, an interactive digital SSB reduction program, with a static patient education (PE) website. We explored (1) changes in SSB-related habit strength at post-intervention (9-week) and 18-month follow-up, and (2) SSB intake trajectories among participants with high vs. low baseline habit strength.
SSB habit strength (1-5 scale; 1=weak, 5=strong) and intake (BEV-Q, ounces) were assessed with validated measures. Analyses included completers only. Linear regression estimated changes in habit strength, adjusting for age, sex, race, income, education, and health literacy. Longitudinal models tested main and interaction effects of time, baseline habit, and intervention on SSB intake with the same covariates.
Of 249 participants, 211 (85%) were included in the analyses (mean age=42; 89% White; 83% female; 50% annual income <$55,000; 86% rural; 82% overweight/obese). Habit strength scores declined (indicating weaker SSB habits) at 9-week (iSIPsmarter: -1.19 vs PE comparison: -0.75, both p<0.001) and 18-month (iSIPsmarter: -1.63, vs PE comparison: -1.23, both p<0.001), with greater reductions for iSIPsmarter at both time points (9-week: –0.35, p=0.018, d=0.33; 18-month: –0.40, p=0.017, d=0.34). Subgroup analyses included 56 high and 96 low baseline habit strength participants. At 9-week, SSB intake decreased for both low (iSIPsmarter: –25.42 vs. PE comparison: –24.62, both p<0.001) and high habit strength groups (iSIPsmarter: –24.35, p<0.001 vs. PE comparison: –10.21, p=0.019), with a significant between-group difference only for high habit strength group (–14.14, p=0.019). At 18-month, intake declined in both low (iSIPsmarter: –26.94 vs. PE comparison: –23.28, both p<0.001) and high habit strength groups (iSIPsmarter: –25.21 vs. PE comparison: –21.04, both p<0.001), but between-group differences were not significant.
Relative to the PE comparison, iSIPsmarter produced greater improvements in SSB habit strength both short- and long-term. Participants with stronger baseline habits achieved larger short-term SSB intake reductions, underscoring the importance of targeting habit mechanisms to enhance intervention impact.
Authors:
Presenter - Esha Dwibedi, University of Virginia
Co-Author - Wen You, University of Virginia
Co-Author - Lee Ritterband, University of Virginia
Co-Author - Kathleen Porter, University of Virginia
Co-Author - Annie Reid, University of Virginia
Co-Author - Donna-Jean Brock, University of Virginia
Co-Author - Jamie Zoellner, PhD, RD, University of Virginia
Origins of Comfort Eating Behavior: Mixed-Method Insights from the Eating in America Study
Poster Number: E51Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Social and Environmental Context and Health
Objective: Characterize the etiology of comfort eating from a life course perspective using a mixed-methods approach.
Method: A national census-matched sample of U.S. adults 18 and older (N = 2,022) was recruited for a survey using a Qualtrics panel from December 2019 to January 2020. We characterized the origins of comfort eating by analyzing both quantitative and open-ended survey data.
Results: Comfort eaters (77% of the sample) most often initiated comfort eating between the ages of 11-17 (26%) or 18-25 (27%). More than twice as many comfort eaters versus non-comfort eaters (72% vs. 32%) reported that a family member gave them food when they were upset when they were growing up. Rich open-ended data (1,568 individual responses) reveal the diverse and most common reasons why comfort eaters believe they first took up the behavior (e.g., the various emotions, social contexts, adverse events, coping attempts, and food qualities).
Conclusion: These findings regarding when in the lifespan comfort eating most often develops—and the social, familial, and adverse contexts commonly surrounding this—provide novel insights to inform future comfort eating intervention and prevention efforts.
Keywords: Eating behaviors, Health behaviorsMethod: A national census-matched sample of U.S. adults 18 and older (N = 2,022) was recruited for a survey using a Qualtrics panel from December 2019 to January 2020. We characterized the origins of comfort eating by analyzing both quantitative and open-ended survey data.
Results: Comfort eaters (77% of the sample) most often initiated comfort eating between the ages of 11-17 (26%) or 18-25 (27%). More than twice as many comfort eaters versus non-comfort eaters (72% vs. 32%) reported that a family member gave them food when they were upset when they were growing up. Rich open-ended data (1,568 individual responses) reveal the diverse and most common reasons why comfort eaters believe they first took up the behavior (e.g., the various emotions, social contexts, adverse events, coping attempts, and food qualities).
Conclusion: These findings regarding when in the lifespan comfort eating most often develops—and the social, familial, and adverse contexts commonly surrounding this—provide novel insights to inform future comfort eating intervention and prevention efforts.
Authors:
Presenter - Laura Finch, PhD, NORC at the University of Chicago
Co-Author - Sylvia Brown, NORC at the University of Chicago
Co-Author - Jenna Cummings, PhD, University of Liverpool
Co-Author - Maddy Roberts, University of Liverpool
Co-Author - Vince Welch, NORC at the University of Chicago
Co-Author - Marc Hernandez, PhD, NORC at the University if Chicago
Co-Author - A. Janet Tomiyama, PhD, UCLA
Barriers to Nutrition Security Among Adults with Uncontrolled Type 2 Diabetes and At Risk of Food Insecurity: A Qualitative Study
Poster Number: E52Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Diabetes
Introduction: Nutrition security is a relatively new concept that embodies the field’s longstanding appreciation for the importance of healthy food access and health equity. Despite growing interest, key research gaps persist, including limited insight into how people experience and navigate nutrition security barriers in daily life, particularly while managing chronic disease. This study explored these barriers using qualitative data from the LINK trial, a pragmatic randomized controlled trial addressing food insecurity and uncontrolled Type 2 Diabetes.
Study Setting: LINK uses a 2×2 factorial design to test layered interventions in community settings in a Midwestern city. All participants received weekly produce through the Mid-Ohio Farmacy (MOF), a produce prescription program distributing fresh produce via food pantries. Participants were randomized to one of four arms: (1) MOF only; (2) MOF plus Cooking Matters for Diabetes (CMFD), a six-week culinary and diabetes self-management program; (3) MOF plus Health Impact Ohio (HIO), a community health worker model addressing social needs; or (4) MOF plus both CMFD and HIO.
Methods: We conducted ~30-minute semi-structured interviews with 25 participants, purposively recruited from across all four study arms, at their 3-month follow-up visit. To support the process of thematic analysis, a codebook was developed based on the two-item Nutrition Security Screener and organized using the domains of the Social Ecological Model, then refined inductively via iterative transcript review and applied consistently across transcripts.
Results: Most participants were female (72%), non-Hispanic Black (76%), and aged >50 years. Analysis identified four themes: structural barriers (e.g., non-inclusive food environments), competing constraints (e.g., unstable housing, work demands), individual-level challenges (e.g., health conditions, stress, unmet dietary needs), and barriers to self-efficacy and information gaps (e.g., limited foodwork-related skills, confusion about resources).
Discussion: Barriers to nutrition security encompass an interrelated set of factors that compound in the lives of individuals burdened by chronic disease and unmet social needs to effectively limit achievement of nutrition security. Their experiences highlight the need for practical, sustained supports that enhance health-related autonomy and self-efficacy in the context of competing life demands.
Keywords: Nutrition, InterventionStudy Setting: LINK uses a 2×2 factorial design to test layered interventions in community settings in a Midwestern city. All participants received weekly produce through the Mid-Ohio Farmacy (MOF), a produce prescription program distributing fresh produce via food pantries. Participants were randomized to one of four arms: (1) MOF only; (2) MOF plus Cooking Matters for Diabetes (CMFD), a six-week culinary and diabetes self-management program; (3) MOF plus Health Impact Ohio (HIO), a community health worker model addressing social needs; or (4) MOF plus both CMFD and HIO.
Methods: We conducted ~30-minute semi-structured interviews with 25 participants, purposively recruited from across all four study arms, at their 3-month follow-up visit. To support the process of thematic analysis, a codebook was developed based on the two-item Nutrition Security Screener and organized using the domains of the Social Ecological Model, then refined inductively via iterative transcript review and applied consistently across transcripts.
Results: Most participants were female (72%), non-Hispanic Black (76%), and aged >50 years. Analysis identified four themes: structural barriers (e.g., non-inclusive food environments), competing constraints (e.g., unstable housing, work demands), individual-level challenges (e.g., health conditions, stress, unmet dietary needs), and barriers to self-efficacy and information gaps (e.g., limited foodwork-related skills, confusion about resources).
Discussion: Barriers to nutrition security encompass an interrelated set of factors that compound in the lives of individuals burdened by chronic disease and unmet social needs to effectively limit achievement of nutrition security. Their experiences highlight the need for practical, sustained supports that enhance health-related autonomy and self-efficacy in the context of competing life demands.
Authors:
Author - Katharine Garrity, PhD, RD, University of Michigan
Co-Author - Jennifer Garner, PhD, RD, University of Michigan
Co-Author - Chong Katie Man Hei, University of Michigan
Co-Author - Kendrin Sonneville, ScD, RD, University of Michigan
Co-Author - Shawna Smith, PhD, University of Michigan
Co-Author - Joshua J. Joseph, MD, Ohio State University
Co-Author - Daniel Walker, PhD, MPH, Ohio State University
Through the Patient’s Lense: A Photovoice Study of Social Support-Related Barriers and Facilitators to Renal Dietary Adherence in Adults with Kidney Failure and Obesity
Poster Number: E53Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Social and Environmental Context and Health
Patients with kidney failure (KF) are encouraged to follow renal dietary guidelines (RDG) to limit fluid, sodium, potassium, phosphorus intake, and consume adequate protein and fiber. Over 30% of KF patients have poor adherence to RDG, increasing risk of hospitalization and mortality. Diet is influenced by sociobehavioral factors, but the relationship between adherence to RDG and social support is unclear.
In July-Nov. 2024, we recruited 10 patients from an R01 study (R01DK124388) examining the health trajectories of adults with coexisting KF and obesity (BMI≥30 kg/m²). Patients consented to a participatory Photovoice activity and took guided photos of meals, food preparation methods and eating environments over 2 weeks. We interpreted the images with patients, first in in-depth interviews, then in focus groups with patients of similar ages. We conducted a thematic analysis of images and interview transcripts in NVivo and integrated findings with dietary intake, social support and 1-yr clinical data.
Patients varied in age (32 to 72 yrs), BMI at baseline (30.1 to 41.6 kg/m ²), Medical Outcomes Study Social Support Survey scores (17 to 86 out of 100 ), 1 yr weight change (-21.9 to +12.9 kg ). Each patient took 10-15 images and selected two that best captured their diet.
Patients in their 30s had an inner circle (household members, immediate relatives) aware of their dietary needs, and an outer circle (colleagues, distant relatives) that provided an escape from their patient persona. They reported a desire to maintain a sense of normalcy, which was reflected in their dietary behaviors (e.g. intentionally maintaining strict RDG adherence most of the week to forgo adherence when eating with friends). Moving near family and preparing meals in advance helped patients leverage instrumental support and avoid convenience behaviors such as eating takeout meals, especially when experiencing post-treatment fatigue. Photos showed portion-packaged foods used to facilitate integrating RDG into social events. Patients aged 65+ had limited social support due to retirement, death of peers, reduced mobility. Images showed food cooked by home health aides and large meals prepared for the week, to fill this gap in social support.
Long-term planning and instrumental social support help younger patients with KF and obesity integrate their dietary needs into social settings. Older patients experience social isolation and reduced mobility, impacting their adherence to RDG.
Keywords: Diet, Social supportIn July-Nov. 2024, we recruited 10 patients from an R01 study (R01DK124388) examining the health trajectories of adults with coexisting KF and obesity (BMI≥30 kg/m²). Patients consented to a participatory Photovoice activity and took guided photos of meals, food preparation methods and eating environments over 2 weeks. We interpreted the images with patients, first in in-depth interviews, then in focus groups with patients of similar ages. We conducted a thematic analysis of images and interview transcripts in NVivo and integrated findings with dietary intake, social support and 1-yr clinical data.
Patients varied in age (32 to 72 yrs), BMI at baseline (30.1 to 41.6 kg/m ²), Medical Outcomes Study Social Support Survey scores (17 to 86 out of 100 ), 1 yr weight change (-21.9 to +12.9 kg ). Each patient took 10-15 images and selected two that best captured their diet.
Patients in their 30s had an inner circle (household members, immediate relatives) aware of their dietary needs, and an outer circle (colleagues, distant relatives) that provided an escape from their patient persona. They reported a desire to maintain a sense of normalcy, which was reflected in their dietary behaviors (e.g. intentionally maintaining strict RDG adherence most of the week to forgo adherence when eating with friends). Moving near family and preparing meals in advance helped patients leverage instrumental support and avoid convenience behaviors such as eating takeout meals, especially when experiencing post-treatment fatigue. Photos showed portion-packaged foods used to facilitate integrating RDG into social events. Patients aged 65+ had limited social support due to retirement, death of peers, reduced mobility. Images showed food cooked by home health aides and large meals prepared for the week, to fill this gap in social support.
Long-term planning and instrumental social support help younger patients with KF and obesity integrate their dietary needs into social settings. Older patients experience social isolation and reduced mobility, impacting their adherence to RDG.
Authors:
Author - Bengucan Gunen, MSPH, Drexel University Dornsife School of Public Health
Co-Author - Meera Harhay, MD, MSCE, Drexel University College of Medicine
Co-Author - Meghan Butryn, PhD, Drexel University College of Arts and Sciences
Co-Author - Brandy-Joe Milliron, PhD, Drexel University College of Nursing and Health Professions
Co-Author - Reneé Moore, PhD, Drexel University Dornsife School of Public Health
Co-Author - Mridula Ghotane, MPH, Drexel University Dornsife School of Public Health
Co-Author - Ann Klassen, PhD, Drexel University Dornsife School of Public Health
User Experience, Feasibility, and Dietary Influences in Grocery vs. Meal Delivery Services
Poster Number: E54Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Diabetes
Background: The concept of Food is Medicine underscores the role of nutritious foods in preventing and managing chronic disease. However, limited access to healthy foods can hinder sustaining changes encouraged in lifestyle interventions. To address this gap, we piloted two approaches, delivery of groceries and delivery of prepared meals, within the Dietary Guidelines: 3 Diets (DG3D) Study, a teaching kitchen intervention conducted in 12-month cohorts among African American adults living in South Carolina at risk of developing type 2 diabetes mellitus. This delivery pilot was conducted in cohort 3 to evaluate feasibility, acceptability, and potential to support dietary behavior change.
Methods: Cohort 3 of DG3D included 34 participants (91.2% women, mean age= 52.2 years). Actively engaged participants (N=31, 90.3% women, mean age= 52.9 years) received groceries in week 22 and prepared meals in week 24. Grocery deliveries (via Instacart) were based on the scheduled recipe of the week, while prepared meals (via Purple Carrot) included five plant-based options selected by the study team, with quantities for both determined by the study budget. Surveys were administered one week after each delivery to capture feedback on enjoyment, convenience, freshness, and perceived impact on dietary behaviors, using both Likert scale ratings and open-ended questions. Paired t-tests compared grocery vs. meal delivery ratings, and regression models examined predictors of enjoyment and food use.
Results: Participants (N=26) rated grocery delivery significantly more enjoyable (M= 6.91, SD= 0.43) than meal delivery (M= 5.36, SD= 1.29), p < .001. Freshness ratings were also higher for groceries (M= 6.95, SD =.21) p < .05. Regression analyses showed grocery delivery was positively associated with enjoyment (B= 1.68, p= .037) and amount of food used (B= 0.70, p= .013), while freshness did not significantly predict outcomes. Qualitative feedback highlighted the convenience of prepared meals but emphasized the flexibility of groceries to create multiple dishes, share food with family, and reinforce cooking skills.
Conclusion: Providing healthy foods during interventions is a practical application of Food is Medicine. Grocery delivery was rated as more enjoyable and fresher and was linked to greater food use and overall satisfaction. Future research should examine these approaches in larger, diverse samples and assess long-term impacts on diet, health, and cost-effectiveness.
Keywords: Diet, InterventionsMethods: Cohort 3 of DG3D included 34 participants (91.2% women, mean age= 52.2 years). Actively engaged participants (N=31, 90.3% women, mean age= 52.9 years) received groceries in week 22 and prepared meals in week 24. Grocery deliveries (via Instacart) were based on the scheduled recipe of the week, while prepared meals (via Purple Carrot) included five plant-based options selected by the study team, with quantities for both determined by the study budget. Surveys were administered one week after each delivery to capture feedback on enjoyment, convenience, freshness, and perceived impact on dietary behaviors, using both Likert scale ratings and open-ended questions. Paired t-tests compared grocery vs. meal delivery ratings, and regression models examined predictors of enjoyment and food use.
Results: Participants (N=26) rated grocery delivery significantly more enjoyable (M= 6.91, SD= 0.43) than meal delivery (M= 5.36, SD= 1.29), p < .001. Freshness ratings were also higher for groceries (M= 6.95, SD =.21) p < .05. Regression analyses showed grocery delivery was positively associated with enjoyment (B= 1.68, p= .037) and amount of food used (B= 0.70, p= .013), while freshness did not significantly predict outcomes. Qualitative feedback highlighted the convenience of prepared meals but emphasized the flexibility of groceries to create multiple dishes, share food with family, and reinforce cooking skills.
Conclusion: Providing healthy foods during interventions is a practical application of Food is Medicine. Grocery delivery was rated as more enjoyable and fresher and was linked to greater food use and overall satisfaction. Future research should examine these approaches in larger, diverse samples and assess long-term impacts on diet, health, and cost-effectiveness.
Authors:
Author - Enid Keseko, MS, RD, University of South Carolina
Co-Author - Brie Turner-McGrievy, PhD, MS, RD, FSBM, University of South Carolina
Co-Author - Shiba Bailey, PhD, University of South Carolna
Co-Author - Taylor Duncan, University of South Carolina
Co-Author - Denine Ward-Johnson, MS, BSN, RN, University of South Carolina
Co-Author - Sara Wilcox, PhD, FSBM, University of South Carolina
Co-Author - Daniela Friedman, PhD, University of South Carolina
Co-Author - Angela Liese, PhD, University of South Carolina
Assessing acceptability of an on-demand digital intervention for negative emotions following binge eating among young adults
Poster Number: E55Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Digital Health
Eating disorders are severe mental health disorders; in the US, 9-13% of individuals will experience an eating disorder. Despite this high prevalence, 80% of individuals with eating disorders will never access treatment, largely due to financial and geographic barriers. To address this disparity, low-cost, easily disseminated treatments that are relevant to a large share of individuals with eating disorders are needed. The most prevalent eating disorder behavior is binge eating, defined as consuming a large amount of food in a short time while experiencing a loss of control. Binge eating results in elevations in shame that may prompt and maintain other eating disorder symptoms such as extreme food restriction, excessive exercise, and/or purging. Reducing shame following binge eating may therefore in turn reduce the risk of future binge eating and other eating disorder symptoms. Because shame can be effectively treated using compassion-focused techniques, the purpose of the present study was to assess the acceptability of a brief, digital compassion-focused intervention that could be accessed on-demand following binge eating. Twenty-five participants (Mage=23.68; 64% cisgender women) with recurrent binge eating (≥1/week for the past month; 80% bulimia nervosa, 8% binge-eating disorder, 12% other eating disorder) completed a semi-structured interview. Inductive thematic analysis revealed that 88% of participants were interested in using an on-demand digital intervention to reduce negative emotions following binge eating. The majority (N=22; 88%) desired digital treatment due to ease of use and perceived helpfulness. For content, participants largely wanted support resolving their distress, including feelings of guilt (N=20; 80%), shame, (N=13; 52%) and other negative emotions (i.e., anger, disgust; N=18; 72%). 88% expressed interest in learning skills consistent with compassion-focused therapy (e.g., mindfulness, self-kindness). Regarding intervention duration, participants expressed interest in a single-session intervention; most (N = 21; 84%) desired it to be brief (either <20 mins or 20-30 mins in length) and a minority others (N=4; 16%) desired a longer intervention (>30 mins). Findings indicate brief, single-session digital interventions that can be accessed immediately after binge eating to address feelings of shame using compassion-focused techniques would be acceptable and potentially helpful for young adults with binge eating.
Keywords: Binge eating, InterventionsAuthors:
Author - Jacqueline Kosmas, MA, Virginia Tech
Co-Author - Dayna Winograd, BS, Virginia Tech
Co-Author - Heather Davis, PhD, Virginia Tech
Feasibility with Two Produce Prescription Delivery Methods Among Adults with Overweight and Obesity Experiencing Nutrition Insecurity
Poster Number: E56Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Weight Related Health
Background: Eating a healthy diet is key to the prevention and management of overweight and obesity. Produce prescription (PRx) programs can increase access to healthy food and support nutrition security. However, it is unknown how delivery methods (i.e., how produce and nutrition education are provided) impact the feasibility of PRx programs.
Objective: To assess the feasibility of two PRx delivery mechanisms, home-delivered produce boxes and produce vouchers, among adults with overweight/obesity experiencing nutrition insecurity.
Methods: We implemented an 8-week pilot randomized controlled trial at a community market in Baltimore, MD. Participants (n=48) were randomized to receive a PRx via home-delivered produce box delivery or produce vouchers at a local market. Participants also received an 8-week text message intervention designed to support dietary behavior change. We assessed feasibility via participant reach and retention, intervention fidelity, engagement in the intervention, and satisfaction with the intervention. This included PRx delivery or redemption rates, text message delivery rates, response rates to self-monitoring prompts, and self-reported satisfaction.
Results: 48 adults were enrolled (mean age 50 [SD=16]; 65% women, 83% non-Hispanic Black), 23 of which were assigned to produce delivery and 25 vouchers. Home-delivered produce boxes were successfully delivered 99% of the time, while produce vouchers were redeemed 75% of weeks on average. The text message delivery rate was high (99%), and few participants (4%) opted out of receiving text messages. Approximately 88% of participants completed data collection. Engagement with self-monitoring prompts varied; most participants were medium-engagers (35%) who responded to 50-74% of prompts, followed by low-engagers (27%) who responded to < 50%, high-engagers (25%) who responded to ≥75%, and non-engagers (13%) who did not respond to prompts. Most participants said that the intervention improved their access to fresh produce (77%), helped them make healthier food choices (79%), and they would recommend the program (93%).
Conclusions: In a randomized pilot trial of PRx delivery methods, we found both produce vouchers and home-delivered produce boxes to be feasible with high levels of satisfaction. However, engagement in text message self-monitoring prompts varied widely. Future research is needed to optimize delivery of behavior change techniques delivered alongside PRx interventions.
Keywords: Nutrition, Behavior ChangeObjective: To assess the feasibility of two PRx delivery mechanisms, home-delivered produce boxes and produce vouchers, among adults with overweight/obesity experiencing nutrition insecurity.
Methods: We implemented an 8-week pilot randomized controlled trial at a community market in Baltimore, MD. Participants (n=48) were randomized to receive a PRx via home-delivered produce box delivery or produce vouchers at a local market. Participants also received an 8-week text message intervention designed to support dietary behavior change. We assessed feasibility via participant reach and retention, intervention fidelity, engagement in the intervention, and satisfaction with the intervention. This included PRx delivery or redemption rates, text message delivery rates, response rates to self-monitoring prompts, and self-reported satisfaction.
Results: 48 adults were enrolled (mean age 50 [SD=16]; 65% women, 83% non-Hispanic Black), 23 of which were assigned to produce delivery and 25 vouchers. Home-delivered produce boxes were successfully delivered 99% of the time, while produce vouchers were redeemed 75% of weeks on average. The text message delivery rate was high (99%), and few participants (4%) opted out of receiving text messages. Approximately 88% of participants completed data collection. Engagement with self-monitoring prompts varied; most participants were medium-engagers (35%) who responded to 50-74% of prompts, followed by low-engagers (27%) who responded to < 50%, high-engagers (25%) who responded to ≥75%, and non-engagers (13%) who did not respond to prompts. Most participants said that the intervention improved their access to fresh produce (77%), helped them make healthier food choices (79%), and they would recommend the program (93%).
Conclusions: In a randomized pilot trial of PRx delivery methods, we found both produce vouchers and home-delivered produce boxes to be feasible with high levels of satisfaction. However, engagement in text message self-monitoring prompts varied widely. Future research is needed to optimize delivery of behavior change techniques delivered alongside PRx interventions.
Authors:
Co-Author - Ashauna Lee, Johns Hopkins University
Co-Author - Wura Olawole, Johns Hopkins University
Co-Author - Azuka Amaka Ngige, Johns Hopkins University
Co-Author - Philip Okonkwo, Johns Hopkins University
Co-Author - Joyline Chepkorir, BS, MS, PhD, Johns Hopkins University
Co-Author - Janna Stephens, University of Illinois Chicago
Co-Author - Cheryl Himmelfarb, Johns Hopkins University
Co-Author - Hailey Miller, PhD, RN, Johns Hopkins University
Assessing UC Berkeley’s Beverage Environment: Policy Compliance After the Pepsi Pouring Rights Contract
Poster Number: E57Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Climate Change and Health
Introduction: UC Berkeley implement a first-of-its-kind nutrition policy that mandates shelf spaces to be limited to 30% for sugar-sweetened beverages and requires that water be sold at the same or lower price as sweetened beverages, effective November 2020, along with a novel UC-wide policy that aimed to phase out single-use plastic beverage bottles by January 2024. However, in 2023, UC Berkeley renewed a ten-year pouring-rights contract with PepsiCo, which may reduce its ability to adhere to the aforementioned health and sustainability policies. The press release for the PepsiCo contract stated that only 10% of beverages sold on campus would still be offered in plastic packaging.
Objective: We conducted a case study to describe the extent to which UC Berkeley’s beverage environment under the pouring rights contract aligns with its policies and commitments.
Method: From May to September 2024, we sampled a census of campus-managed stores and foodservice facilities subject to UC Berkeley’s pouring rights contract with PepsiCo, where packaged beverages were sold. We also purposively sampled all areas frequented by undergraduate students (e.g., the main gym and student union) and randomly sampled 40 buildings on campus to assess vending machines with beverages. We collected, coded, and evaluated all beverage options sold in each of these locations for the following characteristics: beverage type, added sugar contents, price, and packaging material.
Results: Only 25% of drinks were sugar-sweetened beverages, compliant with UC Berkeley’s shelf space requirement (30%). However, the average price of water was approximately 14% higher than that of sugary beverages ($2.46 for water vs. $2.16 for soda). The least expensive water prices were $2.00 compared to $1.25 for the least expensive soda, which is not compliant with the campus’ nutrition policy. One-third (33%) of beverages were bottled in plastic packaging— inconsistent with the single-use plastic phase-out policy.
Conclusion: UC Berkeley’s beverage environment does not align with its policies and commitments on sustainable packaging or pricing. There is a high presence of single-use plastic packaged beverages on campus and lower affordability of water compared to soda. The university’s pouring rights contract with PepsiCo may have played a role, as it limits the selection of products and packaging and establishes wholesale beverage prices.
Keywords: Policy, HealthObjective: We conducted a case study to describe the extent to which UC Berkeley’s beverage environment under the pouring rights contract aligns with its policies and commitments.
Method: From May to September 2024, we sampled a census of campus-managed stores and foodservice facilities subject to UC Berkeley’s pouring rights contract with PepsiCo, where packaged beverages were sold. We also purposively sampled all areas frequented by undergraduate students (e.g., the main gym and student union) and randomly sampled 40 buildings on campus to assess vending machines with beverages. We collected, coded, and evaluated all beverage options sold in each of these locations for the following characteristics: beverage type, added sugar contents, price, and packaging material.
Results: Only 25% of drinks were sugar-sweetened beverages, compliant with UC Berkeley’s shelf space requirement (30%). However, the average price of water was approximately 14% higher than that of sugary beverages ($2.46 for water vs. $2.16 for soda). The least expensive water prices were $2.00 compared to $1.25 for the least expensive soda, which is not compliant with the campus’ nutrition policy. One-third (33%) of beverages were bottled in plastic packaging— inconsistent with the single-use plastic phase-out policy.
Conclusion: UC Berkeley’s beverage environment does not align with its policies and commitments on sustainable packaging or pricing. There is a high presence of single-use plastic packaged beverages on campus and lower affordability of water compared to soda. The university’s pouring rights contract with PepsiCo may have played a role, as it limits the selection of products and packaging and establishes wholesale beverage prices.
Authors:
Author - Alejandra Marquez, MS, UC Davis
Co-Author - Noelle Chin, BS, UC Berkeley
Co-Author - Andrea Gil, BS, UC Davis
Co-Author - Ethan Wolf, MPH, UC Berkeley
Co-Author - Jennifer Falbe, ScD, MPH, UC Davis
Presenter - Andrea Gil, BS, UC Davis
Voices of Latine families in eating disorder treatment: A qualitative study
Poster Number: E58Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Child and Family Health
Latine youth are an emerging population for eating disorders (EDs), and the impact of barriers - stigma, provider bias, lack of provider education, language barriers, and insurance type- on their receipt of care is not well understood. Research demonstrates that disproportionate access to specialized mental health services contributes to health disparities amongst patients with EDs, perpetuating a cycle of hospital readmissions. This qualitative study aimed to examine the perspectives of Latine families on eating disorder care and to identify barriers, facilitators, and culturally relevant recommendations. Families were recruited from a large children’s hospital in the Midwest. Twenty-two Latine families participated in three 60-minute family focus groups (2 Spanish-speaking, 1 English-speaking) and six 30-minute interviews. One bilingual investigator reviewed Spanish transcripts for accuracy, and a team of six investigators (two qualitative analysis experts, two eating disorder specialists, two Bilingual clinicians) coded transcripts. Utilizing the Health Equity Implementation Framework, we conducted direct content analysis of transcripts. Themes reflected systemic barriers: 1) interpreter service quality and availability, 2) ED stigma, 3) treatment costs, and 4) limited ED specialists . Facilitators for treatment included: 1) therapeutic alliance, 2) clinic flexibility, 3) value of family , 4) provider attunement, and 5) help-seeking by youth with EDs. Notably, these themes are not unique to Latine families but hold relevance for all families engaged in ED care. Cultural humility is an ongoing process of provider self-exploration paired with openness to learning from others and honoring their beliefs, customs and values. FBT (family-based treatment) addresses ED stigma and ED- specific challenges, and when integrated with cultural humility, can strengthen the therapeutic alliance, support values-based goals, and improve outcomes across cultural groups. Findings highlight culturally relevant recommendations for providers such as briefing interpreters before sessions, exploring families’ perspectives on mental health and EDs, and adapting treatment to align with each family’s needs and traditions. This study informs earlier interventions for EDs by utilizing identified facilitators and aims to reduce modifiable barriers to care. Practicing cultural humility is one step providers can take towards health equity.
Keywords: Adolescents, HispanicAuthors:
Author - Katrina Obleada, PhD, Ann & Robert H. Lurie Children's Hospital/Northwestern Feinberg School of Medicine
Co-Author - Anna Ros, PhD, Ann & Robert H. Lurie Children's Hospital/Northwestern Feinberg School of Medicine
Co-Author - Kelly Horn, PhD, LCSW, Ann & Robert H. Lurie Children's Hospital
Co-Author - Roxanna de la Torre, MD, Ann & Robert H. Lurie Children's Hospital/Northwestern Feinberg School of Medicine
Co-Author - Gregg Montalto, MD, MPH, Ann & Robert H. Lurie Children's Hospital/Northwestern Feinberg School of Medicine
Co-Author - Jessica Guzman, MSW, LCSW, Family Service Association of Greater Elgin
Intuitive Eating and Affect in Daily Life: The Moderating Role of Sexual Minority Status
Poster Number: E59Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Women's Health
Intuitive eating is an adaptive eating style characterized by attunement to internal hunger and satiety cues, with benefits including reduced cardiovascular risk, greater motivation to exercise, and improved cholesterol. Research suggests affect is linked to intuitive eating, but reliance on cross-sectional data has left directionality unestablished. To address this gap, we used an ecological momentary assessment (EMA) design to assess momentary associations between affect and intuitive eating. We also evaluated whether associations differed by sexual minority status, as research suggests eating behaviors vary by sexual orientation. Participants were 150 heterosexual and 146 sexual minority women (SMW) aged 18-30 (Mage = 25.36; 58.1% White) who completed EMA measures of 4 intuitive eating constructs (trust in one’s body, permission to eat desirable foods, eating foods that support performance, enjoyment of eating) and positive affect (PA) and negative affect (NA) 5 times/day for 14 days. Concurrent (eating predicting later affect) and time-lagged (affect predicting later eating) multilevel models tested associations between affect and intuitive eating, with sexual minority status as a moderator. Analyses of affect prior to eating found higher PA predicted higher subsequent enjoyment of eating (p<.001), and higher NA predicted lower subsequent permission to eat desirable foods (p=.01) and enjoyment of eating (p=.01); associations were not moderated by sexual minority status. Analyses of affect following eating found that after all intuitive eating behaviors, women had greater PA (ps<.002); these effects were moderated by sexual minority status, with weaker links among SMW for permission to eat desirable foods and eating foods that support performance (ps<.02). Following eating episodes with lower trust in one’s body, eating to support performance, and enjoyment of eating, women experienced higher NA (ps<.02), with no moderation by sexual minority status. Overall, findings suggest prior affect is associated with intuitive eating, and the benefits of intuitive eating may in turn extend to later affect. Weaker links between PA and some intuitive eating constructs for SMW indicate possible barriers (e.g., stigma, minority stress) that may dampen PA benefits. These results highlight potential targets for interventions promoting intuitive eating, including affect processes, emotion regulation, and unique sociocultural challenges faced by SMW.
Keywords: Eating behaviors, EmotionsAuthors:
Co-Author - Kaitlyn Ryan, B.A., Virginia Consortium Program in Clinical Psychology
Co-Author - Jennifer Shipley, Ph.D., M.P.H.I., University of Oregon
Co-Author - Abby Braitman, PhD, Old Dominion University
Co-Author - Kristin Heron, PhD, FSBM, Old Dominion University
Qualitative Analysis to Explore the Psychosocial Impact of Hepatocellular Carcinoma on the Somali Population
Poster Number: E6Time: 05:00 PM - 05:50 PM
Topics: Cancer
Background: Despite the elevated risk of hepatocellular carcinoma (HCC), there is a lack of research on the psychosocial experiences of liver cancer within the Somali community. This study aimed to gather qualitative feedback regarding the impact of HCC in the community and identify areas of need that can be addressed from a psychosocial perspective to examine the role of cultural/communal/spiritual impact on how the Somali community in Minnesota understands liver cancer.
Methods: We held three, 60-minute focus group sessions, consisting of a total of 28 adult Somali participants. These sessions were audio recorded, transcribed and translated into English. We applied the Sort and Sift, Think and Shift method model of qualitative analysis of the focus group transcripts with team consensus discussion. Major themes and subthemes were grouped together and later analyzed through the lens of the Biopsychosocial Model.
Results: The major themes were support, psychological, and spirituality. Within the support theme, participants highlighted opportunities to strengthen healthy literacy in the Somali community, particularly around symptom recognition, cancer progression, and the hepatitis/liver cancer link. Barriers to care such as transportation, childcare, and language differences were noted. Participants also discussed the benefits of community solidarity in navigating health challenges. In the psychological impact theme, participants discussed hesitancy to share cancer diagnoses with other community members due to stigma. Participants reported stigma around seeking mental health services. Conversely, others discussed the detrimental impacts of not discussing mental health care. In the spirituality theme, participants discussed the importance of spirituality as a source of strength and how they conceptualized health and illness. Prayers were a form of communal support for those who were ill. Participants also acknowledged how spiritual beliefs of predestination can strongly conflict with providers traditionally discussing prognosis surrounding potentially terminal illnesses.
Discussion: This study examined how various factors such as community support, spirituality, etc. impact how liver cancer is understood within the Somali community. These results can help inform culturally-tailored interventions for psychosocial support for Somali patients diagnosed with liver cancer.
Keywords: Cancer, Minority groupsMethods: We held three, 60-minute focus group sessions, consisting of a total of 28 adult Somali participants. These sessions were audio recorded, transcribed and translated into English. We applied the Sort and Sift, Think and Shift method model of qualitative analysis of the focus group transcripts with team consensus discussion. Major themes and subthemes were grouped together and later analyzed through the lens of the Biopsychosocial Model.
Results: The major themes were support, psychological, and spirituality. Within the support theme, participants highlighted opportunities to strengthen healthy literacy in the Somali community, particularly around symptom recognition, cancer progression, and the hepatitis/liver cancer link. Barriers to care such as transportation, childcare, and language differences were noted. Participants also discussed the benefits of community solidarity in navigating health challenges. In the psychological impact theme, participants discussed hesitancy to share cancer diagnoses with other community members due to stigma. Participants reported stigma around seeking mental health services. Conversely, others discussed the detrimental impacts of not discussing mental health care. In the spirituality theme, participants discussed the importance of spirituality as a source of strength and how they conceptualized health and illness. Prayers were a form of communal support for those who were ill. Participants also acknowledged how spiritual beliefs of predestination can strongly conflict with providers traditionally discussing prognosis surrounding potentially terminal illnesses.
Discussion: This study examined how various factors such as community support, spirituality, etc. impact how liver cancer is understood within the Somali community. These results can help inform culturally-tailored interventions for psychosocial support for Somali patients diagnosed with liver cancer.
Authors:
Author - Khalid Abdalla, BS, University of Minnesota Medical School
Co-Author - Yahya Abdulrahman, BS, University of Minnesota Medical School
Co-Author - Abby Lohr, PhD, MPH, Mayo Clinic
Co-Author - Khadija Ali, BS, Pamoja Women
Co-Author - Ahmed Mohamed, MD, Mayo Clinic
Co-Author - Luz Molina, Rochester Healthy Community Partnership
Co-Author - Mark Wieland, MD, MPH, Mayo Clinic
Co-Author - Irene Sia, MD, MS, Mayo Clinic
Co-Author - Carrie Bronars, PhD, LP, Mayo Clinic
The Role of Experiential Avoidance in Eating and Body Image Cued Reactive Exercise
Poster Number: E60Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Physical Activity
Body dissatisfaction is a common, uncomfortable internal experience, that contributes to eating psychopathology maintenance. Individuals with eating psychopathology often exercise in reaction to shape (e.g., body dissatisfaction), eating, and weight cues. Such exercise also maintains eating psychopathology. An individual’s tendency to avoid uncomfortable internal situations (i.e., experiential avoidance) may affect their degree of engagement in such exercise. For example, the urge to experientially avoid body dissatisfaction is associated with increased eating disordered behaviors and cognitions such as bingeing and purging, and overvaluation of weight and shape. Individuals higher in experiential avoidance may be at heightened risk of exercising in response to body dissatisfaction to try to avoid this internal experience. The primary hypothesis was that experiential avoidance would moderate the relation between body dissatisfaction and exercise in reaction to eating/body image (E/BI) cues.
N=296 undergraduate students (Mage 19.77±1.92, 72.6% female, 84.1% non-Hispanic White) completed measures of exercise in reaction to E/BI cues and negative and positive affect cues, trait body dissatisfaction subscale, and general experiential avoidance.
A moderation analysis covarying for exercise in reaction to negative and positive affect showed that the interaction between body dissatisfaction and experiential avoidance did not explain unique variance of E/BI cued reactive exercise, ΔR2 = .003, F(1, 290)=1.98, p=.16. After removing the interaction term, the main effect of body dissatisfaction was significantly positively associated with E/BI reactive exercise (β=.324, t=7.60, p <.001), while experiential avoidance was not (β= .048, t=1.12, p=.263).
As the study hypothesis was not supported it is possible that experiential avoidance does not play a meaningful role in E/BI reactive exercise engagement. Body dissatisfaction is associated with reactive exercise and remains a relevant risk factor. Future research should explore if E/BI cued reactive exercise follows heightened state body dissatisfaction; experiential avoidance may be associated with responses to state rather than trait body dissatisfaction. Using ecological momentary data collection may offer insight into state factors that increase risk for E/BI cued reactive exercise.
Keywords: Eating behaviors, ExerciseN=296 undergraduate students (Mage 19.77±1.92, 72.6% female, 84.1% non-Hispanic White) completed measures of exercise in reaction to E/BI cues and negative and positive affect cues, trait body dissatisfaction subscale, and general experiential avoidance.
A moderation analysis covarying for exercise in reaction to negative and positive affect showed that the interaction between body dissatisfaction and experiential avoidance did not explain unique variance of E/BI cued reactive exercise, ΔR2 = .003, F(1, 290)=1.98, p=.16. After removing the interaction term, the main effect of body dissatisfaction was significantly positively associated with E/BI reactive exercise (β=.324, t=7.60, p <.001), while experiential avoidance was not (β= .048, t=1.12, p=.263).
As the study hypothesis was not supported it is possible that experiential avoidance does not play a meaningful role in E/BI reactive exercise engagement. Body dissatisfaction is associated with reactive exercise and remains a relevant risk factor. Future research should explore if E/BI cued reactive exercise follows heightened state body dissatisfaction; experiential avoidance may be associated with responses to state rather than trait body dissatisfaction. Using ecological momentary data collection may offer insight into state factors that increase risk for E/BI cued reactive exercise.
Authors:
Author - Lucy Wetherall, M.S., University of Wyoming
Author - Lindsay Gillikin, M.S., University of Wyoming
Author - Kyle De Young, Ph.D., University of Wyoming
Digital Self-Monitoring and Health Outcomes of a Pilot Intervention to Prevent Weight Gain in Adults Who Emotionally Eat
Poster Number: E62Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Diet, Nutrition, and Eating Disorders
Background: The use of technology may improve self-monitoring in behavioral interventions for weight. Health interventions that include digital platforms to self-monitor behaviors have shown positive effects on health outcomes. However, limited data exist on the frequency of self-monitoring among adults with obesity (BMI ≥ 30) who emotionally eat. Thus, the purpose of this study is to examine whether frequent digital self-monitoring was associated with changes in interoceptive awareness (IA) and disinhibition among adults with obesity and emotional eating. Methods: A secondary analysis was conducted using data from the 12-week SATISFY intervention, a pilot feasibility and acceptability trial where participants (N=31) were instructed to use a digital survey platform to record mealtimes, hunger and satiety signals, and pre-/post-meal emotions approximately five times per day throughout 12 weeks. Adherence to self-monitoring was captured by tracking each participant’s digital survey logins. We also examined the relationship between self-monitoring and interoceptive awareness (IA)using the MAIA-2 (Multidimensional Assessment of Interoceptive Awareness Assessment, Version 2) questionnaire to measure 8 dimensions: noticing not-distracting, not-worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting. Multiple Linear Regression models were used to assess the association between login frequency and changes in IA, with adjustments made for age. Results: The sample (N = 31) was 54.84% African American/Black and predominantly female (90.32%). On average, participants logged on to the digital self-monitoring survey 346 times±235 during the 12-week intervention (82% adherence rate). After adjusting for age, higher login frequency to the digital self-monitoring survey was associated with higher body listening (a dimension of IA focusing on perceiving bodily cues like hunger) post-intervention scores (p = .004). The relationship between higher login scores and the other subscales was not significant. Conclusion: Findings suggest that higher digital self-monitoring frequency strengthened the ability to notice bodily cues. Future research needs to examine whether these improvements in IA lead to lasting changes in eating behavior among adults with obesity and emotional eating. Exploring mechanisms behind adherence to digital self-monitoring platforms may further optimize intervention effectiveness.
Keywords: e-Health, NutritionAuthors:
Co-Author - Yu (Irene) Wang, BS, Yale
Co-Author - Ana Paola Campos, PhD, UNC-Chapel HIll
Co-Author - Tyisha Harper-Cooks, MBA, UNC- Chapel Hill
Co-Author - Katherine Matthes, BSW, UNC-Chapel Hill
Co-Author - Ramine Alexander, PhD, MPH, UNC Chapel Hill
Co-Author - Wehazit Mussie, UNC-Chapel Hill
Author - Rachel Goode, PhD, MPH, LCSW, UNC-Chapel Hill
Perceptions of Generative Artificial Intelligence (Gen AI) as a Co-Creative Tool in Behavior Change Intervention Development
Poster Number: E63Time: 05:00 PM - 05:50 PM
Topics: Digital Health
Background: Generative artificial intelligence (Gen AI) can learn and apply information to support the development of behavior change interventions. For example, researchers can use Gen AI to create content for interventions (e.g., message banks) by providing information about behavior change techniques, theory, and how to apply it in an intervention context. The goal of this study was to investigate whether a co-creative process (i.e., prompt-engineering) was advantageous for intervention development by comparing it to default Gen AI language. We hypothesized that participants would prefer prompt-engineered messages, ranking them with a higher quality, appropriateness, and ability to create behavior change.
Methods: Participants who self-identified as a behavioral science trainee or professional were recruited to complete a survey evaluating message banks that could be used in a pediatric behavioral intervention that were either prompt-engineered or created using Gen AI (no prompt-engineering). Blinded participants were asked to evaluate messages for 1) quality of behavior change content, 2) appropriateness for adolescents, and 3) odds of creating behavior change. Participants were then asked to rank-order messages based on their suitability for a behavior change intervention and complete a short measure about their attitudes towards AI.
Results: Paired sample t-tests showed that prompt-engineered messages were rated significantly lower than Gen AI messages for quality, behavior change, and appropriateness. Prompt-engineered messages were also ranked significantly lower compared to Gen AI messages. An independent samples t-test also found that career level impacted ratings, where trainees rated all messages significantly more favorable than professionals for change and quality.
Discussion: Contrary to hypotheses, participants rated Gen AI messages as more appropriate, higher quality, and being more likely to create behavior change than prompt-engineered messages. The difference between trainee and professionals' perceptions of messaging also reveals a potential generational or training divide in perception of AI generated messaging. Further research is needed to determine whether Gen AI text effectively promotes behavior change compared to a co-creative process with experts, increases efficiency of development, and how trainee and professional levels impact perception of Gen AI text.
Generative AI was used to create study content.
Keywords: Health behavior change, TechnologyMethods: Participants who self-identified as a behavioral science trainee or professional were recruited to complete a survey evaluating message banks that could be used in a pediatric behavioral intervention that were either prompt-engineered or created using Gen AI (no prompt-engineering). Blinded participants were asked to evaluate messages for 1) quality of behavior change content, 2) appropriateness for adolescents, and 3) odds of creating behavior change. Participants were then asked to rank-order messages based on their suitability for a behavior change intervention and complete a short measure about their attitudes towards AI.
Results: Paired sample t-tests showed that prompt-engineered messages were rated significantly lower than Gen AI messages for quality, behavior change, and appropriateness. Prompt-engineered messages were also ranked significantly lower compared to Gen AI messages. An independent samples t-test also found that career level impacted ratings, where trainees rated all messages significantly more favorable than professionals for change and quality.
Discussion: Contrary to hypotheses, participants rated Gen AI messages as more appropriate, higher quality, and being more likely to create behavior change than prompt-engineered messages. The difference between trainee and professionals' perceptions of messaging also reveals a potential generational or training divide in perception of AI generated messaging. Further research is needed to determine whether Gen AI text effectively promotes behavior change compared to a co-creative process with experts, increases efficiency of development, and how trainee and professional levels impact perception of Gen AI text.
Generative AI was used to create study content.
Authors:
Author - Zachary Bricken, B.A., University of Kansas
Co-Author - Peter Fantozzi, M.A., University of Kansas
Co-Author - Calissa Leslie-Miller, MS, University of Kansas
Co-Author - David Fedele, Ph.D., ABPP, Nemours Children's Health
Co-Author - Christopher Cushing, PhD, University of Kansas
Associations Between Activity Planning and Daily Step Counts: Evidence from a Yearlong mHealth Intervention (HeartSteps II)
Poster Number: E64Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Physical Activity
Background: Activity planning has consistently been associated with physical activity in short-term and cross-sectional studies, but its role over longer periods in real-world conditions remains unclear. Additionally, longitudinal data poses several analytic challenges, primarily due to missingness, variability, and within-person correlation, highlighting the need for methods that address these complexities.
Methods: We analyzed longitudinal data from the HeartSteps II study (n=91), a yearlong deployment of the HeartSteps mHealth intervention that provided opportunities for activity planning, in addition to other message and goal-based intervention components. Data on daily planning activities, step counts, and ecological momentary assessments (EMA), as well as baseline personality data was used. To address the data challenges described above, a Bayesian multi-level model (BMM) was used, which accounts for nested data (days within individuals), provides robust uncertainty estimation, and captures differences in baseline step counts across people.
Results: Across participants, daily planning was found to be associated with higher step counts, corresponding to 162 additional steps per day (95% BCI: 75, 250). This effect remained detectable, despite the conservative modeling assumptions and accounting for uncertainty due to missingness. The Bayesian framework also accounted for individual differences, while estimating a population-level association between planning and daily steps. Additional findings indicated that the impact of answering the daily EMA was also positively associated with higher step counts (142 steps per day (95% BCI: 18-267)), while the interaction between the two (planning and EMA) was negative (-56 (95% BCI: -147, 38)), suggesting their combined effect may be less than the sum of the individual effects, indicating there may be a potential overlap in their underlying mechanisms, although the evidence was suggestive and not conclusive.
Conclusions: These findings extend prior short-term evidence by showing that activity planning was associated with higher physical activity over the course of a full year, despite the daily fluctuations of everyday life. Although the effect size was modest, the associations were detectable even with missing, and highly variable data, highlighting the potential relevance of activity planning for supporting sustained physical activity behavior over longer periods of time.
Keywords: Behavior Change, Physical activityMethods: We analyzed longitudinal data from the HeartSteps II study (n=91), a yearlong deployment of the HeartSteps mHealth intervention that provided opportunities for activity planning, in addition to other message and goal-based intervention components. Data on daily planning activities, step counts, and ecological momentary assessments (EMA), as well as baseline personality data was used. To address the data challenges described above, a Bayesian multi-level model (BMM) was used, which accounts for nested data (days within individuals), provides robust uncertainty estimation, and captures differences in baseline step counts across people.
Results: Across participants, daily planning was found to be associated with higher step counts, corresponding to 162 additional steps per day (95% BCI: 75, 250). This effect remained detectable, despite the conservative modeling assumptions and accounting for uncertainty due to missingness. The Bayesian framework also accounted for individual differences, while estimating a population-level association between planning and daily steps. Additional findings indicated that the impact of answering the daily EMA was also positively associated with higher step counts (142 steps per day (95% BCI: 18-267)), while the interaction between the two (planning and EMA) was negative (-56 (95% BCI: -147, 38)), suggesting their combined effect may be less than the sum of the individual effects, indicating there may be a potential overlap in their underlying mechanisms, although the evidence was suggestive and not conclusive.
Conclusions: These findings extend prior short-term evidence by showing that activity planning was associated with higher physical activity over the course of a full year, despite the daily fluctuations of everyday life. Although the effect size was modest, the associations were detectable even with missing, and highly variable data, highlighting the potential relevance of activity planning for supporting sustained physical activity behavior over longer periods of time.
Authors:
Author - Steven De La Torre, PhD, MPH, University of Michigan
Co-Author - Predrag Klasnja, PhD, University of Michigan
Personalized Digital Outreach Reveals Equity Patterns in Mammography
Poster Number: E65Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Health Disparities
Background and Objective: Digital health interventions (DHIs) may improve access for underserved populations via personalized outreach at scale. This intervention applied behavioral science strategies and reinforcement learning (RL) to deliver data-driven, tailored email messages to women due for mammography screenings. Research objectives were to increase screening and examine equity implications across demographic groups.
Methods: Behavioral outcomes were evaluated from two mammography DHIs in U.S. health systems from August 2020 to December 2024. Women (N = 219,245; ages 40-80) due for screening received intervention emails, and demographics were obtained from health records. Exploratory chi-square tests assessed demographic differences, and Bonferroni-adjusted pairwise comparisons evaluated relative engagement and attendance.
Results: Email engagement was high (83.2%), yet only 22% of engaged women attended screenings. Attendance differed significantly by race (χ² = 329.41, df = 5), age (χ² = 535.94, df = 1), BMI (χ² = 244.77, df = 3), and education (χ² = 122.23, df = 3, all ps < .001). Relative attendance rates (RARs: attended/delivered) were higher among African American and American Indian/Alaska Native women than Caucasians (+6.1%, p < .001 and +6.8%, p = 0.04, respectively), higher among African American compared to Asian women (+6%, p < .001), and higher among Hispanic compared to Caucasian women (+4.9%, p = 0.01). RARs were also higher among women ages 40-64 than older women (+4.5%, p <.001), and among obese women compared to underweight (+4.8%), normal weight (+5.2%), and overweight women (+3.3%, all ps < .001). Graduate school completers had lower RARs than high school graduates (-3.8%, p < .001) college graduates (-3.2%, p < .001) and vocational/technical school attendees (-3.6%, p = 0.002).
Conclusions: Data-driven personalization in mammography DHIs was associated with high overall patient engagement, yet screening was low. Although groups with larger representation in the reachable population accounted for more overall screenings, RARs revealed greater attendance in historically underrepresented populations. These exploratory findings suggest that combining behavioral science with RL to deliver the right intervention to the right population at the right time may be a promising precision public health strategy for advancing equity. Future DHIs should refine strategies to better optimize attendance and engagement in diverse populations.
Keywords: Diversity, Cancer screeningMethods: Behavioral outcomes were evaluated from two mammography DHIs in U.S. health systems from August 2020 to December 2024. Women (N = 219,245; ages 40-80) due for screening received intervention emails, and demographics were obtained from health records. Exploratory chi-square tests assessed demographic differences, and Bonferroni-adjusted pairwise comparisons evaluated relative engagement and attendance.
Results: Email engagement was high (83.2%), yet only 22% of engaged women attended screenings. Attendance differed significantly by race (χ² = 329.41, df = 5), age (χ² = 535.94, df = 1), BMI (χ² = 244.77, df = 3), and education (χ² = 122.23, df = 3, all ps < .001). Relative attendance rates (RARs: attended/delivered) were higher among African American and American Indian/Alaska Native women than Caucasians (+6.1%, p < .001 and +6.8%, p = 0.04, respectively), higher among African American compared to Asian women (+6%, p < .001), and higher among Hispanic compared to Caucasian women (+4.9%, p = 0.01). RARs were also higher among women ages 40-64 than older women (+4.5%, p <.001), and among obese women compared to underweight (+4.8%), normal weight (+5.2%), and overweight women (+3.3%, all ps < .001). Graduate school completers had lower RARs than high school graduates (-3.8%, p < .001) college graduates (-3.2%, p < .001) and vocational/technical school attendees (-3.6%, p = 0.002).
Conclusions: Data-driven personalization in mammography DHIs was associated with high overall patient engagement, yet screening was low. Although groups with larger representation in the reachable population accounted for more overall screenings, RARs revealed greater attendance in historically underrepresented populations. These exploratory findings suggest that combining behavioral science with RL to deliver the right intervention to the right population at the right time may be a promising precision public health strategy for advancing equity. Future DHIs should refine strategies to better optimize attendance and engagement in diverse populations.
Authors:
Co-Author - Emily Frith, PhD, Lirio
Co-Author - Sarah Deedat, PhD, Lirio
Co-Author - E. Blazek, PhD, Stripe
Co-Author - Amy Bucher , PhD, Lirio
Examining the Long-Term Impact of a Gamified mHealth App: An 18-Month Prospective Cohort Study
Poster Number: E66Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Physical Activity
Background: Few mobile health applications (mHealth apps) have been evaluated longer term (i.e., >12 months). Methods: We conducted a prospective cohort study with 18-month follow-up to evaluate WayBetter, an mHealth app that targets health behavior change in physical activity (PA) and nutrition using gamification, coach and peer support, and financial incentives in the form of a deposit contract. We initially recruited a cohort of 1,178 new WayBetter users starting a free trial (Nov 2023-Jan 2024), who completed a baseline survey (i.e. sociodemographics, health behaviors). In June 2025, we decided to send a follow-up survey to the same cohort, which assessed app opinions (i.e., Mobile Application Rating Scale) as well as current and previous (i.e., “while actively using WayBetter”) self-reported health behaviors. Follow-up survey respondents were classified into three groups: (1) Never members (free trial only), (2) Former members, and (3) Current members. Group differences in app opinions and health behaviors were examined using χ² tests and ordinal logistic regression with covariates included in the model to adjust for baseline differences. Results: One hundred and fifty-seven participants (Mean age: 40.83 years; % female: 92.09; 13.33% of initial cohort) responded to the follow-up survey (Never, n=60; Former, n=55; Current, n=42). Current members rated app ease-of-use more positively compared to Former and Never members (p=.007, V=.264). Current members were significantly more likely to agree that the app encouraged help-seeking (p=.025, V=.276) and that they would recommend it to others (p=.017, V=.290). Current members reported higher levels of PA at baseline. However, after adjusting for baseline differences in PA levels, at follow up former members were more likely to report higher levels of vigorous PA compared to Current members (p=.044) and Never members were more likely to report higher levels of moderate PA compared to Current members (p=0.024). No groups differences in nutrition were observed (p>.05). Conclusion: Eighteen months after initiating a 7-day free trial, as expected, Current members held more positive app opinions than Former and Never members. On the other hand, and somewhat surprisingly, Current members self-reported less PA than the other two groups, after adjusting for baseline PA differences. This disparate finding may be because Current members had less room to improve (‘ceiling effect’) and warrants further investigation.
Keywords: Behavior Change, e-HealthAuthors:
Author - Youssef Genaidy, Western University
Co-Author - Erika Bloom, PhD, WayBetter Inc.
Author - Marc Mitchell, PhD, Western University
A Conversational AI-Based Intervention to Enhance Treatment Adherence in Breast Cancer Survivors: Study Protocol
Poster Number: E67Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Cancer
Background: Breast cancer is the most common cancer among women in the U.S., with approximately 80% of patients diagnosed with hormone receptor-positive (HR+) tumors. For these individuals, adjuvant endocrine therapy (AET), such as tamoxifen or aromatase inhibitors, offers significant survival benefits when taken for 5–10 years. However, adherence remains a major challenge, with many women discontinuing treatment early, increasing their risk of recurrence and reduced survival. Despite growing interest, few interventions use conversational AI to address AET adherence. Conversational AI technologies offer a scalable, cost-effective solution by delivering timely, personalized support without increasing clinical workload. We developed and completed a beta version testing on a conversational AI-based intervention designed to improve motivation and behavior related to AET restart.
Methods: This study protocol outlines the methodology and qualitative evaluation of iCARE (Comprehensive Adjuvant Research in Endocrine Therapy), designed for breast cancer survivors who have prematurely discontinued AET. Phase I involved internal testing and usability evaluation with cancer survivor advocates to refine its design, content, and workflow. When a user engages with the platform, iCARE initiates interaction with a greeting and delivers daily ecological momentary assessments (EMAs) to assess motivation, emotional state, and perceived risk. Based on EMA responses and individual clinical profiles, participants receive personalized messages grounded in behavior change techniques and informed by a curated clinical knowledge base. The messages are randomly selected from a message bank focusing on 10 different themes. Users can also interact with iCARE to ask questions related to AET, side effects, and survivorship concerns.
Results and Conclusion: This work presents operational details, designs, results from internal testing, and conversational AI-based intervention procedures. Usability testing assessed the functionality, engagement, and relevance of message flows. The final version is designed for use in a trial to support treatment adherence and survivorship care. iCARE represents an innovative, AI-powered intervention tailored to support AET adherence among HR+ breast cancer survivors. By leveraging scalable AI-mediated communication, iCARE has the potential to address critical gaps in post-treatment cancer care.
Keywords: Cancer, Health communicationMethods: This study protocol outlines the methodology and qualitative evaluation of iCARE (Comprehensive Adjuvant Research in Endocrine Therapy), designed for breast cancer survivors who have prematurely discontinued AET. Phase I involved internal testing and usability evaluation with cancer survivor advocates to refine its design, content, and workflow. When a user engages with the platform, iCARE initiates interaction with a greeting and delivers daily ecological momentary assessments (EMAs) to assess motivation, emotional state, and perceived risk. Based on EMA responses and individual clinical profiles, participants receive personalized messages grounded in behavior change techniques and informed by a curated clinical knowledge base. The messages are randomly selected from a message bank focusing on 10 different themes. Users can also interact with iCARE to ask questions related to AET, side effects, and survivorship concerns.
Results and Conclusion: This work presents operational details, designs, results from internal testing, and conversational AI-based intervention procedures. Usability testing assessed the functionality, engagement, and relevance of message flows. The final version is designed for use in a trial to support treatment adherence and survivorship care. iCARE represents an innovative, AI-powered intervention tailored to support AET adherence among HR+ breast cancer survivors. By leveraging scalable AI-mediated communication, iCARE has the potential to address critical gaps in post-treatment cancer care.
Authors:
Presenter - Sunny Jung Kim, PhD, Virginia Commonwealth University
Co-Author - Farnese Murielle Edimo Motto, MSPH, CHES, Virginia Commonwealth University
Co-Author - Erinn Miles, KLaunch
Co-Author - Vanessa Sheppard, Virginia Commonwealth University
Impact of Input Detail in Accuracy of Large Language Models in Classifying Commonly Eaten Foods
Poster Number: E68Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Diet, Nutrition, and Eating Disorders
Accurate classification of foods items into groups is essential for tracking and evaluating diet quality, a determinant of noncommunicable disease risk. With the growing use of image-based dietary assessment to reduce participant burden, large language models (LLMs) are being tested for their ability to recognize food from images, which are then translated into text for categorization. What remains unclear is how well LLMs perform with varying levels of input detail in food categorization, and if performance differs by food groups.
We assessed four popular LLMs (ChatGPT-4o, Claude Sonnet 4, Gemini 2.5 Pro, and Llama 4 Maverick) on their ability to classify food names into one of nine Nutrition Coordinating Center (NCC) groups. The analysis included 171 most commonly consumed, non-infant foods from the 2017–2020 NHANES dataset. Foods were tested under scaffolded prompting conditions, each adding detail from the prior iteration: (1) nine NCC food groups without reference to NCC; (2) explicit mention of NCC; (3) addition of the NCC Food Group Serving Count System; and (4) inclusion of an NCC reference appendix. Model outputs were compared with dietitian-verified classifications as the gold standard. Percent accuracy was calculated as the number of correct classifications divided by the total number of food items, multiplied by 100.
Claude, Gemini, and Llama yielded the highest accuracy in condition 4 (91-99%), while ChatGPT performed best under condition 3 (59%). Claude and Gemini produced the lowest accuracy in condition 1 (54-80%), while Llama performed worst in condition 2 (77%) and ChatGPT in condition 4 (50%). When analyzed by food groups, Llama, Gemini, and Claude achieved perfect accuracy for beverages under conditions 2 through 4, while ChatGPT reached 100% only under condition 3. Claude and Llama maintained >80% classification accuracy for the Meat, Fish, and Poultry group, as well as for Sweets, across all conditions. Gemini reached this threshold only in conditions 3 and 4. In condition 4, Claude, Gemini, and Llama achieved >80% accuracy across all food groups except Fats. ChatGPT rarely exceeded the 80% threshold, performing well only for Beverages and Dairy in condition 3.
Most LLMs showed strong accuracy in food classification when provided with detailed input, although performance varied by LLM and food group. Future work should examine how LLMs can be applied in dietary assessment and if they have consistent, reliable performance.
Keywords: Nutrition, TechnologyWe assessed four popular LLMs (ChatGPT-4o, Claude Sonnet 4, Gemini 2.5 Pro, and Llama 4 Maverick) on their ability to classify food names into one of nine Nutrition Coordinating Center (NCC) groups. The analysis included 171 most commonly consumed, non-infant foods from the 2017–2020 NHANES dataset. Foods were tested under scaffolded prompting conditions, each adding detail from the prior iteration: (1) nine NCC food groups without reference to NCC; (2) explicit mention of NCC; (3) addition of the NCC Food Group Serving Count System; and (4) inclusion of an NCC reference appendix. Model outputs were compared with dietitian-verified classifications as the gold standard. Percent accuracy was calculated as the number of correct classifications divided by the total number of food items, multiplied by 100.
Claude, Gemini, and Llama yielded the highest accuracy in condition 4 (91-99%), while ChatGPT performed best under condition 3 (59%). Claude and Gemini produced the lowest accuracy in condition 1 (54-80%), while Llama performed worst in condition 2 (77%) and ChatGPT in condition 4 (50%). When analyzed by food groups, Llama, Gemini, and Claude achieved perfect accuracy for beverages under conditions 2 through 4, while ChatGPT reached 100% only under condition 3. Claude and Llama maintained >80% classification accuracy for the Meat, Fish, and Poultry group, as well as for Sweets, across all conditions. Gemini reached this threshold only in conditions 3 and 4. In condition 4, Claude, Gemini, and Llama achieved >80% accuracy across all food groups except Fats. ChatGPT rarely exceeded the 80% threshold, performing well only for Beverages and Dairy in condition 3.
Most LLMs showed strong accuracy in food classification when provided with detailed input, although performance varied by LLM and food group. Future work should examine how LLMs can be applied in dietary assessment and if they have consistent, reliable performance.
Authors:
Author - Razi Lawabni, The Hormel Institute, University of Minnesota
Co-Author - Leo Kampen, BS, The Hormel Institute, University of Minnesota
Co-Author - Olivia Solano, BS, The Hormel Institute, University of Minnesota
Co-Author - Dongji Feng, PhD, California State University, Monterey Bay
Co-Author - Annie Lin, PhD, RD, University of Minnesota
Feasibility and Efficacy of a Multi-Technology ‘Sit Less’ Program in Cardiovascular Disease and Type 2 Diabetes
Poster Number: E69Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Physical Activity
Background: Individuals with cardiometabolic disease spend 10–14 hours/day sedentary, which increases their risk of complications and mortality. Because sedentary behavior is habitual, multi-technology interventions may help individuals recognize sitting patterns and interrupt prolonged bouts. The purpose of this study was to evaluate the feasibility and preliminary efficacy of a multi-technology “Sit Less” program to reduce sedentary behavior in this population.
Methods: Adults with cardiovascular disease (CVD) or type 2 diabetes (T2D) were recruited in Nashville, TN, and randomized to the Sit Less intervention or a control group. The Sit Less program included one physical activity counseling session, a Fitbit for self-monitoring, a smart water bottle designed to prompt sedentary breaks and encourage more frequent restroom trips, and 12 weeks of tailored weekly text messages incorporating Fitbit data. Control participants received educational materials. Sedentary time (activPAL) was the primary outcome; secondary outcomes included physical activity, psychological measures, HbA1C, and 24-h glucose (continuous glucose monitoring). Post-intervention group differences were tested using generalized linear models adjusted for baseline values and diagnosis (CVD vs. T2D).
Results: Of 37 participants with CVD or T2D, 35 completed the study (95% retention; 62% male; median age 67; baseline sedentary time 10.4 h/day, 37% T2D). In Sit Less, 2 of 19 (10%) dropped out due to Fitbit privacy concerns and recording errors. Among completers, 89% would recommend the program, and 88% reported increased awareness of sedentary behavior. Post-intervention, Sit Less sat 33 min/day less (95% CI –77 to 11), had 64 min/day fewer prolonged sitting (95% CI –122 to –7), and 4.7 more sit-to-stand transitions/day (95% CI –0.8 to 10.2) than controls, adjusted for baseline and diagnoses. Sit Less also reduced average glucose from 113 to 100 mg/dL, while the control group increased from 103 to 113 mg/dL (adjusted mean difference: –8.3 mg/dL, 95% CI –16.0 to –0.5). HbA1c improved, with an adjusted mean difference of –0.6% (95% CI –1.2 to –0.1) favoring Sit Less. No meaningful differences were observed for physical activity or psychological outcomes between groups.
Conclusions: Sit Less was feasible and effective in reducing sedentary behavior while improving glucose levels in people with cardiometabolic disease. These findings support larger trials to confirm efficacy and scalability.
Keywords: Behavior Change, Metabolic regulationMethods: Adults with cardiovascular disease (CVD) or type 2 diabetes (T2D) were recruited in Nashville, TN, and randomized to the Sit Less intervention or a control group. The Sit Less program included one physical activity counseling session, a Fitbit for self-monitoring, a smart water bottle designed to prompt sedentary breaks and encourage more frequent restroom trips, and 12 weeks of tailored weekly text messages incorporating Fitbit data. Control participants received educational materials. Sedentary time (activPAL) was the primary outcome; secondary outcomes included physical activity, psychological measures, HbA1C, and 24-h glucose (continuous glucose monitoring). Post-intervention group differences were tested using generalized linear models adjusted for baseline values and diagnosis (CVD vs. T2D).
Results: Of 37 participants with CVD or T2D, 35 completed the study (95% retention; 62% male; median age 67; baseline sedentary time 10.4 h/day, 37% T2D). In Sit Less, 2 of 19 (10%) dropped out due to Fitbit privacy concerns and recording errors. Among completers, 89% would recommend the program, and 88% reported increased awareness of sedentary behavior. Post-intervention, Sit Less sat 33 min/day less (95% CI –77 to 11), had 64 min/day fewer prolonged sitting (95% CI –122 to –7), and 4.7 more sit-to-stand transitions/day (95% CI –0.8 to 10.2) than controls, adjusted for baseline and diagnoses. Sit Less also reduced average glucose from 113 to 100 mg/dL, while the control group increased from 103 to 113 mg/dL (adjusted mean difference: –8.3 mg/dL, 95% CI –16.0 to –0.5). HbA1c improved, with an adjusted mean difference of –0.6% (95% CI –1.2 to –0.1) favoring Sit Less. No meaningful differences were observed for physical activity or psychological outcomes between groups.
Conclusions: Sit Less was feasible and effective in reducing sedentary behavior while improving glucose levels in people with cardiometabolic disease. These findings support larger trials to confirm efficacy and scalability.
Authors:
Author - Chorong Park, PhD, RN, Seoul National University
Co-Author - Mary Dietrich, PhD, Vanderbilt University
Co-Author - Britta Larsen, PhD, University of California, San Diego
Co-Author - Lindsay Mayberry, PhD, FSBM, Vanderbilt University Medical Center
Co-Author - Abigail Doyle, MSHI, Vanderbilt University
Co-Author - Soojung Ahn, PhD, Boston College
Co-Author - Mulubrhan Mogos, PhD, Vanderbilt University
Co-Author - James Muchira, PhD, Vanderbilt University
Co-Author - Shelagh Mulvaney, PhD, Vanderbilt University
Exploring physical and vascular function in breast cancer patients from the Discovery and Elimination of Cardio-Oncology Disparities Toward Equity Study
Poster Number: E7Time: 05:00 PM - 05:50 PM
Topics: Cancer, Cardiovascular Disease
Background:
Adverse cardiovascular events are the second leading cause of non-cancer related mortality among breast cancer survivors. Black/African American (B/AA) survivors exhibit a higher incidence of cardiotoxicity directly and/or indirectly linked to treatment. The Discovery and Elimination of Cardio-Oncology Disparities Toward Equity in the Heartland Center includes 3 projects examining how treatment impacts vascular function, the potential mitigating effects of exercise and how socioenvironmental factors moderate treatment and exercise effects. We examined baseline results for physical function, endothelial function, and socioenvironmental factors, highlighting significant differences between B/AA and Non-Hispanic White (NHW) women newly diagnosed with breast cancer.
Methods:
Eligible patients must be female, 18+ years old, recently diagnosed with breast cancer, and identify as B/AA or NHW. Prior to treatment, physical function is assessed using VO2 peak, 6-minute walk (6MW), 30-second chair stand, and handgrip strength. Endothelial function is measured using flow mediated dilation.
Results:
The study includes 83 participants (61 NHW, 22 B/AA; mean age = 49.4 [11.6]) providing baseline data. Physical function results for the overall sample were in normal range (22.0 ml/min/kg for VO2 peak, 523 meters for 6MW, 16 for 30-second chair stand, and 30.6kg for dominant handgrip strength). However, B/AA participants demonstrated significantly lower VO2 peak, 30-second chair stand, and handgrip strength vs NHW counterparts (all p values <.05). While peak endothelial dilation was similar between NHW and B/AA participants, B/AA participants exhibited slower vascular response kinetics and differences in shear-normalized endothelial responsiveness. B/AA participants also had higher social vulnerability index rank (61 [26] vs 23 [23]), percent tree canopy (14 [6] vs 24 [10]), and perceived neighborhood cohesion (16 [3] vs 19 [3]) compared to NHW participants (all p values <.01).
Conclusion:
Preliminary baseline results suggest that B/AA women enter breast cancer treatment with reduced physical function and are more vulnerable to developing cardiotoxicity. Socioenvironmental factors likely contribute to this increased risk and highlight the value of interventions directed at reducing risk and changing systems.
Keywords: Cancer survivorship, Cardiovascular reactivityAdverse cardiovascular events are the second leading cause of non-cancer related mortality among breast cancer survivors. Black/African American (B/AA) survivors exhibit a higher incidence of cardiotoxicity directly and/or indirectly linked to treatment. The Discovery and Elimination of Cardio-Oncology Disparities Toward Equity in the Heartland Center includes 3 projects examining how treatment impacts vascular function, the potential mitigating effects of exercise and how socioenvironmental factors moderate treatment and exercise effects. We examined baseline results for physical function, endothelial function, and socioenvironmental factors, highlighting significant differences between B/AA and Non-Hispanic White (NHW) women newly diagnosed with breast cancer.
Methods:
Eligible patients must be female, 18+ years old, recently diagnosed with breast cancer, and identify as B/AA or NHW. Prior to treatment, physical function is assessed using VO2 peak, 6-minute walk (6MW), 30-second chair stand, and handgrip strength. Endothelial function is measured using flow mediated dilation.
Results:
The study includes 83 participants (61 NHW, 22 B/AA; mean age = 49.4 [11.6]) providing baseline data. Physical function results for the overall sample were in normal range (22.0 ml/min/kg for VO2 peak, 523 meters for 6MW, 16 for 30-second chair stand, and 30.6kg for dominant handgrip strength). However, B/AA participants demonstrated significantly lower VO2 peak, 30-second chair stand, and handgrip strength vs NHW counterparts (all p values <.05). While peak endothelial dilation was similar between NHW and B/AA participants, B/AA participants exhibited slower vascular response kinetics and differences in shear-normalized endothelial responsiveness. B/AA participants also had higher social vulnerability index rank (61 [26] vs 23 [23]), percent tree canopy (14 [6] vs 24 [10]), and perceived neighborhood cohesion (16 [3] vs 19 [3]) compared to NHW participants (all p values <.01).
Conclusion:
Preliminary baseline results suggest that B/AA women enter breast cancer treatment with reduced physical function and are more vulnerable to developing cardiotoxicity. Socioenvironmental factors likely contribute to this increased risk and highlight the value of interventions directed at reducing risk and changing systems.
Authors:
Author - Estefania Alonso, Medical College of Wisconsin
Co-Author - Andreas Beyer, PhD, Medical College of Wisconsin
Co-Author - Kirsten Beyer, PhD, Medical College of Wisconsin
Co-Author - Shane Phillips, PhD, University of Illinois Chicago
Co-Author - Alison Kriegel, PhD, Medical College of Wisconsin
Co-Author - Courtney Jankowski, MPH, Medical College of Wisconsin
Co-Author - Margaret Tovar, MPH, Medical College of Wisconsin
Co-Author - Dan Sanfelippo, MPH, Medical College of Wisconsin
Co-Author - Natalia Do Couto, University of Illinois Chicago
Co-Author - Matt Durand, PhD, Medical College of Wisconsin
Co-Author - Michael Widlansky, PhD, Medical College of Wisconsin
Co-Author - Amanda Kong, MD, Medical College of Wisconsin
Co-Author - Kent Hoskins, MD, University of Illinois Chicago
Co-Author - Melinda Stolley, PhD, Medical College of Wisconsin
AI Disclosure in Digital Mental Health: User Expectations and Preferences
Poster Number: E70Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Mental Health
Introduction
Mental health (MH) concerns are common in the US and affect approximately 1 in 5 adults each year. They can be chronic and severely disrupt functioning, but many adults face significant barriers to care. Prior work suggests AI can be integrated into digital mental health (DMH) tools to enhance user engagement; however, the stakes related to MH warrant careful consideration of risks that may be associated with AI, such as output instability, privacy concerns, and the onset or worsening of MH symptoms. Thus, there have been increased calls for AI disclosure when AI is used for MH, but it is unclear how individuals with MH concerns perceive the use of AI for MH or what their expectations are for AI disclosure in DMH tools.
Methods
This study included 28 adults (aged 19-67) with experiences of depression to share their attitudes towards integrating AI in DMH tools. Participants were recruited through advertisements on social media and a national clinical research registry. They engaged in an online discussion group where they shared their perceptions of AI for MH support, preferences for the design of AI-supported tools, and concerns related to AI disclosure. Discussion group transcripts were subject to thematic analysis.
Results
Participants expressed interest in a variety of AI-integrated MH support contexts, including: (1) a conversational AI-assisted automated SMS program for depression; and (2) a therapist using AI for writing support in client interactions. Participants reported mixed attitudes towards AI disclosure in these two contexts. Many participants encouraged full disclosure of AI in DMH tools to build “transparency” and “trust” with users. A few participants expressed disinterest, noting a preference to defer awareness of the degree to which AI is integrated within support tools to clinicians and developers. Some participants demonstrated ambivalence, citing confidence in their ability to identify AI-generated text or fears that increased awareness of AI involvement could lead to a decline in perceived helpfulness and negatively impact their perception of care.
Conclusion
AI DMH tools may be able to support the needs of adults in the US with MH concerns. Many users endorse AI disclosure, but others highlight how it can introduce cognitive demands that impact perceptions of care. Our findings underscore the need for AI literacy efforts that clarify the risks of non-disclosure and encourage critical engagement with AI DMH tools.
Keywords: Mental health, TechnologyMental health (MH) concerns are common in the US and affect approximately 1 in 5 adults each year. They can be chronic and severely disrupt functioning, but many adults face significant barriers to care. Prior work suggests AI can be integrated into digital mental health (DMH) tools to enhance user engagement; however, the stakes related to MH warrant careful consideration of risks that may be associated with AI, such as output instability, privacy concerns, and the onset or worsening of MH symptoms. Thus, there have been increased calls for AI disclosure when AI is used for MH, but it is unclear how individuals with MH concerns perceive the use of AI for MH or what their expectations are for AI disclosure in DMH tools.
Methods
This study included 28 adults (aged 19-67) with experiences of depression to share their attitudes towards integrating AI in DMH tools. Participants were recruited through advertisements on social media and a national clinical research registry. They engaged in an online discussion group where they shared their perceptions of AI for MH support, preferences for the design of AI-supported tools, and concerns related to AI disclosure. Discussion group transcripts were subject to thematic analysis.
Results
Participants expressed interest in a variety of AI-integrated MH support contexts, including: (1) a conversational AI-assisted automated SMS program for depression; and (2) a therapist using AI for writing support in client interactions. Participants reported mixed attitudes towards AI disclosure in these two contexts. Many participants encouraged full disclosure of AI in DMH tools to build “transparency” and “trust” with users. A few participants expressed disinterest, noting a preference to defer awareness of the degree to which AI is integrated within support tools to clinicians and developers. Some participants demonstrated ambivalence, citing confidence in their ability to identify AI-generated text or fears that increased awareness of AI involvement could lead to a decline in perceived helpfulness and negatively impact their perception of care.
Conclusion
AI DMH tools may be able to support the needs of adults in the US with MH concerns. Many users endorse AI disclosure, but others highlight how it can introduce cognitive demands that impact perceptions of care. Our findings underscore the need for AI literacy efforts that clarify the risks of non-disclosure and encourage critical engagement with AI DMH tools.
Authors:
Author - Sarah Popowski, BA, Northwestern University
Co-Author - Jack Svoboda, BA, Northwestern University
Co-Author - Claire Moon, Northwestern University
Co-Author - Jonah Meyerhoff, PhD, Northwestern University
Co-Author - David Mohr, PhD, Northwestern University
Co-Author - Rachel Kornfield, PhD, Northwestern University
Iterative mHealth Deployment to Identify Design Constraints Endogenous to Melanoma Survivors’ Lifestyles
Poster Number: E71Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Cancer
Background: Melanoma survivors face an increased risk of ultraviolet (UV) light exposure causing a new melanoma. This risk incentivizes behavioral changes, thereby making certain traits common among the clinical population. To Mobile Health (mHealth) researchers, such traits constitute design constraints; factors that must be known when designing a technology for a clinical population. To aid melanoma survivors’ UV exposure management, mHealth research has explored integrating UV dosimetry with mobile apps hosting various features for UV exposure monitoring and intervention. When features conflict with survivors’ behavioral traits, the system’s usability suffers. To address this, we present a design strategy of developing and iteratively revising such a system across two groups of melanoma survivors.
Methods: We developed a wrist-worn UV dosimeter and integrated mobile app supporting up to 7 interventional features for UV monitoring, protection, and education; deploying various combinations of features over 8 participants (2 groups of 4) for 2 weeks each, rapidly iterating minor changes between the 1st and 2nd weeks and major changes between the two groups. Changes were derived from analyses of verbal feedback, user behavior, and the System Usability Scale (SUS); which was completed after each week.
Results: All SUS scores fell above 68, the standard usability pass/fail threshold. Group 1 (app only) mean SUS was 91.7 (13.1SD), and Group 2 (app & wearable) mean was 68.3 (13.1SD). Between weeks 1 and 2, scores increased by 3.3 (G1) and 11.9 (G2), suggesting rapid iterations improved user experience. Verbal feedback affirmed the changes made between groups and revealed incongruencies between traits of melanoma survivors and elements of the mHealth system: 1) survivors’ high knowledge of UV dynamics devalues educational features, 2) many survivors develop sun-avoidance habits that preclude or make redundant certain intervention types, 3) survivors trend towards tech unfamiliarity and use of mobile accessibility features, likely due to the positive correlation between age and melanoma incidence.
Conclusions: Iterative deployment of our UV exposure management system with melanoma survivors revealed population-specific design constraints, our accounting for which then improved the system’s usability. This work prepares us for our future directions of examining the feasibility and efficacy of integrating our system in melanoma survivors’ post-treatment care.
Keywords: Cancer, e-HealthMethods: We developed a wrist-worn UV dosimeter and integrated mobile app supporting up to 7 interventional features for UV monitoring, protection, and education; deploying various combinations of features over 8 participants (2 groups of 4) for 2 weeks each, rapidly iterating minor changes between the 1st and 2nd weeks and major changes between the two groups. Changes were derived from analyses of verbal feedback, user behavior, and the System Usability Scale (SUS); which was completed after each week.
Results: All SUS scores fell above 68, the standard usability pass/fail threshold. Group 1 (app only) mean SUS was 91.7 (13.1SD), and Group 2 (app & wearable) mean was 68.3 (13.1SD). Between weeks 1 and 2, scores increased by 3.3 (G1) and 11.9 (G2), suggesting rapid iterations improved user experience. Verbal feedback affirmed the changes made between groups and revealed incongruencies between traits of melanoma survivors and elements of the mHealth system: 1) survivors’ high knowledge of UV dynamics devalues educational features, 2) many survivors develop sun-avoidance habits that preclude or make redundant certain intervention types, 3) survivors trend towards tech unfamiliarity and use of mobile accessibility features, likely due to the positive correlation between age and melanoma incidence.
Conclusions: Iterative deployment of our UV exposure management system with melanoma survivors revealed population-specific design constraints, our accounting for which then improved the system’s usability. This work prepares us for our future directions of examining the feasibility and efficacy of integrating our system in melanoma survivors’ post-treatment care.
Authors:
Presenter - Christopher Romano, Northwestern University
Co-Author - Tammy Stump, PhD, University of Utah
Co-Author - Tanmeet Butani, Northwestern University
Co-Author - Harrison Dong, Northwestern University
Co-Author - Sarah DeSantis, University of Utah
Co-Author - Liberty Woodside, University of Utah
Co-Author - Bonnie Nolan, Northwestern University
Co-Author - Nabil Alshurafa, PhD, Northwestern University
Views on VR-Enhanced Exposure Therapy: Thematic analysis from online and in-person discussions
Poster Number: E72Time: 05:00 PM - 05:50 PM
Topics: Digital Health, Mental Health
Background: Virtual reality (VR) is an emerging technology with potential to enhance exposure therapy for conditions such as obsessive-compulsive disorder (OCD), panic disorder, phobias, and post-traumatic stress disorder (PTSD). Despite its promise, relatively little is known about practitioners’ views on its utility and barriers to use.
Methods: Two qualitative studies were conducted to examine practitioners’ perspectives. Study 1 analyzed data scraped from a topic-specific online discussion board where 94 practitioners using PsyTechVR posted between February–May 2025. Posts were coded by one expert researcher to identify modal themes. Study 2 involved semi-structured in-person interviews with eight clinical psychology PhD trainees (February–April 2025). Participants received a guided 15-minute introduction to PsyTechVR apps, including an exposure demo and generative-AI stimuli creation, followed by 15-minute interviews. Interviews were transcribed and thematically coded by one researcher with a second coder resolving ambiguities. No financial conflicts of interest related to PsyTechVR or other VR businesses were reported.
Results: From the online community (Study 1), themes included: (1) active use of VR for exposure therapy, relaxation, and mindfulness across PTSD, OCD, anxiety, phobias, and panic disorder; (2) clinician requests for training, research, scenario customization, and resource sharing; and (3) enthusiasm for future innovations. From the in-person interviews (Study 2), themes included: (1) personalization of VR for heterogeneous disorders with scenario specificity (23 mentions); (2) VR as a “bridge” between imaginal and in-vivo exposures (18 mentions); (3) barriers including client discomfort (e.g., motion sickness), therapist expertise, and training needs (10 mentions); and (4) factors increasing willingness to adopt VR, such as positive client testimonials, published efficacy data, and well-developed training (8 mentions).
Conclusions: Across both studies, clinicians viewed VR as a promising tool to enhance exposure therapy, particularly through personalization, capacity to generate anxiety-provoking but controlled scenarios, and applicability across disorders. Key concerns included client readiness, therapist expertise, limited training opportunities, and insufficient efficacy data. Successful implementation will require further research, practitioner training, and integration of clinician and client perspectives.
Keywords: Technology, Mental healthMethods: Two qualitative studies were conducted to examine practitioners’ perspectives. Study 1 analyzed data scraped from a topic-specific online discussion board where 94 practitioners using PsyTechVR posted between February–May 2025. Posts were coded by one expert researcher to identify modal themes. Study 2 involved semi-structured in-person interviews with eight clinical psychology PhD trainees (February–April 2025). Participants received a guided 15-minute introduction to PsyTechVR apps, including an exposure demo and generative-AI stimuli creation, followed by 15-minute interviews. Interviews were transcribed and thematically coded by one researcher with a second coder resolving ambiguities. No financial conflicts of interest related to PsyTechVR or other VR businesses were reported.
Results: From the online community (Study 1), themes included: (1) active use of VR for exposure therapy, relaxation, and mindfulness across PTSD, OCD, anxiety, phobias, and panic disorder; (2) clinician requests for training, research, scenario customization, and resource sharing; and (3) enthusiasm for future innovations. From the in-person interviews (Study 2), themes included: (1) personalization of VR for heterogeneous disorders with scenario specificity (23 mentions); (2) VR as a “bridge” between imaginal and in-vivo exposures (18 mentions); (3) barriers including client discomfort (e.g., motion sickness), therapist expertise, and training needs (10 mentions); and (4) factors increasing willingness to adopt VR, such as positive client testimonials, published efficacy data, and well-developed training (8 mentions).
Conclusions: Across both studies, clinicians viewed VR as a promising tool to enhance exposure therapy, particularly through personalization, capacity to generate anxiety-provoking but controlled scenarios, and applicability across disorders. Key concerns included client readiness, therapist expertise, limited training opportunities, and insufficient efficacy data. Successful implementation will require further research, practitioner training, and integration of clinician and client perspectives.
Authors:
Author - Eddie Silber, MS, Illinois Institute of Technology
Co-Author - Arlen Moller, PhD, Illinois Institute of Technology
MOTIVATOR-COLOMBIA: Adaptation of a tool to develop communication skills in healthcare professionals
Poster Number: E73Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy
Objective: To culturally adapt a motivational communication training tool (MOTIVATOR) to the Colombian context, with the aim of strengthening healthcare professionals’ communication skills. Method: The adaptation process followed three phases—translation, cultural adaptation, and iteration—corresponding to phase 2 of the ORBIT model (proof-of-concept preparation). First, the material was translated independently by a social communicator and a nurse, and discrepancies were resolved through consensus with an argumentation expert and a psychologist. Cultural adaptation involved reviewing idiomatic expressions, adjusting culturally relevant elements, and paraphrasing when literal translation was inadequate. Content was refined by reducing non-essential information and expanding sections that required clarification (“downsizing” and “expansion”). In the iteration phase, the material was evaluated by seven leaders from a major Colombian healthcare organization. Continuous feedback was also obtained from the tool’s original development team. Results: Translation and adaptation yielded a 92.4% inter-rater consistency. Key cultural aspects were successfully integrated, such as healthcare professionals’ roles and patients’ expectations. Iteration results showed: visual appeal index of 0.43 (highlighting the need for a more engaging presentation), 0.86 for time adequacy, and 1.0 for content relevance. Qualitative feedback emphasized the inclusion of interactive activities, images of local populations, and the importance of face-to-face delivery with segmented sessions. These adjustments were incorporated into the revised version, now ready for proof-of-concept testing. Conclusions: Systematic translation and cultural adaptation processes are essential to ensure training materials remain understandable, culturally appropriate, and engaging, while preserving their original intent and effectiveness.
Keywords: Health behavior change, Chronic illnessAuthors:
Co-Author - Laura Maria Ceballos Ramirez, SURA
Co-Author - Maria Guevara Gonzalez, EAFIT University
Presenter - Mariantonia Lemos, PhD, Universidad EAFIT
Co-Author - Julder Alexander Gomez Posada, EAFIT University
Co-Author - Simon Bacon, BSc (Hons) MSc PhD, Concordia University
Co-Author - Kim Lavoie, PhD, University of Quebec at Montreal
To Tell or Not to Tell? A Qualitative Exploration on Disease Disclosure, Stigma, and Health among College Students Living with Chronic Conditions
Poster Number: E74Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy, Decision Making
For young adults living with chronic conditions, that burden may compound the struggle of navigating college. As students negotiate changing social environments and shifts in disease management roles, they may consider whether to share their diagnosis to seek additional support or accommodations. Previous studies have shown a high prevalence of diagnosis concealment for fear of stigmatization. This study explored disease disclosure, the influence of stigma on decision-making about disclosure, and the impact of those experiences on physical and mental health for college students with chronic conditions. Participants (n=7, Mage=22, SD = 2.31, 71% White, 86% female) completed a semi-structured interview with open-ended questions about transitioning to college with a chronic condition. Interviews were conducted in person or via Zoom and lasted approximately 60 minutes. Diagnoses included epilepsy, Crohn’s disease, migraine, asthma, and irritable bowel syndrome, with 86% reporting comorbid conditions. Interviews were coded and interpreted by MH, utilizing a deductive-inductive thematic analysis. MH engaged in reflexivity and examined her biases to ensure the quality, rigor, and trustworthiness of the research. Preliminary findings produced six themes describing how students navigate disease disclosure with peers and professors through selective disclosure, unintentional disclosure, disclosure avoidance, difficulties with disclosure decision-making, transfer of skills from early life, and feeling prepared to advocate for their needs. Stigma processes influenced decisions of disease disclosure through experiences of enacted stigma, anticipated stigma, and internalized stigma. Disclosure experiences influenced health through increased social support and improved self-advocacy skills but limited opportunities for social activities. Themes and quotations to be included in the poster. Our study aimed to understand the experiences of young adults living with chronic conditions as they navigate disease disclosure in a new social environment, the role stigma plays in these interactions, and related impacts on health. This study provides potential intervention targets to support young adults in developing self-advocacy and communication skills to ease the transition to college and shifts in disease management roles. Research and clinical practice should consider the context of college for young adults navigating communication about their chronic conditions.
Keywords: Health communication, Chronic illnessAuthors:
Presenter - Mackenzie Hood, University of North Carolina, Charlotte
Co-Author - Dhanashree Bahulekar, MA, University of North Carolina, Charlotte
Co-Author - Amy Peterman, PhD, University of North Carolina, Charlotte
Co-Author - Aimee W. Smith, PhD, University of North Carolina, Charlotte
Co-Author - V. Gil-Rivas, PhD, University of North Carolina, Charlotte
“There's comfort in seeing a person filming their story:” Understanding the Role of Media in Black Maternal Health. A Qualitative Study
Poster Number: E75Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy, Women's Health
Authors: Elizabeth Joseph-Williams, MSPH, Samia Tasnim, MBBS, MPH, Robin Page, PhD, Kobi V. Ajayi, MBA, MPH, PhD
Background:
Despite progress in regulation and oversight, the media’s portrayal of Black women often relies on stereotypes and unrealistic depictions that erode trust in health information. This leads many, especially young people, to seek health information online, where they are more vulnerable to misinformation and its adverse health consequences. Yet, the impact of media on Black maternal health—and on younger women in particular—is not fully understood.
This study aims to explore how the media shapes young Black women’s perceptions of Black maternal health in the US, and how these perceptions affect their health-seeking behaviors.
Methods:
This qualitative research study used a phenomenological approach with a semi-structured interview design. We recruited participants who self-identify as Black females and are over 18 years old. Interviews were conducted between June and September 2023 and analyzed inductively using thematic analysis.
Results:
Ten participants aged 19 to 22 were interviewed for this study. Thematic analysis revealed three broad themes: 1) media and health care perception, 2) media and health-seeking behavior, and 3) awareness of disparities in Black maternal health. There was a preference for social media platforms over traditional media. Media and entertainment industry narratives about Black women influenced health-seeking behavior, and implicit bias was perceived as a contributing factor to poor health outcomes. Due to stereotypes and mistrust, all participants in this study preferred social media content from Instagram, Facebook, X, or TikTok more than they did cable news and government agencies. They also overwhelmingly preferred real-life stories like birth stories or hospital encounters from Black mothers or individuals.
Conclusion:
Results have serious implications for culturally responsive health communication strategies and research. Our findings emphasize the need to spotlight Black women’s voices in advancing Black maternal health research, advocacy, and programs to influence young people’s health behaviors during preconception. Additionally, we highlight that institutions of higher learning serve as essential entry points for evidence-based education on Black maternal health.
Keywords: Health communication, Women's healthBackground:
Despite progress in regulation and oversight, the media’s portrayal of Black women often relies on stereotypes and unrealistic depictions that erode trust in health information. This leads many, especially young people, to seek health information online, where they are more vulnerable to misinformation and its adverse health consequences. Yet, the impact of media on Black maternal health—and on younger women in particular—is not fully understood.
This study aims to explore how the media shapes young Black women’s perceptions of Black maternal health in the US, and how these perceptions affect their health-seeking behaviors.
Methods:
This qualitative research study used a phenomenological approach with a semi-structured interview design. We recruited participants who self-identify as Black females and are over 18 years old. Interviews were conducted between June and September 2023 and analyzed inductively using thematic analysis.
Results:
Ten participants aged 19 to 22 were interviewed for this study. Thematic analysis revealed three broad themes: 1) media and health care perception, 2) media and health-seeking behavior, and 3) awareness of disparities in Black maternal health. There was a preference for social media platforms over traditional media. Media and entertainment industry narratives about Black women influenced health-seeking behavior, and implicit bias was perceived as a contributing factor to poor health outcomes. Due to stereotypes and mistrust, all participants in this study preferred social media content from Instagram, Facebook, X, or TikTok more than they did cable news and government agencies. They also overwhelmingly preferred real-life stories like birth stories or hospital encounters from Black mothers or individuals.
Conclusion:
Results have serious implications for culturally responsive health communication strategies and research. Our findings emphasize the need to spotlight Black women’s voices in advancing Black maternal health research, advocacy, and programs to influence young people’s health behaviors during preconception. Additionally, we highlight that institutions of higher learning serve as essential entry points for evidence-based education on Black maternal health.
Authors:
Presenter - Elizabeth Joseph- Williams, Department of Health Behavior, School of Public Health, Texas A&M University
Co-Author - Samia Tasnim, MBBS, MPH, Department of Health Behavior, School of Public Health, Texas A&M University
Co-Author - Robin Page, PhD, College of Nursing, Health Science Center, Texas A&M University
Co-Author - Kobi Ajayi, MBA, MPH, PhD, Center for Community Health and Aging, Department of Health Behavior, School of Public Health, Texas A&M University
An online randomized controlled trial comparing the FDA’s proposed front-of-package nutrient label against other label designs on consumer understanding, perceptions, and behavior
Poster Number: E76Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy, Diet, Nutrition, and Eating Disorders
Introduction: In 2025, the US Food and Drug Administration (FDA) proposed a mandatory “Nutrition Info” front-of-package label (FOPL) indicating Low/Med/High content and the percent Daily Value (%DV) for saturated fat, sodium, and added sugars. This novel design requires testing before adoption.
Methods: A national sample of adults (n=13,929) approximating key U.S. socio-demographics participated in an online randomized controlled trial. There were 5 conditions: (1) No-label control; (2) FDA’s proposed Nutrition Info %DV scheme; (3) Nutrition Info Red scheme (“High” highlighted in red, %DV removed); (4) High In scheme (developed by the FDA); and (5) Multi High In scheme (black box label for each nutrient, similar to Latin American FOPLs). Participants viewed real products labeled according to condition. Primary outcomes included correct identification of the healthiest and least healthy nutrient profiles from sets of 3 products (desserts, yogurts, sandwiches, frozen meals); perceived healthfulness of unhealthy products high in 1 but low in 2 nutrients of concern; and correct assessment of high nutrient content. Other outcomes included perceptions, reactions, and behaviors.
Results: All FOPL schemes improved consumer understanding and behavior compared to the control. Nutrition Info Red outperformed Nutrition Info %DV in accurate identification of the healthiest (89% vs 83%) and least healthy (84% vs 81%) nutrient profiles (all p<0.001). Multi High In outperformed Nutrition Info %DV for identification of the least healthy nutrient profiles (82% vs 81%; p<0.05). Nutrition Info Red (94%) and Multi High In (93%) had higher probabilities of correct assessment of high nutrient content than Nutrition Info %DV (92%) (all p<0.05). Compared to High In schemes, Nutrition Info Red and Nutrition Info %DV exhibited the unintended consequence of misperceiving unhealthy items as healthier. Multi High In yielded the highest label recall and use, the lowest percentage of participants selecting a high-in food, and the fastest response times.
Conclusion: The Nutrition Info Red and Multi High In schemes outperformed the FDA’s proposed Nutrition Info %DV scheme in consumer understanding and other outcomes. However, Nutrition Info Red displayed the unintended consequence of misperceiving the healthfulness of unhealthy products. Multi High In helped consumers make quick, accurate assessments and healthier food selections and should be considered for a mandatory FOPL.
Keywords: Health policy, NutritionMethods: A national sample of adults (n=13,929) approximating key U.S. socio-demographics participated in an online randomized controlled trial. There were 5 conditions: (1) No-label control; (2) FDA’s proposed Nutrition Info %DV scheme; (3) Nutrition Info Red scheme (“High” highlighted in red, %DV removed); (4) High In scheme (developed by the FDA); and (5) Multi High In scheme (black box label for each nutrient, similar to Latin American FOPLs). Participants viewed real products labeled according to condition. Primary outcomes included correct identification of the healthiest and least healthy nutrient profiles from sets of 3 products (desserts, yogurts, sandwiches, frozen meals); perceived healthfulness of unhealthy products high in 1 but low in 2 nutrients of concern; and correct assessment of high nutrient content. Other outcomes included perceptions, reactions, and behaviors.
Results: All FOPL schemes improved consumer understanding and behavior compared to the control. Nutrition Info Red outperformed Nutrition Info %DV in accurate identification of the healthiest (89% vs 83%) and least healthy (84% vs 81%) nutrient profiles (all p<0.001). Multi High In outperformed Nutrition Info %DV for identification of the least healthy nutrient profiles (82% vs 81%; p<0.05). Nutrition Info Red (94%) and Multi High In (93%) had higher probabilities of correct assessment of high nutrient content than Nutrition Info %DV (92%) (all p<0.05). Compared to High In schemes, Nutrition Info Red and Nutrition Info %DV exhibited the unintended consequence of misperceiving unhealthy items as healthier. Multi High In yielded the highest label recall and use, the lowest percentage of participants selecting a high-in food, and the fastest response times.
Conclusion: The Nutrition Info Red and Multi High In schemes outperformed the FDA’s proposed Nutrition Info %DV scheme in consumer understanding and other outcomes. However, Nutrition Info Red displayed the unintended consequence of misperceiving the healthfulness of unhealthy products. Multi High In helped consumers make quick, accurate assessments and healthier food selections and should be considered for a mandatory FOPL.
Authors:
Author - Brittany Lemmon, MS, University of California, Davis
Co-Author - Anna H Grummon, PhD, Stanford University
Co-Author - Alejandra Marquez, MS, University of California, Davis
Co-Author - Lisa M Soederberg Miller, PhD, University of California, Davis
Co-Author - Lauren E Au, PhD, RD, University of California, Davis
Co-Author - Susan D Brown, PhD, University of California, Davis
Co-Author - Aijia Wang, BA, University of California, Davis
Co-Author - Lisa M Powell, PhD, University of Illinois, Chicago
Co-Author - Jennifer Falbe, ScD, MPH, University of California, Davis
Artificial Intelligence and eHealth Literacy in cancer survivors: a cross-sectional online survey
Poster Number: E77Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy, Digital Health
Background: eHealth literacy is critical towards acquiring, appraising and understanding health information online. This might be especially relevant to those with greater needs for health information, such as cancer survivors. Artificial intelligence’s (AI) role in healthcare, from diagnostics to patient services, is extensive; yet the role that eHealth literacy plays on AI perceptions is unknown. This study assesses the association between eHealth literacy and AI perceptions in a sample of cancer survivors.
Methods: Participants recruited through Prolific completed an online survey focused on eHealth literacy, use of AI, and patient outcomes (n=275). A screener was used to identify cancer history (type and time since diagnosis). Recent diagnosis was oversampled, and non-melanoma skin cancer was excluded. Multivariable logistic regressions were performed to assess associations between the 7 domains of the eHealth Literacy Questionnaire (eHLQ; domain score range= 1-4) and 4 areas of AI in care delivery: data privacy and security, patient-provider relationships, medical errors, and health outcomes. All models were adjusted for age, education and income.
Results: A 1-point score increase in domain 5 (motivated to engage with digital services) was associated with a higher likelihood to strongly agree that “…AI in healthcare and medicine will lead to better health outcomes for patients” (OR=14.40, P<.001). A 1-point increase in domain 4 (feeling safe and in control) was associated with a greater likelihood to strongly agree that “…health data is kept secure when AI is used” (OR=6.87, P<.001). A 1-point score increase in domain 2 (engagement in own health) was associated with an increased likelihood to strongly disagree that “…AI increases medical errors” (OR=6.28, P<.001), and to strongly disagree that “…AI will hurt their relationship with healthcare providers” (OR=3.13, P<.001).
Conclusion: Increasing eHealth literacy is associated with more positive perceptions about AI use in healthcare. Engagement and perceived safety with eHealth were the strongest predictors for positive perceptions regarding patient outcomes and AI safety, respectively, while knowledge of one’s own health was associated with lower concerns for AI-driven medical errors and AI’s impact on patient-provider relationships. Given that potential AI data privacy and security risks exist for patients, this is an important future area of health communication research.
Keywords: e-Health, Health communicationMethods: Participants recruited through Prolific completed an online survey focused on eHealth literacy, use of AI, and patient outcomes (n=275). A screener was used to identify cancer history (type and time since diagnosis). Recent diagnosis was oversampled, and non-melanoma skin cancer was excluded. Multivariable logistic regressions were performed to assess associations between the 7 domains of the eHealth Literacy Questionnaire (eHLQ; domain score range= 1-4) and 4 areas of AI in care delivery: data privacy and security, patient-provider relationships, medical errors, and health outcomes. All models were adjusted for age, education and income.
Results: A 1-point score increase in domain 5 (motivated to engage with digital services) was associated with a higher likelihood to strongly agree that “…AI in healthcare and medicine will lead to better health outcomes for patients” (OR=14.40, P<.001). A 1-point increase in domain 4 (feeling safe and in control) was associated with a greater likelihood to strongly agree that “…health data is kept secure when AI is used” (OR=6.87, P<.001). A 1-point score increase in domain 2 (engagement in own health) was associated with an increased likelihood to strongly disagree that “…AI increases medical errors” (OR=6.28, P<.001), and to strongly disagree that “…AI will hurt their relationship with healthcare providers” (OR=3.13, P<.001).
Conclusion: Increasing eHealth literacy is associated with more positive perceptions about AI use in healthcare. Engagement and perceived safety with eHealth were the strongest predictors for positive perceptions regarding patient outcomes and AI safety, respectively, while knowledge of one’s own health was associated with lower concerns for AI-driven medical errors and AI’s impact on patient-provider relationships. Given that potential AI data privacy and security risks exist for patients, this is an important future area of health communication research.
Authors:
Presenter - Maria Rincon, PhD, MPH, National Cancer Institute
Author - Roxanne Jensen, PhD, National Cancer Institute
A Construal Level Approach to Anti-Vaccination Discussions: A Content Analysis of Reddit Posts about COVID-19 Vaccines
Poster Number: E78Time: 05:00 PM - 05:50 PM
Topics: Health Communication and Policy
Background: Extensive research has identified prevalent themes in anti-vaccination discussions, yet theory-driven content analysis is needed to systematically examine the variations across these themes and the potential mechanisms through which each theme influences public opinions. Guided by construal level theory, this study conducted a content analysis of anti-vaccination discussions regarding COVID-19 vaccines on Reddit to investigate the difference across three dominant anti-vaccination themes: conspiracy theories, adverse effects, and vaccine efficacy. The hypotheses and research questions focused on (1) whether construal level and evidence type (narratives versus statistics) varied across themes, and (2) how construal level interacted with evidence type to influence engagement outcomes including commenting and upvoting.
Method: Posts were collected from two subreddits (r/conspiracy and r/debatevaccines, all in English) for the period from January 30, 2020, to December 31, 2022, using a publicly available dataset. Titles of the posts were filtered to retain those relevant to COVID-19 vaccines, and 1,050 posts were randomly selected from this dataset. Each post was treated as a unit of analysis. The study developed a codebook to evaluate stance toward vaccination, anti-vaccination theme, construal level (five items), and evidence use (two items) in each post. Two independent coders established intercoder reliability using 200 randomly selected posts (19.1%). Across all coded items, Cohen's kappa ranged from .69 to 1.00 (M = .81), indicating overall acceptable reliability.
Results: Analysis showed that conspiracy posts exhibited higher-level construal with greater use of narrative evidence and lesser use of statistical evidence, while efficacy and adverse-effects posts showed lower-level construal, relied more on statistical evidence, and included fewer narratives. A construal fit was also observed, with high-level construal content paired with statistical evidence eliciting more comments. These findings advance our understanding of the construal level theory and the potential persuasive mechanisms of different anti-vaccination themes. By tailoring counter-messages to the framing and evidence strategies of specific themes, public health practitioners can more effectively combat misinformation and reduce vaccine hesitancy.
Keywords: Health communication, TheoryMethod: Posts were collected from two subreddits (r/conspiracy and r/debatevaccines, all in English) for the period from January 30, 2020, to December 31, 2022, using a publicly available dataset. Titles of the posts were filtered to retain those relevant to COVID-19 vaccines, and 1,050 posts were randomly selected from this dataset. Each post was treated as a unit of analysis. The study developed a codebook to evaluate stance toward vaccination, anti-vaccination theme, construal level (five items), and evidence use (two items) in each post. Two independent coders established intercoder reliability using 200 randomly selected posts (19.1%). Across all coded items, Cohen's kappa ranged from .69 to 1.00 (M = .81), indicating overall acceptable reliability.
Results: Analysis showed that conspiracy posts exhibited higher-level construal with greater use of narrative evidence and lesser use of statistical evidence, while efficacy and adverse-effects posts showed lower-level construal, relied more on statistical evidence, and included fewer narratives. A construal fit was also observed, with high-level construal content paired with statistical evidence eliciting more comments. These findings advance our understanding of the construal level theory and the potential persuasive mechanisms of different anti-vaccination themes. By tailoring counter-messages to the framing and evidence strategies of specific themes, public health practitioners can more effectively combat misinformation and reduce vaccine hesitancy.
Authors:
Author - Chun Zhou, Florida International University
Sexual Minority Disparities in Lung Cancer Screening Discussions: Findings from HINTS 2022 and 2024
Poster Number: E79Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Cancer
Background: Tobacco companies have historically targeted low-income, Black, and sexual minority populations, leading to higher smoking rates and greater lung cancer risk. Thus, individuals from these groups are more likely to be at high risk for lung cancer than higher-income, non-Hispanic White, and heterosexual populations. In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its age and tobacco pack-year guidelines for lung cancer screening based on evolving evidence demonstrating that these changes would expand eligibility for women and racial and ethnic minority groups, helping to address disparities. It is not known, however, whether this shift has led to more equitable discussions of lung cancer screening in clinical practice.
Purpose: Using large, nationally representative samples from the 2022 and 2024 Health Information National Trends Survey (HINTS) datasets, we evaluated the pre-registered hypothesis that low-income, Black, and/or sexual minority patients would be more likely to report discussions about lung cancer screening with clinicians, given their greater risk for lung cancer.
Method: We analyzed a subsample (n=2,147; weighted n=68,227,775) of adults who are between 50-80 years old, reported current or former smoking, and had no prior lung cancer. We used multivariate logistic regression to examine income, race, and sexual orientation as predictors of lung cancer screening discussions (yes/no), controlling for education, age, birth sex, survey year, and medical characteristics.
Results: Gay or lesbian participants (vs. heterosexual) were 83% less likely to report having a patient-clinician discussion about lung cancer screening (p=.039, SE=0.15, 95% CI [0.03, 0.91]). There were no differences in lung cancer screening discussions by race, income, or sex (all p>.05). Greater age was also associated with higher likelihood of reporting lung cancer screening discussions (p=.003, SE=0.02, 95% CI [1.02, 1.08]).
Conclusions: Despite expanded USPSTF guidelines, sexual minority patients reported fewer lung cancer screening discussions, highlighting persistent disparities. Given the mortality reduction benefits of early detection, promoting patient-clinician screening discussions is crucial for addressing lung cancer disparities and improving outcomes for underserved populations. Findings underscore the need for clinician training and tailored outreach to ensure implementation of screening recommendations across diverse populations.
Keywords: Screening, Sexual orientationPurpose: Using large, nationally representative samples from the 2022 and 2024 Health Information National Trends Survey (HINTS) datasets, we evaluated the pre-registered hypothesis that low-income, Black, and/or sexual minority patients would be more likely to report discussions about lung cancer screening with clinicians, given their greater risk for lung cancer.
Method: We analyzed a subsample (n=2,147; weighted n=68,227,775) of adults who are between 50-80 years old, reported current or former smoking, and had no prior lung cancer. We used multivariate logistic regression to examine income, race, and sexual orientation as predictors of lung cancer screening discussions (yes/no), controlling for education, age, birth sex, survey year, and medical characteristics.
Results: Gay or lesbian participants (vs. heterosexual) were 83% less likely to report having a patient-clinician discussion about lung cancer screening (p=.039, SE=0.15, 95% CI [0.03, 0.91]). There were no differences in lung cancer screening discussions by race, income, or sex (all p>.05). Greater age was also associated with higher likelihood of reporting lung cancer screening discussions (p=.003, SE=0.02, 95% CI [1.02, 1.08]).
Conclusions: Despite expanded USPSTF guidelines, sexual minority patients reported fewer lung cancer screening discussions, highlighting persistent disparities. Given the mortality reduction benefits of early detection, promoting patient-clinician screening discussions is crucial for addressing lung cancer disparities and improving outcomes for underserved populations. Findings underscore the need for clinician training and tailored outreach to ensure implementation of screening recommendations across diverse populations.
Authors:
Co-Author - Timothy Williamson, PhD, MPH, Loyola Marymount University
Evaluating recruitment strategies for a clinical trial with young adult cancer survivors
Poster Number: E8Time: 05:00 PM - 05:50 PM
Topics: Cancer, Methods and Measurement
Background: As a hard-to-reach population, young adult (YA) cancer survivors are difficult to recruit and under-represented in research. This study evaluated recruitment methods and differences in sociodemographic characteristics based on recruitment source.
Methods: Preliminary analyses of an oncofertility study were conducted. Eligibility criteria included: assigned female at birth, 18-45 years old, and post-cancer treatment. Recruitment included hospital-based methods (clinic referral, electronic health records review), non-profit email, non-profit social media post, and ‘other’ strategies (printed ads, webinars, or participant did not remember). Participants completed an online recruitment form prior to screening. ANOVAs and chi-square evaluated recruitment strategies and sociodemographic differences.
Results: In an 18-month period, 645 screening forms were completed and 300 met eligibility criteria. 256 participants enrolled and completed a baseline survey (85%, 256/300); 14% through hospital-based methods (n=37/256), 43% from non-profit email (n=110/256), 21% from non-profit social media post (n=53/256), and 22% from “other” (n=56/256). Enrollment rates differed by recruitment strategy (𝜒2=13.7, p=0.003); non-profit email (92%, n=110/120) was higher than hospital-based methods (76%, n=37/49) and ‘other’ strategies (77%, n=56/73). Hospital-based recruitment averaged a longer time to enroll participants (M=40.1 days, SD=45.9) compared to non-profit email (M=15.8 days, SD=18.9) or social media post (M=16.9 days, SD=15.3; F[3, 252]=8.8, p<0.001). Participants averaged 31.9 years (SD=6.4), 6.0 years (SD=6.5) post diagnosis, were 70% White, and 19% identified as Hispanic/Latina; most common cancer types were breast (36%) and lymphoma (16%). Those from hospital-based recruitment were more likely to be younger and less educated with a greater time since diagnosis, more likely to identify as a non-Asian minority and Hispanic/Latina, and less likely to have a fertility preservation history compared to those recruited through partnerships with nonprofit organizations (p’s<0.05).
Conclusion: Recruitment via collaboration with nonprofit cancer organizations may be a more efficient strategy compared with hospital-based methods. However, differences in sociodemographics by recruitment source were identified that could bias findings and limit generalizability. A variety of recruitment methods may be needed to ensure a diverse study sample.
Keywords: Research methods, MethodologyMethods: Preliminary analyses of an oncofertility study were conducted. Eligibility criteria included: assigned female at birth, 18-45 years old, and post-cancer treatment. Recruitment included hospital-based methods (clinic referral, electronic health records review), non-profit email, non-profit social media post, and ‘other’ strategies (printed ads, webinars, or participant did not remember). Participants completed an online recruitment form prior to screening. ANOVAs and chi-square evaluated recruitment strategies and sociodemographic differences.
Results: In an 18-month period, 645 screening forms were completed and 300 met eligibility criteria. 256 participants enrolled and completed a baseline survey (85%, 256/300); 14% through hospital-based methods (n=37/256), 43% from non-profit email (n=110/256), 21% from non-profit social media post (n=53/256), and 22% from “other” (n=56/256). Enrollment rates differed by recruitment strategy (𝜒2=13.7, p=0.003); non-profit email (92%, n=110/120) was higher than hospital-based methods (76%, n=37/49) and ‘other’ strategies (77%, n=56/73). Hospital-based recruitment averaged a longer time to enroll participants (M=40.1 days, SD=45.9) compared to non-profit email (M=15.8 days, SD=18.9) or social media post (M=16.9 days, SD=15.3; F[3, 252]=8.8, p<0.001). Participants averaged 31.9 years (SD=6.4), 6.0 years (SD=6.5) post diagnosis, were 70% White, and 19% identified as Hispanic/Latina; most common cancer types were breast (36%) and lymphoma (16%). Those from hospital-based recruitment were more likely to be younger and less educated with a greater time since diagnosis, more likely to identify as a non-Asian minority and Hispanic/Latina, and less likely to have a fertility preservation history compared to those recruited through partnerships with nonprofit organizations (p’s<0.05).
Conclusion: Recruitment via collaboration with nonprofit cancer organizations may be a more efficient strategy compared with hospital-based methods. However, differences in sociodemographics by recruitment source were identified that could bias findings and limit generalizability. A variety of recruitment methods may be needed to ensure a diverse study sample.
Authors:
Co-Author - Sumitra Ananth, BS, Stanford University School of Medicine
Co-Author - Susanne Lee, MPH, Stanford University School of Medicine
Co-Author - Annemarie Jagielo, MS, PGSP-Stanford PsyD Consortium, Palo Alto University & Stanford University School of Medicine
Co-Author - Lidia Schapira, MD, Stanford Cancer Institute
Co-Author - Pamela Simon, MSN, CPNP, CPHON, Lucile Packard Children's Hospital at Stanford
Co-Author - Jennifer Ford, PhD, FSBM, Hunter College, City University of New York
Co-Author - Michael Diefenbach, PhD, FSBM, Northwell Health
Co-Author - David Spiegel, MD, FSBM, Stanford University School of Medicine & Stanford Cancer Institute
Co-Author - Catherine Benedict, PhD, Stanford University School of Medicine & Stanford Cancer Institute
Food insecurity did not influence vaccination uptake in Hispanic caregivers of preschool children
Poster Number: E80Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Diet, Nutrition, and Eating Disorders
Background
Food insecurity has been associated with low vaccine uptake. In the wake of the pandemic, food insecurity worsened, which may have affected vaccine uptake for COVID-19. However, few investigations on this topic have been conducted, particularly in Hispanic populations. Improved understanding, accounting for relevant covariates, may illuminate potential pathways for research, policy, and practice to reduce the impact of future wide-spread, preventable disease outbreaks.
Methods
Adult caregivers (N=414; 82.6% parents, 17.4% preschool teachers; M=34.8±9.9 years; 91.3% women; 10.6% Black non-Hispanic, 63.0% Hispanic, 19.3% White non-Hispanic, 7% all others; 39.6% ≤ high school graduation, 35.3% some college, 25.1% college graduate) of preschool-aged children at low-income serving preschools in a large metropolitan city completed a cross-sectional survey in 2022-2023 as part of the RADx-UP initiative. Food security was measured using the USDA six-item screener. Participants answered whether they had ever received at least one COVID-19 vaccine. Covariates included race/ethnicity, health insurance, educational attainment, age and language of survey (English/Spanish). We estimated associations using a generalized linear model with Poisson distribution and model-based covariance estimates. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were derived from Wald statistics.
Results
Of the 414, 26.6% reported food insecurity, and 68.6% had received at least one COVID-19 vaccine. In unadjusted models, there was a crude association between food insecurity and vaccine uptake. In adjusted models, food insecurity was not associated with increased vaccine uptake (RR Exp(B) = 1.034, 95% CI:[.774-1.380]). Educational attainment was the only covariate associated with vaccination (RR Exp(B) =.679, 95% CI:[.471-.978]). No other bivariable associations remained significant in the full model.
Discussion
In this cross-sectional study, food insecurity was not associated with vaccine uptake, after accounting for key covariates. Findings suggest that educational attainment may have broad buffering effects washing out other socioeconomic variables (e.g., race/ethnicity, health insurance coverage) that can reduce healthcare access. In the face of enduring social challenges such as food security, increasing educational attainment opportunities may help in the prevention of communicable disease, reducing the burden of population-wide disease events.
Keywords: Health disparities, Public healthFood insecurity has been associated with low vaccine uptake. In the wake of the pandemic, food insecurity worsened, which may have affected vaccine uptake for COVID-19. However, few investigations on this topic have been conducted, particularly in Hispanic populations. Improved understanding, accounting for relevant covariates, may illuminate potential pathways for research, policy, and practice to reduce the impact of future wide-spread, preventable disease outbreaks.
Methods
Adult caregivers (N=414; 82.6% parents, 17.4% preschool teachers; M=34.8±9.9 years; 91.3% women; 10.6% Black non-Hispanic, 63.0% Hispanic, 19.3% White non-Hispanic, 7% all others; 39.6% ≤ high school graduation, 35.3% some college, 25.1% college graduate) of preschool-aged children at low-income serving preschools in a large metropolitan city completed a cross-sectional survey in 2022-2023 as part of the RADx-UP initiative. Food security was measured using the USDA six-item screener. Participants answered whether they had ever received at least one COVID-19 vaccine. Covariates included race/ethnicity, health insurance, educational attainment, age and language of survey (English/Spanish). We estimated associations using a generalized linear model with Poisson distribution and model-based covariance estimates. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were derived from Wald statistics.
Results
Of the 414, 26.6% reported food insecurity, and 68.6% had received at least one COVID-19 vaccine. In unadjusted models, there was a crude association between food insecurity and vaccine uptake. In adjusted models, food insecurity was not associated with increased vaccine uptake (RR Exp(B) = 1.034, 95% CI:[.774-1.380]). Educational attainment was the only covariate associated with vaccination (RR Exp(B) =.679, 95% CI:[.471-.978]). No other bivariable associations remained significant in the full model.
Discussion
In this cross-sectional study, food insecurity was not associated with vaccine uptake, after accounting for key covariates. Findings suggest that educational attainment may have broad buffering effects washing out other socioeconomic variables (e.g., race/ethnicity, health insurance coverage) that can reduce healthcare access. In the face of enduring social challenges such as food security, increasing educational attainment opportunities may help in the prevention of communicable disease, reducing the burden of population-wide disease events.
Authors:
Presenter - Rebecca E. Lee, PhD, FSBM, Arizona State University
Co-Author - Elizabeth Oluwafolakemi Aleru, Pennsylvania State University
Co-Author - Anna-Maria Al Dannaoui, Pennsylvania State University
Co-Author - Cindy L. Herrick, PMH-C, CPSS, Arizona State University
Co-Author - Lakshmi Nair, PMHNP-BC, Arizona State University
Co-Author - Meg Bruening, PhD MPH RD, Pennsylvania State University
Common Practices for Promoting Dignity in the Food Banking System
Poster Number: E81Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Social and Environmental Context and Health
Background: Feelings of shame and stigma prevent the community from accessing the food banking system. Food dignity, which emphasizes respect, accessibility, inclusivity, and a sense of belonging, has emerged as a key approach to addressing this issue while fostering empowerment and overall well-being. The food banking system, being diverse with organizations having varied scopes and goals, lacks a standardized and universally recognized approach to promote dignity.
Objective: To conduct a scoping review of resources created by and/or for organizations within the food banking system to identify themes in organizational practices that promote client dignity.
Methods: A comprehensive search was conducted for grey literature sources, including food bank policy briefs, reports, program toolkits, guidelines, and manuals. The search terms were identified with feedback from a Community Advisory Board (CAB), including combinations of terms related to the food banking system (i.e., food bank, food pantry, emergency food assistance, charitable food system) and terms related to stigma and dignity (i.e., anti-racism, inclusive, racism, accessibility, trauma-informed). Four reviewers independently screened the resources and extracted the data for thematic analysis.
Results: Forty-five resources were identified. The following themes in recommendations to promote client dignity were identified: providing client choice pantry layout; emphasizing community engagement and representation; establishing client advisory boards; ensuring culturally preferred food options and healthy choices; maintaining confidentiality, trustworthiness, and transparency; and embedding dignity and inclusion into organizational mission and values.
Conclusion: The identified best practices hold strong potential for normalizing dignified client experiences within the food banking system. To achieve this goal, they should be embedded into the organization’s core mission and policies while establishing evaluation and assessment strategies. Long-term, these study findings will aid in the development of standardized approaches to promoting dignity and justice in the food banking system.
Keywords: Low-income, Health disparitiesObjective: To conduct a scoping review of resources created by and/or for organizations within the food banking system to identify themes in organizational practices that promote client dignity.
Methods: A comprehensive search was conducted for grey literature sources, including food bank policy briefs, reports, program toolkits, guidelines, and manuals. The search terms were identified with feedback from a Community Advisory Board (CAB), including combinations of terms related to the food banking system (i.e., food bank, food pantry, emergency food assistance, charitable food system) and terms related to stigma and dignity (i.e., anti-racism, inclusive, racism, accessibility, trauma-informed). Four reviewers independently screened the resources and extracted the data for thematic analysis.
Results: Forty-five resources were identified. The following themes in recommendations to promote client dignity were identified: providing client choice pantry layout; emphasizing community engagement and representation; establishing client advisory boards; ensuring culturally preferred food options and healthy choices; maintaining confidentiality, trustworthiness, and transparency; and embedding dignity and inclusion into organizational mission and values.
Conclusion: The identified best practices hold strong potential for normalizing dignified client experiences within the food banking system. To achieve this goal, they should be embedded into the organization’s core mission and policies while establishing evaluation and assessment strategies. Long-term, these study findings will aid in the development of standardized approaches to promoting dignity and justice in the food banking system.
Authors:
Author - Kritee Niroula, Phd, University of Connecticut
Co-Author - Kate W. Bauer, PhD, University of Michigan
Co-Author - Snehaa Ray, PhD Candidate, University of Connecticut
Co-Author - Tannis Thompson-Catlett, University of Michigan
Co-Author - Kayla-Audrey Njoh-Sam, University of Connecticut
Co-Author - Allison Karpyn, PhD, University of Delaware
Co-Author - Shreela Sharma , PhD, University of Texas Houston
Chair - Kristen Cooksey Stowers, PhD, UConn Allied Health Sciences
Gender-Stratified Predictors of Healthcare Affordability Barriers in the United States: Findings from BRFSS 2023
Poster Number: E82Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Social and Environmental Context and Health
Abstract:
Background: Cost-related barriers to healthcare persist in the United States despite major policy interventions, including the Affordable Care Act. These barriers disproportionately affect socioeconomically disadvantaged groups and are shaped by structural and social determinants, including insurance coverage, transportation access, and emotional support. While prior studies have examined predictors of affordability, few have conducted large-scale, gender-stratified analyses to explore differences across men, women, and gender-diverse populations.
Objective: To examine socioeconomic, healthcare access, and social support factors associated with self-reported inability to afford medical care in the past 12 months, stratified by gender identity, using the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data.
Methods: This cross-sectional analysis included 431,785 adults meeting inclusion criteria. The dependent variable was inability to afford needed care due to cost (Yes=1, No=0). Independent variables included age, race/ethnicity, education, income, employment, insurance status, personal doctor access, metropolitan residence, emotional support availability, and transportation reliability. Bivariate associations were assessed using chi-square tests (reporting χ² values, degrees of freedom, and p-values). Multivariable logistic regression models estimated adjusted odds ratios (ORs), 95% confidence intervals (CIs), and model fit statistics (Omnibus χ², df, p; Nagelkerke R²), stratified by gender.
Results: Overall, 8.6% of participants reported inability to afford care. Across genders, being uninsured, having lower income, lacking a personal doctor, reporting low emotional support, and experiencing unreliable transportation were significantly associated with higher odds of cost-related unmet need (p<0.001). Unreliable transportation emerged as the strongest predictor for all genders. Older age and insurance coverage were protective factors.
Conclusions: Addressing healthcare affordability requires multifaceted interventions that extend beyond insurance expansion, including improving transportation access, strengthening social support, and ensuring inclusive care for gender-diverse populations.
Keywords: healthcare affordability, gender disparities, BRFSS, social determinants of health, cost-related unmet need
Keywords: Health disparities, SocioeconomicBackground: Cost-related barriers to healthcare persist in the United States despite major policy interventions, including the Affordable Care Act. These barriers disproportionately affect socioeconomically disadvantaged groups and are shaped by structural and social determinants, including insurance coverage, transportation access, and emotional support. While prior studies have examined predictors of affordability, few have conducted large-scale, gender-stratified analyses to explore differences across men, women, and gender-diverse populations.
Objective: To examine socioeconomic, healthcare access, and social support factors associated with self-reported inability to afford medical care in the past 12 months, stratified by gender identity, using the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data.
Methods: This cross-sectional analysis included 431,785 adults meeting inclusion criteria. The dependent variable was inability to afford needed care due to cost (Yes=1, No=0). Independent variables included age, race/ethnicity, education, income, employment, insurance status, personal doctor access, metropolitan residence, emotional support availability, and transportation reliability. Bivariate associations were assessed using chi-square tests (reporting χ² values, degrees of freedom, and p-values). Multivariable logistic regression models estimated adjusted odds ratios (ORs), 95% confidence intervals (CIs), and model fit statistics (Omnibus χ², df, p; Nagelkerke R²), stratified by gender.
Results: Overall, 8.6% of participants reported inability to afford care. Across genders, being uninsured, having lower income, lacking a personal doctor, reporting low emotional support, and experiencing unreliable transportation were significantly associated with higher odds of cost-related unmet need (p<0.001). Unreliable transportation emerged as the strongest predictor for all genders. Older age and insurance coverage were protective factors.
Conclusions: Addressing healthcare affordability requires multifaceted interventions that extend beyond insurance expansion, including improving transportation access, strengthening social support, and ensuring inclusive care for gender-diverse populations.
Keywords: healthcare affordability, gender disparities, BRFSS, social determinants of health, cost-related unmet need
Authors:
Author - Rashmi Patel , Rutgers School of Public Health
Effects of Adverse Childhood Experiences (ACEs) and Sexual Orientation on Vaccine Uptake in US Adults
Poster Number: E83Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Health Communication and Policy
With adult vaccination rates low and declining (“Call to Action,” n.d.), it is vital that public health practitioners understand the dynamics of vaccination. This study investigates the relationship between LGBTQ+ identity and adverse childhood experiences (ACEs) on vaccine uptake. Though LGBTQ+ identity is predictive of vaccine behaviors, preliminary literature exploring the relationship between ACEs and vaccine uptake requires additional research, particularly among subgroups vulnerable to preventive care gaps. Compared to heterosexual, cisgender people, LGBTQ+ people tend to experience more ACEs and the associated negative health outcomes (Tran et al., 2023).
To investigate the role of ACEs and sexual orientation on vaccine uptake, a series of linear regression models were constructed using a subset of data from the 2023 Behavioral Risk Factor Surveillance Survey (CDC; 2023). Flu and pneumonia vaccine uptake served as the dependent variables for each analysis, with ACEs as the key independent variable and sexual orientation as a moderator.
ACEs were negatively associated with flu vaccine uptake among both male and female respondents (β = -0.02; 95% CI = -0.04, -0.00; β = -0.02; 95% CI = -0.03, -0.01). Compared to straight respondents, gay male and bisexual female respondents were more likely to have had a flu vaccine within the last year (β = 0.66; 95% CI = 0.35, 0.97; β = 0.39; 95% CI = 0.13, 0.66). ACEs were positively associated with pneumonia vaccine uptake among both male and female respondents (β = 0.04; 95% CI = 0.02, 0.06; β = 0.03; 95% CI = 0.01, 0.04). Compared to straight respondents, gay male, bisexual male, and bisexual female respondents were more likely to have received a pneumonia vaccination (β = 0.43; 95% CI = 0.11, 0.75; β = 0.76; 95% CI = 0.37, 1.15: β = 0.72; 95% CI = 0.40, 1.04) and being a male respondent of another sexuality moderates the relationship between ACEs and receiving a pneumonia vaccine (β = 0.15; 95% CI = 0.04, 0.27).
ACEs are a risk factor for individual as well as population health for the seasonal flu. ACEs may act as a protective factor against going unvaccinated for pneumonia. LGBTQ+ people are more likely to receive the flu and pneumonia vaccines, indicating potential insights about targeted preventive health campaigns. ACEs and LGBTQ+ identity are meaningful factors for predicting vaccine uptake and should inform preventive medicine efforts, including vaccine campaigns and community health interventions.
Keywords: Sexual orientation, PreventionTo investigate the role of ACEs and sexual orientation on vaccine uptake, a series of linear regression models were constructed using a subset of data from the 2023 Behavioral Risk Factor Surveillance Survey (CDC; 2023). Flu and pneumonia vaccine uptake served as the dependent variables for each analysis, with ACEs as the key independent variable and sexual orientation as a moderator.
ACEs were negatively associated with flu vaccine uptake among both male and female respondents (β = -0.02; 95% CI = -0.04, -0.00; β = -0.02; 95% CI = -0.03, -0.01). Compared to straight respondents, gay male and bisexual female respondents were more likely to have had a flu vaccine within the last year (β = 0.66; 95% CI = 0.35, 0.97; β = 0.39; 95% CI = 0.13, 0.66). ACEs were positively associated with pneumonia vaccine uptake among both male and female respondents (β = 0.04; 95% CI = 0.02, 0.06; β = 0.03; 95% CI = 0.01, 0.04). Compared to straight respondents, gay male, bisexual male, and bisexual female respondents were more likely to have received a pneumonia vaccination (β = 0.43; 95% CI = 0.11, 0.75; β = 0.76; 95% CI = 0.37, 1.15: β = 0.72; 95% CI = 0.40, 1.04) and being a male respondent of another sexuality moderates the relationship between ACEs and receiving a pneumonia vaccine (β = 0.15; 95% CI = 0.04, 0.27).
ACEs are a risk factor for individual as well as population health for the seasonal flu. ACEs may act as a protective factor against going unvaccinated for pneumonia. LGBTQ+ people are more likely to receive the flu and pneumonia vaccines, indicating potential insights about targeted preventive health campaigns. ACEs and LGBTQ+ identity are meaningful factors for predicting vaccine uptake and should inform preventive medicine efforts, including vaccine campaigns and community health interventions.
Authors:
Presenter - Zoe Price, Agnes Scott College
Co-Author - Atticus Wolfe, PhD MPH, Agnes Scott College
Measuring intersectional discrimination experiences in everyday life among racially diverse sexual minority and heterosexual young women who binge eat
Poster Number: E84Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Methods and Measurement
Racial disparities in disordered eating are well documented, and research suggests sexual minority women (SMW; e.g., lesbian, bisexual, queer) report some disordered eating behaviors at higher rates than heterosexual women (HW). Minority stress theories explain how discrimination tied to stigmatized identities can contribute to stress and, in turn, poor mental and physical health, including disordered eating. Despite calls to study discrimination-health behavior processes in daily life, a key barrier is a lack of measures suited for ecological momentary assessment (EMA). This study adapted existing measures to examine the frequency and characteristics of momentary discrimination experiences among young Black and White SMW and HW. Cisgender women (N=244; 86 White SMW, 35 Black SMW, 86 White HW, 37 Black HW) who binge eat completed 5 surveys/day for 2 weeks. Participants reported whether any of 15 experiences occurred in the past several hours (e.g., called a name, treated with less respect, glared at), and if so, which identity aspect(s) they believe contributed (gender, race/ethnicity, sexual orientation, weight/appearance, other). Results showed 187 women (64.3%) reported at least one discrimination event. The rate of events did not vary by group (p=.86), with participants reporting an event on 9-12% of their EMA surveys. However, group differences emerged in identity attributions for gender (p=.02), race (p<.001), sexual orientation (p<.001), and weight/appearance (p<.001). White SMW were more likely than all groups to report discrimination based on gender and sexual orientation (Tukey HSD ps<.001). Black SMW were more likely to report race-based discrimination (ps<.001), and less likely to report weight-appearance discrimination (ps<.001). White HW were more likely to report weight/appearance discrimination (ps<.001). As a novel examination of momentary discrimination among racially diverse SMW and HW, findings demonstrate the feasibility of capturing discrimination in daily life and suggest women’s experiences of discrimination vary by intersectional identities. This work can inform development of EMA-appropriate discrimination measures to better capture the unique discrimination experiences of women with diverse identities. Future studies examining how momentary discrimination experiences are associated with mental and physical health behaviors, including disordered eating, are needed to advance theory and interventions for these at-risk groups.
Keywords: Disparities, Minority healthAuthors:
Author - Meredith Turner, M.S., Virginia Consortium Program in Clinical Psychology
Co-Author - Kaitlyn Ryan, Virginia Consortium in Clinical Psychology
Co-Author - Kayla Pitchford, MS, Virginia Consortium Program in Clinical Psychology
Co-Author - Alyssa Giannone, M.S., Virginia Consortium Program in Clinical Psychology
Co-Author - Emily Panza, PhD, Brown Medical School/The Miriam Hospital
Co-Author - Abby Braitman, PhD, Old Dominion University
Co-Author - Robin Lewis, PhD, Old Dominion University
Co-Author - Kristin Heron, PhD, FSBM, Old Dominion University
Empathy and Action: A VR-Based Intervention to Promote Inclusive Workplace Behaviors among Health Care Staff
Poster Number: E85Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Implementation Science
Virtual reality (VR) is increasingly used as an instructional tool for behavior rehearsal. VR also enables embodiment, allowing users to experience perspectives different from their own. Both mechanisms may enhance empathy and improve interactions with diverse patients and colleagues.
A VR-based learning experience was developed for medical staff with embodied experiences as avatars representing people of different races/ethnicities and opportunities to practice responding to situations in which a coworker faces blatant discrimination or microaggression. The intervention was delivered in an online group setting, with groups randomly assigned to interact with VR content using an immersive headset or computer screen. To support learning and reflection, participants engaged in facilitated discussion sessions between each scenario.
Using a pre-post survey design with staff at a large national health care organization, we assessed changes in 1) empathy constructs, 2) Theory of Planned Behavior (TPB) predictors of responding to a coworker facing discrimination, 3) intentions to practice upstander behaviors, and 4) intended actions in response to a vignette. We also tested whether changes in empathy and TPB constructs mediated intervention effects on behavioral intentions and whether effects varied by delivery mode (headset vs. computer screen).
Of 219 staff who participated, 175 (80%) completed both pre- and post-test surveys. Paired sample t-tests indicated significant improvements (p<.05) in empathic awareness, perspective taking, 4 of 5 TPB constructs (experiential and instrumental attitudes, injunctive norms, perceived behavioral control), knowledge, upstander behavior intentions, and upstander responses to the vignette. Mediation models showed that increases in empathic awareness indirectly predicted greater upstander behavior intentions via injunctive norms and perceived behavioral control (indirect effect=0.102, 95% CI [0.039, 0.164], p=.001). Empathic awareness also indirectly predicted endorsing immediate correction in the vignette via injunctive norms (indirect effect=0.101, 95% CI [0.032, 0.170], p=.004). Intervention effects did not differ by VR delivery mode.
VR intervention improved upstander intentions by increasing intergroup empathy and changing injunctive norms and perceived ability to act. The intervention was effective regardless of use of a headset, suggesting that VR is a scalable and accessible strategy to change intergroup behaviors.
Keywords: Intervention, RaceA VR-based learning experience was developed for medical staff with embodied experiences as avatars representing people of different races/ethnicities and opportunities to practice responding to situations in which a coworker faces blatant discrimination or microaggression. The intervention was delivered in an online group setting, with groups randomly assigned to interact with VR content using an immersive headset or computer screen. To support learning and reflection, participants engaged in facilitated discussion sessions between each scenario.
Using a pre-post survey design with staff at a large national health care organization, we assessed changes in 1) empathy constructs, 2) Theory of Planned Behavior (TPB) predictors of responding to a coworker facing discrimination, 3) intentions to practice upstander behaviors, and 4) intended actions in response to a vignette. We also tested whether changes in empathy and TPB constructs mediated intervention effects on behavioral intentions and whether effects varied by delivery mode (headset vs. computer screen).
Of 219 staff who participated, 175 (80%) completed both pre- and post-test surveys. Paired sample t-tests indicated significant improvements (p<.05) in empathic awareness, perspective taking, 4 of 5 TPB constructs (experiential and instrumental attitudes, injunctive norms, perceived behavioral control), knowledge, upstander behavior intentions, and upstander responses to the vignette. Mediation models showed that increases in empathic awareness indirectly predicted greater upstander behavior intentions via injunctive norms and perceived behavioral control (indirect effect=0.102, 95% CI [0.039, 0.164], p=.001). Empathic awareness also indirectly predicted endorsing immediate correction in the vignette via injunctive norms (indirect effect=0.101, 95% CI [0.032, 0.170], p=.004). Intervention effects did not differ by VR delivery mode.
VR intervention improved upstander intentions by increasing intergroup empathy and changing injunctive norms and perceived ability to act. The intervention was effective regardless of use of a headset, suggesting that VR is a scalable and accessible strategy to change intergroup behaviors.
Authors:
Presenter - Xuan Zhu, PhD, Mayo Clinic
Co-Presenter - Sean Phelan, PhD, MPH, Mayo Clinic
Co-Author - Todd Huschka, MS, Mayo Clinic
Co-Author - Valeria Thomas, PMP, CSM, Mayo Clinic
Co-Author - Meshach Phillips, Mayo Clinic
Co-Author - Yu-Hui Chang, PhD, MS, Mayo Clinic
Co-Author - Emily McTate, PhD, LP, ABPP, Mayo Clinic
Co-Author - Erin Standen, PhD, Rice University
Co-Author - Ashley Proulx, MSN, RN, RN-BC, Mayo Clinic
Co-Author - Holly Burkhartzmeyer, MAN, RN, Mayo Clinic
Feasibility and Acceptability of a Mindfulness Intervention for Caregivers of People Living with HIV/AIDS
Poster Number: E86Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Digital Health
Background: One third of people living with HIV/AIDS (PLWHA) report receiving care from informal caregivers, typically friends and family, who offer emotional, physical, and financial support. Caregivers of PLWHA are at risk for stress-related disease and adverse health outcomes. Mindfulness-based interventions can help caregivers manage stress; however, traditional in-person delivery methods often limit accessibility for caregivers who face competing responsibilities. Expanding access through a digitally delivered mindfulness intervention may better meet the needs of this population by offering support that is flexible and accessible. The purpose of this feasibility trial was to establish recruitment procedures and finalize measures to be used in a full clinical trial of a previously developed mindfulness intervention delivered through a smartphone application.
Methods: This single-group cohort study utilized self-reported data collected through researcher-led interviews conducted between January and March 2025. Eligible participants were required to be 18 years or older, reside in the United States, identify as Black or African American, and currently serve as an informal, unpaid caregiver for an individual living with HIV/AIDS. Characteristics of the cohort are described.
Results: In this feasibility trial (n=30), caregivers’ mean age was 46 (range 38-54), with most identifying as male (53%). Caregivers identified as spouses or partners (33%), friends (23%), or in other non-parental relationships (23%) with a PLWHA. The majority (70%) of participants provided emotional, physical, and financial support, with fewer (30%) providing only one type of support. Baseline assessments showed high to moderate anxiety levels in nearly all participants (87%), regardless of reported stress level, with over two-thirds also at risk for clinical depression. All participants had daily access to digital devices and the internet, with most expressing comfort using new apps, suggesting strong feasibility for digital health interventions in this population.
Conclusion: These findings highlight the significant emotional and psychological burdens experienced by caregivers. The high prevalence of anxiety and depression risk underscores the urgent need for targeted mental health support within this population. Tailoring evidence-based mindfulness interventions to address stress, anxiety, and long-term caregiving demands could greatly enhance the quality of life for caregivers.
Keywords: Caregiving, Mindfulness-Based Stress ReductionMethods: This single-group cohort study utilized self-reported data collected through researcher-led interviews conducted between January and March 2025. Eligible participants were required to be 18 years or older, reside in the United States, identify as Black or African American, and currently serve as an informal, unpaid caregiver for an individual living with HIV/AIDS. Characteristics of the cohort are described.
Results: In this feasibility trial (n=30), caregivers’ mean age was 46 (range 38-54), with most identifying as male (53%). Caregivers identified as spouses or partners (33%), friends (23%), or in other non-parental relationships (23%) with a PLWHA. The majority (70%) of participants provided emotional, physical, and financial support, with fewer (30%) providing only one type of support. Baseline assessments showed high to moderate anxiety levels in nearly all participants (87%), regardless of reported stress level, with over two-thirds also at risk for clinical depression. All participants had daily access to digital devices and the internet, with most expressing comfort using new apps, suggesting strong feasibility for digital health interventions in this population.
Conclusion: These findings highlight the significant emotional and psychological burdens experienced by caregivers. The high prevalence of anxiety and depression risk underscores the urgent need for targeted mental health support within this population. Tailoring evidence-based mindfulness interventions to address stress, anxiety, and long-term caregiving demands could greatly enhance the quality of life for caregivers.
Authors:
Author - Karen Alexander, PhD, RN, Friends Research Institute
Author - Jan Gryczynski, PhD, Friends Research Institute
Author - Rachel Woolworth, MSW, COG Analytics
Author - Aryana Simpson, MPH, Friends Research Institute
Author - Steven Carswell, PhD, COG Analytics
Identifying Potential Clients for HIV Low-Barrier Care Within a Centralized HIV Resource Navigation Program: A Latent Class Analysis
Poster Number: E87Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Social and Environmental Context and Health
Introduction: The Chicago HIV Resource HUB is a rapid-response referral program meant to connect clients to HIV resources in the Chicago area. Despite the HUB’s original design of short-term referrals, some clients use the HUB for long-term case management of multiple complex needs, which hinders service capacity. These clients may be more suited for low-barrier care, an intensive evidence-based service-delivery model starting in Chicago that consists of walk-in visits, integrated case management, and incentives for treatment goals. To refer clients to low-barrier care, HUB staff can identify clients whose service characteristics indicate the most intensive needs.
Methods: We used survey data of HUB clients living with HIV (n=180) to conduct a latent class analysis of service request patterns across 13 services. We collected data from November 2024 to May 2025. We ran descriptive statistics of service outcomes (number of services requested, frequency of service contacts) by class. We used multivariable logistic regression with several covariates (age, race/ethnicity, gender, sexual orientation, and region of residence in Chicago) to examine differences between classes.
Results: Participants were aged M=39.5 years, 56.1% non-Hispanic Black and 15.0% Hispanic, 71.7% cisgender men, and 66.1% gay/lesbian/same-gender loving. The latent class analysis resulted in a two-class solution consisting of Heavy Utilizers (35.5%) and Lower Utilizers (64.5%). The most requested services among Heavy Utilizers were housing (89.8%), case management (89.7%), food assistance (77.9%), and financial assistance (69.5%), and the most requested services among Lower Utilizers were housing (48.8%) and financial assistance (43.8%). Heavy Utilizers requested more services (M=7.0 v. M=2.2, p<.001) and were more likely to contact the HUB at least 8 times in the past two years (17.7% v. 1.7%, p<.001) than Lower Utilizers. In the multivariable logistic regression model, Heavy Utilizers were younger (OR: 0.95, p=.004) and more likely to live in the South Side (OR: 3.51, p=.009) than the North Side compared to Lower Utilizers.
Conclusions: A large proportion (~36%) of Chicago HIV Resource HUB survey participants were Heavy Utilizers based on number of services requested for complex needs and frequency of service contacts. Findings can inform recruitment for low-barrier care services and help guide HUB staff in utilizing their service data for appropriate client referrals.
Keywords: HIV, AIDSMethods: We used survey data of HUB clients living with HIV (n=180) to conduct a latent class analysis of service request patterns across 13 services. We collected data from November 2024 to May 2025. We ran descriptive statistics of service outcomes (number of services requested, frequency of service contacts) by class. We used multivariable logistic regression with several covariates (age, race/ethnicity, gender, sexual orientation, and region of residence in Chicago) to examine differences between classes.
Results: Participants were aged M=39.5 years, 56.1% non-Hispanic Black and 15.0% Hispanic, 71.7% cisgender men, and 66.1% gay/lesbian/same-gender loving. The latent class analysis resulted in a two-class solution consisting of Heavy Utilizers (35.5%) and Lower Utilizers (64.5%). The most requested services among Heavy Utilizers were housing (89.8%), case management (89.7%), food assistance (77.9%), and financial assistance (69.5%), and the most requested services among Lower Utilizers were housing (48.8%) and financial assistance (43.8%). Heavy Utilizers requested more services (M=7.0 v. M=2.2, p<.001) and were more likely to contact the HUB at least 8 times in the past two years (17.7% v. 1.7%, p<.001) than Lower Utilizers. In the multivariable logistic regression model, Heavy Utilizers were younger (OR: 0.95, p=.004) and more likely to live in the South Side (OR: 3.51, p=.009) than the North Side compared to Lower Utilizers.
Conclusions: A large proportion (~36%) of Chicago HIV Resource HUB survey participants were Heavy Utilizers based on number of services requested for complex needs and frequency of service contacts. Findings can inform recruitment for low-barrier care services and help guide HUB staff in utilizing their service data for appropriate client referrals.
Authors:
Presenter - John Guigayoma, Northwestern University
Author - Gregory Swann, Northwestern University
Author - Andrea Dakin, AIDS Foundation of Chicago
Author - Cory Bradley, Northwestern University
Author - Alec Powers, Northwestern University
Author - Sharon Hoefer, Northwestern University
Author - Olivia Panegos, Northwestern University
Author - Devan Derricotte, AIDS Foundation of Chicago
Author - Nora Bouacha, AIDS Foundation of Chicago
Author - Jill Dispenza, Northwestern University
Author - Nanette Benbow, Northwestern University
Author - Dennis Li, Northwestern University
“Don't be scared. Take your medication and live your best life”: A qualitative exploration of newly HIV diagnosed Black sexual minority men on healthcare engagement, coping mechanisms, and mental health
Poster Number: E89Time: 05:00 PM - 05:50 PM
Topics: HIV/AIDS, Mental Health
Background: The first months after an HIV diagnosis are critical for intervention. In the US, Black Sexual Minority Men (BSMM) bear a disproportionate HIV burden and have higher rates of trauma exposure, including physical violence and emotional abuse. Mental health issues such as traumatic stress are often cited as barriers to HIV medication adherence. Purpose: Formative semi-structured in-depth interviews were done to assist with development of the Resilience-Based Intervention for Stress-Reduction and HIV-Related Efficacy (RISE) intervention, a telehealth, Cognitive Behavior Therapy-based intervention to help newly diagnosed BSMM adjust to living with HIV by reducing traumatic stress and improving engagement in HIV care. Methods: Participants were BSMM living with HIV (n=12). Interviews focused on psychosocial implications associated with learning about their diagnosis and subsequent engagement in HIV care and medication adherence. Interviews were coded using an inductive/deductive coding approach to capture key experiences, including development of coping mechanisms, experiences accessing HIV healthcare services, social support, and HIV-related information seeking. Participants were segmented by the time since their HIV diagnosis (3-6, 6-9 and 9-12 months; 1-2 years, 2+ years). A comparative thematic analysis was then conducted to identify shared and unique themes amongst the sample. Results: Several key preliminary themes emerged, including illicit drug use to moderate HIV-related depression and trauma, delayed HIV healthcare engagement due to limited HIV health literacy and the belief that HIV was a “death sentence.” Some also discussed the implications of managing co-occurring mental health disorders with substance use disorders, including resulting physical effects of the drug-to-drug interactions. Many participants’ decision to engage in care was the result of two primary factors, social support from family/peers and information from an HIV healthcare provider about HIV treatment (ART). Furthermore, participants agreed that that their perceptions of HIV have shifted since being diagnosed, including beliefs regarding their quality of life and overall health outcomes. Conclusions: For the next steps, these insights will be leveraged to inform how RISE will address newly diagnosed BSMM’s mental health and, ultimately, under-engagement in HIV care.
Keywords: HIV, Mental healthAuthors:
Presenter - Caseem Luck, M.S., University of South Florida
Author - Wilson Vincent, PhD MPH MA, Temple University
Author - Sarah Bass, PhD, MPH, FSBM, Temple University
Co-Author - Katie Singley, MPH, Temple University Risk Communication Lab
Co-Author - Cody Lentz, MA, Temple University
Co-Author - Rose Marcelin, MPH, Temple University
Co-Author - Imani Wilson-Shabazz, MS, Temple University
Co-Author - Benjamin Dominguez, BS, Temple University
Co-Author - Sydney Telaak, BA, Temple University
Co-Author - Simrahn Bidaye, BS, Temple University
Co-Author - Arianna Vacio, M.S., Temple University
Co-Author - Emma Clark, BS, Tulane University
Co-Author - Murad Wali, BS, Temple University
Author - Nathan Hansen, PhD, University of Georgia
Increasing Parental HPV Vaccine Receptivity through General and Targeted Health Education
Poster Number: E9Time: 05:00 PM - 05:50 PM
Topics: Cancer, Health Disparities
Nearly all cases of cervical cancer are caused by human papillomavirus (HPV). The HPV vaccine is highly effective in preventing high-risk infections that can lead to cervical cancer, particularly when administered prior to exposure—typically between 9 and 12 years of age. HPV vaccination is especially important for African Americans, who experience disproportionately higher rates of cervical cancer incidence and mortality. Nevertheless, HPV vaccine uptake remains suboptimal. The present research examined the effects of HPV vaccine education on parents’ receptivity to vaccination and tested whether culturally targeted messaging could further enhance vaccine receptivity among African American parents. African American (N = 103) and White (N = 82) parents of vaccine-eligible daughters were recruited through CloudResearch for an online survey. Participants were randomly assigned to a no-education control condition or to an education condition in which they received information about HPV vaccination and cervical cancer. Within the education condition, half of African American participants also viewed culturally targeted messaging highlighting racial disparities in cervical cancer and the importance of personal control in HPV vaccination to overcome these disparities. Following education, participants reported their receptivity to the HPV vaccine using the Theory of Planned Behavior constructs (attitudes, normative beliefs, perceived control, intentions). One-way ANOVAs revealed a significant effect of messaging on vaccine attitudes (p = .001) and a marginally significant effect on vaccine intentions (p = .057). Pairwise comparisons showed that African American participants in the no-education control condition reported more negative attitudes (p = .007) and lower intentions (p = .074) than White participants. While education did not influence attitudes or intentions among White participants, it significantly increased attitudes among African Americans (p = .004). Moreover, culturally targeted messaging significantly increased both attitudes (p < .001) and intentions (p = .003) among African Americans relative to the control condition. Finally, there was evidence that culturally targeted messaging amplified the effect of education, leading to greater intentions than education alone (p = .096). These findings underscore the importance of culturally targeted health education and can inform future efforts to promote HPV vaccination among African American families.
Keywords: Cancer, Health communicationAuthors:
Author - Olivia Aspiras, PhD, Michigan State University
Co-Author - Todd Lucas, PhD, Michigan State University
Co-Author - Leah Johnson, MPH, Genesee County Health Department
Patients’ and Providers’ Perceived Acceptability of an Exercise is Medicine Protocol
Poster Number: E90Time: 05:00 PM - 05:50 PM
Topics: Implementation Science
Background: The American College of Sports Medicine’s Exercise is Medicine (EIM) initiative calls for integrating physical activity into primary care by screening patients for inactivity and then counseling and/or referring inactive patients to local resources. However, patient and provider’s acceptability of EIM programs are under researched. Purpose: To explore patient and provider’s acceptability of an EIM initiative at a large midwestern hospital. Methods: Providers and patients from a large Family Medicine clinic exposed to an existing EIM program were recruited to complete online surveys assessing their perceived acceptability (e.g., understanding, like/dislike, perceived effort to participate, impact on quality of care, confidence in the process, satisfaction, thoughts on expansion to other patients/clinics) of an EIM program implemented in June 2023. Each item was assessed using a 5-point Likert scale. Descriptive statistics were used to analyze results. Results: Twenty-five providers (76% female, 43.3+8.2 years, 88% White, 15.6+9.1 years practicing, 76.4% physicians) and 380 patients (74% female, 43.1+12.4 years, 81% White) participated. Most providers “agreed or strongly agreed” that the EIM program improved patient care (74%), helped them manage their patient’s health (68%), that they would continue using the EIM program (84%), and that the program should be expanded to other clinics (72%). Less than half of providers agreed/strongly agreed their patients understood the EIM process (48%). While most providers felt comfortable counseling patients on aerobic (96%) and muscle strengthening exercise (64%), few agreed they had sufficient time to counsel patients (36%). Most patients agreed or strongly agreed that they understood how to answer questions about their physical activity (89%) but fewer agreed that they understood how to connect with a health coach (40%). Most patients agreed/strongly agreed that other patients should be screened for inactivity (79%) and connected with a health coach (74%). Conclusion: These findings suggest both patients and providers support the implementation of an EIM program that screens patients for inactivity and connects patients to local health coaches for support. Additional research is needed to improve patients’ understanding on how to connect with local health coaches.
Keywords: Health behavior change, Physical activityAuthors:
Author - Leah Aitchison, University of Iowa
Co-Author - Garrett Steinbrink, B.S. Kinesiology, University of Wisconsin-Milwaukee
Co-Author - Jenna Springer, University of Iowa
Co-Author - Britt Marcusson, University of Iowa
Co-Author - Korey Kennelty, University of Iowa
Chair - Lucas Carr, PhD, University of Iowa
Teacher and Parent Preferences and Priorities for Elementary Health Education Interventions
Poster Number: E91Time: 05:00 PM - 05:50 PM
Topics: Implementation Science , Community Engagement
Evidence-based health education interventions (EBHEI) during childhood support student health literacy and health behavior change. However, limited information is known about teacher and parent preferences for elementary-level EBHEIs and teacher priorities for curricular adoption decisions. Team Thrive Elementary (TTE) is a multicultural health promotion curriculum co-created by undergraduate students, the University of Utah Center for Community Nutrition, the Utah State Board of Education (USBE), and University Neighborhood Partners (UNP). During the curriculum development process, students and research team members distributed surveys to elementary teachers (N=12) at an annual teacher conference. Teachers had an opportunity to review a printed version of TTE and provide additional feedback. Teachers rated alignment of TTE with constructs from the Practical, Robust Implementation and Sustainability model on a 5-point scale (5=highest) and ranked 7 factors (7=most important) related to adoption decision-making. Additionally, UNP-affiliated parents (N=37) also provided feedback to curriculum materials by rating TTE readability and understanding, alignment with learning expectations, and cultural sensitivity on a 5-point scale (5=highest). Teachers reported high alignment between TTE and teacher expectations (4.3±0.8), teacher expertise (3.9±1.1), student expectations (3.7±0.8), available resources (3.7±1.2), and external factors (3.7±1.2). Additionally, teachers valued student (4.0±0.9) and teacher perspectives (4.3±0.7) for curricular adoption decision-making. When ranking adoption-related factors, teachers prioritized improved student health outcomes (5.1±2.4), low program burden (5.0±1.9), alignment with USBE standards (4.5±2.2), appearing easy to deliver (3.9±2.3), good student engagement strategies (3.6±1.2), fit with other curricula (3.0±1.6), and endorsement by USBE (2.9±1.8), respectively. Parents found TTE to have moderate to high readability (4.0±0.9) and alignment with learning expectations (3.8±0.9), and moderate cultural sensitivity (3.2±1.2). Parents also provided open-ended feedback to improve cultural relevance (e.g., introducing multicultural foods and experiences). Elementary teachers valued low-burden health curricula that improved student health outcomes and aligned with state educational standards. Parents found TTE to be aligned with learning expectations for their children but made recommendations for improving cultural relevance.
Keywords: Health education, ChildrenAuthors:
Author - Mickey Bolyard, MS, University of Utah
Co-Author - Alejandra Huerta Hernandez, University of Utah
Co-Author - Pramod Karthikeyan, University of Utah
Co-Author - Mia Krause, University of Utah
Co-Author - Marissa Manley, University of Utah
Co-Author - Merrin Maughan, University of Utah
Co-Author - Mayette Pahulu, University of Utah
Co-Author - Payton Reynard, University of Utah
Co-Author - Kate Southwick, University of Utah
Co-Author - Helen Wang, University of Utah
Co-Author - Maddie French, MS, RDN, CD, University of Utah Center for Community Nutrition
Co-Author - Amy Loverin, MS, RD, CD, University of Utah Center for Community Nutrition
Co-Author - Shannon Jones, MS, University of Utah Center for Community Nutrition
Co-Author - Jodi Parker, MA, Utah State Board of Education
Co-Author - Teresa Molina, PhD, University of Utah
Co-Author - Paul Estabrooks, PhD, University of Utah
Implementation Characteristics of a Single-session Mental Health Intervention for Latina Teens and their Female Caregivers: Findings from a Pilot Study
Poster Number: E92Time: 05:00 PM - 05:50 PM
Topics: Implementation Science , Mental Health
Background: Floreciendo is a four-session sexual and reproductive health (SRH) program for Latina teens (14-18 years) and their female caregivers (e.g., mothers, sisters). From July 2024-April 2025, our team worked to develop a fifth session on mental health and its relation to SRH based on the literature and feedback from our community collaborators. This study aimed to assess the preliminary acceptability, appropriateness, and feasibility of the novel mental health session.
Methods: We piloted the two-hour mental health session at community partner organizations in Chicago. Teens and caregivers completed surveys immediately post-session to assess acceptability (e.g., “Overall, did you like the session?”), appropriateness (e.g., “How well does Floreciendo align with Latine cultural values?”), and feasibility (e.g., “In general, how safe did you feel traveling to Floreciendo?”), drawing on the Mental Health Implementation Science Tools (mhIST). We held focus group discussions to further expand on quantitative responses. Survey data were analyzed using descriptive statistics (e.g., means (M), standard deviations (SD)). Focus group data were analyzed using rapid qualitative analysis.
Results: Twenty-four dyads (n=48 participants) received the intervention. Findings from teens yielded high mean scores for acceptability (M = 2.74/3, SD = 0.31) and appropriateness (M = 2.71/3, SD = 0.41) and slightly lower scores for feasibility (M = 2.39/3, SD = 0.48). Caregiver data showed high mean scores for acceptability (M = 2.78/3, SD = 0.32), appropriateness (M = 2.75/3, SD = 0.43), and feasibility (M = 2.62/3, SD = 0.48) alike. On surveys, 100% of teens and caregivers reported they would recommend Floreciendo to others. Perceptions shared in focus groups supported the high scores observed for appropriateness, with participants appreciating how Floreciendo addresses Latine cultural norms and stigma around mental health. Proximity to, perceived safety of, and parking around the programming sites were described as factors affecting feasibility, with one teen noting: “The distance [was a challenge because] we live up North. Also, the neighborhood is a bit iffy; my mom had her doubts.”
Conclusion: Our study highlights the value of integrating implementation science into the creation of innovative youth programming. Overall, findings support the implementability of the mental health session and will inform its future delivery and testing on a larger scale.
Keywords: Mental health, AdolescentsMethods: We piloted the two-hour mental health session at community partner organizations in Chicago. Teens and caregivers completed surveys immediately post-session to assess acceptability (e.g., “Overall, did you like the session?”), appropriateness (e.g., “How well does Floreciendo align with Latine cultural values?”), and feasibility (e.g., “In general, how safe did you feel traveling to Floreciendo?”), drawing on the Mental Health Implementation Science Tools (mhIST). We held focus group discussions to further expand on quantitative responses. Survey data were analyzed using descriptive statistics (e.g., means (M), standard deviations (SD)). Focus group data were analyzed using rapid qualitative analysis.
Results: Twenty-four dyads (n=48 participants) received the intervention. Findings from teens yielded high mean scores for acceptability (M = 2.74/3, SD = 0.31) and appropriateness (M = 2.71/3, SD = 0.41) and slightly lower scores for feasibility (M = 2.39/3, SD = 0.48). Caregiver data showed high mean scores for acceptability (M = 2.78/3, SD = 0.32), appropriateness (M = 2.75/3, SD = 0.43), and feasibility (M = 2.62/3, SD = 0.48) alike. On surveys, 100% of teens and caregivers reported they would recommend Floreciendo to others. Perceptions shared in focus groups supported the high scores observed for appropriateness, with participants appreciating how Floreciendo addresses Latine cultural norms and stigma around mental health. Proximity to, perceived safety of, and parking around the programming sites were described as factors affecting feasibility, with one teen noting: “The distance [was a challenge because] we live up North. Also, the neighborhood is a bit iffy; my mom had her doubts.”
Conclusion: Our study highlights the value of integrating implementation science into the creation of innovative youth programming. Overall, findings support the implementability of the mental health session and will inform its future delivery and testing on a larger scale.
Authors:
Author - Jamison Merrill, MSc, University of Illinois Chicago
Co-Author - Wendy Chu, PhD, University of Illinois Chicago
Co-Author - Jessica Carney, PhD, University of Illinois Chicago
Co-Author - Jacqueline Silva, MPH, University of Illinois Chicago
Co-Author - Fatima Muniz, Emory University
Co-Author - Susana Salgado, BA, Centro Romero
Co-Author - Abi Delgado, Girls in the Game
Co-Author - Evelyn Delgado, Girls in the Game
Co-Author - Gisel Romero, LCSW, LoSAH Center of Hope
Co-Author - Blanca Gabino, Gads Hill Center
Co-Author - Katherine Merrill, PhD, University of Illinois Chicago
Pilot of a pharmacist-delivered habit-based intervention to support medication adherence in primary care
Poster Number: E93Time: 05:00 PM - 05:50 PM
Topics: Implementation Science , Multiple Health Behavior Change
Background: Pharmacists discuss medications with patients. Use of habit science is not well-established. This pilot examined the feasibility and preliminary effectiveness of a pharmacist-led, habit intervention to support adherence to a newly prescribed daily medication. Guided by the Extended Common Sense Model of Self-Regulation, the intervention used a habit worksheet incorporating cue specification and action planning.
Objectives:
1) Pillot a pharmacist-led habit-based medication adherence intervention compared to a standard education approach; 2) evaluate the relative utility of patients’ beliefs about medicines versus habit strength in predicting self-reported adherence at follow-up, and 3) describe patient-selected cues.
Methods: This study was conducted in a primary care clinic in the Midwest U.S. and delivered by the clinical pharmacist. A non-randomized design was used with the first group receiving standard education and the second group receiving education plus completing the habit worksheet with the pharmacist. Patients completed a baseline survey and a follow-up survey by mail ~100 days. Both surveys assessed habit strength, and beliefs about medicines. The 100-day survey also included doses missed in the past week and the 5-item medication adherence report scale (MARS). Habit worksheet responses were coded to describe cue types.
Results: Thirty-three participants enrolled (16 control, 17 intervention), with high follow-up response rates (75% and 94% respectively). Both groups reported high baseline adherence and habit strength, limiting room for improvement. No significant differences were identified between groups in habit strength or self-reported adherence (MARS-5). Regression analyses showed habit strength was the only significant predictor of adherence (MARS-5; p=0.02), while higher necessity beliefs were associated with fewer missed doses (p=0.03). Habit strength and adherence appeared higher for patients selecting meal (n=9) and hygiene cues (n=3) compared to patients selecting location-based cues (n=5).
Conclusion: While the habit-based intervention did not significantly outperform standard education, findings support the relevance of habit strength and necessity beliefs in predicting adherence. The high baseline habit strength among participants may have masked potential intervention effects. Future research should target populations with known non-adherence or without established routines and explore cue effectiveness further.
Keywords: Compliance, Health behavior changeObjectives:
1) Pillot a pharmacist-led habit-based medication adherence intervention compared to a standard education approach; 2) evaluate the relative utility of patients’ beliefs about medicines versus habit strength in predicting self-reported adherence at follow-up, and 3) describe patient-selected cues.
Methods: This study was conducted in a primary care clinic in the Midwest U.S. and delivered by the clinical pharmacist. A non-randomized design was used with the first group receiving standard education and the second group receiving education plus completing the habit worksheet with the pharmacist. Patients completed a baseline survey and a follow-up survey by mail ~100 days. Both surveys assessed habit strength, and beliefs about medicines. The 100-day survey also included doses missed in the past week and the 5-item medication adherence report scale (MARS). Habit worksheet responses were coded to describe cue types.
Results: Thirty-three participants enrolled (16 control, 17 intervention), with high follow-up response rates (75% and 94% respectively). Both groups reported high baseline adherence and habit strength, limiting room for improvement. No significant differences were identified between groups in habit strength or self-reported adherence (MARS-5). Regression analyses showed habit strength was the only significant predictor of adherence (MARS-5; p=0.02), while higher necessity beliefs were associated with fewer missed doses (p=0.03). Habit strength and adherence appeared higher for patients selecting meal (n=9) and hygiene cues (n=3) compared to patients selecting location-based cues (n=5).
Conclusion: While the habit-based intervention did not significantly outperform standard education, findings support the relevance of habit strength and necessity beliefs in predicting adherence. The high baseline habit strength among participants may have masked potential intervention effects. Future research should target populations with known non-adherence or without established routines and explore cue effectiveness further.
Authors:
Author - Matthew Witry, PhD, PharmD, University of Iowa College of Pharmacy
Co-Author - James Hoehns, PharmD, University of Iowa College of Pharmacy
Author - L. Alison Phillips, PhD, FSBM, Iowa State University
Incorporating Positive Psychological Interventions into Primary Care Behavioral Health: A Pilot Study
Poster Number: E94Time: 05:00 PM - 05:50 PM
Topics: Integrated Primary Care, Quality of Life
Behavioral health services are increasingly integrated into primary care setting however these services have emphasized reducing illness and not promoting well-being. Given the potential impact of explicit efforts to enhance well-being, we began incorporating positive psychological interventions (PPIs) into the Primary Care Group at The University of Chicago Medicine that serves 29,000 annually. For context, our behavioral medicine service on average provides 3,000 patient encounters per year where patients are referred from their primary care provider and receive up to 10 brief sessions during an episode of care. Recently, we began incorporating PPIs into our practice by updating our assessment battery and training our behavioral medicine clinicians. We began incorporating gratitude and self-compassion into our services due to their robust associations with well-being and less psychological distress as well as their evidence-based interventions that can easily be interwoven with CBT, ACT, DBT, and IPT that we routinely use in our behavioral medicine service. Pilot data from 66 patients (primarily female, 75.8%; Mean age = 52 years, range: 20-84 years) during the first three months of implementation revealed the following: Gratitude interventions were utilized when patients presented with mixed anxiety and depressive symptoms while self-compassion interventions were incorporated when patients presented with the aforementioned symptoms and grief. Gratitude was often paired with behavioral activation and mindfulness, and self-compassion was often used as a standalone treatment. Using both PPIs, we observed reductions in anxiety and depressive symptoms and increases in self-compassion scores. Data collection is ongoing. At the SBM conference, we anticipate having a year of data collected and analyzed to present. In doing so, this will offer more robust longitudinal analyses.
Keywords: Primary care, ResilienceAuthors:
Author - Fabiana Araújo, PhD, University of Chicago
Author - Byron Brooks, PhD, University of Illinois Chicago
Leveraging Wearable Technology to Evaluate Behavioral Pain Interventions in Military Primary Care Settings: A Pilot Study
Poster Number: E95Time: 05:00 PM - 05:50 PM
Topics: Integrated Primary Care, Pain
Background: Chronic pain is highly prevalent among military beneficiaries and contributes substantially to disability, and reduced readiness. Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP), delivered by Behavioral Health Consultants (BHCs) in military primary care clinics, offers a scalable, nonpharmacologic intervention. Traditional outcomes rely heavily on self-report; wearable devices such as Fitbit provide an opportunity to capture real-world functional data in pragmatic trials.
Methods: Participants in a pilot pragmatic trial of BCBT-CP were issued Fitbit devices to track physical activity and sleep across treatment. Step counts were summarized at sequential BHC appointments (APPT2–APPT5) and follow-up intervals (FU1, FU2). Non-parametric analyses (Kruskal–Wallis tests) were used to evaluate differences in activity across visits.
Results: A total of 43 individuals initiated Fitbit monitoring. Most were affiliated with the Army (90.9%) and identified as retirees, veterans, or family members; the sample was predominantly female (76.7%), with 48.8% identifying as White and 34.9% as Black. The number of observations decreased over time - suggesting a decreased use of monitoring for some individuals. The Kruskal–Wallis test revealed significant differences in step counts across appointments (χ²=20.7, df=3, p<.001). While the test does not specify directionality, inspection of distributions indicated an upward trend for a subgroup of participants. Notably, several individuals demonstrated consistent increases across successive appointments, suggesting that changes were not random but reflected structured improvements over time. This trajectory of increases was further supported by the GEE model, which captured the overall pattern across visits.
Conclusions: Incorporating Fitbit into a pragmatic pilot trial demonstrated the feasibility of wearable technology to capture objective functional outcomes in primary care pain management. Findings suggest that BCBT-CP, as delivered by BHCs, is associated with measurable improvements in physical activity among some participants, providing convergent support for patient-reported reductions in pain interference. Wearable devices represent a scalable adjunct for monitoring treatment response and long-term maintenance, enhancing the evaluation of nonpharmacologic pain interventions in military primary care.
Keywords: Primary care, PainMethods: Participants in a pilot pragmatic trial of BCBT-CP were issued Fitbit devices to track physical activity and sleep across treatment. Step counts were summarized at sequential BHC appointments (APPT2–APPT5) and follow-up intervals (FU1, FU2). Non-parametric analyses (Kruskal–Wallis tests) were used to evaluate differences in activity across visits.
Results: A total of 43 individuals initiated Fitbit monitoring. Most were affiliated with the Army (90.9%) and identified as retirees, veterans, or family members; the sample was predominantly female (76.7%), with 48.8% identifying as White and 34.9% as Black. The number of observations decreased over time - suggesting a decreased use of monitoring for some individuals. The Kruskal–Wallis test revealed significant differences in step counts across appointments (χ²=20.7, df=3, p<.001). While the test does not specify directionality, inspection of distributions indicated an upward trend for a subgroup of participants. Notably, several individuals demonstrated consistent increases across successive appointments, suggesting that changes were not random but reflected structured improvements over time. This trajectory of increases was further supported by the GEE model, which captured the overall pattern across visits.
Conclusions: Incorporating Fitbit into a pragmatic pilot trial demonstrated the feasibility of wearable technology to capture objective functional outcomes in primary care pain management. Findings suggest that BCBT-CP, as delivered by BHCs, is associated with measurable improvements in physical activity among some participants, providing convergent support for patient-reported reductions in pain interference. Wearable devices represent a scalable adjunct for monitoring treatment response and long-term maintenance, enhancing the evaluation of nonpharmacologic pain interventions in military primary care.
Authors:
Presenter - Jeffrey Goodie, PhD, ABPP, FSBM, Uniformed Services University
Co-Author - Kathryn Kanzler, PsyD, ABPP, FSBM, Baylor College of Medicine
Co-Author - Cindy McGeary, Ph.D., ABPP, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio
Co-Author - Yan Qiao, Ph.D., Uniformed Services University
Co-Author - Elizabeth Hisle-Gorman, MSW, Ph.D., Uniformed Services University
Co-Author - Christine Buhrer, MSW, Harker Heights Medical Home, Harker Heights, TX
Co-Author - Paul Fowler, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio
Co-Author - Nicole Brakins, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio
Co-Author - Anne Dobmeyer, Ph.D., ABPP, Medical Affairs, Defense Health Agency
Co-Author - Aditya Bhagwat, Ph.D., Medical Affairs, Defense Health Agency
Co-Author - Claire Demming, Ph.D., Uniformed Services University
Co-Author - Jennifer Gerson, Uniformed Services University
Co-Author - Stacey Young-McCaughan, RN, Ph.D., Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio
Co-Author - Alan Peterson, Ph.D., ABPP, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio
Co-Author - Melody Cardona, Uniformed Services University
Co-Author - Donald McGeary, PhD, ABPP, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio
Integrating Self-Compassion into Health Coaching: Coaches’ Experiences and Perspectives
Poster Number: E96Time: 05:00 PM - 05:50 PM
Topics: Integrative Health and Spirituality, Implementation Science
Background: Self-compassion (SC) is the acknowledgement that the self, as well as others, are deserving of compassion. People with higher SC can take a supportive and caring stance when faced with personal hardship, challenges, or perceived inadequacies. Despite its benefits, limited research has examined how SC is applied within health coaching practices. SC can help health coaching clients experience improved health by buffering against setbacks and fostering adaptive coping. As such, it is essential to examine perceptions of SC among health coaches to understand how it aligns with their coaching practice. The purpose of this study was to explore perceptions of integrating SC into health coaching, and its effects on client rapport. Further, we aimed to understand challenges and facilitators that shape the consistent use of SC in health coaching.
Methods: In total, 11 health coaches (average age 21.50 years, n=10, 90% female; 100% White, non-Hispanic) participated in focus groups. Participants were eligible to participate in this study if they 1) were a health coach for a weight-inclusive university coaching program, and 2) had completed a 1-hour asynchronous virtual training on SC in health coaching. Focus groups were audio recorded and transcribed verbatim. Thematic analysis was conducted to identify relevant themes. Three coders independently coded text units in 30% of the transcribed data to develop a preliminary coding framework, noting anything related to health coaches’ perceptions of SC, including barriers and facilitators to SC, and how SC influenced their coaching practice. The study team reviewed original codes and discussed contextualization of themes to develop the framework for coding of the remaining text.
Findings: Six themes were generated: 1. Retrospective vs. present self-regulation of health coaches 2. Common humanity among health coaches and clients, 3. Feedback receptivity of health coaches, 4. Alignment with affirmations and SC, 5. SC as a method to reduce stress among health coaches, and 6. SC to cultivate self-worth and mindful presence.
Conclusions: By cultivating SC, health coaches can create more supportive and effective relationships with their clients. Coaches reported increased self-awareness, reduced self-criticism, enhanced relationships with clients, and a greater sense of self-worth. These findings suggest that SC is a valuable tool for promoting well-being and effectiveness in health coaching.
Keywords: Health behavior change, TrainingMethods: In total, 11 health coaches (average age 21.50 years, n=10, 90% female; 100% White, non-Hispanic) participated in focus groups. Participants were eligible to participate in this study if they 1) were a health coach for a weight-inclusive university coaching program, and 2) had completed a 1-hour asynchronous virtual training on SC in health coaching. Focus groups were audio recorded and transcribed verbatim. Thematic analysis was conducted to identify relevant themes. Three coders independently coded text units in 30% of the transcribed data to develop a preliminary coding framework, noting anything related to health coaches’ perceptions of SC, including barriers and facilitators to SC, and how SC influenced their coaching practice. The study team reviewed original codes and discussed contextualization of themes to develop the framework for coding of the remaining text.
Findings: Six themes were generated: 1. Retrospective vs. present self-regulation of health coaches 2. Common humanity among health coaches and clients, 3. Feedback receptivity of health coaches, 4. Alignment with affirmations and SC, 5. SC as a method to reduce stress among health coaches, and 6. SC to cultivate self-worth and mindful presence.
Conclusions: By cultivating SC, health coaches can create more supportive and effective relationships with their clients. Coaches reported increased self-awareness, reduced self-criticism, enhanced relationships with clients, and a greater sense of self-worth. These findings suggest that SC is a valuable tool for promoting well-being and effectiveness in health coaching.
Authors:
Author - Lea Cambranes, MSc , Northern Arizona University
Co-Author - Kailey Cooper, BS, Northern Arizona University
Co-Author - Ellena Slater, Northern Arizona University
Co-Author - Nikole Squires, MS, CHES, ATC, Northern Arizona University
Co-Author - Megan Meyer, MPH, RDN, Northern Arizona University
Co-Author - Dawn Clifford, PhD, RDN, Northern Arizona University
Co-Author - Samantha Soulsby, MPH, Northern Arizona University
Co-Presenter - Natalie Papini, PhD, MA, Northern Arizona University
Bridging Faith and Medicine: Insights from Islamic Religious Leaders on Psychosocial Support for Somali Patients with Liver Cancer
Poster Number: E97Time: 05:00 PM - 05:50 PM
Topics: Integrative Health and Spirituality, Social and Environmental Context and Health
Background:
Many Somali immigrants in the U.S. have a strong religious tradition in Islam, and religious leaders often play a central role in shaping health beliefs and behaviors. Liver cancer is closely tied to chronic hepatitis B prevalence in the Somali population. Hence, Muslim religious leaders may have unique insights into how to best serve Somali immigrant patients facing these diagnoses.
Methods:
We collaborated with two faith leaders, an Muslim chaplain and an Imam, to co-analyze findings from focus group interviews with Somali community members. The leaders reviewed participant quotations and themes, then provided reflections on how Islamic beliefs affect the psychosocial experiences of liver cancer patients. Through their reflections, they revealed challenges patients face as well as culture-specific support that can be implemented.
Results:
Leaders emphasized the need for clinicians to avoid definitive prognostic timelines (e.g., “six months to live”), which conflict with the Islamic belief in predestination (Qadr) and can erode trust. They encouraged clinicians to use faith-centered language such as “it is in God’s hands” while still recommending treatment. Leaders also described how chaplains and imams could partner with clinicians to support patients through Qur’an recitation, prayer, counseling, and community solidarity. They highlighted that seeking medical treatment is not in conflict with faith but is part of one’s responsibility (“Tie your camel and rely on Allah”). Meaning that while ultimate mortality outcomes rest with God, individuals are expected to take practical steps such as pursuing liver cancer treatment. Finally, leaders identified community education in mosques as a key strategy to reduce stigma and normalize discussion of cancer care.
Conclusion:
Collaborating with Muslim religious leaders provides guidance for designing culturally relevant psychosocial interventions in clinical and community settings. Their perspectives may help integrate religious beliefs with medical care, supporting Somali patients’ trust, and leveraging mosques as trusted community spaces for education. Partnerships between clinicians and religious leaders can help address stigma, improve communication, and align medical treatment with spiritual beliefs that guide many Somali patients in health decision making.
Keywords: Cancer, SpiritualityMany Somali immigrants in the U.S. have a strong religious tradition in Islam, and religious leaders often play a central role in shaping health beliefs and behaviors. Liver cancer is closely tied to chronic hepatitis B prevalence in the Somali population. Hence, Muslim religious leaders may have unique insights into how to best serve Somali immigrant patients facing these diagnoses.
Methods:
We collaborated with two faith leaders, an Muslim chaplain and an Imam, to co-analyze findings from focus group interviews with Somali community members. The leaders reviewed participant quotations and themes, then provided reflections on how Islamic beliefs affect the psychosocial experiences of liver cancer patients. Through their reflections, they revealed challenges patients face as well as culture-specific support that can be implemented.
Results:
Leaders emphasized the need for clinicians to avoid definitive prognostic timelines (e.g., “six months to live”), which conflict with the Islamic belief in predestination (Qadr) and can erode trust. They encouraged clinicians to use faith-centered language such as “it is in God’s hands” while still recommending treatment. Leaders also described how chaplains and imams could partner with clinicians to support patients through Qur’an recitation, prayer, counseling, and community solidarity. They highlighted that seeking medical treatment is not in conflict with faith but is part of one’s responsibility (“Tie your camel and rely on Allah”). Meaning that while ultimate mortality outcomes rest with God, individuals are expected to take practical steps such as pursuing liver cancer treatment. Finally, leaders identified community education in mosques as a key strategy to reduce stigma and normalize discussion of cancer care.
Conclusion:
Collaborating with Muslim religious leaders provides guidance for designing culturally relevant psychosocial interventions in clinical and community settings. Their perspectives may help integrate religious beliefs with medical care, supporting Somali patients’ trust, and leveraging mosques as trusted community spaces for education. Partnerships between clinicians and religious leaders can help address stigma, improve communication, and align medical treatment with spiritual beliefs that guide many Somali patients in health decision making.
Authors:
Author - Yahya Abdulrahman, BS, University of Minnesota Medical School
Co-Author - Khalid Abdalla, BS, University of Minnesota Medical School
Co-Author - Carrie Bronars, PhD, LP, Mayo Clinic
Co-Author - Fadumo Warsame, Mayo Clinic
Co-Author - Salah Mohamed, Rochester Health Community Partnership
Co-Author - Khadija Ali, BS, Pamoja Women
Co-Author - Ahmed Mohamed, MD, Mayo Clinic
Co-Author - Luz Molina, Mayo Clinic
Co-Author - Mark Wieland, MD, MPH, Mayo Clinic
Co-Author - Irene Sia, MD, MS, Mayo Clinic
Co-Author - Abby Lohr, PhD, MPH, Mayo Clinic
Integrating Mindfulness, Movement, and Cultural Tailoring to Advance Adolescent Health: Proof-of-Concept of the RESPIRA+ Program
Poster Number: E98Time: 05:00 PM - 05:50 PM
Topics: Integrative Health and Spirituality, Physical Activity
Introduction: Latina adolescents face intersecting challenges of physical inactivity and psychological distress, yet few culturally tailored interventions address these burdens. RESPIRA+ is an 8-week yoga and mindfulness program culturally tailored to promote physical activity (PA) and psychological well-being among Latina adolescents. To our knowledge, this is one of the first proof-of-concept studies to integrate yoga, mindfulness, and cultural tailoring within a PA intervention for Latina youth.
Methods: Using a proof-of-concept design, we evaluated the feasibility and preliminary efficacy of PA and mindfulness. RESPIRA+ provides teens with a workbook, a Fitbit, a yoga mat and blocks, and 16 one-hour sessions of yoga, mindfulness, and health education. Sessions are culturally tailored by embedding a Latina instructor, bilingual classes, and incorporating discussions on familismo (the value of family) and marianismo (the expectation of self-sacrifice) within the context of PA and mental health. Feasibility was assessed via retention, attendance, and adherence to the Fitbit monitor. Youth wore Fitbit activity trackers throughout the program, including baseline and posttest. The PA Questionnaire for Adolescents, Five-Facet Mindfulness Questionnaire, Yoga-Self Efficacy Scale, and PA Enjoyment Scale were collected at baseline, midpoint, and posttest. Friedman’s non-parametric tests and Cohen’s d effect sizes were calculated for each outcome.
Results: Six Latina adolescents (Mage = 17.3) completed the program with 100% retention, 73% attendance, and 93% adherence to Fitbit. From baseline to posttest, Fitbit total PA significantly increased (MCHANGE=126.13 min/day, SD=36.0, d =1.23, χ²(2) = 16.86, p<.05), self-reported PA score also increased, though not significantly (MCHANGE=1.1 units SD=0.49, d =2.11, χ²(2)=4.33, p>.05). Yoga self-efficacy (χ²(2) = 10.16, p <.01, d = 2.10) and PA enjoyment (χ²(2)=9.0, p=.01, d = 0.46) also improved. Mindfulness awareness (χ²(2) = 10.6, p <.01, d = 1.88) and non-judgment (χ²(2) = 6.09, p=.048, d=1.50) increased.
Discussion: RESPIRA+, a culturally tailored intervention, demonstrated feasibility and promising preliminary efficacy for improving PA, mindfulness, and psychosocial determinants of health in Latina adolescents. This proof-of-concept study suggests RESPIRA+ has the potential to advance adolescent health promotion and mechanistic understanding of the effects of yoga on mental health in future trials.
Keywords: Adolescents, Physical activityMethods: Using a proof-of-concept design, we evaluated the feasibility and preliminary efficacy of PA and mindfulness. RESPIRA+ provides teens with a workbook, a Fitbit, a yoga mat and blocks, and 16 one-hour sessions of yoga, mindfulness, and health education. Sessions are culturally tailored by embedding a Latina instructor, bilingual classes, and incorporating discussions on familismo (the value of family) and marianismo (the expectation of self-sacrifice) within the context of PA and mental health. Feasibility was assessed via retention, attendance, and adherence to the Fitbit monitor. Youth wore Fitbit activity trackers throughout the program, including baseline and posttest. The PA Questionnaire for Adolescents, Five-Facet Mindfulness Questionnaire, Yoga-Self Efficacy Scale, and PA Enjoyment Scale were collected at baseline, midpoint, and posttest. Friedman’s non-parametric tests and Cohen’s d effect sizes were calculated for each outcome.
Results: Six Latina adolescents (Mage = 17.3) completed the program with 100% retention, 73% attendance, and 93% adherence to Fitbit. From baseline to posttest, Fitbit total PA significantly increased (MCHANGE=126.13 min/day, SD=36.0, d =1.23, χ²(2) = 16.86, p<.05), self-reported PA score also increased, though not significantly (MCHANGE=1.1 units SD=0.49, d =2.11, χ²(2)=4.33, p>.05). Yoga self-efficacy (χ²(2) = 10.16, p <.01, d = 2.10) and PA enjoyment (χ²(2)=9.0, p=.01, d = 0.46) also improved. Mindfulness awareness (χ²(2) = 10.6, p <.01, d = 1.88) and non-judgment (χ²(2) = 6.09, p=.048, d=1.50) increased.
Discussion: RESPIRA+, a culturally tailored intervention, demonstrated feasibility and promising preliminary efficacy for improving PA, mindfulness, and psychosocial determinants of health in Latina adolescents. This proof-of-concept study suggests RESPIRA+ has the potential to advance adolescent health promotion and mechanistic understanding of the effects of yoga on mental health in future trials.
Authors:
Presenter - Yuliana Soto, PhD, Department of Medicine, University of Illinois at Chicago
Co-Author - Diana Morales, BS, Department of Health and Kinesiology, University of Illinois at Urbana-Champaign
Co-Author - Mandy Vukits, MS, Department of Kinesiology and Nutrition, University of Illinois Chicago
Co-Author - Timber Terrell, BS, Department of Kinesiology and Nutrition, University of Illinois Chicago
Co-Author - Eduardo Bustamante, PhD, Department of Kinesiology and Nutrition, University of Illinois Chicago
Co-Author - Susan Aguinaga, PhD, Department of Health and Kinesiology, University of Illinois Urbana-Champaign
Mental Health and Lifestyle Factors in Rural College Freshmen Based on a Cross-Sectional Survey
Poster Number: E99Time: 05:00 PM - 05:50 PM
Topics: Mental Health, Physical Activity
The transition to college introduces academic, social, and lifestyle adjustments that may affect student well-being. For students at rural institutions, these challenges can be compounded by limited resources and unique campus dynamics. This study examined how demographic factors, living arrangements, and athletic participation relate to mental health and health behaviors among first-year students at a rural college. A cross-sectional survey was administered to freshmen in their first month at college (n = 98; 57% female). Demographic variables included age, gender, commuter vs. residential status, and athlete status (club, varsity, intramural, or non-athlete). Validated instruments assessed resilience (Brief Resiliency Scale, Connor-Davidson Resilience Scale), loneliness (UCLA Loneliness Scale), psychological distress (Kessler Distress Scale), weight concerns, sleep quality (Pittsburgh Sleep Quality Index), flourishing (Diener Flourishing Scale), physical activity (International Physical Activity Questionnaire), and diet (Food Frequency Questionnaire). Results indicated significant group differences. All athlete groups reported higher levels of flourishing (48.7-51.5 vs 40 ± 1.3) and lower psychological distress than non-athletes (4.4-6.6 vs 11.1 ± 0.8), while students engaged in organized sports (varsity and club) demonstrated higher resilience and better sleep quality compared to their peers. Commuter students reported more distress (8.7 ± 1.0 vs 7.0 ± 0.6) and higher loneliness compared to residential peers (46.9 ± 2.3 vs 41.9 ± 1.4). Female students reported significantly higher distress than male students (7.3 ± 0.6 vs 4.7 ± 0.6), while also exhibiting consistently lower resilience across both measures. Findings suggest that health and wellness outcomes among rural first-year students vary by living arrangement, gender, and athletic involvement. Interventions that foster resilience, reduce loneliness, and address sleep habits may enhance student well-being during the critical transition to college.
Keywords: Mental health, Physical activityAuthors:
Author - Sharon Asolmia Aganah, Vermont State University
Co-Author - Kylie Blodgett, Norwich University
Co-Author - Emily Tarleton, Vermont State University
Co-Author - Andrea Corcoran, Vermont State Unversity
Ethnic Segregation of Public Schools in California Has Persisted Over the Last 20 Years, and Remains Tied to Socio-Economic Segregation
Poster Number: E107Time: 05:00 PM - 05:50 PM
Topics: Social and Environmental Context and Health, Child and Family Health
California, one of the most diverse states in the nation, offers an opportunity to study whether changes in population demographics have led to changes in school ethnic segregation, a key determinant of many learning and health outcomes. We examine 20 years of school ethnic segregation in California, and explore how residential segregation and children’s household’s socio-economic status (SES) are associated with changes in school ethnic segregation.
This study uses California Department of Education enrollment data (2000/01–2022/23). We calculate schools’ Index of Concentration at the Extremes (ICE) scores, based on the concentration of underrepresented minority (URM) children versus White and Asian children. Scores range from -1 (all URM) to 1 (all White/Asian), with 0 indicating 50/50 integration. Residential segregation was measured by schools’ census tract ICE (same formula as school ICE), and child SES by the school-level percentage of students qualifying for free and reduced priced meals (%FRPM). We compute descriptives across school ICE quintiles (ICE1: the most minoritized, to ICE5: majority white). Next, we fit mixed-effects models to examine the associations between Census ICE and %FRPM with school ICE over time.
Overall, schools grew more minoritized, shown by decreasing ICE scores over time. Yet, Black and Latino children were the only groups to become more concentrated in schools that were heavily or extremely minoritized schools (i.e., in 2000, 43.9% of Black children attended schools in ICE1-2, vs. 60.2% in 2022). In 2000, a higher Census ICE significantly predicted a higher school ICE (b=0.51, p<.001), but this relationship weakened significantly over time (b=-0.17, p<.001). The weakened association was due to the increasing concentration of minoritized children in schools with higher Census ICE scores. In 2000, a higher school-level proportion of children eligible for free or reduced school meals was significantly associated with lower school ICE (b=–0.03, p<.001). That relationship did not change over time (b=0.0, p=1).
In California, school ethnic segregation persists, and has grown less related to residential segregation (i.e., the weakening association of school ICE and census ICE). Further, the tight link between ethnic and socio-economic segregation persists, despite demographic changes in both neighborhoods and schools. These findings have implications for interventions to reduce place-related disparities in child health.
Keywords: Built environment, RaceThis study uses California Department of Education enrollment data (2000/01–2022/23). We calculate schools’ Index of Concentration at the Extremes (ICE) scores, based on the concentration of underrepresented minority (URM) children versus White and Asian children. Scores range from -1 (all URM) to 1 (all White/Asian), with 0 indicating 50/50 integration. Residential segregation was measured by schools’ census tract ICE (same formula as school ICE), and child SES by the school-level percentage of students qualifying for free and reduced priced meals (%FRPM). We compute descriptives across school ICE quintiles (ICE1: the most minoritized, to ICE5: majority white). Next, we fit mixed-effects models to examine the associations between Census ICE and %FRPM with school ICE over time.
Overall, schools grew more minoritized, shown by decreasing ICE scores over time. Yet, Black and Latino children were the only groups to become more concentrated in schools that were heavily or extremely minoritized schools (i.e., in 2000, 43.9% of Black children attended schools in ICE1-2, vs. 60.2% in 2022). In 2000, a higher Census ICE significantly predicted a higher school ICE (b=0.51, p<.001), but this relationship weakened significantly over time (b=-0.17, p<.001). The weakened association was due to the increasing concentration of minoritized children in schools with higher Census ICE scores. In 2000, a higher school-level proportion of children eligible for free or reduced school meals was significantly associated with lower school ICE (b=–0.03, p<.001). That relationship did not change over time (b=0.0, p=1).
In California, school ethnic segregation persists, and has grown less related to residential segregation (i.e., the weakening association of school ICE and census ICE). Further, the tight link between ethnic and socio-economic segregation persists, despite demographic changes in both neighborhoods and schools. These findings have implications for interventions to reduce place-related disparities in child health.
Authors:
Author - Sydney Miller, PhD, Drexel University
Co-Author - Md Karimuzzaman, Drexel University
Co-Author - Emma Sanchez-Vaznaugh, Sc.D, MPH, San Francisco State University
Co-Author - Brisa Sanchez, PhD, Drexel University
Improvement in Provider Knowledge, Barriers to Practice Change Implementation & Course Feedback: Survey Results from a Cancer Survivorship-Focused Continuing Medical Education Course
Poster Number: E61Time: 05:00 PM - 05:50 PM
Topics: Cancer, Integrated Primary Care
Objective: To assess whether CME participants improved their knowledge across evidence-based domains and collected information on provider-reported barriers to change implementation in their practice.
Methods. Survey responses were collected from medical professionals caring for patients and survivors of cancer from an online CME course offered from April 2021 to April 2024 at Dana-Farber Cancer Institute and Harvard Medical School. The CME course was comprised of four content modules guided by the American Society of Clinical Oncology Survivorship Curriculum (Introduction and Major Cancer Types; Physical and Late and Long-Term Effects of Cancer; Psychosocial Health after Cancer; General Health and Wellbeing). Paired samples t-tests were utilized to examine changes in content knowledge from each pre- to post-test. Perceived barriers to practice change implementation based on CME education were measured using post-course evaluations and were analyzed using descriptive statistics and Fisher’s exact tests.
Results: Between 4/22/2021 and 4/12/2024, 357 medical professionals registered for the CME course and 193 completed it (54.1%). Most were physicians/physician assistants (42.9%) or nurses (30.8%) and 65.3% were from the United States. Median post-test scores (Module 1=88.9; Module 2=100.0; Module 3=100.0; Module 4=100.0) significantly improved from pre-test scores (Module 1=50.0; Module 2=60.0; Module 3=50.0; Module 4=50.0; all p=<0.001). Overall course satisfaction was high, with ≥94% reporting high satisfaction (very good/excellent). 86.9% experienced at least one barrier to practice change implementation: lack of provider time (34.3%), institutional barriers (30.8%), insurance/financial barriers (28.3%), and/or challenges in communication/collaboration with care team members (23.7%). The most endorsed clinical goals included implementing new information/skills (83.3%), seeking additional information about what providers learned in the CME (47.0%), and creating/revising protocols, policies, and procedures within their practice (45.5%).
Conclusions: This cancer survivorship-focused CME improved provider knowledge across all topic areas, but numerous barriers to practice change implementation remain. Future CME courses in this area should include practice change implementation guidance, integrating a variety of strategies to overcome barriers that medical professionals face within clinical settings.
Keywords: Cancer survivorship, Primary careMethods. Survey responses were collected from medical professionals caring for patients and survivors of cancer from an online CME course offered from April 2021 to April 2024 at Dana-Farber Cancer Institute and Harvard Medical School. The CME course was comprised of four content modules guided by the American Society of Clinical Oncology Survivorship Curriculum (Introduction and Major Cancer Types; Physical and Late and Long-Term Effects of Cancer; Psychosocial Health after Cancer; General Health and Wellbeing). Paired samples t-tests were utilized to examine changes in content knowledge from each pre- to post-test. Perceived barriers to practice change implementation based on CME education were measured using post-course evaluations and were analyzed using descriptive statistics and Fisher’s exact tests.
Results: Between 4/22/2021 and 4/12/2024, 357 medical professionals registered for the CME course and 193 completed it (54.1%). Most were physicians/physician assistants (42.9%) or nurses (30.8%) and 65.3% were from the United States. Median post-test scores (Module 1=88.9; Module 2=100.0; Module 3=100.0; Module 4=100.0) significantly improved from pre-test scores (Module 1=50.0; Module 2=60.0; Module 3=50.0; Module 4=50.0; all p=<0.001). Overall course satisfaction was high, with ≥94% reporting high satisfaction (very good/excellent). 86.9% experienced at least one barrier to practice change implementation: lack of provider time (34.3%), institutional barriers (30.8%), insurance/financial barriers (28.3%), and/or challenges in communication/collaboration with care team members (23.7%). The most endorsed clinical goals included implementing new information/skills (83.3%), seeking additional information about what providers learned in the CME (47.0%), and creating/revising protocols, policies, and procedures within their practice (45.5%).
Conclusions: This cancer survivorship-focused CME improved provider knowledge across all topic areas, but numerous barriers to practice change implementation remain. Future CME courses in this area should include practice change implementation guidance, integrating a variety of strategies to overcome barriers that medical professionals face within clinical settings.
Authors:
Author - Kate Dibble, Ph.D., Dana-Farber Cancer Institute & Harvard Medical School
Co-Author - Lauren Knelson, MSPH, Dana-Farber Cancer Institute
Co-Author - Alicia Morgans, MD, MPH, Dana-Farber Cancer Institute
Co-Author - Ann Partridge, MD, MPH, Dana-Farber Cancer Institute
Co-Author - Larissa Nekhlyudov, MD, MPH, Dana-Farber Cancer Institute
Collateral Benefits of a Brief Counterfactual-Based Intervention for Drinking on Disordered Eating Behaviors Among College Students
Poster Number: E110Time: 05:00 PM - 05:50 PM
Topics: Diet, Nutrition, and Eating Disorders, Multiple Health Behavior Change
Objective: Counterfactual thinking (i.e., thoughts of “if only”) is a pervasive cognitive strategy in which one imagines an alternative outcome to past events. Counterfactual-based interventions (CF) on drinking were found to be effective in increasing alcohol protective behavioral strategies (PBS) use and perceived behavioral control over drinking (PBCD), as well as decreasing alcohol consumption in college students. It is possible that cognitive training in counterfactual thinking with PBS may also have collateral health benefits on top of the intervention’s primary targets, as individuals may apply strategies they learned from CF in other settings. Disordered eating behaviors are prevalent among college students and include binge eating and compensatory behaviors (e.g., self-induced vomiting). The present study aims to examine the effects of a brief CF intervention for drinking on disordered eating behaviors among college students and to compare these effects to a personalized normative feedback (PBS-PNF) intervention.
Method: Undergraduate students (n=295) completed a brief intervention study. Participants were randomly assigned to one of four conditions: negative event only (Control), negative event with details (Sham), negative event with counterfactuals (CF), and personalized normative feedback (PBS-PNF). Participants also completed the Eating Disorder Diagnostic Scale (EDDS) and PBCD measures at baseline and follow-ups.
Results: Compared with those in the Control condition, participants in the CF condition demonstrated a nonsignificant downward trend in excessive weight concern over time (B = -0.22, p = 0.071). Neither PBS-PNF nor Sham conditions showed any changes in disordered eating behaviors relative to the Control Condition. Compensatory behavior frequency was also negatively associated with PBCD (B = -1.37, p = 0.016), such that participants with a greater sense of behavioral control reported fewer incidences of compensatory behaviors. Because prior research associated CF with a greater PBCD score at the follow-up, it was plausible that CF interventions could also indirectly influence eating behaviors by increasing participants’ feelings of behavioral control.
Conclusion: This study provides some support for the generalized positive effects of counterfactual-based interventions on disordered eating behaviors among college students. Future studies should further examine the cognitive mechanisms underlying these multifinality effects.
Keywords: Eating behaviors, Health behavior changeMethod: Undergraduate students (n=295) completed a brief intervention study. Participants were randomly assigned to one of four conditions: negative event only (Control), negative event with details (Sham), negative event with counterfactuals (CF), and personalized normative feedback (PBS-PNF). Participants also completed the Eating Disorder Diagnostic Scale (EDDS) and PBCD measures at baseline and follow-ups.
Results: Compared with those in the Control condition, participants in the CF condition demonstrated a nonsignificant downward trend in excessive weight concern over time (B = -0.22, p = 0.071). Neither PBS-PNF nor Sham conditions showed any changes in disordered eating behaviors relative to the Control Condition. Compensatory behavior frequency was also negatively associated with PBCD (B = -1.37, p = 0.016), such that participants with a greater sense of behavioral control reported fewer incidences of compensatory behaviors. Because prior research associated CF with a greater PBCD score at the follow-up, it was plausible that CF interventions could also indirectly influence eating behaviors by increasing participants’ feelings of behavioral control.
Conclusion: This study provides some support for the generalized positive effects of counterfactual-based interventions on disordered eating behaviors among college students. Future studies should further examine the cognitive mechanisms underlying these multifinality effects.
Authors:
Author - Jiulin Dai, Texas A&M University
Co-Author - Sherecce Fields, PhD, Texas A&M University
Co-Author - Rachel Smallman, Texas A&M University
Examining the Unequal Burdens of Social Determinants for Health Risk Factors for those Unaffected and Affected by Diabetes: A Multinomial Regression Analysis of a Nationally Representative Dataset.
Poster Number: E105Time: 05:00 PM - 05:50 PM
Topics: Diabetes, Social and Environmental Context and Health
Background: Individuals with diabetes are more likely to experience adverse social determinants of health (SDOH), such as lower social support, increased economic instability, and food insecurity. Research demonstrates these factors contribute to diabetes distress and poor health outcomes. However, no existing study examines how SDOH risk varies across individuals without diabetes, with prediabetes, and with Type 1 Diabetes (T1D) or Type 2 Diabetes (T2D).
Methods: The Behavioral Risk Factor Surveillance System (BRFSS) dataset was used to perform a multinomial regression analysis comparing individuals reporting no diagnosis of diabetes, those reporting prediabetes, T1D, and T2D. The Kaiser SDOH Model guided variable selection. Specifically, we included variables measuring stress, life satisfaction, emotional support, loneliness, food insecurity, transportation barriers, employment instability, and challenges paying bills. We then created a composite score, adding each of the variables included within our model to analyze overall SDOH risk. Complex survey design weights were applied to provide nationally representative estimates.
Results: The sample for each of the analyses consisted of 142,206 individuals. Of these individuals, 14,260 indicated having prediabetes, 1,422 reported having T1D, and 12,798 reported having T2D. When examining overall SDOH risk, those with prediabetes (β = 0.07, p < 0.01), T1D (β = 0.10, p < 0.01), and T2D (β = 0.08, p < 0.01) had higher rates of overall SDOH risk factors relative to those without diabetes. Those with T2D (β = 0.23, p<0.01) and prediabetes (β = 0.11, p<0.05) had significantly lower rates of life satisfaction compared with those without diabetes. Similarly, those with prediabetes (β = -0.16, p<0.01) and T2D (β = -0.06, p<0.05) had increased stress levels. Those with T1D (β = -0.26, p<0.01) and T2D (β = -0.10, p<0.05) had increased rates of food insecurity compared to those without diabetes. Last, those with T2D had more problems paying bills (β = 0.24, p<0.05).
Conclusion: Individuals with prediabetes and diabetes have greater overall SDOH risk when compared to those without diabetes. Those with T1D have a slightly higher risk, followed by those with T2D, and those with prediabetes. There is variation regarding specific risk factors, with life satisfaction being slightly lower among those with T2D and food insecurity being more pronounced among those with T1D.
Keywords: Diabetes, Social stressMethods: The Behavioral Risk Factor Surveillance System (BRFSS) dataset was used to perform a multinomial regression analysis comparing individuals reporting no diagnosis of diabetes, those reporting prediabetes, T1D, and T2D. The Kaiser SDOH Model guided variable selection. Specifically, we included variables measuring stress, life satisfaction, emotional support, loneliness, food insecurity, transportation barriers, employment instability, and challenges paying bills. We then created a composite score, adding each of the variables included within our model to analyze overall SDOH risk. Complex survey design weights were applied to provide nationally representative estimates.
Results: The sample for each of the analyses consisted of 142,206 individuals. Of these individuals, 14,260 indicated having prediabetes, 1,422 reported having T1D, and 12,798 reported having T2D. When examining overall SDOH risk, those with prediabetes (β = 0.07, p < 0.01), T1D (β = 0.10, p < 0.01), and T2D (β = 0.08, p < 0.01) had higher rates of overall SDOH risk factors relative to those without diabetes. Those with T2D (β = 0.23, p<0.01) and prediabetes (β = 0.11, p<0.05) had significantly lower rates of life satisfaction compared with those without diabetes. Similarly, those with prediabetes (β = -0.16, p<0.01) and T2D (β = -0.06, p<0.05) had increased stress levels. Those with T1D (β = -0.26, p<0.01) and T2D (β = -0.10, p<0.05) had increased rates of food insecurity compared to those without diabetes. Last, those with T2D had more problems paying bills (β = 0.24, p<0.05).
Conclusion: Individuals with prediabetes and diabetes have greater overall SDOH risk when compared to those without diabetes. Those with T1D have a slightly higher risk, followed by those with T2D, and those with prediabetes. There is variation regarding specific risk factors, with life satisfaction being slightly lower among those with T2D and food insecurity being more pronounced among those with T1D.
Authors:
Presenter - Zach Cooper, LCSW, University of Georgia
Co-Author - Kylie Zarecki, University of Georgia
Co-Author - Jay O'Shields, PhD, LMSW, University of Alabama at Birmingham
Co-Author - Francisco Pasquel, MD, MPH, Emory University
Co-Author - Georgia Davis, MD, Emory University
Co-Author - Leslie Johnson, PhD, Emory University
The Influence of Mother-Daughter Sexual Health Communication and Connectedness on HPV Vaccine Completion Among Latina Mothers
Poster Number: E88Time: 05:00 PM - 05:50 PM
Topics: Health Disparities , Child and Family Health
Background: The Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and a leading cause of cervical cancer. Latina women have higher rates of cervical cancer incidence and mortality compared to non-Latina White women. The HPV vaccine is a primary form of prevention recommended for pre-adolescents. Vaccine completion of the two-dose vaccine series is low among Latina adolescents, leaving this population at increased risk for HPV-related cancers. This study examined whether mother–daughter comfort discussing sexual health and connectedness predicted HPV vaccination completion among daughters of Latina mothers.
Methods: The study consisted of a cross-sectional survey with 192 Latina mothers of Mexican descent. Participants answered a questionnaire assessing mother–daughter connectedness, comfort discussing sexual health, whether mothers had engaged in conversations about birth control with daughters, whether they had vaccinated their daughters against HPV and number of doses verified through immunization records. A linear regression and an exploratory model depicting associations between the variables and vaccination completion was tested through path analysis
Results: Results of the regression analysis indicated that Mother–daughter conversations about birth control emerged as the strongest predictor of vaccination uptake (β = 0.84, p < .001) after controlling for daughter’s age, education, income and insurance, accounting for 12% of model variance. Results of the path analysis revealed that the model fit the data well. Indices of fit were χ2(18)=1.28 χ2/df=5.76, p = .001; CFI =.96; TLI = .94; RMSEA = .03. Estimates of indirect effects indicated that mother-daughter connectedness had an indirect effect on comfort having sexuality-related conversations and comfort having sexuality-related conversations had an indirect effect on having conversations about birth control.
Conclusions: Our findings indicate that having discussions about birth control was associated with vaccination completion and that a strong mother-daughter bond promotes comfort engaging in discussions about sexuality. Comfort in turn, was associated with discussions about birth control. Findings emphasize the nuanced mechanisms through which parental relationship quality and communication practices shape parental uptake of reproductive health preventive behaviors for children.
Keywords: Women's health, Children's healthMethods: The study consisted of a cross-sectional survey with 192 Latina mothers of Mexican descent. Participants answered a questionnaire assessing mother–daughter connectedness, comfort discussing sexual health, whether mothers had engaged in conversations about birth control with daughters, whether they had vaccinated their daughters against HPV and number of doses verified through immunization records. A linear regression and an exploratory model depicting associations between the variables and vaccination completion was tested through path analysis
Results: Results of the regression analysis indicated that Mother–daughter conversations about birth control emerged as the strongest predictor of vaccination uptake (β = 0.84, p < .001) after controlling for daughter’s age, education, income and insurance, accounting for 12% of model variance. Results of the path analysis revealed that the model fit the data well. Indices of fit were χ2(18)=1.28 χ2/df=5.76, p = .001; CFI =.96; TLI = .94; RMSEA = .03. Estimates of indirect effects indicated that mother-daughter connectedness had an indirect effect on comfort having sexuality-related conversations and comfort having sexuality-related conversations had an indirect effect on having conversations about birth control.
Conclusions: Our findings indicate that having discussions about birth control was associated with vaccination completion and that a strong mother-daughter bond promotes comfort engaging in discussions about sexuality. Comfort in turn, was associated with discussions about birth control. Findings emphasize the nuanced mechanisms through which parental relationship quality and communication practices shape parental uptake of reproductive health preventive behaviors for children.
Authors:
Presenter - Junqi Chen, Hunter College
Author - Julia Lechuga, PhD, Hunter College
Author - Alia Komsany, MD, Weil Cornell
Poster Session E
Description
Date: 4/24/2026
Start: 5:00 PM
End: 5:50 PM
Location: Salon D