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Poster Session D
CogCare: Tailoring Cognitive Rehabilitation Programs for Black/African American Older Adults
Poster Number: D1Time: 11:00 AM - 11:50 AM
Topics: Aging, Social and Environmental Context and Health
Background/Objectives: Cognitive rehabilitation programs provide compensatory cognitive strategies for individuals with varying levels of cognitive decline. The goal of these programs is to improve cognitive and functional outcomes. Black/African American individuals are not only disproportionately affected by dementia, but also have cultural preferences that may not addressed nor integrated in known and present-day cognitive rehabilitation programs. Greater resources are required to aid this underserved population. This concurrent mixed methods study guided development of the CogCare program. This program aims to provide tailored cognitive rehabilitation strategies to improve stress, alleviate mood symptoms, and improve cognitive and daily functioning for older Black/African American adults with mild/moderate dementia and their caregivers.
Research Designs/Methods: We recruited Black/African American older adults and Black/African American dementia caregivers (N = 16 older adults; N = 3 caregivers). They participated in qualitative focus groups. Select participants were chosen to participate in one-on-one qualitative interviews to further discuss cultural/personal preferences in dementia care and dementia caregiving. In these interviews and focus groups, we aimed to gather information about cultural considerations of the Black/African American community, ways to culturally tailor known cognitive rehabilitation programs, and barriers Black/African American individuals face in trying to receive cognitive health treatment and information.
Results: Thematic Analysis identified the following themes regarding cultural tailoring: 1) Inclusivity and Respect, 2) Flexibility, 3) Caregiver Support, 4) Stigma and Denial, 5) Racial Inequalities in Care, 6) Provider and System Level Barriers, and 7) Access to Information and Misunderstanding.
Discussion and Implications: Participant feedback underscores the importance of integrating cultural considerations in cognitive rehabilitation program development. These findings will inform an open pilot to evaluate feasibility and refine CogCare prior to conducting a randomized trial.
Keywords: Aging, CultureResearch Designs/Methods: We recruited Black/African American older adults and Black/African American dementia caregivers (N = 16 older adults; N = 3 caregivers). They participated in qualitative focus groups. Select participants were chosen to participate in one-on-one qualitative interviews to further discuss cultural/personal preferences in dementia care and dementia caregiving. In these interviews and focus groups, we aimed to gather information about cultural considerations of the Black/African American community, ways to culturally tailor known cognitive rehabilitation programs, and barriers Black/African American individuals face in trying to receive cognitive health treatment and information.
Results: Thematic Analysis identified the following themes regarding cultural tailoring: 1) Inclusivity and Respect, 2) Flexibility, 3) Caregiver Support, 4) Stigma and Denial, 5) Racial Inequalities in Care, 6) Provider and System Level Barriers, and 7) Access to Information and Misunderstanding.
Discussion and Implications: Participant feedback underscores the importance of integrating cultural considerations in cognitive rehabilitation program development. These findings will inform an open pilot to evaluate feasibility and refine CogCare prior to conducting a randomized trial.
Authors:
Author - Dumichel Harley, PhD, Massachusetts General Hospital
Co-Author - Yoojee Kim, Massachusetts General Hospital
Co-Author - Ryan Mace, PhD, Massachusetts General Hospital/Harvard Medical School
In-Person versus Remote Delivery of a Yoga Intervention for Patients with Thoracic Cancers and their Family Caregivers
Poster Number: D10Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity
BACKGROUND: Patients with thoracic cancers have a high risk of experiencing performance declines, high symptom burden and poor quality of life (QOL). Although they have a high need for care and support from their families, family caregivers experience low caregiving efficacy and report high levels of distress. We developed and tested a patient-caregiver yoga intervention as a supportive care modality and now seek to compare in-person versus remote delivery of the intervention on feasibility, acceptability and intervention outcomes using a natural experimental design.
METHODS: Secondary analyses of an RCT testing the efficacy of a 15-session yoga intervention on patient functional capacity (6-min walk test (6MWT)) and patient and caregiver QOL outcomes were performed. Initially, the intervention was delivered in-person at the hospital. With the onset of the COVID pandemic, the sessions were delivered via videoconference (Zoom). Dyads completed self-report assessments with patients also completing the 6MWT before randomization, 6 weeks (end of treatment) and 12 weeks later. A subset of participants completed semi-structured interviews about their intervention experience.
RESULTS: 55 patient-dyads were randomized to the yoga arm; 19 dyads completed the sessions in-person and 36 dyads via Zoom. Session attendance did not differ based on delivery mode (P=.74). Multi-level modeling controlling for baseline level of the outcome and relevant covariates suggested that patients’ responses to the yoga sessions did not differ as a function of delivery mode for the 6MWT (P=.50) and physical QOL (PCS of SF-36; P=.32). However, patients attending the sessions in-person reported clinically significantly improved mental QOL (MCS of SF-36; P=.09), significantly greater coping efficacy (F=6.3, P=.03), and marginally significantly better dyadic illness communication (F=3.4, P=.07) than those via Zoom. For caregivers, we did not find group differences for any outcomes. The qualitative interviews revealed strengths for both delivery modes.
CONCLUSIONS: Although our findings are limited by a non-randomized design, they indicate the importance of weighing feasibility benefits of remote intervention delivery with improved treatment response of in-person delivery. Additional research is needed to examine delivery differences based on sample characteristics using a hybrid delivery method combining initial in-person training with remote follow-up sessions as a possible solution.
Keywords: Cancer survivorship, Physical activityMETHODS: Secondary analyses of an RCT testing the efficacy of a 15-session yoga intervention on patient functional capacity (6-min walk test (6MWT)) and patient and caregiver QOL outcomes were performed. Initially, the intervention was delivered in-person at the hospital. With the onset of the COVID pandemic, the sessions were delivered via videoconference (Zoom). Dyads completed self-report assessments with patients also completing the 6MWT before randomization, 6 weeks (end of treatment) and 12 weeks later. A subset of participants completed semi-structured interviews about their intervention experience.
RESULTS: 55 patient-dyads were randomized to the yoga arm; 19 dyads completed the sessions in-person and 36 dyads via Zoom. Session attendance did not differ based on delivery mode (P=.74). Multi-level modeling controlling for baseline level of the outcome and relevant covariates suggested that patients’ responses to the yoga sessions did not differ as a function of delivery mode for the 6MWT (P=.50) and physical QOL (PCS of SF-36; P=.32). However, patients attending the sessions in-person reported clinically significantly improved mental QOL (MCS of SF-36; P=.09), significantly greater coping efficacy (F=6.3, P=.03), and marginally significantly better dyadic illness communication (F=3.4, P=.07) than those via Zoom. For caregivers, we did not find group differences for any outcomes. The qualitative interviews revealed strengths for both delivery modes.
CONCLUSIONS: Although our findings are limited by a non-randomized design, they indicate the importance of weighing feasibility benefits of remote intervention delivery with improved treatment response of in-person delivery. Additional research is needed to examine delivery differences based on sample characteristics using a hybrid delivery method combining initial in-person training with remote follow-up sessions as a possible solution.
Authors:
Co-Author - Angelica Moore, MS, University of Texas MD Anderson Cancer Center
Co-Author - Meagan Whisenant, PhD, APRN, UTHealth Cizik School of Nursing
Co-Author - Aileen Chen, MD, University of Texas MD Anderson Cancer Center
Co-Author - Rosangela Silva, MBA, University of Texas MD Anderson Cancer Center
Co-Author - Lorenzo Cohen, PhD, University of Texas MD Anderson Cancer Center
Co-Author - Kathrin Milbury, PhD, University of Texas MD Anderson Cancer Center
Integrated Primary Care and Behavioral Health Workforce Development in 10 Rural and Frontier West Texas Counties
Poster Number: D100Time: 11:00 AM - 11:50 AM
Topics: Integrated Primary Care, Professional Development
Introduction: Texas Public Health Regions 8, 9, and 10 include 10 counties with some of the highest mental Health Professional Shortage (HPSA) scores in the country with Medically Underserved Populations (MUP) experiencing high need for and limited access, to behavioral health services. Often, the first point of contact for behavioral health support in for MPUs is the primary care health provider. Integrating behavioral health workforce trainees and evidence-based biopsychosocial interventions in primary care settings is a necessity in such rural/frontier and medically underserved communities. Many residents in this region have limited English proficiency. Methods: The “Juntos en la Comunidad” Interprofessional Behavioral Health Workforce Education and Training Program (BHWET Pro) , (Grant Number M01HP45373; 2021- 2029) is a rural consortium collaboration between three Hispanic Serving Institutions including a medical school, two Federally Qualified Health Centers (FQHC), and rural experiential site networks to increase the supply of behavioral health professionals who are trained to provide integrated behavioral health care in interprofessional primary care settings utilizing collaborative training by using team-based models of. Masters and Doctoral trainees across 4 disciplines - Mental Health Counseling, Rehabilitation Counseling, Occupational Therapy and Education Clinical Mental Health Counseling- receive evidence-based and biopsychosocial behavioral health experiential training and job placement assistance in interprofessional integrated primary care settings. Results: Since 2021, 82 graduate trainees have been placed in rural interprofessional and primary care settings across 6 counties and the program has been awarded another 4-year grant cycle 2025-2029 to train 64 trainees while expanding to 10 rural counties (N= 142 professionals by 2029). Trainees in over 30 field sites address local health needs related to opioid use disorder, mental health, primary care access, rehabilitation etc. in pediatric and adult populations. Conclusion: A coordinated community and academic partnership response is key to sustaining integration of primary care and behavioral health services in rural and/or underserved areas. Interprofessional behavioral health training further enhances the local health workforce capacity for access, supply, and quality of behavioral health services in rural primary care settings.
Keywords: Health outcomes, PsychophysiologyAuthors:
Author - Thenral Mangadu, MD MPH PHD, The University of Texas at El Paso
Author - Adrian Billings, MD, Ph.D., FAAFP, Texas Tech University Health Sciences Center Permian Basin
Author - Geneva Nieto, BS, The University of Texas at El Paso
Co-Author - Jessica Schauman , B.S. , Sul Ross State University
Co-Author - Barbara Tucker, Ph.D., Sul Ross State University
Co-Author - Chu-Ling Lo, Ph.D., CRC, The University of Texas at El Paso
Co-Author - Veronica Estala, Ph.D., The University of Texas at El Paso
Co-Author - Johana Rocha, Ph.D., The University of Texas at El Paso
Co-Author - Emre Umucu, Ph.D., The University of Texas at El Paso
Intrapersonal Interplay between Depressive Symptoms and Self-Esteem: Connection with Self-Concept Clarity
Poster Number: D101Time: 11:00 AM - 11:50 AM
Topics: Mental Health
Depression is a prevalent mental health condition that has a complicated psychological framework; therefore, making sense of the contributing elements that lead to its symptomology, such as self-esteem (SE) and self-concept clarity (SCC), can provide helpful insights to both clinical practice and theory. This study investigates the interplay between depression symptoms and SE discrepancy by examining the potential mediating role of SCC, which is the degree to which self-beliefs are internally consistent. A longitudinal research design was employed to evaluate 66 US-based adults over three points in time, each one week apart, on SCC measured by the Self-Concept Clarity Scale (SCCS), implicit SE measured by the Self-Esteem Implicit Association Test (Self-IAT), explicit SE measured by the Rosenberg Self-Esteem Scale (RSES), and depression symptoms as measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Based on prior research, we hypothesized that SCC mediates the relationship between SE discrepancy and depressive symptoms, with all three individual variables of implicit SE, explicit SE and SCC presenting a negative correlation with depression. Consistent with our hypothesis, our results indicated a negative correlation between explicit SE and depression cross-sectionally (r = -0.41, p < .001 in Wave 1; n = 66). In subsequent waves, the correlation was significant in Wave 3, or two weeks later (r = -0.40, p = .018; n = 39), but not in Wave 2 (r = 0, p = 0.98; n = 55). In line with predictions, SCC was found to be negatively correlated with depression (r = -0.50, p < .001 in Wave 2; r = -0.49, p = .003 in Wave 3). Repeated measures ANOVA findings demonstrated that SCC strongly predicted lesser depressive symptoms, but SE discrepancies had inconsistent effects. In terms of clinical application, our results demonstrate that explicit SE and SCC could be considered when assessing for depression.
Keywords: Depression, Mental healthAuthors:
Author - Gabriella Bann, M.A., University of Chicago Department of Psychiatry and Behavioral Neuroscience
Co-Author - Royce Lee, M.D., University of Chicago Department of Psychiatry and Behavioral Neuroscience
Co-Author - Amanda Ceniti, Ph.D., University of Chicago Department of Psychology
Co-Author - Hanna Molla, Ph.D., University of Chicago Department of Psychiatry and Behavioral Neuroscience
Co-Author - Harriet de Wit, Ph.D., University of Chicago Department of Psychiatry and Behavioral Neuroscience
Co-Author - Alysson Light, Ph.D., University of Chicago Department of Psychology
Co-Author - Dario Maestripieri, Ph.D., University of Chicago Department of Comparative Human Development
Exploring the Sociodemographic Risk Factors of Mental Health Outcomes in a Sample of Jamaican Adults
Poster Number: D102Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Social and Environmental Context and Health
Population data indicate that over 14% of Jamaican adults report clinically relevant symptoms of depression (DS). However, there is limited data on the population prevalence of other mental health conditions though the evidence suggests that their prevalence is increasing. As a result, the sociodemographic risk factors/moderators (i.e., contexts) of mental health remain unclear. This self-report, cross-sectional study examined sociodemographic risk factors/moderators of clinically relevant DS, anxiety symptoms (AS), and psychological stress symptoms (SS) in a convenience sample of Jamaican adults, with the goal of informing appropriate health behavior interventions to improve mental health outcomes. The sample included 433 adults aged 20 – 60 years (M = 31.6, SD = 10.7), the majority of whom were female (60.5%), aged 30 years or younger (53.8%), tertiary level educated (71.4%), employed (69.8%) and unmarried (69.8%). Approximately one in three participants met the criteria for clinically relevant DS (28%), AS (34%), and SS (34%). Bivariate analyses revealed significant sociodemographic differences in mental health outcomes across some sociodemographic groups. Younger adults (≤30 years) reported higher DS (Z = –4.05, p < .001, η = .19), AS (Z = –3.55, p < .001, η = .18), and SS (t(431) = 2.81, p = .005, d = 0.27). Females had significantly higher SS (t(431) = 3.86, p < .001, d = 0.38) and AS (Z = –5.10, p < .001, η = .23) and DS (Z = –2.41, p = .016, η = .10). Unemployment showed the strongest and most consistent associations, with unemployed individuals reporting significantly higher DS (Z = –4.70, p < .001, η = .23), AS (Z = –5.55, p < .001, η = .27), and SS (t(422) = 3.65, p < .001, d = 0.39). Relationship status differences were also significant but weaker, with unmarried individuals reporting higher DS (Z = –3.72, p < .001, η = .17), AS (Z = –2.13, p = .033, η = .10), and SS (t(428) = 1.93, p = .042, d = 0.20). No significant differences were found for education. These findings demonstrate that being a younger age, female, and especially unemployed are key sociodemographic risk factors (i.e., potential moderators) of poor mental health outcomes in Jamaican adults, with relationship status being a weaker correlate. Health behaviour interventions targeting improved mental health symptoms in this population should specifically account for these at-risk sociodemographic groups to maximize relevance and optimize effectiveness.
Keywords: Mental health, SocioeconomicAuthors:
Author - Andre Bateman, PhD, The University of the West Indies at Mona
Co-Author - Ayesha M. Facey, PhD, The University of the West Indies at Mona
Co-Author - Chelsi Ricketts, PhD, University of Toronto, Toronto
Identity Development and Mental Health in Transgender and Gender Nonbinary Adults Living with Disabilities
Poster Number: D103Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Health Disparities
Transgender and gender nonbinary (TGNB) individuals and people with disabilities (PWD) represent two marginalized populations at elevated risk for adverse mental health outcomes due to discrimination, stigmatization, and violence. Limited research suggests that individuals at the intersection of TGNB and disability identities may face heightened vulnerability. While identity development is typically examined during adolescence or emerging adulthood, TGNB PWD may continue this process well into adulthood.
This study examined disability- (DIDS) and gender (Pride subscale of GMSR) identity–based development in relation to mental health (PHQ-9; GAD-7) among 289 TGNB PWD. TGNB identity development was weakly, negatively associated with depression (r = –0.24, p < .01) and anxiety (r = –0.24, p < .01). Disability identity development also showed weak, negative associations with depression (r = –0.18, p < .01) and anxiety (r = –0.16, p < .01). Age group analyses (emerging adults [18–25], middle adults [26–40], later adults [41+]) revealed weak, positive correlations between age and TGNB identity development (r = 0.14, p < .05) as well as disability identity development (r = 0.12, p < .05). Age was also weakly, negatively correlated with depression (r = –0.18, p < .01) and anxiety (r = –0.19, p < .01).
These findings support hypotheses that identity development differs by age, with older adults reporting stronger identity development, and that stronger identity development is associated with fewer depressive and anxiety symptoms. Results underscore the importance of examining identity development beyond early life stages and highlight the need for further research on adults holding multiple marginalized identities.
Keywords: Mental health, DisabilityThis study examined disability- (DIDS) and gender (Pride subscale of GMSR) identity–based development in relation to mental health (PHQ-9; GAD-7) among 289 TGNB PWD. TGNB identity development was weakly, negatively associated with depression (r = –0.24, p < .01) and anxiety (r = –0.24, p < .01). Disability identity development also showed weak, negative associations with depression (r = –0.18, p < .01) and anxiety (r = –0.16, p < .01). Age group analyses (emerging adults [18–25], middle adults [26–40], later adults [41+]) revealed weak, positive correlations between age and TGNB identity development (r = 0.14, p < .05) as well as disability identity development (r = 0.12, p < .05). Age was also weakly, negatively correlated with depression (r = –0.18, p < .01) and anxiety (r = –0.19, p < .01).
These findings support hypotheses that identity development differs by age, with older adults reporting stronger identity development, and that stronger identity development is associated with fewer depressive and anxiety symptoms. Results underscore the importance of examining identity development beyond early life stages and highlight the need for further research on adults holding multiple marginalized identities.
Authors:
Author - Steph Cull, M.S., Virginia Commonwealth University
Co-Author - Eric Benotsch, PhD, Virginia Commonwealth University
Co-Author - Paige Nurkin, Virginia Commonwealth University
Co-Author - Foster Mardigian, Virginia Commonwealth University
Co-Author - Jackie Otieno, Virginia Commonwealth University
Co-Author - Regina Easter, Virginia Commonwealth University
NAVIGATING ADVERSITY: THE IMPACT OF ADVERSE CHILDHOOD EXPERIENCES ON MENTAL HEALTH OUTCOMES AND THE ROLE OF RACIAL-CULTURAL IDENTITY
Poster Number: D104Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Child and Family Health
Adverse Childhood Experiences (ACEs) are widely recognized as significant predictors
of mental health outcomes in adulthood, particularly within African/Black and other
underrepresented and oppressed communities. This study explores the relationship between
ACEs and mental health outcomes, with a focus on African American adults. Additionally, it
investigates how cultural and racial identity measured by African Self-Consciousness (ASC) and
the Multidimensional Inventory of Black Identity (MIBI) influences the relationship between
ACEs and psychological distress. The study also examines the association between ACEs and
Benevolent Childhood Experiences (BCEs), and the protective role of BCEs against mental
distress.
Results indicated that higher ACEs were significantly associated with increased
psychological distress, especially among female participants. For females, racial identity
centrality and cultural identity were found to moderate the relationship between ACEs and
mental health, suggesting that a strong cultural and racial identity may buffer the negative
psychological effects of childhood adversity. However, these moderating effects were not
significant among males. Additionally, BCEs were found to have a small, though non-
significant, protective effect on mental health outcomes.
These findings underscore the importance of culturally informed approaches to mental
health, particularly in addressing the unique experiences of African American individuals. They
highlight the need for interventions that strengthen cultural and racial identity as a means of
promoting resilience and mitigating the long-term psychological impact of early adversity.
Keywords: Resilience, Advocacyof mental health outcomes in adulthood, particularly within African/Black and other
underrepresented and oppressed communities. This study explores the relationship between
ACEs and mental health outcomes, with a focus on African American adults. Additionally, it
investigates how cultural and racial identity measured by African Self-Consciousness (ASC) and
the Multidimensional Inventory of Black Identity (MIBI) influences the relationship between
ACEs and psychological distress. The study also examines the association between ACEs and
Benevolent Childhood Experiences (BCEs), and the protective role of BCEs against mental
distress.
Results indicated that higher ACEs were significantly associated with increased
psychological distress, especially among female participants. For females, racial identity
centrality and cultural identity were found to moderate the relationship between ACEs and
mental health, suggesting that a strong cultural and racial identity may buffer the negative
psychological effects of childhood adversity. However, these moderating effects were not
significant among males. Additionally, BCEs were found to have a small, though non-
significant, protective effect on mental health outcomes.
These findings underscore the importance of culturally informed approaches to mental
health, particularly in addressing the unique experiences of African American individuals. They
highlight the need for interventions that strengthen cultural and racial identity as a means of
promoting resilience and mitigating the long-term psychological impact of early adversity.
Authors:
Author - Courtney Harold, M.S., Florida A&M University
Chair - Jermaine Robertson, PhD, Florida A&M University
Co-Author - Novell Tani, PhD, Florida A&M University
Co-Author - Rasheda Haughbrook, PhD, Florida State University
Gender Differences and Differential Subconstruct Effects of Character Strength Hope/Optimism on Post-OHS Mental Health
Poster Number: D105Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Cardiovascular Disease
Objectives: Depression and anxiety are mental health indicators associated with mortality risks in cardiac diseases (CD). Psychosocial stress and depression were greater risk factors for morbidity and mortality in women than in men with CD. Gender-related disparity in CD has also become an increasing concern (Cho et al., 2022), but few studies have examined the gender effect in symptoms of patients undergoing open-heart surgery (OHS)—a stressful lifesaving procedure. Using a prospective design, the current analysis examined gender differences in mental health of men and women and potential mediation of subconstructs in character strength hope/optimism (the Life Orientation Test/LOT’s optimism and pessimism-R). Method. A three-wave clinical study was conducted before and one month following OHS in a cohort of U.S. patients (N=312). Multiple regression and structural equation modelling (SEM) were performed to reveal gender differences. Results. Women reported poorer mental health both pre- and post-operatively compared to men, Whole-group paired t-test showed reduced scores of post-OHS anxiety but elevated levels of depression, compared to preoperatively. However, subgroup t-test showed only an increase in depression for women was significant. Regression analyses a significant impact of optimism-subconstruct on reduced post-OHS anxiety but a trend effect of low pessimism-R on post-OHS depression. The final SEM indicated direct associations between female gender and higher levels of post-OHS symptoms but no mediation of pre-OHS hope/optimism for this gender effect despite the mediation of subconstruct between pre- and post-operative symptoms. Conclusions. The findings suggest an independent effect of gender on and female disadvantages in post-OHS depression and anxiety. whereas strength hope/optimism may be protective for both men and women, it was optimism subconstruct contributes to reduction in post-OHS anxiety. Women’s rising levels of post-OHS depression should be attributable to their multifaceted vulnerability but especially the lack of social-economic resources. For incidence, Wagner and Ibrahim (2024) found the greater likelihood for women to receive post-CABG care at low-quality hospitals, where the sex disparity in mortality was twice that in high-quality ones. Pre-OHS assessment and intervention should address the gender-related disparities to improve outcomes of the expensive medical procedure in an era of patient-centered cardiac care.
Keywords: Cardiovascular disease, Mental healthAuthors:
Author - Amy Ai, PhD, Florida State University
Co-Author - Bu Huang, PhD, University of Washington
Co-Author - George Stouffer, MD, University of North Carolina
Co-Author - Thomas Knobel, Florida State University
Suicidal Ideation Among People Who Use Opioids: Findings from a Cross-Sectional Study
Poster Number: D106Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Substance Misuse
Introduction
People who use opioids (PWUO) are at 10-14 times higher risk of suicidal ideation than the general population. Despite an escalating public health crisis of the opioid epidemic, existing research has minimally focused on mental health care utilizations and its barriers among PWUO. Therefore, we aimed to examine the prevalence and specific risk factors for suicidal ideation among opioid users, as well as their utilization of and barriers to accessing mental health services.
Methods
This is a secondary data analysis of a cross-sectional survey conducted between April and June 2024 among patients recruited from the New Haven Syringe Service Program in Connecticut (N=199). Suicidal ideation was assessed using two validated self-report screening tools: a single-item World Mental Health Composite International Diagnostic Interview (WHM-CIDI) scale and an item from the Patient Health Questionnaire (PHQ-9) scale. Bivariate and multivariable logistic regression were conducted to identify factors associated with suicidal ideation among PWUO.
Results
Overall, more than one-third of the sample reported experiencing suicidal ideation in the past two weeks (34.7%), as measured by the PHQ-9 item, while 22.6% had similar thoughts in the last 6 months according to the WHM-CIDI scale. Nearly one-third of participants (31.2%) reported unmet mental health needs, and 84.4% experienced at least one barrier to accessing care. Individuals with depressive symptoms [PHQ-9 (aOR: 5.8; 95% CI: 2.7–12.4); WHM-CIDI item (aOR: 6.8; 95% CI: 2.5–18.7)] had higher odds of experiencing suicidal ideation. Interestingly, two additional factors, living with HIV (aOR: 7.5; 95% CI: 1.3–43.3) and prior experience of a nonfatal drug overdose (aOR: 5.3; 95% CI: 2.2–12.8) were significantly associated with suicidal ideation on the WHM-CIDI scale but not the PHQ-9.
Conclusion
Our study revealed a high prevalence of suicidal ideation, regardless of the screening tool used, and suboptimal utilization of mental health services in this highly vulnerable population. These findings underscore the need for regular screening and linkage to mental health care, especially for individuals who may have co-morbid conditions (e.g., HIV, depression, substance use).
Keywords: Opioids, Mental healthPeople who use opioids (PWUO) are at 10-14 times higher risk of suicidal ideation than the general population. Despite an escalating public health crisis of the opioid epidemic, existing research has minimally focused on mental health care utilizations and its barriers among PWUO. Therefore, we aimed to examine the prevalence and specific risk factors for suicidal ideation among opioid users, as well as their utilization of and barriers to accessing mental health services.
Methods
This is a secondary data analysis of a cross-sectional survey conducted between April and June 2024 among patients recruited from the New Haven Syringe Service Program in Connecticut (N=199). Suicidal ideation was assessed using two validated self-report screening tools: a single-item World Mental Health Composite International Diagnostic Interview (WHM-CIDI) scale and an item from the Patient Health Questionnaire (PHQ-9) scale. Bivariate and multivariable logistic regression were conducted to identify factors associated with suicidal ideation among PWUO.
Results
Overall, more than one-third of the sample reported experiencing suicidal ideation in the past two weeks (34.7%), as measured by the PHQ-9 item, while 22.6% had similar thoughts in the last 6 months according to the WHM-CIDI scale. Nearly one-third of participants (31.2%) reported unmet mental health needs, and 84.4% experienced at least one barrier to accessing care. Individuals with depressive symptoms [PHQ-9 (aOR: 5.8; 95% CI: 2.7–12.4); WHM-CIDI item (aOR: 6.8; 95% CI: 2.5–18.7)] had higher odds of experiencing suicidal ideation. Interestingly, two additional factors, living with HIV (aOR: 7.5; 95% CI: 1.3–43.3) and prior experience of a nonfatal drug overdose (aOR: 5.3; 95% CI: 2.2–12.8) were significantly associated with suicidal ideation on the WHM-CIDI scale but not the PHQ-9.
Conclusion
Our study revealed a high prevalence of suicidal ideation, regardless of the screening tool used, and suboptimal utilization of mental health services in this highly vulnerable population. These findings underscore the need for regular screening and linkage to mental health care, especially for individuals who may have co-morbid conditions (e.g., HIV, depression, substance use).
Authors:
Author - Kiran Paudel, MS, University of Connecticut
Co-Author - Kamal Gautam, University of Connecticut
Co-Author - Sherry Pagoto, PhD, FSBM, University of Connecticut
Co-Author - Ran Xu, Uconn
Co-Author - Roman Shrestha, PhD, MPH, University of Connecticut
Paternal Difficulties in Emotion Regulation is associated with Relationship Satisfaction and Parental Self-Efficacy During the Postpartum Period
Poster Number: D107Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Child and Family Health
Emotion regulation is a vital component of maintaining a relationship and effective parenting. Many life experiences increase stressors that demand high levels of emotion regulation skills. The transition to parenthood is a pivotal period in a man’s life. Prior research has explored the impact of emotion regulation skills for new mothers, but little has been done to examine how fathers’ emotion regulation relates to relationships and self-beliefs in early fatherhood. Survey data were collected from 180 fathers within the first year of having a child. All participants were 18-50 years old (M = 33.9), cohabitating with a partner, represented a wide range of annual household incomes (SES) (median bracket = $90,000-99,999), and identified as heterosexual. Surveys assessed the Difficulties in Emotion Regulation Short Form (DERS-SF), one item from the Karitane Parenting Confidence Scale (Parental Self-Efficacy), one item from the Marital/Relationship Satisfaction Scale (Relationship Satisfaction), and one item asking about SES. To understand the association between the DERS-SF and other constructs of interest, bivariate correlations were examined. Difficulties in emotion regulation were negatively related to relationship satisfaction (r = -0.301, p < 0.001) and parental self-efficacy (r = -.387, p < 0.001). Income was not significantly related to the DERS- SF (r = -0.131, p = .07) but did relate to relationship satisfaction (r = 0.151, p = 0.04) and parental self-efficacy (r = 0.156, p = 0.03). This suggests that fathers with greater difficulties regulating emotion have lower relationship satisfaction and lower confidence in their abilities to parent well. Although SES and DERS-SF were not significantly related, this test may have been underpowered. The purpose of the current study is to better understand emotion regulation in new fathers and how difficulties in emotion regulation relate to individual and family functioning. Previous studies have linked low emotion regulation and psychopathology; exploration of associated factors is essential for effectively supporting new fathers.
Keywords: Emotions, Parent-child transactionsAuthors:
Author - Sierra Quintana, MPH, CHES, University of Colorado Denver
Co-Author - Maura Gissen, MA, University of Colorado Denver
Co-Author - Jessica Hopkins, MC, University of Colorado Denver
Co-Author - Anna Lindstrom, BA, University of Colorado Denver
Co-Author - Travis Kelly, BS, University of Colorado Denver
Co-Author - Krista Ranby, PhD, University of Colorado Denver
Physical activity in psychotherapy: How are we translating research to practice?
Poster Number: D108Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Physical Activity
Introduction. Pharmacological and psychotherapeutic interventions are evidence-based approaches to treating mental health disorders, with combined use enhancing outcomes. However, treatment outcomes vary and interventions are not universally effective, highlighting a need for alternative approaches. Physical activity (PA) is consistently associated with improvements in psychological and functional outcomes, yet its integration into standardized care is inconsistent. Barriers such as limited time to dedicate to PA-specific training for clinicians, limited resources (and access to resources), and a lack of standardized guidance restrict systematic use of PA. Given the established benefits of lifestyle interventions, this narrative review was designed to examine the context that PA is embedded within psychotherapeutic frameworks. Methods. Treatment manuals identified by the American Psychological Association’s Clinical Psychology Division and rated as “strong empirical support” (Tolin criteria) were reviewed. Two independent raters systematically identified PA mentions across 93 manuals. Results. Forty-two manuals (45%) mentioned PA. Three domains of integration included: (1) pathology, (2) therapeutic mechanism, and (3) coping strategy. In relation to pathology, PA had a reciprocal relationship with symptoms (e.g., avoidance in panic, hyperactivity in mania, maladaptive use in eating disorders, behavioural shutdown in depression) and health outcomes (e.g., sleep regulation and mood stability). As a therapeutic mechanism, PA was embedded in established interventions through exposure-based practices, behavioural activation, distress tolerance, routine stabilization, and mindfulness-based exercises. As a coping strategy, PA was framed as a substitute for maladaptive behaviours, a contingency management tool, and a means of regulating urges, stress, or relational difficulties. Manuals also specified strategies to enhance engagement in PA, such as goal setting, pacing, enjoyment, values clarification, and increasing incidental movement. Discussion. Collectively, while PA is acknowledged in nearly half of the treatment manuals, there is inconsistent and non-systematic presentation (and suggested value/use) of PA. Guidance and training could strengthen the integration of PA thus supporting more comprehensive and effective psychotherapeutic care within all standardized practices – including the 55% of treatment manuals that lacked any PA mention.
Keywords: Mental health, Physical activityAuthors:
Author - Danika Quesnel, University of Toronto
Author - Michael Jorgensen, PhD, University of Toronto
Author - Isabella Tremonte, University of Toronto
Author - Catherine Sabiston, PhD, University of Toronto
Childhood Adversity and Pandemic Anxiety: An Analysis for Future Preparedness
Poster Number: D109Time: 11:00 AM - 11:50 AM
Topics: Mental Health, Stress
Background: Childhood trauma can disrupt a child’s sense of safety and stability, often resulting in long-term mental health challenges. During a pandemic, these challenges may be intensified by increased stress, social isolation, and uncertainty. Adverse Childhood Experiences (ACEs) are linked to a range of negative health outcomes, including anxiety. The primary objective of this study was to examine the relationship between ACEs and COVID-19-related anxiety.
Methods: This study analyzed data from 84 participants enrolled in a research project examining mental health and telehealth experiences among both the general public and healthcare providers. Data were collected between November 2020 and March 2021. The Adverse Childhood Experiences (ACE) Questionnaire measured childhood trauma, and the COVID Anxiety Scale (CAS) measured COVID-19-related anxiety. A linear regression analysis was conducted to assess the extent to which ACE scores predicted levels of COVID-related anxiety as measured by CAS.
Results: : The majority of participants were female (82.35%), White (54.12%), and had some college education (28.24%). The average age was 31 years (SD=14.11). Over 25% of the sample had an ACE score of four or more (M=2.71; SD=2.64). The regression model was statistically significant, with ACE scores explaining 13% of the variance in COVID-related anxiety scores, F(1,82) = 12.677, p < .001. ACE scores positively predicted CAS scores (β = .366, p < .001), indicating that individuals with higher ACE scores reported greater anxiety during the pandemic.
Conclusion: Findings suggest that individuals with higher ACE scores experienced elevated anxiety during the COVID-19 pandemic. These results underscore the importance of trauma-informed care, particularly during a national crises. Addressing the long-term effects of childhood trauma may be essential for mitigating mental health challenges and promoting resilience in vulnerable populations.
Keywords: Anxiety, TraumaMethods: This study analyzed data from 84 participants enrolled in a research project examining mental health and telehealth experiences among both the general public and healthcare providers. Data were collected between November 2020 and March 2021. The Adverse Childhood Experiences (ACE) Questionnaire measured childhood trauma, and the COVID Anxiety Scale (CAS) measured COVID-19-related anxiety. A linear regression analysis was conducted to assess the extent to which ACE scores predicted levels of COVID-related anxiety as measured by CAS.
Results: : The majority of participants were female (82.35%), White (54.12%), and had some college education (28.24%). The average age was 31 years (SD=14.11). Over 25% of the sample had an ACE score of four or more (M=2.71; SD=2.64). The regression model was statistically significant, with ACE scores explaining 13% of the variance in COVID-related anxiety scores, F(1,82) = 12.677, p < .001. ACE scores positively predicted CAS scores (β = .366, p < .001), indicating that individuals with higher ACE scores reported greater anxiety during the pandemic.
Conclusion: Findings suggest that individuals with higher ACE scores experienced elevated anxiety during the COVID-19 pandemic. These results underscore the importance of trauma-informed care, particularly during a national crises. Addressing the long-term effects of childhood trauma may be essential for mitigating mental health challenges and promoting resilience in vulnerable populations.
Authors:
Co-Author - Sierra Tentis, MPH, University of South Florida
Co-Author - Jocelyn Jarvis, BS, University of South Florida
Co-Author - Amber Gum, PhD, University of South Florida
Black Patients' Experiences with Cancer-Related Pain Communication: A Qualitative Exploration
Poster Number: D11Time: 11:00 AM - 11:50 AM
Topics: Cancer, Pain
Background: Cancer-related pain is common, distressing, and often under-treated among Black patients, who report greater severity and impact of pain than White patients. Despite this disproportionate burden, Black patients are less likely to receive adequate pain treatment compared to their White counterparts. Research points to communication breakdowns shaped by historical racism and patient, provider, and patient-provider factors as central to these inequities. However, limited work has examined how Black patients themselves experience and interpret communication with healthcare providers about their cancer pain.
Objective: This study explored how Black patients with cancer communicate about cancer-related pain and perceive provider communication, with the goal of defining a grounded theory of cancer-related pain communication for Black patients.
Methods: We conducted semi-structured interviews with 28 Black/African American patients (20 women, 8 men) diagnosed with solid-tumor cancers (29% breast, 18% lung, 53% other cancers) who reported moderate-to-severe cancer-related pain (≥4 on 0-10 scale). Patients were referred by oncologists and palliative care clinicians from hospitals in Washington, D.C. The interview guide was developed by researchers and clinicians from prior research on cancer-related pain and communication. Interviews were audio-recorded, transcribed verbatim, and coded using a grounded theory methodology to identify themes related to communication dynamics.
Results: Patient-level factors contributing to pain communication outcomes included opioid stigma, self-advocacy and timing of pain communication. Social factors included support and advocacy from caregivers. Provider-level factors consisted of pain dismissal and discrimination, offering emotional and instrumental support, and patients’ perceptions of the content, extent, and timing/initiation of pain management communication. Patient-provider relationship valence, efforts to build relationships, and involvement of other care team members also influenced pain communication quality.
Conclusions: Pain communication for Black patients with cancer is shaped by a complex interplay of patient, provider, relational and social dynamics. Our findings underscore the need for interventions that equip patients to advocate for their pain management as well as train providers to recognize and counter biases, validate patient experiences, and engage in relationship-centered communication.
Keywords: Pain, Health communicationObjective: This study explored how Black patients with cancer communicate about cancer-related pain and perceive provider communication, with the goal of defining a grounded theory of cancer-related pain communication for Black patients.
Methods: We conducted semi-structured interviews with 28 Black/African American patients (20 women, 8 men) diagnosed with solid-tumor cancers (29% breast, 18% lung, 53% other cancers) who reported moderate-to-severe cancer-related pain (≥4 on 0-10 scale). Patients were referred by oncologists and palliative care clinicians from hospitals in Washington, D.C. The interview guide was developed by researchers and clinicians from prior research on cancer-related pain and communication. Interviews were audio-recorded, transcribed verbatim, and coded using a grounded theory methodology to identify themes related to communication dynamics.
Results: Patient-level factors contributing to pain communication outcomes included opioid stigma, self-advocacy and timing of pain communication. Social factors included support and advocacy from caregivers. Provider-level factors consisted of pain dismissal and discrimination, offering emotional and instrumental support, and patients’ perceptions of the content, extent, and timing/initiation of pain management communication. Patient-provider relationship valence, efforts to build relationships, and involvement of other care team members also influenced pain communication quality.
Conclusions: Pain communication for Black patients with cancer is shaped by a complex interplay of patient, provider, relational and social dynamics. Our findings underscore the need for interventions that equip patients to advocate for their pain management as well as train providers to recognize and counter biases, validate patient experiences, and engage in relationship-centered communication.
Authors:
Author - David Bradford, BA, University of Colorado Denver
Co-Author - Chiamaka Nwazue, Georgetown University
Co-Author - Katherine Brauer, Georgetown University
Co-Author - Kat Liang, MD, Los Angeles General Medical Center
Co-Author - Rebecca Spiro, MSW, MedStar Washington Hospital Center
Co-Author - Nina Liang, MSW, MedStar Washington Hospital Center
Co-Author - Candice Tavares, PharmD, Thomas Jefferson University Hospital
Co-Author - Hunter Groninger, MD, MedStar Washington Hospital Center, Georgetown University
Co-Author - Hannah Arem, PhD, MedStar Health Research Institute, Department of Oncology, Georgetown University
Co-Author - Kristi Graves, PhD, FSBM, Georgetown University
Co-Author - Katarina AuBuchon, PhD, Georgetown University
Bridging the Gap: Integrating Non-Traditional Staff to Improve Post-Discharge Follow-up Rates for Those with Severe Mental Illnesses
Poster Number: D110Time: 11:00 AM - 11:50 AM
Topics: Mental Health
Patients with serious mental illness (SMI) are known to have very low rates of follow-up care after psychiatric hospitalization. Nearly 40% of SMI patients discharged from psychiatric inpatient units failed to receive follow-up outpatient behavioral health (BH) treatment, creating a critical gap in the continuum of care (Velligan et al., 2017), which predicts higher rates of re-hospitalization (Cullen, 2018) and leads to poorer outcomes and reduced rates of recovery.
To address this gap, our program established an innovative model (“Bridge Program”) that integrates several non-traditional outpatient staff roles at the core of post-discharge support. The multidisciplinary team included peer specialists and patient navigators, who are trained to understand common barriers impacting SMI individuals, meet with patients who just prior to discharge to emphasize the value of continued care, address engagement barriers, and personally escort them to initial outpatient BH appointments that they may not otherwise attend without support. They also offer help to connect them to the BH outpatient services specifically designed to support SMI patients, such as peer groups, thereby lowering common barriers to follow-up care for this population.
From May 2022 to August 2024, our Bridge staff met and gave support to 176 patients with SMI diagnoses while still on the psychiatric unit, all of whom had a scheduled outpatient BH appointment after discharge. Of these, 108 patients attended the initial outpatient appointment (61.3%). Of those 108 patients, 78 were still successfully engaged in treatment four months later (72.2%), highlighting the effectiveness of having trained but non-traditional outpatient staff meet SMI patients while in the hospital but just prior to discharge.
Future work will examine psychiatric inpatients with SMI who missed scheduled outpatient appointments despite Bridge support, to identify barriers that continue to impede follow-up care. We will also analyze diagnostic and demographic predictors, including racial and ethnic differences, to understand factors influencing engagement after discharge.
Overall, the Bridge Program offers a scalable, low-cost, patient-centered approach to a prevalent challenge affecting those with SMI: improving low rates of connection to outpatient BH treatment after a hospitalization and increasing low levels of sustained engagement once they do connect to outpatient BH services.
Keywords: Mental health, Community interventionTo address this gap, our program established an innovative model (“Bridge Program”) that integrates several non-traditional outpatient staff roles at the core of post-discharge support. The multidisciplinary team included peer specialists and patient navigators, who are trained to understand common barriers impacting SMI individuals, meet with patients who just prior to discharge to emphasize the value of continued care, address engagement barriers, and personally escort them to initial outpatient BH appointments that they may not otherwise attend without support. They also offer help to connect them to the BH outpatient services specifically designed to support SMI patients, such as peer groups, thereby lowering common barriers to follow-up care for this population.
From May 2022 to August 2024, our Bridge staff met and gave support to 176 patients with SMI diagnoses while still on the psychiatric unit, all of whom had a scheduled outpatient BH appointment after discharge. Of these, 108 patients attended the initial outpatient appointment (61.3%). Of those 108 patients, 78 were still successfully engaged in treatment four months later (72.2%), highlighting the effectiveness of having trained but non-traditional outpatient staff meet SMI patients while in the hospital but just prior to discharge.
Future work will examine psychiatric inpatients with SMI who missed scheduled outpatient appointments despite Bridge support, to identify barriers that continue to impede follow-up care. We will also analyze diagnostic and demographic predictors, including racial and ethnic differences, to understand factors influencing engagement after discharge.
Overall, the Bridge Program offers a scalable, low-cost, patient-centered approach to a prevalent challenge affecting those with SMI: improving low rates of connection to outpatient BH treatment after a hospitalization and increasing low levels of sustained engagement once they do connect to outpatient BH services.
Authors:
Co-Author - Jon Marrelli, Psy.D., NYU Langone Family Health Center
Co-Author - Cecile Xu, B.S., NYU Langone Health
Co-Author - Michael Calle, B.A. , NYU Langone Family Health Center
Co-Author - Lingwei Wu, LCSW, NYU Langone Family Health Center
Co-Author - Julia Bentum, MA, M.Ed., LC-MHC, NYU Langone Family Health Center
Co-Author - Yulonda Bell, NYU Langone Family Health Center
Co-Author - Alvin Mendez, CPS, NYU Langone Family Health Center
Co-Author - Kevin Hoy, CPS, NYU Langone Family Health Center
Development and Validation of the COVID-19 Testing Decision-Making Scale (CTDMS) and Video Feedback Scale (VFS) in Black Community Settings
Poster Number: D111Time: 11:00 AM - 11:50 AM
Topics: Methods and Measurement, Health Disparities
Reliable measures are essential for evaluating behavioral and communication strategies to reduce health disparities. Few validated tools exist to assess COVID-19 testing decision-making or reactions to culturally tailored health communication in Black communities. This study aimed to develop and validate two new instruments, the COVID-19 Testing Decision-Making Scale (CTDMS) and the Video Feedback Scale (VFS). As part of the Culturally relevant Community Connections (C3) study, 327 Black/African American adults, recruited from salons and barbershops, completed the CTDMS and VFS following exposure to culturally tailored videos. The CTDMS (12 items) assessed sentiment, support, and social influences related to testing. The VFS (9 items) measured perceived impact and cultural resonance of video content. Exploratory Structural Equation Modeling (ESEM), Confirmatory Factor Analysis (CFA), and bifactor CFA models evaluated construct validity. Internal consistency was estimated with Cronbach’s alpha and McDonald’s omega. Missing data (3.8%) were addressed via multiple imputation with sensitivity checks. For the CTDMS, a two-factor solution emerged, General Sentiment (α=0.74, ω=0.78) and Practical Support (α=0.72, ω=0.75). The hypothesized Informational Social Influence subscale was excluded due to poor reliability. A bifactor model confirmed that CTDMS functions best as two distinct subscales rather than a total score. For the VFS, a bifactor CFA supported a strong general factor (CFI=0.95, RMSEA=0.099; ωₕ=0.875, ECV=0.80), validating a total score with exploratory group factors (Impact & Influence, Cultural Resonance). Sensitivity analyses using complete-case data (n=310 for CTDMS; n=264 for VFS) replicated findings. CTDMS and VFS are psychometrically sound tools tailored for community-based health interventions. The CTDMS captures general attitudes and practical supports influencing testing decisions, while the VFS provides a validated measure of participant engagement with culturally relevant video messaging. These measures will support implementation science, program evaluation, and health communication research aimed at reducing disparities.
Keywords: Health disparities, Community interventionAuthors:
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
Co-Author - Schenita Randolph, PhD, MPH, RN, FAAN, Duke University School of Nursing
Momentary Engagement and Compliance Profiles in Ecological Momentary Assessments: A Multilevel Latent Class Analysis
Poster Number: D112Time: 11:00 AM - 11:50 AM
Topics: Methods and Measurement, Decision Making
Background
Ecological momentary assessment (EMA) captures real-time behavioral and contextual information through repeated surveys, enabling analysis of within- and between-person variability, but participant engagement and compliance are multifaceted and vary across individuals and time. Multilevel latent class analysis (MLCA) enables modeling these behaviors jointly within moments, enabling improved EMA data collection.
Methods
Young adult college students (n=90; 5,896 moments; 67% female) who reported alcohol and cannabis use participated in a 21-day EMA study, responding to 4 daily survey prompts via automated text messages. Surveys assessed momentary behaviors and experiences; prompts expired after 60 minutes. MLCA indicators included momentary survey completion , response speed, phone use when prompted , receipt of visualization of study progress so far , and response to previous survey. Intra-class correlation coefficients were examined to quantify the within- vs. between-person variance. MLCA was used to model momentary compliance patterns, accounting for the nested data structure.
Results
Less than 20% of variance in momentary engagement and compliance behaviors was due to between-person differences (ICC range: .10-.19). MLCA results indicated 4 distinct momentary latent classes: Fast Response (36%, characterized by fast survey completion time, high likelihood of phone use when prompted); Conscientious Response (29%, characterized by moderate response speed, less likely to be using phone when prompted, very likely to have completed the previous survey); Slow Response (12%, characterized by slow response time, very low likelihood of phone use when prompted, low likelihood to have completed previous prompt); and Missing Response (22%, no response). Response patterns were consistent in terms of the times of day and whether a data dashboard was provided. Conclusion
These results highlight variability in participant engagement patterns during EMA studies and convey the complex patterns of momentary engagement and compliance behaviors. Young adults who were on their phone at the time of the prompt tended to respond quickly, suggesting that phone use patterns could be used to individualize prompt schedules. Fast responses when not on the phone may indicate particularly high engagement. Identifying distinct responder profiles can inform tailored strategies to improve compliance and optimize data quality in future EMA research.
Keywords: Methodology, Mobile phoneEcological momentary assessment (EMA) captures real-time behavioral and contextual information through repeated surveys, enabling analysis of within- and between-person variability, but participant engagement and compliance are multifaceted and vary across individuals and time. Multilevel latent class analysis (MLCA) enables modeling these behaviors jointly within moments, enabling improved EMA data collection.
Methods
Young adult college students (n=90; 5,896 moments; 67% female) who reported alcohol and cannabis use participated in a 21-day EMA study, responding to 4 daily survey prompts via automated text messages. Surveys assessed momentary behaviors and experiences; prompts expired after 60 minutes. MLCA indicators included momentary survey completion , response speed, phone use when prompted , receipt of visualization of study progress so far , and response to previous survey. Intra-class correlation coefficients were examined to quantify the within- vs. between-person variance. MLCA was used to model momentary compliance patterns, accounting for the nested data structure.
Results
Less than 20% of variance in momentary engagement and compliance behaviors was due to between-person differences (ICC range: .10-.19). MLCA results indicated 4 distinct momentary latent classes: Fast Response (36%, characterized by fast survey completion time, high likelihood of phone use when prompted); Conscientious Response (29%, characterized by moderate response speed, less likely to be using phone when prompted, very likely to have completed the previous survey); Slow Response (12%, characterized by slow response time, very low likelihood of phone use when prompted, low likelihood to have completed previous prompt); and Missing Response (22%, no response). Response patterns were consistent in terms of the times of day and whether a data dashboard was provided. Conclusion
These results highlight variability in participant engagement patterns during EMA studies and convey the complex patterns of momentary engagement and compliance behaviors. Young adults who were on their phone at the time of the prompt tended to respond quickly, suggesting that phone use patterns could be used to individualize prompt schedules. Fast responses when not on the phone may indicate particularly high engagement. Identifying distinct responder profiles can inform tailored strategies to improve compliance and optimize data quality in future EMA research.
Authors:
Author - Danny Wang, The Pennsylvania State University
Co-Author - Stephanie Lanza, The Pennsylvania State University
Insomnia Risk in the U.S. Air Force Physician Workforce: Shifting Patterns from 2014 to 2024
Poster Number: D113Time: 11:00 AM - 11:50 AM
Topics: Military and Veterans' Health, Sleep
Introduction: Military physicians face risks to sleep health common to civilian physicians alongside additional military-specific stressors. Insomnia is prevalent among service members and associated with cognitive, health, and occupational impairment, yet its incidence among military physicians remains poorly characterized. This project examined the one-year incidence of insomnia among U.S. Air Force (USAF) physicians and assessed variation by demographic and occupational characteristics across two cohorts a decade apart.
Methods: We constructed a retrospective cohort using deidentified electronic health record and personnel data. USAF physicians on orders in 2014 and 2024 were included. Incident insomnia was defined as a first-time diagnosis using ICD-9 and ICD-10 codes, excluding individuals with prior diagnoses since 2006. Multivariable logistic regression assessed associations with rank, sex, race/ethnicity, and service component. Separate models examined associations with physician specialty and aggregated specialty categories. Robust standard errors and Bonferroni-adjusted comparisons were used. Analyses assume near-complete capture of clinically documented diagnoses within the Military Health System.
Results: The analytic sample included 8,292 physicians. The one-year incidence proportion of documented insomnia declined from 3.6 percent in 2014 to 1.1 percent in 2024. In 2014, higher incidence was associated with senior officer rank and active-duty status, and differed by aggregated specialty category, with elevated odds in preventive, diagnostic, and administrative specialties compared with general medical specialties. In 2024, higher incidence was associated with junior officer rank and male sex, and no statistically significant specialty differences were observed, although point estimates remained highest in emergency and critical care fields.
Conclusion: There was a marked decrease in documented insomnia incidence over the decade, alongside shifts in demographic and occupational correlates, among USAF physicians. These findings likely reflect changes in documentation, workforce composition, and help-seeking rather than true reductions in sleep disturbance. Continued surveillance and targeted prevention efforts are warranted to support physician readiness and force health protection
Keywords: Sleep disorders, Population healthMethods: We constructed a retrospective cohort using deidentified electronic health record and personnel data. USAF physicians on orders in 2014 and 2024 were included. Incident insomnia was defined as a first-time diagnosis using ICD-9 and ICD-10 codes, excluding individuals with prior diagnoses since 2006. Multivariable logistic regression assessed associations with rank, sex, race/ethnicity, and service component. Separate models examined associations with physician specialty and aggregated specialty categories. Robust standard errors and Bonferroni-adjusted comparisons were used. Analyses assume near-complete capture of clinically documented diagnoses within the Military Health System.
Results: The analytic sample included 8,292 physicians. The one-year incidence proportion of documented insomnia declined from 3.6 percent in 2014 to 1.1 percent in 2024. In 2014, higher incidence was associated with senior officer rank and active-duty status, and differed by aggregated specialty category, with elevated odds in preventive, diagnostic, and administrative specialties compared with general medical specialties. In 2024, higher incidence was associated with junior officer rank and male sex, and no statistically significant specialty differences were observed, although point estimates remained highest in emergency and critical care fields.
Conclusion: There was a marked decrease in documented insomnia incidence over the decade, alongside shifts in demographic and occupational correlates, among USAF physicians. These findings likely reflect changes in documentation, workforce composition, and help-seeking rather than true reductions in sleep disturbance. Continued surveillance and targeted prevention efforts are warranted to support physician readiness and force health protection
Authors:
Presenter - Chase Aycock, PsyD, MPH, ABPP, United States Air Force
Co-Author - Emily A. Stone, Ph.D., Defense Health Agency
Author - Carol M. Copeland, PhD, University of Virginia School of Medicine
Author - Sowan Kang, PhD, United States Air Force
Author - Wen You, PhD, University of Virginia School of Medicine
Moderating Role of Blast Exposure on the Relations between Pain, PTSD, and Functional Outcomes in U.S. Combat Veterans
Poster Number: D114Time: 11:00 AM - 11:50 AM
Topics: Military and Veterans' Health, Pain
Background: Blast exposure is one of the most common traumatic events experienced by post-9/11 United States (U.S.) veterans. Blast injuries in U.S. veterans are tied to higher rates of mental and physical health concerns, including posttraumatic stress disorder (PTSD), and less improvement in chronic pain intensity following treatment. Veterans with blast injuries demonstrate particularly strong longitudinal associations between pain and PTSD, suggesting that blast injury exposure may contribute to more severe pain and PTSD symptoms. However, few studies directly examine pain, PTSD symptoms, and functional outcomes in the context of blast exposure, limiting intervention efforts following blast exposure.
This study aims to examine the relations among blast exposure, pain intensity, and PTSD symptoms on later disability and quality of life in a sample of U.S. combat veterans, and to compare these relations between veterans who were and who were not exposed to a blast.
Methods: We examined data from 351 post-9/11 U.S. combat veterans using Bayesian linear models for continuous outcomes (disability, PTSD symptoms and quality of life) and logistic regression for binary outcomes (presence of chronic pain). We tested 1) cross-sectional associations between blast exposure, PTSD symptoms, and pain intensity; 2) whether blast exposure longitudinally predicts chronic pain, functional disability, and quality of life; and 3) whether blast exposure moderates the longitudinal associations among pain intensity, PTSD symptoms, functional disability, and quality of life.
Results: Blast exposure increased odds of PTSD and pain and was positively associated with functional disability and negatively associated with quality of life. The relation of PTSD to greater functional disability and lessened quality of life was stronger for those exposed to a blast than those who were not.
Conclusions: This study identify the relevance of transdiagnostic mechanisms of mental health outcomes (pain intensity) to PTSD symptoms, quality of life and functioning following blast exposure. These results point to targeting Veterans with a history of blast exposure in prevention efforts for chronic pain and PTSD; such prevention and early intervention efforts are crucial to improving functioning and quality of life following blast exposures.
Keywords: Pain, TraumaThis study aims to examine the relations among blast exposure, pain intensity, and PTSD symptoms on later disability and quality of life in a sample of U.S. combat veterans, and to compare these relations between veterans who were and who were not exposed to a blast.
Methods: We examined data from 351 post-9/11 U.S. combat veterans using Bayesian linear models for continuous outcomes (disability, PTSD symptoms and quality of life) and logistic regression for binary outcomes (presence of chronic pain). We tested 1) cross-sectional associations between blast exposure, PTSD symptoms, and pain intensity; 2) whether blast exposure longitudinally predicts chronic pain, functional disability, and quality of life; and 3) whether blast exposure moderates the longitudinal associations among pain intensity, PTSD symptoms, functional disability, and quality of life.
Results: Blast exposure increased odds of PTSD and pain and was positively associated with functional disability and negatively associated with quality of life. The relation of PTSD to greater functional disability and lessened quality of life was stronger for those exposed to a blast than those who were not.
Conclusions: This study identify the relevance of transdiagnostic mechanisms of mental health outcomes (pain intensity) to PTSD symptoms, quality of life and functioning following blast exposure. These results point to targeting Veterans with a history of blast exposure in prevention efforts for chronic pain and PTSD; such prevention and early intervention efforts are crucial to improving functioning and quality of life following blast exposures.
Authors:
Author - Marcus Wild, PhD, VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Luke Hammett, VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Emma Harris, VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Alison Krauss, PhD, VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Corina Mendoza, MS, VISN 17 Center of Excellence for Research on Returning War Veterans
Co-Author - Suzannah Creech, PhD, VISN 17 Center of Excellence for Research on Returning War Veterans
Feasibility of an 8-week Lifestyle Intervention in a High-Risk Population
Poster Number: D115Time: 11:00 AM - 11:50 AM
Topics: Multiple Health Behavior Change , Child and Family Health
Background: Individuals with intellectual and developmental disabilities (IDD) are at higher risk for obesity than the general population. Interventions addressing obesity through lifestyle behaviors observe improved outcomes when family members are included with participants. This is crucial for those with IDD as caregivers influence lifestyle behaviors. Efficacious interventions including family members in this field of IDD are limited. Given this gap, our team collaborated with Special Olympics to design an 8-week program for individuals with IDD and their caregivers (i.e., family units). This program aimed to increase family unit engagement in healthy lifestyles behaviors. The goal of this study was to determine if the program is feasible in a population of family units.
Methods: Participants were recruited from Special Olympics North America locations and provided demographics (i.e., age, ethnicity, disability, and gender) via survey. Feasibility was assessed via retention, fidelity (to evaluate program execution compared to intended program structure), and acceptability (via theory-informed questionnaire (Sekhon, Cartwright, & Francis, 2022)). Body mass index (BMI; kg/m2) was calculated via height (to the nearest 0.1 cm; Seca 251 wall-mounted stadiometer, Detroit) and weight (to the nearest 0.1 kg; Tanita 300 series, San Antonio).
Results: A total of 36 family units attended baseline data collection, 28 of which returned for post data collection. Program fidelity was high. Specifically, on a 5-point Likert scale, trained observers rated the extent to which family units appeared to be engaged in, to enjoy, and felt comfortable during sessions (4.2) and the extent to which facilitators were engaging and supportive during sessions (4.6). Intervention acceptability was also high (4.0). Across all participants (i.e., individuals with IDD and caregivers) a significant decrease from pre to post BMI was observed (p = .035). A closer examination revealed major shifts in weight were among those with IDD who also had overweight or obesity (p = .012).
Conclusion: This program is a first step in developing an efficacious intervention as shown through high fidelity, acceptability, and significant preliminary effects. The need for lifestyle intervention in this high-risk population is clear. These results are promising as the main components of feasibility achieved high ratings, underscoring the potential of this program to support the health of family units.
Keywords: Intervention, ObesityMethods: Participants were recruited from Special Olympics North America locations and provided demographics (i.e., age, ethnicity, disability, and gender) via survey. Feasibility was assessed via retention, fidelity (to evaluate program execution compared to intended program structure), and acceptability (via theory-informed questionnaire (Sekhon, Cartwright, & Francis, 2022)). Body mass index (BMI; kg/m2) was calculated via height (to the nearest 0.1 cm; Seca 251 wall-mounted stadiometer, Detroit) and weight (to the nearest 0.1 kg; Tanita 300 series, San Antonio).
Results: A total of 36 family units attended baseline data collection, 28 of which returned for post data collection. Program fidelity was high. Specifically, on a 5-point Likert scale, trained observers rated the extent to which family units appeared to be engaged in, to enjoy, and felt comfortable during sessions (4.2) and the extent to which facilitators were engaging and supportive during sessions (4.6). Intervention acceptability was also high (4.0). Across all participants (i.e., individuals with IDD and caregivers) a significant decrease from pre to post BMI was observed (p = .035). A closer examination revealed major shifts in weight were among those with IDD who also had overweight or obesity (p = .012).
Conclusion: This program is a first step in developing an efficacious intervention as shown through high fidelity, acceptability, and significant preliminary effects. The need for lifestyle intervention in this high-risk population is clear. These results are promising as the main components of feasibility achieved high ratings, underscoring the potential of this program to support the health of family units.
Authors:
Author - Jessica Kirschmann, MSc, University of Houston
Co-Author - Eman Loya, University of Houston
Discussant - Randi Betts, Ed.D, University of Houston
Co-Author - Srivarshini Achanta, University of Houston
Co-Author - Olivia Broaddus, University of Houston
Chair - Craig Johnston, Ph.D., University of Houston
Health behaviors at a sport, health, and outdoor event (the MUV Festival 2025): Physical activity, sedentary behavior, sleep, and nutrition
Poster Number: D116Time: 11:00 AM - 11:50 AM
Topics: Multiple Health Behavior Change , Community Engagement
Introduction: The MUV Festival 2025 in Bern (June 13–15), held alongside the IFSC Boulder World Cup, is a new flagship Swiss event for sport, health, and outdoor enthusiasts. The festival featured themed villages focusing on Alpine Sports, Fitness, Health & Wellness, Digitalization & Technology, and Nutrition, alongside workshops, expert talks, and a Food Market. Such events represent innovative platforms for engaging the public in health promotion, yet empirical data on health behaviors of participants are limited. Understanding the health behaviors of festival visitors can help inform future strategies to leverage festivals for large-scale multiple behavior change. Profiling festival goers will facilitate targeted health promotion messages to promote and reinforce health behaviors. Thus, this study aimed to describe core health behaviors of MUV Festival participants and to examine sex differences.
Methods: Festival visitors (N=127, mean age = 35.9 ± 11.7 years; mean body mass index = 22.4 ± 2.3; 48.4% women) completed an online survey on moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior, sleep quality, and fruit and vegetable (F&V) intake. Missing data was pairwise deleted, and outliers were trimmed to ±3 SD. Sex differences were analyzed with independent-samples t-tests.
Results: Participants reported an average of 379.1 ± 287.5 min/week MVPA; 315.6 ± 213.6 min/day sedentary time. Sleep quality averaged 6.2 ± 2.1 on a 10-point scale (0 = terrible, 10 = excellent) and F&V intake was 4.3 ± 1.8 portions/day. No sex differences were observed in MVPA, light activity, or sedentary time. Women, however, reported significantly better sleep quality and higher F&V intake (both p’s < .05).
Discussion: The MUV Festival demonstrated that festival visitors were highly active while accumulating considerable sedentary time. Sleep quality was moderate to good, and fruit and vegetable intake, while higher in women, remained below recommendations. These findings indicate both strengths, such as high levels of MVPA and reasonable sleep, and areas requiring improvement, particularly sedentary behavior and diet. Women displayed healthier patterns in sleep and FV consumption, suggesting that sex-specific strategies may be warranted. Overall, festivals like MUV represent large-scale settings to promote targeted healthy behaviors aligned with participant behavior profiles, combining entertainment with health promotion opportunities.
Keywords: Multiple risk factors, Population healthMethods: Festival visitors (N=127, mean age = 35.9 ± 11.7 years; mean body mass index = 22.4 ± 2.3; 48.4% women) completed an online survey on moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior, sleep quality, and fruit and vegetable (F&V) intake. Missing data was pairwise deleted, and outliers were trimmed to ±3 SD. Sex differences were analyzed with independent-samples t-tests.
Results: Participants reported an average of 379.1 ± 287.5 min/week MVPA; 315.6 ± 213.6 min/day sedentary time. Sleep quality averaged 6.2 ± 2.1 on a 10-point scale (0 = terrible, 10 = excellent) and F&V intake was 4.3 ± 1.8 portions/day. No sex differences were observed in MVPA, light activity, or sedentary time. Women, however, reported significantly better sleep quality and higher F&V intake (both p’s < .05).
Discussion: The MUV Festival demonstrated that festival visitors were highly active while accumulating considerable sedentary time. Sleep quality was moderate to good, and fruit and vegetable intake, while higher in women, remained below recommendations. These findings indicate both strengths, such as high levels of MVPA and reasonable sleep, and areas requiring improvement, particularly sedentary behavior and diet. Women displayed healthier patterns in sleep and FV consumption, suggesting that sex-specific strategies may be warranted. Overall, festivals like MUV represent large-scale settings to promote targeted healthy behaviors aligned with participant behavior profiles, combining entertainment with health promotion opportunities.
Authors:
Author - Claudio Nigg, PhD, FSBM, University of Bern
Co-Author - Claudia Kubica, PhD, University of Bern
Co-Author - Sally Haddad, MS, University of Bern
Co-Author - Roksana Shiran, MS, University of Bern
Co-Author - Stephanie Brenner, MS, University of Bern
Co-Author - Martin Bührer, MS, University of Bern
Co-Author - Kai Gensitz, MS, University of Bern
Co-Author - Nicolas Iseli, BS, University of Bern
Co-Author - Céline Marquis, BS, University of Bern
Co-Author - Robin Schärer, BS, University of Bern
Co-Author - Yannick Pomorin, BS, University of Bern
Co-Author - Yesim Ege-Vogel, BA, University of Bern
Co-Author - Sascha Ketelhut, PhD, University of Bern
Co-Author - Joana Staub, BS, University of Bern
Co-Author - Irma Kurth, BS, University of Bern
Co-Author - Michael Rosenberg, PhD, MPH, University of Western Australia
Loneliness coping strategies moderate the association between loneliness and cannabis use
Poster Number: D117Time: 11:00 AM - 11:50 AM
Topics: Pain, Substance Misuse
Objective: Cannabis use (CU) is growing in the U.S. and is often used to manage pain or psychological distress despite known risks and mixed efficacy evidence. This study examined loneliness and pain in relation to CU frequency and whether loneliness-specific coping strategies moderate the connection between loneliness/pain and CU in a nationally representative sample of U.S. adults. specific coping strategies
Method: In an online sample of 1,747 adults (Mean age=43.9 years [SD=15.2], 50.7% female, 81.1% White, 12.1% Hispanic), loneliness, pain interference, CU frequency, and six loneliness coping domains were assessed using validated self-report measures. Kruskal-Wallis tests compared loneliness and pain across CU groups (non, light, moderate, heavy use), and Spearman’s correlations examined associations among continuous measures of CU, loneliness, and pain. Among cannabis users, generalized ordinal logistic regressions assessed whether loneliness and pain, loneliness coping strategies, and their interactions were associated with CU. report measures. , light, moderate, heavy use), and Spearman’s correlations examined associations
Results: Among the full sample, CU was positively correlated with loneliness and pain. The moderate CU group reported higher loneliness compared to non-use, and moderate and heavy CU groups reported higher pain compared to non-use. Although loneliness and pain showed no direct main effects on CU frequency, greater use of Social Support Network and Distancing and Denial coping were associated with stronger positive associations between loneliness and moderate/heavy CU relative to light use.
Conclusions: Findings suggest that individuals employ multiple coping strategies to manage loneliness, and that loneliness-related coping processes may help explain which individuals with elevated loneliness are more likely to engage in moderate to heavy CU.
Keywords: Pain, CopingMethod: In an online sample of 1,747 adults (Mean age=43.9 years [SD=15.2], 50.7% female, 81.1% White, 12.1% Hispanic), loneliness, pain interference, CU frequency, and six loneliness coping domains were assessed using validated self-report measures. Kruskal-Wallis tests compared loneliness and pain across CU groups (non, light, moderate, heavy use), and Spearman’s correlations examined associations among continuous measures of CU, loneliness, and pain. Among cannabis users, generalized ordinal logistic regressions assessed whether loneliness and pain, loneliness coping strategies, and their interactions were associated with CU. report measures. , light, moderate, heavy use), and Spearman’s correlations examined associations
Results: Among the full sample, CU was positively correlated with loneliness and pain. The moderate CU group reported higher loneliness compared to non-use, and moderate and heavy CU groups reported higher pain compared to non-use. Although loneliness and pain showed no direct main effects on CU frequency, greater use of Social Support Network and Distancing and Denial coping were associated with stronger positive associations between loneliness and moderate/heavy CU relative to light use.
Conclusions: Findings suggest that individuals employ multiple coping strategies to manage loneliness, and that loneliness-related coping processes may help explain which individuals with elevated loneliness are more likely to engage in moderate to heavy CU.
Authors:
Co-Author - Natalie Durieux, Department of Psychological Sciences, University of Connecticut
Co-Author - Crystal Park, PhD, FSBM, Department of Psychological Sciences, University of Connecticut
Co-Author - Beth Russell, PhD, Department of Human Development & Family Sciences, University of Connecticut
Co-Author - Michael Fendrich, PhD, Department of Emergency Medicine, Medical College of Wisconsin
Co-Author - Debarchana Ghosh, PhD, Department of Geography, Sustainability, Community, and Urban Studies, University of Connecticut
Co-Author - Hsiu-Ju Lin, PhD, School of Social Work, University of Connecticut
The association between high impact chronic pain and pain intensity levels 24 hours prior to an emergency department visit
Poster Number: D118Time: 11:00 AM - 11:50 AM
Topics: Pain
Introduction: Individuals with high impact chronic pain (HICP) experience frequent variation in their pain symptoms. Some acute exacerbations may result in emergency department (ED) visits due to the patient’s perceived need to seek additional treatment. This study examines pain intensity levels prior to an ED visit among patients with and without HICP.
Methods: Two waves of cross-sectional surveys were conducted at a large, urban safety-net hospital ED during June-August 2024 and January-May 2025. Adult patients who visited the ED were systematically sampled 8am-10pm, 7 days a week. Participants responded to a 3-item chronic pain screener. The study outcome was self-reported recall pain intensity level (0-10) 24 hours prior to the ED visit. We used the Graded Chronic Pain Scale-Revised to measure HICP and functional limitations. We conducted multivariable regression models to test the association between pain intensity level and HICP, while controlling for pain location, duration, use of treatment, mental health (Patient Health Questionnaire-4), age, sex and race/ethnicity.
Results: A total of 1,078 ED patients responded to the chronic pain screener. The analytic sample included 253 who had chronic pain and completed the chronic pain questionnaire (51% male, mean age 50.8 years, 75% Hispanic, 52% had HICP). Participants who visited the ED for chronic pain had a significantly higher pain level 24 hours prior to their ED visit, compared to those who visited the ED for acute/non-chronic pain or non-pain conditions (mean pain level: 8.3 vs. 6.7 vs. 5.9, p<0.001). Compared with other patients with chronic pain, patients with HICP reported significantly higher pain levels in the 24 hours before their ED visit (mean pain level: 8.2 vs. 6.9 with no HICP; β: 1.43, 95% CI: 0.7-2.2, p<0.001) after controlling for covariates. Breakdown of HICP elements suggests that higher pain levels were associated with greater functional limitations. However, there was no association between HICP and visiting the ED for chronic pain.
Conclusion: Patients who visited the ED for chronic pain suffered from higher levels of pain 24 hours prior to their ED visits. Variations in pain intensity and the associated temporary changes in physical abilities are expected with HICP. Careful assessment of pain and physical function is important for patients with HICP, as well as educating patients about these typical patterns to reduce unnecessary ED visits.
Keywords: Pain, Chronic illnessMethods: Two waves of cross-sectional surveys were conducted at a large, urban safety-net hospital ED during June-August 2024 and January-May 2025. Adult patients who visited the ED were systematically sampled 8am-10pm, 7 days a week. Participants responded to a 3-item chronic pain screener. The study outcome was self-reported recall pain intensity level (0-10) 24 hours prior to the ED visit. We used the Graded Chronic Pain Scale-Revised to measure HICP and functional limitations. We conducted multivariable regression models to test the association between pain intensity level and HICP, while controlling for pain location, duration, use of treatment, mental health (Patient Health Questionnaire-4), age, sex and race/ethnicity.
Results: A total of 1,078 ED patients responded to the chronic pain screener. The analytic sample included 253 who had chronic pain and completed the chronic pain questionnaire (51% male, mean age 50.8 years, 75% Hispanic, 52% had HICP). Participants who visited the ED for chronic pain had a significantly higher pain level 24 hours prior to their ED visit, compared to those who visited the ED for acute/non-chronic pain or non-pain conditions (mean pain level: 8.3 vs. 6.7 vs. 5.9, p<0.001). Compared with other patients with chronic pain, patients with HICP reported significantly higher pain levels in the 24 hours before their ED visit (mean pain level: 8.2 vs. 6.9 with no HICP; β: 1.43, 95% CI: 0.7-2.2, p<0.001) after controlling for covariates. Breakdown of HICP elements suggests that higher pain levels were associated with greater functional limitations. However, there was no association between HICP and visiting the ED for chronic pain.
Conclusion: Patients who visited the ED for chronic pain suffered from higher levels of pain 24 hours prior to their ED visits. Variations in pain intensity and the associated temporary changes in physical abilities are expected with HICP. Careful assessment of pain and physical function is important for patients with HICP, as well as educating patients about these typical patterns to reduce unnecessary ED visits.
Authors:
Presenter - Chun Nok Lam, PhD, MPH, University of Southern California
Co-Author - Katherine Applegate, PhD, Duke University Medical Center
Co-Author - Michael Menchine, MD, MPH, University of Southern California
Co-Author - Doerte Junghaenel, Ph.D., University of Southern California
Predictors of Baseline Analgesic Burden among Underserved Older Adults Participating in a Trial of a Chronic Pain Self-Management Intervention
Poster Number: D119Time: 11:00 AM - 11:50 AM
Topics: Pain, Aging
Background
Underserved older adults experience disproportionate chronic pain, where multimorbidity, polypharmacy, and limited access to non-pharmacologic care increase reliance on medications and risk of adverse events. Little is known about analgesic burden in community samples of older adults with chronic pain. The Quantitative Analgesic Questionnaire (QAQ) measures burden from opioid, non-opioid, and over-the-counter use. This study characterizes the distribution of QAQ scores and examines variation by age, sex, race/ethnicity, education, comorbidities, and pain severity.
Methods
We analyzed baseline data from the Seniors Using Technology To Engage in Pain Self Management (STEPS) randomized trial (ClinicalTrials.gov NCT05278234), testing a community health worker–delivered pain self-management program in Detroit, Michigan. Participants were ≥50 years, community-dwelling, with self-reported chronic musculoskeletal pain. Baseline surveys collected demographics, pain, and medication use. QAQ scores incorporated morphine milligram equivalents for opioids and proportional maximum doses for non-opioids, based on weekly frequency and dosage. Descriptive statistics summarized distributions. Pearson’s correlations tested continuous variables, Spearman’s correlations ordinal variables, and t-tests binary variables.
Results
Among 413 participants (mean age 66.9, SD 8.2), most were female (86%), non-Hispanic (97%), and Black (81%). Nearly half (46%) rated health as fair; most had ≥2 comorbidities. Mean QAQ was 2.8 (SD 3.1; median 2, range 0–26), driven by non-opioids (mean 2.4, SD 2.6) more than opioids (mean 0.5, SD 1.2). Non-opioid use was reported by 80%, opioids by 20%. QAQ did not differ by sex (p=0.50), education (p=0.68), or race/ethnicity (2.7 vs. 3.5 for Black vs. non-Black, p=0.06). Clinical factors were associated: older age correlated with lower QAQ (r=–0.26, p<0.001); higher pain severity (r=0.31, p<0.001) and more comorbidities (r=0.21, p<0.001) with higher scores. Participants with ≥4 comorbidities had a greater burden than those with 2–3 (3.1 vs. 1.9, p=0.01).
Conclusion
Demographics were not associated with QAQ scores. Greater pain and multimorbidity predicted higher burden, while older age was linked to lower scores. Interventions should prioritize clinical complexity over demographic targeting. Heightened use with multimorbidity raises concerns about polypharmacy; future analyses will assess whether the intervention reduces analgesic burden.
Keywords: Aging, Health disparitiesUnderserved older adults experience disproportionate chronic pain, where multimorbidity, polypharmacy, and limited access to non-pharmacologic care increase reliance on medications and risk of adverse events. Little is known about analgesic burden in community samples of older adults with chronic pain. The Quantitative Analgesic Questionnaire (QAQ) measures burden from opioid, non-opioid, and over-the-counter use. This study characterizes the distribution of QAQ scores and examines variation by age, sex, race/ethnicity, education, comorbidities, and pain severity.
Methods
We analyzed baseline data from the Seniors Using Technology To Engage in Pain Self Management (STEPS) randomized trial (ClinicalTrials.gov NCT05278234), testing a community health worker–delivered pain self-management program in Detroit, Michigan. Participants were ≥50 years, community-dwelling, with self-reported chronic musculoskeletal pain. Baseline surveys collected demographics, pain, and medication use. QAQ scores incorporated morphine milligram equivalents for opioids and proportional maximum doses for non-opioids, based on weekly frequency and dosage. Descriptive statistics summarized distributions. Pearson’s correlations tested continuous variables, Spearman’s correlations ordinal variables, and t-tests binary variables.
Results
Among 413 participants (mean age 66.9, SD 8.2), most were female (86%), non-Hispanic (97%), and Black (81%). Nearly half (46%) rated health as fair; most had ≥2 comorbidities. Mean QAQ was 2.8 (SD 3.1; median 2, range 0–26), driven by non-opioids (mean 2.4, SD 2.6) more than opioids (mean 0.5, SD 1.2). Non-opioid use was reported by 80%, opioids by 20%. QAQ did not differ by sex (p=0.50), education (p=0.68), or race/ethnicity (2.7 vs. 3.5 for Black vs. non-Black, p=0.06). Clinical factors were associated: older age correlated with lower QAQ (r=–0.26, p<0.001); higher pain severity (r=0.31, p<0.001) and more comorbidities (r=0.21, p<0.001) with higher scores. Participants with ≥4 comorbidities had a greater burden than those with 2–3 (3.1 vs. 1.9, p=0.01).
Conclusion
Demographics were not associated with QAQ scores. Greater pain and multimorbidity predicted higher burden, while older age was linked to lower scores. Interventions should prioritize clinical complexity over demographic targeting. Heightened use with multimorbidity raises concerns about polypharmacy; future analyses will assess whether the intervention reduces analgesic burden.
Authors:
Author - Olubukola Tikare, BPharm, MSc, University of Michigan Ann Arbor
Co-Author - Michelle Hood, MS, University of Michigan Ann Arbor
Co-Author - Rebecca Lindsay, MPH, University of Michigan Ann Arbor
Author - Mary Janevic, PhD, MPH, University of Michigan Ann Arbor
The Impact of Time Restricted Eating with and without a Prebiotic Supplement on Cardiometabolic Outcome in Young Adult Pediatric Cancer Survivors
Poster Number: D12Time: 11:00 AM - 11:50 AM
Topics: Cancer, Diet, Nutrition, and Eating Disorders
Introduction: Survival rates for pediatric cancer have exceeded an 80% threshold with almost half a million survivors of a pediatric cancer alive in the United States today. Despite the success in short term survivorship, pediatric cancer survivors (PCS) are at high risk for long term chronic disease related to cardiometabolic dysregulation at an early age as compared to the non-survivor population. PCS often have poor diet quality compared to matched controls which may be driving increased adiposity, perturbation in the gut microbiome and chronic systemic inflammation related to increased risk for chronic disease. Time restricted eating (TRE) has emerged as a salient dietary intervention to promote weight loss in individuals with increased adiposity. Prebiotic supplements may enhance the efficacy of this TRE as it relates to cardiometabolic risk marker by promoting satiety via the gut microbiome. Given the accessibility of both TRE and prebiotic supplements, this type of dietary intervention may be ideal for PCS. Cardiometabolic outcomes such as body weight, body composition, blood markers of cardiovascular (CVD) disease and glucose regulation were analyzed before and after an intervention that employed 8-hour TRE with and without a prebiotic supplement in PCS. Methods: Outcomes related to cardiometabolic risk were taken before and following the 12-week intervention. Body weight was measured using a balance beam scale, body composition was measured via dual x-ray absorptiometry, blood pressure via blood pressure cuff and additional blood based markers related to CVD risk and glucose regulation were measured after a 12 hours fast. Results: Improvements were observed in some cardiometabolic risk markers including a significant decrease in fat mass and visceral fat mass in both arms following the intervention. Conclusion: Given the positive outcomes and salient nature of the intervention, a larger fully powered intervention in this population is warranted.
Keywords: Cancer survivorship, DietAuthors:
Presenter - Kate Cares, Phd, MS, RD, University of Illinois at Chicago
Co-Author - Manoela Lima-Oliveira, PhD, MS, RD, University of Iowa
Co-Author - Alyssa Bryner, MS, RD, University of Illinois at Chicago
Co-Author - Bernice Man, MD, University of Illinois at Chicago
Co-Author - Zhengjia Chen, Phd, University of Illinois at Chicago
Co-Author - Beatriz Penalver Bernabe, PhD, University of Illinois at Chicago
Co-Author - Lisa Tussing-Humphreys, PhD, RD, University of Illinois at Chicago
Co-Author - Mary Lou Schmidt, MD, University of Illinois at Chicago
Co-Author - Kelsey Gabel, PhD, MS, RD, University of Illinois at Chicago
When the Pain Clinic Closes: Comparing Embedded vs. Integrated Pain Psychology Services
Poster Number: D120Time: 11:00 AM - 11:50 AM
Topics: Pain, Social and Environmental Context and Health
Background: Pain psychology interventions have shown to contribute to reduced pain and pain catastrophizing, improved depression, anxiety, and quality of life.1,2 Integrated Pain Management Models propose pain psychology services embedded within pain clinics and/or other medical areas.3 While these models offer many benefits, a downside is that the pain psychologist may be dependent upon the functioning and existence of the medical office. Purpose: The current study examined the feasibility of pain psychology services continuing within a health care setting after the closure of a pain clinic. Methods: The study examined practice and referral data for pain psychology services across two separate 8-month time points in the same healthcare system: 1) a pain psychologist embedded in a pain clinic and 2) a pain psychologist within a health psychology team after the pain clinic closed. Descriptive and comparative analyses were conducted. Results: When embedded in the Pain Clinic, Pain Psychology received an average of 16.25 referrals per month. After the Pain Clinic closed and Pain Psychology services remained available, the average referrals to Pain Psychology dropped to 9.75 per month, a statistically significant decrease (p = .015). In the embedded model, referrals to Pain Psychology were primarily from the Pain Clinic providers (48%) followed by Psychiatry (29%). In the current model, offering Pain Psychology as part of Health Psychology services, most referrals came from Psychiatry (42%) followed by BHC/Primary Care (20%). In the embedded model, 63% of referrals completed an initial appointment. In the current model without a pain clinic, 81% of referred patients scheduled an initial appointment and 82% of those complete the initial. Among all Pain Psychology referrals, 69% complete an initial Pain Psychology appointment which is comparable to the embedded model (p=.38). Conclusions: The current data suggest that Pain Psychology services may be sustainable in a healthcare setting after the closure of a Pain Clinic. Referral numbers may be lower when the psychologist is not embedded directly with a team, but patient acceptance and engagement remains comparable to an Embedded Pain Psychology model. Additional efforts may be needed to increase medical provider awareness of Pain Psychology services and how to make appropriate referrals. Future research should examine ongoing engagement and satisfaction among patients and care teams using this model.
Keywords: Pain, InterventionAuthors:
Co-Author - Caroline Wojtas, M.A., Christiana Care Health System
Co-Author - Shannon Virtue, PsyD, Christiana Care Health System
Co-Author - Kelsey Roper, PsyD, Christiana Care Health System
Greater Overall and Weekly Demands for Effortful Self-Control are Related to Lower Physical Activity Engagement
Poster Number: D121Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Decision Making
Long-term maintenance of moderate-to-vigorous physical activity (MVPA) is critical for health benefits, yet most interventions show only short-term effects. Thus, there is a need to identify targets for interventions to support sustained MVPA. One promising candidate is effortful self-control or “willpower.” Relying on effortful self-control to engage in MVPA may undermine maintenance because it is aversive and susceptible to failure. Recent cross-sectional evidence showed that the demand for effortful self-control explained 25-28% variance in MVPA and mediated associations between autonomous motivation and habit with MVPA. However, it is unknown whether overall effortful self-control demands can predict MVPA and if within-person fluctuations in demands are associated with MVPA.
Purpose: To test whether overall and weekly demands for effortful self-control are related to MVPA over four weeks.
Methods: Adults intending to engage in MVPA (N=120 participants; 70 female; age=23.8±7.2 years) completed a baseline survey of overall effortful self-control and four weekly surveys of effortful self-control and MVPA (IPAQ-SF). A multilevel model examined the effects of overall and weekly effortful self-control on MVPA, adjusting for demographics. A square root transformation was conducted on MVPA to address heteroscedasticity of level 1 residuals.
Results: Both overall (B = -1.43, p < .01, 95% CI [-2.51, -0.36]) and weekly (B = -1.19, p < .001, 95% CI [-1.70, -0.67]) effortful self-control demands were related to lower MVPA. Age, gender, and week were not related to MVPA. Fixed effects accounted for 11% of the variance in MVPA, marginal r2 = .11, and both fixed and random effects explained 72% of the variance in MVPA, conditional r2 = 72.
Conclusion: Greater effortful self-control demands were related to lower MVPA, suggesting that reducing reliance on willpower may promote sustained physical activity. Future research should assess the relationship between effortful self-control demands and MVPA across longer periods of time to test its role in maintenance of physical activity.
Keywords: Physical activity, Behavior ChangePurpose: To test whether overall and weekly demands for effortful self-control are related to MVPA over four weeks.
Methods: Adults intending to engage in MVPA (N=120 participants; 70 female; age=23.8±7.2 years) completed a baseline survey of overall effortful self-control and four weekly surveys of effortful self-control and MVPA (IPAQ-SF). A multilevel model examined the effects of overall and weekly effortful self-control on MVPA, adjusting for demographics. A square root transformation was conducted on MVPA to address heteroscedasticity of level 1 residuals.
Results: Both overall (B = -1.43, p < .01, 95% CI [-2.51, -0.36]) and weekly (B = -1.19, p < .001, 95% CI [-1.70, -0.67]) effortful self-control demands were related to lower MVPA. Age, gender, and week were not related to MVPA. Fixed effects accounted for 11% of the variance in MVPA, marginal r2 = .11, and both fixed and random effects explained 72% of the variance in MVPA, conditional r2 = 72.
Conclusion: Greater effortful self-control demands were related to lower MVPA, suggesting that reducing reliance on willpower may promote sustained physical activity. Future research should assess the relationship between effortful self-control demands and MVPA across longer periods of time to test its role in maintenance of physical activity.
Authors:
Author - Jonathon Bourque, Rutgers University
Co-Author - Luke Poole, Rutgers University
Co-Author - Hannah Purdue, Rutgers University
Co-Author - Amber Sarwani, Rutgers University
Co-Author - Brandon Alderman, Rutgers University
Social Support and Physical Activity Among U.S. Adults with Cognitive Disabilities
Poster Number: D122Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Health Disparities
Background: Adults with cognitive disabilities, including intellectual and developmental disabilities and acquired conditions such as traumatic brain injury, dementia, or stroke, are less likely to meet physical activity guidelines, contributing to disparities in health outcomes. Social support may influence physical activity engagement, but population-level patterns remain understudied. This cross-sectional study examined the association between social support and physical activity among adults with cognitive disabilities using nationally representative data.
Methods: Data were from 15,326 adults with self-reported cognitive disability in the 2023 Behavioral Risk Factor Surveillance System dataset. Physical activity was classified as physical activity vs. no physical activity in the past 30 days. Perceived social support was categorized as good, medium, or poor. Weighted descriptive statistics and multivariable logistic regression models assessed associations between social support and physical activity, adjusting for sociodemographic and health-related variables. Interaction terms tested moderation by age and race.
Results: Mean age was 52.8 years; 54.1% were female, and 59.1% were non-Hispanic White. Overall, 33.6% of adults with good social support were physically active, compared to 14.2% with medium and 9.2% with poor support (p < .001). In adjusted models, good vs. poor support was associated with higher odds of physical activity (OR = 1.33; 95% CI: 1.08–1.63). Older age strongly predicted inactivity (ages 35–54: OR = 2.22; 55–64: OR = 2.83; 65+: OR = 3.28). Significant interactions emerged: among White adults, low support predicted inactivity across ages 35–54 (OR = 1.30), 55–64 (OR = 1.36), and 65+ (OR = 1.21); among Black adults aged 55–64, low support was linked to nearly triple the odds of inactivity (OR = 2.79). Higher income, health insurance, college education, and male sex were positively associated with physical activity, while worse physical and mental health were inversely associated.
Conclusion: Low social support is a barrier to physical activity among adults with cognitive disabilities, particularly in midlife and older age among some racial groups. Findings highlight the need for equity-driven interventions that strengthen interpersonal support networks to promote physical activity in adults with cognitive disabilities.
Keywords: Disability, Physical activityMethods: Data were from 15,326 adults with self-reported cognitive disability in the 2023 Behavioral Risk Factor Surveillance System dataset. Physical activity was classified as physical activity vs. no physical activity in the past 30 days. Perceived social support was categorized as good, medium, or poor. Weighted descriptive statistics and multivariable logistic regression models assessed associations between social support and physical activity, adjusting for sociodemographic and health-related variables. Interaction terms tested moderation by age and race.
Results: Mean age was 52.8 years; 54.1% were female, and 59.1% were non-Hispanic White. Overall, 33.6% of adults with good social support were physically active, compared to 14.2% with medium and 9.2% with poor support (p < .001). In adjusted models, good vs. poor support was associated with higher odds of physical activity (OR = 1.33; 95% CI: 1.08–1.63). Older age strongly predicted inactivity (ages 35–54: OR = 2.22; 55–64: OR = 2.83; 65+: OR = 3.28). Significant interactions emerged: among White adults, low support predicted inactivity across ages 35–54 (OR = 1.30), 55–64 (OR = 1.36), and 65+ (OR = 1.21); among Black adults aged 55–64, low support was linked to nearly triple the odds of inactivity (OR = 2.79). Higher income, health insurance, college education, and male sex were positively associated with physical activity, while worse physical and mental health were inversely associated.
Conclusion: Low social support is a barrier to physical activity among adults with cognitive disabilities, particularly in midlife and older age among some racial groups. Findings highlight the need for equity-driven interventions that strengthen interpersonal support networks to promote physical activity in adults with cognitive disabilities.
Authors:
Presenter - Mussammat Snigdha Sowrin, University of New Mexico
Co-Author - Acadia Buro, University of New Mexico
Co-Author - Aditya Chakraborty, Old Dominion University
Differences in physical activity, physical activity enjoyment, and self-efficacy between cisgender and gender minority college students
Poster Number: D123Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Health Disparities
Purpose: Examining physical activity (PA) behaviors in gender minority (GM) college students is an area with limited research in the literature. Among GM college students, understanding the relationship between PA behaviors, PA enjoyment, and self-efficacy barriers to performing exercise could aid in promoting PA in this population. The purpose of this study was to compare GM college student PA participation, PA behaviors, and self-efficacy barriers for exercise with their cisgender counterparts.
Methods: Participants were a volunteer sample of students from a large, Northeastern university (2018-2025). Participants reported their demographics (age, race/ethnicity, gender identity, sexual identity), leisure time physical activity (LTPA) participation, strength training (ST) participation, PA enjoyment (PAE) and self-efficacy barriers for exercise (SEE) via self-report survey. Gender identities were dichotomized (cisgender vs GM) for the analysis . Independent sample t-tests were used to compare mean MET-mins/week of LTPA, ST-mins/week, PAE, and SEE score by gender identification. A 5000-sample bootstrapping (95% CI) mediation method was used to examine if PAE and SEE total score mediated the association between gender identity, MET-mins/week of LTPA, and ST mins/week.
Results: Participants (n=6,667) were majority cisgender (98%, n=6,503), women (n=3,907, 59%), Non-Hispanic White (n=4,805, 72%), and Heterosexual (n=5,715, 86%). Independent sample-t tests found GM students reported significantly lower LTPA MET-mins/week (p<0.01), ST mins/week (p<0.01), PAE (p<0.01), and SEE (p=0.02) compared to cisgender students. PAE had an indirect mediation effect on the association between gender identity and ST mins/week (a*b = −34.51, CI [−46.75, -22.25]). SEE had a direct and indirect mediation effect on the association between gender identity, LTPA MET-mins/week (path c’ = −528.20, p = .003) (a*b = −259.04, CI [−435.21, -77.00]), and ST mins/week (path c’ = −28.67, p = .0474) (a*b = −17.30, CI [−29.18, -15.39]).
Conclusion: GM college students in our sample participated in less PA, experience less PAE, and have low self-efficacy to participate in exercise. PAE and self-efficacy provided a direct and indirect mediating effect for PA participation. The findings from this study provide further understanding of PA behaviors among the GM college student population and could be used to help improve PA promotional efforts in the GM college student population.
Keywords: Physical activity, GenderMethods: Participants were a volunteer sample of students from a large, Northeastern university (2018-2025). Participants reported their demographics (age, race/ethnicity, gender identity, sexual identity), leisure time physical activity (LTPA) participation, strength training (ST) participation, PA enjoyment (PAE) and self-efficacy barriers for exercise (SEE) via self-report survey. Gender identities were dichotomized (cisgender vs GM) for the analysis . Independent sample t-tests were used to compare mean MET-mins/week of LTPA, ST-mins/week, PAE, and SEE score by gender identification. A 5000-sample bootstrapping (95% CI) mediation method was used to examine if PAE and SEE total score mediated the association between gender identity, MET-mins/week of LTPA, and ST mins/week.
Results: Participants (n=6,667) were majority cisgender (98%, n=6,503), women (n=3,907, 59%), Non-Hispanic White (n=4,805, 72%), and Heterosexual (n=5,715, 86%). Independent sample-t tests found GM students reported significantly lower LTPA MET-mins/week (p<0.01), ST mins/week (p<0.01), PAE (p<0.01), and SEE (p=0.02) compared to cisgender students. PAE had an indirect mediation effect on the association between gender identity and ST mins/week (a*b = −34.51, CI [−46.75, -22.25]). SEE had a direct and indirect mediation effect on the association between gender identity, LTPA MET-mins/week (path c’ = −528.20, p = .003) (a*b = −259.04, CI [−435.21, -77.00]), and ST mins/week (path c’ = −28.67, p = .0474) (a*b = −17.30, CI [−29.18, -15.39]).
Conclusion: GM college students in our sample participated in less PA, experience less PAE, and have low self-efficacy to participate in exercise. PAE and self-efficacy provided a direct and indirect mediating effect for PA participation. The findings from this study provide further understanding of PA behaviors among the GM college student population and could be used to help improve PA promotional efforts in the GM college student population.
Authors:
Author - Caellum Crescent, M.S., Physical Activity and Public Health Lab at Pennsylvania State University
Co-Author - Keegan Peterson, PhD, MPH, National Cancer Institute
Co-Author - Michele Duffy, M.S., Penn State University
Co-Author - Melissa Bopp, PhD, Pennsylvania State University
Mixed Methods Evaluation of the Influences of Pain and HIV Status on Physical Activity among Women with Hypertension
Poster Number: D124Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, HIV/AIDS
BACKGROUND: Women living with HIV are at high risk for hypertension (HTN) and cardiovascular diseases. According to data from national cohort study, HTN affects 58% of women living with HIV and 53% of women living without HIV in the US South and disproportionately affects Black women. Lifestyle modifications including physical activity (PA) are recommended for reducing blood pressure. We undertook a mixed methods study informed by Social Cognitive Theory (SCT) to describe barriers and facilitators to daily PA among women with HTN, living with and without HIV in the US South.
METHODS: Twenty-four women age 40 and above diagnosed with HTN confirmed by medical records were recruited from HIV and Family Medicine primary care clinics in Alabama (16 HIV+ women, 8 HIV- women; 23/24 Black/African American). They participated in a 7-day observational study that included wearing an accelerometer (Actigraph wGT3X-BT) on their waist/hip while completing experience sampling measures three-times per day delivered at random intervals in morning, afternoon, and evening time blocks. Measures included a 1-item pain severity (0-10) scale at every interval. After seven days of observation, participants completed an in-depth phone interview about their experiences with PA. Using a convergent mixed methods design, quantitative and qualitative data were compared and contrasted to yield recommendations for increasing PA behavior in this population.
RESULTS: Average daily pain was in the moderate range for both groups (HIV+: M=4.55 (SD=3.42); HIV-: M=5.37 (SD=1.65)). Women engaged in a mean of 11 minutes (SD: 2.93, range: 1-31 minutes) of moderate to vigorous activity (MVPA) per day, without a significant difference by HIV status. In a multi-level model assessing within-person associations between same-day pain and MVPA, pain was associated with a lower daily MVPA within-persons (γ10= -0.72, p<0.10). In qualitative interviews, pain was the most frequently referenced barrier to PA endorsed by 16 out of 24 women.
CONCLUSIONS: It this study, pain appeared to be the most significant barrier to PA among women with HTN regardless of HIV status. Findings suggest pain should be assessed and addressed when making PA recommendations for women with HTN. Women may benefit from psychoeducation on the benefits of PA for managing pain in addition to its benefits for heart health, activity pacing, overcoming fear of movement, and addressing unhelpful thinking about pain and movement.
Keywords: Hypertension, PainMETHODS: Twenty-four women age 40 and above diagnosed with HTN confirmed by medical records were recruited from HIV and Family Medicine primary care clinics in Alabama (16 HIV+ women, 8 HIV- women; 23/24 Black/African American). They participated in a 7-day observational study that included wearing an accelerometer (Actigraph wGT3X-BT) on their waist/hip while completing experience sampling measures three-times per day delivered at random intervals in morning, afternoon, and evening time blocks. Measures included a 1-item pain severity (0-10) scale at every interval. After seven days of observation, participants completed an in-depth phone interview about their experiences with PA. Using a convergent mixed methods design, quantitative and qualitative data were compared and contrasted to yield recommendations for increasing PA behavior in this population.
RESULTS: Average daily pain was in the moderate range for both groups (HIV+: M=4.55 (SD=3.42); HIV-: M=5.37 (SD=1.65)). Women engaged in a mean of 11 minutes (SD: 2.93, range: 1-31 minutes) of moderate to vigorous activity (MVPA) per day, without a significant difference by HIV status. In a multi-level model assessing within-person associations between same-day pain and MVPA, pain was associated with a lower daily MVPA within-persons (γ10= -0.72, p<0.10). In qualitative interviews, pain was the most frequently referenced barrier to PA endorsed by 16 out of 24 women.
CONCLUSIONS: It this study, pain appeared to be the most significant barrier to PA among women with HTN regardless of HIV status. Findings suggest pain should be assessed and addressed when making PA recommendations for women with HTN. Women may benefit from psychoeducation on the benefits of PA for managing pain in addition to its benefits for heart health, activity pacing, overcoming fear of movement, and addressing unhelpful thinking about pain and movement.
Authors:
Presenter - Kaylee Crockett, PhD, University of Alabama at Birmingham
Co-Author - Tejossy John, MPH, University of Alabama at Birmingham
Co-Author - Mari Katundu, MSc, University of Alabama at Birmingham
Co-Author - Elizabeth Jackson, MD MPH, University of Alabama, Birmingham
Co-Author - Gareth Dutton, PhD, FSBM, University of Alabama at Birmingham
Co-Author - Janet Turan, PhD, University of Alabama at Birmingham
From Design to Delivery: Implementation of Behavior Change Techniques in a Peer Coaching Physical Activity Intervention for Breast Cancer Survivors
Poster Number: D125Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Cancer
Developing effective physical activity (PA) interventions is critical to cancer survivorship, enhancing both physical and mental well-being. Behavioral change techniques (BCTs) such as goal setting, self-monitoring, and action planning, have become essential for understanding effective interventions and the mechanisms driving PA behavior change. Identifying which BCTs are planned and the extent they are delivered during intervention is under researched. Our goal was to identify and quantify the delivery of BCT’s in a behavioral intervention and assess their associations with PA outcomes. Purpose: This study sought to identify, code and calculate the proportion of BCTs implemented (calculated as a ratio of implemented to intended BCTs) and examine the association between this proportion and weekly PA, across a 12-week peer-coaching PA intervention among breast cancer survivors. Methods: Peer coaches (n=10) were trained by research staff to deliver a 12-week intervention via a web platform (webMFT) to breast cancer survivors (n=30 randomized to this condition at baseline). Two independent coders completed an online BCT training and then mapped and coded weekly intervention calls for BCTs (per 93v1 taxonomy) in the intervention. All disagreements were recorded and resolved via discussion. Weekly interrater reliability was calculated. Using a series of generalized linear models, we examined associations between proportion of BCTs implemented vs. intended and active PA minutes (as measured via FitBit). Results: Coaches were 58 ± 8 years of age on average, 90% white/Caucasian and 100% with at least some college level education. The proportion of intended BCT’s (n=11) implemented varied significantly over time (p<.01), ranging from 34% to 91%, with higher proportions in the first 6 weeks of the study. Results indicate a significant association between proportion of BCTs implemented and PA, such that weeks with higher proportions of BCTs implemented also had higher minutes of active PA minutes (b=10.68, SE=2.54, p<.01). Conclusion: BCT delivery significantly varied overtime, with higher proportions delivered during earlier vs. later calls, suggesting the need for additional training of coaches to sustain BCTs later in the intervention phase. Favorable associations between BCT’s delivered and PA outcomes show that intervention content, if delivered as intended, has the potential to benefit participants. This is particularly salient when content was peer-delivered.
Keywords: Health behavior change, Physical activityAuthors:
Author - Victoria DeScenza, PhD, University of Connecticut
Author - Madison Kindred, PhD, Augusta University
Author - Shira Dunsiger, PhD, Brown University, School of Public Health
Author - Bernardine Pinto, PhD, FSBM, University of South Carolina
A Prescribable Dose of Exercise: A Framework for Prescription in Behavioral Medicine
Poster Number: D126Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Mental Health
Introduction
Exercise is increasingly recognized as a powerful adjunct to traditional behavioral health treatments for many disorders, such as depression, anxiety, PTSD, and ADHD. Currently, a gap exists in psychology between clinicians who are trained in exercise science and those who are not, resulting in the misaligned or ineffective integration of exercise into behavioral health treatment. This poster introduces a 7-specifier framework ranging from physiological metrics like METs and heart rate variability to psychological dimensions such as behavioral activation and breathing control to help clinicians conceptualize exercise prescriptions that match interventions to individual treatment targets, barriers, symptom patterns, patient needs, and therapeutic goals.
Methods:
We conducted a comprehensive literature review to synthesize extant research on factors influencing exercise prescription in behavioral health. Sources included peer-reviewed articles, clinical guidelines, meta-analyses, and key texts from exercise science and psychology. Databases (i.e., PubMed, PsycINFO, and SPORTDiscus) were searched using terms such as “exercise prescription” and “exercise and mental health.”
Results:
Seven specifiers were identified that contribute to the clinical precision of exercise prescription in behavioral health: (1) MET scores, (2) Heart Rate (HR), (3) Breathing Control, (4) Neurological and Physiological Targeting, (5) Specific Exercise Type, (6) Time/Frequency, and (7) Behavioral Health. Together, these specifiers inform both physiological targets and psychological goals. Each specifier enables therapists to match the “when,” “how,” and “why” of exercise to specific therapeutic treatments, such as adjusting intensity via heart rate zones.
Discussion:
Exercise interventions in psychological care are often either overgeneralized or underutilized due to a lack of evidence-based and standardized frameworks that are clinically relevant. By introducing a 7-specifier model that integrates both physiological precision and psychological nuance, this work seeks to bridge that gap. The framework helps clinicians move beyond generic exercise recommendations and toward tailored prescriptions that clinicians, researchers, and interdisciplinary teams can use to integrate exercise as a meaningful, measurable, and context-sensitive component of behavioral healthcare, offering a more flexible and adaptable model that can be used across populations and treatment goals.
Keywords: Exercise, Research to practice translationExercise is increasingly recognized as a powerful adjunct to traditional behavioral health treatments for many disorders, such as depression, anxiety, PTSD, and ADHD. Currently, a gap exists in psychology between clinicians who are trained in exercise science and those who are not, resulting in the misaligned or ineffective integration of exercise into behavioral health treatment. This poster introduces a 7-specifier framework ranging from physiological metrics like METs and heart rate variability to psychological dimensions such as behavioral activation and breathing control to help clinicians conceptualize exercise prescriptions that match interventions to individual treatment targets, barriers, symptom patterns, patient needs, and therapeutic goals.
Methods:
We conducted a comprehensive literature review to synthesize extant research on factors influencing exercise prescription in behavioral health. Sources included peer-reviewed articles, clinical guidelines, meta-analyses, and key texts from exercise science and psychology. Databases (i.e., PubMed, PsycINFO, and SPORTDiscus) were searched using terms such as “exercise prescription” and “exercise and mental health.”
Results:
Seven specifiers were identified that contribute to the clinical precision of exercise prescription in behavioral health: (1) MET scores, (2) Heart Rate (HR), (3) Breathing Control, (4) Neurological and Physiological Targeting, (5) Specific Exercise Type, (6) Time/Frequency, and (7) Behavioral Health. Together, these specifiers inform both physiological targets and psychological goals. Each specifier enables therapists to match the “when,” “how,” and “why” of exercise to specific therapeutic treatments, such as adjusting intensity via heart rate zones.
Discussion:
Exercise interventions in psychological care are often either overgeneralized or underutilized due to a lack of evidence-based and standardized frameworks that are clinically relevant. By introducing a 7-specifier model that integrates both physiological precision and psychological nuance, this work seeks to bridge that gap. The framework helps clinicians move beyond generic exercise recommendations and toward tailored prescriptions that clinicians, researchers, and interdisciplinary teams can use to integrate exercise as a meaningful, measurable, and context-sensitive component of behavioral healthcare, offering a more flexible and adaptable model that can be used across populations and treatment goals.
Authors:
Author - Spencer J. Hills, Pacific University
Co-Author - Marshall T. Beauchamp, PhD, Pacific University
Instagram-Based Physical Activity Intervention for Female College Students Leveraging Fitness Influencer Content: A Pilot Study
Poster Number: D127Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Digital Health
Background
Female college students engage in less moderate-to-vigorous-intensity physical activity (MVPA) and muscle-strengthening activities than male peers. Tailored interventions addressing their unique barriers are needed. Social media is a low-cost, accessible venue this population already uses for PA information. Yet, platforms (e.g., Instagram) remain unexplored for both intervention delivery and incorporating fitness content. This mixed-methods pilot tested the feasibility and acceptability of an Instagram-based intervention leveraging fitness influencer content to promote MVPA and muscle-strengthening activities.
Method
Insufficiently physically active female college students (ages 18-24) were recruited. The 8-week intervention included five components: 1) researcher-generated Instagram posts, 2) peer group chat, 3) tool for PA content identification, 4) researcher-selected fitness influencer content, and 5) Fitbit app accounts for self-monitoring. The primary aim was to assess the feasibility and acceptability via online survey; the secondary aim was to evaluate self-reported MVPA and muscle-strengthening activities. Follow-up interviews were conducted with a subset of participants.
Results
Of 33 female college students who expressed interest, 25 enrolled (75.8%) and 23 (Mage= 20.3±1.8 years) completed the intervention. There was high retention (92.0%). The intervention was seen as acceptable: 73.9% recommended, 69.6% were satisfied, and 69.6% would participate again. Some participants improved in identifying misinformation using the tool for PA content identification. However, certain success metrics were not met (e.g., engagement, PA self-monitoring rates). Interview results highlighted enjoyed components (e.g., Instagram posts, fitness influencer content, and tool for content identification), Instagram materials’ accessibility, and the positive group chat. Post-intervention, self-reported MVPA and MET-minutes/week increased slightly, though not statistically significant (very small-small effects), and a small proportion of participants met muscle-strengthening recommendations post-intervention.
Conclusions
This novel approach successfully recruited and retained participants and delivered intervention content in an innovative social media context. Although the study was not powered to assess PA changes and some pilot metrics were unmet, findings provide preliminary support and offer insights for future PA interventions targeting college women.
Keywords: Physical activity, e-HealthFemale college students engage in less moderate-to-vigorous-intensity physical activity (MVPA) and muscle-strengthening activities than male peers. Tailored interventions addressing their unique barriers are needed. Social media is a low-cost, accessible venue this population already uses for PA information. Yet, platforms (e.g., Instagram) remain unexplored for both intervention delivery and incorporating fitness content. This mixed-methods pilot tested the feasibility and acceptability of an Instagram-based intervention leveraging fitness influencer content to promote MVPA and muscle-strengthening activities.
Method
Insufficiently physically active female college students (ages 18-24) were recruited. The 8-week intervention included five components: 1) researcher-generated Instagram posts, 2) peer group chat, 3) tool for PA content identification, 4) researcher-selected fitness influencer content, and 5) Fitbit app accounts for self-monitoring. The primary aim was to assess the feasibility and acceptability via online survey; the secondary aim was to evaluate self-reported MVPA and muscle-strengthening activities. Follow-up interviews were conducted with a subset of participants.
Results
Of 33 female college students who expressed interest, 25 enrolled (75.8%) and 23 (Mage= 20.3±1.8 years) completed the intervention. There was high retention (92.0%). The intervention was seen as acceptable: 73.9% recommended, 69.6% were satisfied, and 69.6% would participate again. Some participants improved in identifying misinformation using the tool for PA content identification. However, certain success metrics were not met (e.g., engagement, PA self-monitoring rates). Interview results highlighted enjoyed components (e.g., Instagram posts, fitness influencer content, and tool for content identification), Instagram materials’ accessibility, and the positive group chat. Post-intervention, self-reported MVPA and MET-minutes/week increased slightly, though not statistically significant (very small-small effects), and a small proportion of participants met muscle-strengthening recommendations post-intervention.
Conclusions
This novel approach successfully recruited and retained participants and delivered intervention content in an innovative social media context. Although the study was not powered to assess PA changes and some pilot metrics were unmet, findings provide preliminary support and offer insights for future PA interventions targeting college women.
Authors:
Author - Hannah Lavoie, PhD, University of Florida
Co-Author - Megan McVay, PhD, University of Florida
Co-Author - Rebecca Pearl, PhD, University of Florida
Co-Author - Carla Fisher, PhD, University of Florida
Co-Presenter - Danielle Jake-Schoffman, PhD, University of Florida
Optimizing Generative Artificial Intelligence Prompts to Evoke Urges for Physical Activity in Middle-Aged and Older Adults
Poster Number: D128Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Digital Health
Background: Most middle-aged and older adults do not engage in sufficient physical activity. Text messages have proven effective for promoting physical activity, but little is known about how message content can engage motivational mechanisms, such as momentary urges to be physically active. This study examined how generative artificial intelligence prompts could be engineered to create messages that evoke such urges.
Methods: Two studies were conducted. Study 1 involved iterative prompt development and expert evaluations of messages generated by ChatGPT using prompts varying in physical activity context (preparation vs. execution), benefit (short-term vs. long-term), experience (past vs. future), and behavioral target (move more vs. sit less). Study 2 involved a web-based factorial experiment to assess how these factors affected self-reported momentary urges to be physically active among middle-aged and older adults after reading each message.
Results: In study 1, ratings of confidence that text messages (nMessages=16) would evoke urges to be physically active were moderate yet heterogenous across the physical activity experts (nExperts=15). Themes including physical activity cues and affective appeal emerged as key factors. In Study 2, 640 adults (aged 40–85 years, M = 57; 52% female) rated 80 messages. Results indicated that compared to women, men reported higher physical activity urges in response to the text messages, and participants with higher baseline urges to move reported higher momentary urges after reading the messages. Age moderated two effects: older adults responded more favorably to execution vs. preparation prompts, and the advantage of past over future experiences diminished with age. Two significant three-way interactions showed that (1) execution-based prompts were most effective when paired with short-term benefits and past or future experiences (compared with long-term benefits and future experiences), and (2) execution prompts tended to evoke higher urges than preparation prompts except when messages targeted future physical activity experiences; In this latter case, preparation was more effective.
Conclusions: This study identified how specific prompt features can evoke physical activity urges in middle-aged and older adults. Future work should explore longitudinal impacts, real-world effectiveness, and personalization strategies for developing physical activity messages.
Keywords: Physical activity, AgingMethods: Two studies were conducted. Study 1 involved iterative prompt development and expert evaluations of messages generated by ChatGPT using prompts varying in physical activity context (preparation vs. execution), benefit (short-term vs. long-term), experience (past vs. future), and behavioral target (move more vs. sit less). Study 2 involved a web-based factorial experiment to assess how these factors affected self-reported momentary urges to be physically active among middle-aged and older adults after reading each message.
Results: In study 1, ratings of confidence that text messages (nMessages=16) would evoke urges to be physically active were moderate yet heterogenous across the physical activity experts (nExperts=15). Themes including physical activity cues and affective appeal emerged as key factors. In Study 2, 640 adults (aged 40–85 years, M = 57; 52% female) rated 80 messages. Results indicated that compared to women, men reported higher physical activity urges in response to the text messages, and participants with higher baseline urges to move reported higher momentary urges after reading the messages. Age moderated two effects: older adults responded more favorably to execution vs. preparation prompts, and the advantage of past over future experiences diminished with age. Two significant three-way interactions showed that (1) execution-based prompts were most effective when paired with short-term benefits and past or future experiences (compared with long-term benefits and future experiences), and (2) execution prompts tended to evoke higher urges than preparation prompts except when messages targeted future physical activity experiences; In this latter case, preparation was more effective.
Conclusions: This study identified how specific prompt features can evoke physical activity urges in middle-aged and older adults. Future work should explore longitudinal impacts, real-world effectiveness, and personalization strategies for developing physical activity messages.
Authors:
Author - Yingjia Liu, MS, University of Michigan
Co-Author - Allyson Tabaczynski, PhD, University of Michigan
Co-Author - Saeed Abdullah, PhD, The Pennsylvania State University
Co-Author - Lizbeth Benson, PhD, University of Michigan
Co-Author - David Conroy, PhD, FSBM, University of Michigan
Association Between Perceived Community Social Cohesion and Physical Activity Among College Students: A Survey Study
Poster Number: D129Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Social and Environmental Context and Health
Background: Few college students meet recommended levels of physical activity (PA). Social environmental interventions may be an effective strategy for this population, given the college campus environment, with research showing positive relationships between perceived community social cohesion and PA. However, little is known about the relationship between community social cohesion, including online connections, and college student PA. This study explored whether perceived community social cohesion, across neighborhoods, social connections, and engagement with PA-focused social media predicted PA among college students.
Methods: Full-time residential undergraduate students (aged 18-24) at a large Southeastern university completed a Qualtrics survey. Measures included self-reported minutes/week of moderate to vigorous PA (MVPA), strength training, perceived neighborhood cohesion, organized social participation, social norms, and social support (using support and sabotage sub-scales), frequency of viewing PA-related content, and membership in PA-focused social media communities. Regression analyses adjusted for gender, race, and ethnicity assessed associations between social factors and PA. Non-parametric tests were conducted for additional comparisons.
Results: Complete data were available from 208 students (Mage 20.0 years; 76.4% female, 46.6% Asian, 43.8% White; and 13.0% Hispanic). In regression models, perceived neighborhood cohesion, organized participation, and social norms did not significantly predict MVPA or strength training (ps>0.05). However social support from friends significantly predicted both MVPA and strength training (ps<0.05), while friend sabotage significantly predicted greater strength training (p=0.03). Non-parameric tests showed viewing PA-related social media was positively correlated with MVPA and strength training (ps<0.05). Membership in PA-oriented virtual communities was associated with greater strength training (p<0.05) and marginally with MVPA (p=0.051).
Conclusion: The present survey found that traditional neighborhoods and organized community factors were not significant predictors of PA, whereas peer support and engagement with PA-related social media and virtual communities were. This suggests community and social influence may need to be reimagined for effective interventions for this population, including emphasizing peer-based strategies and integrating digital platforms that foster PA-supportive social environments.
Keywords: Physical activity, Social supportMethods: Full-time residential undergraduate students (aged 18-24) at a large Southeastern university completed a Qualtrics survey. Measures included self-reported minutes/week of moderate to vigorous PA (MVPA), strength training, perceived neighborhood cohesion, organized social participation, social norms, and social support (using support and sabotage sub-scales), frequency of viewing PA-related content, and membership in PA-focused social media communities. Regression analyses adjusted for gender, race, and ethnicity assessed associations between social factors and PA. Non-parametric tests were conducted for additional comparisons.
Results: Complete data were available from 208 students (Mage 20.0 years; 76.4% female, 46.6% Asian, 43.8% White; and 13.0% Hispanic). In regression models, perceived neighborhood cohesion, organized participation, and social norms did not significantly predict MVPA or strength training (ps>0.05). However social support from friends significantly predicted both MVPA and strength training (ps<0.05), while friend sabotage significantly predicted greater strength training (p=0.03). Non-parameric tests showed viewing PA-related social media was positively correlated with MVPA and strength training (ps<0.05). Membership in PA-oriented virtual communities was associated with greater strength training (p<0.05) and marginally with MVPA (p=0.051).
Conclusion: The present survey found that traditional neighborhoods and organized community factors were not significant predictors of PA, whereas peer support and engagement with PA-related social media and virtual communities were. This suggests community and social influence may need to be reimagined for effective interventions for this population, including emphasizing peer-based strategies and integrating digital platforms that foster PA-supportive social environments.
Authors:
Presenter - David Mejia, BA, University of Florida
Co-Author - Angela Jiang, University of Florida
Co-Author - Danielle Jake-Schoffman, PhD, University of Florida
Adolescent and Young Adult Survivors (AYAs) of Cancer and Their Parents’ Perceptions and Experiences Related to Physical Activity
Poster Number: D13Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity
Background: Physical activity (PA) can reduce the risk of cancer-treatment-related late effects experienced by adolescent and young adult survivors (AYAs) of cancer. Parents play a key role in their child’s PA, yet little is known about AYAs’ and their parents’ perceptions of PA.
Purpose: To describe AYAs’ and parents’ perceptions and experiences related to PA in AYAs.
Methods: Using a qualitative descriptive design, we recruited AYAs (ages 15-19) with solid tumors or blood cancers from Wilmot Cancer Institute’s Golisano Children’s Hospital. Eligibility required completion of systemic or radiation therapy within the past 1-5 years. Exclusions included surgery-only treatment, central nervous system tumors, hematopoietic cell transplantation, or amputation. Each AYA identified one parent to participate. Individual interviews were conducted with each AYA and parent, transcribed verbatim, and verified through repeated listening/reading by the first author. Data were analyzed individually and then dyadically to develop themes reflecting both perspectives. Two coders independently analyzed transcripts and reached consensus on themes.
Results: Ten AYAs [Mean age = 17.2 years (±1.4), 70% male, 40% Hodgkin Lymphoma, 100% chemotherapy] and ten parents [Mean age = 46.5 years (±4.5), 80% female] completed interviews. Most AYAs and parents were highly active with average scores of 80 (±42) and 50 (±25) on the Godin Leisure-Time Exercise Questionnaire, respectively. Four themes were identified: 1) PA perceptions changed for AYAs and parents following cancer diagnosis/treatment (e.g., shifting from engaging in PA “to be good at sports” to using it “to stay healthy”); 2) AYAs sought new ways to engage in PA, supported by parents (e.g., AYA tried new forms of PA, parent hired personal trainer); 3) PA served as an important coping mechanism for AYAs and parents (e.g., method of managing health and enhancing parent–child relationship); and 4) AYAs and parents expressed varying PA needs (e.g., AYAs wanted tailored PA programs, while parents wanted more information). Overall, AYAs and parents shared many similar perceptions. However, AYAs valued mental well-being outcomes the most, while parents valued physical function outcomes the most.
Conclusions: AYAs and their parents value PA. Research is needed to develop and test novel interventions to promote PA by engaging both AYAs and parents, while accommodating different values to improve survivorship outcomes.
Keywords: Physical activity, AdolescentsPurpose: To describe AYAs’ and parents’ perceptions and experiences related to PA in AYAs.
Methods: Using a qualitative descriptive design, we recruited AYAs (ages 15-19) with solid tumors or blood cancers from Wilmot Cancer Institute’s Golisano Children’s Hospital. Eligibility required completion of systemic or radiation therapy within the past 1-5 years. Exclusions included surgery-only treatment, central nervous system tumors, hematopoietic cell transplantation, or amputation. Each AYA identified one parent to participate. Individual interviews were conducted with each AYA and parent, transcribed verbatim, and verified through repeated listening/reading by the first author. Data were analyzed individually and then dyadically to develop themes reflecting both perspectives. Two coders independently analyzed transcripts and reached consensus on themes.
Results: Ten AYAs [Mean age = 17.2 years (±1.4), 70% male, 40% Hodgkin Lymphoma, 100% chemotherapy] and ten parents [Mean age = 46.5 years (±4.5), 80% female] completed interviews. Most AYAs and parents were highly active with average scores of 80 (±42) and 50 (±25) on the Godin Leisure-Time Exercise Questionnaire, respectively. Four themes were identified: 1) PA perceptions changed for AYAs and parents following cancer diagnosis/treatment (e.g., shifting from engaging in PA “to be good at sports” to using it “to stay healthy”); 2) AYAs sought new ways to engage in PA, supported by parents (e.g., AYA tried new forms of PA, parent hired personal trainer); 3) PA served as an important coping mechanism for AYAs and parents (e.g., method of managing health and enhancing parent–child relationship); and 4) AYAs and parents expressed varying PA needs (e.g., AYAs wanted tailored PA programs, while parents wanted more information). Overall, AYAs and parents shared many similar perceptions. However, AYAs valued mental well-being outcomes the most, while parents valued physical function outcomes the most.
Conclusions: AYAs and their parents value PA. Research is needed to develop and test novel interventions to promote PA by engaging both AYAs and parents, while accommodating different values to improve survivorship outcomes.
Authors:
Author - Yuri Choi, PhD, University of Rochester Medical Center
Co-Author - AnnaLynn M. Williams, PhD, University of Rochester Medical Center
Co-Author - Marie Flannery, PhD, University of Rochester
Co-Author - Karen Mustian, PhD, MPH, FSBM, University of Rochester School of Medicine
Co-Author - Po-Ju Lin, PhD, MPH, RD, University of Rochester Medical Center
Co-Author - Lauren V. Ghazal, PhD, FNP-BC, University of Rochester School of Nursing
Co-Author - Lindsey Mattick, PhD, University of Rochester
Co-Author - Viktor Clark, PhD, MS, BS, University of Rochester
Co-Author - Jeffrey Ramos-Santiago, PhD, University of Rochester Medical Center
Co-Author - Sally Norton, PhD, RN, University of Rochester
Co-Author - Meghan L. Underhill, PhD, APRN, University of Rochester School of Nursing
Moderators of Effects of Adjunctive Exercise on Smoking Cessation Among Women: The Role of Socioeconomic Status
Poster Number: D130Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Women's Health
Smoking remains a leading preventable cause of morbidity and mortality in the US, with women less likely to successfully quit than men. Prior research has shown that exercise can attenuate common barriers to quitting among women, including cigarette cravings, withdrawal symptoms, and fear of weight gain. However, meta-analyses have not demonstrated an overall effect of exercise on smoking cessation rates. This discrepancy suggests the effects of exercise on smoking cessation may be heterogeneous. This study examined whether socioeconomic status (SES) (i.e., education, household income, employment status, occupational category) and race/ethnicity moderated the effects of adjunctive exercise on smoking cessation among women with low levels of physical activity enrolled in a smoking cessation program. First, a latent variable was created as a function of education, income, employment and race/ethnicity (as these constructs were highly correlated in the sample). Next, the latent SES construct was entered as a conditional effect into a Generalized Estimating Equation to examine potential moderating effects on the association between group assignment (exercise/control) and 7-day point-prevalence abstinence (PPA) at end of treatment. The final sample included 105 women (Age M= 42.5, SD=11.2; 93% non-Hispanic white enrolled in a 12-week a smoking cessation program (brief counseling and nicotine patch), plus random assignment to moderate intensity exercise or control. SES and race/ethnicity were self-reported at baseline. Smoking cessation outcomes were defined as 7-day PPA at 12-weeks. Statistical analyses included longitudinal models, with Generalized Estimating Equations with robust standard errors. Models included the main effects of the latent SES variable, treatment assigned, time, treatment x SES and covariates. Results indicate a significant moderating effect such that women randomized to exercise who had higher weighted scores on SES were significantly more likely to be quit at end of treatment compared to control (OR=1.72, 95% CI: 1.40-4.29). There were no significant findings among those with low latent SES scores (p=.46). These findings provide support for exercise as an adjunct to smoking cessation treatment among women with SES indicators at or above national median levels. Future work should investigate how to better support smoking cessation and physical activity among women with low SES.
Keywords: Women's health, SmokingAuthors:
Author - Michael Onu, BS, Brown University
Co-Author - Shira Dunsiger, PhD, Brown University, School of Public Health
Co-Author - Lauren Connell Bohlen, PhD, Brown University School of Public Health
Co-Author - Cara Murphy, PhD, Brown University
Co-Author - Tayla Von Ash, ScD, MPH, Brown University School of Public Health
Co-Author - David Williams, PhD, FSBM, Brown University
Evaluating the Implementation of an Exercise is Medicine® Solution in Family Medicine Clinics at a Large, Academic Teaching Hospital in the U.S.
Poster Number: D131Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Implementation Science
Background: Physical activity (PA) reduces chronic disease risk, but 75% of U.S. adults do not meet PA guidelines. Healthcare systems can promote PA. The Exercise is Medicine® (EIM) solution has been adopted by multiple healthcare systems, but its impact is understudied.
Purpose: To evaluate the implementation of an EIM solution at a large, academic teaching hospital in the U.S.
Methods: An EIM solution was implemented in Family Medicine clinics from June 2023-March 2025. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guided its evaluation. The number (%) of patients who were (1) screened for inactivity, (2) identified as inactive, (3) interested in referral to one of three behavioral counseling interventions (BCIs), and (4) connected with a BCI was assessed (Reach & Effectiveness). The ability to identify inactive patients in clinic was confirmed by out-of-clinic accelerometry (Effectiveness). The number (%) of providers referring patients were described (Adoption). Changes to (1) the solution’s language and (2) provider burden were made and evaluated (Implementation). The variability in outcomes over the last 6 and 12 months were calculated (Maintenance).
Results: Out of 1,855 patients screened for inactivity each month, 1,069 (57.6%) were identified as inactive. A median of 311 (29%) inactive patients expressed interested in a BCI, with 251 (87.2%) referred, and 20 patients connected with a BCI per month. A median of 1.8%, 6.5%, and 9.4% of patients who were inactive, interested in referral, and referred, were connected to a BCI per month, respectively. Patients connected to a BCI were mostly women (64%), non-Hispanic, (92%), White (87%), married (79%), and had at least a bachelor’s degree (68%). 44% of patients identified as inactive in clinic met PA recommendations via accelerometry. A median of 45 (68.2%) providers referred patients per month. Changes to the solution had marked impacts on RE-AIM outcomes. Most outcomes demonstrated high variability (CVs >10%) in the last 6 to 12 months of evaluation.
Conclusion: This was our initial effort to identify and refer patients to PA resources from primary care. Strategies that better (1) identify inactive patients, (2) connect patients to resources, and (3) maintain its adoption should be developed, tested, and implemented if effective. Future work should evaluate the extent to which this solution improves patient health, reduces costs, and promotes health equity.
Keywords: Physical activity, Primary carePurpose: To evaluate the implementation of an EIM solution at a large, academic teaching hospital in the U.S.
Methods: An EIM solution was implemented in Family Medicine clinics from June 2023-March 2025. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guided its evaluation. The number (%) of patients who were (1) screened for inactivity, (2) identified as inactive, (3) interested in referral to one of three behavioral counseling interventions (BCIs), and (4) connected with a BCI was assessed (Reach & Effectiveness). The ability to identify inactive patients in clinic was confirmed by out-of-clinic accelerometry (Effectiveness). The number (%) of providers referring patients were described (Adoption). Changes to (1) the solution’s language and (2) provider burden were made and evaluated (Implementation). The variability in outcomes over the last 6 and 12 months were calculated (Maintenance).
Results: Out of 1,855 patients screened for inactivity each month, 1,069 (57.6%) were identified as inactive. A median of 311 (29%) inactive patients expressed interested in a BCI, with 251 (87.2%) referred, and 20 patients connected with a BCI per month. A median of 1.8%, 6.5%, and 9.4% of patients who were inactive, interested in referral, and referred, were connected to a BCI per month, respectively. Patients connected to a BCI were mostly women (64%), non-Hispanic, (92%), White (87%), married (79%), and had at least a bachelor’s degree (68%). 44% of patients identified as inactive in clinic met PA recommendations via accelerometry. A median of 45 (68.2%) providers referred patients per month. Changes to the solution had marked impacts on RE-AIM outcomes. Most outcomes demonstrated high variability (CVs >10%) in the last 6 to 12 months of evaluation.
Conclusion: This was our initial effort to identify and refer patients to PA resources from primary care. Strategies that better (1) identify inactive patients, (2) connect patients to resources, and (3) maintain its adoption should be developed, tested, and implemented if effective. Future work should evaluate the extent to which this solution improves patient health, reduces costs, and promotes health equity.
Authors:
Author - Garrett Steinbrink, M.S., University of Iowa
Co-Author - Jenna Springer, M.S., University of Iowa
Co-Author - Leah Aitchison, University of Iowa
Co-Author - Britt Marcussen, M.D., University of Iowa Healthcare
Co-Author - Korey Kennelty, PharmD, Ph.D., University of Iowa Healthcare
Co-Author - Dale Bond, Ph.D., Hartford Healthcare
Co-Author - Yin Wu, Ph.D., Hartford Healthcare
Co-Author - Lucas Carr, Ph.D., University of Iowa
Evaluating the effects of optimized versus generic text messages written by artificial intelligence on momentary urges to move among middle-aged and older adults
Poster Number: D132Time: 11:00 AM - 11:50 AM
Topics: Physical Activity, Digital Health
Background: Text messages that engage urges to move could support physical activity (PA) behavior change. Previously, we identified optimal prompt features to engage urges to move in generative AI (GenAI)-authored messages. Message features included preparatory or execution contexts, long- or short-term benefits, and remembered past or imagined future experiences. The purpose of this study was to evaluate the effect of messages written using urge-optimized prompts compared to generic prompts to promote PA on engaging urges to move.
Methods: Adults aged 40 years or older, reporting less than 150 min/week of PA were recruited through Prolific. Text messages targeting moving more and sitting less were written by GenAI using high-urge (prompts that produced the strongest urges), low-urge optimized (prompts that produced the weakest urges), and generic prompts (contained no urge features). Messages (24 for each type) were presented in a randomized order. After reading each message, participants rated how strongly they desired to move with higher ratings indicating stronger urges. A multilevel model where messages were nested within people was estimated to compare the effects of optimized messages versus generic messages on urges to move.
Results: Participants (N=298; 54.7% female) had a mean age of 56.9 (SD=10.3) years. Messages written with high-urge optimized prompts produced significantly stronger urges than those written with generic prompts (b=0.48; p=0.02). There were no significant differences between low-urge optimized and generic prompts (p=0.92). Age moderated those effects for both high-urge (b=-0.01; p=0.02) and low-urge optimized messages (b=-0.01; p=0.02), where the differences between optimized and generic messages was greater for middle-aged adults compared to older adults. Behavioral target (move more or sit less) moderated the effect of message type for both high- (b=0.28; p<0.001) and low-urge optimized messages (b=-0.41; p<0.001). High-urge optimized messages produced stronger urges than generic, but only for move more messages. Low-urge optimized messages produced weaker urges than generic messages, but this difference was greater for sit less messages.
Conclusion: Text messages can be written using GenAI to engage urges to move, compared to standard PA messages. Experimental evaluations of the effects of urge-optimized messages on behavior change are needed to determine their value in physical activity interventions.
Keywords: Physical activity, Health behavior changeMethods: Adults aged 40 years or older, reporting less than 150 min/week of PA were recruited through Prolific. Text messages targeting moving more and sitting less were written by GenAI using high-urge (prompts that produced the strongest urges), low-urge optimized (prompts that produced the weakest urges), and generic prompts (contained no urge features). Messages (24 for each type) were presented in a randomized order. After reading each message, participants rated how strongly they desired to move with higher ratings indicating stronger urges. A multilevel model where messages were nested within people was estimated to compare the effects of optimized messages versus generic messages on urges to move.
Results: Participants (N=298; 54.7% female) had a mean age of 56.9 (SD=10.3) years. Messages written with high-urge optimized prompts produced significantly stronger urges than those written with generic prompts (b=0.48; p=0.02). There were no significant differences between low-urge optimized and generic prompts (p=0.92). Age moderated those effects for both high-urge (b=-0.01; p=0.02) and low-urge optimized messages (b=-0.01; p=0.02), where the differences between optimized and generic messages was greater for middle-aged adults compared to older adults. Behavioral target (move more or sit less) moderated the effect of message type for both high- (b=0.28; p<0.001) and low-urge optimized messages (b=-0.41; p<0.001). High-urge optimized messages produced stronger urges than generic, but only for move more messages. Low-urge optimized messages produced weaker urges than generic messages, but this difference was greater for sit less messages.
Conclusion: Text messages can be written using GenAI to engage urges to move, compared to standard PA messages. Experimental evaluations of the effects of urge-optimized messages on behavior change are needed to determine their value in physical activity interventions.
Authors:
Presenter - Allyson Tabaczynski, PhD, University of Michigan
Co-Author - Yingjia Liu, MS, University of Michigan
Co-Author - Saeed Abdullah, PhD, The Pennsylvania State University
Co-Author - Lizbeth Benson, PhD, University of Michigan
Co-Author - David Conroy, PhD, FSBM, University of Michigan
Sexual violence trauma in cisgender/heterosexual women and women who identify as members of the LGBTQ+ community: Risk for probable nightmare disorder and moderate to severe inosmnia
Poster Number: D133Time: 11:00 AM - 11:50 AM
Topics: Sleep, Women's Health
Emerging adult women are at higher risk of exposure to sexual violence traumatic events such as Sexual Assault (SA) than men of a similar age. However, few studies have investigated the impact of SA on risk for clinically significant insomnia and nightmare symptoms, as indicated by scores on screening measures that exceed established clinical cut-off thresholds. Fewer studies still have investigated risk among women who identify as members of the LGBTQ+ community. To estimate risk of sleep disorders based on SA history, we gathered data from an introductory psychology course at a large midwestern university (N=957: 565 women, 95 identified as members of LGBTQ+ community). Study participants completed the Life Event Checklist (LEC), the Insomnia Severity Index (ISI), and the Nightmare Disorder Index (NDI).
Of 565 women 137 (24%) reported a lifetime history of SA. Cisgender/Heterosexual women with a history of SA had an 8.7 times greater risk of an NDI score indicative of nightmare disorder, and a 3.6 times greater risk of ISI scores indicative of moderate to severe insomnia symptoms. Women who identified as members of the LGBTQ+ community had a 9.35 times greater risk of scores indicative of nightmare disorder and 6.85 times greater risk of scores consistent (χ² ranged from 11.04 to 50.238, all p<.004). Because of limitations of the sample, we could not examine gender identity and sexual orientation separately. That important concern aside, these data indicate that SA history among women is a risk factor for clinically relevant sleep disorder symptomatology.
Keywords: Sleep disorders, TraumaOf 565 women 137 (24%) reported a lifetime history of SA. Cisgender/Heterosexual women with a history of SA had an 8.7 times greater risk of an NDI score indicative of nightmare disorder, and a 3.6 times greater risk of ISI scores indicative of moderate to severe insomnia symptoms. Women who identified as members of the LGBTQ+ community had a 9.35 times greater risk of scores indicative of nightmare disorder and 6.85 times greater risk of scores consistent (χ² ranged from 11.04 to 50.238, all p<.004). Because of limitations of the sample, we could not examine gender identity and sexual orientation separately. That important concern aside, these data indicate that SA history among women is a risk factor for clinically relevant sleep disorder symptomatology.
Authors:
Author - Nancy Hamilton, PhD, University of Kansas
Author - Garrett Baber, MA, University of Kansas
Author - Matthew Gratton, M.A., University of Kansas
Author - Julia Russell, PhD, John's Hopkins
Author - Elijah Nichols, BA, University of Kansas
Author - Anna Quesada, BA, University of Kansas
Factors contributing to sleep disparities among Asian Americans: An ecological review
Poster Number: D134Time: 11:00 AM - 11:50 AM
Topics: Sleep
Background: Asian Americans experience disproportionately high rates of sleep disturbances, yet the multilevel factors driving these disparities remain underexplored.
Objective: Guided by the Socio-Ecological Model, this review synthesizes the intrapersonal, interpersonal/family, community/occupational, and societal determinants contributing to sleep-related problems among Asian Americans.
Methods: We conducted a systematic search of Google Scholar, MEDLINE, PsycINFO, and Social Science Abstracts for English-language empirical and review studies. Search terms combined "Asian American" or specific ethnic subgroups (e.g., Chinese, Filipino, Hmong, Vietnamese) with sleep-related outcomes (e.g., sleep duration, quality, disorders). Eligible studies were categorized across four ecological levels: individual/intrapersonal, interpersonal/family, community/occupational, and societal.
Findings: At the individual/intrapersonal and interpersonal levels, acculturative stress, family pressure, and perceived discrimination are consistently associated with shorter sleep duration and poorer sleep quality. Community‐level factors, such as low income, crowded housing, and shift work, further compromised sleep health. Societal barriers, including high uninsured rates and out-of-pocket costs, and a shortage of bilingual, bicultural CBT-I providers and culturally tailored resources, impede help-seeking and treatment adherence.
Conclusions: Sleep disparities among Asian Americans stem from complex, interacting factors across multiple ecological levels. Interventions must move beyond individual behavior change and incorporate multilevel strategies to address these intersecting barriers, which are essential to improving sleep health in this population.
Keywords: Sleep disorders, Minority healthObjective: Guided by the Socio-Ecological Model, this review synthesizes the intrapersonal, interpersonal/family, community/occupational, and societal determinants contributing to sleep-related problems among Asian Americans.
Methods: We conducted a systematic search of Google Scholar, MEDLINE, PsycINFO, and Social Science Abstracts for English-language empirical and review studies. Search terms combined "Asian American" or specific ethnic subgroups (e.g., Chinese, Filipino, Hmong, Vietnamese) with sleep-related outcomes (e.g., sleep duration, quality, disorders). Eligible studies were categorized across four ecological levels: individual/intrapersonal, interpersonal/family, community/occupational, and societal.
Findings: At the individual/intrapersonal and interpersonal levels, acculturative stress, family pressure, and perceived discrimination are consistently associated with shorter sleep duration and poorer sleep quality. Community‐level factors, such as low income, crowded housing, and shift work, further compromised sleep health. Societal barriers, including high uninsured rates and out-of-pocket costs, and a shortage of bilingual, bicultural CBT-I providers and culturally tailored resources, impede help-seeking and treatment adherence.
Conclusions: Sleep disparities among Asian Americans stem from complex, interacting factors across multiple ecological levels. Interventions must move beyond individual behavior change and incorporate multilevel strategies to address these intersecting barriers, which are essential to improving sleep health in this population.
Authors:
Co-Author - Shannon Cheung, Hackensack Meridian Health - Center for Discovery and Innovation
Co-Presenter - Aleena Kuriakose, Hackensack Meridian Health
Author - Gary Kwok, PhD, Hackensack Meridian Health
Examining differences in perceived social support across chronotypes in college students
Poster Number: D135Time: 11:00 AM - 11:50 AM
Topics: Sleep, Social and Environmental Context and Health
Introduction: Chronotype refers to an individual’s preference for sleep-wake times and is often classified as morning-types (MTs), intermediate-types (ITs), or evening-types (ETs). Evening preference has been linked to poorer health outcomes in college students, including increased substance use and worse mental health. Social support may buffer these risks, but evidence linking it to chronotype is mixed. Examining specific types of social support, rather than composite scores, may clarify these findings by demonstrating whether chronotypes perceive distinct forms of support differently. We hypothesized that perceived social support would differ across chronotypes, with variations depending on the type of support. Methods: In an online cross-sectional study, 617 college students (mean age±SD = 19.65±2.61 years; 73% female; 44% White) completed the Composite Scale of Morningness (CSM) to assess chronotype and the Interpersonal Support Evaluation List (ISEL)-College Version to assess social support (subscales: tangible, self-esteem, appraisal, belonging). A MANOVA was run to examine differences in social support across chronotypes. Results: Chronotypes included 16 MTs, 533 ITs, and 68 ETs. A one-way MANOVA found significant differences across chronotype, F(8,1222)=3.91, p< .001. Follow-up ANOVAs (Bonferroni-adjusted α=.0125) showed group effects for tangible, F(2,614)=6.76, p=.001, and self-esteem, F(2,614)=6.56, p=.002, but not for appraisal (p=.358) or belonging (p=.316). Post-hoc tests indicated MTs (M=42.31, SD=6.20) reported more tangible support than ITs (M=37.25, SD=6.11; p=.003), and ETs (M=30.12, SD=5.36) reported lower self-esteem support than both MTs (M=34.38, SD=4.90; p=.008) and ITs (M=32.17, SD=5.12; p=.006). Discussion: Findings suggest that chronotype is linked to differences in perceived social support, with effects specific to support type. MTs report more tangible support, potentially due to better alignment of their routines with their social networks, which may make practical help more accessible. In contrast, ETs report lower self-esteem support, potentially reflecting schedule misalignment or greater social isolation, which could reduce opportunities for affirmation and positive social comparisons. Examining distinct types of social support reveals chronotype-specific patterns, notably highlighting ETs’ risk for lower self-esteem support, and offers potential insights for addressing social and health challenges for college students.
Keywords: Social support, HealthAuthors:
Author - Ashley Miller, MS, Virginia Commonwealth University
Co-Author - Rachel Pitts, MS, Virginia Commonwealth University
Co-Author - Madeleine Suhs, BS, Virginia Commonwealth University
Co-Author - James Clark, Virginia Commonwealth University
Co-Author - Robin Everhart, PhD, Virginia Commonwealth University
Sleep Changes before and After Healthy Lifestyle Behavioral Intervention for Parent-Child Dyads among Pediatric Cancer Survivors
Poster Number: D136Time: 11:00 AM - 11:50 AM
Topics: Sleep, Child and Family Health
Background: Sleep quality and quantity are often disrupted following cancer treatment, particularly in pediatric populations who face additional challenges such as weight fluctuations, treatment-related late effects, pain, and anxiety. Parents of pediatric cancer survivors (PCS) may also experience compromised sleep, potentially driven by ongoing stress and anxiety related to their child’s cancer journey. Despite these concerns, sleep disturbances within parent-child dyads remain underexplored. This project aims to address this gap by evaluating changes in sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), among parents and PCS with overweight/obesity before and after participating in a healthy lifestyle behavioral intervention.
Methods: Parents and children who finished an ongoing randomized control lifestyle behavioral intervention (NOURISH-T+) and completed the PSQI before and after receiving an 8-week intervention. A total of 93 parent-child dyads (total n=186) were included in this analysis. PSQI scores were summed (range 1-21), with higher scores being worse sleep quality. A paired-samples t-test was conducted to compare pre- and post-intervention PSQI scores. Descriptive statistics were performed for demographics.
Results: Most parents identified as female (n=88; 94%), with an average age (SD) of 43 (7.7) years, and 28% identified as Hispanic/Latino (n=26). 50% children were female (n=47), with an average age (SD) of 12 (3) years, and 25% identified as Hispanic/Latino (n=23). The average Children’s body mass index (BMI) percentile (SD) was 94 (4.4), and the parents’ average (SD) BMI was 34.3 (8.4) kg/m2. Between the pre-intervention (mean=9.423.3) and post-intervention (mean=10.33.2) PSQI scores, a significant difference was observed in parents’ reported scores (MD=-0.849, t(92)=-2.686, p=.009), indicating that parents showed improved sleep scores post-intervention. However, there was no significant change in PSI among children (t(92)=0.565, p=.574).
Conclusion: Parents of children with PCS demonstrated significant improvements in sleep behaviors, as evidenced by higher PSQI scores following participation in a healthy lifestyle behavioral intervention. These findings underscore the importance of integrating behavioral medicine into broader health strategies and highlight the potential of lifestyle interventions as scalable, evidence-based solutions.
Keywords: Cancer survivorship, Sleep disordersMethods: Parents and children who finished an ongoing randomized control lifestyle behavioral intervention (NOURISH-T+) and completed the PSQI before and after receiving an 8-week intervention. A total of 93 parent-child dyads (total n=186) were included in this analysis. PSQI scores were summed (range 1-21), with higher scores being worse sleep quality. A paired-samples t-test was conducted to compare pre- and post-intervention PSQI scores. Descriptive statistics were performed for demographics.
Results: Most parents identified as female (n=88; 94%), with an average age (SD) of 43 (7.7) years, and 28% identified as Hispanic/Latino (n=26). 50% children were female (n=47), with an average age (SD) of 12 (3) years, and 25% identified as Hispanic/Latino (n=23). The average Children’s body mass index (BMI) percentile (SD) was 94 (4.4), and the parents’ average (SD) BMI was 34.3 (8.4) kg/m2. Between the pre-intervention (mean=9.423.3) and post-intervention (mean=10.33.2) PSQI scores, a significant difference was observed in parents’ reported scores (MD=-0.849, t(92)=-2.686, p=.009), indicating that parents showed improved sleep scores post-intervention. However, there was no significant change in PSI among children (t(92)=0.565, p=.574).
Conclusion: Parents of children with PCS demonstrated significant improvements in sleep behaviors, as evidenced by higher PSQI scores following participation in a healthy lifestyle behavioral intervention. These findings underscore the importance of integrating behavioral medicine into broader health strategies and highlight the potential of lifestyle interventions as scalable, evidence-based solutions.
Authors:
Author - Rachel Sauls, University of North Carolina at Chapel Hill
Co-Author - Jocelyn Jarvis, BS, University of South Florida
Co-Author - Ana Paula Rodrigues, PhD, University of South Florida
Co-Author - Sahar Heydari, University of South Florida
Co-Author - Heewon Gray, PhD, University of South Florida
Co-Author - Marilyn Stern, PhD, University of South Florida
A Scoping Review of the Effects of Light Therapy Interventions on Non-Clinical Sleep and Mood Disturbances
Poster Number: D137Time: 11:00 AM - 11:50 AM
Topics: Sleep, Mental Health
Background One in three adults experience sleep disturbances and one in five adults experience symptoms of anxiety or depression. Light therapy is an emerging approach to regulate sleep and mood disturbances, however, little research has systematically captured the strength of these effects in non-clinical populations. The purpose of this review was to quantify the magnitude of the effect of light exposure interventions on non-clinical sleep and mood disturbances among adults in the general population. Methods This review followed the PRISMA-ScR guidelines for a scoping review. The search was conducted in PubMed, Web of Science, Scopus, PsycINFO, and CINAHL using search terms related to light therapy, sleep, and mood. Studies were included if they described a light therapy intervention, included either non-clinical sleep or mood outcomes, were conducted in adults, and reported sufficient data to calculate effect sizes. Studies were excluded if they did not meet inclusion criteria. Articles were reviewed and data was extracted by two independent researchers. Information on study design, intervention design, measurement protocol, and study results were extracted. Cohen’s d effect sizes were calculated using means and standard deviations, F statistics, and/or Chi-Square statistics and corrected using the Hedges g correction factor due to heterogeneity in sample size. Results The search resulted in N=7,888 studies; a total of n=114 studies were included that met inclusion criteria. Sample sizes ranged from 6 to 160 (median=33). There was a small (g=0.01) to large (g=1.96) effect of light therapy interventions on sleep variables with the largest significant effect of light therapy on sleep quality (g=0.93, p<0.001). There was a significant moderate effect (g=0.59, p<0.001) of light therapy on non-clinical depressive symptoms. Significant small effects of light therapy were observed for anxiety (g=0.23, p=0.011) and positive affect (g=0.36, p=0.007). A non-significant small effect was observed for negative affect (g=0.19, p=0.135). Conclusions This is one of the first systematic reviews to identify the magnitude of the effect of light therapy on non-clinical sleep and mood disturbances. Light therapy appears to offer particularly promising effects on sleep quality and depressive symptoms. Future research is warranted to further evaluate how moderators like age, sex, or weight status alter these effects.
Keywords: Health behaviors, InterventionsAuthors:
Author - Jamie Whitney, M.S., ATC, Pennsylvania State University
Co-Author - Victoria A. Suhy, M.S., Pennsylvania State University
Co-Author - Abigail Pauley, PhD, The Pennsylvania State University
Co-Author - Danielle Downs, PhD, The Pennsylvania State University
The Role of Socioeconomic Status in Moderating the Effects of Depression and Perceived Stress on Health Outcomes
Poster Number: D138Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Health Disparities
Background: Individuals living in socioeconomically disadvantaged neighborhoods experience higher rates of depression and stress and are less likely to engage in health behaviors. These disparities are particularly prevalent among Black women. This study examined socioeconomic status (SES) as it relates to depressive symptoms, perceived stress and health.
Methods: Analyses were conducted on baseline data from a pilot randomized controlled trial of a self-management program. Inclusion criteria were Black women, ages 18-49 with depression or stress impacting functioning and at least one hypertension risk factor. Adjusted regression models evaluated the impact of SES on the association between depression (PHQ-9) and health outcomes. SES was measured with the (1) Neighborhood Stress Score (NSS) and the (2) Area Deprivation Index (ADI). NSS provides information on income, poverty, employment, public assistance, transportation, single-parent households, and education. Health outcomes were diet, exercise, body mass index (BMI), systolic blood pressure (SBP), and smoking. Linear regressions examined NSS variables in relation to PHQ-9 and NSS as moderators between PHQ-9 and PSS-10. All models were adjusted for age, marital status, occupation, living alone, and years of education.
Results: The sample included 82 Black women; mean age was 34.49 (SD=8.44); mean years of education 14.67 (SD=2.16). Mean State ADI was 7.1 (SD 2.6) out of 10, indicating high deprivation. Participants live in areas where an average of 59.58% (25.47) live in single parent households and an average of 39.88% (18.12) have incomes <200% below the federal poverty line. In adjusted models, PHQ-9 was positively associated with SBP (B = 2.19, p = .017) and moderated by ADI (PHQ-9 × ADI, B = –0.28, p = .018). SES was not a significant moderator between PHQ-9 and other health outcomes. NSS variables were not significantly related to PHQ-9. PSS-10 remained a strong predictor of higher PHQ-9 and was not moderated by NSS.
Conclusions: Neighborhood SES moderated the relationship between depression and SBP, with a weaker association in high deprivation areas. Perhaps in such areas, environmental stressors may overshadow individual mental health symptoms as primary drivers of health. As most participants resided in highly deprived areas with limited SES variability, our findings may underestimate the true moderating effects of neighborhood disadvantage on the depression-health relationship.
Keywords: Health disparities, Health outcomesMethods: Analyses were conducted on baseline data from a pilot randomized controlled trial of a self-management program. Inclusion criteria were Black women, ages 18-49 with depression or stress impacting functioning and at least one hypertension risk factor. Adjusted regression models evaluated the impact of SES on the association between depression (PHQ-9) and health outcomes. SES was measured with the (1) Neighborhood Stress Score (NSS) and the (2) Area Deprivation Index (ADI). NSS provides information on income, poverty, employment, public assistance, transportation, single-parent households, and education. Health outcomes were diet, exercise, body mass index (BMI), systolic blood pressure (SBP), and smoking. Linear regressions examined NSS variables in relation to PHQ-9 and NSS as moderators between PHQ-9 and PSS-10. All models were adjusted for age, marital status, occupation, living alone, and years of education.
Results: The sample included 82 Black women; mean age was 34.49 (SD=8.44); mean years of education 14.67 (SD=2.16). Mean State ADI was 7.1 (SD 2.6) out of 10, indicating high deprivation. Participants live in areas where an average of 59.58% (25.47) live in single parent households and an average of 39.88% (18.12) have incomes <200% below the federal poverty line. In adjusted models, PHQ-9 was positively associated with SBP (B = 2.19, p = .017) and moderated by ADI (PHQ-9 × ADI, B = –0.28, p = .018). SES was not a significant moderator between PHQ-9 and other health outcomes. NSS variables were not significantly related to PHQ-9. PSS-10 remained a strong predictor of higher PHQ-9 and was not moderated by NSS.
Conclusions: Neighborhood SES moderated the relationship between depression and SBP, with a weaker association in high deprivation areas. Perhaps in such areas, environmental stressors may overshadow individual mental health symptoms as primary drivers of health. As most participants resided in highly deprived areas with limited SES variability, our findings may underestimate the true moderating effects of neighborhood disadvantage on the depression-health relationship.
Authors:
Author - Salayna Abdallah, BS, MA, Kent State University and University Hospitals
Co-Author - Erika Kelly , PhD, University Hospitals
Co-Author - Farren Briggs , PhD, University Hospitals
Co-Author - Martha Sajatovic, MD, Case Western Reserve University
Co-Author - Davina Patel, MS, University Hospitals Cleveland Medical Center
Co-Author - Taylor Maniglia, MA , University Hospitals Cleveland Medical Center
Co-Author - Emma Church , MA , University of Toledo and University Hospitals Cleveland Medical Center
Co-Author - Kathy-Diane Reich, MA , Kent State University
Co-Author - Nicole Fiorelli , MA , University Hospitals Cleveland Medical Center
Co-Author - Jessica Surdam, MPH, University Hospitals Cleveland Medical Center
Chair - Jennifer Levin, PhD, University Hospitals of Cleveland Medical Center/CWRU SOM
Application of Mixture Models to Study Acculturation/Enculturation among Latinos/as/x/e/Hispanic Americans in the United States: A Systematized Literature Review
Poster Number: D139Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Methods and Measurement
Introduction: This systematized literature review synthesized studies that used mixture modeling to inform on acculturation/enculturation among Latinos/as/x/e/Hispanic Americans in the United States (US). It informs on the feasibility of mixture models to study acculturation/enculturation and its relationship to contexts and health. Methods: To identify the relevant literature, several databases were searched: PubMed, CINAHL, PsycInfo, and Scopus. Articles were included in the review if the study: 1) through self-report or archival data, measured individual-level cultural variables that represented external (e.g., language use) and/or internal (e.g., familism) acculturation/enculturation, 2) used a type of mixture model (e.g., latent profile analysis, latent class analysis, latent transition analysis, or multilevel mixture modeling) to examine patterns of responses to these cultural variables, 3) included US-residing Latino/a/x/e/Hispanic American adults (>18 years), and 4) were published in English or Spanish. Results: Twenty-nine individual studies met eligibility criteria. This yielded 115 classes/profiles. Findings show that cross-sectional and longitudinal mixture models are feasible to measure acculturation/enculturation as a multidimensional, bidirectional, context-dependent process, and can distinguish between internal versus external acculturation/enculturation. Eighteen studies used Berry’s (1997) typologies to guide the interpretation of their classes/profiles. The synthesis found that thirty-four classes/profiles (30.63%) could be identified as separation, 53 could be identified as integration/bicultural (47.75%), 16 could be identified as assimilation (14.41%), and 8 could be identified as marginalization (7.21%). The synthesis also found that mixture models can be extended to examine the relationship between acculturation/enculturation and both health and contexts. Findings depict several statistically significant relationships between classes/profiles and both health and contextual variables. An important caveat when interpreting these findings is that several studies had limitations in the design and evaluation of their mixture models. Conclusions: This review provides novel knowledge and recommendations on how to apply mixture models to study US Latinos/as/x/e/Hispanic Americans’ acculturation/enculturation and health according to modern acculturation/enculturation theory.
Keywords: Acculturation, CultureAuthors:
Presenter - Cristian Garcia Alacaraz, MA, MS, San Diego State University/University of California San Diego
Co-Author - Karl Bailey Williams, MA, SDSU HealthLINK Center
Author - Guadalupe Xochitl Ayala, PhD, SDSU HealthLINK Center
Author - Vanessa Malcarne, PhD, FSBM, San Diego State University
Author - Scott Roesch, PhD, San Diego State University
Author - Kristen Wells, PhD MPH, San Diego State University
Variation in Genetic Literacy by Cancer Diagnosis, Education, Health Literacy, and Language Among a Diverse Cohort of Cancer Patients in New York City
Poster Number: D14Time: 11:00 AM - 11:50 AM
Topics: Cancer, Health Communication and Policy
Background: Medically underserved and racial/ethnic minority cancer patients access genetic testing for hereditary cancers at lower rates than medically advantaged and White patients. Research has recognized a gap in genetic literacy that may impact decision-making processes and testing access. Although factors such as education, health literacy, and language are associated with genetic literacy, there is limited insight into how genetic literacy differs by cancer diagnosis among this population. Understanding the impact of diagnosis on genetic literacy may highlight inequities in how genetic information is communicated or prioritized.
Methods: In an ongoing trial to develop, test, and evaluate a linguistically and culturally appropriate streamlined approach to genetic testing, we conducted baseline surveys with N=93 breast (66%), colorectal (12%), and prostate (23%) cancer patients in four New York City hospitals. The survey contains self-reported sociodemographic factors and validated measures of genetic literacy and health literacy. We used one-way ANOVA to assess if genetic literacy differs by cancer type and ANCOVA to control for education, health literacy, and language.
Results: Most participants (age M=62.6) identified as women (70%) and non-Hispanic (67%). Races included Black (53%), Other (18%), White (12%), Asian (8%), and American Indian/Alaska Native (3%). Education varied with 48% completing post high school training or education. Participants spoke English (73%) or Spanish (27%). One-way ANOVA indicated significant differences in genetic literacy (M=5.07, SD=1.79) by cancer diagnosis (F(2,90)=4.18, p=.018) such that those with breast cancer had significantly higher scores than those with colorectal (p=.013), but not significantly more than prostate (p=.86). The difference between prostate and colorectal was not significant (p=.08). Analysis confirmed genetic literacy did not differ by gender. After controlling for education, health literacy, and language, cancer diagnosis was no longer significant (p=.11), although education was significantly associated with genetic literacy (F(1,87)=8.86, p=.004).
Conclusion: Genetic literacy did not differ by cancer type while controlling for education, health literacy, and language, yet it was associated with education. Few studies have addressed informational needs of this population. Tailoring strategies to account for differences in education levels may aid in ensuring equitable testing access.
Keywords: Cancer, GeneticsMethods: In an ongoing trial to develop, test, and evaluate a linguistically and culturally appropriate streamlined approach to genetic testing, we conducted baseline surveys with N=93 breast (66%), colorectal (12%), and prostate (23%) cancer patients in four New York City hospitals. The survey contains self-reported sociodemographic factors and validated measures of genetic literacy and health literacy. We used one-way ANOVA to assess if genetic literacy differs by cancer type and ANCOVA to control for education, health literacy, and language.
Results: Most participants (age M=62.6) identified as women (70%) and non-Hispanic (67%). Races included Black (53%), Other (18%), White (12%), Asian (8%), and American Indian/Alaska Native (3%). Education varied with 48% completing post high school training or education. Participants spoke English (73%) or Spanish (27%). One-way ANOVA indicated significant differences in genetic literacy (M=5.07, SD=1.79) by cancer diagnosis (F(2,90)=4.18, p=.018) such that those with breast cancer had significantly higher scores than those with colorectal (p=.013), but not significantly more than prostate (p=.86). The difference between prostate and colorectal was not significant (p=.08). Analysis confirmed genetic literacy did not differ by gender. After controlling for education, health literacy, and language, cancer diagnosis was no longer significant (p=.11), although education was significantly associated with genetic literacy (F(1,87)=8.86, p=.004).
Conclusion: Genetic literacy did not differ by cancer type while controlling for education, health literacy, and language, yet it was associated with education. Few studies have addressed informational needs of this population. Tailoring strategies to account for differences in education levels may aid in ensuring equitable testing access.
Authors:
Co-Author - Stephanie N. Christian-Afflu, PhD, MPH, Memorial Sloan Kettering Cancer Center
Co-Author - Anthony M. Chicaiza, MS, Memorial Sloan Kettering Cancer Center
Co-Author - Etson Barthelus, MA, Memorial Sloan Kettering Cancer Center
Co-Author - Sabrina Oliveros, MS, Memorial Sloan Kettering Cancer Center
Co-Author - Rania Sheikh, MS, CGC, Memorial Sloan Kettering Cancer Center
Co-Author - Anna Strang, MS, CGC, Memorial Sloan Kettering Cancer Center
Co-Author - Elizabeth Schofield, DrPH, Memorial Sloan Kettering Cancer Center
Co-Author - Rosa Nouvini, MD, Memorial Sloan Kettering Cancer Center, Jamaica Hospital Medical Center
Co-Author - J. Jaime Alberty-Oller, MD, NYC Health + Hospitals/Kings County
Co-Author - Andrew G. Winer, MD, NYC Health + Hospitals/Kings County
Co-Author - Jason P. Gonsky, MD, PhD, NYC Health + Hospitals/Kings County
Co-Author - Linda Bulone, RN, OCN, CCRC, Queens Cancer Center of NYC Health + Hospitals/Queens
Co-Author - Ying L. Liu, MD, MPH, Memorial Sloan Kettering Cancer Center
Co-Author - Kenneth Offit, MD, MPH, Memorial Sloan Kettering Cancer Center
Co-Author - Mark E. Robson, MD, Memorial Sloan Kettering Cancer Center
Co-Author - Jennifer L. Hay, PhD, Memorial Sloan Kettering Cancer Center
Co-Author - Zsofia K. Stadler, MD, Memorial Sloan Kettering Cancer Center
Co-Author - Jada G. Hamilton, PhD, MPH, Memorial Sloan Kettering Cancer Center
School-level Demographics Predict Prices of Foods in Nearby Convenience Stores
Poster Number: D140Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Child and Family Health
Unhealthy food environments near schools remain a major barrier to improving child health. Studies have found that unhealthy food outlets like convenience stores are prevalent near schools, especially those predominantly attended by minoritized and low-income children. Although food pricing at these stores may play a key role, the relationship between school demographic composition and nearby store pricing has been underexplored. We examine if prices of unhealthy and healthy snacks and beverages differ between convenience stores based on ethnic and socio-economic composition of nearby schools.
We obtained item- and store-level data from Nielsen’s Retail Scanner database for chain convenience store sales during academic years 2018–2019 and 2022–2023, including sales volume and prices. We linked it to school-level ethnic composition and free or reduced price [FRPM] eligibility of students in public schools located within one mile of each store. The analytic dataset had 1,765 stores and 177 top-selling items grouped into six categories (healthy/unhealthy beverages, sweet snacks, and healthy/unhealthy salty snacks). To examine associations between store-level item prices with surrounding school demographics, we fit scaled marginal models with multiple continuous outcomes, treating stores as subjects and item prices as outcomes. Models estimated standardized associations averaging across items (average effect size), and item-specific associations, adjusted for urbanicity.
A 10% increase in White student enrollment in nearby schools was associated with lower prices for sweet snacks (effect size: b = –0.069, 95% CI: –0.091, –0.046), unhealthy salty snacks (b = –0.041, 95% CI: –0.063, –0.019), healthy salty snacks (b = –0.023, 95% CI: –0.044, –0.002), and healthy beverages (b = –0.093, 95% CI: –0.122, –0.064). Higher poverty concentration was linked to higher prices: a 10% increase in FRPM eligibility among students in nearby schools was associated with higher prices for sweet snacks (b = 0.029, 95% CI: 0.012, 0.046) and healthy beverages (b = 0.045, 95% CI: 0.023, 0.067).
This study contributes to the literature by adding evidence of price differences across stores within children’s school environments. Prices of both healthy and unhealthy foods and drinks were lower when stores were located near schools with higher proportions of children who were White or from high income households. Implications will be discussed.
Keywords: Built environment, NutritionWe obtained item- and store-level data from Nielsen’s Retail Scanner database for chain convenience store sales during academic years 2018–2019 and 2022–2023, including sales volume and prices. We linked it to school-level ethnic composition and free or reduced price [FRPM] eligibility of students in public schools located within one mile of each store. The analytic dataset had 1,765 stores and 177 top-selling items grouped into six categories (healthy/unhealthy beverages, sweet snacks, and healthy/unhealthy salty snacks). To examine associations between store-level item prices with surrounding school demographics, we fit scaled marginal models with multiple continuous outcomes, treating stores as subjects and item prices as outcomes. Models estimated standardized associations averaging across items (average effect size), and item-specific associations, adjusted for urbanicity.
A 10% increase in White student enrollment in nearby schools was associated with lower prices for sweet snacks (effect size: b = –0.069, 95% CI: –0.091, –0.046), unhealthy salty snacks (b = –0.041, 95% CI: –0.063, –0.019), healthy salty snacks (b = –0.023, 95% CI: –0.044, –0.002), and healthy beverages (b = –0.093, 95% CI: –0.122, –0.064). Higher poverty concentration was linked to higher prices: a 10% increase in FRPM eligibility among students in nearby schools was associated with higher prices for sweet snacks (b = 0.029, 95% CI: 0.012, 0.046) and healthy beverages (b = 0.045, 95% CI: 0.023, 0.067).
This study contributes to the literature by adding evidence of price differences across stores within children’s school environments. Prices of both healthy and unhealthy foods and drinks were lower when stores were located near schools with higher proportions of children who were White or from high income households. Implications will be discussed.
Authors:
Author - Sydney Miller, PhD, Drexel University
Co-Author - Yijun Guo, Drexel University
Co-Author - Emma Sanchez-Vaznaugh, Sc.D., MPH, San Francisco State University
Co-Author - Brisa Sanchez, Drexel University
Social and physical environmental correlates of movement behaviors, body weight status, and well-being among adolescents in Nigeria: A YoPA project narrative review
Poster Number: D141Time: 11:00 AM - 11:50 AM
Topics: Social and Environmental Context and Health, Health Disparities
Background: Nigeria is experiencing rapid urbanization and a chronic disease epidemiological transition, with adolescents increasingly affected by physical inactivity, sedentary behavior, overweight and obesity, as well as mental health challenges. While evidence supports the importance of social and physical environmental factors in improving adolescents’ health, understanding these issues among Nigerian adolescents remains limited. This narrative review aims to synthesize findings from available literature on social and physical environment correlates of movement behaviors, body weight status, and well-being among adolescents in Nigeria.
Methods: We searched electronic databases for original research articles, published prior to January 2025, on socioenvironmental factors and movement behaviors and health among Nigerian adolescents (aged 10-20 years). Each study underwent screening and data extraction by two reviewers. Study quality was assessed with the modified Downs and Black checklist, and data were analyzed using narrative synthesis.
Results: A total of 25 articles met the inclusion criteria, all of which were cross-sectional studies. The review suggests that social class, school settings, peer relationships, family structure, electronic device use in the bedroom, neighborhood walkability features, availability of open recreational spaces, and urbanization are important socioenvironmental factors related to multiple movement behaviors and health outcomes among Nigerian adolescents. Some of these relationships were modified by gender and socioeconomic status.
Conclusions: The evidence highlights the need for context-specific interventions and more longitudinally designed research that incorporates socioenvironmental factors to promote healthier lifestyle movement behaviors, and enhance health and overall well-being among Nigerian adolescents.
Keywords: Adolescents, Health behaviorsMethods: We searched electronic databases for original research articles, published prior to January 2025, on socioenvironmental factors and movement behaviors and health among Nigerian adolescents (aged 10-20 years). Each study underwent screening and data extraction by two reviewers. Study quality was assessed with the modified Downs and Black checklist, and data were analyzed using narrative synthesis.
Results: A total of 25 articles met the inclusion criteria, all of which were cross-sectional studies. The review suggests that social class, school settings, peer relationships, family structure, electronic device use in the bedroom, neighborhood walkability features, availability of open recreational spaces, and urbanization are important socioenvironmental factors related to multiple movement behaviors and health outcomes among Nigerian adolescents. Some of these relationships were modified by gender and socioeconomic status.
Conclusions: The evidence highlights the need for context-specific interventions and more longitudinally designed research that incorporates socioenvironmental factors to promote healthier lifestyle movement behaviors, and enhance health and overall well-being among Nigerian adolescents.
Authors:
Presenter - Adewale Oyeyemi, PhD, Arizona State University
Co-Author - Adefunke Ogunleye, M.Tech, Gender and Education Department, VARCE, Osogbo, Nigeria
Co-Author - Abita Okafor, M.Sc, Department of Physiotherapy, Redeemer’s University, Ede, Nigeria
Co-Author - Neha Kollipara, Barrett Honors College, Arizona State University, Tempe, USA
Co-Author - Mai ChinAPaw, Ph.D, Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
Co-Author - Dayo Omotoso, Ph.D, Department of Human Anatomy, Redeemer’s University, Ede, Nigeria
Stress, Positive Affect, and Gastrointestinal Symptoms in College Students During COVID-19
Poster Number: D142Time: 11:00 AM - 11:50 AM
Topics: Stress, Social and Environmental Context and Health
College students often experience high levels of stress, which can manifest in both psychological and physical symptoms, including gastrointestinal (GI) distress. Positive affect (PA) has been linked to improved health outcomes across a variety of physical health conditions and may serve as a potential buffer against stress-related physical symptoms. This study aimed to examine how perceived stress among college students during the COVID-19 pandemic influenced the severity of gastrointestinal symptoms (e.g., nausea, diarrhea, stomach pain), with positive affect moderating the relationship. During the height of the COVID-19 pandemic, data were collected from 292 students through a questionnaire assessing perceived stress and state affect in May 2020, and a second questionnaire assessing physical symptom severity in September 2020. Linear regressions were performed to analyze the main effects of an interaction between positive emotion and stress on gastrointestinal symptoms. The results indicated that students with greater levels of perceived stress reported more severity of gastrointestinal symptoms (b = 0.41, p = 0.766). However, positive affect was found not to be a significant moderator of the association between perceived stress and GI symptoms (p < 0.05). While positive affect did not significantly moderate the association between perceived stress and GI symptoms, this study emphasizes the importance of stress in reducing the physical manifestations of stress.
Keywords: Health outcomes, StressAuthors:
Author - Saori Cochachin, Chapman University
Author - Brooke Jenkins, Ph.D., Chapman University
The impact of a college biology course with integrated mindfulness practice on students’ physiological response to acute social stress
Poster Number: D143Time: 11:00 AM - 11:50 AM
Topics: Stress, Mental Health
Background: Mindfulness practice in the Thích Nhất Hạnh’s Plum Village tradition was integrated into the teaching of a ten-week college human physiology course (Mindful Physiology). This randomized controlled trial examined the course’s effect on students’ physiological reactivity to acute social stress.
Methods: Undergraduates students who attempted to enroll in Mindful Physiology were randomized to the course (N=50) or waitlist (N=135). 29 enrolled students and 47 waitlist controls consented to participate in the study (mean age 20.9 ± 2.74 years; 54% female). At course completion, 50 students (class N=17; control N=33) completed a modified Trier Social Stress Test (TSST). Students were given 5 minutes to prepare for an oral presentation for a mock job-interview and then delivered a 5-minute presentation to a remote panel that was designed to appear live but was pre-recorded. Participants then completed 5 minutes of videotaped mental arithmetic. Heart rate (HR) and inter-beat interval were recorded via a Polar H10 chest strap throughout. Participants rated their perceived stress before and after the TSST with the Subjective Units of Distress Scale (SUDS, range 0-10). Linear mixed effect models with random intercepts by participant were run to test group differences in changes in mean HR and heart rate variability (SDRR, standard deviation of beat-to-beat intervals) across TSST phases. Changes in SUDS were compared between groups with two-sample t-tests.
Results: Baseline mean HR was 76.8 bpm (SD=13.5) and SDRR was 76.3 ms (SD=50.7) across all participants and did not differ by intervention condition (p=0.11 and p=.78). HR significantly increased during the presentation phase versus baseline among all participants (mean ∆HR= 9.37 bmp, p=.001). No significant changes in HR were found during the presentation preparation (mean ∆HR=4.13, p=.10) or math challenge (mean ∆HR = -1.10, p=.28) phases. Importantly, students in the class experienced a significantly smaller increase in HR during the TSST presentation phase than controls (5.51 vs 11.53 bpm, p <.001). No significant SDRR changes were observed across phases or between groups (all p > .05). Overall, SUDS increased after the TSST (mean change = 0.88; p < .0001) but did not differ between groups (p = .24).
Conclusions: Integrating Plum Village mindfulness practice into a college physiology course was associated with lowered physiological reactivity to an acute social-evaluative stressor in students.
Keywords: Stress, MindfulnessMethods: Undergraduates students who attempted to enroll in Mindful Physiology were randomized to the course (N=50) or waitlist (N=135). 29 enrolled students and 47 waitlist controls consented to participate in the study (mean age 20.9 ± 2.74 years; 54% female). At course completion, 50 students (class N=17; control N=33) completed a modified Trier Social Stress Test (TSST). Students were given 5 minutes to prepare for an oral presentation for a mock job-interview and then delivered a 5-minute presentation to a remote panel that was designed to appear live but was pre-recorded. Participants then completed 5 minutes of videotaped mental arithmetic. Heart rate (HR) and inter-beat interval were recorded via a Polar H10 chest strap throughout. Participants rated their perceived stress before and after the TSST with the Subjective Units of Distress Scale (SUDS, range 0-10). Linear mixed effect models with random intercepts by participant were run to test group differences in changes in mean HR and heart rate variability (SDRR, standard deviation of beat-to-beat intervals) across TSST phases. Changes in SUDS were compared between groups with two-sample t-tests.
Results: Baseline mean HR was 76.8 bpm (SD=13.5) and SDRR was 76.3 ms (SD=50.7) across all participants and did not differ by intervention condition (p=0.11 and p=.78). HR significantly increased during the presentation phase versus baseline among all participants (mean ∆HR= 9.37 bmp, p=.001). No significant changes in HR were found during the presentation preparation (mean ∆HR=4.13, p=.10) or math challenge (mean ∆HR = -1.10, p=.28) phases. Importantly, students in the class experienced a significantly smaller increase in HR during the TSST presentation phase than controls (5.51 vs 11.53 bpm, p <.001). No significant SDRR changes were observed across phases or between groups (all p > .05). Overall, SUDS increased after the TSST (mean change = 0.88; p < .0001) but did not differ between groups (p = .24).
Conclusions: Integrating Plum Village mindfulness practice into a college physiology course was associated with lowered physiological reactivity to an acute social-evaluative stressor in students.
Authors:
Presenter - Zhuoya Zhang, Dartmouth College
Co-Author - Elizabeth Shelto, Dartmouth College
Co-Author - John Brand, Dartmouth College
Co-Author - Mingliang Ge, Dartmouth College
Co-Author - Caroline Borowy, Dartmouth College
Co-Author - Diane Gilbert-Diamond, ScD, Dartmouth College
Navigating Neighborhood Stressors in Opioid Use Recovery: A Qualitative Study of Methadone Treatment Engagement
Poster Number: D144Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Stress
Background:
Neighborhood stressors (NS) have emerged as significant predictors of engagement for the treatment of opioid use disorder (OUD). Individuals residing in under-resourced urban neighborhoods face many stressors, such as crime and financial instability that may interrupt recovery progress, yet these stressors remain under-explored in behavioral medicine research.
Objective:
This aim of this study was to understand how NS may contribute to methadone treatment (MT) engagement among patients with OUD. This qualitative study explored the successes and barriers to MT related to built environment characteristics, neighborhood disorder, and individual and community stressors.
Methods:
As part of a larger randomized clinical trial (NCT05933226) involving participants from a MT program in Baltimore City, MD, we conducted semi-structured, in-depth interviews until saturation was met. Interviews occurred March-June 2025. The interview guide applied concepts from the Stress Process Model to focus on neighborhood factors and individual experiences with recovery. Transcripts were analyzed using thematic analysis in NVivo, and inter-rater reliability was employed to identify themes using inductive and deductive methods, as well as open coding techniques. Themes and subthemes were formed and interpreted to expose patterns about the data.
Results:
The sample (n=18) included 11 females and 7 males: 8 Black and 10 White, with ages ranging from 27–65. Interviews lasted 30 minutes and participants received a $25 gift card. Three main themes emerged. 1) Drug exposure in the community, which described the prevalent drug use in neighborhoods, with a) barriers and b) facilitators, as sub-themes. 2) Neighborhood safety, which discussed perceptions of safety in neighborhoods and had a) barriers and b) facilitators as sub-themes. 3) Neighborhood economic disadvantages, which described structural constraints. Findings show that NS contributed to MT engagement. NS influenced recovery, but participants often demonstrated motivation to attend MT.
Discussion:
This study highlights the importance of integrating patient narratives into behavioral medicine research that deepens understanding of the ways NS shape MT engagement. Findings show how barriers and resilience strategies influence participation in MT among patients in recovery and point to the need for interventions to better support recovery and address the OUD crisis in under-resourced urban neighborhoods.
Keywords: Addictive behaviors Adherence, OpioidsNeighborhood stressors (NS) have emerged as significant predictors of engagement for the treatment of opioid use disorder (OUD). Individuals residing in under-resourced urban neighborhoods face many stressors, such as crime and financial instability that may interrupt recovery progress, yet these stressors remain under-explored in behavioral medicine research.
Objective:
This aim of this study was to understand how NS may contribute to methadone treatment (MT) engagement among patients with OUD. This qualitative study explored the successes and barriers to MT related to built environment characteristics, neighborhood disorder, and individual and community stressors.
Methods:
As part of a larger randomized clinical trial (NCT05933226) involving participants from a MT program in Baltimore City, MD, we conducted semi-structured, in-depth interviews until saturation was met. Interviews occurred March-June 2025. The interview guide applied concepts from the Stress Process Model to focus on neighborhood factors and individual experiences with recovery. Transcripts were analyzed using thematic analysis in NVivo, and inter-rater reliability was employed to identify themes using inductive and deductive methods, as well as open coding techniques. Themes and subthemes were formed and interpreted to expose patterns about the data.
Results:
The sample (n=18) included 11 females and 7 males: 8 Black and 10 White, with ages ranging from 27–65. Interviews lasted 30 minutes and participants received a $25 gift card. Three main themes emerged. 1) Drug exposure in the community, which described the prevalent drug use in neighborhoods, with a) barriers and b) facilitators, as sub-themes. 2) Neighborhood safety, which discussed perceptions of safety in neighborhoods and had a) barriers and b) facilitators as sub-themes. 3) Neighborhood economic disadvantages, which described structural constraints. Findings show that NS contributed to MT engagement. NS influenced recovery, but participants often demonstrated motivation to attend MT.
Discussion:
This study highlights the importance of integrating patient narratives into behavioral medicine research that deepens understanding of the ways NS shape MT engagement. Findings show how barriers and resilience strategies influence participation in MT among patients in recovery and point to the need for interventions to better support recovery and address the OUD crisis in under-resourced urban neighborhoods.
Authors:
Presenter - Jessica Anane, MPH, University of Maryland, College Park
Co-Author - Sophia Nahabedian, MPS, University of Maryland, College Park
Co-Author - James Butler, DrPH, MEd, University of Maryland, College Park
Co-Author - Adam Milam, MD, PhD, Mayo Clinic Arizona
Co-Author - Jessica Magidson, PhD, University of Maryland, College Park
Understanding Poverty as a Predictor of Illicit Substance Use: A Nationally Representative, Longitudinal Study
Poster Number: D145Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Stress
Background: Over 80,000 illicit drug involved deaths were reported in the United States from 2024-2025. Importantly, individuals living in poverty report higher rates of illicit drug use1 and experience disproportionate consequences than their more affluent counterparts.2-5 We address this gap by analyzing whether experiencing poverty at two life stages is associated with downstream illicit drug use.
Methods: Data were from the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study spanning from 1994-95 to 2016-18 (n=9041 to 9076, depending on type of substance). We performed logistic regression-based generalized structural equation models to assess whether poverty in adolescence (dichotomized as Yes/No at Wave I, 1994/95, when respondents were in grades 7 through 12) was associated with poverty in early adulthood (Yes/No at Wave IV, 2008-09), and whether poverty at these time points was associated with past 30 day illicit substance use later in life (Any/None at Wave V, 2016-18). We then conducted sensitivity analyses to determine whether associations differed by type of substance. Models included survey weights and age, sex, race, education, parental education, and illicit substance use in adolescence as covariates.
Results: No total effect between adolescent poverty and any illicit substance use at early midlife was found after factoring in poverty in early adulthood as a mediator. Sensitivity analyses showed a significant total effect between experiencing adolescent poverty and higher adjusted odds of prescription painkiller use not as prescribed by a doctor (Adjusted Odds Ratio (AOR): 1.46, 95% Confidence Interval (CI): 1.09-1.95). We also found early adult poverty mediated the relationship between adolescent poverty and the use of prescription painkillers (AOR: 1.40, 95% CI: 1.10-1.79) and methamphetamine (AOR: 2.24, 95% CI: 1.38-3.64), such that experiencing poverty in adolescence was associated with higher odds of adult poverty (Painkiller AOR: 2.40, p<0.001; Methamphetamine AOR: 2.39, p<0.001), which was in turn associated with prescription painkiller use (AOR: 1.48, p=0.004) and methamphetamine use (AOR: 2.52, p=0.001).
Conclusion: Experiencing poverty in adolescence was not associated with higher odds of any illicit substance use at early midlife, though significant, positive total effects existed between adolescent poverty and the likelihood of prescription painkiller use. Moreover, experiencing poverty at different life stages is associated indirectly with higher odds of prescription painkiller and methamphetamine use later in life. More research is needed to understand what is driving the relationship between poverty and substance use.
Keywords: Substance abuse, StressMethods: Data were from the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study spanning from 1994-95 to 2016-18 (n=9041 to 9076, depending on type of substance). We performed logistic regression-based generalized structural equation models to assess whether poverty in adolescence (dichotomized as Yes/No at Wave I, 1994/95, when respondents were in grades 7 through 12) was associated with poverty in early adulthood (Yes/No at Wave IV, 2008-09), and whether poverty at these time points was associated with past 30 day illicit substance use later in life (Any/None at Wave V, 2016-18). We then conducted sensitivity analyses to determine whether associations differed by type of substance. Models included survey weights and age, sex, race, education, parental education, and illicit substance use in adolescence as covariates.
Results: No total effect between adolescent poverty and any illicit substance use at early midlife was found after factoring in poverty in early adulthood as a mediator. Sensitivity analyses showed a significant total effect between experiencing adolescent poverty and higher adjusted odds of prescription painkiller use not as prescribed by a doctor (Adjusted Odds Ratio (AOR): 1.46, 95% Confidence Interval (CI): 1.09-1.95). We also found early adult poverty mediated the relationship between adolescent poverty and the use of prescription painkillers (AOR: 1.40, 95% CI: 1.10-1.79) and methamphetamine (AOR: 2.24, 95% CI: 1.38-3.64), such that experiencing poverty in adolescence was associated with higher odds of adult poverty (Painkiller AOR: 2.40, p<0.001; Methamphetamine AOR: 2.39, p<0.001), which was in turn associated with prescription painkiller use (AOR: 1.48, p=0.004) and methamphetamine use (AOR: 2.52, p=0.001).
Conclusion: Experiencing poverty in adolescence was not associated with higher odds of any illicit substance use at early midlife, though significant, positive total effects existed between adolescent poverty and the likelihood of prescription painkiller use. Moreover, experiencing poverty at different life stages is associated indirectly with higher odds of prescription painkiller and methamphetamine use later in life. More research is needed to understand what is driving the relationship between poverty and substance use.
Authors:
Presenter - David C. Colston, MPH, University of North Carolina - Chapel Hill
Co-Author - Taylor W. Hargrove, PhD, Univeristy of Maryland
Co-Author - Marissa G. Hall, PhD, University of North Carolina - Chapel Hill
Co-Author - Kathryn E. Moracco, PhD, University of North Carolina - Chapel Hill
Co-Author - Chantel L. Martin, PhD, UNC Chapel Hill
Co-Author - Vivian F. Go, PhD, University of North Carolina - Chapel Hill
Habitual Caffeine Consumption in Emerging Adulthood: Unpacking Social Determinants of Health
Poster Number: D146Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Social and Environmental Context and Health
Emerging adulthood is marked by elevated caffeine consumption driven by academic, occupational, and social demands. Although often viewed as normative, habitual use may pose risks for cardiovascular, sleep, and reproductive health. Prior research has largely emphasized individual behaviors, yet caffeine use is also shaped by broader social determinants of health (SDOH). This study examined the prevalence and determinants of habitual caffeine consumption among Korean emerging adults using a mixed-methods approach guided by the WHO SDOH framework.
Quantitative analyses drew on secondary data from the 2019–2021 Korea National Health and Nutrition Examination Survey, including 892 adults aged 19–25. Structural and intermediary variables, derived from literature review and reflecting sociodemographic, biological, behavioral, and psychosocial factors, were examined via logistic regression. Qualitative data came from five focus group interviews with 19 emerging adults, analyzed with a framework-guided codebook and inductive additions. Integration employed joint display to identify convergent and divergent determinants.
Results showed that 59% habitually consumed ≥25 mg/day of caffeine, with habitual consumers ingesting over 30 times the amount of non-habitual consumers. Structurally, affordability, limited public resources, and sociocultural norms framed caffeine as harmless and socially endorsed. Employment, higher income, and metropolitan residence significantly predicted habitual use, with urban living reflecting increased accessibility. Intermediary determinants included older age, higher BMI, and female hormonal influences; behavioral risks such as smoking, binge drinking, poor diet, and low health literacy; and psychosocial influences including shorter weekend sleep and peer or family norms. Structural contexts shaped these intermediary conditions, generating gender-specific pathways: women linked use to hormonal and weight-control motives, men to occupational and social pressures.
Habitual caffeine use thus extends beyond individual choice, reflecting a health-risk behavior embedded in structural contexts. By identifying structural determinants and their pathways to biological, behavioral, and psychosocial factors, this study expands the SDOH framework and highlights the need for interventions at policy and community levels. Standardized definitions and objective measures of habitual caffeine consumption remain essential for future research.
Keywords: Caffeine, Substance abuseQuantitative analyses drew on secondary data from the 2019–2021 Korea National Health and Nutrition Examination Survey, including 892 adults aged 19–25. Structural and intermediary variables, derived from literature review and reflecting sociodemographic, biological, behavioral, and psychosocial factors, were examined via logistic regression. Qualitative data came from five focus group interviews with 19 emerging adults, analyzed with a framework-guided codebook and inductive additions. Integration employed joint display to identify convergent and divergent determinants.
Results showed that 59% habitually consumed ≥25 mg/day of caffeine, with habitual consumers ingesting over 30 times the amount of non-habitual consumers. Structurally, affordability, limited public resources, and sociocultural norms framed caffeine as harmless and socially endorsed. Employment, higher income, and metropolitan residence significantly predicted habitual use, with urban living reflecting increased accessibility. Intermediary determinants included older age, higher BMI, and female hormonal influences; behavioral risks such as smoking, binge drinking, poor diet, and low health literacy; and psychosocial influences including shorter weekend sleep and peer or family norms. Structural contexts shaped these intermediary conditions, generating gender-specific pathways: women linked use to hormonal and weight-control motives, men to occupational and social pressures.
Habitual caffeine use thus extends beyond individual choice, reflecting a health-risk behavior embedded in structural contexts. By identifying structural determinants and their pathways to biological, behavioral, and psychosocial factors, this study expands the SDOH framework and highlights the need for interventions at policy and community levels. Standardized definitions and objective measures of habitual caffeine consumption remain essential for future research.
Authors:
Author - Jisu Lee, Ph.D., Yonsei University
Author - Hyeonkyeong Lee, Ph.D., Yonsei University
Co-Author - Sue Kim, Ph.D., Yonsei University
Co-Author - Sohee Park, Ph.D., Yonsei University
Co-Author - Young-Me Lee, Ph.D., DePaul University
Co-Author - Meen Hye Lee, Ph.D., Gangneung-Wonju National University
Substance Use Among Transgender and Gender Nonconforming Youth Living in the US: A Systematic Review
Poster Number: D147Time: 11:00 AM - 11:50 AM
Topics: Substance Misuse, Social and Environmental Context and Health
Literature examining substance use of transgender and nonconforming (TGNC) youth have grown rapidly over the past decade, demonstrating TGNC youth report higher substance use rates than cisgender youth. Yet, TGNC youth have not received sufficiently detailed attention in evidence syntheses on TGNC persons’ substance use. This systematic review was conducted to describe prevalence of substance use among TGNC youth under the age of 25 in the US, identify demographic disparities at the intersection of gender, sex assigned at birth, race, ethnicity, and sexual orientation, and elucidate modifiable factors that can facilitate or mitigate of substance use.
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, LGBTQ+ Source, CINAHL, and PsycINFO databases were searched to identify peer-reviewed literature published in English since 2006 examining substance use among US-based TGNC youth (ages <25). Study quality was appraised via the Mixed Methods Appraisal Tool.
The review identified 89 eligible quantitative (n=82), qualitative (n=6), and mixed methods (n=1) peer-reviewed records. Studies reported high levels of substance use among TGNC youth that may start as early as middle school. A disproportionately higher burden of substance use was identified among transfeminine youth and youth of color. Gender minority stress factors, socio-structural vulnerabilities, and intimate partner-linked factors were among facilitators of substance use whereas social support, and community-related and socio-structural factors were identified as a mitigatory. TGNC youth in qualitative literature described some substance use (e.g., cannabis) as a helpful coping tool against more hazardous alternatives (e.g., opioids) when facing intersecting stressors and highlighted the importance of harm reduction approaches.
There has been significant growth in literature over the past two decades, linking minority stressors and socio-structural vulnerabilities with substance use among TGNC youth. Qualitative literature elucidated how youth may use substances for a multitude of reasons and that harm reduction may be more appropriate for some. Notwithstanding significant limitations and gaps, findings suggest a multi-pronged approach that includes use of public policy to lower stressors and community-based and pragmatic approaches to identify and treat substance use among TGNC youth maybe helpful.
Keywords: Substance abuse, Minority healthThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, LGBTQ+ Source, CINAHL, and PsycINFO databases were searched to identify peer-reviewed literature published in English since 2006 examining substance use among US-based TGNC youth (ages <25). Study quality was appraised via the Mixed Methods Appraisal Tool.
The review identified 89 eligible quantitative (n=82), qualitative (n=6), and mixed methods (n=1) peer-reviewed records. Studies reported high levels of substance use among TGNC youth that may start as early as middle school. A disproportionately higher burden of substance use was identified among transfeminine youth and youth of color. Gender minority stress factors, socio-structural vulnerabilities, and intimate partner-linked factors were among facilitators of substance use whereas social support, and community-related and socio-structural factors were identified as a mitigatory. TGNC youth in qualitative literature described some substance use (e.g., cannabis) as a helpful coping tool against more hazardous alternatives (e.g., opioids) when facing intersecting stressors and highlighted the importance of harm reduction approaches.
There has been significant growth in literature over the past two decades, linking minority stressors and socio-structural vulnerabilities with substance use among TGNC youth. Qualitative literature elucidated how youth may use substances for a multitude of reasons and that harm reduction may be more appropriate for some. Notwithstanding significant limitations and gaps, findings suggest a multi-pronged approach that includes use of public policy to lower stressors and community-based and pragmatic approaches to identify and treat substance use among TGNC youth maybe helpful.
Authors:
Presenter - Tural Mammadli, BA, MSW, University of Maryland Baltimore
Co-Author - Linda Jeanne M. Mack, MSW, University of Maryland Baltimore, School of Social Work
Co-Author - Yali Deng, MSW, University of Maryland Baltimore, School of Social Work
Co-Author - Gail D. Betz, University of Maryland Baltimore, School of Social Work
Co-Author - Chenglin Hong, PhD, MSW, MPH, University of Connecticut
Co-Author - Zach Runge, MA, Harford Community College
Co-Author - Tharyn Giovanni, MSW, University of Maryland Baltimore, School of Social Work
Co-Author - Bruce DeForge, PhD, University of Maryland Baltimore, School of Social Work
Co-Author - Darren W. Whitfield, PhD, MSW, University of Maryland Baltimore, School of Social Work
Examining Associations Between Cancer-Related Beliefs and Cancer Screening Among Firefighters in the Virginia Firefighters for Lifelong Health (VA-FLH) Research Registry
Poster Number: D15Time: 11:00 AM - 11:50 AM
Topics: Cancer
Background: Compared to the general population, firefighters are at higher risk of cancer due to occupational exposures. The Virginia Firefighters for Lifelong Health (VA-FLH) research registry was developed to collect annual data from Virginia firefighters in order to describe their health. The current study focuses on cancer-related beliefs and their association with prostate and colorectal cancer screening, due to the promotion of increased cancer screening in the fire service and lack of research examining cancer-related beliefs among firefighters.
Method: To join the VA-FLH registry, participants completed a baseline survey with questions related to occupational status, health status, and cancer-related beliefs. Current or former Virginia firefighters (career or volunteer) could participate. The current study included 262 participants with data for colorectal cancer screening (age 45+ as recommended by the International Association of Fire Fighters [IAFF]) and 179 participants with data for prostate cancer screening (males age 50+ based on the IAFF). Two logistic regression models were conducted for each screening type, controlling for age, sex (colon cancer only), work status (i.e., career, volunteer, or retired), tenure (in years), race, education, and prior cancer diagnosis.
Results: Overall, 86% and 90% of participants reported ever been screened for colorectal and prostate cancer, respectively. Participants who automatically think of death when thinking of cancer (OR=0.34, p=.03) and believe everything causes cancer (OR=0.28, p=.046) were less likely to report ever been screened for colorectal cancer. Participants who reported being overloaded by recommendations to prevent cancer were more likely to report ever been screened for colorectal cancer (OR=3.41, p=.02). None of the beliefs were associated with prostate cancer screening.
Discussion: Former and current firefighters who held fatalistic beliefs about cancer and believed that everything causes cancer were less likely to ever been screened for colorectal cancer. Interestingly, cancer information overload was associated with higher odds of ever been screened for colorectal cancer. Further research is needed to better understand why some beliefs are associated with higher odds and other beliefs with lower odds and why associations existed for colorectal, but not prostate cancer. The findings could be used to develop targeted interventions to increase cancer screening in the fire service.
Keywords: Cancer screening, Health beliefsMethod: To join the VA-FLH registry, participants completed a baseline survey with questions related to occupational status, health status, and cancer-related beliefs. Current or former Virginia firefighters (career or volunteer) could participate. The current study included 262 participants with data for colorectal cancer screening (age 45+ as recommended by the International Association of Fire Fighters [IAFF]) and 179 participants with data for prostate cancer screening (males age 50+ based on the IAFF). Two logistic regression models were conducted for each screening type, controlling for age, sex (colon cancer only), work status (i.e., career, volunteer, or retired), tenure (in years), race, education, and prior cancer diagnosis.
Results: Overall, 86% and 90% of participants reported ever been screened for colorectal and prostate cancer, respectively. Participants who automatically think of death when thinking of cancer (OR=0.34, p=.03) and believe everything causes cancer (OR=0.28, p=.046) were less likely to report ever been screened for colorectal cancer. Participants who reported being overloaded by recommendations to prevent cancer were more likely to report ever been screened for colorectal cancer (OR=3.41, p=.02). None of the beliefs were associated with prostate cancer screening.
Discussion: Former and current firefighters who held fatalistic beliefs about cancer and believed that everything causes cancer were less likely to ever been screened for colorectal cancer. Interestingly, cancer information overload was associated with higher odds of ever been screened for colorectal cancer. Further research is needed to better understand why some beliefs are associated with higher odds and other beliefs with lower odds and why associations existed for colorectal, but not prostate cancer. The findings could be used to develop targeted interventions to increase cancer screening in the fire service.
Authors:
Presenter - Trevin Glasgow, PhD, University of Virginia
Co-Presenter - Jim Burch, MS, PhD, Virginia Commonwealth University
Co-Presenter - Chrisa Arcan, PhD, MBA, MHS, RDN, Virginia Commonwealth University
Co-Presenter - Jeremy Barsell, MS, Virginia Commonwealth University
Co-Presenter - Obinna Diala, MBBS, MPH, Virginia Commonwealth University
Co-Presenter - Bernard Fuemmeler, PhD, MPH, FSBM, Virginia Commonwealth University
Perceived messages of tobacco products in popular music videos
Poster Number: D150Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior
Introduction: Depictions of tobacco in music videos can shape youth perceptions by portraying tobacco in a desirable light. Research investigating tobacco imagery in music videos has only focused on the prevalence of tobacco depictions. This study examined how tobacco is portrayed in music videos, categorizing each depiction as either portraying pro-tobacco use (glamorizing or normalizing use) or anti-tobacco use (discouraging use or highlighting harm).
Methods: The top 10 songs of each week in 2023 were identified using Billboard Charts (Hot 100, R&B/Hip-Hop, Country, Rock & Alternative, Dance/Electronic, Pop Airplay). Two coders analyzed the top songs with music videos using the validated Thumbs up Thumbs Down methodology. Each instance of tobacco products (cigarettes, cigars, hookah, pipe tobacco, e-cigarettes, unclear) was recorded. Coders identified how tobacco was portrayed (pro or anti) in music videos and the characteristics of the users (race and gender). Depictions portrayed as cool, fun, relaxing, wealth/power, or rebellious were categorized as pro-tobacco use. Depictions portrayed as habit/addiction, villains using tobacco, and/or a source of tension/stress were categorized as anti-tobacco. Depictions were categorized as neutral if the tobacco was onscreen but not lit. Music videos with equal depictions of pro and anti-tobacco messages were categorized as balanced. Music videos with mixed messaging were categorized based on the dominant message.
Results: 33 out of 39 (90%) of music videos that contained tobacco imagery had an overall pro-tobacco use message. Two music videos had an overall anti-tobacco use message. In the videos that were pro-tobacco use, tobacco was mostly depicted as cool or a sign of wealth/power. In the videos that were anti-tobacco use, the people using tobacco were portrayed as being villains or bad guys. No music video contained mixed messaging. There was no difference by race or gender on tobacco messaging. Majority of the musicians portrayed tobacco use in a desirable light.
Conclusion: Pro-tobacco messaging in music videos may amplify the glamorization and normalization of tobacco use regardless of the race and/or gender of the tobacco user. As a result, young people may perceive tobacco as positive, increasing their receptivity to tobacco use. Young people are more susceptible to these messages given that music videos are easily accessible to watch on multiple platforms without regulation.
Keywords: Tobacco control, Tobacco useMethods: The top 10 songs of each week in 2023 were identified using Billboard Charts (Hot 100, R&B/Hip-Hop, Country, Rock & Alternative, Dance/Electronic, Pop Airplay). Two coders analyzed the top songs with music videos using the validated Thumbs up Thumbs Down methodology. Each instance of tobacco products (cigarettes, cigars, hookah, pipe tobacco, e-cigarettes, unclear) was recorded. Coders identified how tobacco was portrayed (pro or anti) in music videos and the characteristics of the users (race and gender). Depictions portrayed as cool, fun, relaxing, wealth/power, or rebellious were categorized as pro-tobacco use. Depictions portrayed as habit/addiction, villains using tobacco, and/or a source of tension/stress were categorized as anti-tobacco. Depictions were categorized as neutral if the tobacco was onscreen but not lit. Music videos with equal depictions of pro and anti-tobacco messages were categorized as balanced. Music videos with mixed messaging were categorized based on the dominant message.
Results: 33 out of 39 (90%) of music videos that contained tobacco imagery had an overall pro-tobacco use message. Two music videos had an overall anti-tobacco use message. In the videos that were pro-tobacco use, tobacco was mostly depicted as cool or a sign of wealth/power. In the videos that were anti-tobacco use, the people using tobacco were portrayed as being villains or bad guys. No music video contained mixed messaging. There was no difference by race or gender on tobacco messaging. Majority of the musicians portrayed tobacco use in a desirable light.
Conclusion: Pro-tobacco messaging in music videos may amplify the glamorization and normalization of tobacco use regardless of the race and/or gender of the tobacco user. As a result, young people may perceive tobacco as positive, increasing their receptivity to tobacco use. Young people are more susceptible to these messages given that music videos are easily accessible to watch on multiple platforms without regulation.
Authors:
Co-Author - Jessica Rath, PhD, MPH, CHES, Truth Initiative
Presenter - Brenda Dimaya, MPH, Truth Initiative
Co-Author - Kennedy Sarvis, Truth Initiative
Predictors of Exposure to and Use of E-cigarettes in Vehicles: Results from a Young Adult Sample
Poster Number: D151Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Social and Environmental Context and Health
Introduction. Prior studies have demonstrated that vaping in vehicles poses health risks to other bystanders. However, there are few published studies examining predictors of vaping in vehicles and no studies to date examining predictors for being exposed to vaping in vehicles. This study identifies factors associated with being exposed to and using e-cigarettes in vehicles as a means of identifying pathways for intervention.
Methods. Data were obtained from a cross-sectional, online convenience sample of Qualtrics panel participants collected from July to December 2024. Participants included United States residing youth and young adults (aged 15-25 years), who reported using any tobacco product in the past 30 days, and answered items measuring exposure to and/or use of e-cigarettes in vehicles (n=3482). Separate logistic regression models predicting vaping in vehicles and exposure to vaping in vehicles, adjusted for the effects of age, gender identity, sexual minority identity, race, ethnicity, financial situation, living with someone who uses tobacco products were fit to the data. E-cigarette dependence was also included in the prediction model for vaping in vehicles.
Results. Of the recruited sample, 79.6% reported current e-cigarette use (on at least one day in the past 30 days) and 69.3% reported riding in a car, truck, SUV, or other vehicle when someone else was using an e-cigarette/vape. Of those reporting current e-cigarette use (N=2336), 60.6% reported using their e-cigarette/vape while driving in the car in the past 30 days. Higher nicotine dependence (OR=1.61; 95% CI: 1.40, 1.85) was associated with greater odds of reporting vaping in vehicles. Compared to those who reported not meeting financial needs, those who reported just meeting basic expenses (OR=1.49; 95% CI: 1.09, 2.04) or meeting needs with a little left over (OR=1.65; 95% CI: 1.18, 2.31), and those living with a tobacco user (OR=4.13, 95% CI: 3.25, 5.25) had higher odds of reporting being in a vehicle when someone else was vaping.
Discussion. Those with higher e-cigarette dependence are more likely to vape in vehicles and those reporting just meeting basic expenses or meeting needs with a little left and living with a tobacco user are more likely to be exposed to vaping in vehicles. Public health initiatives need to target these factors to reduce vaping in vehicles and related health risks to exposed non-users and youth.
Keywords: Tobacco use, AdolescentsMethods. Data were obtained from a cross-sectional, online convenience sample of Qualtrics panel participants collected from July to December 2024. Participants included United States residing youth and young adults (aged 15-25 years), who reported using any tobacco product in the past 30 days, and answered items measuring exposure to and/or use of e-cigarettes in vehicles (n=3482). Separate logistic regression models predicting vaping in vehicles and exposure to vaping in vehicles, adjusted for the effects of age, gender identity, sexual minority identity, race, ethnicity, financial situation, living with someone who uses tobacco products were fit to the data. E-cigarette dependence was also included in the prediction model for vaping in vehicles.
Results. Of the recruited sample, 79.6% reported current e-cigarette use (on at least one day in the past 30 days) and 69.3% reported riding in a car, truck, SUV, or other vehicle when someone else was using an e-cigarette/vape. Of those reporting current e-cigarette use (N=2336), 60.6% reported using their e-cigarette/vape while driving in the car in the past 30 days. Higher nicotine dependence (OR=1.61; 95% CI: 1.40, 1.85) was associated with greater odds of reporting vaping in vehicles. Compared to those who reported not meeting financial needs, those who reported just meeting basic expenses (OR=1.49; 95% CI: 1.09, 2.04) or meeting needs with a little left over (OR=1.65; 95% CI: 1.18, 2.31), and those living with a tobacco user (OR=4.13, 95% CI: 3.25, 5.25) had higher odds of reporting being in a vehicle when someone else was vaping.
Discussion. Those with higher e-cigarette dependence are more likely to vape in vehicles and those reporting just meeting basic expenses or meeting needs with a little left and living with a tobacco user are more likely to be exposed to vaping in vehicles. Public health initiatives need to target these factors to reduce vaping in vehicles and related health risks to exposed non-users and youth.
Authors:
Presenter - Elizabeth Do, PhD, MPH, Truth Initiative
Co-Author - Joslynn A. Watkins, MPH, Truth Initiative
Co-Author - Madison Iskra, MPH, Truth Initiative
Co-Author - Kristiann Koris, MPP, Truth Initiative
Co-Author - Sarah Cha, MSPH, Truth Initiative
Co-Author - Amanda Graham, PhD, FSBM, Truth Initiative
Co-Author - Eric Soule, PhD, East Carolina University
Co-Author - Elizabeth Hair, PhD, Truth Initiative
Evaluating Nicotine Dependence and Smoking Identity on a Rurality Spectrum
Poster Number: D152Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior
SIGNIFICANCE: Smoking remains disproportionately high among people residing in rural U.S. areas, potentially due to stronger pro-tobacco norms. Smoking identity (i.e., perceived importance of smoking to one’s identity) has been positively associated with nicotine dependence, but little is known about how nicotine dependence and smoking identity vary between rural and urban individuals, particularly among those who are not actively quitting smoking.
METHODS: The current study used data from a cross-sectional, online survey study of non-treatment seeking U.S. adults who smoked cigarettes in the last 30 days (N=451, mean age=46.1 years; 59.6% female; 23.9% racial/ethnic minority). Rurality was self-reported on a 7-point Likert scale (0=minimally rural to 6=very rural) and nicotine dependence was measured using the Fagerström Test for Nicotine Dependence (FTND). Smoking identity endorsement scores were averaged using four items from the Tobacco Identity Scale (e.g., “How much is being a tobacco user part of who you are?”; 1=Not at all to 4=A lot). Descriptive statistics and linear regressions were used to examine associations of rurality with nicotine dependence and smoking identity endorsement.
RESULTS: Overall, 27.9% of participants reported coming from a more rural area (Rurality ≥4). Rurality was correlated only with sex, employment, income, and education (ps<.001), with more rural areas having higher proportions of individuals who were female, unemployed, lower income, and lower education. Regarding tobacco use, 82.0% reported daily combustible cigarette use and 63.2% met criteria for high nicotine dependence (FTND≥4). Most participants endorsed tobacco use as a part of who they are (89.6%) and that they were known by others for using tobacco (93.1%). After controlling for sex, employment, income, and education, rurality was not associated with nicotine dependence (p>.05). However, while additionally controlling for FTND, rurality was significantly associated with smoking identity endorsement (B=-0.079, p<.001), where individuals from less rural areas had higher smoking identity endorsement compared to those from more rural areas.
CONCLUSION: Findings suggest that rurality may impact endorsement of smoking identity, but not nicotine dependence. Future studies should continue to explore how psychosocial factors (e.g., community norms) may contribute to smoking behavior, particularly in individuals from more rural areas who are not trying to quit smoking.
Keywords: Tobacco control, Tobacco useMETHODS: The current study used data from a cross-sectional, online survey study of non-treatment seeking U.S. adults who smoked cigarettes in the last 30 days (N=451, mean age=46.1 years; 59.6% female; 23.9% racial/ethnic minority). Rurality was self-reported on a 7-point Likert scale (0=minimally rural to 6=very rural) and nicotine dependence was measured using the Fagerström Test for Nicotine Dependence (FTND). Smoking identity endorsement scores were averaged using four items from the Tobacco Identity Scale (e.g., “How much is being a tobacco user part of who you are?”; 1=Not at all to 4=A lot). Descriptive statistics and linear regressions were used to examine associations of rurality with nicotine dependence and smoking identity endorsement.
RESULTS: Overall, 27.9% of participants reported coming from a more rural area (Rurality ≥4). Rurality was correlated only with sex, employment, income, and education (ps<.001), with more rural areas having higher proportions of individuals who were female, unemployed, lower income, and lower education. Regarding tobacco use, 82.0% reported daily combustible cigarette use and 63.2% met criteria for high nicotine dependence (FTND≥4). Most participants endorsed tobacco use as a part of who they are (89.6%) and that they were known by others for using tobacco (93.1%). After controlling for sex, employment, income, and education, rurality was not associated with nicotine dependence (p>.05). However, while additionally controlling for FTND, rurality was significantly associated with smoking identity endorsement (B=-0.079, p<.001), where individuals from less rural areas had higher smoking identity endorsement compared to those from more rural areas.
CONCLUSION: Findings suggest that rurality may impact endorsement of smoking identity, but not nicotine dependence. Future studies should continue to explore how psychosocial factors (e.g., community norms) may contribute to smoking behavior, particularly in individuals from more rural areas who are not trying to quit smoking.
Authors:
Author - Vanessa Y. Fishel, BS, Rosalind Franklin University of Medicine and Science
Co-Author - Neo Gebru, PhD, Emory University School of Medicine
Co-Author - Brian A. Feinstein, PhD, Rosalind Franklin University of Medicine and Science
Co-Author - Nancy C. Jao, PhD, Rosalind Franklin University of Medicine and Science
What Sustains Quitting among Sexual and Gender Minority Young Adults: Internalized Motivation and Self Determination Needs
Poster Number: D153Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Health Communication and Policy
Significance: Many smokers are motivated to quit, yet relapse is common, including for sexual and gender minority (SGM) smokers. Relapses do not necessarily signal a lack of motivation. It may suggest that the form and internalization of motivation matter for abstaining. Self-Determination Theory (SDT) suggests that motivations range from external to intrinsic and satisfying needs of autonomy, competence and relatedness helps motivations become self-endorsed and sustained. Using this lens, we examine where motivations sit on the continuum and how need fulfillment shapes their internalization among SGM young adults.
Methods: We conducted in-depth interviews with 33 SGM young adults aged 18-30 who are current or recent tobacco users. A semi-structured guide was used to elicit narratives of tobacco initiation, quit attempts, turning points, perceived support and barriers. Transcripts were team-coded, then further analyzed for quitting experience using SDT. Motivations were mapped to six regulation types (none, external, introjected, identified, integrated, intrinsic), and need fulfillment was coded for autonomy, competence, and relatedness. Quitting stages (precontemplation, contemplation, preparation, action, maintenance, relapse) were also recorded.
Results: Participants often reported multiple regulation types during the quitting process. Precontemplation, contemplation and relapse stages clustered with non- or external regulation. External constraints and pressure often trigger attempts, but sustained quitting outcomes are aligned with more internalized motivations and fulfillment of autonomy, competence, and relatedness. When these needs were less satisfied, participants delayed action or returned to tobacco use despite feeling motivated. Progress to action or maintenance stage (60.6% participants) and serious abstinence, even not sustained, consistently featured identified and integrated reasons anchored in health, performance, personal value, and identity, with all three needs satisfied. Intrinsic motivation was rarely observed.
Conclusion: Quitting is likely sustained when efforts shifted from externally driven to self-endorsed and internalized motivation when autonomy, competence and relatedness are satisfied. Future practices are encouraged to implement SDT-informed care that elicits identified reasons, offers positive feedback and highlights small wins to build competence, and activates dependable social ties for accountability and empowerment.
Keywords: Tobacco control, Health communicationMethods: We conducted in-depth interviews with 33 SGM young adults aged 18-30 who are current or recent tobacco users. A semi-structured guide was used to elicit narratives of tobacco initiation, quit attempts, turning points, perceived support and barriers. Transcripts were team-coded, then further analyzed for quitting experience using SDT. Motivations were mapped to six regulation types (none, external, introjected, identified, integrated, intrinsic), and need fulfillment was coded for autonomy, competence, and relatedness. Quitting stages (precontemplation, contemplation, preparation, action, maintenance, relapse) were also recorded.
Results: Participants often reported multiple regulation types during the quitting process. Precontemplation, contemplation and relapse stages clustered with non- or external regulation. External constraints and pressure often trigger attempts, but sustained quitting outcomes are aligned with more internalized motivations and fulfillment of autonomy, competence, and relatedness. When these needs were less satisfied, participants delayed action or returned to tobacco use despite feeling motivated. Progress to action or maintenance stage (60.6% participants) and serious abstinence, even not sustained, consistently featured identified and integrated reasons anchored in health, performance, personal value, and identity, with all three needs satisfied. Intrinsic motivation was rarely observed.
Conclusion: Quitting is likely sustained when efforts shifted from externally driven to self-endorsed and internalized motivation when autonomy, competence and relatedness are satisfied. Future practices are encouraged to implement SDT-informed care that elicits identified reasons, offers positive feedback and highlights small wins to build competence, and activates dependable social ties for accountability and empowerment.
Authors:
Presenter - Sixiao Liu, PhD, University of Central Florida
Co-Author - Jiaxi Wu, Virginia Commonwealth University
Co-Author - Elaine Hanby, University of Pennsylvania
Co-Author - Chris McLain, University of Pennsylvania
Co-Author - Andy Tan, University of Pennsylvania
Supporter Preferences for Text Messages Designed to Guide and Aid Smoking Cessation Support
Poster Number: D154Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Digital Health
Introduction: Interventions that guide supporters in offering effective support may improve quit rates among adults with mental health conditions, and text messaging offers a practical means to deliver such strategies. This study developed text messages to provide supporters with information on the quitting process and to encourage helpful support behaviors.
Methods: The research team developed 65 messages informed by the perceived responsiveness framework, which emphasizes interpersonal behaviors that promote psychological safety and motivation (responsiveness-based messages), and by empirical literature on smoking cessation, which addressed challenges, benefits, and mental health considerations (information-based messages). We recruited participants (n = 196) using the Prolific platform. Individuals were eligible if they were ≥18 years and knew someone who currently smokes. We examined whether mean ratings differed by message category and participant characteristics using a mixed-effects regression model with crossed random intercepts for participants and messages.
Results: More than half of participants were male (51.8%), the majority were White (72.1%) and non-Hispanic (92.4%). Supporters reported high relationship closeness to someone who smokes (M = 7.1, SD = 1.9 on a 1–9 scale), and most had a history of tobacco use (76.1%). Overall, mean ratings did not differ significantly by message category (b = 0.07, SE = 0.07, p = 0.322). Compared with participants who reported knowing a spouse/partner who smoked, those who knew a friend (b = 0.35, SE = 0.15, p = 0.020), family member (b = 0.38, SE = 0.15, p = 0.014), or coworker/roommate (b = 0.57, SE = 0.21, p = 0.008) provided relatively higher ratings. Greater perceived closeness to the individual who smokes was also positively associated with higher ratings (b = 0.35, SE = 0.15, p = 0.020). An interaction between message category and sex (b = 0.23, SE = 0.11, p = 0.041) suggested women rated responsiveness-based messages more positively than men.
Conclusion: Findings suggest that a balanced mix of information- and responsiveness-based messages may best support quitting, with higher ratings linked to closer supporter-smoker relationships and greater receptivity to responsiveness-based content among women.
Keywords: Health behavior change, Social supportMethods: The research team developed 65 messages informed by the perceived responsiveness framework, which emphasizes interpersonal behaviors that promote psychological safety and motivation (responsiveness-based messages), and by empirical literature on smoking cessation, which addressed challenges, benefits, and mental health considerations (information-based messages). We recruited participants (n = 196) using the Prolific platform. Individuals were eligible if they were ≥18 years and knew someone who currently smokes. We examined whether mean ratings differed by message category and participant characteristics using a mixed-effects regression model with crossed random intercepts for participants and messages.
Results: More than half of participants were male (51.8%), the majority were White (72.1%) and non-Hispanic (92.4%). Supporters reported high relationship closeness to someone who smokes (M = 7.1, SD = 1.9 on a 1–9 scale), and most had a history of tobacco use (76.1%). Overall, mean ratings did not differ significantly by message category (b = 0.07, SE = 0.07, p = 0.322). Compared with participants who reported knowing a spouse/partner who smoked, those who knew a friend (b = 0.35, SE = 0.15, p = 0.020), family member (b = 0.38, SE = 0.15, p = 0.014), or coworker/roommate (b = 0.57, SE = 0.21, p = 0.008) provided relatively higher ratings. Greater perceived closeness to the individual who smokes was also positively associated with higher ratings (b = 0.35, SE = 0.15, p = 0.020). An interaction between message category and sex (b = 0.23, SE = 0.11, p = 0.041) suggested women rated responsiveness-based messages more positively than men.
Conclusion: Findings suggest that a balanced mix of information- and responsiveness-based messages may best support quitting, with higher ratings linked to closer supporter-smoker relationships and greater receptivity to responsiveness-based content among women.
Authors:
Presenter - Catherine Nagawa, PhD, The University of Oklahoma Health Sciences
Co-Author - Katie Qualls Fay, MS, MCHES, The University of Oklahoma Health Sciences
Co-Author - Sydney Newell Chesebro, BS, The University of Oklahoma Health Sciences
Co-Author - Madeline Hardage, BS, The University of Oklahoma-Tulsa
Co-Author - Frances Wen, PhD, The University of Oklahoma-Tulsa
Co-Author - Michelle VanDellen, PhD, The University of Oklahoma Health Sciences
Blunt Use vs. Other Combustible Cannabis Use and Chronic Health Conditions among Cannabis and Tobacco Co-users
Poster Number: D155Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Substance Misuse
SIGNIFICANCE: Blunt use (i.e., smoking cannabis rolled in a tobacco wrapper) is associated with exposure to carcinogens and other toxins, and poorer outcomes for both cannabis and tobacco cessation. Thus, blunts may be a particularly risky form of cannabis use, relative to other forms of combustible cannabis. Despite established risks, few studies have examined the association between blunt use and health outcomes.
METHODS: We describe the association between blunt use (vs. other combustible cannabis use) and chronic health conditions among US adult cannabis and tobacco past 30-day co-users recruited nationally online (n=1832). Chi-square and t-tests describe sample characteristics. Logistic regressions estimate the associations of blunt use with the following chronic health conditions (controlling for age, gender, and race/ethnicity): asthma, anxiety, cancer, cardiac disease, chronic pain, depression, diabetes, dyslipidemia, HIV, hypertension, kidney disease, lung disease, PTSD, stroke, and ulcers.
RESULTS: On average, participants were 42.62 (SD=15.18) years old, cis-gender women (50.5%) or men (48.3%), and were primarily non-Hispanic White (53.2%) or Black (25.7%). Most used combustible cannabis in the past 30 days (91.3%), and 55.8% of all co-users reported past 30-day blunt use. Compared to those using non-blunt combustible cannabis (n=739), blunt users (n=933) were younger (age = 37.5 vs 48.1, p<.001), more urban (Index of Relative Rurality = .20 vs. .22, p=.006), reported more cannabis use days in the past month (avg = 21.0 vs 17.1 days, p<.001), and were more likely to be Black (36.5% vs 15.6%, p<.001), female (54.0% vs. 44.7%, p<.001), and to meet the criteria for possible cannabis use disorder (49.7% vs 31.9%, p<.001). Blunt users (vs. other combustible cannabis users) were more likely to report a lifetime diagnosis of anxiety (OR=1.36, 95% CI: 1.09, 1.70), chronic pain (OR=1.48, CI: 1.13, 1.95), depression (OR=1.52, CI: 1.22, 1.91), and PTSD (OR=1.42, CI: 1.05, 1.91).
CONCLUSION: Blunt use in this diverse sample was associated with increased likelihood of reporting chronic mental health conditions and pain. This is concerning as these health conditions are often cited as reasons for seeking cannabis by users or are approved conditions by medical cannabis state laws. Public health efforts should encourage less harmful forms of cannabis use, and future work should explore the temporal relationship between mental health, pain, and blunt use
Keywords: Substance abuse, Chronic illnessMETHODS: We describe the association between blunt use (vs. other combustible cannabis use) and chronic health conditions among US adult cannabis and tobacco past 30-day co-users recruited nationally online (n=1832). Chi-square and t-tests describe sample characteristics. Logistic regressions estimate the associations of blunt use with the following chronic health conditions (controlling for age, gender, and race/ethnicity): asthma, anxiety, cancer, cardiac disease, chronic pain, depression, diabetes, dyslipidemia, HIV, hypertension, kidney disease, lung disease, PTSD, stroke, and ulcers.
RESULTS: On average, participants were 42.62 (SD=15.18) years old, cis-gender women (50.5%) or men (48.3%), and were primarily non-Hispanic White (53.2%) or Black (25.7%). Most used combustible cannabis in the past 30 days (91.3%), and 55.8% of all co-users reported past 30-day blunt use. Compared to those using non-blunt combustible cannabis (n=739), blunt users (n=933) were younger (age = 37.5 vs 48.1, p<.001), more urban (Index of Relative Rurality = .20 vs. .22, p=.006), reported more cannabis use days in the past month (avg = 21.0 vs 17.1 days, p<.001), and were more likely to be Black (36.5% vs 15.6%, p<.001), female (54.0% vs. 44.7%, p<.001), and to meet the criteria for possible cannabis use disorder (49.7% vs 31.9%, p<.001). Blunt users (vs. other combustible cannabis users) were more likely to report a lifetime diagnosis of anxiety (OR=1.36, 95% CI: 1.09, 1.70), chronic pain (OR=1.48, CI: 1.13, 1.95), depression (OR=1.52, CI: 1.22, 1.91), and PTSD (OR=1.42, CI: 1.05, 1.91).
CONCLUSION: Blunt use in this diverse sample was associated with increased likelihood of reporting chronic mental health conditions and pain. This is concerning as these health conditions are often cited as reasons for seeking cannabis by users or are approved conditions by medical cannabis state laws. Public health efforts should encourage less harmful forms of cannabis use, and future work should explore the temporal relationship between mental health, pain, and blunt use
Authors:
Presenter - Bethany Shorey Fennell, PhD, University of Kentucky
Co-Author - Cherell Cottrell-Daniels, PhD, MPH, Health Choice Network
Co-Author - Delvon Mattingly, PhD, University of Kentucky College of Medicine
Co-Author - Wura Jacobs, MS PhD, Indiana University School of Public Health
Co-Author - Allison Glasser, PhD, MPH, Rutgers Institute for Nicotine and Tobacco Studies
Co-Author - Kory Heier, MS, University of Kentucky
Co-Author - Kristen McQuerry, PhD, University of Kentucky
Barriers and facilitators for smoking cessation among hospitalized patients with high cardiovascular risk: A qualitative study
Poster Number: D156Time: 11:00 AM - 11:50 AM
Topics: Tobacco Control and Nicotine-Related Behavior, Cardiovascular Disease
Rationale: Tobacco use is a major public health issue and a risk factor for cardiovascular (CV) disease, causing up to 30% of global CV deaths. Despite a decline in smoking rates in Colombia, it remains a significant challenge. Interventions in the hospital setting have been shown to be effective, but research in low- and middle-income countries is lacking. This study aimed to explore the barriers and facilitators for providing smoking cessation support in a tertiary hospital in Bogota, Colombia.
Methods: An exploratory qualitative study using semi-structured interviews and focus groups included three groups of participants: a) hospitalized patients who smoke (≥18 years) with high CV risk; b) health professionals; and c) health system representatives. An inductive and deductive thematic approach was used to analyze the data, guided by the COM-B model and Theoretical Domains Framework.
Results: A total of 28 interviews (15 with patients and 13 with health system representatives) and two focus groups (one with nurses and another with physicians) were conducted from April to June 2024. Identified barriers among patients included stress, unawareness of support resources, strong nicotine addiction, and inconsistent health provider engagement. Facilitators included the hospital's restricted environment, willingness to quit with appropriate support, and structured programs. Health professionals noted barriers such as insufficient knowledge about interventions and debated their relevance for geriatric patients, with the presence of an intervention team considered a facilitator. These views aligned with those of health system representatives, emphasizing the need for a systematic integration of programs, interdisciplinary support, patient education, and tailored interventions, with conflicting perspectives regarding pharmacotherapy.
Conclusions: Findings reveals critical gaps in smoking cessation support for high CV patients in a Colombian tertiary hospital. The identified barriers, particularly patients' low awareness of resources and inconsistent health provider engagement, highlight the need for interventions that bridge knowledge-behavior gaps. Although this aligns with previous research on leveraging acute events for behavior change, the lack of a systematic delivery of cessation programs underscores an implementation challenge. These findings will inform the development of a behavioral intervention to promote smoking cessation care in the hospital setting.
Keywords: Health behavior change, SmokingMethods: An exploratory qualitative study using semi-structured interviews and focus groups included three groups of participants: a) hospitalized patients who smoke (≥18 years) with high CV risk; b) health professionals; and c) health system representatives. An inductive and deductive thematic approach was used to analyze the data, guided by the COM-B model and Theoretical Domains Framework.
Results: A total of 28 interviews (15 with patients and 13 with health system representatives) and two focus groups (one with nurses and another with physicians) were conducted from April to June 2024. Identified barriers among patients included stress, unawareness of support resources, strong nicotine addiction, and inconsistent health provider engagement. Facilitators included the hospital's restricted environment, willingness to quit with appropriate support, and structured programs. Health professionals noted barriers such as insufficient knowledge about interventions and debated their relevance for geriatric patients, with the presence of an intervention team considered a facilitator. These views aligned with those of health system representatives, emphasizing the need for a systematic integration of programs, interdisciplinary support, patient education, and tailored interventions, with conflicting perspectives regarding pharmacotherapy.
Conclusions: Findings reveals critical gaps in smoking cessation support for high CV patients in a Colombian tertiary hospital. The identified barriers, particularly patients' low awareness of resources and inconsistent health provider engagement, highlight the need for interventions that bridge knowledge-behavior gaps. Although this aligns with previous research on leveraging acute events for behavior change, the lack of a systematic delivery of cessation programs underscores an implementation challenge. These findings will inform the development of a behavioral intervention to promote smoking cessation care in the hospital setting.
Authors:
Author - Luz Angela Torres López, MD, MPH, PhD (c), Hebrew University of Jerusalem
Co-Author - Luz Helena Alba, MD, MSc, Family Medicine Service-Hospital Universitario San Ignacio. Department of Preventive and Social Medicine-Pontificia Universidad Javeriana
Co-Author - Daniela Hernández, MD, Family Medicine Service-Hospital Universitario San Ignacio. Department of Preventive and Social Medicine-Pontificia Universidad Javeriana
Co-Author - Nelci Becerra, MD, Javesalud
Co-Author - Yehuda Neumark, MPH, PhD, Hebrew University of Jerusalem
Co-Author - Yael Bar-Zeev, MD, MPH, PhD, Hebrew University of Jerusalem
The Personality and Ideology Predictors of Weight Bias
Poster Number: D157Time: 11:00 AM - 11:50 AM
Topics: Weight Related Health , Social and Environmental Context and Health
Background: Weight bias, or negative attitudes toward individuals based on body weight, is a pervasive stigma with substantial psychological, social, and health consequences, including increased risk of depression, anxiety, disordered eating, and healthcare avoidance. Although both personality traits and ideological beliefs have been linked to prejudice, the extent to which each contributes to weight bias remains unclear. Personality traits shape empathy and social perception, while ideological beliefs shape views of social hierarchies and fairness, jointly influencing the strength of weight-biased attitudes.
Methods: A total of 788 adults, aged 18 years or older, completed assessments of personality and ideological beliefs. Personality was assessed via the Big Five traits: agreeableness, openness, conscientiousness, extraversion, and neuroticism. Ideological beliefs were measured with scales for social dominance orientation (SDO), rape myth acceptance (RMA), Protestant work ethic (PWE), belief in a just world (BJW), and empathy. Weight bias was measured using the Universal Measure of Bias–Fat. Ordinary least squares regression examined unique contributions, and Relative Weights Analysis (RWA) quantified comparative influence.
Results: Personality traits and ideological beliefs together accounted for 33% of the variance in weight bias. Lower agreeableness (β = –0.12, p < .001) and lower openness (β = –0.09, p = .005) were significant personality predictors of higher weight bias, with RWA indicating that agreeableness (8.5%) and openness (5.1%) contributed most strongly among the personality variables. Among ideological predictors, higher SDO (β = 0.36, p < .001) and RMA (β = 0.17, p < .001) were the strongest predictors, together accounting for 54% of the variance explained. PWE was a moderate positive predictor (β = 0.18, p < .001), while BJW (β = –0.08, p = .032) and empathy were negatively associated with weight bias.
Conclusion: Ideological beliefs that reinforce social hierarchies and promote victim-blaming were the strongest contributors to weight bias, while personality traits had smaller but meaningful effects. These findings highlight the role of belief systems in shaping weight stigma and the mechanisms of social bias. By integrating dispositional and belief-based factors across multiple psychological and ideological perspectives, researchers can gain a better understanding of how weight bias develops and its social and health consequences.
Keywords: Beliefs, PersonalityMethods: A total of 788 adults, aged 18 years or older, completed assessments of personality and ideological beliefs. Personality was assessed via the Big Five traits: agreeableness, openness, conscientiousness, extraversion, and neuroticism. Ideological beliefs were measured with scales for social dominance orientation (SDO), rape myth acceptance (RMA), Protestant work ethic (PWE), belief in a just world (BJW), and empathy. Weight bias was measured using the Universal Measure of Bias–Fat. Ordinary least squares regression examined unique contributions, and Relative Weights Analysis (RWA) quantified comparative influence.
Results: Personality traits and ideological beliefs together accounted for 33% of the variance in weight bias. Lower agreeableness (β = –0.12, p < .001) and lower openness (β = –0.09, p = .005) were significant personality predictors of higher weight bias, with RWA indicating that agreeableness (8.5%) and openness (5.1%) contributed most strongly among the personality variables. Among ideological predictors, higher SDO (β = 0.36, p < .001) and RMA (β = 0.17, p < .001) were the strongest predictors, together accounting for 54% of the variance explained. PWE was a moderate positive predictor (β = 0.18, p < .001), while BJW (β = –0.08, p = .032) and empathy were negatively associated with weight bias.
Conclusion: Ideological beliefs that reinforce social hierarchies and promote victim-blaming were the strongest contributors to weight bias, while personality traits had smaller but meaningful effects. These findings highlight the role of belief systems in shaping weight stigma and the mechanisms of social bias. By integrating dispositional and belief-based factors across multiple psychological and ideological perspectives, researchers can gain a better understanding of how weight bias develops and its social and health consequences.
Authors:
Author - Katie DeRouen, East Carolina University
Co-Author - Thomas Vitti, East Carolina University
Co-Author - Courtney Baker, PhD, East Carolina University
Co-Author - Robert Carels, PhD MBA ABPP, FSBM, East Carolina University
Weight Discrimination in Context: Attributions, Settings, and Associations with Cardiometabolic Health
Poster Number: D159Time: 11:00 AM - 11:50 AM
Topics: Weight Related Health , Health Disparities
Introduction: While higher body weight is largely associated with worse cardiometabolic health, the association between weight discrimination and cardiometabolic health is understudied. Weight discrimination is heterogenous and can be experienced in various settings, including in medical settings, and can intersect with discrimination related to other marginalized social identities. The present study aimed to understand characteristics of weight discrimination (i.e., weight as single attribution vs. in combination with additional discrimination attributions; in everyday life vs. medical settings) and their associations with cardiometabolic health, as defined by metabolic syndrome and self-rated health (SRH).
Method: Participants with a BMI ≥ 25 kg/m2 (n = 46,994; aged 55.6 ± 15.2 years; 63% female; 83% White, 17% racial minority; 11% Hispanic) from the All of Us Research Program self-reported their experiences of discrimination, SRH, and contributed biomarkers used to determine metabolic syndrome. Participants selected characteristics to which they attributed their discrimination experiences (e.g., weight, gender, age, race). Multiple linear and logistic regression models examined the associations between discrimination attribution (i.e., whether due to weight, another social identity, or both – indicating intersectional discrimination) and cardiometabolic health. We also examined associations between scores on the Everyday Discrimination Scale as well as the Discrimination in Medical Settings Scale and cardiometabolic health.
Results: Participants reporting weight discrimination in addition to other forms of discrimination had 17% higher odds of metabolic syndrome than those reporting no discrimination (OR = 1.17, 95% CI [1.01, 1.35]). Weight discrimination, whether alone (B = -0.35, p < .001) or along with other forms of discrimination (B = -0.34, p < .001), was negatively associated with SRH. Everyday discrimination was positively associated with metabolic syndrome (OR = 1.01, 95% CI [1.00, 1.01]) and negatively associated with SRH (B = -0.02, p = .003). Discrimination in medical settings was positively associated with metabolic syndrome (OR = 1.02, 95% CI [1.01, 1.03]) and negatively associated with SRH (B = -0.03, p < .001).
Conclusion: Findings demonstrate the importance of assessing the burden of weight discrimination, including how intersectional discrimination and discrimination settings may be associated with cardiometabolic health.
Keywords: Metabolic regulation, Health disparitiesMethod: Participants with a BMI ≥ 25 kg/m2 (n = 46,994; aged 55.6 ± 15.2 years; 63% female; 83% White, 17% racial minority; 11% Hispanic) from the All of Us Research Program self-reported their experiences of discrimination, SRH, and contributed biomarkers used to determine metabolic syndrome. Participants selected characteristics to which they attributed their discrimination experiences (e.g., weight, gender, age, race). Multiple linear and logistic regression models examined the associations between discrimination attribution (i.e., whether due to weight, another social identity, or both – indicating intersectional discrimination) and cardiometabolic health. We also examined associations between scores on the Everyday Discrimination Scale as well as the Discrimination in Medical Settings Scale and cardiometabolic health.
Results: Participants reporting weight discrimination in addition to other forms of discrimination had 17% higher odds of metabolic syndrome than those reporting no discrimination (OR = 1.17, 95% CI [1.01, 1.35]). Weight discrimination, whether alone (B = -0.35, p < .001) or along with other forms of discrimination (B = -0.34, p < .001), was negatively associated with SRH. Everyday discrimination was positively associated with metabolic syndrome (OR = 1.01, 95% CI [1.00, 1.01]) and negatively associated with SRH (B = -0.02, p = .003). Discrimination in medical settings was positively associated with metabolic syndrome (OR = 1.02, 95% CI [1.01, 1.03]) and negatively associated with SRH (B = -0.03, p < .001).
Conclusion: Findings demonstrate the importance of assessing the burden of weight discrimination, including how intersectional discrimination and discrimination settings may be associated with cardiometabolic health.
Authors:
Author - Rafael Leite, PhD, Brown University
Co-Author - Maria Llabre, PhD, FSBM, University of Miami
Co-Author - Patrice Saab, PhD, University of Miami
Perceptions of the AYA Survivors’ Coping and Emotional Needs Toolkit (ASCENT): Comparing Young Adults and Adolescent/Emerging Adults
Poster Number: D16Time: 11:00 AM - 11:50 AM
Topics: Cancer, Digital Health
Introduction: Adolescent and young adult cancer survivors (AYACS; ages 15-39) are a diverse group whose developmental stage may shape how they use digital health tools. Adolescents and emerging adults (AEA; 15-25) may differ in preferences and needs compared to young adults (YA; 26-39). The AYA Survivors’ Coping and Emotional Needs Toolkit (ASCENT) is a digital tool designed to help AYACS manage depressive symptoms. Building on our prior studies that identified distinct preferences across the AYACS spectrum, ASCENT was adapted to both AEA and YA. This analysis examined whether age-related differences in engagement and perceptions persisted after modifications, evaluating the success of ASCENT’s refinements and readiness for a larger trial.
Methods: Participants were identified via medical records at a rural academic medical center and invited to a pilot full factorial trial of ASCENT. They completed a virtual orientation and engaged with modules over six weeks. At follow-up, participants completed an exit interview and self-report measures, including the System Usability Scale, an investigator-developed acceptability scale, and the eHealth Engagement Scale. ASCENT usage data, including time spent and modules completed, was collected directly from the tool.
Results: Analyses of survey-based outcomes (n = 12; AEA = 6, YA = 6) revealed no significant differences between AEA and YA in acceptability (t(10) = -0.28, p = .785, d = -0.16) or engagement (t(10) = 1.66, p = .129, d = 0.96). Analyses of platform usage outcomes, including weekly use and content completion (n = 16; AEA = 9, YA = 7), also revealed no significant group differences in weekly use, t(14) = 1.15, p = .270, d = 0.58; percent of content started, t(14) = -0.29, p = .776, d = -0.15; and percent of content completed, t(14) = 0.10, p = .921, d = 0.05. A marginally significant difference was observed in usability, with YA (M = 85.83, SD = 4.92) rating ASCENT higher than AEA (M = 77.08, SD = 8.58), t(10) = -2.17, p = .055, d = -1.15.
Conclusions: ASCENT demonstrated acceptability and usability among both AEA and YA, with no significant differences in acceptability or engagement. The findings support ASCENT’s broad applicability across age groups. The marginally lower usability rating among AEA suggests a need to address their specific usability concerns in future iterations. Overall, the results highlight successful tailoring of ASCENT to AYACS broadly, despite the wide age range of this group.
Keywords: Cancer, e-HealthMethods: Participants were identified via medical records at a rural academic medical center and invited to a pilot full factorial trial of ASCENT. They completed a virtual orientation and engaged with modules over six weeks. At follow-up, participants completed an exit interview and self-report measures, including the System Usability Scale, an investigator-developed acceptability scale, and the eHealth Engagement Scale. ASCENT usage data, including time spent and modules completed, was collected directly from the tool.
Results: Analyses of survey-based outcomes (n = 12; AEA = 6, YA = 6) revealed no significant differences between AEA and YA in acceptability (t(10) = -0.28, p = .785, d = -0.16) or engagement (t(10) = 1.66, p = .129, d = 0.96). Analyses of platform usage outcomes, including weekly use and content completion (n = 16; AEA = 9, YA = 7), also revealed no significant group differences in weekly use, t(14) = 1.15, p = .270, d = 0.58; percent of content started, t(14) = -0.29, p = .776, d = -0.15; and percent of content completed, t(14) = 0.10, p = .921, d = 0.05. A marginally significant difference was observed in usability, with YA (M = 85.83, SD = 4.92) rating ASCENT higher than AEA (M = 77.08, SD = 8.58), t(10) = -2.17, p = .055, d = -1.15.
Conclusions: ASCENT demonstrated acceptability and usability among both AEA and YA, with no significant differences in acceptability or engagement. The findings support ASCENT’s broad applicability across age groups. The marginally lower usability rating among AEA suggests a need to address their specific usability concerns in future iterations. Overall, the results highlight successful tailoring of ASCENT to AYACS broadly, despite the wide age range of this group.
Authors:
Presenter - Rachel Glock, B.A., East Carolina University
Co-Author - AnneMarie Coffey, B.S., East Carolina University
Co-Author - Reid Anctil, B.A., East Carolina University
Co-Author - Lane Williamson, B.A., East Carolina University
Co-Author - Savanah Tribbe, East Carolina University
Co-Author - Karly M. Ingram, Ph.D., East Carolina University
Psychiatric symptoms and eating behaviors before and after metabolic and bariatric surgery: Associations with weight loss
Poster Number: D160Time: 11:00 AM - 11:50 AM
Topics: Weight Related Health , Mental Health
Background: Although metabolic and bariatric surgery (MBS) is the most effective treatment for class III obesity, a proportion of patients will experience suboptimal weight loss. The purpose of this study was to examine changes in psychiatric symptoms and maladaptive eating behaviors among patients undergoing MBS and to determine whether these factors were associated with weight loss outcomes.
Methods: All patients at a single health care system that were between 6 months and 4 years post-MBS were invited to complete a web-based survey that included validated measures of depression, anxiety, emotional eating, and food addiction as well as report their weight at the time of survey completion. Data from routine pre-operative psychosocial evaluations were obtained from participants’ electronic medical records. Percent total weight loss (%TWL) was calculated from preoperative weight to the postoperative survey.
Results: Participants (N= 539) were primarily female (89.2%) and White (61.8%) or Black (36.3%), with a mean age of 44 years. Depressive symptoms (t= 5.79, p< .001) and symptoms of food addiction (t= 8.52, p< .001) decreased after MBS whereas anxiety symptoms (t= -6.52, p< .001) and emotional eating scores increased (t= -2.62, p= .01). Preoperative body mass index (BMI) was not associated with preoperative psychiatric symptoms or maladaptive eating behaviors (p> .05). %TWL was not associated with preoperative psychiatric symptoms or maladaptive eating behaviors (p> .05). However, greater %TWL was associated with lower postoperative depressive symptoms (r= -.25, p< .001), anxiety symptoms (r= -.12, p= .01), emotional eating scores (r= -.21, p<.001), and symptoms of food addiction (r= -.30, p<.001).
Conclusions: Patients may experience changes in psychiatric symptoms and maladaptive eating behaviors after MBS. Additionally, higher levels of postoperative psychiatric symptoms and maladaptive eating behaviors were associated with less weight loss after MBS. Clinicians may want to monitor patients postoperatively for increases in psychiatric symptoms and maladaptive eating behaviors and provide education to patients about the associations with weight outcomes. Early identification of a rise in symptoms could signal a need for interventions to promote optimal weight outcomes.
Keywords: Weight loss, Mental healthMethods: All patients at a single health care system that were between 6 months and 4 years post-MBS were invited to complete a web-based survey that included validated measures of depression, anxiety, emotional eating, and food addiction as well as report their weight at the time of survey completion. Data from routine pre-operative psychosocial evaluations were obtained from participants’ electronic medical records. Percent total weight loss (%TWL) was calculated from preoperative weight to the postoperative survey.
Results: Participants (N= 539) were primarily female (89.2%) and White (61.8%) or Black (36.3%), with a mean age of 44 years. Depressive symptoms (t= 5.79, p< .001) and symptoms of food addiction (t= 8.52, p< .001) decreased after MBS whereas anxiety symptoms (t= -6.52, p< .001) and emotional eating scores increased (t= -2.62, p= .01). Preoperative body mass index (BMI) was not associated with preoperative psychiatric symptoms or maladaptive eating behaviors (p> .05). %TWL was not associated with preoperative psychiatric symptoms or maladaptive eating behaviors (p> .05). However, greater %TWL was associated with lower postoperative depressive symptoms (r= -.25, p< .001), anxiety symptoms (r= -.12, p= .01), emotional eating scores (r= -.21, p<.001), and symptoms of food addiction (r= -.30, p<.001).
Conclusions: Patients may experience changes in psychiatric symptoms and maladaptive eating behaviors after MBS. Additionally, higher levels of postoperative psychiatric symptoms and maladaptive eating behaviors were associated with less weight loss after MBS. Clinicians may want to monitor patients postoperatively for increases in psychiatric symptoms and maladaptive eating behaviors and provide education to patients about the associations with weight outcomes. Early identification of a rise in symptoms could signal a need for interventions to promote optimal weight outcomes.
Authors:
Presenter - Lisa Miller-Matero, Henry Ford Health
Co-Author - Erin Haley, Henry Ford Health
Co-Author - Penelope Friday, Henry Ford Health
Co-Author - Sarah Bendit, Henry Ford Health
Co-Author - Carly Brescacin, Henry Ford Health
Co-Author - Jordan Braciszewski, Henry Ford Health
Co-Author - Oliver Varban, Henry Ford Health
Co-Author - Arthur Carlin, Henry Ford Health System
Patient knowledge of and interest in GLP-1 agonists: Opportunities to improve decision support
Poster Number: D161Time: 11:00 AM - 11:50 AM
Topics: Weight Related Health , Decision Making
Newer obesity management medications (OMMs; e.g., GLP-1 agonists) are gaining popularity and have garnered significant media attention. OMMs’ established and potential health benefits also continue to grow. Despite this, less is known about: 1) what patients have heard about OMMs, 2) where patients get OMM information, and 3) the main reasons patients would or would not use OMMs. This study investigated these questions among diverse, English-speaking adult patients recruited from two primary and two specialty care clinics in a large urban/suburban health system. Patients (N=52) completed a brief online survey in early 2025. Descriptive statistics were calculated. Overall, 98% had heard at least “a little” about newer OMMs. Most patients were female (88%) and identified as Hispanic (40.4%), Black (26.9%), and “slightly” or “very” overweight (80.1%). Mean age was 39±12 years. In total, 40% reported previous or current OMM use; 58% of OMM-naïve patients were interested in use. The top 3 topics patients had heard “a lot” about related to OMMs were weight loss (84%), supply issues (61%), and prevention/treatment of health conditions (51%). Less often, patients heard “a lot” about potential negative health effects (12%), impact on cigarette cravings (16%), and side effects (18%). The most commonly reported information sources for OMMs were advertisements (73%), health professionals (63%), and mass/social media (53%). The strongest motivators for use among current/prior OMM users were weight loss, food noise reduction, and prevention/treatment of type 2 diabetes (71%, 57%, and 52% rated “extremely important,” respectively). These were also the areas where patients most often reported “moderate” or “extreme” satisfaction with OMMs’ effects (all >62% endorsement). OMM-naïve patients reported similar reasons for potential use (e.g., >70% rated weight loss and food noise reduction as “extremely important”). Top concerns among these OMM-naïve patients centered on cost, insurance coverage, supply availability, and risk for regain after discontinuation (>66% rated “extremely important”). Overall, findings indicate strong interest in OMMs and a good match between motivators for use and treatment satisfaction among those on OMMs. However, results also highlight opportunities for improved patient education to ensure informed decision-making, as well as structural barriers to use. Findings can inform multi-level efforts to promote patient-centered, evidence-based care.
Keywords: Decision making, ObesityAuthors:
Presenter - Leah Schumacher, PhD, Temple University
Co-Author - Elise Rodrigues, Lewis Katz School of Medicine, Temple University
Co-Author - Erin Mraz, Temple University
Co-Author - Doria Wohler, Temple University
Co-Author - Astha Rajpal, Temple University
Co-Author - Daniel Rubin, MD, MSC, FACE, Lewis Katz School of Medicine, Temple University
Co-Author - Sharon Herring, MD, MPH, Lewis Katz School of Medicine, Temple University
Co-Author - Ajay Rao, MD, MMSc, FACP, Lewis Katz School of Medicine, Temple University
Co-Author - Laura Igarabuza, MD, Lewis Katz School of Medicine, Temple University
Co-Author - Samantha Flanagan, DO, Lewis Katz School of Medicine, Temple University
Co-Author - Daniel Edmundowicz, MS, MD, FACP, FACC, Lewis Katz School of Medicine, Temple University
Co-Author - Resa Jones, MPH, PhD, Temple University
Co-Author - David Sarwer, PhD, Temple University
Maternal Perceptions of Children’s Weight Status in North Macedonia
Poster Number: D162Time: 11:00 AM - 11:50 AM
Topics: Weight Related Health , Child and Family Health
Background:
Accurate maternal perceptions of children’s weight status are essential for early obesity prevention. Using a nationally representative sample of children in North Macedonia, this study examined maternal perceptions of children’s weight status and predictors of misperceptions.
Methods:
Data for this study were obtained from the World Health Organization’s (WHO) European Childhood Obesity Surveillance Initiative—5th round. Maternal perceptions of children’s weight status were classified as underweight, normal weight, slightly overweight, or extremely overweight. Anthropometric data from 7–8-year-old children (n=1,495) were used to calculate BMI-for-age Z-scores using 2007 WHO growth references. Descriptive analyses summarized BMI-for-age Z-score categories, maternal perceptions of child weight status, and perception accuracy. Among children living with overweight and obesity, multivariate logistic regression identified predictors of maternal misperceptions while controlling for covariates. Logistic regression results were presented as adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs).
Results:
Based on WHO growth references, one-third of children were classified as having overweight (18.2%) or obesity (19.4%), while 59.3% were within recommended BMI values and 3.1% were underweight. More than half of mothers (60.7%) accurately identified their child’s weight status (boys: 60.1%; girls: 61.3%). In contrast, 35.1% underestimated their child’s weight (boys: 35.2%; girls: 35.0%), and 4.1% overestimated it (boys: 4.6%; girls: 3.7%). Underestimation was especially pronounced among mothers with overweight (83.5%; boys: 87.9%; girls: 80.1%) and obese (94.5%; boys: 94.7%; girls: 94.2%) children. Among children with overweight and obesity, mothers were significantly more likely to underestimate weight status among boys (aOR:1.82; 95% CI:1.01–3.21). Maternal weight status (aOR:0.96; 95% CI:0.54–1.68), maternal age (aOR:1.03; 95% CI:0.97–1.09), maternal education level (aOR: 1.55; 95% CI:0.88–2.74), and rural residence (aOR:0.87; 95% CI:0.40–1.87) were not significant predictors of underestimation.
Discussion:
These findings underscore the pervasive underestimation of child overweight and obesity among mothers in North Macedonia, particularly for boys. Interventions that enhance parental awareness and recognition of excess weight are therefore critical for supporting timely and effective childhood obesity prevention efforts.
Keywords: Obesity, Children's healthAccurate maternal perceptions of children’s weight status are essential for early obesity prevention. Using a nationally representative sample of children in North Macedonia, this study examined maternal perceptions of children’s weight status and predictors of misperceptions.
Methods:
Data for this study were obtained from the World Health Organization’s (WHO) European Childhood Obesity Surveillance Initiative—5th round. Maternal perceptions of children’s weight status were classified as underweight, normal weight, slightly overweight, or extremely overweight. Anthropometric data from 7–8-year-old children (n=1,495) were used to calculate BMI-for-age Z-scores using 2007 WHO growth references. Descriptive analyses summarized BMI-for-age Z-score categories, maternal perceptions of child weight status, and perception accuracy. Among children living with overweight and obesity, multivariate logistic regression identified predictors of maternal misperceptions while controlling for covariates. Logistic regression results were presented as adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs).
Results:
Based on WHO growth references, one-third of children were classified as having overweight (18.2%) or obesity (19.4%), while 59.3% were within recommended BMI values and 3.1% were underweight. More than half of mothers (60.7%) accurately identified their child’s weight status (boys: 60.1%; girls: 61.3%). In contrast, 35.1% underestimated their child’s weight (boys: 35.2%; girls: 35.0%), and 4.1% overestimated it (boys: 4.6%; girls: 3.7%). Underestimation was especially pronounced among mothers with overweight (83.5%; boys: 87.9%; girls: 80.1%) and obese (94.5%; boys: 94.7%; girls: 94.2%) children. Among children with overweight and obesity, mothers were significantly more likely to underestimate weight status among boys (aOR:1.82; 95% CI:1.01–3.21). Maternal weight status (aOR:0.96; 95% CI:0.54–1.68), maternal age (aOR:1.03; 95% CI:0.97–1.09), maternal education level (aOR: 1.55; 95% CI:0.88–2.74), and rural residence (aOR:0.87; 95% CI:0.40–1.87) were not significant predictors of underestimation.
Discussion:
These findings underscore the pervasive underestimation of child overweight and obesity among mothers in North Macedonia, particularly for boys. Interventions that enhance parental awareness and recognition of excess weight are therefore critical for supporting timely and effective childhood obesity prevention efforts.
Authors:
Presenter - Aleksandra Stamenova, MD, University Ss.Cyril and Methodius in Skopje, Faculty of Medicine-Skopje
Author - Lorraine Wallace, PhD, The Ohio State University
Author - Igor Spiroski, MD, PhD, MPH, University Ss.Cyril and Methodius in Skopje, Faculty of Medicine-Skopje; Institute of Public Health of the Republic of North Macedonia, Skopje, N.Macedonia
Improving the Measurement of Prenatal Food Insecurity: A Community-Engaged, Qualitative Measure Development Study
Poster Number: D163Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Diet, Nutrition, and Eating Disorders
Background: Food insecurity (inadequate/uncertain food access) in pregnancy is linked to adverse intergenerational health outcomes. Prior research is limited by the lack of validated food insecurity measures that account for pregnancy-specific changes to food needs or access. In this community-engaged measure development study we aimed to define and operationalize prenatal food insecurity via focus groups and develop and refine self-report items capturing prenatal food insecurity via cognitive interviews.
Method: Our community-engaged study team (academic researchers and community partners who experienced and/or provide services to those with prenatal food insecurity) recruited N=73 pregnant participants in the U.S. who endorsed food insecurity on the two-item Hunger Vital Signs screener. We conducted four 90-minute focus groups (n=43 participants) to define and operationalize prenatal food insecurity. Next, we generated candidate self-report items based on focus group findings and prior literature. We used the Question Appraisal System (QAS-99) to identify potentially problematic (e.g., vague) items to include in cognitive interviews (n=30 participants) to assess item interpretation. Rapid qualitative analysis was used to efficiently operationalize the construct and create and refine items.
Results: Focus group themes suggested that prenatal food insecurity involves disruptions to food access (inadequate food quantity, nutrition quality, or preferred foods) and associated distress (psychological or physiological distress, stigma, or cognitive labor). We derived 74 candidate items covering these domains; 45 were included in cognitive interviews. Items were revised, dropped, or added, resulting in a final 73-item bank.
Discussion: Our item bank includes 73 content valid items assessing seven domains of prenatal food insecurity related to inadequate food access and associated distress, such as “I had to eat foods that made me nauseous or physically uncomfortable because I could not get other foods” (domain: insufficient preferred foods) and “I worried about my developing baby's health because I could not get the foods I needed” (domain: psychological distress). These items, developed based on firsthand accounts of pregnant individuals with food insecurity, may provide a more accurate, comprehensive and acceptable assessment of prenatal food insecurity. Our future research will evaluate the psychometric properties of the items in a large pregnant sample.
Keywords: Pregnancy, AssessmentMethod: Our community-engaged study team (academic researchers and community partners who experienced and/or provide services to those with prenatal food insecurity) recruited N=73 pregnant participants in the U.S. who endorsed food insecurity on the two-item Hunger Vital Signs screener. We conducted four 90-minute focus groups (n=43 participants) to define and operationalize prenatal food insecurity. Next, we generated candidate self-report items based on focus group findings and prior literature. We used the Question Appraisal System (QAS-99) to identify potentially problematic (e.g., vague) items to include in cognitive interviews (n=30 participants) to assess item interpretation. Rapid qualitative analysis was used to efficiently operationalize the construct and create and refine items.
Results: Focus group themes suggested that prenatal food insecurity involves disruptions to food access (inadequate food quantity, nutrition quality, or preferred foods) and associated distress (psychological or physiological distress, stigma, or cognitive labor). We derived 74 candidate items covering these domains; 45 were included in cognitive interviews. Items were revised, dropped, or added, resulting in a final 73-item bank.
Discussion: Our item bank includes 73 content valid items assessing seven domains of prenatal food insecurity related to inadequate food access and associated distress, such as “I had to eat foods that made me nauseous or physically uncomfortable because I could not get other foods” (domain: insufficient preferred foods) and “I worried about my developing baby's health because I could not get the foods I needed” (domain: psychological distress). These items, developed based on firsthand accounts of pregnant individuals with food insecurity, may provide a more accurate, comprehensive and acceptable assessment of prenatal food insecurity. Our future research will evaluate the psychometric properties of the items in a large pregnant sample.
Authors:
Presenter - Christine Call, PhD, University of Pittsburgh
Co-Author - Abigale Regal, University of Pittsburgh Medical Center
Co-Author - Jharlyn Angel-Meija, CCHW, University of New Mexico
Co-Author - Quala Bennett, University of Pittsburgh
Co-Author - Cassandra Boness, PhD, University of New Mexico
Co-Author - Abigail Carpenter, MPH, MSW, LSW, UPMC Children's Hospital of Pittsburgh
Co-Author - Rachel Conlon, PhD, University of Pittsburgh School of Medicine
Co-Author - Jane Eberhardt, RD, LDN, CLC, Adagio Health
Co-Author - Desirey Gomez, BS, University of Pittsburgh
Co-Author - Jennifer Grace, MS, University of Pittsburgh Medical Center
Co-Author - Tylah Harrison, BSPH, University of Virginia School of Medicine
Co-Author - Raven Hilfiker, LSW, PMH-C, UPMC Magee-Womens Hospital
Co-Author - Riley Jouppi, M.S., University of Pittsburgh
Co-Author - Abby Jo Perez, BA, Pittsburgh Bereavement Doulas
Co-Author - Michele Levine, PhD, FSBM, University of Pittsburgh Medical Center
Expecting the unexpected: The role of pregnancy in depression exacerbation among kidney transplant patients
Poster Number: D164Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Quality of Life
Background:
Kidney transplant recipients are at an increased risk of depression and may be considered high-risk pregnancies post-transplant. Current guidelines do not address depression monitoring or preconception counseling but rather are included as postpartum guidelines as needed. Such discussions could enhance preparedness and minimize negative outcomes for both mother and baby. This study assessed how pregnancy influences depression exacerbation in kidney transplant patients with a history of depression.
Methods:
The TriNetX US Collaborative Health Research Network was used in this retrospective cohort study to evaluate the medical records of 65 million female adults aged 18 and over. Patients with kidney transplant history and pregnancy at least one year after were identified using ICD and CPT codes and divided into two cohorts: those with history of depression (n=284) and those without (n=1,926). Propensity score matching (PSM) was performed based on race, ethnicity, and comorbidities to reduce potential confounding variables. Outcome of interest was depression exacerbation assessed two weeks to two years after the index event.
Results:
After 1:1 PSM, the study population consisted of 282 patients. The cohort was predominantly white, with a mean age at index of 30 years. Analysis revealed that in patients who experienced depression exacerbation following pregnancy, 52.8% (n=149) had a history of depression compared with 19.9% (n=56) who did not. Patients with a history of depression prior to kidney transplant were at an increased risk of experiencing depression two weeks to two years after pregnancy compared to patients with no history of depression (RR= 2.661, [95% CI: 2.053-3.448], p<0.0001). The Kaplan Meier survival curve illustrates a statistically significant improvement (p<0.0001) in depression-free survival at two weeks to two years after pregnancy. Cohort 1, history of depression, indicates a lower survival probability of 40.798% compared to Cohort 2, no history of depression, survival probability of 78.476%.
Conclusion:
Female patients with a history of kidney transplant and depression have a greater risk of experiencing depression exacerbation after pregnancy. These patients who are planning to conceive should be evaluated by a multi-disciplinary team, and this relationship may improve future guidelines, comprehensive patient care, and provider awareness.
Keywords: Women's health, Quality of lifeKidney transplant recipients are at an increased risk of depression and may be considered high-risk pregnancies post-transplant. Current guidelines do not address depression monitoring or preconception counseling but rather are included as postpartum guidelines as needed. Such discussions could enhance preparedness and minimize negative outcomes for both mother and baby. This study assessed how pregnancy influences depression exacerbation in kidney transplant patients with a history of depression.
Methods:
The TriNetX US Collaborative Health Research Network was used in this retrospective cohort study to evaluate the medical records of 65 million female adults aged 18 and over. Patients with kidney transplant history and pregnancy at least one year after were identified using ICD and CPT codes and divided into two cohorts: those with history of depression (n=284) and those without (n=1,926). Propensity score matching (PSM) was performed based on race, ethnicity, and comorbidities to reduce potential confounding variables. Outcome of interest was depression exacerbation assessed two weeks to two years after the index event.
Results:
After 1:1 PSM, the study population consisted of 282 patients. The cohort was predominantly white, with a mean age at index of 30 years. Analysis revealed that in patients who experienced depression exacerbation following pregnancy, 52.8% (n=149) had a history of depression compared with 19.9% (n=56) who did not. Patients with a history of depression prior to kidney transplant were at an increased risk of experiencing depression two weeks to two years after pregnancy compared to patients with no history of depression (RR= 2.661, [95% CI: 2.053-3.448], p<0.0001). The Kaplan Meier survival curve illustrates a statistically significant improvement (p<0.0001) in depression-free survival at two weeks to two years after pregnancy. Cohort 1, history of depression, indicates a lower survival probability of 40.798% compared to Cohort 2, no history of depression, survival probability of 78.476%.
Conclusion:
Female patients with a history of kidney transplant and depression have a greater risk of experiencing depression exacerbation after pregnancy. These patients who are planning to conceive should be evaluated by a multi-disciplinary team, and this relationship may improve future guidelines, comprehensive patient care, and provider awareness.
Authors:
Co-Author - Megha Girn, B.S. , Department of Urology and Transplant, University of Toledo College of Medicine and Life Sciences
Co-Author - Megan Charette, RN, BSN, MPH, Department of Urology and Transplant, University of Toledo College of Medicine and Life Sciences
Co-Author - Obi Ekwenna, MD, Department of Urology and Transplant, University of Toledo College of Medicine and Life Sciences
Breaking the Treatment Gap: Efficacy of Biomedical Therapies for Mental Health Treatment in Women - A Comprehensive Meta-Analysis
Poster Number: D165Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Mental Health
Women experience mental health disorders at disproportionately higher rates than men, with major depressive disorder occurring twice as frequently in women (Kuehner, 2017). Significant gaps exist in understanding biomedical therapies specifically tailored for women's mental health needs (Altemus et al., 2014). Sex differences in pharmacokinetics, hormonal influences, and treatment responses necessitate gender-specific psychiatric care approaches (Kornstein et al., 2000; Young et al., 2009). Recent neuroimaging research reveals substantial sex differences in psychopharmacological treatment responses (Syan et al., 2021).
Methods: Systematic searches across PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, and CINAHL from inception to September 2024 following PRISMA-P guidelines. Randomized controlled trials examining biomedical therapies (pharmacological interventions, hormonal treatments, neurostimulation techniques, combination therapies) for mental health disorders in female populations will be included (Cipriani et al., 2018). Primary outcomes include symptom reduction by standardized scales. Secondary outcomes encompass quality of life and treatment adherence (Dragioti et al., 2024). Risk of bias assessed using Cochrane Risk of Bias Tool 2 (Sterne et al., 2019).
Expected Results: Evidence suggests significant sex differences in treatment responses. Women demonstrate superior responses to selective serotonin reuptake inhibitors, with response rates 15-25% higher than men (Sramek et al., 2016; Young et al., 2009). Hormonal therapies show promise, with estradiol supplementation reducing depressive symptoms by 35-40% in perimenopausal women (Gordon et al., 2018; Schmidt et al., 2015). Combination therapies generate significantly greater clinical responses in women with treatment-resistant depression (Seney & Sibille, 2014). Neurostimulation techniques demonstrate enhanced efficacy in female populations (Aparicio et al., 2019).
Clinical Implications: This meta-analysis will provide critical evidence for developing sex-specific treatment guidelines for women's mental health care. Results may inform clinical decision-making regarding optimal biomedical interventions tailored to female physiology (Bao & Swaab, 2020). The synthesis will highlight treatment gaps and identify priority areas for future research, potentially revolutionizing personalized medicine approaches (LeGates et al., 2019).
Keywords: Mental health, Biobehavioral mechanismsMethods: Systematic searches across PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, and CINAHL from inception to September 2024 following PRISMA-P guidelines. Randomized controlled trials examining biomedical therapies (pharmacological interventions, hormonal treatments, neurostimulation techniques, combination therapies) for mental health disorders in female populations will be included (Cipriani et al., 2018). Primary outcomes include symptom reduction by standardized scales. Secondary outcomes encompass quality of life and treatment adherence (Dragioti et al., 2024). Risk of bias assessed using Cochrane Risk of Bias Tool 2 (Sterne et al., 2019).
Expected Results: Evidence suggests significant sex differences in treatment responses. Women demonstrate superior responses to selective serotonin reuptake inhibitors, with response rates 15-25% higher than men (Sramek et al., 2016; Young et al., 2009). Hormonal therapies show promise, with estradiol supplementation reducing depressive symptoms by 35-40% in perimenopausal women (Gordon et al., 2018; Schmidt et al., 2015). Combination therapies generate significantly greater clinical responses in women with treatment-resistant depression (Seney & Sibille, 2014). Neurostimulation techniques demonstrate enhanced efficacy in female populations (Aparicio et al., 2019).
Clinical Implications: This meta-analysis will provide critical evidence for developing sex-specific treatment guidelines for women's mental health care. Results may inform clinical decision-making regarding optimal biomedical interventions tailored to female physiology (Bao & Swaab, 2020). The synthesis will highlight treatment gaps and identify priority areas for future research, potentially revolutionizing personalized medicine approaches (LeGates et al., 2019).
Authors:
Co-Author - Vardha Kharbanda, Illinois Institute of Technology
Co-Author - Souzan Mirza, MHSc Clinical Engineering, Unaffiliated
Postpartum Body Image and Eating Behaviors: Receptivity to Non-Diet Approaches in a Qualitative Study of Perinatal Women
Poster Number: D166Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Diet, Nutrition, and Eating Disorders
Introduction: The perinatal period is marked by profound physical and emotional changes, presenting unique body image challenges which may impact maternal health and wellbeing. This study explored barriers and receptivity to non-diet approaches among pregnant and postpartum women through eight focus groups with participants (n=20) engaged with doula services or the Arizona Supplemental Nutrition Program for Women, Infants, and Children (WIC) program.
Methods: A total of 20 perinatal women (average age 32.95 years ± 5.5 years, 75% Not Hispanic, White; 60% postpartum) were recruited to participate in virtual focus groups. Participants were eligible if they were 18 years of age or older, female, and either currently pregnant or in the postpartum period (defined as 18 months after delivery). Interviews were conducted between January 2024 and June 2024. All interviews were audio recorded and transcribed. Three interdisciplinary team members independently coded text units in 35% of the transcripts to develop a preliminary coding framework, noting anything related to body image and perceptions of a non-diet approach. The study team reviewed original codes and discussed contextualization of themes to develop the framework for coding of the remaining transcripts. Thematic analysis led to the identification of several themes.
Results: Participants identified barriers to adopting non-diet approaches, including: 1) weight loss goals driven by pervasive societal factors, 2) misinterpretation of non-diet principles, and 3) reduced trust in internal regulation mechanisms such as hunger and fullness cues. Breastfeeding demands and an interest in nutrient-dense diets emerged as influential factors shaping participants' health behaviors and body image. Despite these concerns, many expressed receptivity to the holistic focus of non-diet approaches, particularly in promoting joyful movement and sustainable health practices.
Conclusions and Implications: Findings from this study highlight the importance of addressing misconceptions around non-dieting approaches, enhancing education, and fostering trust in internal regulation to improve the adoption of non-diet strategies during the perinatal period. This study underscores the need for holistic, evidence-based nutrition interventions that support physical and mental health during pregnancy and postpartum, empowering women to prioritize wellbeing in this critical juncture.
Keywords: Nutrition, Women's healthMethods: A total of 20 perinatal women (average age 32.95 years ± 5.5 years, 75% Not Hispanic, White; 60% postpartum) were recruited to participate in virtual focus groups. Participants were eligible if they were 18 years of age or older, female, and either currently pregnant or in the postpartum period (defined as 18 months after delivery). Interviews were conducted between January 2024 and June 2024. All interviews were audio recorded and transcribed. Three interdisciplinary team members independently coded text units in 35% of the transcripts to develop a preliminary coding framework, noting anything related to body image and perceptions of a non-diet approach. The study team reviewed original codes and discussed contextualization of themes to develop the framework for coding of the remaining transcripts. Thematic analysis led to the identification of several themes.
Results: Participants identified barriers to adopting non-diet approaches, including: 1) weight loss goals driven by pervasive societal factors, 2) misinterpretation of non-diet principles, and 3) reduced trust in internal regulation mechanisms such as hunger and fullness cues. Breastfeeding demands and an interest in nutrient-dense diets emerged as influential factors shaping participants' health behaviors and body image. Despite these concerns, many expressed receptivity to the holistic focus of non-diet approaches, particularly in promoting joyful movement and sustainable health practices.
Conclusions and Implications: Findings from this study highlight the importance of addressing misconceptions around non-dieting approaches, enhancing education, and fostering trust in internal regulation to improve the adoption of non-diet strategies during the perinatal period. This study underscores the need for holistic, evidence-based nutrition interventions that support physical and mental health during pregnancy and postpartum, empowering women to prioritize wellbeing in this critical juncture.
Authors:
Presenter - Megan Meyer, MPH, RDN, Northern Arizona University
Co-Author - Jocelyn Carter, MPH, RDN, Northern Arizona University
Co-Author - Emily Woodworth, BA, University at Albany, State University of New York
Co-Author - Rachel Vanderkruik, PhD, Massachusetts General Hospital; Center for Women's Mental Health
Co-Author - Nanette Lopez, PhD, MS/MS, RD, Northern Arizona University
Co-Author - Natalie Papini, PhD, Northern Arizona University
Unmet Social Needs and Psychological Distress in Black Women at Risk for Hypertension: Baseline Findings from the TEAM-Red Trial
Poster Number: D167Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Health Disparities
Background:
Unmet health-related social needs (HRSNs) increase the risk of poor health outcomes and greater healthcare utilization. Minority populations face a disproportionate burden of unmet social needs, contributing to widening health disparities. This study examines how unmet social needs impact depression, stress, and discrimination in depressed Black women at risk for hypertension.
Methods:
Baseline data from a pilot randomized controlled trial (RCT) testing a remotely delivered self-management program for Black women at risk of hypertension were analyzed. Measures included the Accountable Health Communities Health-Related Social Needs (AHC-HRSN) Screening Tool, PHQ-9 (depression), PSS-10 (perceived stress), and the EDS (discrimination). The HRSN was divided into 5 core domains (housing, food, transportation, utilities, and safety) and 8 supplemental domains (financial strain, employment, education, physical activity, family/community support, substance use, mental health, and disabilities). T-tests evaluated differences between groups (needs unmet vs met) for core domains in relation to PHQ-9, PSS-10, and EDS. Spearman correlations were calculated for total core and supplemental domains.
Results:
Participants (N = 82) were Black females aged 20-48 (M= 34.49; SD=8.44) with 14.67 (SD=2.16) years of education. Means were 1.32 (SD=1.22) and 4.66 (SD=1.69) for unmet core and supplemental needs, respectively. Those with unmet housing needs had higher EDS (p = .004). Those with unmet food needs had higher PHQ-9 (p = .013) and PSS-10 (p = .002). Those with unmet utilities needs had higher PHQ-9 (p < .001) and EDS (p < .001). Those with unmet safety needs had higher PHQ-9 (p = .044) and EDS (p = .003). Unmet core and supplemental needs were strongly positively correlated (r = .55, p < .001). Finally, average unmet core and supplemental needs were positively correlated with higher PHQ-9 (r = .43 and .37, respectively; both p < .001), PSS-10 (r = .28, p = .011 and r = .31, p =.004, respectively), and EDS (r = .42 and .49, respectively; both p < .001) scores.
Conclusion:
Unmet social needs are significantly related to higher levels of depression, stress, and discrimination in Black women at risk for hypertension. These women face psychosocial challenges that compound their mental health burden. These findings highlight the importance of addressing social needs for effective depression management and cardiovascular risk reduction in this vulnerable population.
Keywords: Women's health, Health disparitiesUnmet health-related social needs (HRSNs) increase the risk of poor health outcomes and greater healthcare utilization. Minority populations face a disproportionate burden of unmet social needs, contributing to widening health disparities. This study examines how unmet social needs impact depression, stress, and discrimination in depressed Black women at risk for hypertension.
Methods:
Baseline data from a pilot randomized controlled trial (RCT) testing a remotely delivered self-management program for Black women at risk of hypertension were analyzed. Measures included the Accountable Health Communities Health-Related Social Needs (AHC-HRSN) Screening Tool, PHQ-9 (depression), PSS-10 (perceived stress), and the EDS (discrimination). The HRSN was divided into 5 core domains (housing, food, transportation, utilities, and safety) and 8 supplemental domains (financial strain, employment, education, physical activity, family/community support, substance use, mental health, and disabilities). T-tests evaluated differences between groups (needs unmet vs met) for core domains in relation to PHQ-9, PSS-10, and EDS. Spearman correlations were calculated for total core and supplemental domains.
Results:
Participants (N = 82) were Black females aged 20-48 (M= 34.49; SD=8.44) with 14.67 (SD=2.16) years of education. Means were 1.32 (SD=1.22) and 4.66 (SD=1.69) for unmet core and supplemental needs, respectively. Those with unmet housing needs had higher EDS (p = .004). Those with unmet food needs had higher PHQ-9 (p = .013) and PSS-10 (p = .002). Those with unmet utilities needs had higher PHQ-9 (p < .001) and EDS (p < .001). Those with unmet safety needs had higher PHQ-9 (p = .044) and EDS (p = .003). Unmet core and supplemental needs were strongly positively correlated (r = .55, p < .001). Finally, average unmet core and supplemental needs were positively correlated with higher PHQ-9 (r = .43 and .37, respectively; both p < .001), PSS-10 (r = .28, p = .011 and r = .31, p =.004, respectively), and EDS (r = .42 and .49, respectively; both p < .001) scores.
Conclusion:
Unmet social needs are significantly related to higher levels of depression, stress, and discrimination in Black women at risk for hypertension. These women face psychosocial challenges that compound their mental health burden. These findings highlight the importance of addressing social needs for effective depression management and cardiovascular risk reduction in this vulnerable population.
Authors:
Author - Davina Patel, MS, University Hospitals Cleveland Medical Center
Author - Nicole Fiorelli, MA, Case Western Reserve University
Author - Farren Briggs, PhD, University of Miami Miller School of Medicine
Author - Martha Sajatovic, MD, University Hospitals Cleveland Medical Center & Case Western Reserve University
Author - Erika Kelley, PhD, University Hospitals Cleveland Medical Center & Case Western Reserve University
Author - Salayna Abdallah, MA, University Hospitals Cleveland Medical Center & Kent State University
Author - Taylor Maniglia, MA, Case Western Reserve University
Author - Emma Church, MA, University Hospitals Cleveland Medical Center & University of Toledo
Author - Kathy-Diane Reich, University Hospitals Cleveland Medical Center & Cleveland State University
Author - Jessica Surdam, MPH, University Hospitals Cleveland Medical Center
Chair - Jennifer Levin, PhD, University Hospitals Cleveland Medical Center & Case Western Reserve University
Associations between the Four Domain Food Insecurity Scale Scores and Mental Health Outcomes in a Pregnant Sample.
Poster Number: D168Time: 11:00 AM - 11:50 AM
Topics: Women's Health, Diet, Nutrition, and Eating Disorders
Background: Food insecurity (FI) is a multi-domain construct involving insufficient food quantity and quality and psychological (preoccupation about food access) and social (alienation) concerns. Although FI has been associated with prenatal mental health, no prior research has examined associations between the unique domains of food insecurity and prenatal mental health. We aimed to explore cross-sectional relationships between mental health and the Four Domain Food Insecurity Scale (4D-FIS) during pregnancy, a critical period for mental health promotion.
Method: Pregnant participants (N=74; 23.97±9.43 weeks pregnant; 31.61±11.86 years old) who reported food insecurity at any point in their pregnancy completed the Center for Epidemiological Studies Depression Scale (CES-D), the State- Trait Anxiety Inventory (STAI; trait subscale), the Perceived Stress Scale (PSS10), and the Four -Domain Food Insecurity Scale (4D-FIS). Pearson correlation analyses examined cross- sectional associations between each 4D-FIS subscale and depressive symptoms, anxiety, and perceived stress.
Results: Based on 4D-FIS scores, 87.7% of the sample had severe food insecurity, 9.5% mild, and 2.7% none. Increased disruptions to food quantity and food quality, as well preoccupation about food access were associated with higher scores on the CES-D (r(71)=.36, p=.002; r(69)=.26, p=.029; r(71)=.28, p=.018), and the PSS10 (r(71)=.43, p<.001; r(69)=.35, p=.003; r(71)=.42, p<.001). Greater social alienation related to food access on the 4D-FIS was correlated with higher scores on the PSS10 (r(71)=.328, p=.005). STAI scores were not significantly correlated with any of the 4D-FIS subscales.
Discussion: The present analysis is the first to examine the correlation between the theorized domains of food insecurity, as defined by the 4D-FIS, and mental health outcomes during pregnancy. Inadequate food quantity and quality and psychological concerns (preoccupation with food access) were each related to higher depressive symptoms and perceived stress, whereas social concerns (alienation related to food access) were only related to higher perceived stress. None of the domains were associated with anxiety. Findings suggest that different food insecurity experiences may have differential impacts on mental health. Future research should consider how interventions can address each domain of food insecurity to improve mental health during pregnancy.
Keywords: Pregnancy, Mental healthMethod: Pregnant participants (N=74; 23.97±9.43 weeks pregnant; 31.61±11.86 years old) who reported food insecurity at any point in their pregnancy completed the Center for Epidemiological Studies Depression Scale (CES-D), the State- Trait Anxiety Inventory (STAI; trait subscale), the Perceived Stress Scale (PSS10), and the Four -Domain Food Insecurity Scale (4D-FIS). Pearson correlation analyses examined cross- sectional associations between each 4D-FIS subscale and depressive symptoms, anxiety, and perceived stress.
Results: Based on 4D-FIS scores, 87.7% of the sample had severe food insecurity, 9.5% mild, and 2.7% none. Increased disruptions to food quantity and food quality, as well preoccupation about food access were associated with higher scores on the CES-D (r(71)=.36, p=.002; r(69)=.26, p=.029; r(71)=.28, p=.018), and the PSS10 (r(71)=.43, p<.001; r(69)=.35, p=.003; r(71)=.42, p<.001). Greater social alienation related to food access on the 4D-FIS was correlated with higher scores on the PSS10 (r(71)=.328, p=.005). STAI scores were not significantly correlated with any of the 4D-FIS subscales.
Discussion: The present analysis is the first to examine the correlation between the theorized domains of food insecurity, as defined by the 4D-FIS, and mental health outcomes during pregnancy. Inadequate food quantity and quality and psychological concerns (preoccupation with food access) were each related to higher depressive symptoms and perceived stress, whereas social concerns (alienation related to food access) were only related to higher perceived stress. None of the domains were associated with anxiety. Findings suggest that different food insecurity experiences may have differential impacts on mental health. Future research should consider how interventions can address each domain of food insecurity to improve mental health during pregnancy.
Authors:
Presenter - Abigale Regal, BS, UPMC Western Psychiatric Hospital
Co-Author - Christine Call, Ph.D., University of Pittsburgh
Co-Author - Michele Levine, Ph.D., University of Pittsburgh
Vasomotor Symptoms and Associated Symptom Toxicities in Breast Cancer Patients Undergoing Chemotherapy
Poster Number: D17Time: 11:00 AM - 11:50 AM
Topics: Cancer, Sleep
INTRODUCTION: Approximately 40-65% of breast cancer (BC) patients develop vasomotor symptoms (VMS), including hot flashes (HFs), which are highly bothersome and a common cause of treatment discontinuation. Typical treatments for VMS are often contraindicated in BC patients, and little investigation has been conducted into how VMS affect the mental, socioeconomic, and physical well-being of BC patients. METHODS: 141 women diagnosed with BC (stage I-III), experiencing insomnia, and receiving chemotherapy were recruited from the Stanford Women’s Cancer Center for a clinical trial assessing a behavioral intervention for insomnia. Participants provided demographic and medical information and completed the European Organisation for Research and Treatment of Cancer Quality of Life Survey (EORTC), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). Correlations were performed to determine degrees of associations between HF severity and other toxicities. T-tests and chi-square tests were conducted to determine the significance of differences between means. RESULTS: 46.1% (n = 65) of participants experienced HFs. The mean age of women experiencing HFs (47.23 ± 9.35) was significantly lower than that of women without HFs (52.42 ± 11.32), p =.004. There were no other significant demographic differences between the two groups. Women experiencing HFs had worsened ISI scores, with means straddling sub-threshold and clinical insomnia measures (M = 15.62 ± 4.60 vs M = 13.26 ± 5.09, p = .005), and worsened PSQI scores (M = 10.34 ± 3.71 vs M = 8.57 ± 3.73, p =.006). Adverse psychosocial outcomes as reported in the EORTC were also more prominent in participants with HFs, including difficulty concentrating (M = 2.11 ± 0.87 vs M = 1.80 ± 0.83, p = .038), increased tension (M = 2.26 ± 0.87 vs M = 1.91 ± 0.70, p = .013), greater irritability (M = 2.32 ± 0.90 vs M = 1.99 ± 0.76, p = .024), and higher levels of depression symptoms (M = 2.06 ± 0.87 vs M = 1.68 ± 0.73, p = .007) along with higher burdens of financial toxicity (M = 2.11 ± 1.02 vs M = 1.68 ± 0.94, p = .015) and more headaches (M = 2.11 ± 0.95 vs M = 1.76 ± 0.83, p = .030). DISCUSSION: HFs in BC patients receiving chemotherapy are related to numerous toxicities. The treatment of HFs remains challenging, but more robust treatments are available for symptoms like insomnia, pain, and psychological dysfunction. Future research could investigate the effects of these treatments on HFs in BC patients.
Keywords: Cancer survivorship, Sleep disordersAuthors:
Author - Joanna He, College of William & Mary
Co-Author - Priyanka Patel, Virginia Commonwealth University
Co-Author - Chelsey McGill, PhD, Virginia Commonwealth University
Co-Author - Oliver Richardson, Virginia Commonwealth University
Co-Author - Oxana Palesh, PhD, MPH, Virginia Commonwealth University
Paging Psychosocial Oncology: Influence of Sociodemographic and Medical Factors on Time to Consultation and Length of Hospitalization
Poster Number: D18Time: 11:00 AM - 11:50 AM
Topics: Cancer
Background: Individuals hospitalized with cancer benefit from psychosocial oncology consultation services (PCOS) for management of biopsychosocial needs. However, literature is limited in understanding the utilization, scope, and value of POCS. This project examined the influence of sociodemographic and medical factors on consultation timing and length of stay (LOS), and whether time to consultation was associated with LOS.
Methods: Data on patients with cancer admitted to Internal Medicine service during 2024-2025 who were referred to POCS were abstracted from the electronic medical record, including: time to consultation, LOS, consultation reason, cancer diagnosis and staging, and sociodemographic characteristics. Consultation reason was iteratively coded using a directed content analysis approach. Non-parametric tests examined associations between patient characteristics, time to consultation, and LOS. Negative binomial regression examined the relationship between time to consultation and LOS, controlling for age, metastatic status, and leukemia diagnosis.
Results: Of 304 consults, 262 were unique patients (M age=60, 64% female, 34% Black, 21% Hispanic/Latinx). On average, patients were hospitalized for 11.39 days (SD=9.85); consults were placed 4.92 days (SD=5.70) after admission. Consult reasons included cancer-specific coping (50%), psychiatric (30%), general coping (19%), care engagement (14%), and non-specific coping (10%) concerns. There were no associations between time to consultation or LOS and race, ethnicity, sex, cancer type, or metastatic status. However, older patients were more likely to be consulted later (M=5.54 days) and admitted longer (M=12.43 days) than younger patients (p-values<.05). Greater time to consultation was associated with longer LOS such that each additional day to consultation was associated with an 8.6% increase in expected LOS (B=.083, p<.001), independent of age, metastatic status, and leukemia diagnosis.
Conclusions: Findings suggest early involvement of POCS may support shorter LOS for hospitalized patients with cancer; other potential confounding factors will be discussed. Consultation delays for older adults warrants further exploration of facilitators and barriers to consultation. As POCS expand across hospital systems, more data are needed to characterize their utility and value in alignment with key performance indicators (e.g., LOS, re-admission rates, and patient satisfaction).
Keywords: Cancer risk perceptions, Clinical applicationsMethods: Data on patients with cancer admitted to Internal Medicine service during 2024-2025 who were referred to POCS were abstracted from the electronic medical record, including: time to consultation, LOS, consultation reason, cancer diagnosis and staging, and sociodemographic characteristics. Consultation reason was iteratively coded using a directed content analysis approach. Non-parametric tests examined associations between patient characteristics, time to consultation, and LOS. Negative binomial regression examined the relationship between time to consultation and LOS, controlling for age, metastatic status, and leukemia diagnosis.
Results: Of 304 consults, 262 were unique patients (M age=60, 64% female, 34% Black, 21% Hispanic/Latinx). On average, patients were hospitalized for 11.39 days (SD=9.85); consults were placed 4.92 days (SD=5.70) after admission. Consult reasons included cancer-specific coping (50%), psychiatric (30%), general coping (19%), care engagement (14%), and non-specific coping (10%) concerns. There were no associations between time to consultation or LOS and race, ethnicity, sex, cancer type, or metastatic status. However, older patients were more likely to be consulted later (M=5.54 days) and admitted longer (M=12.43 days) than younger patients (p-values<.05). Greater time to consultation was associated with longer LOS such that each additional day to consultation was associated with an 8.6% increase in expected LOS (B=.083, p<.001), independent of age, metastatic status, and leukemia diagnosis.
Conclusions: Findings suggest early involvement of POCS may support shorter LOS for hospitalized patients with cancer; other potential confounding factors will be discussed. Consultation delays for older adults warrants further exploration of facilitators and barriers to consultation. As POCS expand across hospital systems, more data are needed to characterize their utility and value in alignment with key performance indicators (e.g., LOS, re-admission rates, and patient satisfaction).
Authors:
Author - Annemarie D. Jagielo, MS, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Julia Pincever, MA, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine
Co-Author - Payton Solk, MS, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Shaylin Excel, PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Kyle Jozsa, PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Pippa Tucker, PsyD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Luciana Oliveira Dos Santos, PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Lauren Rynar, PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Patricia Fank, PsyD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Elizabeth L. Kacel , PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Pallavi Babu , PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Co-Author - Yasmin Asvat, PhD, Supportive Oncology Program, Rush MD Anderson Cancer Center; Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
Dipping Your Toe in the Pool of Future Possibilities: Biographical Disruption and Possible Selves of Emerging Adult Cancer Survivors
Poster Number: D19Time: 11:00 AM - 11:50 AM
Topics: Cancer, Mental Health
Introduction: Cancer in emerging adulthood (ages 20-25) is “off-time” in the normative life cycle (Revenson & Pranikoff, 2005) and can change how a survivor envisions their future and the person they could become (their “possible self”) (Sansom-Daly et al., 2018). Possible selves have been linked to future-focused health behaviors (Corte et al., 2020), such as physical activity and dietary improvements. The aim of the current study is to analyze how a cancer diagnosis interrupts an emerging adult’s view of their present and future self.
Background: Cancer in adolescent and young adult (AYA) populations (ages 15-39) has been increasing steadily (Scott et al., 2020), with hematological cancers (HC) representing a significant proportion of new AYA cancer diagnoses (Huang & He, 2024). Nearly 50% of AYA HC survivors are nonadherent to oral medications (Hall et al., 2023), increasing the risk for poor health outcomes (McGrady & Pai, 2019). Psychosocial factors, including the desire for normalcy, are linked to medication nonadherence among AYAs (Carr & Rosengarten, 2021). AYAs exhibit less medication adherence than their older and pediatric counterparts, yet receive substantially less research focus.
Methods: In-depth qualitative interviews were conducted with 10 young adults ages 20-25 diagnosed with HC, recruited from a major cancer center and a national young adult cancer survivor organization. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis (Braun & Clarke, 2006).
Results: Several common themes occurred. First, many participants felt alienated from others in their age group due to the way cancer disrupted their expected life trajectory. Second, this alienation led to a sense of forced maturity, as cancer forced survivors to grow up faster than their peers. Third, after completing treatment, many expressed the desire for life to return to ‘normal’, restoring their pre-cancer identity. Fourth, cancer interfered with the completion of developmental tasks, such as establishing independence and autonomy.
Conclusion: The findings provide insight into how the identities of young adult cancer survivors are shaped by illness. Healthcare professionals should be aware of the psychosocial effects of a cancer diagnosis on young adult survivors, particularly its impact on identity development and sense of belonging, and how that could influence treatment adherence.
Keywords: Cancer survivorship, CancerBackground: Cancer in adolescent and young adult (AYA) populations (ages 15-39) has been increasing steadily (Scott et al., 2020), with hematological cancers (HC) representing a significant proportion of new AYA cancer diagnoses (Huang & He, 2024). Nearly 50% of AYA HC survivors are nonadherent to oral medications (Hall et al., 2023), increasing the risk for poor health outcomes (McGrady & Pai, 2019). Psychosocial factors, including the desire for normalcy, are linked to medication nonadherence among AYAs (Carr & Rosengarten, 2021). AYAs exhibit less medication adherence than their older and pediatric counterparts, yet receive substantially less research focus.
Methods: In-depth qualitative interviews were conducted with 10 young adults ages 20-25 diagnosed with HC, recruited from a major cancer center and a national young adult cancer survivor organization. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis (Braun & Clarke, 2006).
Results: Several common themes occurred. First, many participants felt alienated from others in their age group due to the way cancer disrupted their expected life trajectory. Second, this alienation led to a sense of forced maturity, as cancer forced survivors to grow up faster than their peers. Third, after completing treatment, many expressed the desire for life to return to ‘normal’, restoring their pre-cancer identity. Fourth, cancer interfered with the completion of developmental tasks, such as establishing independence and autonomy.
Conclusion: The findings provide insight into how the identities of young adult cancer survivors are shaped by illness. Healthcare professionals should be aware of the psychosocial effects of a cancer diagnosis on young adult survivors, particularly its impact on identity development and sense of belonging, and how that could influence treatment adherence.
Authors:
Author - Bailey Lisker, Hunter College, City University of New York
Author - Rebecca Rendon, BA, Hunter College, City University of New York
Author - Alexandra Karas, MA, The Graduate Center, City University of New York
Author - Lisa Rubin, PhD, The New School for Social Research
Author - Tracey Revenson, PhD, Hunter College & The Graduate Center, City University of New York
From Mindset to Motion: The Role of Exercise Self-Identity in Functional Recovery in Older Adults with Knee Replacement
Poster Number: D2Time: 11:00 AM - 11:50 AM
Topics: Aging
Background:
Total Knee Arthroplasty (TKA) is the most commonly performed inpatient surgical procedure in the U.S., with 75% of patients being older than 65 years and annual procedures projected to reach approximately 3.48 million by 2030. However, up to 30% of patients report suboptimal functional outcomes post-surgery. Traditional recovery models primarily focus on physical and clinical measures, but emerging evidence suggests that theory-based factors, such as exercise self-identity and perceived exercise competence from the Self-Determination Theory, may also influence functional recovery. This study aimed to evaluate whether theory-based factors assist in predicting functional outcomes after TKA.
Methods:
This secondary analysis used baseline data from a randomized trial of a telephone-based weight loss intervention in adults within six months post-TKA. Participants completed surveys assessing exercise self-identity (5-point Likert) and perceived exercise competence (7-point Likert). Physical function was assessed by the six-minute walk test (6MWT). Linear regression models were used to examine whether exercise self-identity and perceived exercise competence (independent variables) predicted 6MWT distance (dependent variable), while adjusting for age, sex, BMI, and time since surgery.
Results:
Older adults (N = 174, 68.4% Female, Age: 65.5±8.3 years, BMI: 33.9±4.6 kg/m2, Time since surgery: 78.3±20.9 days, 6MWT: 1193.7±240.2 feet) were included in these analyses. Exercise self-identity (R2 = 0.31, β = 50.10, p = 0.008) significantly predicted 6MWT distance when accounting for age, sex, BMI, and time since surgery. Each one-point increase in exercise identity (mean: 2.9±0.9) was associated with a 50-foot improvement in 6MWT distance. Perceived exercise competence (mean: 5.1±1.4) was not found to be a significant predictor.
Conclusion:
Exercise self-identity significantly predicted functional outcomes in older adults following TKA, even after controlling for demographic and clinical factors. These findings highlight the importance of psychosocial factors—particularly exercise identity—in post-operative recovery and support the integration of behaviorally informed, theory-driven approaches in rehabilitation planning.
Keywords: Older adults, Musculoskeletal disordersTotal Knee Arthroplasty (TKA) is the most commonly performed inpatient surgical procedure in the U.S., with 75% of patients being older than 65 years and annual procedures projected to reach approximately 3.48 million by 2030. However, up to 30% of patients report suboptimal functional outcomes post-surgery. Traditional recovery models primarily focus on physical and clinical measures, but emerging evidence suggests that theory-based factors, such as exercise self-identity and perceived exercise competence from the Self-Determination Theory, may also influence functional recovery. This study aimed to evaluate whether theory-based factors assist in predicting functional outcomes after TKA.
Methods:
This secondary analysis used baseline data from a randomized trial of a telephone-based weight loss intervention in adults within six months post-TKA. Participants completed surveys assessing exercise self-identity (5-point Likert) and perceived exercise competence (7-point Likert). Physical function was assessed by the six-minute walk test (6MWT). Linear regression models were used to examine whether exercise self-identity and perceived exercise competence (independent variables) predicted 6MWT distance (dependent variable), while adjusting for age, sex, BMI, and time since surgery.
Results:
Older adults (N = 174, 68.4% Female, Age: 65.5±8.3 years, BMI: 33.9±4.6 kg/m2, Time since surgery: 78.3±20.9 days, 6MWT: 1193.7±240.2 feet) were included in these analyses. Exercise self-identity (R2 = 0.31, β = 50.10, p = 0.008) significantly predicted 6MWT distance when accounting for age, sex, BMI, and time since surgery. Each one-point increase in exercise identity (mean: 2.9±0.9) was associated with a 50-foot improvement in 6MWT distance. Perceived exercise competence (mean: 5.1±1.4) was not found to be a significant predictor.
Conclusion:
Exercise self-identity significantly predicted functional outcomes in older adults following TKA, even after controlling for demographic and clinical factors. These findings highlight the importance of psychosocial factors—particularly exercise identity—in post-operative recovery and support the integration of behaviorally informed, theory-driven approaches in rehabilitation planning.
Authors:
Presenter - Kailyn Horn, DPT, University of South Carolina
Co-Author - Halle Prine, University of South Carolina
Co-Author - Jongwon Lee, M.P.H, University of South Carolina
Co-Author - Scott Jamieson, The University of South Carolina
Co-Author - Sara Nakhi, University of South Carolina
Co-Author - Chih-Liang Wang, University of South Carolina
Co-Author - Chih-Hsiang Yang, University of South Carolina
Co-Author - Christine Pellegrini, PhD, FSBM, University of South Carolina
Determinants of Success for Achieving and Maintaining a Cancer-Preventative Diet: A Longitudinal Qualitative Analysis of Coaching in the MyBestGI Study
Poster Number: D20Time: 11:00 AM - 11:50 AM
Topics: Cancer, Diet, Nutrition, and Eating Disorders
Background: Diet is a known risk factor for colorectal cancer (CRC), yet the development of effective and pragmatic approaches targeting dietary prevention of CRC has been challenging. The MyBestGI study is a randomized trial that tests an app-supported intervention in individuals at high-risk for CRC. The MyBestGI program includes telephone-delivered coaching to promote adherence to a cancer preventive diet using a novel behavioral framework.
Objective: The objective of this study is to identify how themes related to dietary behaviors and attitudes evolve over the year-long intervention as participants are asked to adopt and then sustain behavior changes related to dietary prevention of colorectal cancer.
Methods: This longitudinal qualitative study utilized inductive thematic analysis on a total of 20 support calls at three different time points: 8, 24, and 48 weeks. Telephone-delivered support calls were obtained via purposive sampling based on race/ethnicity and gender from the MyBestGI study. From these calls, identified diet-related themes were directly compared and assessed across all three time points to evaluate if themes transformed over time.
Results: The data show that participants exhibited adaptive behaviors and attitudes which uniquely supported their capacity to self-regulate personal dietary challenges. Diet related behaviors and attitudes were classified into themes that evolved over time related to behaviors 1) establishing consistent logging practices within everyday life 2) reading nutrition labels routinely 3) mastering flexibility within social settings and 4) approaching healthy eating as a shared experience with friends and family. The themes that remained consistent at all three time points included behaviors related to 1) heightened self-awareness during dietary decision making 2) the ability to enhance everyday recipes with healthy alternatives and 3) the capacity to recognize personal physical benefits as a result of healthful eating.
Conclusion: Findings from this research illuminate the behavioral processes experienced by persons at high-risk for CRC within the MyBestGI intervention. The change in dietary themes over time provides insight as to how participants navigate dietary challenges while simultaneously building strategies for dietary adherence over one year. This longitudinal aspect is rarely explored yet is crucial to shape impactful supportive strategies for helping individuals reach preventive eating behaviors.
Keywords: Health behavior change, NutritionObjective: The objective of this study is to identify how themes related to dietary behaviors and attitudes evolve over the year-long intervention as participants are asked to adopt and then sustain behavior changes related to dietary prevention of colorectal cancer.
Methods: This longitudinal qualitative study utilized inductive thematic analysis on a total of 20 support calls at three different time points: 8, 24, and 48 weeks. Telephone-delivered support calls were obtained via purposive sampling based on race/ethnicity and gender from the MyBestGI study. From these calls, identified diet-related themes were directly compared and assessed across all three time points to evaluate if themes transformed over time.
Results: The data show that participants exhibited adaptive behaviors and attitudes which uniquely supported their capacity to self-regulate personal dietary challenges. Diet related behaviors and attitudes were classified into themes that evolved over time related to behaviors 1) establishing consistent logging practices within everyday life 2) reading nutrition labels routinely 3) mastering flexibility within social settings and 4) approaching healthy eating as a shared experience with friends and family. The themes that remained consistent at all three time points included behaviors related to 1) heightened self-awareness during dietary decision making 2) the ability to enhance everyday recipes with healthy alternatives and 3) the capacity to recognize personal physical benefits as a result of healthful eating.
Conclusion: Findings from this research illuminate the behavioral processes experienced by persons at high-risk for CRC within the MyBestGI intervention. The change in dietary themes over time provides insight as to how participants navigate dietary challenges while simultaneously building strategies for dietary adherence over one year. This longitudinal aspect is rarely explored yet is crucial to shape impactful supportive strategies for helping individuals reach preventive eating behaviors.
Authors:
Presenter - Molly MacDonald, MPH, RD, University of Michigan
Co-Author - Michelle Segar, PhD MPH MS FSBM, University of Michigan
Co-Author - Kathleen Poore , M.Ed, University of Michigan
Co-Author - Timothy Guetterman, PhD, University of Michigan
Co-Author - Melanie Konin, University of Michigan
Co-Author - Robert Adwere-Boamah, M.A , University of Michigan
Co-Author - Juno Orr, BS, University of Michigan
Co-Author - Reema Kadri, MLIS, University of Michigan
Co-Author - Lorraine Buis, PhD MSI, University of Michigan
Co-Author - Zora Djuric, PhD , University of Michigan
Scaling Psychosocial Support: Implementation and Dissemination of the Mind Over Matter Group Intervention through Facilitator Training
Poster Number: D21Time: 11:00 AM - 11:50 AM
Topics: Cancer, Mental Health
Background
Psychosocial distress and physical side effects are common among individuals affected by cancer. However, limited funding for psychosocial oncology care creates a gap between patient needs and available resources. Group-based interventions can help address this gap by offering effective, cost-efficient support, though they are often resource-intensive to develop and implement.
Methods
Inova Peterson Life with Cancer (PLWC) developed Mind Over Matter (MOM) for cancer patients and caregivers, a five-week group program integrating cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mind-body practices. MOM was standardized for system-wide use and later adapted for virtual delivery. Preliminary data suggest MOM reduces anxiety, depression, and physical symptom burden. In response to external interest, PLWC created a MOM Facilitator Training (MFT) program to support broader dissemination and build capacity for delivery in diverse settings.
Results
From 2022–2025, PLWC trained 92 participants from 39 organizations nationwide, including hospitals, NCI-designated centers, and community organizations. The 2024 training included a Spanish-language adaptation. Most participants rated the training as excellent (72%) or very good (24%). The majority agreed it met expectations (96%) and built core competencies: facilitation readiness (89%), theoretical understanding (92%), intervention familiarity (95%), and use of CBT/ACT tools (98%). Satisfaction with training length improved significantly over time (p < .05), increasing from 62% in 2022 to 91% in 2025. The current training is 13 hours over 3 days. Participants reported intentions to implement MOM within six months (74%) or within a year (26%). Participants reported intentions to implement MOM within six months (74%) or within a year (26%). Perceived barriers included participant logistics (38%), limited resources (36%), institutional policies (21%), and administrative hurdles (14%). Qualitative feedback highlighted the value of the training structure and interactive practice, including role-play.
Conclusions
Meeting the psychosocial needs of cancer patients requires effective and scalable interventions. LWC’s dissemination of MOM offers a potential model for expanding evidence-based programs through community partnerships. Ongoing MFTs support fidelity to core components while enabling culturally responsive adaptations by facilitators reflecting the communities they serve.
Keywords: Mindfulness, TrainingPsychosocial distress and physical side effects are common among individuals affected by cancer. However, limited funding for psychosocial oncology care creates a gap between patient needs and available resources. Group-based interventions can help address this gap by offering effective, cost-efficient support, though they are often resource-intensive to develop and implement.
Methods
Inova Peterson Life with Cancer (PLWC) developed Mind Over Matter (MOM) for cancer patients and caregivers, a five-week group program integrating cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mind-body practices. MOM was standardized for system-wide use and later adapted for virtual delivery. Preliminary data suggest MOM reduces anxiety, depression, and physical symptom burden. In response to external interest, PLWC created a MOM Facilitator Training (MFT) program to support broader dissemination and build capacity for delivery in diverse settings.
Results
From 2022–2025, PLWC trained 92 participants from 39 organizations nationwide, including hospitals, NCI-designated centers, and community organizations. The 2024 training included a Spanish-language adaptation. Most participants rated the training as excellent (72%) or very good (24%). The majority agreed it met expectations (96%) and built core competencies: facilitation readiness (89%), theoretical understanding (92%), intervention familiarity (95%), and use of CBT/ACT tools (98%). Satisfaction with training length improved significantly over time (p < .05), increasing from 62% in 2022 to 91% in 2025. The current training is 13 hours over 3 days. Participants reported intentions to implement MOM within six months (74%) or within a year (26%). Participants reported intentions to implement MOM within six months (74%) or within a year (26%). Perceived barriers included participant logistics (38%), limited resources (36%), institutional policies (21%), and administrative hurdles (14%). Qualitative feedback highlighted the value of the training structure and interactive practice, including role-play.
Conclusions
Meeting the psychosocial needs of cancer patients requires effective and scalable interventions. LWC’s dissemination of MOM offers a potential model for expanding evidence-based programs through community partnerships. Ongoing MFTs support fidelity to core components while enabling culturally responsive adaptations by facilitators reflecting the communities they serve.
Authors:
Co-Author - Kimberly Lower-Walker, MBA, LCSW, Inova Peterson Life with Cancer
Co-Author - Michelle Ferretti, LCSW, OSW-C, Inova Peterson Life with Cancer
Co-Author - Karen Lopez-Jovel, Inova Peterson Life with Cancer
Co-Author - Tara Schapmire, PhD, MSSW, OSW-C, APHSW-C, University of Louisville, Kent School of Social Work and Family Science
Presenter - Melissa F. Miller, PhD, MPH, Inova Peterson Life with Cancer
The Relationship Between Stress, Resilience, and Fatigue in Adolescent and Young Adult Survivors of Childhood Cancer
Poster Number: D22Time: 11:00 AM - 11:50 AM
Topics: Cancer, Quality of Life
Background: Fatigue is prevalent and debilitating in adolescent and young adult (AYA) survivors of childhood cancer. Stress is associated with fatigue among adult patients, but less is known among AYAs, or whether resilience (i.e., ability to adapt to stressors) mitigates this relationship. Using baseline data from the multisite StepByStep Study (NCT04089358), we examined associations between stress and resilience with fatigue in AYA survivors.
Methods: Participants were childhood cancer survivors 15-21 years old at enrollment, 3-36 months off therapy with a history of chemotherapy and/or radiation, English-speaking, and not meeting physical activity guidelines. Participants reported sociodemographic information, stress (Perceived Stress Scale), resilience (2-item Connor-Davidson Resilience Scale), and fatigue (PedsQL Multidimensional Fatigue Scale); all scores were converted to z-scores and analyzed continuously. Multivariable linear regression was used to examine the simultaneous, independent contributions of stress and resilience, as well as their interaction, on fatigue while adjusting for sex, age at diagnosis, and cancer diagnosis.
Results: Participants (N = 314) were diagnosed at a mean age of 15.3 years (standard deviation [SD] = 2.2). Overall, 56% (n = 175) were female, 54% (n = 168) were non-Hispanic white, 62% (n = 196) had public insurance, and 70% (n = 221) were diagnosed with leukemia or lymphoma. In adjusted analyses, greater stress (B = -0.36, p < 0.001) and lower resilience (B = 0.17, p = 0.003) were significantly associated with worse fatigue, such that increasing stress by 1.0 SD would worsen fatigue by 0.36 SDs, while increasing resilience by 1.0 SD would improve fatigue by 0.17 SDs. The interaction between stress and resilience was not significantly associated with fatigue (B = -0.05, p = 0.333).
Conclusions: Greater stress and lower resilience each independently contribute to worse fatigue in AYA survivors of childhood cancer, but to different magnitudes. Interventions that both reduce stress and improve resilience may help manage fatigue in this population.
Keywords: Cancer survivorship, ResilienceMethods: Participants were childhood cancer survivors 15-21 years old at enrollment, 3-36 months off therapy with a history of chemotherapy and/or radiation, English-speaking, and not meeting physical activity guidelines. Participants reported sociodemographic information, stress (Perceived Stress Scale), resilience (2-item Connor-Davidson Resilience Scale), and fatigue (PedsQL Multidimensional Fatigue Scale); all scores were converted to z-scores and analyzed continuously. Multivariable linear regression was used to examine the simultaneous, independent contributions of stress and resilience, as well as their interaction, on fatigue while adjusting for sex, age at diagnosis, and cancer diagnosis.
Results: Participants (N = 314) were diagnosed at a mean age of 15.3 years (standard deviation [SD] = 2.2). Overall, 56% (n = 175) were female, 54% (n = 168) were non-Hispanic white, 62% (n = 196) had public insurance, and 70% (n = 221) were diagnosed with leukemia or lymphoma. In adjusted analyses, greater stress (B = -0.36, p < 0.001) and lower resilience (B = 0.17, p = 0.003) were significantly associated with worse fatigue, such that increasing stress by 1.0 SD would worsen fatigue by 0.36 SDs, while increasing resilience by 1.0 SD would improve fatigue by 0.17 SDs. The interaction between stress and resilience was not significantly associated with fatigue (B = -0.05, p = 0.333).
Conclusions: Greater stress and lower resilience each independently contribute to worse fatigue in AYA survivors of childhood cancer, but to different magnitudes. Interventions that both reduce stress and improve resilience may help manage fatigue in this population.
Authors:
Presenter - Brenna Mossman, PhD, MA, Georgetown Lombardi Comprehensive Cancer Center
Author - Jason Mendoza, MD, MPH, Fred Hutchinson Cancer Center
Author - Wendy Leisenring, ScD, Fred Hutchinson Cancer Center
Author - Willem Collier, PhD, University of Southern California
Author - Eric Chow, MD, MPH, Fred Hutchinson Cancer Center
Author - K. Scott Baker, MD, MS, Fred Hutchinson Cancer Center
Author - Yaiomy Santiago-Rivera, MPH, Georgetown Lombardi Comprehensive Cancer Center
Author - Claire Conley, PhD, Georgetown Lombardi Comprehensive Cancer Center
Co-Author - Nina Kadan-Lottick, MD, MSPH, Georgetown Lombardi Comprehensive Cancer Center
Usability, Acceptability, & Engagement with a Digital Depression Self-Management Tool Tailored to Adolescent and Young Adult (AYA) Cancer Survivors
Poster Number: D23Time: 11:00 AM - 11:50 AM
Topics: Cancer, Digital Health
Background: Adolescent and young adult cancer survivors (AYACS, aged 15-39) report poorer psychosocial outcomes than their peers or other cancer survivors. Indeed, estimates of the prevalence of depression in this population range from 25-32%, but few interventions have sought to address this issue in AYACS. Our team developed ASCENT (the AYA Survivors Coping and Emotional Needs Toolkit), a digital depression self-management tool tailored to AYACS that includes four evidence-based components. In preparation for a full factorial trial of ASCENT, we conducted a randomized pilot study in which we evaluated participants’ perceptions of the usability and acceptability of ASCENT, as well as their engagement with and usage of ASCENT.
Methods: Sixteen AYACS were recruited from an academic medical center in the Southeastern United States. Participants were asked to complete a baseline assessment, attend a virtual orientation call, complete the ASCENT modules they were randomized to receive, and complete a follow-up assessment and exit interview after using ASCENT. Self-report measures of usability (System Usability Scale; SUS), acceptability (investigator-developed survey), and engagement (eHealth Engagement Scale) with ASCENT were administered at follow-up. Usage data were collected by ASCENT. Descriptive statistics were used to summarize participant characteristics, self-report questionnaires, and usage data.
Results: Twelve participants (mean age = 26, 50% female, 75% Caucasian) completed the follow-up questionnaire. On average, these participants rated their satisfaction with ASCENT overall at 3.4/4. Additionally, the mean score on the SUS was 81.4 indicating excellent usability. The mean score on the eHealth Engagement Scale was 3.5/5 suggesting moderate engagement. Usage data from all 16 (mean age = 26, 56% female, 63% Caucasian) participants suggested that, on average, users spent 26.4 minutes/week using ASCENT (SD=16.6, Range=1.6, 55.8) and completed 42% of the content they were assigned.
Conclusions: Overall, participants were satisfied with ASCENT and found it easy to use. However, engagement ratings were more moderate. Further, usage of ASCENT ranged widely, and on average participants completed less than half of the content they were assigned. This suggests that prior to launching a larger trial of ASCENT, it will be important to make adaptations to enhance engagement with ASCENT, ensuring participants receive a sufficient dose of the intervention.
Keywords: Depression, e-HealthMethods: Sixteen AYACS were recruited from an academic medical center in the Southeastern United States. Participants were asked to complete a baseline assessment, attend a virtual orientation call, complete the ASCENT modules they were randomized to receive, and complete a follow-up assessment and exit interview after using ASCENT. Self-report measures of usability (System Usability Scale; SUS), acceptability (investigator-developed survey), and engagement (eHealth Engagement Scale) with ASCENT were administered at follow-up. Usage data were collected by ASCENT. Descriptive statistics were used to summarize participant characteristics, self-report questionnaires, and usage data.
Results: Twelve participants (mean age = 26, 50% female, 75% Caucasian) completed the follow-up questionnaire. On average, these participants rated their satisfaction with ASCENT overall at 3.4/4. Additionally, the mean score on the SUS was 81.4 indicating excellent usability. The mean score on the eHealth Engagement Scale was 3.5/5 suggesting moderate engagement. Usage data from all 16 (mean age = 26, 56% female, 63% Caucasian) participants suggested that, on average, users spent 26.4 minutes/week using ASCENT (SD=16.6, Range=1.6, 55.8) and completed 42% of the content they were assigned.
Conclusions: Overall, participants were satisfied with ASCENT and found it easy to use. However, engagement ratings were more moderate. Further, usage of ASCENT ranged widely, and on average participants completed less than half of the content they were assigned. This suggests that prior to launching a larger trial of ASCENT, it will be important to make adaptations to enhance engagement with ASCENT, ensuring participants receive a sufficient dose of the intervention.
Authors:
Presenter - Karly Ingram, PhD, East Carolina University
Co-Author - Alexander Schoemann, PhD, East Carolina University
Co-Author - Rachel Glock, MA, East Carolina University
Co-Author - Lane Williamson, BA, East Carolina University
Co-Author - Reid Anctil, BS, East Carolina University
Co-Author - AnneMarie Coffey, BS, East Carolina University
Co-Author - Savanah Tribbe, East Carolina University
Co-Author - Antonija Augustinovic, MA, East Carolina University
Co-Author - David Victorson, PhD, Northwestern University
Co-Author - John Salsman, PhD, FSBM, Wake Forest University School of Medicine
From Built and Home Exercise Environments to Anxiety Symptoms in Rural Cancer Survivors: Evidence for an Association Mediated by Sitting Time
Poster Number: D24Time: 11:00 AM - 11:50 AM
Topics: Cancer, Mental Health
Objective: Environments that cue or enable movement can lower sedentary time, and prolonged sitting may be associated with anxiety via behavioral (e.g., reduced social engagement) and physiological stress pathways. This study examines whether home equipment availability, neighborhood walkability/safety, and facility access predict (a) sitting time and (b) anxiety, and whether sitting time mediates the association between environments and anxiety.
Methods: Cross-sectional analyses were conducted using survey data from the Partnering to Prevent and Control Cancer (PPCC) study. Rural cancer survivors (N=219) completed measures of home exercise environment, perceived neighborhood environment, daily sitting time, and anxiety symptoms. Multivariable linear regression models assessed associations between environmental resources and sitting time and anxiety symptoms. Mediation analysis examined the indirect effect of sitting time on the environment-anxiety relationship.
Results: Participants were older adults (mean age 64 years), 60% female, and predominantly non-Hispanic White, with diverse cancer types. Greater exercise equipment in the home (B=-0.28, p=.001) and neighborhood aesthetics (B=-0.69, p=.042) were associated with fewer hours of daily sitting. Similarly, higher perceived neighborhood safety (B=-1.38, p=.010) and satisfaction with the neighborhood environment (B=-3.79, p<.001) were associated with lower anxiety, whereas higher neighborhood character (i.e., mixed commercial and residential use) (B=5.47, p=.002) and residential density (B=0.09, p<.001) were positively associated with anxiety. Greater sitting time was associated with higher anxiety symptoms (B=0.44, p=.014), and mediation analysis supported a significant indirect pathway in which greater availability of home exercise equipment related to lower anxiety via reduced sitting time (indirect effect=-0.11; bootstrap 95% CI, -0.285 to -0.0004).
Conclusion: Expanding access to basic exercise equipment at home appears to reduce sedentary time, which in turn relates to lower anxiety among rural cancer survivors. Future interventions that (1) provide low-cost home equipment or vouchers, (2) include strategies to reduce or break up sitting time, and (3) partner with communities to enhance safety and aesthetics of the neighborhood environment may yield mental-health benefits alongside physical activity gains among rural cancer survivors to reduce cancer health disparities.
Keywords: Cancer survivorship, Health behavior changeMethods: Cross-sectional analyses were conducted using survey data from the Partnering to Prevent and Control Cancer (PPCC) study. Rural cancer survivors (N=219) completed measures of home exercise environment, perceived neighborhood environment, daily sitting time, and anxiety symptoms. Multivariable linear regression models assessed associations between environmental resources and sitting time and anxiety symptoms. Mediation analysis examined the indirect effect of sitting time on the environment-anxiety relationship.
Results: Participants were older adults (mean age 64 years), 60% female, and predominantly non-Hispanic White, with diverse cancer types. Greater exercise equipment in the home (B=-0.28, p=.001) and neighborhood aesthetics (B=-0.69, p=.042) were associated with fewer hours of daily sitting. Similarly, higher perceived neighborhood safety (B=-1.38, p=.010) and satisfaction with the neighborhood environment (B=-3.79, p<.001) were associated with lower anxiety, whereas higher neighborhood character (i.e., mixed commercial and residential use) (B=5.47, p=.002) and residential density (B=0.09, p<.001) were positively associated with anxiety. Greater sitting time was associated with higher anxiety symptoms (B=0.44, p=.014), and mediation analysis supported a significant indirect pathway in which greater availability of home exercise equipment related to lower anxiety via reduced sitting time (indirect effect=-0.11; bootstrap 95% CI, -0.285 to -0.0004).
Conclusion: Expanding access to basic exercise equipment at home appears to reduce sedentary time, which in turn relates to lower anxiety among rural cancer survivors. Future interventions that (1) provide low-cost home equipment or vouchers, (2) include strategies to reduce or break up sitting time, and (3) partner with communities to enhance safety and aesthetics of the neighborhood environment may yield mental-health benefits alongside physical activity gains among rural cancer survivors to reduce cancer health disparities.
Authors:
Presenter - Jeong-Hui Park, PhD, The University of Texas MD Anderson Cancer Center
Co-Author - Kathryn H. Schmitz, PhD, University of Pittsburgh
Chair - Scherezade Mama, DrPH, The University of Texas MD Anderson Cancer Center
Alcohol and Marijuana Use Associated with Sunburn Contexts: Health Information National Trends Survey
Poster Number: D25Time: 11:00 AM - 11:50 AM
Topics: Cancer, Substance Misuse
Sunburn is the primary modifiable risk factor for melanoma and non-melanoma skin cancer. Sunburn is known to be associated with contexts like physical activity and sunbathing, but little is known about how alcohol or marijuana use are related to overall risk of sunburn in specific contexts.
Purpose: 1) To examine the effect of alcohol or marijuana use on the odds of experiencing a context-specific sunburn episode (sunbathing, attending sporting events, etc.) within the past 12 months and 2) determine if alcohol use during most recent sunburn occurrence was associated with general alcohol consumption.
Methods: Data were obtained from the Health Information National Trends Survey 6 and 7. Weighted analyses were conducted using R. Respondents reported on the number of sunburns experienced (≤12 months) and general alcohol consumption (datasets included the derived variable of average drinks/week). Sunburned respondents also reported the context of the most recent sunburn episode and if alcohol or marijuana was used. Logistic regressions examined the odds of alcohol or marijuana use and context-specific sunburn episodes. A linear regression examined the association between alcohol use during most recent sunburn and average drinks/week.
Results: Among respondents reporting one or more sunburns (n=4019), 21% (n=811) reported drinking alcohol and 4% (n=101) reported marijuana use during their most recent sunburn. The average drinks/week was approximately 3 drinks. Alcohol use was associated with higher odds of sunburn while sunbathing (aOR=2.81 [2.09, 3.78]), swimming (aOR=2.68 [1.96, 3.68]), and watching a sporting event (aOR=2.24 [1.62, 3.10]). Marijuana use was not significantly associated with sunburn in a specific context. Individuals who reported alcohol use during their most recent sunburn consumed more drinks/week compared to those who did not consume alcohol during their most recent sunburn (β=6.36, SE=0.52, t=12.29, p<0.001).
Conclusions: Alcohol use may increase the odds of sunburn occurrence, with alcohol being associated with episode-specific sunburn likelihood within specific high-risk contexts. Also, alcohol use during most recent sunburn represents a potential behavioral marker for elevated general alcohol consumption. These findings provide necessary information for tailored interventions that encourage sun protective behaviors within specific contexts and alongside other distinct health behaviors.
Keywords: Cancer, Sun safetyPurpose: 1) To examine the effect of alcohol or marijuana use on the odds of experiencing a context-specific sunburn episode (sunbathing, attending sporting events, etc.) within the past 12 months and 2) determine if alcohol use during most recent sunburn occurrence was associated with general alcohol consumption.
Methods: Data were obtained from the Health Information National Trends Survey 6 and 7. Weighted analyses were conducted using R. Respondents reported on the number of sunburns experienced (≤12 months) and general alcohol consumption (datasets included the derived variable of average drinks/week). Sunburned respondents also reported the context of the most recent sunburn episode and if alcohol or marijuana was used. Logistic regressions examined the odds of alcohol or marijuana use and context-specific sunburn episodes. A linear regression examined the association between alcohol use during most recent sunburn and average drinks/week.
Results: Among respondents reporting one or more sunburns (n=4019), 21% (n=811) reported drinking alcohol and 4% (n=101) reported marijuana use during their most recent sunburn. The average drinks/week was approximately 3 drinks. Alcohol use was associated with higher odds of sunburn while sunbathing (aOR=2.81 [2.09, 3.78]), swimming (aOR=2.68 [1.96, 3.68]), and watching a sporting event (aOR=2.24 [1.62, 3.10]). Marijuana use was not significantly associated with sunburn in a specific context. Individuals who reported alcohol use during their most recent sunburn consumed more drinks/week compared to those who did not consume alcohol during their most recent sunburn (β=6.36, SE=0.52, t=12.29, p<0.001).
Conclusions: Alcohol use may increase the odds of sunburn occurrence, with alcohol being associated with episode-specific sunburn likelihood within specific high-risk contexts. Also, alcohol use during most recent sunburn represents a potential behavioral marker for elevated general alcohol consumption. These findings provide necessary information for tailored interventions that encourage sun protective behaviors within specific contexts and alongside other distinct health behaviors.
Authors:
Author - Keegan Peterson, National Cancer Institute
Co-Author - David Berrigan, National Cancer Institute
Co-Author - Joseph Ciccolo, PhD, National Cancer Institute
Co-Author - Richard Moser, PhD, FSBM, National Cancer Institute
Co-Author - Frank Perna, PhD, FSBM, National Cancer Institute
Preparation for End of Life among Couples Coping with Advanced Cancer: Associations with Psychological and Relationship Adjustment
Poster Number: D26Time: 11:00 AM - 11:50 AM
Topics: Cancer, Quality of Life
Historically, the focus of quality of life (QOL) assessment among patients with cancer has been on symptom burden and psychological distress. However, for patients and partners facing advanced cancer, it may also be important to understand existential/spiritual aspects of QOL, such as accepting the dying process and reconciling concerns about their family members’ ability to cope without them (i.e., end of life [EOL] preparedness).
Our objectives were to (a) characterize levels of patient and partner EOL preparation (EOLprep) as assessed by the Preparation scale of the QUAL-E, and (b) identify demographic and psychosocial predictors of EOLprep among couples coping with advanced cancer using baseline data collected from an ongoing couple-based RCT (R01CA229425). We used multiple linear regression models to predict EOLprep from sociodemographic (e.g., age, sex, race/ethnicity) and psychosocial (e.g., positive and negative affect, psychological distress, relationship satisfaction) variables.
Participants were 217 patients diagnosed with stage III or IV breast, lung, gastrointestinal, genitourinary, or gynecologic cancers (55% female; mean age=57.8, SD=11.9; 83% Caucasian) and their partners (45% female, mean age=58.0, SD=12.0; 83% Caucasian).
EOLprep scores were moderate among both patients (mean=9.3, SD=3.6) and partners (mean= 10.3, SD= 3.2). Partners were less prepared than patients (t(203) =-3.7, p <.001, with higher scores=less preparedness). Among patients and partners, regression models were significant, explaining 50% and 34% of the variance in EOLprep, respectively. Among both patients and partners, younger age was associated with lower EOLprep (p’s < .006). Among patients, higher levels of negative affect and psychological distress were associated with lower EOLprep (p’s < .001). Among partners, positive affect and relationship satisfaction were associated with higher EOLprep (p’s < .03) and psychological distress was associated with lower EOLprep (p < .001).
Findings suggest that patients and partners facing advanced cancer may not feel prepared for end-of-life, particularly those who are younger and experiencing more psychological distress. For partners, positive affect and relationship satisfaction may contribute to preparedness. These findings offer nuanced perspectives that could inform innovations in dyadic interventions by focusing on individual and relational aspects of readiness regarding EOL.
Keywords: Aging, Cancer survivorshipOur objectives were to (a) characterize levels of patient and partner EOL preparation (EOLprep) as assessed by the Preparation scale of the QUAL-E, and (b) identify demographic and psychosocial predictors of EOLprep among couples coping with advanced cancer using baseline data collected from an ongoing couple-based RCT (R01CA229425). We used multiple linear regression models to predict EOLprep from sociodemographic (e.g., age, sex, race/ethnicity) and psychosocial (e.g., positive and negative affect, psychological distress, relationship satisfaction) variables.
Participants were 217 patients diagnosed with stage III or IV breast, lung, gastrointestinal, genitourinary, or gynecologic cancers (55% female; mean age=57.8, SD=11.9; 83% Caucasian) and their partners (45% female, mean age=58.0, SD=12.0; 83% Caucasian).
EOLprep scores were moderate among both patients (mean=9.3, SD=3.6) and partners (mean= 10.3, SD= 3.2). Partners were less prepared than patients (t(203) =-3.7, p <.001, with higher scores=less preparedness). Among patients and partners, regression models were significant, explaining 50% and 34% of the variance in EOLprep, respectively. Among both patients and partners, younger age was associated with lower EOLprep (p’s < .006). Among patients, higher levels of negative affect and psychological distress were associated with lower EOLprep (p’s < .001). Among partners, positive affect and relationship satisfaction were associated with higher EOLprep (p’s < .03) and psychological distress was associated with lower EOLprep (p < .001).
Findings suggest that patients and partners facing advanced cancer may not feel prepared for end-of-life, particularly those who are younger and experiencing more psychological distress. For partners, positive affect and relationship satisfaction may contribute to preparedness. These findings offer nuanced perspectives that could inform innovations in dyadic interventions by focusing on individual and relational aspects of readiness regarding EOL.
Authors:
Author - Katherine Ramos, PhD, Duke University School of Medicine
Author - Karen Steinhauser, Ph.D., Duke University School of Medicine
Author - Laura Porter, PhD, Duke University Medical Center
Mixed methods evaluation of the acceptability, feasibility, and appropriateness of a physical activity intervention during chemotherapy for breast cancer
Poster Number: D27Time: 11:00 AM - 11:50 AM
Topics: Cancer, Implementation Science
Background: Early intervention with physical activity (PA) during chemotherapy can protect against cancer-related health declines; however, implementation is challenging. We piloted a randomized controlled PA intervention during breast cancer chemotherapy and assessed the appropriateness, feasibility, and acceptability of the PA intervention, as well as program benefits, challenges, and suggested improvements. Methods: Participants, newly diagnosed with stage I-III breast cancer, completed a clinical PA trial (NCT05716542) at a Midwestern comprehensive cancer center from 2023-2024 (n=18). Participants randomized to the intervention arm (n=18) were asked to rank the acceptability, appropriateness, and feasibility of the trial using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Measure items were summed for a total score ranging from 4 to 20 for each measure; higher scores indicate greater feasibility. Participants also completed virtual semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR) for in-depth patient feedback; all transcripts were coded and analyzed thematically. Results: Intervention participants who completed the trial (n=12) had an average age of 51.2 +/- 14.1 years, were obese (BMI=35.2 +/- 7.3), majority White (58.3%), and had an equal distribution (33.3%) of disease stage and chemotherapy timing (50% neoadjuvant). Participants rated the intervention highly across all three quantitative measures (mean±SD AIM=17.8 ± 2.4; IAM=18.2 ± 2.1; FIM=17.7 ± 2.3). Eleven of the 12 intervention participants completed a semi-structured interview. Three key themes emerged within the innovation, outer setting, and inner setting CFIR domains: (1) participating in the intervention was beneficial but emotionally challenging, (2) coaching sessions, activity trackers, and delivery flexibility were the most meaningful intervention features, and (3) chemotherapy side effects and intervention time commitment were the biggest adherence barriers. Conclusions: A remotely-delivered PA intervention was considered feasible by participants with breast cancer undergoing chemotherapy, although unique barriers to participation during active cancer treatment were identified. Future PA interventions in this space should be highly flexible, individualized, and provide emotionally supportive structures to assist with fidelity and adherence.
Keywords: Physical activity, Cancer survivorshipAuthors:
Presenter - Elizabeth Salerno, PhD, MPH, University of Michigan
Co-Author - Diana Andrade, MPH, Washington University School of Medicine in St. Louis
Co-Author - Loni Parrish, PhD, University of Kansas Medical Center
Co-Author - Courtney Harriss, MHA, Washington University School of Medicine in St. Louis
Co-Author - Lindsay Peterson, MD, MSCR, Washington University School of Medicine in St. Louis
Co-Author - Ryan Duncan, PT, DPT, MSCI, Washington University School of Medicine in St. Louis
Co-Author - Jingqin Luo, PhD, Washington University School of Medicine in St. Louis
Co-Author - Maura Kepper, PhD, Washington University School of Public Health in St. Louis
Co-Author - Christine Marx, MA, Washington University School of Medicine in St. Louis
Improvements in functional performance of African American men with prostate cancer from Men Moving Forward, a lifestyle intervention
Poster Number: D28Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity
Background: Due to many socio-biological factors, African American (AA) men have the highest prostate cancer (PC) incidence and mortality rates in the US. PC treatments can cause functional decline and reduced quality of life (QoL). Functional performance tests offer simple, objective markers of strength, endurance, and fitness, making them valuable indicators of QoL, independence, and functional decline. Lifestyle interventions report beneficial results for PC survivors, but the inclusion of AA men is critically limited. We examined the efficacy of Men Moving Forward (MMF) on improving functional performance measured by handgrip (HG), 6-minute walk (6MW), and sit-to-stand (STS).
Methods: MMF is a randomized, waitlist control trial with a 16-week community and group-based lifestyle intervention. The intervention focuses on physical activity, nutrition, and QoL. Physical assessments are completed at baseline and follow-up (post-intervention or post-16-week waitlist period), including HG, 6MW, and STS. Student’s t-tests were used to compare within and between group differences in functional performance.
Results: 120 men completed baseline data collection with a mean age of 65.9 ± 7.1 years. Normal HG scores for this age group (64-69) are 28.2-44.0kg. At baseline, mean HG scores (n=120) were 39.8 ± 7.9kg for right and 38.4 ± 8.0kg for left. Normal 6MW distance for men aged 65-69 is 0.572km. Mean 6MW baseline score (n=90) was 0.42 ± 0.11km. Normal STS for this age (65-69) is ≥12; mean STS at baseline was 12.1 ± 4.1. At follow-up, 98 men completed HG. No significant changes were observed for the intervention group, but the control group had significant improvement in left HG (p = 0.04). 76 men completed 6MW at follow-up. On average 6MW improved by 9.5% (0.04km) among the intervention group (p < 0.01). Control saw no significant improvement. 93 men completed STS at follow-up with significant improvement for intervention (1.83 + 2.4, p<0.001) and waitlist (1.19 + 2.8, p<0.01) groups. Between group t-tests showed that 6MW was significantly more improved among intervention participants compared to controls (p = 0.03), but no significant difference for HG or STS.
Conclusion: 6MW, HG, and STS improved post-intervention, with significant gains in 6MW and STS. COVID-19 related recruitment challenges reduced sample size, limiting detectable change, however findings still highlight the value of tailoring community-based programs to enhance functional outcomes.
Keywords: Cancer survivorship, Minority healthMethods: MMF is a randomized, waitlist control trial with a 16-week community and group-based lifestyle intervention. The intervention focuses on physical activity, nutrition, and QoL. Physical assessments are completed at baseline and follow-up (post-intervention or post-16-week waitlist period), including HG, 6MW, and STS. Student’s t-tests were used to compare within and between group differences in functional performance.
Results: 120 men completed baseline data collection with a mean age of 65.9 ± 7.1 years. Normal HG scores for this age group (64-69) are 28.2-44.0kg. At baseline, mean HG scores (n=120) were 39.8 ± 7.9kg for right and 38.4 ± 8.0kg for left. Normal 6MW distance for men aged 65-69 is 0.572km. Mean 6MW baseline score (n=90) was 0.42 ± 0.11km. Normal STS for this age (65-69) is ≥12; mean STS at baseline was 12.1 ± 4.1. At follow-up, 98 men completed HG. No significant changes were observed for the intervention group, but the control group had significant improvement in left HG (p = 0.04). 76 men completed 6MW at follow-up. On average 6MW improved by 9.5% (0.04km) among the intervention group (p < 0.01). Control saw no significant improvement. 93 men completed STS at follow-up with significant improvement for intervention (1.83 + 2.4, p<0.001) and waitlist (1.19 + 2.8, p<0.01) groups. Between group t-tests showed that 6MW was significantly more improved among intervention participants compared to controls (p = 0.03), but no significant difference for HG or STS.
Conclusion: 6MW, HG, and STS improved post-intervention, with significant gains in 6MW and STS. COVID-19 related recruitment challenges reduced sample size, limiting detectable change, however findings still highlight the value of tailoring community-based programs to enhance functional outcomes.
Authors:
Author - Margaret Tovar, MPH, Medical College of Wisconsin
Author - Iwalola Awoyinka, PhD, MPH, Medical College of Wisconsin
Co-Author - Meheret Gebreegziabher, Medical College of Wisconsin
Co-Author - Paula Papanek, PhD, MPT, Marquette University
Co-Author - Toni Uhrich, MS, Marquette University
Co-Author - Kathryn Bylow, MD, Medical College of Wisconsin
Co-Author - Deepak Kilari, MD, Medical College of Wisconsin
Co-Author - Kathleen O'Connell, PhD, Medical College of Wisconsin
Co-Author - Patricia Sheean, PhD, RD, Loyola University Chicago
Author - Melinda Stolley, PhD, Medical College of Wisconsin
Prevalence Estimates of Current Heart Conditions in U.S. Children and Adolescents: Evidence from the National Survey of Children's Health (NSCH) 2021-2022
Poster Number: D29Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Child and Family Health
Background and Objective: Heart conditions (i.e., congenital heart defects, arrhythmias, and cardiomyopathy) in children and adolescents can lead to severe health consequences. Estimates of prevalence and associated sociodemographic disparities can guide resource allocation and intervention. The purpose of this study was to estimate the prevalence of current heart conditions in U.S. children and adolescents, and to compare these findings with results from the Child and Adolescent Health Measurement Initiative’s Data Resource Center (CAHMI DRC).
Methods: A secondary data analysis was conducted using data from the 2021–2022 National Survey of Children’s Health (NSCH), a U.S. Census Bureau–administered survey that collects information on the health and well-being of children aged 0–17 years across the United States. Prevalence estimates were calculated overall and stratified by sociodemographic characteristics (age, sex, race/ethnicity, family structure, and income). Differences in prevalence across these groups were assessed using the Rao–Scott chi-square test. All analyses incorporated survey weights to account for the complex sampling design.
Results: Among 104,816 children included in the analysis, 1.42% were reported to currently have a heart condition, translating to approximately 1,031,484 children nationwide. A statistically significant association was observed between heart conditions and race/ethnicity (p = 0.004). White, non-Hispanic children had the highest prevalence (0.97%), followed by Hispanic children (0.20%). No significant differences were observed for other sociodemographic variables.
Conclusion: Heart conditions affect a small but significant proportion of U.S. children and adolescents, with substantial race/ethnic differences. Future longitudinal research may wish to assess the associated financial burdens and health consequences of pediatric heart conditions.
Keywords: Cardiovascular disease, Public healthMethods: A secondary data analysis was conducted using data from the 2021–2022 National Survey of Children’s Health (NSCH), a U.S. Census Bureau–administered survey that collects information on the health and well-being of children aged 0–17 years across the United States. Prevalence estimates were calculated overall and stratified by sociodemographic characteristics (age, sex, race/ethnicity, family structure, and income). Differences in prevalence across these groups were assessed using the Rao–Scott chi-square test. All analyses incorporated survey weights to account for the complex sampling design.
Results: Among 104,816 children included in the analysis, 1.42% were reported to currently have a heart condition, translating to approximately 1,031,484 children nationwide. A statistically significant association was observed between heart conditions and race/ethnicity (p = 0.004). White, non-Hispanic children had the highest prevalence (0.97%), followed by Hispanic children (0.20%). No significant differences were observed for other sociodemographic variables.
Conclusion: Heart conditions affect a small but significant proportion of U.S. children and adolescents, with substantial race/ethnic differences. Future longitudinal research may wish to assess the associated financial burdens and health consequences of pediatric heart conditions.
Authors:
Presenter - Mina Davari, PhD Candidate, University of South Florida
Co-Author - Suman Chowdhury, PhD Candidate , University of South Florida
Chair - Marilyn Stern, Professor , University of South Florida
Chair - Russell Kirby, Professor, University of South Florida
Mobile Assessment of Inhibition Control is Associated with Subjective Cognition in Older adults at risk of Alzheimer’s Disease and Related Dementias
Poster Number: D3Time: 11:00 AM - 11:50 AM
Topics: Aging
Background: Neurodegenerative diseases such as Alzheimer’s disease and related dementias (ADRD) rely on early preventive strategies to mitigate the effects of cognitive decline. Despite subjective cognition (perceived cognition) being an early marker of mild cognitive impairment, most interventions focus on objective cognitive outcomes. Subjective cognition is linked to reduced engagement in daily health behaviors, so it may be a useful screening marker. Understanding how subjective cognition is related to which domain of objective cognition could help inform interventions to target specific outcomes to strengthen subjective cognition and ultimately promote sustained health behaviors in older adults. Objective: This study investigated whether specific domains of performance based cognitive outcomes are associated with older adults’ subjective cognition through mobile assessment. Methods: A secondary analysis was applied to data collected from 97 older adults, ≥ 60 years exhibiting at least one elevated risk factor of ADRD (i.e., family history, BMI ≥ 25 kg/m2, or self-reported cognitive decline) with no preexisting history of mood or brain abnormalities. Participants were given an activPAL and completed 14 days of daily surveys comprised of both subjective cognitive items and objective cognition tasks measuring different domains of cognition including processing speed (symbol search), inhibition (Go/No-Go), and visuospatial memory (dot memory). A linear mixed regression model was used to test the associations, controlling for demographics, daily step counts, and mindfulness. Results: Our sample (n = 97) comprised of predominately white (78%) female (65%) older adults with a mean age of 68 ±7 years. Our findings revealed that only inhibition (Go/No-Go task) was a significant predictor of subjective cognition (β = 1.34, p = 0.001), such that on a given day when participants had greater instances of inhibitory control than their average levels, they also perceived better subjective cognition. Conclusion: These findings suggest that inhibition can best explain subjective cognition among other domains, indicating that everyday cognitive complaints may reflect deficits in inhibitory control. Accordingly, assessing inhibitory control may be more useful than other performance based cognitive outcomes for detecting subjective cognitive decline. Future studies should investigate this relationship to potentially inform future timely interventions for early detection.
Keywords: Aging, Alzheimer's diseaseAuthors:
Presenter - Halle Prine, MS, University of South Carolina
Co-Author - Jongwon Lee, M.P.H, University of South Carolina
Co-Author - Kailyn Horn, DPT, University of South Carolina
Co-Author - Scott Jamieson, MS, University of South Carolina
Co-Author - Christine Pellegrini, PhD, FSBM, University of South Carolina
Co-Author - Chih-Hsiang Yang, PhD, University of South Carolina
Medical Students’ Recognition of Barriers to Medication Adherence among Patients with Hypertension: A Summary and Comparison to Patient-Reported Barriers
Poster Number: D30Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Social and Environmental Context and Health
Background: Medication nonadherence is pervasive among patients with hypertension (HTN). Ongoing patient-health professional (HP) discussions about medications can facilitate adherence. Yet, many HPs fail to recognize or evaluate adherence barriers during clinical interactions with patients. Improving medical students’ skills may be particularly fruitful given student behavior is still malleable and training in adherence assessment could be added to medical school curricula. Aims: To describe the most common HTN medication barriers identified by medical students and to examine how these compare to patient-reported HTN medication barriers. Methods: 409 medical students from accredited US programs participated. Participants were mostly female (69%) and Non-White (42%). Participants were recruited via emails to all accredited DO and MD programs in the US. Via an online survey, participants read a vignette depicting a patient with recently-diagnosed HTN who reported nonadherence and were asked to identify 3-5 potential barriers to medication adherence. Responses were categorized as practical, perceptual, or other barriers by 2 independent raters (94% agreement) and then subcategorized into 3 perceptual subcategories (96% agreement) and 7 practical subcategories (90% agreement). Results: On average, students reported 4.27 barriers (SD = .94). 1658 adherence barriers were reported across all 409 participants; 56% were practical, 39% were perceptual, 9% were other barriers. The 5 most commonly reported barriers identified by medical students included medication concern beliefs (20%), issues with remembering (18%), financial (16%), low necessity beliefs (16%) and lack of knowledge/skills (9%). All other barriers comprised ≤5% of responses. Compared to meta-analytic data (Khatib et al., 2014), medical students were less likely than patients to identify knowledge or skill deficits as barriers (9% v 46%; Z=-26.99, p<.001); memory-related barriers (18% v 55%; Z=-30.45, p<.001), medication availability barriers (5% v 29%; Z=-21.36, p <.001), and side effects (20% v 29%; Z=-8.21, p<.001). Conclusions: Although medical students identified a range of adherence barriers; there was a mismatch between the barriers they identified most often and the barriers that patients identified as most problematic for their HTN management. Improving medical student understanding of adherence barriers experienced by patients with HTN has the potential to improve patient outcomes.
Keywords: Hypertension, ComplianceAuthors:
Author - Nicole Ofer, University of Wisconsin-Madison
Presenter - Sophia Rintell, MS, Rosalind Franklin University of Medicine & Science
Co-Author - Erin Flynn, BA, Rosalind Franklin University of Medicine & Science
Co-Author - Hunter Crowton, BA, Rosalind Franklin University of Medicine & Science
Co-Author - Jeanette Morrison, MD, Rosalind Franklin University of Medicine & Science
Co-Author - Rachel Greenley, PhD, Rosalind Franklin University of Medicine & Science
Daily Associations between Alcohol Consumption and Physical Activity among Women in Midlife with Elevated Cardiovascular Disease Risk
Poster Number: D31Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Women's Health
Midlife is a critical period of transition for women (ages 40–65), bringing physiological changes (e.g., menopause, weight gain) and shifts in mental health, caregiving responsibilities, occupational stress, and economic pressures. These biological, psychosocial, and structural challenges increase risk for cardiovascular disease (CVD). At the same time, these challenges make it difficult for women to prioritize their own health, and they struggle to consistently engage in cardioprotective behaviors such as physical activity (PA). Coping behaviors such as consuming alcohol may further exacerbate CVD risk, though little is known about day-to-day associations between alcohol use and PA - particularly as they occur in the context of deliberate efforts to increase PA. The goal of this study was to examine these associations among 62 women in midlife with ≥1 CVD risk factors (e.g., hypertension; MAge=52, MBMI=31 kg/m2, 44% from underrepresented groups) who enrolled in an 8-week PA intervention. These women completed end-of-day surveys during each day of the program, including 1 week of baseline assessment, 6 weeks of active intervention, and 1 week of post-intervention assessment. Daily reports showed that on average, women drank alcohol on 15.28% of days during the program (~1.07 days per week). Two-level multilevel models showed considerable within-person variability in alcohol use (ICC=0.61 during Week 1, 0.55 during Weeks 2–8). The odds of drinking on a given day were 0.08 (~1 in 12) and this did not change over the course of the intervention (OR=0.97, 95% CI: 0.90, 1.05). On days when women did (vs. did not) drink alcohol, they were 17% less likely to set PA intentions for the next day (OR=0.83, 95% CI: 0.58, 1.17). Despite not setting intentions, however, they took significantly more steps the day after drinking (vs. not; +611 steps; F[1,2225]=13.80, p<0.001, sr=0.24). Notably, this association decreased over time, with additional steps following alcohol use declining by ~345 steps per week over the intervention (t[2223]=-3.60, p<0.001, sr=0.21). These findings demonstrate that while alcohol use is infrequent during participation in a PA intervention and may not undermine overall PA behavior change, it may temporarily disrupt motivation to plan PA. Greater attention to barriers to PA, coping methods, facilitators of PA intentions and behavior at the day level will increase the benefits of PA intervention to reduce CVD risk in this population.
Keywords: Cardiovascular disease, Women's healthAuthors:
Presenter - Gabrielle Salvatore, PhD, Rowan University
Co-Author - Amanda Folk, Rowan University
Co-Author - Danielle Arigo, PhD, LP, FSBM, Rowan University
Postpartum cardiovascular health behaviors and intrinsic motivation in the longitudinal PETALS-2 cohort
Poster Number: D32Time: 11:00 AM - 11:50 AM
Topics: Cardiovascular Disease, Multiple Health Behavior Change
Background: Healthy eating, physical activity, and weight management behaviors impact maternal cardiovascular health. Yet health behavior motivation is poorly understood, particularly in racial/ethnic minority populations with higher cardiovascular risk. Methods: We examined whether intrinsic motivation predicts clinically meaningful engagement in these cardiovascular health behaviors throughout the postpartum period. Participants in the Pregnancy, Lifestyle and Environment Study-2 (PETALS-2) prospectively completed validated self-report surveys assessing psychosocial factors and healthy eating, physical activity, and self-weighing behaviors from pregnancy through 24-30 months postpartum (N=311; 70% from minority backgrounds). Intrinsic motivation and self-efficacy were assessed separately for each behavior. Corresponding behavioral outcomes were categorized by national guidelines (e.g., 150 minutes/week of at least moderate physical activity) or sample-specific thresholds at the 75th percentile. Longitudinal analyses retained the temporal sequence of intrinsic motivation to predict a subsequent, non-concurrent postpartum behavior. Regression analyses adjusted for age, pre-pregnancy BMI, race/ethnicity, education, parity, and self-efficacy. Results: Each one-unit intrinsic motivation increase was associated with greater likelihood of (A) having a Healthy Eating Index score at or above the 75th percentile at 30+ months postpartum (RR=2.38; 95% CI=1.02, 5.56); (B) self-weighing regularly (i.e., ≥ once/week) at 6 (1.65; 1.11, 2.45) and 12 months postpartum (1.63; 1.15, 2.32); (C) meeting the physical activity guidelines at 12 (2.64; 1.67, 4.19); and (D) reaching the 75th percentile for hours/week of moderate-to-vigorous physical activity at 6 (1.67; 1.14, 2.46), 12 (1.84; 1.06, 3.17), and 24 months postpartum (1.55; 1.17, 2.04). Conclusions: Intrinsic motivation predicted specific cardiovascular health related long-term postpartum behaviors. Future trials could examine whether enhancing intrinsic motivation improves maternal cardiovascular health.
Keywords: Health behaviors, Women's healthAuthors:
Presenter - Brooke Wickman, PhD, RD, University of California, Davis
Co-Author - Bridgette Smith, MPH, UC Davis
Co-Author - Michaela Kiernan, PhD, Stanford University School of Medicine
Co-Author - Samantha Ehrlich, PhD, MPH, University of Tennessee, Knoxville
Co-Author - Charles Quesenberry, PhD, Kaiser Permanente Northern California
Co-Author - Monique Hedderson, PhD, Kaiser Permanente Northern California
Co-Author - Andrea Millman, MA, Kaiser Permanente Division of Research
Co-Author - Hillary Serrato Bandera, BA, Kaiser Permanente
Co-Author - Jun Shan, PhD, Kaiser Permanente Northern California
Co-Author - Assiamira Ferrara, MD, PhD, Kaiser Permanente Northern California
Co-Author - Susan Brown, PhD, University of California, Davis
Bidirectional associations between fathers’ food parenting practices and children’s adherence to dietary recommendations
Poster Number: D33Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Diet, Nutrition, and Eating Disorders
Background: Extensive research illustrates the influence of food parenting practices on children’s dietary behaviors. Most of this research focuses on mothers, is cross sectional, and ignores child evocative effects. Objective: We examine the bidirectional and longitudinal relationships between fathers’ food parenting practices, specifically coercive control (e.g., using food as a reward) and structure (e.g., limiting availability of unhealthy foods) and children’s adherence to dietary recommendations for fruit, vegetables, fast food, and sweetened drinks. Methods: Participants include fathers (N=768) of children 2–6 years participating in the Fathers & Families study who had data for 2 consecutive years. We estimated cross-lagged panel models in R with separate models for each domain of food parenting and for each diet behavior, adjusting for time 1 covariates (child age, father’s education, race/ethnicity, family-meal frequency). Results: Most fathers were 35–40 years (74.7%), Non-Hispanic White (69.3%), and held at least a bachelor’s degree (86.2%). Children were mostly 2–3 years old (58.5%) and male (52.6%). Consistent bidirectional and longitudinal relationships were identified. Specifically, higher structure at Time 1 predicted greater dietary adherence for all diet measures at Time 2 (fruits: β=.08, 95%CI=.03–0.14; vegetables β=.11, 95% CI=.04–0.17; fast food β=.16, 95%CI=.09–0.22; sweetened drinks β=.14, 95%CI=.08–.20). Likewise, children’s adherence to diet recommendations at Time 1 predicted higher structure at Time 2 (fruits β=.07, 95%CI=.02-.12; vegetables β=.08, 95%CI= .03–.13; fast food β=.13, 95%CI=.08–.18; sweetened drinks β=.12, 95%CI=.07–.17). In addition, higher coercive control at Time 1 predicted poorer children’s adherence to sweetened beverage Time 2 (β = −0.097, 95%CI: −0.166 to −0.027), and greater adherence to sweetened beverage recommendations at Time 1 predicted lower coercive control at Time 2 (β =−.031, 95%CI: −.054 to−0.008). Conclusions: This study provides new evidence, with one of the largest samples of fathers to date, that fathers’ food parenting practices, particularly those focused on structure, play an important role in shaping children’s dietary behaviors. Results also illustrate that these relationships are reciprocal, with children’s dietary adherence predicting fathers’ subsequent food parenting practices.
Keywords: Nutrition, Health behaviorsAuthors:
Presenter - Mariane De Oliveira, PhD, Boston College, School of Social Work
Co-Author - Rebekah Levine Coley, PhD, Boston College, Lynch School of Education and Human Development
Co-Author - Jess Haines, PhD, University of Guelph Department of Family Relations & Applied Nutrition
Co-Author - Kirsten Davison, PhD, Boston College, School of Social Work
Fathers and Children Exercising Together (FACEiT): African American Fathers as Catalysts for Active Lifestyles in Children
Poster Number: D34Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Physical Activity
Background: Promoting children’s physical activity (PA) fosters their healthy physical development, mental and emotional well-being, and may serve as a protective factor for the development of chronic diseases (e.g., diabetes and obesity). The role of maternal parental influence is shaping children’s PA has been studied extensively, yet recent studies suggest fathers also play a unique role. Yet, how African American (AA) fathers may support their children’s PA is underexplored. This study explores AA fathers/father figures’ perceptions of their influence on their children’s PA and the barriers and facilitators they encounter in supporting active lifestyles.
Methods: We conducted three virtual focus groups (mean: 68 minutes) and seven individual interviews (mean: 60 minutes) with 23 AA fathers/father figures with children aged 6-10 from the Southern region of the US. Interview questions explored fathers’ perceptions of the importance of PA for their child, their role and influence in their child’s PA engagement, and barriers and facilitators to increasing their children’s PA. We used Atlas TI to conduct thematic analysis of the verbatim transcribed audio recordings.
Results: We found that fathers felt they were architects of opportunities for children's PA, promoted children’s PA by limiting the recreational use of electronic devices, and bolstered children’s holistic development through PA. Given declines in PA being a standard part of children’s daily activities across generations and declines in children’s attitudes towards PA, fathers found it difficult to encourage their children’s PA. Despite these challenges, fathers found that sharing the goal of promoting children’s active lifestyles across the family unit and strategically identifying activities to appeal to the unique motivations of children facilitated PA.
Conclusion: AA fathers viewed themselves as primary influencers of their child’s PA, especially during early childhood, and emphasized the importance of modeling healthy behaviors. In addition to replicating findings from previous studies that found AA fathers can serve as models and co-participants of child PA, the current investigation unveiled concerns regarding excessive screen time use of electronic devices and the need for cohesive family involvement to support PA. These findings can inform the development of culturally relevant, family-based PA interventions that leverage the unique role of AA fathers in promoting child PA.
Keywords: Physical activity, Minority healthMethods: We conducted three virtual focus groups (mean: 68 minutes) and seven individual interviews (mean: 60 minutes) with 23 AA fathers/father figures with children aged 6-10 from the Southern region of the US. Interview questions explored fathers’ perceptions of the importance of PA for their child, their role and influence in their child’s PA engagement, and barriers and facilitators to increasing their children’s PA. We used Atlas TI to conduct thematic analysis of the verbatim transcribed audio recordings.
Results: We found that fathers felt they were architects of opportunities for children's PA, promoted children’s PA by limiting the recreational use of electronic devices, and bolstered children’s holistic development through PA. Given declines in PA being a standard part of children’s daily activities across generations and declines in children’s attitudes towards PA, fathers found it difficult to encourage their children’s PA. Despite these challenges, fathers found that sharing the goal of promoting children’s active lifestyles across the family unit and strategically identifying activities to appeal to the unique motivations of children facilitated PA.
Conclusion: AA fathers viewed themselves as primary influencers of their child’s PA, especially during early childhood, and emphasized the importance of modeling healthy behaviors. In addition to replicating findings from previous studies that found AA fathers can serve as models and co-participants of child PA, the current investigation unveiled concerns regarding excessive screen time use of electronic devices and the need for cohesive family involvement to support PA. These findings can inform the development of culturally relevant, family-based PA interventions that leverage the unique role of AA fathers in promoting child PA.
Authors:
Presenter - Jerraco Johnson, PhD, University of North Texas
Author - Denisha Thomas, Pennington Biomedical Research Center
Author - Julie Hardee, Pennington Biomedical Research Center
Author - Bantu Gross, PhD, Fathers Matter NOLA
Author - Derek Griffith, PhD, University of Pennsylvania
Author - Robert Newton, PhD, FSBM, Pennington Biomedical Research Center
Medical trauma from the NICU: How financial stability and parenting impact child development
Poster Number: D35Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Social and Environmental Context and Health
Each year, 10-15% of parents have an infant admitted to a Neonatal Intensive Care Unit (NICU). These infants experience medical complications (e.g., prematurity, stroke) that impact development and contribute to parental distress (~50%) and more intrusive parenting styles. Ongoing complications can also create financial strain. Here, we examined how infant neurobiological risk during the NICU, financial stability, and parenting style impacted child behavioral and social-emotional development two years after discharge.
We enrolled 101 parents (21–45 years; M = 33.35 ± 5.38) of toddlers (1.5–2.5 years old) seen in a Neonatal Follow-Up Program. Medical severity was indexed from records (Neurobiological Risk Index), and child outcomes were assessed with the Brief Infant-Toddler Social and Emotional Assessment. Parents reported financial stability (Family Resources Scale) and parenting style (Parent as Social Context Questionnaire).
Hierarchical regressions revealed that more toddler behavioral issues were associated with less medical severity (β = -.028, p = .006) and financial stability (β = -.015, p = .044) (R² = 10%). Controlling for these, negative parenting (rejection, chaos, coercion; β = .664, p < .001) was associated with more behavioral issues (R² = 29.2%); positive parenting (warmth, structure, autonomy support) was not. In contrast, more toddler social-emotional challenges were associated with greater medical severity (β = .023, p = .039) and less financial stability (β = -.017, p = .032) (R² = 9.7%). When controlling for these, less positive parenting was associated with more social-emotional issues (β = -.219, p = .038) (R² = 15.6%); negative parenting was not.
Our findings emphasize three key points. First, behavioral and social development are distinct and differentially shaped by health and parenting. Parents reported fewer behavioral issues but more social-emotional problems in medically complex children—perhaps reflecting brain-based differences in cues or a more lenient interpretation of behavior. Second, financial stability matters. Families with fewer resources reported more difficulties—potentially due to intervention access or increased stress. Finally, parenting style is important. Negative parenting was linked to behavioral issues, while positive parenting related to fewer social problems. Intervening on all biopsychosocial levels (medical, finances, parenting) is key for promoting healthy child development.
Keywords: Children's health, PsychophysiologyWe enrolled 101 parents (21–45 years; M = 33.35 ± 5.38) of toddlers (1.5–2.5 years old) seen in a Neonatal Follow-Up Program. Medical severity was indexed from records (Neurobiological Risk Index), and child outcomes were assessed with the Brief Infant-Toddler Social and Emotional Assessment. Parents reported financial stability (Family Resources Scale) and parenting style (Parent as Social Context Questionnaire).
Hierarchical regressions revealed that more toddler behavioral issues were associated with less medical severity (β = -.028, p = .006) and financial stability (β = -.015, p = .044) (R² = 10%). Controlling for these, negative parenting (rejection, chaos, coercion; β = .664, p < .001) was associated with more behavioral issues (R² = 29.2%); positive parenting (warmth, structure, autonomy support) was not. In contrast, more toddler social-emotional challenges were associated with greater medical severity (β = .023, p = .039) and less financial stability (β = -.017, p = .032) (R² = 9.7%). When controlling for these, less positive parenting was associated with more social-emotional issues (β = -.219, p = .038) (R² = 15.6%); negative parenting was not.
Our findings emphasize three key points. First, behavioral and social development are distinct and differentially shaped by health and parenting. Parents reported fewer behavioral issues but more social-emotional problems in medically complex children—perhaps reflecting brain-based differences in cues or a more lenient interpretation of behavior. Second, financial stability matters. Families with fewer resources reported more difficulties—potentially due to intervention access or increased stress. Finally, parenting style is important. Negative parenting was linked to behavioral issues, while positive parenting related to fewer social problems. Intervening on all biopsychosocial levels (medical, finances, parenting) is key for promoting healthy child development.
Authors:
Author - Courtney Kilduff, B.S.Ed., Massachusetts General Hospital
Co-Author - Defne Yucebas, B.A., Massachusetts General Hospital
Co-Author - Victoria Grunberg, Ph.D., Massachusetts General Hospital
The association between paternal childcare and housework with parents’ health in the postpartum period
Poster Number: D36Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Physical Activity
Objective: The purpose of this study was to describe father’s domestic labor contribution (childcare and housework) across the postpartum period, examine agreement in childcare and housework responsibilities between mothers and fathers, and understand the relationship between father’s domestic labor contribution and parental health. Methods: These secondary analyses included a sample of fathers and mothers from a randomized controlled trial to increase new parents’ physical activity in the first 8-months of postpartum. Fathers and mothers self-reported their domestic labor contribution (childcare and housework, levels: low [1-25%], middle [26-50%] or high [51-75%]), perceptions of partner’s domestic labor, physical activity, sleep, stress, and physical health at 2-months, 4-months, 6-months, and 8-months postpartum. Linear mixed models were used for analyses. Results: Among 164 individuals (52 intact couples, 31.5±4.5 y, 53.6% mothers, 82.8% White), about half (54.0%) of fathers self-reported they contributed a high amount of the housework at 2-months but then about half (54.0%) reported the middle amount of the housework at other time points. Fathers self-reported they contributed a middle amount of childcare across time. Mothers’ perception was positively related to fathers’ self-reported housework and childcare contribution. Fathers’ perception of mothers’ housework was related to mothers’ self-reported housework, but not mothers’ self-reported childcare. Fathers were evenly divided into three domestic labor categories (low involvement, middle involvement, and high involvement in domestic labor), but these categories were not associated with their health. Fathers’ domestic labor category was associated with increased maternal physical activity, but not paternal physical activity. Conclusions: These findings highlight the fathers’ contribution to domestic labor in the postpartum period, and opportunities to support maternal and paternal health behaviors.
Keywords: Family, Health behaviorsAuthors:
Presenter - Chelsea Kracht, PhD, University of Kansas Medical Center
Co-Author - Chris Blanchard, PhD, Dalhousie Univ., QEII Health Sciences Ctr
Co-Author - Danielle Downs, PhD, The Pennsylvania State University
Co-Author - Mark Beauchamp, PhD, University of British Columbia
Co-Author - Ryan Rhodes, PhD, FSBM, University of Victoria
Improving Implementation of School-Based Obesity Prevention in Under-Resourced Communities: Insights from Two Phases of the ProudMe Trial
Poster Number: D37Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Implementation Science
Background: Children from under-resourced communities are at an elevated risk for obesity. This study aimed to evaluate the implementation of an adapted school-based multi-component adolescent obesity prevention intervention called, Preventing Obesity Using Digital-Assisted Movement and Eating (ProudMe) across two phases, with refinements made in between. Method: Twelve under-resourced schools from two districts (N=12 and 266 students) participated in the study. The phase 1 trial involved six schools (ProudMe: n=3 schools and 33 students; control: n=3 schools and 46 students) and phase 2 (refined) involved another six schools (ProudMe: n=5 schools and 172 students; control n=1 school and 22 students). ProudMe consisted of four components including ProudMe Cafeteria (simplified Smarter Lunchrooms strategies), ProudMe PE (12-lesson physical education curriculum), ProudMe Tech (AI-assisted behavioral counseling), and ProudMe PD (half-day conference with ongoing support). To examine implementation (penetration, fidelity, sustainability), we collected mixed methods data using observations, interviews, teacher logs, and written records across settings and components. Pre- and post-assessments of cafeterias and students’ health behaviors (i.e. physical activity, screen time, fruit/vegetable intake) and body mass index z scores (BMIz) were compared between phase 1 treatment, phase 2 treatment, and control schools. Results: Phase 2 showed improved penetration and fidelity for ProudMe PE compared to phase 1 (+41.5% penetration, -8.52% modification) and high usage of ProudMe Tech (failed in phase 1). Specifically, 172 student participants set up 6164 goals (63.8% met) and generated 5192 reflections and 5804 AI feedback messages. Both phases had successful implementations of ProudMe Cafeteria (100% penetration) and ProudMe PD (full attendance), whereas phase 2 demonstrated high sustainability across components (e.g., intention: 8.4±1.8). For intervention effect, we observed improved cafeteria scores in both phases (+13.4%, +25.0%, respectively) compared to control (−8.3%). Students’ health behaviors and BMIz did not favor the ProudMe trial over control (p > 0.05). Conclusions: This study indicates that the refined ProudMe trial led to improved implementation outcomes and success at rendering policy and environmental changes at the cafeterias of under-resourced schools. Student-level outcomes including health behaviors and body composition may take time to change.
Keywords: Obesity, Children's healthAuthors:
Author - Yuxin Nie, Louisiana State University
Co-Author - Qiaoyin Tan, Louisiana State University
Co-Author - Paul Son, Louisiana State University
Co-Author - Pengfei Yang, Louisiana State University
Co-Author - Jared Androzzi, PhD, Winthrop University
Co-Author - Katherine Spring, PhD, Pennington Biomedical Research Center
Co-Author - Mónica Suárez-Reyes, PhD, Pennington Biomedical Research Center
Co-Author - Renee Underwood, PhD, Pennington Biomedical Research Center
Co-Author - Amanda Staiano, PhD, MPP, MS, FSBM, Pennington Biomedical Research Center
Co-Author - Richard Rosenkranz, PhD, University of Nevada at Las Vegas
Co-Author - Fahui Wang, PhD, Louisiana State University
Co-Author - Senlin Chen, PhD, Louisiana State University
Acceptability of Project VEGGIE (Vegetable Eating Gets Going by Increasing Exposure): A Program to Increase Fruit and Vegetable Consumption among Preschool-Age Children at Risk of Experiencing Food Insecurity
Poster Number: D38Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Health Disparities
Purpose: Project VEGGIE (Vegetable Eating Gets Going by Increasing Exposure) was a pilot/feasibility intervention which aimed to increase fruit and vegetable (FV) consumption among preschool-age (2-5 years) children at risk of experiencing food insecurity (FI). This abstract reports on parents’ satisfaction with this program. Methods: Parents of preschool-age children (n=13, 100% mothers) were recruited from 3 childcare providers in Orlando, Florida to participate in Project VEGGIE from March-May 2025. Families received boxes of fresh FV delivered to their childcare provider biweekly for 12 weeks (6 boxes in total) alongside education on evidence-based parent feeding practices. Education was provided as 1) hard copies delivered with FV boxes and 2) infographics texted to parents’ phones. Following the intervention, parents completed electronic surveys about their satisfaction with the program. Results: At baseline, children were on average 3.7(0.9) years old. The sample included 31% females, with 46% Hispanic, 31% non-Hispanic White, 8% non-Hispanic Black, 8% other. The majority of households (54%) were considered to have low-income with 40% classified as experiencing FI. Eight mothers (62%) completed the post-test survey; they indicated they were either “satisfied” or “very satisfied” with the amount of fruits (75%) and vegetables (88%) included in the boxes as well as the quality (88%) and variety (75%) of the FVs. Mothers reported that their family “liked” or “strongly liked” the included FV (88%). All mothers (100%) indicated that the boxes helped their child and themself to eat more FV, found the educational materials to be useful, and indicated that they “liked” or “strongly liked” the advice they received. Overall, mothers indicated that they would “probably” (13%) or “definitely” (88%) recommend Project VEGGIE to others. Conclusions: Results from this pilot/feasibility study indicate that program satisfaction was high among mothers who provided feedback. However, 38% of the initial sample was not compliant with the post-test assessment; it is possible that their feedback might differ. Recruitment and retention may have been impacted by concurrent changes in federal immigration policy, particularly given the high prevalence of Hispanic families in the study area.
Keywords: Children's health, InterventionAuthors:
Presenter - Anne-Charles Zimmer, M.S., University of Florida
Co-Author - Layton Reesor-Oyer, PhD, University of Florida
Co-Author - Amy Mobley, PhD, University of Florida
Pandemic-Related Trends in Adverse Childhood Experiences and Cardiovascular Health Among U.S. Children in Grandparent-Headed Households, 2018–2023
Poster Number: D39Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health, Cardiovascular Disease
Background: Approximately 4-5% of U.S. children are raised in grandparent-headed households. There is good reason to suspect that this population is particularly susceptible to an ongoing negative impact from the COVID-19 pandemic. While it is known that these children are particularly susceptible to poor cardiovascular health (CVH) and adverse childhood experiences (ACEs), it remains unclear whether or how the pandemic – and its aftermath – have influenced their CVH risk and ACE exposure. Examining outcomes across pre-pandemic, pandemic, and early post-pandemic periods provides insights into potential shifts in health risks for this group.
Purpose: To examine trends in ACEs and CVH indicators among a nationally representative sample of children living in grandparent-headed households across three stages of the pandemic periods.
Methods: We pooled data from the 2018-2023 National Survey of Children’s Health (N=5,486 children living in grandparent-headed households). Multivariate logistic regression analyses were conducted, with three stages of the COVID pandemic - pre-pandemic (2018-2019), pandemic (2020-2021), and early post-pandemic (2022-2023) - as the primary predictor. Outcomes measured were ACEs (ranging from 0 to 9) and CVH indicators (meeting physical activity guidelines, meeting sleep guidelines, exposure to secondhand smoke, and obesity). We controlled for child’s sex, age, race/ethnicity, household poverty level, and caregiver’s education. As a sensitivity analysis, survey year (2018-2023) was modeled linearly to assess whether observed differences reflected trends or discrete shifts across periods.
Results: Children in grandparent-headed households showed a significant linear decline in meeting sleep recommendations from pre-pandemic to early post-pandemic (linear trend p=0.03); predicted probabilities were 69.1%, 60.0%, and 57.2%, respectively. In contrast, there were no significant differences by period in 1) meeting physical activity guidelines, 2) exposure to secondhand smoke, or 3) obesity. ACE counts did not differ across the pandemic stages; adjusted mean ACE counts were ~2.39 each year.
Conclusions: Across 2018-2023, sleep health worsened, while ACE exposure and other CVH indicators remained stable among children in grandparent-headed households. Further investigation is needed to identify factors contributing to this decline in sleep health during the COVID-19 period in this vulnerable population.
Keywords: Children's health, Cardiovascular diseasePurpose: To examine trends in ACEs and CVH indicators among a nationally representative sample of children living in grandparent-headed households across three stages of the pandemic periods.
Methods: We pooled data from the 2018-2023 National Survey of Children’s Health (N=5,486 children living in grandparent-headed households). Multivariate logistic regression analyses were conducted, with three stages of the COVID pandemic - pre-pandemic (2018-2019), pandemic (2020-2021), and early post-pandemic (2022-2023) - as the primary predictor. Outcomes measured were ACEs (ranging from 0 to 9) and CVH indicators (meeting physical activity guidelines, meeting sleep guidelines, exposure to secondhand smoke, and obesity). We controlled for child’s sex, age, race/ethnicity, household poverty level, and caregiver’s education. As a sensitivity analysis, survey year (2018-2023) was modeled linearly to assess whether observed differences reflected trends or discrete shifts across periods.
Results: Children in grandparent-headed households showed a significant linear decline in meeting sleep recommendations from pre-pandemic to early post-pandemic (linear trend p=0.03); predicted probabilities were 69.1%, 60.0%, and 57.2%, respectively. In contrast, there were no significant differences by period in 1) meeting physical activity guidelines, 2) exposure to secondhand smoke, or 3) obesity. ACE counts did not differ across the pandemic stages; adjusted mean ACE counts were ~2.39 each year.
Conclusions: Across 2018-2023, sleep health worsened, while ACE exposure and other CVH indicators remained stable among children in grandparent-headed households. Further investigation is needed to identify factors contributing to this decline in sleep health during the COVID-19 period in this vulnerable population.
Authors:
Presenter - MinKyoung Song, PhD, RN, FNP, FAHA, Oregon Health & Science University
Co-Author - Nathan Dieckmann, PhD, Oregon Health & Science University
Co-Author - Andrew McHill, PhD, Oregon Health & Science University
Co-Author - Carol Musil, PhD, RN, FAAN, FGSA, Case Western Reserve University
Co-Author - Laura Hayman, MSN, PhD, FAAN, FAHA, University of Massachusetts Boston
Healthy Crew, Healthy Life: The Captain's Role in Commercial Fishing Crew Health
Poster Number: D40Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Quality of Life
Commercial fishermen engage in one of the most dangerous professions in the United States. While research generally focuses on external hazards, this qualitative study aims to explore how the internal priorities of commercial fishermen captains influence the health and well-being of their crew members. This study gathered data from interviews conducted under the 2025 Southeast and Gulf Coast Fishing First Aid and Safety Training program. Ten participants (n=10) were recruited using purposive sampling. Participants included commercial fishermen, captains, law enforcement, and first responders. Data from participants who were captains or spoke about captains’ habits were included. Thematic analysis was performed using ATLAS.ti to identify themes. Participants reported that crew health and wellness were affected by the captain’s attitudes. (1) Four participants (40%) explored crew preparedness as a central theme in captains’ approaches to crew well-being. Captains preferred that their crew members be prepared via crisis management skills and basic seamanship to decrease risk of injury, especially in the captain’s absence. (2) Two participants (20%) highlighted a conflict of priorities between crew productivity and well-being. Some captains expected crew members to work through medical conditions, only addressing those that were severe. Other captains prioritize crew well-being, keeping medication on board for treatable medical conditions and encouraging rest when needed, while returning to shore for more severe conditions. (3) Three participants (30%) mentioned that the captain’s knowledge of pre-existing conditions allowed for a proactive approach to medication management, as well as role assignments on the boat to further reduce injury and illness. (4) Two participants (20%) observed that captains who engaged in drug and alcohol use were more likely to hire friends who engaged in the same substances. Other captains would notify crew members of the zero-tolerance policy against substance use or would refrain from hiring people with addictions. This research offers valuable insight for developing training programs that emphasize crew well-being within the commercial fishing industry. Preparing captains and crew members with safety knowledge and skills can mitigate predictable hazards. These findings highlight the importance of continued research surrounding proactive health management among commercial fishermen captains.
Keywords: Attitude(s), Health behaviorsAuthors:
Author - Sydnee Adams, University of Georgia
Co-Author - Jennifer Tookes, Dr., Georgia Southern University
Co-Author - Bryan Fluech, University of Georgia
Co-Author - Aimee Dyal, Dr. , American Military University
Co-Author - Jennifer Gay, Dr., University of Georgia
Health Promotion in the Circumpolar North: Insights from Black Barbers and Clients in Anchorage, Alaska
Poster Number: D41Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Health Disparities
BACKGROUND: Barbershop-based interventions have been shown to effectively promote mental and physical health among Black men in the U.S. However, little is known about their role in Alaska or the circumpolar north, where geographic isolation, limited culturally relevant services, and racial health inequities shape health outcomes. In partnership with the Alaska Department of Health, the first phase of this multi-year study was to 1) establish community advisory board and 2) qualitatively explore how barbershops support health among Black Alaskan men. METHOD: From Fall 2024-Summer 2025, we conducted focus groups and interviews with seventeen Black barbers and clients in Anchorage barbershops, alongside three meetings of a community advisory board, composed of Black barbers and community leaders. The original research design included gathering barbers in one shop for focus group interviews, but this proved difficult causing the research team to utilize both individual and group interviews. Prior to study activities, the community advisory board reviewed and provided feedback on the study purpose, research question and methodology to ensure recruitment methods and data collection materials were culturally appropriate and aligned with community priorities. FINDINGS: Preliminary analysis of focus group and interview data revealed three main themes including: (1) Barbershops are trusted, culturally safe spaces; 2) Barbershops can serve as entry points for preventive health services; and (3) Barbers offer informal and timely mental health support. CONCLUSIONS: Findings suggest Anchorage barbershops can be vital partners in promoting health and wellbeing among Black men in the circumpolar north. Contrary to our expectation, Black barbers in Anchorage serve a racially diverse clientele composed of youth and adults. This is perhaps expected in a city considered one of the most diverse in the nation. Beyond health promotion, Black barbers foster mentorship, education, entrepreneurship, and self-esteem. These insights will inform phase 2 of this study, which will focus on co-designing a community-driven framework for 1) engaging barbershops as key public health partners and 2) designing barbershop-based health programs that address community priorities.
Keywords: Minority health, Health disparitiesAuthors:
Co-Author - Amana Mbise, University of Alaska
Co-Author - Nathan West, PhD, University of Alaska Anchorage
Co-Author - Rebecca Van Wyck, University of Alaska Anchorage
Co-Author - Megan Mcilmail, MSW, University of Alaska Anchorage
Co-Author - Milee Yu, University of Alaska Anchorage
Investigating Regional Variation in Perceived Community Health Priorities Among African Americans
Poster Number: D42Time: 11:00 AM - 11:50 AM
Topics: Community Engagement, Social and Environmental Context and Health
Intro: Engaging community members to identify their perceived health priorities is an important planning step in developing meaningful health promotion interventions for historically underserved populations, including African Americans (AA). Given the regional variation of neighborhood determinants of health, including differing access to healthcare facilities, green spaces, and fresh foods, capturing perspectives of individuals from various regions regarding community health priorities may support generating programming and policy that advances health equity for AAs residing in different neighborhoods and regions. Thus, this study analyzes perspectives of neighborhood-level health priorities within a majority AA sample from New England, Mid-Atlantic, Midwest, and South regions.
Methods: We used data from the Friends, Families, and Neighborhoods (FFAN) Study, which provides insights into the intricate connections between neighborhood, psychosocial resources, and health-related behaviors among AAs. The study includes interview data from 82 adults who self-identify as AAs or work closely with predominantly AA communities and reside or work in focal states (CT, AL, MD, MO). Interview data from responses to a question on support or resources that neighborhoods need for healthy living were analyzed via thematic analysis for all participants.
Results: The mean sample age was 49.5 years (SD=15.9), with 84.1% identifying as AA. Unifying themes regarding perspectives of critical neighborhood-level health resources among participants included: 1.) Health literacy and health education workshops, health fairs and campaigns 2.) Access to healthy foods, including food banks and full-service grocers and 3.) Access to social service providers and networks. Some variation in resources prioritized was detected, with CT and MO residents frequently emphasizing support from political leadership, while primarily MD and MS residents urged strengthened transportation infrastructure.
Discussion: AA community members provide valuable insights regarding the prioritization of resources for the communities and neighborhoods they live in. Our study highlights the need for systems-of-care that align with the lived experiences and health-related needs of neighborhoods and regions. Future research should further examine these perspectives across additional states and consider how the identified priorities can be translated into health promotion interventions at the neighborhood level.
Keywords: Health promotion, Minority groupsMethods: We used data from the Friends, Families, and Neighborhoods (FFAN) Study, which provides insights into the intricate connections between neighborhood, psychosocial resources, and health-related behaviors among AAs. The study includes interview data from 82 adults who self-identify as AAs or work closely with predominantly AA communities and reside or work in focal states (CT, AL, MD, MO). Interview data from responses to a question on support or resources that neighborhoods need for healthy living were analyzed via thematic analysis for all participants.
Results: The mean sample age was 49.5 years (SD=15.9), with 84.1% identifying as AA. Unifying themes regarding perspectives of critical neighborhood-level health resources among participants included: 1.) Health literacy and health education workshops, health fairs and campaigns 2.) Access to healthy foods, including food banks and full-service grocers and 3.) Access to social service providers and networks. Some variation in resources prioritized was detected, with CT and MO residents frequently emphasizing support from political leadership, while primarily MD and MS residents urged strengthened transportation infrastructure.
Discussion: AA community members provide valuable insights regarding the prioritization of resources for the communities and neighborhoods they live in. Our study highlights the need for systems-of-care that align with the lived experiences and health-related needs of neighborhoods and regions. Future research should further examine these perspectives across additional states and consider how the identified priorities can be translated into health promotion interventions at the neighborhood level.
Authors:
Author - Asli McCullers, MPH, University of Maryland, College Park
Co-Author - Debarchana Ghosh, PhD, University of Connecticut
Co-Author - Hailey Gray, University of Maryland, College Park, School of Public Health
Co-Author - Benjamin Miao, Johns Hopkins University
Co-Author - Tanisha Shah, University of Maryland, College Park, School of Public Health
Co-Author - Aliza Zulfiqar, University of Maryland, College Park, School of Public Health
Co-Author - Cheryl Knott, PhD, University of Maryland, College Park, School of Public Health
Exploring Affective Forecasting Errors in Breast Cancer Risk Management Experiences of Young Women with a Deleterious Variant in the BRCA Genes: A Qualitative Study
Poster Number: D43Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Health Communication and Policy
Background: Young women with harmful BRCA variants may manage increased breast cancer risk through chemoprevention pills, bilateral risk-reducing mastectomy (BRRM), or frequent screenings. In making a choice, women often engage in affective forecasting, which is the process of predicting how options might impact their future emotional well-being. Yet, errors in affective forecasts can lead to sub-optimal decisions and outcomes. This study examines how affective forecasting errors form, manifest in different error types, and shape young women’s decisions and lived experiences with each risk management option.
Method: We recruited women across the US ages 18–35 (n=25) through social media calls, clinic flyers, and the Facing Our Risk of Cancer Empowered website. Consented individuals completed virtual semi-structured interviews. We used a directed content analysis to identify specific affective forecasting errors and used inductive coding to explore the mechanisms and characteristics underlying different error types.
Results: We identified nine errors shaping BRCA carriers’ risk management experiences, with some being particularly influential. Misconstruals occurred when participants lacked the knowledge to accurately envisioning the logistics, environment, or processes of options, leading to unexpected negative emotions. Participants also often focused on one aspect of an option (e.g., BRRM’s long-term benefits) while overlooking short-term impacts (e.g., the emotional toll of recovery) (focalism). Participants made recall errors when drawing on past experiences to predict future coping, for example equating coping from numbness after oral surgery with chest numbness after BRRM. We further identified two novel biases. Intensity bias occurred when participants correctly anticipated the type of emotion but underestimated its intensity, a pattern particularly common in BRRM recovery, which was often described as worse than expected. Reality manifestations referred to moments when participants fully grasped the reality of a given situation, such as screening appointments that made cancer risk more “real”.
Conclusion: Affective forecasting errors significantly shape young BRCA carriers’ decisions and well-being, particularly in the context of BRRM. Understanding the nuances of how and why errors form and affect health outcomes is important for the development of interventions that reduce errors to improve decision-making quality and health outcomes.
Keywords: Genetics, Decision makingMethod: We recruited women across the US ages 18–35 (n=25) through social media calls, clinic flyers, and the Facing Our Risk of Cancer Empowered website. Consented individuals completed virtual semi-structured interviews. We used a directed content analysis to identify specific affective forecasting errors and used inductive coding to explore the mechanisms and characteristics underlying different error types.
Results: We identified nine errors shaping BRCA carriers’ risk management experiences, with some being particularly influential. Misconstruals occurred when participants lacked the knowledge to accurately envisioning the logistics, environment, or processes of options, leading to unexpected negative emotions. Participants also often focused on one aspect of an option (e.g., BRRM’s long-term benefits) while overlooking short-term impacts (e.g., the emotional toll of recovery) (focalism). Participants made recall errors when drawing on past experiences to predict future coping, for example equating coping from numbness after oral surgery with chest numbness after BRRM. We further identified two novel biases. Intensity bias occurred when participants correctly anticipated the type of emotion but underestimated its intensity, a pattern particularly common in BRRM recovery, which was often described as worse than expected. Reality manifestations referred to moments when participants fully grasped the reality of a given situation, such as screening appointments that made cancer risk more “real”.
Conclusion: Affective forecasting errors significantly shape young BRCA carriers’ decisions and well-being, particularly in the context of BRRM. Understanding the nuances of how and why errors form and affect health outcomes is important for the development of interventions that reduce errors to improve decision-making quality and health outcomes.
Authors:
Author - Kerstin Hundal, PhD, Northwestern University
Co-Author - Hoda Fakhari, Northwestern University
Co-Author - Courtney Scherr, PhD, Northwestern University
Co-Author - Brian J. Zikmund-Fisher, PhD, University of Michigan
Patients’ motivations for pursuing multiple genetic risk assessments and responses to receiving identical risk results
Poster Number: D44Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Cancer
Background
Genetic testing is increasingly utilized for risk assessment due to its ability to identify those at increased risk for future health conditions. As clinical practice guidelines and science evolve, it may be beneficial for an individual to undergo genetic testing multiple times. However, little is known about people's motivations for undergoing additional testing when they have a confirmed genetic result. We investigated individuals' motivations for participating in a genetic study after receiving risk information from prior testing.
Method
We conducted semi-structured interviews with 18 participants who received a monogenic risk result in the electronic MEdical Records and GEnomics (eMERGE) IV study after already having genetic risk results from prior genetic testing. Interviews were audio-recorded, transcribed, and anonymized. Using consensus-based coding, two team members conducted inductive thematic analysis. Final themes were identified through a recursive process.
Results
Participants were generally health-conscious, and most engaged in health-protective behaviors like regular physical activity and a healthy diet. They valued genetic testing as a tool to learn information that is otherwise inaccessible or unknown to them about future health risks, moving beyond their current habits and helping them “feel in control of the situation.” They were inclined to participate to verify that no other risks had “popped up” and that their risk management actions were appropriate. Some said they would feel guilty if they did not act on an opportunity to learn more. They all acknowledged the evolving genetic landscape, with a few saying they received updated medical recommendations from eMERGE. Most felt relief about their eMERGE test results, serving as validation that they are on the “right path” to maintaining their health.
Conclusion
Patients aware of advances in scientific knowledge may seek additional genetic information to validate their risk and past health decisions. Genetic testing may help them feel more in control and confident that they are appropriately managing future risks. Given the evolving genetic landscape, managing genetic risks likely requires both consistent information seeking and engaging in health-protective behaviors. Without seeking updates, people may overlook new health risks and guidelines. These insights can urge clinicians to discuss new genetic risk information that might necessitate additional genetic testing.
Keywords: Genetics, RiskGenetic testing is increasingly utilized for risk assessment due to its ability to identify those at increased risk for future health conditions. As clinical practice guidelines and science evolve, it may be beneficial for an individual to undergo genetic testing multiple times. However, little is known about people's motivations for undergoing additional testing when they have a confirmed genetic result. We investigated individuals' motivations for participating in a genetic study after receiving risk information from prior testing.
Method
We conducted semi-structured interviews with 18 participants who received a monogenic risk result in the electronic MEdical Records and GEnomics (eMERGE) IV study after already having genetic risk results from prior genetic testing. Interviews were audio-recorded, transcribed, and anonymized. Using consensus-based coding, two team members conducted inductive thematic analysis. Final themes were identified through a recursive process.
Results
Participants were generally health-conscious, and most engaged in health-protective behaviors like regular physical activity and a healthy diet. They valued genetic testing as a tool to learn information that is otherwise inaccessible or unknown to them about future health risks, moving beyond their current habits and helping them “feel in control of the situation.” They were inclined to participate to verify that no other risks had “popped up” and that their risk management actions were appropriate. Some said they would feel guilty if they did not act on an opportunity to learn more. They all acknowledged the evolving genetic landscape, with a few saying they received updated medical recommendations from eMERGE. Most felt relief about their eMERGE test results, serving as validation that they are on the “right path” to maintaining their health.
Conclusion
Patients aware of advances in scientific knowledge may seek additional genetic information to validate their risk and past health decisions. Genetic testing may help them feel more in control and confident that they are appropriately managing future risks. Given the evolving genetic landscape, managing genetic risks likely requires both consistent information seeking and engaging in health-protective behaviors. Without seeking updates, people may overlook new health risks and guidelines. These insights can urge clinicians to discuss new genetic risk information that might necessitate additional genetic testing.
Authors:
Presenter - Savanna Kerstiens, MA, Northwestern University
Author - Courtney Scherr, PhD, FSBM, Northwestern University
Author - Alina Majid, Northwestern University
Author - Christin Hoell, MS, CGC, University of Chicago, Biological Sciences Division
Author - Rex Chisolm, PhD, Northwestern Medicine, Feinberg School of Medicine
Author - Elizabeth McNally, MD, Ph.D., Northwestern Medicine, Feinberg School of Medicine
Author - Laura Rasmussen-Torvik, PhD, Northwestern Medicine, Feinberg School of Medicine
Religious leaders’ perspectives on barriers and facilitators to Advance Care Planning and End-of-Life conversations among Japanese Americans: A qualitative study
Poster Number: D45Time: 11:00 AM - 11:50 AM
Topics: Decision Making, Aging
Introduction:
Advance care planning (ACP) is a process that helps identify patients' preferences for future medical care. Although ACP is recognized as essential to improve the quality and satisfaction of end-of-life care,
Japanese Americans have a relatively low completion rate of advance directives compared to the US general population. The purpose of this qualitative study was to understand how religious leaders assist Japanese Americans in ACP and end-of-life discussions by identifying the barriers and facilitators that influence ACP dissemination in the US.
Methods:
This study employed a qualitative design using conventional content analysis. Religious leaders with experience in providing pastoral or spiritual care to Japanese Americans in the US were recruited through a convenience and snowball sampling approach. One-hour semi-structured interviews were conducted virtually using an interview protocol that explored how religious leaders addressed issues with Japanese Americans, including facilitators, barriers, and culturally tailored strategies. Interview recordings were transcribed verbatim and independently coded by two researchers with extensive experience in qualitative content analysis.
Results:
Nine religious leaders participated in the study. The mean age of the participants was 56.7 years old. Of these, six participants identified as Christian, and three participants identified as Buddhist. Through content analysis, 4 barriers emerged: 1) language barrier; 2) Japanese cultural barriers (e.g., discomfort with personal disclosure, pressure to show socially acceptable behavior); 3) intergenerational family conflict; and 4) avoidance of death-related conversations. To address these barriers, participants provided supports such as “providing interpretation assistance,” “arranging for religious practices (e.g., chanting),” “building trust in authority figures,” “serving as a listening board,” and “developing support plans through dialogue.”
Discussions:
We identified 4 themes that may hinder ACP and end-of-life care discussions among Japanese Americans. These findings provided insight into how health care providers can improve ACP dissemination by incorporating strategies used by religious leaders to engage Japanese Americans in ACP discussions.
Keywords: Social support, Minority groupsAdvance care planning (ACP) is a process that helps identify patients' preferences for future medical care. Although ACP is recognized as essential to improve the quality and satisfaction of end-of-life care,
Japanese Americans have a relatively low completion rate of advance directives compared to the US general population. The purpose of this qualitative study was to understand how religious leaders assist Japanese Americans in ACP and end-of-life discussions by identifying the barriers and facilitators that influence ACP dissemination in the US.
Methods:
This study employed a qualitative design using conventional content analysis. Religious leaders with experience in providing pastoral or spiritual care to Japanese Americans in the US were recruited through a convenience and snowball sampling approach. One-hour semi-structured interviews were conducted virtually using an interview protocol that explored how religious leaders addressed issues with Japanese Americans, including facilitators, barriers, and culturally tailored strategies. Interview recordings were transcribed verbatim and independently coded by two researchers with extensive experience in qualitative content analysis.
Results:
Nine religious leaders participated in the study. The mean age of the participants was 56.7 years old. Of these, six participants identified as Christian, and three participants identified as Buddhist. Through content analysis, 4 barriers emerged: 1) language barrier; 2) Japanese cultural barriers (e.g., discomfort with personal disclosure, pressure to show socially acceptable behavior); 3) intergenerational family conflict; and 4) avoidance of death-related conversations. To address these barriers, participants provided supports such as “providing interpretation assistance,” “arranging for religious practices (e.g., chanting),” “building trust in authority figures,” “serving as a listening board,” and “developing support plans through dialogue.”
Discussions:
We identified 4 themes that may hinder ACP and end-of-life care discussions among Japanese Americans. These findings provided insight into how health care providers can improve ACP dissemination by incorporating strategies used by religious leaders to engage Japanese Americans in ACP discussions.
Authors:
Presenter - Sotaro Shimada, MHS, RN, PHN, University of Illinois Chicago
Co-Author - Keiko Sugimoto, PhD, RN, Iryo Sosei University
Co-Author - Min Su Kim, MSN, RN, University of Illinois Chicago
Co-Author - Ardith Doorenbos, PhD, RN, FAAN, University of Illinois Chicago
Co-Author - Li-Ting Longcoy, PhD, DrPH, RN, University of Illinois Chicago
Housing instability among people living with uncontrolled diabetes
Poster Number: D46Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Health Disparities
Background: People living with diabetes -- a leading cause of morbidity and mortality -- may be disproportionately affected by housing instability (e.g., evictions or paying most of one's income on housing). However, the relationships between housing instability and diabetes-related financial and behavioral outcomes are not well established. This study assessed the prevalence of housing instability and its associations with cost-related nonadherence and financial toxicity in individuals living with uncontrolled diabetes.
Methods: A secondary analysis was conducted using baseline data from a randomized controlled trial of individuals living with uncontrolled type 1 or 2 diabetes or unmet social needs. Descriptive statistics summarized sample characteristics. Logistic regression assessed housing instability and cost-related nonadherence behaviors, adjusting for demographics (race and ethnicity, sex, diabetes type, income, and non-housing needs). Linear regression examined housing instability and financial toxicity, also controlling for demographics. Analyses were conducted in R, with a significance of p<.05.
Results: Among 600 participants, the mean age was 53 (SD 13), 56% (n=334) were female and 65% (n=388) identified as non-Hispanic White. The average HbA1c was of 8.0% (SD 1.5). Half (n=298) of participants reported unstable housing and/or utility needs. Compared to those with stable housing, a greater proportion of participants experiencing housing instability were: female (62% vs. 50%, p<.01), identified as non-Hispanic Black or African American (22% vs. 12%, p<.05), had a higher mean HbA1c (8.1% vs 7.8%, p<.05), were living with type 2 diabetes (82% vs. 75%, p<.05), reported a greater mean number of chronic conditions (5 vs. 4, p<.0001) and were taking ≥7 medications (54% vs. 37%, p<.001). Participants experiencing housing instability had greater odds of cost-related diabetes nonadherence, after adjusting for covariates (OR= 1.44, p<.05) and reported worse diabetes-related financial toxicity compared to those with stable housing (B= -3.36, p<.0001).
Conclusion: Housing instability is associated with adverse diabetes-related financial and behavioral outcomes in this clinical sample. These findings underscore the importance of optimizing screening and referral practices in healthcare settings to address housing needs, which may improve diabetes management. Future research should externally validate these results using nationally representative samples.
Keywords: Diabetes, Built environmentMethods: A secondary analysis was conducted using baseline data from a randomized controlled trial of individuals living with uncontrolled type 1 or 2 diabetes or unmet social needs. Descriptive statistics summarized sample characteristics. Logistic regression assessed housing instability and cost-related nonadherence behaviors, adjusting for demographics (race and ethnicity, sex, diabetes type, income, and non-housing needs). Linear regression examined housing instability and financial toxicity, also controlling for demographics. Analyses were conducted in R, with a significance of p<.05.
Results: Among 600 participants, the mean age was 53 (SD 13), 56% (n=334) were female and 65% (n=388) identified as non-Hispanic White. The average HbA1c was of 8.0% (SD 1.5). Half (n=298) of participants reported unstable housing and/or utility needs. Compared to those with stable housing, a greater proportion of participants experiencing housing instability were: female (62% vs. 50%, p<.01), identified as non-Hispanic Black or African American (22% vs. 12%, p<.05), had a higher mean HbA1c (8.1% vs 7.8%, p<.05), were living with type 2 diabetes (82% vs. 75%, p<.05), reported a greater mean number of chronic conditions (5 vs. 4, p<.0001) and were taking ≥7 medications (54% vs. 37%, p<.001). Participants experiencing housing instability had greater odds of cost-related diabetes nonadherence, after adjusting for covariates (OR= 1.44, p<.05) and reported worse diabetes-related financial toxicity compared to those with stable housing (B= -3.36, p<.0001).
Conclusion: Housing instability is associated with adverse diabetes-related financial and behavioral outcomes in this clinical sample. These findings underscore the importance of optimizing screening and referral practices in healthcare settings to address housing needs, which may improve diabetes management. Future research should externally validate these results using nationally representative samples.
Authors:
Author - Victoria H Davis, MS, University of Michigan School of Public Health
Co-Author - Roshanak Mehdipanah, PhD, MS, University of Michigan School of Public Health
Co-Author - Minal R Patel, PhD, MPH, University of Michigan School of Public Health
Diabetes Online Communities as a Source of Social Support for People with Type 1 Diabetes
Poster Number: D47Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Social and Environmental Context and Health
Objectives: Social support is a crucial resource for managing type 1 diabetes (T1D), but support can have both helpful and harmful effects. Social support can come from varied sources, including significant others (e.g., friends and family) and similar others (e.g., other people with T1D), which may affect the type and effectiveness of support received. We examined the type and effectiveness of support received from significant and similar others among people with T1D participating in Diabetes Online Communities (DOCs).
Methods: Adults with T1D who were members of a DOC (N=200; age M=44.2 years; 93% non-Hispanic white; 84.5% female; T1D duration M=24.4 years) completed online surveys measuring varied types of support (i.e., emotional and instrumental support, overprotective and illness avoiding behaviors) received from both significant and similar others (i.e., other DOC members). Outcome measures included self-efficacy, self-care behaviors, diabetes distress, and HbA1c.
Results: Participants were long-term and frequent users of the DOC (68.3% >3 years on DOC; 62.1% daily use). Dependent t-tests revealed similar others were perceived to provide more emotional and instrumental support, and less overprotective and avoidance behaviors than significant others (p values <.001). Participants were also more satisfied with similar other support and found their support more helpful (p values <.001). Multilevel models revealed associations between type of support and T1D outcomes differed by source (p values <.05). Compared to support from similar others, emotional support from significant others was associated with more positive outcomes (higher self-efficacy and self-care; lower distress), and instrumental support from significant others was associated with lower distress. Overprotective and avoidance behaviors from significant others were related to less positive outcomes (lower self-efficacy and self-care; higher distress and HbA1c). In contrast, instrumental support from similar others was associated with less positive outcomes (lower self-efficacy; higher diabetes distress). All other types of support from similar others were unrelated to the outcomes.
Conclusion: People with T1D perceive the DOC to be a useful source of social support, but there is a lack of evidence showing associations with enhanced T1D management. Among frequent DOC users, both helpful and harmful social support from significant others play a more influential role in predicting outcomes.
Keywords: Diabetes, Social supportMethods: Adults with T1D who were members of a DOC (N=200; age M=44.2 years; 93% non-Hispanic white; 84.5% female; T1D duration M=24.4 years) completed online surveys measuring varied types of support (i.e., emotional and instrumental support, overprotective and illness avoiding behaviors) received from both significant and similar others (i.e., other DOC members). Outcome measures included self-efficacy, self-care behaviors, diabetes distress, and HbA1c.
Results: Participants were long-term and frequent users of the DOC (68.3% >3 years on DOC; 62.1% daily use). Dependent t-tests revealed similar others were perceived to provide more emotional and instrumental support, and less overprotective and avoidance behaviors than significant others (p values <.001). Participants were also more satisfied with similar other support and found their support more helpful (p values <.001). Multilevel models revealed associations between type of support and T1D outcomes differed by source (p values <.05). Compared to support from similar others, emotional support from significant others was associated with more positive outcomes (higher self-efficacy and self-care; lower distress), and instrumental support from significant others was associated with lower distress. Overprotective and avoidance behaviors from significant others were related to less positive outcomes (lower self-efficacy and self-care; higher distress and HbA1c). In contrast, instrumental support from similar others was associated with less positive outcomes (lower self-efficacy; higher diabetes distress). All other types of support from similar others were unrelated to the outcomes.
Conclusion: People with T1D perceive the DOC to be a useful source of social support, but there is a lack of evidence showing associations with enhanced T1D management. Among frequent DOC users, both helpful and harmful social support from significant others play a more influential role in predicting outcomes.
Authors:
Author - Emily Ellis, University of California, Merced
Co-Author - Deborah Wiebe, PhD, MPH, FSBM, University of California, Merced
Implementation Perspectives on Telehealth in Collaborative Care for Adults with Type 1 Diabetes
Poster Number: D48Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Implementation Science
Introduction: Adults with Type 1 Diabetes (T1D) experience elevated rates of mental illness, yet behavioral health needs are often unmet in routine care. Collaborative care models may expand access, but their success depends on alignment with patient preferences. This study examined differences in how telehealth was perceived for supporting behavioral health, comparing a national sample of adults with T1D to participants enrolled in a collaborative care trial using this approach.
Methods: The ongoing randomized controlled trial (NCT06448429) evaluates a collaborative care model for adults with T1D at a safety net hospital where services are provided regardless of insurance status or ability to pay. A pre-implementation phase consisted of five online focus groups with participants from across the U.S. to examine preferred delivery modes for behavioral health support, which informed trial delivery. In the late-implementation phase, 10 semi-structured interviews were conducted with intervention participants to assess feasibility, acceptability, and appropriateness of the tailored care model. Thematic analysis was applied across both phases to identify consistencies and divergences in perspectives, with interview data used to confirm and contextualize sentiments identified in the national sample.
Results: Pre-implementation findings highlighted broad enthusiasm for telehealth to reduce barriers to in-person behavioral healthcare and increase flexibility for individuals managing T1D. Interviews confirmed that phone-based telehealth enhanced accessibility and provided flexibility around the unpredictability of health fluctuations from diabetes and co-occurring mental health conditions. Some participants preferred a visual component, wanting video or in-person visits. Participants also noted the value of interim text messaging between consultations, which maintained continuity while keeping follow-up manageable when longer sessions were unnecessary. Perspectives varied on whether behavioral health telehealth visits should occur before or after routine diabetes care, with participants emphasizing the need to tailor sequencing to support preparation and care coordination.
Conclusion: Comparing pre- and late-implementation perspectives shows that while telehealth is generally viewed as feasible, acceptable, and appropriate for integrating behavioral health into T1D care, individual preferences for interpersonal connection highlight the need for multiple modalities.
Keywords: Diabetes, Mental healthMethods: The ongoing randomized controlled trial (NCT06448429) evaluates a collaborative care model for adults with T1D at a safety net hospital where services are provided regardless of insurance status or ability to pay. A pre-implementation phase consisted of five online focus groups with participants from across the U.S. to examine preferred delivery modes for behavioral health support, which informed trial delivery. In the late-implementation phase, 10 semi-structured interviews were conducted with intervention participants to assess feasibility, acceptability, and appropriateness of the tailored care model. Thematic analysis was applied across both phases to identify consistencies and divergences in perspectives, with interview data used to confirm and contextualize sentiments identified in the national sample.
Results: Pre-implementation findings highlighted broad enthusiasm for telehealth to reduce barriers to in-person behavioral healthcare and increase flexibility for individuals managing T1D. Interviews confirmed that phone-based telehealth enhanced accessibility and provided flexibility around the unpredictability of health fluctuations from diabetes and co-occurring mental health conditions. Some participants preferred a visual component, wanting video or in-person visits. Participants also noted the value of interim text messaging between consultations, which maintained continuity while keeping follow-up manageable when longer sessions were unnecessary. Perspectives varied on whether behavioral health telehealth visits should occur before or after routine diabetes care, with participants emphasizing the need to tailor sequencing to support preparation and care coordination.
Conclusion: Comparing pre- and late-implementation perspectives shows that while telehealth is generally viewed as feasible, acceptable, and appropriate for integrating behavioral health into T1D care, individual preferences for interpersonal connection highlight the need for multiple modalities.
Authors:
Presenter - Leslie Johnson, PhD, Emory University
Co-Author - Zach Cooper, LCSW, University of Georgia
Co-Author - Katharine Barnard, PhD, Barnard Health
Co-Author - Francisco Pasquel, MD, MPH, Emory University
Co-Author - Georgia Davis, MD, Emory University
Numbers Don’t Tell the Whole Story: A qualitative analysis of the lived realities of Hispanic/Latinx immigrant women with Type 2 diabetes in the US
Poster Number: D49Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Health Disparities
Background: Culturally tailored interventions are essential to addressing the disproportionate impact of type 2 diabetes (T2D) in Hispanic/Latinx communities. Digital storytelling—narrative-based videos created by and for individuals with lived experience—has shown promise as a low-cost strategy that resonates with viewers and promotes behavior change. Rochester Healthy Community Partnership previously developed and tested Stories for Change (S4C) Diabetes, a digital storytelling intervention for Hispanic/Latinx individuals with T2D. This intervention was most effective at improving glycemic management in individuals with shorter T2D duration and increased self-efficacy. To enhance S4C, we sought to better understand the factors that influence behavior change and support self-efficacy in T2D care through qualitative interviews.
Methods: Using stratified sampling based on participants’ changes in self-efficacy (measured via baseline and 3-month follow-up surveys) and hemoglobin A1c (HbA1c) levels, we interviewed 14 S4C participants representing four distinct groups: (1) improved self-efficacy and HbA1c (predicted to improve/improved); (2) no improvement in either (predicted to not improve/did not improve); (3) improved self-efficacy but not HbA1c (predicted to improve/did not improve); and (4) improved HbA1c but not self-efficacy (predicted to not improve/improved). Guided by the Health Belief Model, two researchers analyzed data using thematic analysis and the Sort and Sift, Think and Shift method.
Results: Although 30% of the S4C Diabetes trial participants were men, none agreed to be interviewed. Thus, our findings reflect the experiences of Hispanic/Latinx women only (mean age = 56 [SD 8.6] years). Despite unique outcome patterns, qualitative analysis revealed commonalities, with five cross-cutting themes that affect diabetes management: (1) trauma shapes readiness for change; (2) caregiving responsibilities can hinder self-management; (3) persistence is key to long-term T2D control; (4) social support is essential; and (5) self-advocacy and a desire for knowledge drive success.
Conclusion: These findings underscore the complexity of managing T2D as an immigrant, with multiple intersectionalities shaping self-efficacy and health outcomes. Digital storytelling can document and amplify these realities, providing insights on how to tailor interventions that are culturally meaningful and responsive to the lived experiences of Hispanic/Latinx communities.
Keywords: Diabetes, LatinoMethods: Using stratified sampling based on participants’ changes in self-efficacy (measured via baseline and 3-month follow-up surveys) and hemoglobin A1c (HbA1c) levels, we interviewed 14 S4C participants representing four distinct groups: (1) improved self-efficacy and HbA1c (predicted to improve/improved); (2) no improvement in either (predicted to not improve/did not improve); (3) improved self-efficacy but not HbA1c (predicted to improve/did not improve); and (4) improved HbA1c but not self-efficacy (predicted to not improve/improved). Guided by the Health Belief Model, two researchers analyzed data using thematic analysis and the Sort and Sift, Think and Shift method.
Results: Although 30% of the S4C Diabetes trial participants were men, none agreed to be interviewed. Thus, our findings reflect the experiences of Hispanic/Latinx women only (mean age = 56 [SD 8.6] years). Despite unique outcome patterns, qualitative analysis revealed commonalities, with five cross-cutting themes that affect diabetes management: (1) trauma shapes readiness for change; (2) caregiving responsibilities can hinder self-management; (3) persistence is key to long-term T2D control; (4) social support is essential; and (5) self-advocacy and a desire for knowledge drive success.
Conclusion: These findings underscore the complexity of managing T2D as an immigrant, with multiple intersectionalities shaping self-efficacy and health outcomes. Digital storytelling can document and amplify these realities, providing insights on how to tailor interventions that are culturally meaningful and responsive to the lived experiences of Hispanic/Latinx communities.
Authors:
Author - Abby Lohr, PhD, MPH, Mayo Clinic
Co-Author - Jose M. Falero, Mayo Clinic
Co-Author - Sunny Kim, PhD, MA, Arizona State University
Co-Author - Joan Griffin, PhD, Mayo Clinic
Co-Author - Rozalina McCoy, MD, MS, University of Maryland
Co-Author - John Ruiz, PhD, University of Arizona
Co-Author - Irene G. Sia, MD, MSc, Mayo Clinic
Co-Author - Mark L. Wieland, MD, MPH, Mayo Clinic
Cognitive Correlates of Pain in General Population, Mild Cognitive Impairment, and Early Alzheimer’s Disease Cohorts
Poster Number: D5Time: 11:00 AM - 11:50 AM
Topics: Aging, Pain
Background: While some research suggests that pain intensity and interference are associated with cognitive function, findings are mixed and the underlying cognitive mechanisms remain unclear. Investigating this potential relationship could illuminate next steps for interventions for older adults of varying cognitive capacities. Thus, this study examined candidate cognitive mechanisms between cognition and pain in adults aged 65-85 with normal aging, mild cognitive impairment (MCI) and Alzheimer’s Disease and related dementias (AD).
Methods: Participants (N=413, 55% female, Mage=78) were recruited from 10 Alzheimer’s Disease Research Centers and related cohorts. A comprehensive panel of cognitive domains were assessed using measures from the NIH Toolbox: executive function (Dimensional Change Card Sort, Flanker Inhibitory Control), working memory (List Sorting), episodic memory (Picture Sequence Memory), processing speed (Pattern Comparison), and language (Oral Reading). Pain interference and pain intensity were assessed using NIH Toolbox Sensation Domain scales. Regression analyses tested associations between cognitive domains, demographic factors (age, gender, education, race), cognitive groups (control, MCI, AD) and pain.
Results: Surprisingly, no significant associations were observed between the cognitive domains and pain intensity or interference. Demographic factors and cognitive group were also nonsignificant predictors of pain intensity and pain interference.
Conclusion: These null findings add to the mixed literature and challenge the viewpoint that the pain experience in older adults is related to their level of cognitive functioning. Future research is encouraged to examine additional biopsychosocial mechanisms to advance the development of targeted pain management interventions for aging adults of various cognitive capacities.
Keywords: Aging, PainMethods: Participants (N=413, 55% female, Mage=78) were recruited from 10 Alzheimer’s Disease Research Centers and related cohorts. A comprehensive panel of cognitive domains were assessed using measures from the NIH Toolbox: executive function (Dimensional Change Card Sort, Flanker Inhibitory Control), working memory (List Sorting), episodic memory (Picture Sequence Memory), processing speed (Pattern Comparison), and language (Oral Reading). Pain interference and pain intensity were assessed using NIH Toolbox Sensation Domain scales. Regression analyses tested associations between cognitive domains, demographic factors (age, gender, education, race), cognitive groups (control, MCI, AD) and pain.
Results: Surprisingly, no significant associations were observed between the cognitive domains and pain intensity or interference. Demographic factors and cognitive group were also nonsignificant predictors of pain intensity and pain interference.
Conclusion: These null findings add to the mixed literature and challenge the viewpoint that the pain experience in older adults is related to their level of cognitive functioning. Future research is encouraged to examine additional biopsychosocial mechanisms to advance the development of targeted pain management interventions for aging adults of various cognitive capacities.
Authors:
Presenter - Michelle K. Williams, PhD, University of Chicago
Co-Author - Emily H. Ho, PhD, Northwestern University Feinberg School of Medicine
Co-Author - Francesca R. Farina, PhD, University of Chicago
Co-Author - James W. Griffith, PhD, University of Chicago
Subjective cognitive dysfunction is associated with trouble managing type 2 diabetes: A cross-sectional study
Poster Number: D50Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Multiple Health Behavior Change
Background: Diabetes is a recognized risk factor for cognitive dysfunction. The American population is aging, leading to a growing number of adults experiencing both type 2 diabetes (T2D) and cognitive dysfunction. Given the potential for a reciprocal relationship between diabetes severity and cognitive decline, there is a critical need to understand how cognitive dysfunction affects diabetes management to inform tailored clinical care.
Objectives: 1) To assess the prevalence of subjective cognitive dysfunction in adults with T2D and 2) To assess how cognitive dysfunction relates to individual characteristics and diabetes management.
Methods: We recruited participants from an existing sample of adults with T2D who participated in a prior RCT. They completed the Measurement of Everyday Cognition-short, an abbreviated subjective measure of cognitive dysfunction. The survey also assessed demographic (age, education), clinical (diabetes duration, insulin use), psychological (diabetes distress, depressive symptoms), and behavioral (dietary behavior, physical activity) characteristics. First, we assessed the prevalence of subjective cognitive dysfunction in this sample. Next, we assessed the cross-sectional associations between cognitive dysfunction and the other characteristics using Spearman’s correlations.
Results: Participants (n=95) were on average 56.8±13.0 years old, 36% reported minoritized race or ethnicity, and 35% were male. Average diabetes duration was 15.4±7.8 years, and 34% used insulin. Average subjective cognitive dysfunction score was 17.3±6.9 out of a possible 48, with higher scores indicating more dysfunction. Twenty-seven percent of participants (n=26) reported cognitive dysfunction (n=22 mild; n=4 moderate). More subjective cognitive dysfunction was associated with more diabetes distress (rho=0.32, p=0.002), more depressive symptoms (rho=0.55, p<0.001), less physical activity (rho=-0.31, p=0.002), and worse dietary behaviors (rho=-0.22, p=0.03).
Conclusions: Adults with T2D reported subjective cognitive dysfunction at twice the rate of the general population of American adults. Subjective cognitive dysfunction was not associated with demographic or clinical characteristics. Patients with cognitive dysfunction are at risk for psychological distress and trouble managing diabetes. Should additional data reinforce our findings, further attention should be given to developing tailored support for those with cognitive dysfunction and T2D.
Keywords: Diabetes, Cognitive factorsObjectives: 1) To assess the prevalence of subjective cognitive dysfunction in adults with T2D and 2) To assess how cognitive dysfunction relates to individual characteristics and diabetes management.
Methods: We recruited participants from an existing sample of adults with T2D who participated in a prior RCT. They completed the Measurement of Everyday Cognition-short, an abbreviated subjective measure of cognitive dysfunction. The survey also assessed demographic (age, education), clinical (diabetes duration, insulin use), psychological (diabetes distress, depressive symptoms), and behavioral (dietary behavior, physical activity) characteristics. First, we assessed the prevalence of subjective cognitive dysfunction in this sample. Next, we assessed the cross-sectional associations between cognitive dysfunction and the other characteristics using Spearman’s correlations.
Results: Participants (n=95) were on average 56.8±13.0 years old, 36% reported minoritized race or ethnicity, and 35% were male. Average diabetes duration was 15.4±7.8 years, and 34% used insulin. Average subjective cognitive dysfunction score was 17.3±6.9 out of a possible 48, with higher scores indicating more dysfunction. Twenty-seven percent of participants (n=26) reported cognitive dysfunction (n=22 mild; n=4 moderate). More subjective cognitive dysfunction was associated with more diabetes distress (rho=0.32, p=0.002), more depressive symptoms (rho=0.55, p<0.001), less physical activity (rho=-0.31, p=0.002), and worse dietary behaviors (rho=-0.22, p=0.03).
Conclusions: Adults with T2D reported subjective cognitive dysfunction at twice the rate of the general population of American adults. Subjective cognitive dysfunction was not associated with demographic or clinical characteristics. Patients with cognitive dysfunction are at risk for psychological distress and trouble managing diabetes. Should additional data reinforce our findings, further attention should be given to developing tailored support for those with cognitive dysfunction and T2D.
Authors:
Author - Emily Morrow, PhD, MS, CCC-SLP, Vanderbilt University Medical Center
Author - Robert Greevy, PhD, Vanderbilt University Medical Center
Author - Andrew Spieker, PhD, Vanderbilt University Medical Center
Author - Tom Elasy, MD, MPH, Vanderbilt University Medical Center
Presenter - Lindsay Mayberry, PhD, MS, Vanderbilt University Medical Center
Social Determinants of Health & Medication Adherence in Hispanics with Type 2 Diabetes in an E-Health Intervention Model
Poster Number: D51Time: 11:00 AM - 11:50 AM
Topics: Diabetes, Health Disparities
Hispanics face a higher risk of type 2 diabetes mellitus (T2DM), exhibiting poorer medication adherence, glycemic control, and increased rates of diabetes-related complications and mortality. Inadequate medication adherence contributes to poor glycemic management, heightened risk of complications, and death. One potential pathway by which social determinants of health (SDoH) influence health outcomes and healthcare utilization is through medication adherence, but there is limited research examining this association. This abstract aims to explore the association between SDoH and self-reported medication adherence within an E-Health intervention. Participants (N=178) were predominantly Mexican, Spanish-speaking, immigrant adults with T2DM at a federally qualified health center (FQHC), who were enrolled in a randomized controlled trial evaluating a healthcare delivery model that integrated behavioral health, care coordination, primary care, and E-Health education videos. At baseline, participants self-reported their medication adherence on the Adherence to Refills and Medication scale for Diabetes (ARMS-D; range 0 to 33; lower scores = better adherence) and SDoH, including education level, housing status, income, transportation access, employment status, insurance, social support, and sleep. Additionally, overall SDoH conditions (OSDoH) were assessed using the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) tool. Multivariable linear regression models assessed associations between SDoH, OSDoH, and medication adherence. Participants’ mean age was 57.82 years, and they were predominantly female (71%), married or partnered (53%), had less than a high school education (61%), and were not employed (61%). After controlling for covariates, only housing status (B=2.63, 95% CI: 0.69, 4.57, p=0.01), transportation access (B=-1.51, 95% CI: -2.65, -0.38, p=0.01), and sleep (B=-0.35, 95% CI: -0.66, -0.04, p=0.03) were significantly associated with medication adherence. OSDoH (B=0.14, 95% CI: -0.08, 0.37, p=0.20) was not significantly associated with medication adherence. Poor medication adherence was significantly associated with SDoH, specifically unstable housing, limited transportation access, and insufficient hours of sleep. These findings highlight the importance of addressing SDoH in interventions, specifically the various medication adherence barriers faced by Hispanics, to improve diabetes outcomes and overall well-being.
Keywords: Diabetes, Health disparitiesAuthors:
Author - Ana Rodriguez, San Diego State University Research Foundation
Co-Author - Fernando Arredondo, San Diego State University
Co-Author - Adriana Rivera, BA, San Diego State University
Co-Author - Perla Rocha, BA, San Diego State University
Co-Author - Heidy Mendez-Rodriguez, BA, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
Co-Author - Linda Gallo, PhD, FSBM, San Diego State University
Co-Author - Gregory Talavera, MD, MPH, San Diego State University
Provider and Patient Perspectives on Barriers and Facilitators to Detecting and Treating Binge Eating in Black Women Ages 18–25
Poster Number: D52Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Health Disparities
Background: Black women have some of the highest obesity rates in the U.S., with undetected and untreated binge eating contributing to these disparities. Black women also experience disproportionate rates of weight gain in early to mid-adulthood, and higher rates of emotional eating in adolescence, both risk factors for binge eating disorder (BED). Therefore, early detection and treatment may be critical in reducing these disparities. Fewer than 8% of Black women with BED seek treatment compared to 20% of White women. Barriers include cost, limited BED symptom recognition, and provider bias. Intervening early with emergent adult Black women may reduce obesity and maladaptive eating behaviors. Thus, this study examines the perspectives of providers and patients to understand barriers and facilitators to detecting and treating binge eating in Black women ages 18-25. Methods: Providers who treat black women ages 18-25 who binge eat (n = 8) and Black women ages 18-25 who self-identified as binge eaters and experience at least 2 or more binge eating episodes a month (n = 12) were invited to complete in-depth interviews to identify barriers and facilitators to detecting and treating binge eating. Thematic analysis was used to analyze qualitative data and identify relevant themes. Results: Providers and patients identified multiple barriers and facilitators to binge eating treatment in young black women who binge eat. Providers discussed barriers such as cost, appointment accessibility challenges, lack of accessible doctors, cultural influences, reliance on food for emotional regulation, and limited eating disorder awareness. Facilitators included clinician referrals, integrating technology into treatment, and provider diversity. Patients described barriers like family judgment and denial that treatment was necessary, and treatment facilitators identified were the desire to address childhood trauma, greater autonomy, and the desire for nutrition information. Conclusion: Findings highlight individual, social, and structural factors shape binge eating treatment in young Black women. Future research should consider these barriers and facilitators to intervention and clinical practice, such as diverse provider pools, integrating technology into the treatment options, and enhancing eating disorder awareness. Attention to these factors may improve patient representation, access, and engagement in treatment.
Keywords: Binge eating, NutritionAuthors:
Co-Author - Tyisha Harper-Cooks, MBA, UNC- Chapel Hill
Co-Author - Julian Robles, BS, UNC Chapel Hill
Co-Author - Ximena Arias, BS, UNC-Chapel Hill
Co-Author - Ramine Alexander, PhD,MPH, UNC-Chapel Hill
Author - Rachel Goode, PhD, MPH, LCSW, UNC-Chapel Hill
Facilitators and Challenges Experienced by State SNAP Directors when Implementing and De-Implementing COVID-Era SNAP Policies
Poster Number: D53Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders
Introduction
USDA’s Supplemental Nutrition Assistance Program (SNAP) underwent policy changes in response to the COVID-19 pandemic. USDA’s Food and Nutrition Service (FNS) allowed state SNAP agencies the choice to implement several flexibilities, or waivers, during the national public health emergency. The purpose of this study was to understand state SNAP directors’ experiences implementing and de-implementing these waivers.
Methods
Two in-person focus groups were conducted in August 2024 with 23 SNAP directors representing 20 states. Discussions focused on experiences administering SNAP during COVID-19, including implementing and de-implementing four waivers: emergency allotments (or supplemental benefits), certification period and periodic reporting adjustments, interview adjustments, and telephonic signatures. Discussions were audio-recorded and transcribed verbatim. Data were analyzed using Braun and Clarke’s method for reflexive thematic analysis.
Results
Sub-themes were organized around facilitators and challenges in states’ experiences with the waivers during the pandemic. Facilitator sub-themes included prioritizing SNAP participants’ needs, champions within and outside of state SNAP agencies, and maintaining state SNAP agency operations throughout COVID-19. Challenges sub-themes included the flexibility and inflexibility of FNS throughout the pandemic, states’ outdated infrastructure, workforce challenges, and unintended consequences on relationships between state agencies and SNAP participants. State SNAP directors offered several recommendations in response to these challenges. At the state-level, directors suggested investment in infrastructure modernization. At the federal-level, directors recommended that FNS offer states options, rather than waivers, which do not have the same restrictive requirements as waivers, and for FNS to create a plan for future public health emergencies.
Discussion
State SNAP directors’ lived experiences administering SNAP during the pandemic offer valuable lessons that can inform current and future SNAP policy. Including state SNAP directors as decision-making partners with FNS will be crucial in improving SNAP operations at the state- and federal-level and in creating a playbook that can be enacted in future emergencies.
Keywords: Health policy, NutritionUSDA’s Supplemental Nutrition Assistance Program (SNAP) underwent policy changes in response to the COVID-19 pandemic. USDA’s Food and Nutrition Service (FNS) allowed state SNAP agencies the choice to implement several flexibilities, or waivers, during the national public health emergency. The purpose of this study was to understand state SNAP directors’ experiences implementing and de-implementing these waivers.
Methods
Two in-person focus groups were conducted in August 2024 with 23 SNAP directors representing 20 states. Discussions focused on experiences administering SNAP during COVID-19, including implementing and de-implementing four waivers: emergency allotments (or supplemental benefits), certification period and periodic reporting adjustments, interview adjustments, and telephonic signatures. Discussions were audio-recorded and transcribed verbatim. Data were analyzed using Braun and Clarke’s method for reflexive thematic analysis.
Results
Sub-themes were organized around facilitators and challenges in states’ experiences with the waivers during the pandemic. Facilitator sub-themes included prioritizing SNAP participants’ needs, champions within and outside of state SNAP agencies, and maintaining state SNAP agency operations throughout COVID-19. Challenges sub-themes included the flexibility and inflexibility of FNS throughout the pandemic, states’ outdated infrastructure, workforce challenges, and unintended consequences on relationships between state agencies and SNAP participants. State SNAP directors offered several recommendations in response to these challenges. At the state-level, directors suggested investment in infrastructure modernization. At the federal-level, directors recommended that FNS offer states options, rather than waivers, which do not have the same restrictive requirements as waivers, and for FNS to create a plan for future public health emergencies.
Discussion
State SNAP directors’ lived experiences administering SNAP during the pandemic offer valuable lessons that can inform current and future SNAP policy. Including state SNAP directors as decision-making partners with FNS will be crucial in improving SNAP operations at the state- and federal-level and in creating a playbook that can be enacted in future emergencies.
Authors:
Author - Cerra Antonacci, PhD, MHS, MBE, Johns Hopkins Bloomberg School of Public Health
Co-Author - Christine Weston, PhD, MSEd, Johns Hopkins Bloomberg School of Public Health
Co-Author - Alessandra Uriarte, MSPH, Harvard T. H. Chan School of Public Health
Co-Author - Elise Sheinberg, MPH, RDN, Harvard T. H. Chan School of Public Health
Co-Author - Melissa Laska, PhD, RD, University of Minnesota
Co-Author - Cindy Leung, ScD, MPH, Harvard T. H. Chan School of Public Health
Co-Author - Julia Wolfson, PhD MPP, Johns Hopkins Bloomberg School of Public Health
Effects of Financial Concerns, Race, and Sexual Minority Status on Disordered Eating Behaviors Among Young Women
Poster Number: D54Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Women's Health
Financial concerns play a critical role in disordered eating behaviors due to food insecurity, inconsistent food access, and limited food diversity impacting diet quality. Prior research posits that race and sexual minority (SM) status present unique challenges related to both financial concerns and eating behaviors, yet little is known about the effect of these factors. The present study examined the association of financial concerns on eating behaviors among marginalized identity groups. Young women (N=316) who binge eat (151 sexual minority women [SMW] and 162 heterosexual women [HW]; 180 White and 80 Black) completed an online survey assessing health behaviors. Two-way ANOVAs were conducted to examine the effects of financial concern and sociodemographic group (i.e., SM status and race) on eating behaviors (i.e., binge eating and dietary restriction). Results showed that for binge eating, the interaction and main effects of financial concern with SM status and race were not significant (ps>.05). For restriction, the interaction of financial concern and SM status was significant (p=.036, partial η2=.014). Bonferroni corrected simple effects revealed an effect of financial concern on restriction among SMW (p<.001, partial η2=.056) but not HW, with SMW experiencing financial concerns reporting greater restriction. There was also a simple effect of SM status on restriction (p<.05, partial η2=.014), such that among those reporting financial concern, SMW reported greater restriction than HW; there was no difference between groups for those without financial concern (p=.333). There was not a significant interaction between financial concern and race on restriction (p=.726, partial η2<.001), but financial concern was significantly associated with restriction such that women with financial concerns reported greater restriction (p<.05, partial η2=.036). Overall, results showed that women with financial concerns engaged in greater restriction, but not binge eating. This effect significantly differed by SM status, with only SMW having greater restriction. Given these findings, there may be other factors, such as stigma, discrimination, or strained social support, that uniquely relate to financial concerns and eating behaviors among SM groups. Further exploration of SM stressors, intersectionality of marginalized identities, and additional eating behaviors is warranted to expand our understanding of the role of financial concerns for disordered eating.
Keywords: Eating behaviors, SocioeconomicAuthors:
Presenter - Alyssa Giannone, MS, Virginia Consortium Program in Clinical Psychology
Co-Author - Kristin Heron, PhD, FSBM, Old Dominion University
Co-Author - Robin Everhart, PhD, Virginia Commonwealth University
Nutrition Literacy Among Head and Neck Cancer Survivor and Care Partner Dyads
Poster Number: D55Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Cancer
Background: Nutrition management of head and neck cancer (HNC) survivors is complex due to nutrition impact symptoms like difficulty swallowing and taste changes. Survivors and their informal care partners must understand concepts such as energy and nutrient density and ability to interpret nutrition labels. Nutrition literacy, or the capacity with which individuals can use nutrition information to make informed choices, may improve nutrition status and diet quality, but has not been studied in HNC. The purpose of this study was to characterize nutrition literacy in HNC survivor-care partner dyads.
Methods: This cross-sectional study recruited 50 dyads from an HNC patient registry. Nutrition literacy was measured using the self-administered 42-item Nutrition Literacy Assessment Instrument (NLit) with scores ≤28 interpreted as “poor,” 29-38 as “possibly poor,” and ≥39 as “good.” Inclusion criteria were history of HNC, between 6 months-5 years post-primary treatment with no evidence of disease, no current use of feeding tubes, care partner participates in food procurement or preparation, > 18 years, and English speaking. Survivors and care partners completed the NLit separately and combined, resulting in three NLit scores per dyad: 1)Survivor, 2)Care Partner, and 3)Dyadic.
Results: Survivors were 68% male, care partners were 74% female, and 82% of dyads were married/cohabiting. Nutrition literacy was positively associated with education and inversely associated with ever smoking > 100 cigarettes (p<.05). Nutrition literacy was higher among care partners compared to survivors (34.2 ± 4.2 vs. 32.4 ± 5.4, p=0.02) and was correlated within dyads (r=0.43, p=.002). While most care partners and survivors had poor nutrition literacy (n=35 and n=38, respectively), care partners were more likely than survivors to have good nutrition literacy (n=9 and n=1, respectively, p=0.05). Dyadic scores (35.7 ± 5.4) were higher than both survivors (p<.001, d=.82) and care partners (p=.001, d=.48) individually with 12 dyads achieving good nutrition literacy.
Conclusions: Dyads working together achieved higher nutrition literacy scores overall, highlighting the benefit of shared knowledge and decision-making and underscoring how collaboration can offset individual limitations. These findings indicate that the combined perspective captures strengths not seen when examining survivors or caregivers separately and may help guide strategies to improve healthy eating in this population.
Keywords: Cancer survivorship, Health communicationMethods: This cross-sectional study recruited 50 dyads from an HNC patient registry. Nutrition literacy was measured using the self-administered 42-item Nutrition Literacy Assessment Instrument (NLit) with scores ≤28 interpreted as “poor,” 29-38 as “possibly poor,” and ≥39 as “good.” Inclusion criteria were history of HNC, between 6 months-5 years post-primary treatment with no evidence of disease, no current use of feeding tubes, care partner participates in food procurement or preparation, > 18 years, and English speaking. Survivors and care partners completed the NLit separately and combined, resulting in three NLit scores per dyad: 1)Survivor, 2)Care Partner, and 3)Dyadic.
Results: Survivors were 68% male, care partners were 74% female, and 82% of dyads were married/cohabiting. Nutrition literacy was positively associated with education and inversely associated with ever smoking > 100 cigarettes (p<.05). Nutrition literacy was higher among care partners compared to survivors (34.2 ± 4.2 vs. 32.4 ± 5.4, p=0.02) and was correlated within dyads (r=0.43, p=.002). While most care partners and survivors had poor nutrition literacy (n=35 and n=38, respectively), care partners were more likely than survivors to have good nutrition literacy (n=9 and n=1, respectively, p=0.05). Dyadic scores (35.7 ± 5.4) were higher than both survivors (p<.001, d=.82) and care partners (p=.001, d=.48) individually with 12 dyads achieving good nutrition literacy.
Conclusions: Dyads working together achieved higher nutrition literacy scores overall, highlighting the benefit of shared knowledge and decision-making and underscoring how collaboration can offset individual limitations. These findings indicate that the combined perspective captures strengths not seen when examining survivors or caregivers separately and may help guide strategies to improve healthy eating in this population.
Authors:
Presenter - Heather Gibbs, PhD, RD, University of Kansas Medical Center
Co-Author - Derrick Asante, MS, University of Kansas Medical Center
Co-Author - Xin Chen, MD, University of Kansas Medical Center
Co-Author - Andres Bur, MD, University of Kansas Medical Center
Co-Presenter - Anna Arthur, PhD, MPH, RDN, University of Kansas Medical Center
Shifts in food-related spending, deciding factors for food purchases, and food-related cognitions among users of GLP-1 receptor agonists: results from a cross-sectional survey
Poster Number: D56Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Decision Making
Introduction: Glucagon-like peptide agonists (GLP-1RAs) have become a prevalent pharmacological treatment for obesity, with recent data indicating that 1 in 8 US adults has used these medications. Despite the efficacy of these drugs in treating obesity and anecdotal reports of reductions in food noise (heightened and persistent reactivity to food cues), little is known about how these drugs affect consumer habits, food-related decision-making, and food-related cognitions. Methods: 700 current users of GLP-1RAs were surveyed; 602 met data quality criteria and were included in analyses. Questions encompassed perceived changes in spending habits and in reasons for purchasing food after starting their medication. Perceived changes in food-related cognitions were assessed using a modified version of the General Food Cravings Questionnaire – Trait (G-FCQ-T), which evaluated each question for changes in perceived agreement (i.e., agreeing more, the same, or less with each statement compared to before starting a GLP-1RA). Results: Participants were 51% female, 77% White, 82% non-Hispanic/Latino, with a mean age of 41.6 (± 12.3), a mean BMI of 34.8 (± 8.8), and a mean duration of medication use of 7.5 months (± 7.5). 89% were prescribed a GLP-1RA for weight management, and 47% for diabetes management. The most common medications were Ozempic (51%), Mounjaro (15%), and Wegovy (13%). 65% and 49% of respondents reported spending less than before on foods consumed out of the home and on groceries, respectively. 55% and 33%, respectively, said healthfulness and taste became more important when deciding what foods to buy (38% and 53% responded that it didn’t change). 62% of participants responded mostly “less than before” to G-FCQ-T items. The proportion of “less than before” responses to G-FCQ-T items varied descriptively by drug: 80% for Wegovy, 64% for Mounjaro, and 62% for Ozempic, for instance. These proportions were also different for each subscale of the G-FCQ-T: 60% for loss of control, 58% for preoccupation with food, 54% for emotional craving, and 52% for positive outcome expectancy. Discussion: Most respondents using GLP-1RAs reported changes in food purchasing behaviors, priorities, and food-related cognitions, consistent with a desire to consume healthier foods and with potential reductions in emotional craving, loss of control, positive outcome expectancy, and preoccupation with food, suggesting experiences consistent with reduced food noise.
Keywords: Nutrition, ObesityAuthors:
Author - Daisuke Hayashi, MS, The Pennsylvania State University
Co-Author - Sara J. Maksi, PhD, University of Kentucky
Co-Author - Olivia Lawler, MS, The Pennsylvania State University
Co-Author - Travis D. Masterson, PhD, The Pennsylvania State University
Effect of a Mandatory Healthy Checkout Policy on the Retail Food Environment : A Natural Experimental Evaluation
Poster Number: D57Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Social and Environmental Context and Health
Introduction: In January 2024, Perris, CA, became the second US jurisdiction to implement a mandatory healthy checkout policy, after Berkeley, CA. These healthy checkout ordinances (HCOs) set nutritional standards for products displayed at checkout, with the potential to improve the retail food environment and ultimately dietary intake. Unlike Berkeley’s HCO, which applies to the entire checkout, Perris’ HCO applies only ≤6ft of registers. Perris’ HCO also had more complex and permissive nutritional standards (e.g., allowing low-calorie sugar-sweetened beverages [SSBs] and artificially sweetened beverages and exempting multiple food groups from nutrient limits). One year after implementation, compliance with Berkeley’s HCO increased from 53% to 83%, and the presence of SSBs, candy, and other sweets significantly decreased. The objective of this study was to evaluate the real-world impact on the retail food environments of Perris’ second-in-the-nation HCO.
Methods: We leveraged a natural experiment in which data were collected in June 2023 (baseline) and June 2024 (follow-up; 6 months after implementation) from 13 Perris stores subject to the ordinance and 52 matched stores in three comparison cities without the policy. Using 67,625 product facings, we conducted a difference-in-differences analysis to assess the extent to which: (1) checkout product facings met HCO standards ≤6ft of registers (i.e., were HCO-compliant), >6ft of registers, and across the entire checkout; and (2) food and beverage facings fell into compliant and noncompliant categories ≤6ft.
Results: Among all product facings ≤6ft of registers, compliance in Perris increased from 49% to 66%, a 38% increase relative to comparison cities (PR=1.38, CI=1.12–1.71, p<0.01). Increases in the percentage of facings meeting HCO standards were not significant >6ft and were smaller across the entire checkout (PR=1.30, CI=1.06–1.60, p=0.01). Among food and beverage facings ≤6ft of registers, compliance increased 55% relative to comparison cities, from 34% to 53% (PR=1.55, CI=1.12–2.11, p<0.01), and there was a 143% increase in the prevalence of compliant beverages (PR=2.43, CI=1.40–4.21, p<0.01). However, there were no significant reductions in SSBs, candy, salty snacks, or other sweets.
Conclusions: Perris’ HCO improved checkout food environments but to a lesser extent than Berkeley’s. The effectiveness of HCOs for improving checkout environments may depend in part on the policy’s design and scope.
Keywords: Health policy, NutritionMethods: We leveraged a natural experiment in which data were collected in June 2023 (baseline) and June 2024 (follow-up; 6 months after implementation) from 13 Perris stores subject to the ordinance and 52 matched stores in three comparison cities without the policy. Using 67,625 product facings, we conducted a difference-in-differences analysis to assess the extent to which: (1) checkout product facings met HCO standards ≤6ft of registers (i.e., were HCO-compliant), >6ft of registers, and across the entire checkout; and (2) food and beverage facings fell into compliant and noncompliant categories ≤6ft.
Results: Among all product facings ≤6ft of registers, compliance in Perris increased from 49% to 66%, a 38% increase relative to comparison cities (PR=1.38, CI=1.12–1.71, p<0.01). Increases in the percentage of facings meeting HCO standards were not significant >6ft and were smaller across the entire checkout (PR=1.30, CI=1.06–1.60, p=0.01). Among food and beverage facings ≤6ft of registers, compliance increased 55% relative to comparison cities, from 34% to 53% (PR=1.55, CI=1.12–2.11, p<0.01), and there was a 143% increase in the prevalence of compliant beverages (PR=2.43, CI=1.40–4.21, p<0.01). However, there were no significant reductions in SSBs, candy, salty snacks, or other sweets.
Conclusions: Perris’ HCO improved checkout food environments but to a lesser extent than Berkeley’s. The effectiveness of HCOs for improving checkout environments may depend in part on the policy’s design and scope.
Authors:
Co-Author - Ethan C Wolf, UC Berkeley School of Public Health
Co-Author - Andrea M Gil, UC Davis
Co-Author - Kris Jayme G Matas, UC Davis
Co-Author - Lisa M Powell, School of Public Health, University of Illinois Chicago
Co-Author - Rebecca M Schermbeck, School of Public Health, University of Illinois Chicago, Chicago
Co-Author - Jennifer Falbe, ScD, MPH, UC Davis
Infant Nutrition and Gastrointestinal Habits During First Year of Life among Participants in FeFiFo-MOMS: Effects of Fermented and Fiber-rich Foods on Maternal and Offspring Microbiome Study
Poster Number: D58Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Child and Family Health
Background: Infant feeding and eating habits can influence both gastrointestinal symptoms and long-term health, partly via microbiome modulation. Dietary fiber and fermented foods are among diet factors with established impacts on microbial composition. Objective: To evaluate reported breastfeeding, formula, and solid food behaviors among infants participating in the FeFiFo-MOMS study over the first year of life. Methods: Mothers randomized to one of four diet arms (high fiber, high fermented foods, both, or control) completed surveys on infant daily feeding frequency, weekly food exposure, stool habits, and gastrointestinal symptoms at 9 and 12 months. Regular exposure was defined as ≥5 days/week. Frequency of stool habits (daily) and relevant symptoms (colic, reflux, diarrhea, vomiting) were also collected via survey questions for descriptive analyses. Chi-square tests of independence examined maternal dietary intervention groups and 13 infant food consumption categories at 12 months. Results: Between 9 months (n=77) and 12 months (n=87), exclusive/predominant breastfeeding declined (43%-->21% of participants), coinciding with a slight reduction in formula feeds (8%-->3%). Infants consuming ≤1x/day of either breastmilk or formula at 12 months increased by 17%. Regular food/beverage exposure increased most substantially for milk (6.5%-->36.8%), meat/poultry/fish (35%-->59%), fruit (61%-->84%), yogurt (13%-->35%), and wheat products (14%-->32%). Vegetable, legume, grain, nuts/seeds, and egg intake increased modestly by 3-8%. By 12 months, over 75% of infants had regular fruit and vegetable exposure, with minimal sweet food or fruit juice intake (both 1%). No associations were detected between randomization groups and regular consumption of any food category (all χ² p-values≥0.05, Cramér's V: 0.018-0.185). Over 90% of infants maintained regular bowel patterns (1-3 stools/day), with concern for constipation decreasing as the study progressed. Minimal changes were reported in colic and reflux (maintained around 95% and 86% never experienced, respectively) as well as diarrhea (+3.3%) and vomiting (+5.6%) at 12 months. Conclusions: By 12 months, infants in FeFiFo-MOMS were commonly fed fruits, vegetables, and meat, with milk showing the largest increase. Consistent feeding and eating patterns across maternal diet groups reduce confounding for future microbiome analyses.
Keywords: Nutrition, Children's healthAuthors:
Presenter - Andrea Krenek, PhD, RDN, chef, Stanford University
Co-Author - Dalia Perelman, MS, RDN, Stanford University
Co-Author - Christopher Gardner, PhD, Stanford University
Acute social rejection and momentary eating disorder risk factors in adolescents: Differences by body mass index z-score
Poster Number: D59Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Weight Related Health
Background: Binge-spectrum eating disorders (BSEDs) frequently emerge during adolescence and are elevated among youth with overweight or obesity. Adolescents with overweight or obesity often experience heightened social rejection, yet the momentary pathways linking rejection to eating disorder risk remain poorly understood. This study examined whether acute social rejection was associated with BSEDs risk factors in real time and whether these associations varied by body mass index z-score (BMI-z). Methods: Seventy-four adolescents (ages 14–17) completed a 10-day ecological momentary assessment (EMA) protocol, reporting on experiences of social rejection, eating behaviors (i.e., overeating, loss of control eating [LOCE], restriction), and other BSEDs risk variables (impulsivity, urge to eat, mood improvement eating expectancies, and body dissatisfaction) multiple times per day. Generalized linear mixed models tested associations between momentary rejection and outcomes, including interactions with BMI-z. Results: When adolescents with higher BMI-z experienced elevated rejection compared to their usual, they reported significantly greater subsequent LOCE as well as higher concurrent impulsivity, urge to eat, mood improvement eating expectancies, and restriction (interaction ps=<.001-.02). These associations were not observed among adolescents with lower BMI-z. Between-subjects rejection was also independently associated with higher average LOCE, overeating, and body dissatisfaction. Discussion: These findings suggest that adolescents with higher BMI-z are especially vulnerable to maladaptive behavioral and psychological response to social rejection. This study extends prior research by demonstrating dynamic, momentary pathways between social rejection and core eating disorder risk processes in the real world and highlights maladaptive behavioral response to social rejection as a mechanism for BSEDs risk in youth with obesity.
Keywords: Eating behaviors, AdolescentsAuthors:
Presenter - Tyler Mason, PhD, University of Southern California
Co-Author - Jeremy Morales, BSPH, University of Southern California
Co-Author - Genevieve Dunton, PhD, MPH, FSBM, University of Southern California
Co-Author - Kathryn Smith, PhD, University of Southern California
Developing Narratives to Culturally Adapt a Resistance Exercise Intervention for Black Breast Cancer Survivors
Poster Number: D6Time: 11:00 AM - 11:50 AM
Topics: Cancer, Physical Activity
Background: Although resistance exercise (RE) improves bone and muscular health in women, only 10.3% Black breast cancer survivors (BCS) meet the cancer-specific guideline of ≥ 2 sessions per week compared to 18.9% White BCS. To promote physical activity (PA) adherence, the cultural considerations framework–designed for developing PA interventions for Black women–suggests integrating deep structure cultural factors, such as shared social norms or cultural values. Culturally adapted narratives, or stories, may be an innovative intervention strategy to promote problem solving for culturally relevant PA-related issues. This study aimed to develop narratives by identifying culturally relevant factors and lived experiences influencing RE among Black BCS. The narratives will be integrated into a RE randomized control trial and tested among Black BCS. Methods: Black BCS (N=16; M age=56.3 years, SD=8.5; 56.2% married/living together; 50% with a graduate degree; 68.8% employed; 37.5% Stage I diagnosis; M months since treatment=43.4 months, SD=29.2) completed one-on-one semi-structured interviews over Zoom. Interviews (M duration=69.8 minutes, SD=16.6) were audio recorded and transcribed verbatim. Transcripts were analyzed using inductive thematic analysis to identify key factors under a constructivist paradigm, then deductively mapped onto the cultural considerations framework to develop themes. To develop the narratives based on the analysis, Conley and colleagues’ framework was used. Narratives were member checked for accuracy and cultural sensitivity. Results: Six narratives were developed. Four narratives focused on deep structure cultural factors: 1) protecting hair styles while engaging in PA (factor: physical appearance norms); 2) prioritizing others over engaging in PA (factor: collectivism); 3) perceptions of one’s identity in PA spaces (factor: experiential knowledge); and 4) using meaningful relationships to promote PA (factor: social relationships). Two narratives focused on health-related topics: 5) navigating the negative effects from cancer treatment during PA and 6) using PA for health enhancement. Discussion: Including narratives that reflect the lived experiences of Black BCS may enhance RE adherence by offering a culturally responsive strategy for problem solving PA-related issues during the intervention. Future research will evaluate the relevance, uptake, and efficacy of these narratives in promoting RE adherence among Black BCS.
Keywords: Cancer, Physical activityAuthors:
Presenter - Hala Abbas, University of Michigan
Co-Author - Isabel Wakefield, University of Michigan
Co-Author - Dominique Kinnett-Hopkins, PhD, University of Michigan
Co-Author - Ken Resnicow, PhD, FSBM, University of Minnesota
Co-Author - Angela Fong, PhD, University of Michigan
Food Responsiveness in Preschool-Aged Children: The Role of Screen Media and the Home Food Environment
Poster Number: D60Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Weight Related Health
Background: There is consistent evidence for an association between screen media use and childhood obesity, but the exact mechanisms remain unclear, likely vary between children, and are reinforced within the family and home environment. Children who are strongly drawn toward eating may be particularly vulnerable to the effects of screens on dietary patterns. This study aimed to explore the associations between two commonly cited screen media mechanisms (total screen time exposure and eating while watching screens) and two measures of food responsiveness, and to test the home food environment as a moderator between these associations.
Methods: 108 parents and preschool-aged children participated in lab visits and surveys. We modeled two outcome measures of food responsiveness: a parent report measure (the food responsiveness subscale in the Child Eating Behavior Questionnaire) and a behavioral measure (energy intake during an Eating in the Absence of Hunger [EAH] task). Predictors included total screen time exposure and frequency of eating while watching TV. Interaction terms were created between screen media behaviors and the availability of high energy foods in the home, adapted from the Home Food Inventory. Covariates included child body mass index z-score, family income, child sex, parent feeding practices, child liking of offered EAH foods, and child hunger before the EAH task. The parent-report outcome was modeled using linear regression; the behavioral measure with a zero-inflated negative binomial model.
Results: Screen media behaviors did not predict parent-report food responsiveness; however eating while watching TV negatively predicted energy intake for children in the EAH task (incidence rate ratio, IRR=0.74, p=0.03). There was a positive interaction between watching television during meals and the availability of high energy foods on energy intake (IRR=1.06, p=0.02). Specifically, the negative association between eating while watching TV and EAH energy intake becomes weaker as the availability of high energy foods in the home increases, indicating a context-dependent risk pattern.
Conclusion: While frequency of eating while watching TV was independently associated with a decrease in EAH energy intake, the significant positive interaction with the home food environment suggests this relationship is conditional. Further work should be done to understand the discordance between the two food responsiveness measures and screen media use.
Keywords: Eating behaviors, Children's healthMethods: 108 parents and preschool-aged children participated in lab visits and surveys. We modeled two outcome measures of food responsiveness: a parent report measure (the food responsiveness subscale in the Child Eating Behavior Questionnaire) and a behavioral measure (energy intake during an Eating in the Absence of Hunger [EAH] task). Predictors included total screen time exposure and frequency of eating while watching TV. Interaction terms were created between screen media behaviors and the availability of high energy foods in the home, adapted from the Home Food Inventory. Covariates included child body mass index z-score, family income, child sex, parent feeding practices, child liking of offered EAH foods, and child hunger before the EAH task. The parent-report outcome was modeled using linear regression; the behavioral measure with a zero-inflated negative binomial model.
Results: Screen media behaviors did not predict parent-report food responsiveness; however eating while watching TV negatively predicted energy intake for children in the EAH task (incidence rate ratio, IRR=0.74, p=0.03). There was a positive interaction between watching television during meals and the availability of high energy foods on energy intake (IRR=1.06, p=0.02). Specifically, the negative association between eating while watching TV and EAH energy intake becomes weaker as the availability of high energy foods in the home increases, indicating a context-dependent risk pattern.
Conclusion: While frequency of eating while watching TV was independently associated with a decrease in EAH energy intake, the significant positive interaction with the home food environment suggests this relationship is conditional. Further work should be done to understand the discordance between the two food responsiveness measures and screen media use.
Authors:
Author - Ivan Mendoza, Purdue University
Co-Author - Robert Duncan, PhD, MPH, Colorado State University
Co-Author - Kameron Moding, PhD, Purdue University
Clinical profiles of patients with eating disorder diagnoses presenting to virtual intensive outpatient treatment
Poster Number: D61Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders
Existing eating disorder (ED) treatment models often fail to account for comorbid psychiatric illnesses and psychosocial wellbeing factors that could help explain high rates of symptom recurrence and protracted illness course associated with EDs. We conducted a preliminary descriptive analysis of clinical profiles of patients admitting to virtual intensive outpatient care with ED diagnoses to inform strategies for multimodal treatment. Eighty-two patients had ED diagnoses at intake. The majority were young-adult (Mage = 21.55, SD = 8.82), white (n = 56, 68.3%; n = 20 multiracial), sexual minority (n = 58, 70.7%), cisgender women (n = 43, 52.4%; n = 9 men; n = 30 gender minority). Two had primary and 80 had secondary ED diagnoses. These included anorexia nervosa (n = 13, 15.8%), avoidant restrictive food intake disorder (n = 12, 14.6%), binge-eating disorder (n = 32, 39.0%), and other specified feeding or eating disorder (n = 25, 30.5%). The most frequent comorbid diagnoses were major depressive disorder (n = 39, 47.6%) and generalized anxiety disorder (n = 21, 25.6). Past-month frequencies in days were M = 9.57 (SD = 11.25) for restriction, M = 10.26 (SD = 11.24) for binge eating, and M = 4.21 (SD = 7.86) for compensatory behaviors (e.g., self-induced vomiting). Average PHQ-9 and GAD-7 scores were moderate at M = 15.22 (SD = 7.20) and M = 12.00 (SD = 5.70), respectively. Approximately 40% of patients (n = 27) endorsed past-week suicidal ideation and 50% (n = 36) endorsed past suicide attempts. Average past-month days of self-harm was 1.42 (SD = 3.61). Average wellbeing scores (WHO-5) were low (M = 32.00, SD = 21.37), though average levels of family (M = 20.55, SD = 5.75) and peer (M = 12.28, SD = 3.94) support were moderate-to-high. Questions remain regarding how best to serve patients with EDs in virtual treatment settings, as well as how best to address concurrent psychiatric and psychosocial needs. Present findings highlight a need to directly modulate significant depressive and anxious symptomatology, and suicidality, which could contribute to overall poor response rates to standard ED treatments. Further, despite burgeoning evidence that sexual and gender minority patients are at greater risk for more severe EDs necessitating more intensive treatments, population-specific treatments are sparse. Integrative treatments that target identity-related needs, leverage adaptive familial and peer connection, and accommodate comorbid symptoms are warranted.
Keywords: Eating behaviors, Co-morbidityAuthors:
Author - Matthew F Murray, PhD, Charlie Health, Inc.
Co-Author - Elizabeth L Kroll, MEd, Charlie Health, Inc.
Co-Author - Jonathan Kohlmeier, MA, Charlie Health, Inc.
Co-Author - Caroline Fenkel, DSW, Charlie Health, Inc.
“You Created a Monster”: Investigating Young Adults’ Perspectives on Eating-Related Social Media Content
Poster Number: D62Time: 11:00 AM - 11:50 AM
Topics: Diet, Nutrition, and Eating Disorders, Digital Health
Viewing eating-related short-form videos on social media (SM) (e.g., TikTok) is associated with eating disorder (ED) symptoms, including binge eating. We investigated young adults’ perceptions of how SM affects their eating attitudes, cognitions, and behaviors, and their perspectives on interventions for harmful SM use. Twenty-five participants (Mage=23.68; 64% cisgender women) who consistently viewed short-form SM videos (≥30 minutes/day) and reported binge eating ≥1/week for the past month (80% bulimia nervosa, 8% binge-eating disorder, 12% other) completed a semi-structured qualitative interview. Inductive thematic analysis revealed varied responses to viewing eating-related short-form SM videos. Participants reported sometimes using SM for practical food skills or cooking inspiration, while other times experiencing harmful effects of SM on their eating behaviors, thoughts, and attitudes, including for example, urges to binge eat after viewing overeating content. Regarding interventions, some participants suggested that SM companies implement stricter protective measures (e.g., adding age limits, regulating content/algorithm). Others indicated it was the user’s responsibility to modify and restrict their viewing, and that interventions are not needed. Participants largely agreed that their peers should know SM is a “highlight reel” (i.e., creators display only the positive parts of their life) and that it is important to seek support for the negative effects of SM use. Findings suggest individuals with EDs experience eating-related distress from SM and some desire interventions to modify their use. Future research should develop interventions to address ED symptoms related to SM use.
Keywords: Eating behaviors, Social network analysisAuthors:
Presenter - Dayna Winograd, BS, Virginia Tech
Co-Author - Jacqueline Kosmas, MA, Virginia Tech
Co-Author - Griffin McClain , Virginia Tech
Co-Author - Anna Gabrielle Patarinski, MS, Virginia Tech
Co-Author - Heather Davis, PhD, Virginia Tech
Exploring the Barriers and Facilitators of Participation in a RCT of an mHealth Intervention Targeting Urban Blacks with Uncontrolled Hypertension
Poster Number: D63Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Implementation Science
Introduction: Representative samples are important for research trial; however, recruitment and retention is challenging, particularly in minoritized populations. Trials involving mHealth interventions often experience low uptake and retention, adding further complexity.
Objective: We sought to explore barriers and facilitators of clinical trial recruitment and retention in a 12-month RCT of MI-BP, an mHealth intervention to improve blood pressure (BP) among Blacks with uncontrolled hypertension recruited from emergency departments and community-based settings in Detroit, MI.
Methods: The MI-BP trial enrolled 869 participants, of which 162 were randomized and 87 completed the trial. We conducted an explanatory sequential mixed methods design using surveys and semi-structured interviews, sampling people who enrolled in the trial. Surveys focused on experiences with the trial, including satisfaction and reasons for drop out (if applicable). We followed up with a subset of participants using semi-structured interviews to understand the experiences between those trial completers and dropouts. We integrated qualitative and quantitative results through merging and joint displays to explain barriers and facilitators to trial participation.
Results: Fifty-two participants completed the survey, of which 22 were interviewed. No significant differences were found regarding reasons for joining the study. Overall, participants’ motivation to join the trial was largely to learn more about how to improve BP. Experiences with the study were positive for completers and non-completers. Facilitators of trial participation included desire to maintain health, transportation, monetary incentives, and a friendly staff. Among non-completers, some shared that they had met their goal of lowering BP and did not feel the need to continue. Despite a robust consent process, non-completers reported poorer understanding of some study components relative to completers. Additional barriers included concerns over adverse effects and missing work.
Discussion: This study identified several barriers and facilitators to participation in a RCT of the MI-BP intervention. Findings suggest the importance of improving communication with participants regarding consent, understanding the study, and completing the trial. Doing so may have the potential to increase study retention, as well as the success and outcomes of clinical trials to better serve these communities.
Keywords: Randomized controlled trial, Research methodsObjective: We sought to explore barriers and facilitators of clinical trial recruitment and retention in a 12-month RCT of MI-BP, an mHealth intervention to improve blood pressure (BP) among Blacks with uncontrolled hypertension recruited from emergency departments and community-based settings in Detroit, MI.
Methods: The MI-BP trial enrolled 869 participants, of which 162 were randomized and 87 completed the trial. We conducted an explanatory sequential mixed methods design using surveys and semi-structured interviews, sampling people who enrolled in the trial. Surveys focused on experiences with the trial, including satisfaction and reasons for drop out (if applicable). We followed up with a subset of participants using semi-structured interviews to understand the experiences between those trial completers and dropouts. We integrated qualitative and quantitative results through merging and joint displays to explain barriers and facilitators to trial participation.
Results: Fifty-two participants completed the survey, of which 22 were interviewed. No significant differences were found regarding reasons for joining the study. Overall, participants’ motivation to join the trial was largely to learn more about how to improve BP. Experiences with the study were positive for completers and non-completers. Facilitators of trial participation included desire to maintain health, transportation, monetary incentives, and a friendly staff. Among non-completers, some shared that they had met their goal of lowering BP and did not feel the need to continue. Despite a robust consent process, non-completers reported poorer understanding of some study components relative to completers. Additional barriers included concerns over adverse effects and missing work.
Discussion: This study identified several barriers and facilitators to participation in a RCT of the MI-BP intervention. Findings suggest the importance of improving communication with participants regarding consent, understanding the study, and completing the trial. Doing so may have the potential to increase study retention, as well as the success and outcomes of clinical trials to better serve these communities.
Authors:
Presenter - Lorraine Buis, PhD, University of Michigan
Co-Author - Analay Perez, PhD, University of Michigan
Co-Author - Katee Dawood, MBA, Wayne State University
Co-Author - Reema Kadri, MLIS, University of Michigan
Co-Author - Rachelle Muladore, BS, Wayne State University
Co-Author - Dongru Chen, MS, University of Michigan
Co-Author - Phillip Levy, MD, MPH, Wayne State University
Co-Author - Timothy Guetterman, PhD, University of Michigan
What factors determine patient use of a digital tool to increase family genetic testing for hereditary cancer syndromes?
Poster Number: D64Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cancer
Background: Digital tools are increasingly relevant to patient engagement, including in the context of hereditary cancer syndromes where a key cancer prevention goal is ensuring that families of patients with a pathogenic variant (PV) in a cancer predisposition gene get their own cascade genetic testing (CGT). Despite their availability, patient use of digital tools may be limited by patient location, age, internet access, and other factors. We examined the impact of sociodemographic and clinical factors on engagement with a digital tool designed to promote CGT.
Methods: The EfFORT Study is an ongoing prospective randomized trial to promote CGT using an intervention of provider-mediated family outreach and a digital tool called MyGene Portal compared to standard of care. Participants include cancer affected and unaffected adults with a PV. Using baseline survey data from intervention arm participants, we tested bivariate associations between MyGene Portal use (ever vs never) and cancer status (no history vs diagnosis >1y ago vs active treatment, i.e. diagnosis within 1y), PV penetrance (high vs moderate), time from PV disclosure to study enrollment (same day vs 1 day–1 month vs >1 month), sex, education, income, socioeconomic disadvantage, age, and a validated measure of eHealth literacy.
Results: Data were available for 92 participants (60.9% female, ages 29-89, 85.9% White, 7.6% Latine, 69.5% with a college degree). More than half (55.4%) were in active treatment, 21.7% had a diagnosis >1y ago, and 22.8% had no cancer history. Participants reported high eHealth literacy (M=29.87, SD=5.49, scale range: 8-40). Overall, 71.7% had ever used MyGene Portal. Cancer status was not related to use of MyGene Portal (χ2(2)=.64, p=.73). However, time from PV disclosure to study enrollment was associated (χ2(2)=6.43, p=.04); use of MyGene Portal was more common in those who enrolled on the same day (82%) than in those who enrolled within 1 day–1 month (60.6%) or >1 month (50%) of PV result disclosure. No other factors were significantly associated with digital tool use.
Conclusion: Real-time introduction of relevant digital tools (e.g., during disclosure of genetic test results) may increase patient engagement. Identifying factors that influence digital engagement for CGT will help institutions allocate resources effectively and intervene upstream of hereditary cancer diagnoses.
Keywords: Cancer, GeneticsMethods: The EfFORT Study is an ongoing prospective randomized trial to promote CGT using an intervention of provider-mediated family outreach and a digital tool called MyGene Portal compared to standard of care. Participants include cancer affected and unaffected adults with a PV. Using baseline survey data from intervention arm participants, we tested bivariate associations between MyGene Portal use (ever vs never) and cancer status (no history vs diagnosis >1y ago vs active treatment, i.e. diagnosis within 1y), PV penetrance (high vs moderate), time from PV disclosure to study enrollment (same day vs 1 day–1 month vs >1 month), sex, education, income, socioeconomic disadvantage, age, and a validated measure of eHealth literacy.
Results: Data were available for 92 participants (60.9% female, ages 29-89, 85.9% White, 7.6% Latine, 69.5% with a college degree). More than half (55.4%) were in active treatment, 21.7% had a diagnosis >1y ago, and 22.8% had no cancer history. Participants reported high eHealth literacy (M=29.87, SD=5.49, scale range: 8-40). Overall, 71.7% had ever used MyGene Portal. Cancer status was not related to use of MyGene Portal (χ2(2)=.64, p=.73). However, time from PV disclosure to study enrollment was associated (χ2(2)=6.43, p=.04); use of MyGene Portal was more common in those who enrolled on the same day (82%) than in those who enrolled within 1 day–1 month (60.6%) or >1 month (50%) of PV result disclosure. No other factors were significantly associated with digital tool use.
Conclusion: Real-time introduction of relevant digital tools (e.g., during disclosure of genetic test results) may increase patient engagement. Identifying factors that influence digital engagement for CGT will help institutions allocate resources effectively and intervene upstream of hereditary cancer diagnoses.
Authors:
Presenter - Julia Gruberg, MPH, MA, Memorial Sloan Kettering Cancer Center
Co-Author - Victoria Groner, Memorial Sloan Kettering Cancer Center
Co-Author - Catherine Fanjoy, Memorial Sloan Kettering Cancer Center
Co-Author - Giulia Ongaro, Memorial Sloan Kettering Cancer Center
Co-Author - Dina Green, Memorial Sloan Kettering Cancer Center
Co-Author - Magan Trottier, Memorial Sloan Kettering Cancer Center
Co-Author - Fernanda C. G. Polubriaginof, Memorial Sloan Kettering Cancer Center
Co-Author - Zsofia K. Stadler, Memorial Sloan Kettering Cancer Center
Co-Author - Kenneth Offit, Memorial Sloan Kettering Cancer Center
Co-Author - Jada Hamilton, PhD, MPH, FSBM, Memorial Sloan Kettering Cancer Center
Keep Calm and Drop Out? Predicting Attrition in an mHealth Meditation App Using Bayesian Model Averaged Logistic Regression
Poster Number: D65Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Integrative Health and Spirituality
Background: Despite the proven growing evidence of the benefits of mindfulness meditation delivered via mobile health (mHealth) apps, high attrition remains a critical barrier. Meditation apps account for a majority of active users of mental health apps, but less than five percent of initial users continue practice after 30 days. Some evidence has uncovered demographics and personality factors that predict attrition for traditional in-person formats, yet the reasons why participants drop out of app-based meditation remain unclear. Objective: This project applies Bayesian model-averaged logistic regression to capture dropout patterns and identify profiles of users most at risk for attrition. Method: The sample of 1,390 participants (82% non-male; age M = 35.6 years, SD = 10.4) completed self-report measures of stress, burnout, sleep quality, negative affect, food insecurity, and adverse childhood experiences. A Bayesian model-averaged logistic regression was conducted to evaluate all possible combinations of ten theoretically relevant predictors (1,024 candidate models) and to average the predictive effects across them. Results: The full model including ten predictors had the highest posterior model probability (0.285), although no single model dominated the model space. The Bayes factor (BF) on the model odds indicated that the odds of favoring this model increased by a factor of 2.2. In terms of parameter inclusion, the strongest predictor of attrition at the follow-up was condition (inclusion BF = 20.911), with participants in the meditation group being about 38% more likely to drop out. Income also emerged as a meaningful predictor (inclusion BF = 3.258): middle-income, high-income, and “prefer-not-to-say” participants were approximately 36–39% less likely to drop out than low-income participants. Additional predictors with moderate evidence included baseline stress and adverse childhood experiences, with inclusion BFs ranging from 2.7 to 3.2. Each was associated with small differences in dropout likelihood (approximately –2% and +3%, respectively). Discussion: Findings indicate specific predictors of attrition in an app-based mindfulness meditation intervention with the factors of condition and income being most meaningful. These results have utility for informing targeted strategies to improve engagement and laying the foundation for larger-scale interventions that enhance the effectiveness and reach of mHealth mindfulness programs.
Keywords: Mobile phone, Mindfulness-Based Stress ReductionAuthors:
Co-Author - Ihnwhi Heo, MSc, University of California, Merced
Author - Mercedes Peña, BA, University of California, Merced
Co-Author - Sarah Depaoli, PhD, University of California, Merced
Co-Author - Aric Prather, PhD, University of California, San Francisco
Co-Author - Elissa Epel, PhD, University of California, San Francisco
Co-Author - Matthew Zawadzki, PhD, University of California, Merced
Mental Health and Physical Symptoms Outcomes Among Digital Mental Health Platform Users With Comorbid Conditions
Poster Number: D66Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Mental Health
Background: Many individuals face co-occurring mental and physical health conditions, with each exacerbating the other given their bidirectional link. Thus, improving mental health may positively impact physical symptoms. This study evaluated physical and mental health at baseline and after 3 months of using an employer sponsored digital mental health platform among individuals with co-occurring mental health and physical health concerns.
Methods: In a sample of 304 care-seeking working adults (70% women, Mage =37 years, 38% people of color) with at least moderate anxiety and/or depressive symptoms (PHQ-9 and/or GAD-7 ≥ 10), 170 (55%) reported a physical health condition (e.g., heart disease). Participants (2024-25) completed surveys on depression, anxiety, well-being, physical symptoms (e.g., pain, stomach aches), self-rated health, and healthcare utilization at baseline and 3 months. Baseline analyses used the full sample; follow-up analyses used participants (n=73) with a physical health condition and follow-up data, who used services at least once (therapy [59.9%], psychiatry [1.4%], coaching [12.3%], digital content [58.9%]). T-tests assessed baseline differences between those with and without a physical health condition and 3 month changes for those with a physical health condition who engaged.
Results: At baseline, those with a physical condition had poorer mental health (higher depression, lower well-being, ps<.001), worse physical health (lower self-rated health, more physical symptoms, ps<.001), and higher healthcare utilization (p=.008) compared to those without a physical health condition. At 3 months, engaged participants with a physical health condition reported significant improvements in depression, anxiety, and wellbeing (ps<.01), and potential improvements in physical symptoms and self-rated health that approached significance (p=.08).
Conclusion: Adults with comorbid mental health symptoms and physical health conditions began with poorer health and higher healthcare utilization, but showed significant mental health improvements after 3 months of engagement. A trend toward improvement in physical symptoms and self-rated health suggests potential effects that may emerge as statistically significant with longer follow-up and larger samples. Future research should explore whether short-term mental health gains play a mediating role in driving whole-person health and reduced healthcare use in those with comorbid conditions.
Keywords: Mental health, Co-morbidityMethods: In a sample of 304 care-seeking working adults (70% women, Mage =37 years, 38% people of color) with at least moderate anxiety and/or depressive symptoms (PHQ-9 and/or GAD-7 ≥ 10), 170 (55%) reported a physical health condition (e.g., heart disease). Participants (2024-25) completed surveys on depression, anxiety, well-being, physical symptoms (e.g., pain, stomach aches), self-rated health, and healthcare utilization at baseline and 3 months. Baseline analyses used the full sample; follow-up analyses used participants (n=73) with a physical health condition and follow-up data, who used services at least once (therapy [59.9%], psychiatry [1.4%], coaching [12.3%], digital content [58.9%]). T-tests assessed baseline differences between those with and without a physical health condition and 3 month changes for those with a physical health condition who engaged.
Results: At baseline, those with a physical condition had poorer mental health (higher depression, lower well-being, ps<.001), worse physical health (lower self-rated health, more physical symptoms, ps<.001), and higher healthcare utilization (p=.008) compared to those without a physical health condition. At 3 months, engaged participants with a physical health condition reported significant improvements in depression, anxiety, and wellbeing (ps<.01), and potential improvements in physical symptoms and self-rated health that approached significance (p=.08).
Conclusion: Adults with comorbid mental health symptoms and physical health conditions began with poorer health and higher healthcare utilization, but showed significant mental health improvements after 3 months of engagement. A trend toward improvement in physical symptoms and self-rated health suggests potential effects that may emerge as statistically significant with longer follow-up and larger samples. Future research should explore whether short-term mental health gains play a mediating role in driving whole-person health and reduced healthcare use in those with comorbid conditions.
Authors:
Presenter - Komal Kumar, MS, Modern Health
Co-Author - Valerie Hoffman, PhD, Modern Health
Co-Author - Kristen Van Swearingen, MA, University of North Carolina, Charlotte
Co-Author - Jessica Watrous, PhD, Modern Health
Co-Author - Sara Sagui Henson, PhD, Modern Health
The effect of mHealth intervention on changing sedentary behavioral patterns in adults with knee replacement
Poster Number: D67Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Physical Activity
Introduction
Total knee replacement (TKR) is a common surgery for older adults with end-stage knee osteoarthritis. However, it does not change excess sedentary behavior. We developed an mHealth sedentary reduction program that included an app (NEAT!2), but it did not change total sedentary behavior (SB) time in this population. Given that prolonged SB patterns can also lead to negative health outcomes, providing accessible interventions that change the SB pattern from prolonged to more fragmented in adults recovering from TKR is important. This study investigated whether a NEAT!2 intervention increased fragmented SB in adults within one year of post-TKR.
Methods
Participants were randomized into the NEAT!2 intervention or an attention-matched control, with both receiving biweekly coaching calls during the intervention for 2 months, followed by a 3-month maintenance period. NEAT!2 app provided audible tone/vibrate notifications when participants >30 minutes of continuous SB. The control group utilized the MyKneeGuide app, which provided information about post-operative care. ActiGraph GT9X Link measured SB bout duration classified by a 1-minute epoch length. Sedentary fragmentation was measured by daily Sedentary to Active Transition Probabilities (SATP), the reciprocal of average SB bout duration. Controlling for demographics and physical function performance, a linear mixed model was used to evaluate the intervention effect on SATP at 2 and 5 months.
Results
A total of 83 participants (NEAT!2 group=42) were included in the analysis (female, 67%), age 64.71 (9.21) years, BMI = 32.77 (6.82) kg/m2. A significant time x group interaction effect showed that NEAT!2 intervention increased more SATP (β=0.96, t=2.92, p<0.01) on a given day compared to the control group at 2 months, but not at 5 months (β=0.41, t=1.23, p=0.22). At any given SB hour, adults with TKR who received interrupting SB app notifications were 60% point more likely to break their SB compared to those without notifications over 2 months.
Conclusion
These results suggest that app notifications can help transform more fragmented sedentary behavior patterns throughout the day. Future studies may investigate whether the change to a more fragmented SB pattern can be the precursor to reducing the total SB time. Additional strategies, such as providing app notifications informing of various movement challenges right after breaking the SB, can augment the benefits of breaking the SB.
Keywords: e-Health, Physical activityTotal knee replacement (TKR) is a common surgery for older adults with end-stage knee osteoarthritis. However, it does not change excess sedentary behavior. We developed an mHealth sedentary reduction program that included an app (NEAT!2), but it did not change total sedentary behavior (SB) time in this population. Given that prolonged SB patterns can also lead to negative health outcomes, providing accessible interventions that change the SB pattern from prolonged to more fragmented in adults recovering from TKR is important. This study investigated whether a NEAT!2 intervention increased fragmented SB in adults within one year of post-TKR.
Methods
Participants were randomized into the NEAT!2 intervention or an attention-matched control, with both receiving biweekly coaching calls during the intervention for 2 months, followed by a 3-month maintenance period. NEAT!2 app provided audible tone/vibrate notifications when participants >30 minutes of continuous SB. The control group utilized the MyKneeGuide app, which provided information about post-operative care. ActiGraph GT9X Link measured SB bout duration classified by a 1-minute epoch length. Sedentary fragmentation was measured by daily Sedentary to Active Transition Probabilities (SATP), the reciprocal of average SB bout duration. Controlling for demographics and physical function performance, a linear mixed model was used to evaluate the intervention effect on SATP at 2 and 5 months.
Results
A total of 83 participants (NEAT!2 group=42) were included in the analysis (female, 67%), age 64.71 (9.21) years, BMI = 32.77 (6.82) kg/m2. A significant time x group interaction effect showed that NEAT!2 intervention increased more SATP (β=0.96, t=2.92, p<0.01) on a given day compared to the control group at 2 months, but not at 5 months (β=0.41, t=1.23, p=0.22). At any given SB hour, adults with TKR who received interrupting SB app notifications were 60% point more likely to break their SB compared to those without notifications over 2 months.
Conclusion
These results suggest that app notifications can help transform more fragmented sedentary behavior patterns throughout the day. Future studies may investigate whether the change to a more fragmented SB pattern can be the precursor to reducing the total SB time. Additional strategies, such as providing app notifications informing of various movement challenges right after breaking the SB, can augment the benefits of breaking the SB.
Authors:
Author - Jongwon Lee, M.P.H, University of South Carolina
Co-Author - Christine Pellegrini, PhD, FSBM, University of South Carolina
Co-Author - Scott Jamieson, MS, University of South Carolina
Co-Author - Halle Prine, MS, University of South Carolina
Co-Author - Kailyn Horn, DPT, University of South Carolina
Co-Author - Chih-Hsiang Yang, PhD, University of South Carolina
The Immediate Effects of Momentary Affect and Fatigue on Interstitial Glucose in Non-Diabetic Adults with Overweight and Obesity
Poster Number: D68Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Diabetes
Introduction
Glucose variability is a risk factor for cardiometabolic disease. Postprandial glucose is the primary driver of glucose variability and is affected by 24-hour movement patterns and eating behaviors. Affect and fatigue can influence these health behaviors and may be targets for just-in-time adaptive interventions (JITAIs). This study explored how momentary positive affect, negative affect, and fatigue influence mean interstitial glucose and glucose variability in non-diabetic adults with overweight or obesity.
Methods
Participants (N=74, mean age = 47.84 ± 11.56 years, ranged 20-63 years, 84% female, 54.67% non-Hispanic White, 68% BMI > 30) were randomly prompted 6 times daily about affect and fatigue through mobile ecological momentary assessment (EMA) surveys and wore a continuous glucose monitor (CGM) over a 14-day monitoring period. For analysis, interstitial glucose was averaged 120 minutes after each answered EMA prompt. Mixed-effects location-scale (MELS) linear regression models assessed associations of momentary affect and fatigue with glucose. The MELS models estimated distinct means (location) and within-subject variance (scale) for glucose. Adjusted models included age (<=50 v. >50), BMI (overweight v. obese), sex (M v. F), and race (non-White v. White) as covariates.
Results
Individual-level means were 2.57 (ranged 1.3-4) for positive affect, 1.39 (ranged 1-3.09) for negative affect, and 2.26 (range 1-3.5) for fatigue. The average EMA compliance rate was 82.28%. Differences within subjects contributed largely to variance in mean glucose (ICC=0.404). In unadjusted models, participants who experienced more momentary negative affect than usual (within-subject) had greater mean glucose within the 120-minute window. Participants who experienced more positive affect than others (between-subject) had greater glucose variability. However, neither of these findings were significant after adjusting for covariates. In both unadjusted and adjusted models, participants who experienced more negative affect than usual (within-subject) had greater glucose variability (adjusted coef=0.196, SE=0.0696, p=0.00477).
Conclusion
Affective states may influence glucose variability in non-diabetic adults with overweight or obese. Results from this study highlight the opportunity for JITAIs to assist with emotional regulation in the context of 24-hour movement patterns and eating behaviors for glucose management and cardiometabolic disease prevention.
Keywords: Diabetes, EmotionsGlucose variability is a risk factor for cardiometabolic disease. Postprandial glucose is the primary driver of glucose variability and is affected by 24-hour movement patterns and eating behaviors. Affect and fatigue can influence these health behaviors and may be targets for just-in-time adaptive interventions (JITAIs). This study explored how momentary positive affect, negative affect, and fatigue influence mean interstitial glucose and glucose variability in non-diabetic adults with overweight or obesity.
Methods
Participants (N=74, mean age = 47.84 ± 11.56 years, ranged 20-63 years, 84% female, 54.67% non-Hispanic White, 68% BMI > 30) were randomly prompted 6 times daily about affect and fatigue through mobile ecological momentary assessment (EMA) surveys and wore a continuous glucose monitor (CGM) over a 14-day monitoring period. For analysis, interstitial glucose was averaged 120 minutes after each answered EMA prompt. Mixed-effects location-scale (MELS) linear regression models assessed associations of momentary affect and fatigue with glucose. The MELS models estimated distinct means (location) and within-subject variance (scale) for glucose. Adjusted models included age (<=50 v. >50), BMI (overweight v. obese), sex (M v. F), and race (non-White v. White) as covariates.
Results
Individual-level means were 2.57 (ranged 1.3-4) for positive affect, 1.39 (ranged 1-3.09) for negative affect, and 2.26 (range 1-3.5) for fatigue. The average EMA compliance rate was 82.28%. Differences within subjects contributed largely to variance in mean glucose (ICC=0.404). In unadjusted models, participants who experienced more momentary negative affect than usual (within-subject) had greater mean glucose within the 120-minute window. Participants who experienced more positive affect than others (between-subject) had greater glucose variability. However, neither of these findings were significant after adjusting for covariates. In both unadjusted and adjusted models, participants who experienced more negative affect than usual (within-subject) had greater glucose variability (adjusted coef=0.196, SE=0.0696, p=0.00477).
Conclusion
Affective states may influence glucose variability in non-diabetic adults with overweight or obese. Results from this study highlight the opportunity for JITAIs to assist with emotional regulation in the context of 24-hour movement patterns and eating behaviors for glucose management and cardiometabolic disease prevention.
Authors:
Presenter - Anita On, BS, University of Texas at Arlington
Co-Author - Yue Liao, MPH, PhD, CPH, University of Texas at Arlington
Co-Author - Phrashiah Githinji, PhD, RD, University of Utah
Co-Author - Byunggul Lim, PhD, Texas A&M Agrilife Research
Co-Author - Jacob Szeszulski, PhD, Texas A&M Agrilife Research
Co-Author - Alexandra MacMillan Uribe, PhD, RDN, Texas A&M Agrilife Research
Co-Author - Rebecca Seguin-Fowler, PhD, Texas A&M Agrilife Research
Co-Author - Jane Anderson, PhD, Michael E. DeBakey Veterans Affairs Medical Center
Co-Author - Chad Rethorst, PhD, Texas A&M Agrilife Research
Smart Sipping: Examining initial impact of a connected water bottle on prenatal hydration and components of energy balance
Poster Number: D69Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Weight Related Health
Background: Adequate prenatal hydration is critical for optimal maternal and fetal health outcomes. Hydration is a component of energy balance (e.g., physical activity [PA], energy intake [EI]) and may assist in regulating gestational weight gain (GWG). Hydration guidelines recommend that pregnant women drink 64-96 ounces of water/day, but 42% fall short. The use of a connected water bottle (connects to the user’s phone via an app and records the amount of fluid consumed) may improve prenatal hydration behaviors – yet, little research has examined its use as well as other strategies to promote prenatal hydration. This study examined initial impact of using a connected water bottle on prenatal hydration and EI, PA, and GWG. Methods: Pregnant women (N=8, M age=31.9 years, M BMI=22.0) participated in a 35-39 day pilot intervention study. They used a connected water bottle and participated in weekly 60-min education sessions targeting the importance of adequate hydration, ways to improve hydration, EI, PA, and GWG. Each day, women weighed themselves (Wi-Fit weight scale), used the connected water bottle, and wore the Fitbit Charge 6 (activity monitor); EI was estimated using a back-calculation equation. Descriptive statistics (on the full group and between groups [met vs did not meet recommendations of at least 64 ounces/day]) and Pearson correlations were used to describe and examine the relationship between fluid intake and EI, PA, and GWG. Results: Pre-intervention fluid intake (ounces) was significantly and positively associated with pre-intervention steps (r=.75, p=0.01). Pre- and post-intervention fluid intake were positively associated with PA kcal, PA min, steps, and GWG, and negatively associated with EI (p>.05). At pre-intervention, 37.5% (n=3) and at post-intervention, 62.5% (n=5) met hydration recommendations. Women who met recommendations at post-intervention had higher PA kcal (M=700.2), PA min. (M=207.9), steps (M=6563.8), EI kcals (M=2770.9), and GWG (M=3.7 lb.) compared to women who did not meet recommendations (M=411.9 PA kcal, 133.5 PA min., 2777.4 steps, 2115.1 EI kcals, and 2.3 lb. GWG). Conclusion: The preliminary study findings suggest that prenatal hydration behaviors can be improved with use of a connected water bottle. Meeting hydration guidelines may also have an impact on other health behaviors such as PA, which could assist in regulating GWG. Future research is necessary to test these assumptions in a fully-powered trial.
Keywords: Women's health, Health behavior changeAuthors:
Author - Abigail Pauley, PhD, The Pennsylvania State University
Co-Author - Asher Y Rosinger, PhD, Pennsylvania State University
Co-Author - Jennifer S. Savage, PhD, Pennsylvania State University
Co-Author - David Conroy, PhD, FSBM, University of Michigan
Co-Author - Danielle Downs, PhD, The Pennsylvania State University
Association between Financial Toxicity and Communication Behavior on Advanced Breast Cancer Patients’ and their Spouses’ Affect
Poster Number: D7Time: 11:00 AM - 11:50 AM
Topics: Cancer, Quality of Life
Financial toxicity, the economic hardships cancer during the cancer trajectory, is associated with poor physical and mental health for both patients and their families. In couples, open cancer-related communication is associated with improved cancer adjustment. However, the associations between communication behaviors as they relate to financial concerns have not yet been explored. The current study examined the convergence and divergence in the reporting of financial concerns in patients and their partners, changes in the couple’s affect as a function of discussing financial concerns, and correlations between financial toxicity and other psychosocial measures.
This study reports on the baseline data of a longitudinal study. Eligible participants included women diagnosed with stage III-IV breast cancer and their romantic partner. Upon consent, dyads completed assessments for financial toxicity (COST), depression (CES-D) and anxiety (GAD-7), relational wellbeing (DAS-7), and perceived social support (SPS). Then, participants engaged in a 20-minute spousal interaction task, where each individual identified and discussed a financial concern with a focus on problem solving the selected issues. Before and after the discussion, participants completed an affect assessment (PANAS).
A total of 85 dyads completed the spousal interaction task. Both patients and partners shared similar financial concerns, with 19% of patients and 28% of partners rating concerns regarding treatment side-effects impacting work productivity (paired t= -1.56; p= .12); 13% of patients and 20% of partners rating future financial stability (t= -1.77; p= .08); and 12% of patients and 19% of partners rating discussing financial stressors with each other (t= -.851; p.40) as their most frequent concerns. Dyads often avoided selecting some of the highest-rated concerns, such as maintaining a steady income and burdening one’s partner by discussing financial stressor. Paired t-tests comparing pre- and post-discussion affect suggest a significant reduction in negative affect (p < .001) for partners, but not for patients. Significant correlations were observed between financial distress and social support (r=.297, p<.01) for patients, but not partners.
Discussing financial concerns improved partners’ emotional wellbeing. Healthcare professionals should consider encouraging patients with advanced breast cancer and their partners to discuss financial concerns to improve the dyads’ emotional wellbeing.
Keywords: Cancer, Quality of lifeThis study reports on the baseline data of a longitudinal study. Eligible participants included women diagnosed with stage III-IV breast cancer and their romantic partner. Upon consent, dyads completed assessments for financial toxicity (COST), depression (CES-D) and anxiety (GAD-7), relational wellbeing (DAS-7), and perceived social support (SPS). Then, participants engaged in a 20-minute spousal interaction task, where each individual identified and discussed a financial concern with a focus on problem solving the selected issues. Before and after the discussion, participants completed an affect assessment (PANAS).
A total of 85 dyads completed the spousal interaction task. Both patients and partners shared similar financial concerns, with 19% of patients and 28% of partners rating concerns regarding treatment side-effects impacting work productivity (paired t= -1.56; p= .12); 13% of patients and 20% of partners rating future financial stability (t= -1.77; p= .08); and 12% of patients and 19% of partners rating discussing financial stressors with each other (t= -.851; p.40) as their most frequent concerns. Dyads often avoided selecting some of the highest-rated concerns, such as maintaining a steady income and burdening one’s partner by discussing financial stressor. Paired t-tests comparing pre- and post-discussion affect suggest a significant reduction in negative affect (p < .001) for partners, but not for patients. Significant correlations were observed between financial distress and social support (r=.297, p<.01) for patients, but not partners.
Discussing financial concerns improved partners’ emotional wellbeing. Healthcare professionals should consider encouraging patients with advanced breast cancer and their partners to discuss financial concerns to improve the dyads’ emotional wellbeing.
Authors:
Author - Alice Ahn, MA, University of Houston
Co-Author - Juliet Kroll, PhD, The University of Texas MD Anderson Cancer Center
Co-Author - Morgan Jones, MA, Georgia State University
Co-Author - Mariana Chavez Mac Gregor, The University of Texas MD Anderson Cancer Center
Co-Author - Kathrin Milbury, PhD, University of Texas MD Anderson Cancer Center
Determining the Implementation Potential of Consumer Health Wearables for Infection-Associated Chronic Condition (IACC) Symptom Management
Poster Number: D70Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Implementation Science
BACKGROUND: Consumer health wearables have been clinically recommended for tracking and self-management of symptoms associated with infection-associated chronic conditions (IACCs), including post-acute sequelae of SARS CoV-2 (PASC or “Long COVID”) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Despite these recommendations, minimal research has investigated providers' perspectives on implementing these into healthcare practice. OBJECTIVE: Addressing this gap, a QUANT->qual mixed methods study funded by the Georgia Clinical and Translational Science Alliance (CTSA; UL1TR002378) investigated provider perspectives on acceptability, appropriateness, and feasibility of using consumer health wearable technologies for PASC patient symptom tracking and management. METHODS: Outpatient providers (n = 44) across multiple specialties, including primary care, behavioral medicine, cardiology, neurology, and pulmonology, were recruited into an online based survey. The survey included validated measures of acceptability (AIM), appropriateness (IAM) and feasibility (FIM; Weiner et al., 2017). A subset (n = 21) participated in follow-up one-on-one semi-structured interviews averaging 25 minutes; interviews assessed provider-level implementation barriers and facilitators. Interviews were coded in MAXQDA by two independent coders and thematic analysis followed an inductive, iterative approach. RESULTS: Out of 5, study participants provided a mean AIM rating of 3.99 (SD= 0.804), a mean IAM rating of 3.91 (SD= 0.828), and a mean FIM rating of 3.98 (SD= 0.759). Key barriers identified included: concerns about measurement inaccuracies, data reliability and clinical utility, increased provider burden and time, exacerbation of patient health anxiety and perseveration, device cost, and patient digital health literacy. Key facilitators identified included: promotion of patient autonomy and empowerment, improved patient-provider communication during and between clinic visits, and effective symptom monitoring. DISCUSSION: While consumer health wearables may offer accessible and effective strategies for patient-led tracking and self-monitoring of symptoms, many challenges exist to wide-scale clinical integration. Additionally, special considerations should be taken when encouraging these devices for symptom self-management within IACC patient populations.
Keywords: Ambulatory monitoring, Chronic illnessAuthors:
Author - Nicole Pozzo, Emory University School of Medicine
Co-Author - Nicole Kessler, Emory University School of Medicine
Co-Author - Deanna Kaplan , PhD , Emory University School of Medicine
Patterns and Attribution of Extended Missing Data in Physical Activity and Weight Monitoring: A Retrospective Analysis
Poster Number: D71Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cardiovascular Disease
Introduction: Digital health interventions utilizing wearable devices and remote sensors are increasingly prevalent in behavioral medicine research. However, longitudinal datasets from these technologies frequently exhibit extended periods of missing data, which can complicate data interpretation and analytic rigor.
Objective: To evaluate the patterns and underlying factors contributing to missing data in a decentralized randomized controlled trial that compares two digital health interventions—sensors alone versus sensors combined with a game—for encouraging physical activity and daily weighing in patients diagnosed with heart failure (HF).
Methods: We performed a retrospective analysis of study data involving 146 adults (aged >45) with HF from 20 US states who completed a 6-month digital health trial. Each participant was provided Fitbit or Withings activity tracker and Withings smart scale to monitor physical activity and weight. Extended missing data episodes—defined as intervals exceeding three consecutive days without recorded steps or weights—were attributed to one of fourteen predefined categories, encompassing patient-level, medical, technical, and unknown factors by three independent coders. The proportional contribution of each cause was determined by summing the total days assigned to each code and dividing by the total number of missing days identified across all episodes. AI tools of ChatGPT 4.0 to write code and Microsoft Co-pilot to edit the content were used.
Results: Among 146 adults with HF participating in digital health interventions over 24-weeks, extended missing data episodes were common, comprising 42.9% of daily step counts and 52.1% of daily weight measurements. The predominant contributor to missing data was patient-level factors, particularly loss to follow-up (46% for steps; 38% for weight), followed by unknown causes (26% for steps; 31% for weight) and technical problems (5% for steps; 10% for weight). Furthermore, data classified as missing not at random accounted for 60% of missing step data and 47% of missing weight data.
Conclusion: Missing data is substantial in digital health behavioral intervention trials for individuals with HF and is driven by participant attrition and unknown factors, with a smaller proportion due to technical issues. These findings highlight the necessity for robust methods to code and interpret missingness, which can guide improvements in digital health research design and analytic strategies.
Keywords: Cardiovascular disease, Self ManagementObjective: To evaluate the patterns and underlying factors contributing to missing data in a decentralized randomized controlled trial that compares two digital health interventions—sensors alone versus sensors combined with a game—for encouraging physical activity and daily weighing in patients diagnosed with heart failure (HF).
Methods: We performed a retrospective analysis of study data involving 146 adults (aged >45) with HF from 20 US states who completed a 6-month digital health trial. Each participant was provided Fitbit or Withings activity tracker and Withings smart scale to monitor physical activity and weight. Extended missing data episodes—defined as intervals exceeding three consecutive days without recorded steps or weights—were attributed to one of fourteen predefined categories, encompassing patient-level, medical, technical, and unknown factors by three independent coders. The proportional contribution of each cause was determined by summing the total days assigned to each code and dividing by the total number of missing days identified across all episodes. AI tools of ChatGPT 4.0 to write code and Microsoft Co-pilot to edit the content were used.
Results: Among 146 adults with HF participating in digital health interventions over 24-weeks, extended missing data episodes were common, comprising 42.9% of daily step counts and 52.1% of daily weight measurements. The predominant contributor to missing data was patient-level factors, particularly loss to follow-up (46% for steps; 38% for weight), followed by unknown causes (26% for steps; 31% for weight) and technical problems (5% for steps; 10% for weight). Furthermore, data classified as missing not at random accounted for 60% of missing step data and 47% of missing weight data.
Conclusion: Missing data is substantial in digital health behavioral intervention trials for individuals with HF and is driven by participant attrition and unknown factors, with a smaller proportion due to technical issues. These findings highlight the necessity for robust methods to code and interpret missingness, which can guide improvements in digital health research design and analytic strategies.
Authors:
Author - Daniela Lopez, BS, The University of Texas Austin
Co-Author - Avery Largent, UT Austin
Co-Author - Samara Karthigan, The University of Texas Austin
Co-Author - Grace Lee, The University of Texas Austin
Co-Author - Angelica Rangel, MA, The University of Texas Austin
Co-Author - Jasmine Zeng, MS, The University of Texas Austin
Co-Author - Namuun Clifford, The University of Texas at Austin
Co-Author - Kavita Radhakrishnan, RN PhD, University of Texas Austin School of Nursing
Concordance of Self-Reported vs. Objectively Measured Physical Activity and Step Counts in a Free-Living Environment in Patients with Lung Cancer
Poster Number: D72Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cancer
Introduction: Physical activity (PA) is a cornerstone of cancer prevention and survivorship, with evidence supporting its role in improving health-related quality of life. Clinical guidelines from the American Cancer Society emphasize that cancer survivors should engage in ≥ 150 minutes of moderate-intensity activity per week. However, accurately assessing PA is challenging, as self-report questionnaires often overestimate activity in healthy adults due to recall and social desirability biases. In patients with lung cancer (LC) who experience fatigue, altered functional capacity, and changes in self-perception, the direction and magnitude of this bias remain poorly understood. To address this gap, we examined the concordance between self-reported and objectively measured PA in patients with LC.
Methods: Fifteen adults diagnosed with LC (stage I-IV) wore an activPAL3 micro (right thigh) research-grade activity monitor for seven consecutive days (24-hour protocol). The device was worn during daily activities, but was removed for submersion in water (e.g., swimming). Following the monitoring period, participants completed the International Physical Activity Questionnaire–Short Form. Objective measures of MVPA, walking time, and step count were derived from the activPAL3 data using PAL Technologies' validated VANE algorithm. Summary statistics were calculated for both objective and subjective measures.
Results: Nine participants (66% female; mean age 63.1 ± SD of 8.7 years) completed the protocol. Six out of fifteen enrolled participants were excluded due to dropout (n=2) or incomplete data (n=4). Self-reported mean daily moderate-to-vigorous physical activity (MVPA) was 73.6 ± 41.5 minutes and mean daily walking time was 56.4 ± 34.6 minutes. Objective activPAL data indicated mean MVPA of 49.6 ± 42.9, mean daily walking time of 111.5 ± 46.3 minutes, and average step count of 9,143 ± 5,537. While self-reported MVPA did not significantly differ from objective measures (p=.09), self-reported daily walking time was significantly lower than objective measures (p<.01).
Conclusion: Unlike in healthy populations, self-reported walking time from our participants was significantly lower than objective measures, whereas self-reported MVPA was not significantly higher. This suggests that assumptions and correction factors derived from healthy cohorts may not apply in oncologic populations, where disease-related symptoms and altered self-perceptions may bias recall.
Keywords: Cancer, e-HealthMethods: Fifteen adults diagnosed with LC (stage I-IV) wore an activPAL3 micro (right thigh) research-grade activity monitor for seven consecutive days (24-hour protocol). The device was worn during daily activities, but was removed for submersion in water (e.g., swimming). Following the monitoring period, participants completed the International Physical Activity Questionnaire–Short Form. Objective measures of MVPA, walking time, and step count were derived from the activPAL3 data using PAL Technologies' validated VANE algorithm. Summary statistics were calculated for both objective and subjective measures.
Results: Nine participants (66% female; mean age 63.1 ± SD of 8.7 years) completed the protocol. Six out of fifteen enrolled participants were excluded due to dropout (n=2) or incomplete data (n=4). Self-reported mean daily moderate-to-vigorous physical activity (MVPA) was 73.6 ± 41.5 minutes and mean daily walking time was 56.4 ± 34.6 minutes. Objective activPAL data indicated mean MVPA of 49.6 ± 42.9, mean daily walking time of 111.5 ± 46.3 minutes, and average step count of 9,143 ± 5,537. While self-reported MVPA did not significantly differ from objective measures (p=.09), self-reported daily walking time was significantly lower than objective measures (p<.01).
Conclusion: Unlike in healthy populations, self-reported walking time from our participants was significantly lower than objective measures, whereas self-reported MVPA was not significantly higher. This suggests that assumptions and correction factors derived from healthy cohorts may not apply in oncologic populations, where disease-related symptoms and altered self-perceptions may bias recall.
Authors:
Co-Presenter - Rujul Singh, BS, NYU Grossman School of Medicine
Co-Presenter - Macy Tetrick, BS, The Ohio State University
Co-Author - Anvitha Gogineni, BS, The Ohio State University
Co-Author - Carolyn Presley, MD MHS, The Ohio State University
Co-Author - Emma Fortune, PhD, The Mayo Clinic
Co-Author - Mohsin Sharif, BA, University of Pittsburgh School of Medicine
Co-Author - Zachary Chaplow, PhD, The Ohio State University
Co-Author - Chloe Hery, PhD, The Ohio State University
Co-Author - Peter Washington, PhD, University of California, San Francisco
Co-Author - Frank Penedo, PhD, The University of Miami
Co-Author - Vipul Lugade, PhD, The State University of New York Binghamton
Co-Author - Dana Kim, BS, University of California, Berkeley
Co-Author - Ali Kargarandehkordi, PhD, The Ohio State University
Co-Author - Roberto Benzo, PhD, The Ohio State University
Novel Capability of Physical Activity and Sleep Features to Inform Digital Monitoring and Phenotyping in Relation to Maternal Health Outcomes: A Scoping Review
Poster Number: D73Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Women's Health
Background: Pregnant individuals are at increasing risk for adverse health outcomes (e.g., excessive weight gain, gestational diabetes, preeclampsia) that contribute to growing rates of maternal morbidity and mortality. Digital monitoring (continuous collection of singular digital features) and digital phenotyping (quantification of moment-by-moment digital data assessing individual-level human phenotypes; DM/P) offer a scalable approach to capturing just-in-time physical activity (PA) and sleep data with possible utility for early detection of adverse maternal health outcomes (MHOs). However, research examining such utility of DM/P is scant. To address this gap, the purpose of this systematic review was to examine the literature to understand study and participant characteristics and the extent to which DM/P of PA/sleep/wear time features are used in association with prenatal MHOs. Methods: A scoping review was conducted across PubMed, Web of Science, PsycINFO, CINHAL, and ACM Digital Library, including observational studies collecting passive wearable data to examine PA/sleep/MHOs associations. Results: Of N=667 articles, n=53 met the inclusion criteria. Most used longitudinal designs (85%), were conducted in the US (34%), and published in the past 10 years (76%). Most collected PA or sleep features (89%) at 1 timepoint (55%) and over 7 days (62%). Wrist (55%) and waist-worn devices (43%) were used more frequently than devices designed for other body locations (e.g., ankle). PA/sleep were frequently measured as time-based features (e.g., minutes/day; 25%), and PA/sleep features were frequently and significantly associated with glucose (32%), pre-eclampsia (13%), and depressive (11%) MHOs. Conclusion: Findings highlight the potential for wearable devices to inform DM/P of MHOs by identifying behavioral risk patterns and mapping time-based PA and sleep features to MHOs. Future research is needed to examine the efficacy of wearable devices for DM/P and early detection of MHOs as a potential strategy to reduce maternal morbidity and mortality, especially in communities with limited prenatal care.
Keywords: e-Health, Women's healthAuthors:
Author - Victoria Suhy, M.S., The Pennsylvania State University
Co-Author - Jamie Whitney, M.S., The Pennsylvania State University
Co-Author - Abigail Pauley, PhD, The Pennsylvania State University
Co-Author - Melissa Bopp, PhD, Pennsylvania State University
Co-Author - David Conroy, PhD, FSBM, University of Michigan
Co-Author - Danielle Downs, PhD, The Pennsylvania State University
Exploring User Attitudes and Concerns Toward LLM-based Conversational Agents in Online Peer Support Groups
Poster Number: D74Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Social and Environmental Context and Health
Background: Conversational agents (CAs) powered by large language models (LLMs) are becoming increasingly common in online environments, including online peer support groups (OPSGs). While these technologies offer opportunities for facilitation and support, they also raise various concerns and may adversely affect both social dynamics and individual well-being.
Objective: To explore how individual differences shape attitudes toward and concerns about integrating LLM-based CAs in OPSGs.
Methods: An online survey collected responses from English-speaking adults with varied experience in online support settings, including potential and current OPSG participants, defined broadly to include any group-based online interaction involving mutual support. Participants reported their online support behaviors, LLM experience, and demographics, rated 11 predefined concerns about the use of LLM-based CAs in OPSGs, and provided open-ended feedback.Results: A total of 200 completed survey responses were included in the analysis (53.0% female, mean age = 31.8 (SD = 6.3), 46.5% White/Caucasian). Greater LLM expertise was linked to lower concern that CAs might fail to support participants’ personal and social well-being (τ = −0.17, p = .005), a pattern also observed for age, with older participants reporting lower concern (τ = −0.13, p = .014). Older participants were also more likely to envision situations in which LLM-based CAs would be beneficial (τ = 0.15, p = .006). Frequent online support seekers placed less importance on knowing if a message came from a human or a CA (τ = −0.13, p = .036), while participants who more frequently gave online support expressed higher concern about discussing sensitive topics in the presence of a CA (τ = 0.14, p = .021). Placing greater importance on knowing whether a message came from a human or a CA (τ = 0.19–0.34, p < .05) and greater openness to CA inclusion in group chats (τ = 0.18–0.29, p < .05) were associated with higher concern about discussing sensitive topics with a CA present, sharing more personal information than intended, influences on participants’ autonomy, potential harmful or misleading responses, impacts on personal and social well-being, and the use of personal information.Conclusion: Attitudes toward LLMs in peer support groups were shaped by patterns of online support use, technological expertise, and demographics. Concerns varied across participants, indicating that perceptions of risks and benefits are not uniform but influenced by individual experience and background.
Keywords: Technologies, Social supportObjective: To explore how individual differences shape attitudes toward and concerns about integrating LLM-based CAs in OPSGs.
Methods: An online survey collected responses from English-speaking adults with varied experience in online support settings, including potential and current OPSG participants, defined broadly to include any group-based online interaction involving mutual support. Participants reported their online support behaviors, LLM experience, and demographics, rated 11 predefined concerns about the use of LLM-based CAs in OPSGs, and provided open-ended feedback.Results: A total of 200 completed survey responses were included in the analysis (53.0% female, mean age = 31.8 (SD = 6.3), 46.5% White/Caucasian). Greater LLM expertise was linked to lower concern that CAs might fail to support participants’ personal and social well-being (τ = −0.17, p = .005), a pattern also observed for age, with older participants reporting lower concern (τ = −0.13, p = .014). Older participants were also more likely to envision situations in which LLM-based CAs would be beneficial (τ = 0.15, p = .006). Frequent online support seekers placed less importance on knowing if a message came from a human or a CA (τ = −0.13, p = .036), while participants who more frequently gave online support expressed higher concern about discussing sensitive topics in the presence of a CA (τ = 0.14, p = .021). Placing greater importance on knowing whether a message came from a human or a CA (τ = 0.19–0.34, p < .05) and greater openness to CA inclusion in group chats (τ = 0.18–0.29, p < .05) were associated with higher concern about discussing sensitive topics with a CA present, sharing more personal information than intended, influences on participants’ autonomy, potential harmful or misleading responses, impacts on personal and social well-being, and the use of personal information.Conclusion: Attitudes toward LLMs in peer support groups were shaped by patterns of online support use, technological expertise, and demographics. Concerns varied across participants, indicating that perceptions of risks and benefits are not uniform but influenced by individual experience and background.
Authors:
Co-Author - Ekaterina Uetova, Technological University Dublin
Co-Author - Lucy Hederman, Trinity College Dublin
Co-Author - Dympna O'Sullivan, Technological University Dublin
Co-Author - Robert Ross, Technological University Dublin
Co-Author - Marily Oppezzo, PhD, MS, RD, Stanford University
Mobile health tool ownership and use among cancer survivors in a health system
Poster Number: D75Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Cancer
Background: Physical activity (PA) is associated with improved health outcomes among cancer survivors (CS), yet PA participation and access to PA programs in cancer care is low. Mobile health (mHealth) tools such as wearable activity trackers and smartphone lifestyle applications are promising strategies to promote PA among CS. However, CS’s adoption patterns and willingness to share resulting mHealth data with healthcare providers is underexplored. This study examined mHealth tool ownership and usage and willingness to share wearable data with healthcare providers among CS and identified demographic and health-related correlates.
Methods: Self-reported data were collected from a subset of post-treatment CS (n=518; Mage=56.5 (SD=14.7); 54.6% female) ≥ 5 years post-diagnosis from a large healthcare system who participated in a cross-sectional study of CS’s interests and preferences for remotely-delivered PA interventions. Univariate logistic regression models examined associations between demographic (age, sex, race, education, income, marital status, employment status, BMI, health status) and disease (time since diagnosis, treatment received, disease stage) characteristics and meeting PA guidelines (i.e. 150 minutes/week of moderate to vigorous PA) assessed via the Godin Leisure Time Exercise Questionnaire and activity tracker ownership, lifestyle app usage, and willingness to share wearable data with healthcare providers.
Results: Nearly all CS (97.5%) owned a smartphone. Over half (55.6%) owned an activity tracker, and one-third (32.4%) used a lifestyle app. Most (64.3%) were willing to share wearable data with healthcare providers. Participants with higher education and income, those who met PA guidelines, and those who were overweight/obese were more likely to own a wearable activity tracker or use a lifestyle app (ps<.05). Full-time employment was the only significant predictor of willingness to share data with a healthcare provider.
Conclusions: Many CS use or are open to using mHealth tools. However, differences in adoption by demographic characteristics and unclear drivers of willingness to share data highlight the need for targeted, inclusive, and evidence-based strategies to integrate these tools into survivorship care. Understanding who adopts mHealth technologies is essential to optimizing their potential to improve long-term cancer outcomes.
Keywords: Technologies, CancerMethods: Self-reported data were collected from a subset of post-treatment CS (n=518; Mage=56.5 (SD=14.7); 54.6% female) ≥ 5 years post-diagnosis from a large healthcare system who participated in a cross-sectional study of CS’s interests and preferences for remotely-delivered PA interventions. Univariate logistic regression models examined associations between demographic (age, sex, race, education, income, marital status, employment status, BMI, health status) and disease (time since diagnosis, treatment received, disease stage) characteristics and meeting PA guidelines (i.e. 150 minutes/week of moderate to vigorous PA) assessed via the Godin Leisure Time Exercise Questionnaire and activity tracker ownership, lifestyle app usage, and willingness to share wearable data with healthcare providers.
Results: Nearly all CS (97.5%) owned a smartphone. Over half (55.6%) owned an activity tracker, and one-third (32.4%) used a lifestyle app. Most (64.3%) were willing to share wearable data with healthcare providers. Participants with higher education and income, those who met PA guidelines, and those who were overweight/obese were more likely to own a wearable activity tracker or use a lifestyle app (ps<.05). Full-time employment was the only significant predictor of willingness to share data with a healthcare provider.
Conclusions: Many CS use or are open to using mHealth tools. However, differences in adoption by demographic characteristics and unclear drivers of willingness to share data highlight the need for targeted, inclusive, and evidence-based strategies to integrate these tools into survivorship care. Understanding who adopts mHealth technologies is essential to optimizing their potential to improve long-term cancer outcomes.
Authors:
Presenter - Fiona Webb, Northwestern University
Co-Author - Shirlene Wang, PhD, Northwestern University
Co-Author - Jing Song, MS, 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 - Siobhan Phillips, PhD, MPH, FSBM, Northwestern University
Iterative design and usability testing and development of CaseyChat: a LLM-powered conversational agent for Individuals Experiencing Homelessness
Poster Number: D76Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Mental Health
Background: Unstable housing is linked to adverse mental health outcomes. Barriers such as stigma and fragmented services hinder care. The Kearney Center (KC), a shelter in Tallahassee, faces high demand and case management burdens. CaseyChat, a large language model (LLM)-powered chatbot, aimed to help clients navigate resources and services. Our prior needs assessments (Phase 1) highlighted misalignments between client needs, service access, and staff capacity at KC. Building on the findings, Phase 2 focused on iterative design, usability testing, and refinement of CaseyChat from prototypes to a minimum viable product (MVP).
Methods: Phase 2 involved five steps: 1) Participants (n=7) engaged in a co-design session to provide feedback on app flow and features using a high-fidelity prototype; 2) Usability testing (n=4) informed interface improvements and backend development; 3) Participants (n=6) in co-design sessions ranked CaseyChat features and matched them with needs; 4) Usability testing (n=5) evaluated app navigation and feature clarity, leading to refinements of frontend functionality; 5) A beta MVP was tested (n=7) through one-on-one interviews and a two-week field trial. Staff (n=6) provided operational perspectives and validated design decisions through focus groups.
Results: Nineteen priority features were identified, with strongest demand for information services, tracking, and app onboarding. Usability testing revealed issues such as non-clickable elements, inaccurate service information, and unclear framing of the “daily check-in.” Iterative design added anonymous sign-in, service cards, app customization (e.g., font), and navigation cues. MVP testing showed user acceptance: participants described CaseyChat as intuitive, supportive, and empathetic, referring to the chatbot as human-like. Challenges persisted, including incomplete service information and lack of conversation memory. Staff emphasized CaseyChat’s potential to ease case management burdens, enhance mental health support, and streamline workflow, while noting the importance of multilingual access and real-time accuracy.
Discussion & Conclusion: Phase 2 demonstrated that iterative steps testing enhanced CaseyChat’s design and usability as a supportive tool for individuals experiencing homelessness. Next step is a feasibility study (Phase 3) to evaluate CaseyChat’s feasibility and acceptability and potential for integration into existing service workflows.
Keywords: e-Health, Mental healthMethods: Phase 2 involved five steps: 1) Participants (n=7) engaged in a co-design session to provide feedback on app flow and features using a high-fidelity prototype; 2) Usability testing (n=4) informed interface improvements and backend development; 3) Participants (n=6) in co-design sessions ranked CaseyChat features and matched them with needs; 4) Usability testing (n=5) evaluated app navigation and feature clarity, leading to refinements of frontend functionality; 5) A beta MVP was tested (n=7) through one-on-one interviews and a two-week field trial. Staff (n=6) provided operational perspectives and validated design decisions through focus groups.
Results: Nineteen priority features were identified, with strongest demand for information services, tracking, and app onboarding. Usability testing revealed issues such as non-clickable elements, inaccurate service information, and unclear framing of the “daily check-in.” Iterative design added anonymous sign-in, service cards, app customization (e.g., font), and navigation cues. MVP testing showed user acceptance: participants described CaseyChat as intuitive, supportive, and empathetic, referring to the chatbot as human-like. Challenges persisted, including incomplete service information and lack of conversation memory. Staff emphasized CaseyChat’s potential to ease case management burdens, enhance mental health support, and streamline workflow, while noting the importance of multilingual access and real-time accuracy.
Discussion & Conclusion: Phase 2 demonstrated that iterative steps testing enhanced CaseyChat’s design and usability as a supportive tool for individuals experiencing homelessness. Next step is a feasibility study (Phase 3) to evaluate CaseyChat’s feasibility and acceptability and potential for integration into existing service workflows.
Authors:
Presenter - Liying Wang, Florida State University
Co-Author - Madison Lee, Florida State University
Co-Author - Sergio Belalcazar, Florida State University
Co-Author - Scott Kearney, The Kearney Center
Co-Author - Heather Flynn, Florida State University
Co-Author - Lisa Hightow-Weidman, MD, MPH, Florida State University
One size does not fit all: Development of a personalized text messaging intervention for school-based tobacco and nicotine control
Poster Number: D77Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Tobacco Control and Nicotine-Related Behavior
Background: Classroom-based tobacco and nicotine product (TNP) prevention and control interventions are effective; however, few cover all currently available TNPs and increasing classroom constraints warrant the need to develop low-burden programs. mHealth interventions address these barriers by delivering messages that are acceptable across TNP use patterns and preferences outside of the classroom. The purpose of this study was to test the acceptability of 70 anti-TNP messages to be part of a text-based anti-TNP program delivered in schools.
Methods: Message acceptability was assessed among N=375 9th graders from 8 schools in Virginia across 7 of the most commonly used TNPs in the US. A 4-point Likert-type scale was used to assess message relevance, believability, unpleasantness, discouraged TNP use, increased anxiety, increased perceived harms, and would be shared with others. Mean scores lower than 2.5 were removed from consideration. Messages were compared by TNP and theme across three user groups: non-willing non-users, willing non-users, and past 30-day users.
Results: For relevance, no messages were acceptable for non-willing non-users, 10 and 7 messages were acceptable among current users and willing non-users, respectively. Top messages for relevance for current users were for vaping (Mean 2.8, SD: 1.2); for willing non-users they were for nicotine pouches and dip (Mean = 2.8, SD: 1.3). For believability, 28 messages were acceptable for users (Mean score range: 2.5-2.9), 30 for willing non-users (Mean score range: 2.5-3.2) and 49 for non-willing non-users (Mean score range: 2.5-3.3). Top messages for believability for all groups had themes of general information, harms, social comparisons, stress, and shame. For current willing and non-willing non-users only, top message themes for believability also included tobacco industry manipulation and role modeling. Messages about control and peer pressure were top messages for non-willing non-users only.
Conclusion: Among users and willing non-users, the highest rated TNPs for relevance differed, indicating a potential need to tailor content based on current TNP use and willingness. Non-willing non-users consistently rated messages highest except for relevance, implying that non-TNP content may be needed to encourage engagement among non-willing non-users. The ability of mHealth interventions to be highly personalized with little burden makes this a potentially relevant strategy for youth TNP control.
Keywords: Adolescents, Tobacco controlMethods: Message acceptability was assessed among N=375 9th graders from 8 schools in Virginia across 7 of the most commonly used TNPs in the US. A 4-point Likert-type scale was used to assess message relevance, believability, unpleasantness, discouraged TNP use, increased anxiety, increased perceived harms, and would be shared with others. Mean scores lower than 2.5 were removed from consideration. Messages were compared by TNP and theme across three user groups: non-willing non-users, willing non-users, and past 30-day users.
Results: For relevance, no messages were acceptable for non-willing non-users, 10 and 7 messages were acceptable among current users and willing non-users, respectively. Top messages for relevance for current users were for vaping (Mean 2.8, SD: 1.2); for willing non-users they were for nicotine pouches and dip (Mean = 2.8, SD: 1.3). For believability, 28 messages were acceptable for users (Mean score range: 2.5-2.9), 30 for willing non-users (Mean score range: 2.5-3.2) and 49 for non-willing non-users (Mean score range: 2.5-3.3). Top messages for believability for all groups had themes of general information, harms, social comparisons, stress, and shame. For current willing and non-willing non-users only, top message themes for believability also included tobacco industry manipulation and role modeling. Messages about control and peer pressure were top messages for non-willing non-users only.
Conclusion: Among users and willing non-users, the highest rated TNPs for relevance differed, indicating a potential need to tailor content based on current TNP use and willingness. Non-willing non-users consistently rated messages highest except for relevance, implying that non-TNP content may be needed to encourage engagement among non-willing non-users. The ability of mHealth interventions to be highly personalized with little burden makes this a potentially relevant strategy for youth TNP control.
Authors:
Presenter - Kara Wiseman, MPH, PhD, University of Virginia
Co-Author - Asal Pilehvari, PhD, University of Virginia
Co-Author - Indika Mallawaarachchi, MS, University of Virginia
Co-Author - Melissa Little, PhD, MPH, FSBM, University of Virginia
Feasibility, Impact and Cost of Partnering with Social Media Influencers to Promote Colorectal Cancer Screening
Poster Number: D78Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Digital Health
Collaborating with social media influencers is a widely adopted and influential private sector marketing strategy. However, there have been a limited partnerships between public health and influencers. We conducted a pilot study to explore the feasibility, impact, and cost of partnering with social media nano and micro influencers to promote colorectal cancer (CRC) screening.
Sixteen social media influencers—each with 5,700-50,600 Instagram followers, > 40% of audience aged 45-65+, and no evidence or health misinformation or political content in past posts—created brief videos. We provided content guidance and reviewed videos for accuracy, but encouraged influencers to use their individual styles when creating videos. Influencers published their videos on Instagram Reels and Stories and we collected engagement metrics after 7 days. To explore potential for driving viewers to an online information source, we created a website containing CRC screening information and instructed influencers to share the link.
In the week after being published, the videos garnered 70,714 video views, (M=4,714, SD=4,158), 1,130 comments (M=71, SD=140), 2,624 likes (M= 164, SD=134) and 131 shares (M=8, SD=15). There were 157 visits to the website. The total cost for the campaign, including payments to the recruitment platform ($1,647), influencers ($6,442), a student assistant ($3,608 for 111 hours of effort) who ran the campaign, and a URL tracking tool ($120), was $11,817. Video views therefore cost $0.17 each.
Challenges to collaborating with influencers included identifying willing influencers with our desired audience age range (45+), negotiating payment, and reluctance of influencers to refilm if there were inaccuracies in the draft video. Facilitators included eagerness from influencers to share a potentially life-saving message, reliability from the majority of the influencers, and creative approaches to video creation.
A small collaborative campaign with social media influencers who had modest numbers of followers resulted in a large number of people being exposed to cancer prevention messages. It was possible to motivate some viewers to seek further information on an external website, indicating that influencer campaigns could be used to motivate concrete behaviors such as signing up for screening. Although the collaborative process does have challenges, engaging influencers appears to be a feasible means of reaching thousands of people with public health messages.
Keywords: Health communication, Cancer screeningSixteen social media influencers—each with 5,700-50,600 Instagram followers, > 40% of audience aged 45-65+, and no evidence or health misinformation or political content in past posts—created brief videos. We provided content guidance and reviewed videos for accuracy, but encouraged influencers to use their individual styles when creating videos. Influencers published their videos on Instagram Reels and Stories and we collected engagement metrics after 7 days. To explore potential for driving viewers to an online information source, we created a website containing CRC screening information and instructed influencers to share the link.
In the week after being published, the videos garnered 70,714 video views, (M=4,714, SD=4,158), 1,130 comments (M=71, SD=140), 2,624 likes (M= 164, SD=134) and 131 shares (M=8, SD=15). There were 157 visits to the website. The total cost for the campaign, including payments to the recruitment platform ($1,647), influencers ($6,442), a student assistant ($3,608 for 111 hours of effort) who ran the campaign, and a URL tracking tool ($120), was $11,817. Video views therefore cost $0.17 each.
Challenges to collaborating with influencers included identifying willing influencers with our desired audience age range (45+), negotiating payment, and reluctance of influencers to refilm if there were inaccuracies in the draft video. Facilitators included eagerness from influencers to share a potentially life-saving message, reliability from the majority of the influencers, and creative approaches to video creation.
A small collaborative campaign with social media influencers who had modest numbers of followers resulted in a large number of people being exposed to cancer prevention messages. It was possible to motivate some viewers to seek further information on an external website, indicating that influencer campaigns could be used to motivate concrete behaviors such as signing up for screening. Although the collaborative process does have challenges, engaging influencers appears to be a feasible means of reaching thousands of people with public health messages.
Authors:
Presenter - Natasha Allard, MBA, University at Buffalo School of Public Health and Health Professions
Co-Author - Tiffany Nguyen, Apply Georgetown University
Co-Presenter - Heather Orom, PhD, University at Buffalo
Sugary drinks, salty snacks, and tobacco: characteristics of the advertising environment in Southern California food retail checkout areas
Poster Number: D79Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Social and Environmental Context and Health
Introduction: Checkout areas in food retailers are dominated by foods high in added sugars, sodium, and saturated fats. Manufacturers pay store fees to place these items, and advertising for them, at checkout to encourage impulse purchases, yet no study to date has characterized advertisements (e.g., branded signage, shelf talkers) at store checkouts. This study assessed advertisements at food retail checkout areas in 4 Southern California cities.Methods: Photo data from a stratified random sample of food retailers (n=88) were collected across 4 Southern California cities. We developed a rigorous protocol to identify advertisements at checkout with brand trademarks or logos, images of branded products, slogans or taglines for branded products, or images of mascots, symbols, or other imagery that may influence customer purchasing behaviors. We used this protocol to code advertisements at checkout for: the type of product advertised (e.g., tobacco, sweetened beverage, chips), the presence of child-directed imagery, the use of claims (e.g., health claims, nutrient claims), and the presence of price promotion incorporated into the advertisement (independent of the price tag).Results: Of the 1,349 advertisements examined, the majority were for unhealthy products. The most frequently advertised products were: cigarettes and smoking accessories (13%), magazines (12%), candy (e.g., chocolates, gummies, hard candy, not including mints or gum) (12%), soda (11%), chips (e.g., potato, tortilla, corn) (5%), lottery/gambling (5%), and energy drinks (5%). Roughly 1 in 5 (17%) advertisements used child-directed imagery. When assessing just food and beverage advertising, over 1 in 3 (36%) containing child-directed imagery. We found that 14% of advertisements included a claim, which were most frequently health, nutrient, or ecological/ethical claims, each in 5% of advertisements. We identified price promotion in 11% of advertisements. Roughly two-thirds (61%) of retailers used screens for digital advertising, most of which were used to promote lottery/gambling. Conclusion: The majority of advertising at retail checkouts was for unhealthy products such as tobacco, sweets, sugar-sweetened beverages, and salty snacks. Child-directed advertising; health, nutrient, and ecological or ethical claims; and price promotions were also common. Most stores had the capacity for digital advertising at store checkout areas. These results identify the need for public health intervention.
Keywords: Built environment, DietAuthors:
Author - Andrea Gil, BS, University of California, Davis
Co-Author - Alexandria Reimold, PhD, University of California, Davis
Co-Author - Susan Brown, PhD, FSBM, FABMR, UC Davis Health
Co-Author - Lauren Au, PhD, RD, University of California, Davis
Co-Author - Jennifer Falbe, ScD, MPH, University of California, Davis
Perceived Barriers and Facilitators to Lung Cancer Screening and the Role of the Church Among Black Current and Recently Quit Smokers in Rural Georgia: A Qualitative Study
Poster Number: D8Time: 11:00 AM - 11:50 AM
Topics: Cancer, Health Disparities
Background: Lung cancer is the leading cause of cancer-related deaths in the United States, and lung cancer screening (LCS) rates remain suboptimal, ranging from 0.7%-11.9%. More specifically, LCS rates are low among Black individuals (1.7%), and little is known about barriers and facilitators to LCS among Black high-risk individuals. To better inform future LCS interventions and strategies, we examined perceived barriers and facilitators to LCS as well as perceptions of the role of places of worship in screening promotion among Black smokers.
Methods: Guided by the PRECEDE-PROCEED model, semi-structured phone interviews were conducted with 28 Black current and recently quit smokers between the ages of 50 and 80. Interviews were conducted, recorded, transcribed verbatim, coded, and analyzed using thematic analysis from November 2024 to August 2025.
Results: Among this sample, the mean age was 63.4 years, 78.6% were daily smokers, 64.3% were female, and 60.7% attended church regularly. Several themes emerged regarding perceived barriers to LCS, including lack of knowledge and awareness of screening, fear of results, concerns about cost and insurance coverage, lack of access to screening facilities (e.g., transportation), mistrust of healthcare, and no perceived barriers to obtaining LCS. Additionally, participants exhibited limited general awareness and knowledge of screening overall. Yet, once made aware of LCS, they were enthusiastic about discussing screening with a provider in the near future and held positive perceptions of its benefits. Perceived facilitators included screening awareness, result acceptance, and positive patient-doctor relationships. Several themes also emerged regarding the role of the church in LCS: a variety of church-based lung cancer screening promotion methods, positive attitudes toward church involvement in health (e.g., comfort/acceptability), and a high perceived benefit of a church-based LCS program.
Conclusions: Results from our qualitative analysis suggest that Black smokers are eager to engage in LCS and have mostly favorable perceptions, but several perceived barriers could impede access. To address these reported barriers, churches have strong potential as an intervention setting. Future research should emphasize the importance of increasing screening awareness, provider-patient communication, as well as assessing the feasibility of places of worship serving as an implementation setting for LCS.
Keywords: Cancer, Cancer screeningMethods: Guided by the PRECEDE-PROCEED model, semi-structured phone interviews were conducted with 28 Black current and recently quit smokers between the ages of 50 and 80. Interviews were conducted, recorded, transcribed verbatim, coded, and analyzed using thematic analysis from November 2024 to August 2025.
Results: Among this sample, the mean age was 63.4 years, 78.6% were daily smokers, 64.3% were female, and 60.7% attended church regularly. Several themes emerged regarding perceived barriers to LCS, including lack of knowledge and awareness of screening, fear of results, concerns about cost and insurance coverage, lack of access to screening facilities (e.g., transportation), mistrust of healthcare, and no perceived barriers to obtaining LCS. Additionally, participants exhibited limited general awareness and knowledge of screening overall. Yet, once made aware of LCS, they were enthusiastic about discussing screening with a provider in the near future and held positive perceptions of its benefits. Perceived facilitators included screening awareness, result acceptance, and positive patient-doctor relationships. Several themes also emerged regarding the role of the church in LCS: a variety of church-based lung cancer screening promotion methods, positive attitudes toward church involvement in health (e.g., comfort/acceptability), and a high perceived benefit of a church-based LCS program.
Conclusions: Results from our qualitative analysis suggest that Black smokers are eager to engage in LCS and have mostly favorable perceptions, but several perceived barriers could impede access. To address these reported barriers, churches have strong potential as an intervention setting. Future research should emphasize the importance of increasing screening awareness, provider-patient communication, as well as assessing the feasibility of places of worship serving as an implementation setting for LCS.
Authors:
Author - Shacoria Anderson, Rollins School of Public Health, Emory University
Co-Author - Michelle Kegler, Rollins School of Public Health, Emory University
Co-Author - Yue Guan, Rollins School of Public Health, Emory University
Co-Author - Fayron Epps, UT Health San Antonio
Co-Author - Alexandra Morshed, Rollins School of Public Health, Emory University
Co-Author - Jerik Leung, Rollins School of Public Health, Emory University
The Impact of Traditional and Social Media on South Asian American Youth Communities in Perpetuating Mental Health Stigma
Poster Number: D80Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Mental Health
Introduction: In recent years, media narratives around mental health have improved; however, there is limited understanding of how mental health (MH) misinformation affects South Asian (SA) and South Asian American (SAA) individuals, particularly youth. Exposure to stigmatizing and culturally specific narratives at a young age can perpetuate misinformation and reinforce harmful behaviors. Youth are especially vulnerable, as varying levels of media literacy can make it difficult to assess the accuracy of information. As the SAA population continues to grow, it is crucial to explore what MH misinformation looks like within SA/SAA communities, the role media plays in spreading it, and whether such portrayals help reduce stigma or further marginalize mental health among SAA youth.
Objective: The purpose of this study is to analyze how mental health topics are framed in both traditional and social media to assess misinformation and stigma among SAAs.
Methods: Octoparse, a data-scraping tool, was used to obtain tweets and movie reviews discussing mental health. Related tweets were collected using mental health-related keywords (e.g. “anxiety”) and hashtags (e.g., “desi”) between January-July 2025. SA MH movies were identified through a movie list about mental health. Content analysis was used to identify broader themes related to misinformation. Sentiment analysis was performed using R to identify perceptions and prominent attitudes towards MH.
Results: Tweets (n=10,543) presented positive sentiments (23.9%) towards mental health highlighting supportive attitudes and encouraging individuals to seek care. Together with content analysis, top themes in tweets include self-care, spirituality, and accountability. Misinformation from tweets included perpetuating self-blame and over-reliance on religion/spiritual communities with limited beliefs in treatment. Reviews (n=846) presented positive sentiments (25.44%) towards movies discussing mental health, discussing strength and praising representations of MH disorders. Content analysis showed similar themes, including the need to spread awareness and acceptance of MH disorders in SAA communities.
Conclusions: Positive sentiments towards MH in SA/SAA online communities, model healthy and de-stigmatized views of MH for youth. Continued research and efforts should be made to dissuade misinformed perspectives and provide culturally relevant tools for how MH is represented in SA/SAA circles and its impact on youth.
Keywords: Mental health, Attitude(s)Objective: The purpose of this study is to analyze how mental health topics are framed in both traditional and social media to assess misinformation and stigma among SAAs.
Methods: Octoparse, a data-scraping tool, was used to obtain tweets and movie reviews discussing mental health. Related tweets were collected using mental health-related keywords (e.g. “anxiety”) and hashtags (e.g., “desi”) between January-July 2025. SA MH movies were identified through a movie list about mental health. Content analysis was used to identify broader themes related to misinformation. Sentiment analysis was performed using R to identify perceptions and prominent attitudes towards MH.
Results: Tweets (n=10,543) presented positive sentiments (23.9%) towards mental health highlighting supportive attitudes and encouraging individuals to seek care. Together with content analysis, top themes in tweets include self-care, spirituality, and accountability. Misinformation from tweets included perpetuating self-blame and over-reliance on religion/spiritual communities with limited beliefs in treatment. Reviews (n=846) presented positive sentiments (25.44%) towards movies discussing mental health, discussing strength and praising representations of MH disorders. Content analysis showed similar themes, including the need to spread awareness and acceptance of MH disorders in SAA communities.
Conclusions: Positive sentiments towards MH in SA/SAA online communities, model healthy and de-stigmatized views of MH for youth. Continued research and efforts should be made to dissuade misinformed perspectives and provide culturally relevant tools for how MH is represented in SA/SAA circles and its impact on youth.
Authors:
Author - Sushraya Jay, MPH, South Asian Public Health Association
Co-Author - Tej Shah, South Asian Public Health Association
Co-Author - Preanka Singh, South Asian Public Health Association
Co-Author - Samira Khan, MPH, CHES, South Asian Public Health Association
Co-Author - Malinee Neelamegam, PhD, MPH, MBA, South Asian Public Health Association
Co-Author - Aisha Bhimla, PhD, South Asian Public Health Association
Understanding the effects of exposure to conflicting information about alcohol and cancer risk: Comparing sequential and combined conflict
Poster Number: D81Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Decision Making
Background: Exposure to conflicting health information can elicit a range of negative reactions, including those that are proximal and topic-specific (e.g., anger, uncertainty) or more generalized (e.g., negative perceptions of science). This conflict may arise through exposure to multiple one-sided messages (i.e., sequential conflict), or through two-sided messages that describe opposing sides of an issue (i.e., combined conflict). It is unclear, however, whether these distinct types of exposure generate different psychological effects; this study aims to explore this question within the novel context of alcohol and cancer risk.
Methods: We recruited 1440 U.S. adults via Prolific and randomly assigned them to read (1) a one-sided story about the “Northbridge Institute” (“Not Enough Evidence to Link Moderate Drinking to Multiple Cancers”), (2) a one-sided story about the “ClearPath Institute” (“Strong Evidence Links Moderate Drinking to Multiple Cancers”), (3) both one-sided stories, in sequence (“sequential conflict”), (4) a two-sided, “combined conflict” story (“Is There Sufficient Evidence to Link Moderate Drinking to Multiple Cancers? Two Scientific Reports Disagree”), or (5) an unrelated control. Next, they responded to several proximal (e.g., uncertainty) and generalized (e.g., perceptions of science) outcomes. Data were analyzed using a series of ANCOVA models, controlling for age, sex, and prior awareness of the alcohol-cancer link.
Results: Exposure to conflicting (versus control) stories elicited significantly greater negative effects, including higher anger (p<.05), lower certainty about the alcohol-cancer link (p<.001), less trust in each source (Northbridge p<.001; ClearPath p<.001), higher confusion (p<.001) and backlash (p<.05), and less positive perceptions of science (p<.001). These negative effects were exacerbated when conflict was implied across stories (“sequential conflict”) versus communicated within one story (“combined conflict”).
Conclusions: Findings support prior work on the negative effects of exposure to conflicting information within the novel context of alcohol and cancer. We also uncovered a surprising effect: respondents were more averse to conflict when encountered sequentially (across stories) versus combined (within one story). Future work should look at underlying mechanisms of this effect and develop more effective strategies for communicating complex or incongruent health information.
Keywords: Health communication, Cancer risk perceptionsMethods: We recruited 1440 U.S. adults via Prolific and randomly assigned them to read (1) a one-sided story about the “Northbridge Institute” (“Not Enough Evidence to Link Moderate Drinking to Multiple Cancers”), (2) a one-sided story about the “ClearPath Institute” (“Strong Evidence Links Moderate Drinking to Multiple Cancers”), (3) both one-sided stories, in sequence (“sequential conflict”), (4) a two-sided, “combined conflict” story (“Is There Sufficient Evidence to Link Moderate Drinking to Multiple Cancers? Two Scientific Reports Disagree”), or (5) an unrelated control. Next, they responded to several proximal (e.g., uncertainty) and generalized (e.g., perceptions of science) outcomes. Data were analyzed using a series of ANCOVA models, controlling for age, sex, and prior awareness of the alcohol-cancer link.
Results: Exposure to conflicting (versus control) stories elicited significantly greater negative effects, including higher anger (p<.05), lower certainty about the alcohol-cancer link (p<.001), less trust in each source (Northbridge p<.001; ClearPath p<.001), higher confusion (p<.001) and backlash (p<.05), and less positive perceptions of science (p<.001). These negative effects were exacerbated when conflict was implied across stories (“sequential conflict”) versus communicated within one story (“combined conflict”).
Conclusions: Findings support prior work on the negative effects of exposure to conflicting information within the novel context of alcohol and cancer. We also uncovered a surprising effect: respondents were more averse to conflict when encountered sequentially (across stories) versus combined (within one story). Future work should look at underlying mechanisms of this effect and develop more effective strategies for communicating complex or incongruent health information.
Authors:
Author - Emma Jesch, PhD, MPH, National Institutes of Health
Co-Author - Irina Iles, PhD, MPH, National Institutes of Health
Co-Author - William Klein, PhD, National Institutes of Health
Co-Author - Paul Han, MD, MPH, National Institutes of Health
Navigating Trust: Health Information Sources for Today’s College Students
Poster Number: D82Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Digital Health
Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Roughly 13 million Americans contract HPV each year, with 42 million individuals already infected. College-aged individuals are at the highest risk of HPV infection, yet research shows that this group is less likely to be vaccinated against HPV. Methods: The purpose of this study was to investigate who college students trust for HPV vaccine information. Participants were randomly assigned to one of six experimental conditions in which they received a digital health message that promotes the HPV vaccine from either a: 1) Medical Doctor, 2) Registered Nurse, 3) Pharmacist, 4) the World Health Organization, 5) the Centers for Disease Control and Prevention, or 6) a control condition who were exposed to a neutral video which did not include HPV-related information. Results: Two hundred and eighty college students (Mage = 22.42, SD = 4.31) were included in the study. An ANOVA revealed that there were no group differences in intentions to vaccinate for the HPV vaccine across the six experimental conditions (p = 0.62). Exploratory analyses revealed groups differences among factors such as perceived effectiveness of the HPV vaccine at preventing cervical cancer (p = 0.012) and perceived safety of the HPV vaccine (p = 0.004). Correlation analyses examined the association between individual attitudes about vaccines and family attitudes about vaccines. The correlations ranged from 0.33 to 0.79 and the strongest correlation was between families having negative feelings about vaccines and the belief that vaccines can cause serious illnesses (r = 0.79, p < 0.001). Conclusions: Findings reveal that perceived safety and effectiveness of the HPV vaccine may be influenced by the messenger who is promoting the vaccine. Leveraging trusted healthcare providers in communication efforts and focusing on family units may enhance confidence and increase HPV vaccine uptake among college students.
Keywords: Health communication, Cancer risk perceptionsAuthors:
Presenter - Alyssa A. Martinez, MPH, University of Texas at El Paso
Co-Author - Michelle Gil , MPH, University of Texas at El Paso
Co-Author - Elida Herrera , BS, University of Texas at El Paso
Co-Author - Mark A. Olivas, University of Texas at El Paso
Co-Author - Jessika Cox , University of Texas at El Paso
Co-Author - Paola Martinez-Valenzuela , University of Texas at El Paso
Co-Author - Valeria Garza, University of Texas at El Paso
Co-Author - Miranda Gomez, University of Texas at El Paso
Chair - Gabriel Frietze, PhD, University of Texas at El Paso
Patient-provider discussions about online health information in the Health Information National Trends Survey
Poster Number: D83Time: 11:00 AM - 11:50 AM
Topics: Health Communication and Policy, Digital Health
Online health information seeking is common and may have either positive or negative impacts on patient-provider interactions. Using Health Information National Trends Survey (HINTS) data from 2005, 2008, 2011, and 2024 (n=20,292), this study assessed trends in the percentage of Americans who reported discussing online health information with healthcare providers in the past year. Subsequently, 2024 HINTS data (n=6,350) were used to assess perceptions of provider openness, provider respectfulness, and impact on patient-provider interactions among those who discussed online health information with a provider. Multivariable logistic regressions further tested associations of demographic, internet, health, and healthcare-related factors with occurrence and perceptions of online health information discussions. Prevalence of online health information discussions increased from 2005 (25.87%) to 2024 (36.40%). In 2024, most respondents who discussed online health information with a provider perceived these discussions positively, but nearly 14% didn’t feel their provider was open to these discussions or respected what they had to say, and 9% reported that discussing online information made their interactions with providers worse. In multivariable analyses, odds of discussing online information were greater among those reporting high digital literacy (adjusted odds ratio [aOR]=1.54, 95% confidence interval [CI]=1.06-2.24) or perceived past medical discrimination (aOR=1.74, 95%CI=1.25-2.43), but lower among adults aged 65+ (aOR=0.64, 95%CI=0.49-0.84). Odds of perceiving provider openness were higher among those reporting high digital literacy (aOR=2.33, 95%CI=1.09-4.97), high patient-centeredness (aOR=6.69, 95%CI=4.57-9.80), or excellent quality of care (aOR=1.67, 95%CI=1.04-2.69) in the past year. Patient-provider discussions about online health information have become more prevalent over time and are generally perceived well. However, some patients report negative experiences with these discussions. Ensuring that patients feel comfortable bringing their internet research to providers and that providers respond with openness and respect may strengthen patient-provider relationships and encourage patient engagement, especially among patients with limited digital literacy.
Keywords: Health communication, information seekingAuthors:
Presenter - Nicole Senft Everson, PhD, National Cancer Institute
Co-Author - Anna Gaysynsky, MPH, ICF
Examining the Role of Cultural Factors on Patient Ratings Among Asian Inpatients
Poster Number: D84Time: 11:00 AM - 11:50 AM
Topics: Health Disparities
Background: Research suggests that Asians, a highly heterogeneous racial group, tend to avoid extreme responses on scales assessing patient experience. This study examines the proportion of Asian patients who give top-box ratings (i.e., the highest possible response) on aspects of the inpatient care experience and assesses the relative importance of cultural factors on patients’ ratings.
Methods: Asian adult patients who received inpatient care at an academic medical center between January 2019 and March 2025 were enrolled in the study. Participants (N=470) completed the 15-item Picker Patient Experience Questionnaire. Cultural factors hypothesized to influence patient experience (ethnic identity, language use, collectivism, and emotional restraint) were also assessed. Using logistic regression, we examined whether these factors were associated with giving a top-box rating – defined as a binary outcome (1=top-box, 0=all other ratings except N/A) – on 15 care domains, after controlling for sex, age, level of education, and country of origin.
Results: Participants (M age=56.9 ± 13.7 years) were predominantly female (61.1%), highly educated (50.0% held a Master’s or higher), and had household incomes ≥$100K (51.1%). Ethnicities included Chinese (35.1%), Indian (21.9%), Filipino (15.5%), Vietnamese (7.9%), Korean (4.9%), Japanese (4.7%), and Other (10.0%). For seven care domains, 75% or more patients gave a top-box rating. Involvement with treatment was the only domain where fewer than half of patients (23.8%) gave a top-box rating. Cultural factors significantly influenced ratings in 3 domains. Language-use acculturation was associated with higher odds of top-box ratings for involvement in treatment decisions (OR=1.38, 95% CI 1.03-1.83, p=0.03); Korean patients were more likely than Chinese to rate this domain highly (OR=2.62, 95% CI 0.99-6.89, p=0.05). Filipino, Indian, and Japanese patients were more likely than Chinese to give a top-box rating for identifying staff to share concerns (OR 2.47, 95% CI 1.18-5.16, p=0.02; OR 2.03, 95% CI 1.11-3.74, p=0.02; OR 4.08, 95% CI 1.05-15.84, p=0.04, respectively). Greater collectivism was associated with higher odds of giving a top-box rating on the domain evaluating information support provided to patients’ close contacts (OR=1.05, 95% CI 1.01-1.08, p=0.01).
Conclusion: Patient experience ratings among Asians are sometimes influenced by cultural factors and should be interpreted with cultural context in mind.
Keywords: Race, CultureMethods: Asian adult patients who received inpatient care at an academic medical center between January 2019 and March 2025 were enrolled in the study. Participants (N=470) completed the 15-item Picker Patient Experience Questionnaire. Cultural factors hypothesized to influence patient experience (ethnic identity, language use, collectivism, and emotional restraint) were also assessed. Using logistic regression, we examined whether these factors were associated with giving a top-box rating – defined as a binary outcome (1=top-box, 0=all other ratings except N/A) – on 15 care domains, after controlling for sex, age, level of education, and country of origin.
Results: Participants (M age=56.9 ± 13.7 years) were predominantly female (61.1%), highly educated (50.0% held a Master’s or higher), and had household incomes ≥$100K (51.1%). Ethnicities included Chinese (35.1%), Indian (21.9%), Filipino (15.5%), Vietnamese (7.9%), Korean (4.9%), Japanese (4.7%), and Other (10.0%). For seven care domains, 75% or more patients gave a top-box rating. Involvement with treatment was the only domain where fewer than half of patients (23.8%) gave a top-box rating. Cultural factors significantly influenced ratings in 3 domains. Language-use acculturation was associated with higher odds of top-box ratings for involvement in treatment decisions (OR=1.38, 95% CI 1.03-1.83, p=0.03); Korean patients were more likely than Chinese to rate this domain highly (OR=2.62, 95% CI 0.99-6.89, p=0.05). Filipino, Indian, and Japanese patients were more likely than Chinese to give a top-box rating for identifying staff to share concerns (OR 2.47, 95% CI 1.18-5.16, p=0.02; OR 2.03, 95% CI 1.11-3.74, p=0.02; OR 4.08, 95% CI 1.05-15.84, p=0.04, respectively). Greater collectivism was associated with higher odds of giving a top-box rating on the domain evaluating information support provided to patients’ close contacts (OR=1.05, 95% CI 1.01-1.08, p=0.01).
Conclusion: Patient experience ratings among Asians are sometimes influenced by cultural factors and should be interpreted with cultural context in mind.
Authors:
Author - Deidra Carroll Coleman, DrPH, The University of Texas MD Anderson Cancer Center
Co-Author - Minxing Chen, MS, The University of Texas MD Anderson Cancer Center
Co-Author - Charlotte Hillegass, MA, The University of Texas MD Anderson Cancer Center
Co-Author - Alba Calzada, The University of Texas MD Anderson Cancer Center
Co-Author - Lynne Nguyen, MPH, The University of Texas MD Anderson Cancer Center
Co-Author - Denise Clanton, MA, The University of Texas MD Anderson Cancer Center
Co-Author - Reeni Luke, MBA, The University of Texas MD Anderson Cancer Center
Co-Author - Birnur Buzcu Guven, PhD, The University of Texas MD Anderson Cancer Center
Co-Author - Elizabeth Garcia, The University of Texas MD Anderson Cancer Center
Co-Author - Lorna McNeill, PhD, The University of Texas MD Anderson Cancer Center
Associations of perceived stress and weight status in Black female breast cancer survivors: A pilot intervention study
Poster Number: D85Time: 11:00 AM - 11:50 AM
Topics: Health Disparities , Stress
Psychosocial stress is associated with weight gain that may lead to obesity (BMI ≥ 30kg/m^2). Obesity and psychosocial stress are associated with worse cancer survivorship. Behavioral weight loss interventions (BWLI) offer a lifestyle-based treatment option resulting in moderate weight loss, on average; yet non-Hispanic Black women tend to lose less weight compared to other groups in most studies. We conducted a single-arm pilot-feasibility study of ‘Survivor’s RESET’, a Diabetes Prevention Program (DPP)-based intervention enhanced with cultural- and cancer-relevance and integration of a strong stress management component. Participants were recruited from the Tampa Bay Area. Eligible participants were non-Hispanic Black female breast cancer survivors ≥ 18 years old with obesity and elevated stress (Perceived Stress Scale-10 Score (PSS-10) ≥13) at baseline. Participants attended weekly group-based sessions via Zoom led by a trained interventionist for 16 weeks. We assessed the intervention effect on PSS-10; examined associations between baseline PSS-10 (PSSbx) and post-intervention weight status; and explored associations between attendance and weight change. Descriptive statistics were generated for demographics and attendance. Matched-pairs T-tests were used to evaluate pre/post intervention PSS-10, weight, and waist circumference (WC). Linear regression models were used to examine associations among PSSbx, weight, WC. Chi square tests were used to explore the relationship between weight change and attendance. Twenty participants aged 43-73 years (mean ± SD, 57.9±7.7) enrolled; 35% reported annual income of ≥$80,000, and 95% attended ≥75% of sessions. Statistically significant decreases in mean weight (2.36 kg, t(19)= 3.10, p=.006), WC (3.25 cm, t(19)=3.76, p= .001), and PSS-10 (6.85, t(19)= 3.44, p=.003 ) were observed post-intervention. Linear models (R^2 =0.287, F=4.621, 2, 16, p < 0.001) indicated that PSSbx was a significant predictor of weight change (β =0.25, SE = 0.10, p = 0.025) after controlling for income. We found no association among PSSbx and WC change. Trends toward greater weight loss among those who attended >75% of sessions vs. <50% or ≤75% were observed but did not achieve statistical significance (χ^2 (2, N = 20) = 4, p = 0.14). These findings are consistent with previous research, underscore the need to focus on stress management in BWLI, and support the need for a larger randomized trial to assess the intervention.
Keywords: Obesity, StressAuthors:
Author - Ashley J. Cooper, PhD, Moffitt Cancer Center
Co-Author - Sierra Pittman, MPH, Moffitt Cancer Center
Co-Author - Khaliah Fleming, EdD, Moffitt Cancer Center
Co-Author - Jazmin Henderson, Moffitt Cancer Center
Co-Author - Alissa Pena, Moffitt Cancer Center
Co-Author - Vivian Doerr, PhD, Moffitt Cancer Center
Co-Author - Melissa Mallory, MD, Moffitt Cancer Center
Co-Author - Heather Jim, PhD, Moffitt Cancer Center
Co-Author - Adana Llanos, PhD, Columbia University
Chair - Tiffany L. Carson, PhD, Moffitt
Stigma Toward Obesity and Nicotine Use in MPH Students: A Barrier to Health Equity
Poster Number: D86Time: 11:00 AM - 11:50 AM
Topics: Health Disparities
Background: Obesity affects 41.9% of adults in the United States, yet remains highly stigmatized, and public health messages often overemphasize individual responsibility, reinforcing negative stereotypes. Attitudes among Master of Public Health (MPH) students are important, as they will become the next generation of public health professionals, and bias in training may influence long-term practice and perpetuate inequities.
Methods: Cross-sectional, vignette-based online survey of 234 MPH students in U.S. programs (Mage=26.8±5.3; 50.9% Non-Hispanic White; 19.8% Black/AA; 15.9% Latina(o); training stage: 42.3% 2nd year, 32.5% 1st year, 25.2% other/recent graduates). Participants read two vignettes, one depicting an individual with obesity and another with nicotine dependence (comparative condition). After each vignette, participants completed the PANAS Negative Affect subscale, Attribution Questionnaire-Blame, Attitudinal Social Distance, and intervention-recommendation measures. We examined demographic correlates of weight bias scores via linear regression models, compared within-person differences across vignettes with paired t-tests, and assessed the correlations between weight bias and recommendations for individual- and structural-level interventions.
Results: For the obesity vignette, most participants scored below scale midpoints for negative affect (M=4.34±2.4; 7.7% above midpoint) and social distance (M=6.94±2.6; 4.3% above midpoint). Blame scores were higher, with 24.8% scoring above the midpoint of the blame scale for obesity (M=12.5±4.9). Men reported higher weight bias scores across scales (p<.05), whereas participants who self-identified as having a higher weight and those identifying as White had lower scores across the weight bias measures (ps<.05). Comparing conditions, blame was higher for nicotine dependence than obesity (p<.01). Greater weight bias was positively correlated with stronger recommendations for both individual-level (e.g., personal weight-loss counseling) and structural-level (e.g., increased taxes for harmful products) interventions (ps<.01).
Conclusion: Findings indicate that elements of obesity- and nicotine-related stigma are present among MPH students, particularly in attributions of blame. Integrating bias-awareness and stigma-reduction content into public health training could be an important step toward preparing a workforce that promotes equitable, compassionate care.
Keywords: Public health, Attitude(s)Methods: Cross-sectional, vignette-based online survey of 234 MPH students in U.S. programs (Mage=26.8±5.3; 50.9% Non-Hispanic White; 19.8% Black/AA; 15.9% Latina(o); training stage: 42.3% 2nd year, 32.5% 1st year, 25.2% other/recent graduates). Participants read two vignettes, one depicting an individual with obesity and another with nicotine dependence (comparative condition). After each vignette, participants completed the PANAS Negative Affect subscale, Attribution Questionnaire-Blame, Attitudinal Social Distance, and intervention-recommendation measures. We examined demographic correlates of weight bias scores via linear regression models, compared within-person differences across vignettes with paired t-tests, and assessed the correlations between weight bias and recommendations for individual- and structural-level interventions.
Results: For the obesity vignette, most participants scored below scale midpoints for negative affect (M=4.34±2.4; 7.7% above midpoint) and social distance (M=6.94±2.6; 4.3% above midpoint). Blame scores were higher, with 24.8% scoring above the midpoint of the blame scale for obesity (M=12.5±4.9). Men reported higher weight bias scores across scales (p<.05), whereas participants who self-identified as having a higher weight and those identifying as White had lower scores across the weight bias measures (ps<.05). Comparing conditions, blame was higher for nicotine dependence than obesity (p<.01). Greater weight bias was positively correlated with stronger recommendations for both individual-level (e.g., personal weight-loss counseling) and structural-level (e.g., increased taxes for harmful products) interventions (ps<.01).
Conclusion: Findings indicate that elements of obesity- and nicotine-related stigma are present among MPH students, particularly in attributions of blame. Integrating bias-awareness and stigma-reduction content into public health training could be an important step toward preparing a workforce that promotes equitable, compassionate care.
Authors:
Author - Lecsy Gonzalez, MS, MPH, University of Florida
Co-Author - Rebecca Pearl, PhD, University of Florida
Clinicians’ HPV Vaccination Recommendation Practices for Young Adult Sexual and Gender Minority Patients
Poster Number: D87Time: 11:00 AM - 11:50 AM
Topics: Health Disparities , Health Communication and Policy
There are multiple HPV-related disparities experienced by sexual and gender minority (SGM) populations in the U.S., including higher rates of HPV-associated cancers and lower rates of HPV vaccination. SGM patients also report higher rates of discrimination during healthcare visits. We conducted a national cross-sectional online survey of primary care clinicians (physicians and advanced practice providers [APPs]) in 2024 to examine HPV vaccination recommendation practices for SGM patients. Participants responded to a series of six clinical vignettes which varied by description of the patients’ sexual orientation, sex assigned at birth, and gender identity. The final sample (n=483) was primarily non-Hispanic (92.8%), white (73.7%), physicians (56.3%), and did not practice in a rural/frontier community (70.4%). Across the different vignettes, 59-69% reported always recommending the HPV vaccine, regardless of patient characteristics. APPs reported always recommending the HPV vaccine more frequently than physicians for both cisgender heterosexual men (68.9% vs. 52.8%; p<0.01) and cisgender heterosexual women (72.3% vs. 59.3%; p=0.01). Compared to physicians, APPs always recommended the HPV vaccine more frequently for both bisexual transgender men (83.0% vs. 57.9%; p=0.01) and bisexual cisgender men (69.5% vs. 56.5%; p=0.04). There were no other statistically significant differences in HPV vaccination recommendation. In summary, respondents did not report differing recommendations for HPV vaccination by sex, sexual orientation, or gender identity. However, APPs reported always recommending the vaccine more frequently than physicians. Given high rates of clinicians recommending the HPV vaccination for all patients, future efforts to improve vaccination rates may benefit from focusing on improving uptake by focusing on patient- and systems-level factors as opposed to solely focusing on clinician recommendations.
Keywords: Health disparities, Sexual orientationAuthors:
Presenter - Monica Kasting, PhD, Purdue University
Co-Author - Megan Davish, Purdue University
Co-Author - Steven Sutton, H. Lee Moffitt Cancer Center & Research Institute
Co-Author - Gwendolyn Quinn, New York University
Co-Author - Kelly Donahue, Indiana University
Co-Author - Shannon Christy, PhD, H. Lee Moffitt Cancer Center & Research Institute
Healthcare Stigma and Unmet Healthcare Needs Among Transgender and Gender Diverse Individuals in Japan: Findings from a Nationwide Cross-Sectional Study
Poster Number: D88Time: 11:00 AM - 11:50 AM
Topics: Health Disparities , Social and Environmental Context and Health
Background.
Transgender and gender diverse (TGD) individuals often face stigma in healthcare settings, which can lead them to avoid needed healthcare services. This study examined how enacted and anticipated healthcare stigma relate to unmet care among TGD individuals in Japan, an understudied population.
Methods.
An anonymous online survey was conducted in Japan from June to August 2025, recruiting TGD individuals via community organisations and social media platforms. Six items assessed healthcare stigma (score range 0–24; Cronbach’s α = 0.85), covering enacted stigma (rejection, inferior treatment, gossip, and difficulty receiving care) and anticipated stigma (worry and avoidance of care due to potential disclosure). Unmet healthcare needs were assessed by asking whether participants had any occasion in the past 12 months when they felt they needed healthcare but did not receive it. Associations between stigma and unmet healthcare were examined using Poisson regression with robust variance, and mediation analysis tested whether anticipated stigma mediated the effect of enacted stigma on unmet healthcare.
Results.
The analysis included 468 TGD individuals (median age 31 years, IQR 24–40). Among individuals assigned female at birth (73.1%), 19.0% (65/342) identified as men and 81.0% (277/342) as gender diverse (e.g., non-binary, X-gender, other). Among individuals assigned male at birth (26.9%), 48.4% (61/126) identified as women and 51.6% (65/126) as gender diverse. Overall, 46.4% (217/468) reported unmet medical care needs. Healthcare stigma scores and unmet healthcare needs were similar across gender identity groups. Each 1-point increase in healthcare stigma score was associated with a 5% higher prevalence of unmet healthcare needs (aPR 1.05, 95% CI 1.03–1.06). Mediation analysis indicated that approximately half of the effect of enacted stigma on unmet healthcare was mediated by anticipated stigma (proportion mediated = 51.1%).
Conclusions.
Stigma experiences in healthcare settings remain a serious issue for TGD individuals in Japan, undermining access to needed healthcare by increasing anticipated stigma. To ensure equitable access and culturally competent care, healthcare workers should be trained to cultivate a willingness to understand the physical experiences, emotional needs, and potential pressures and concerns of TGD individuals, with the goal of creating safe and inclusive spaces for dialogue during care.
Keywords: Minority health, GenderTransgender and gender diverse (TGD) individuals often face stigma in healthcare settings, which can lead them to avoid needed healthcare services. This study examined how enacted and anticipated healthcare stigma relate to unmet care among TGD individuals in Japan, an understudied population.
Methods.
An anonymous online survey was conducted in Japan from June to August 2025, recruiting TGD individuals via community organisations and social media platforms. Six items assessed healthcare stigma (score range 0–24; Cronbach’s α = 0.85), covering enacted stigma (rejection, inferior treatment, gossip, and difficulty receiving care) and anticipated stigma (worry and avoidance of care due to potential disclosure). Unmet healthcare needs were assessed by asking whether participants had any occasion in the past 12 months when they felt they needed healthcare but did not receive it. Associations between stigma and unmet healthcare were examined using Poisson regression with robust variance, and mediation analysis tested whether anticipated stigma mediated the effect of enacted stigma on unmet healthcare.
Results.
The analysis included 468 TGD individuals (median age 31 years, IQR 24–40). Among individuals assigned female at birth (73.1%), 19.0% (65/342) identified as men and 81.0% (277/342) as gender diverse (e.g., non-binary, X-gender, other). Among individuals assigned male at birth (26.9%), 48.4% (61/126) identified as women and 51.6% (65/126) as gender diverse. Overall, 46.4% (217/468) reported unmet medical care needs. Healthcare stigma scores and unmet healthcare needs were similar across gender identity groups. Each 1-point increase in healthcare stigma score was associated with a 5% higher prevalence of unmet healthcare needs (aPR 1.05, 95% CI 1.03–1.06). Mediation analysis indicated that approximately half of the effect of enacted stigma on unmet healthcare was mediated by anticipated stigma (proportion mediated = 51.1%).
Conclusions.
Stigma experiences in healthcare settings remain a serious issue for TGD individuals in Japan, undermining access to needed healthcare by increasing anticipated stigma. To ensure equitable access and culturally competent care, healthcare workers should be trained to cultivate a willingness to understand the physical experiences, emotional needs, and potential pressures and concerns of TGD individuals, with the goal of creating safe and inclusive spaces for dialogue during care.
Authors:
Author - Takeshi Miwa, MPH, National Cheng Kung University
Co-Author - Chung-Ying Lin, PhD, National Cheng Kung University
Co-Author - Yuzuru Ikushima, Positive Living And Community Empowerment TOKYO (PLACE TOKYO)
Co-Author - Carol Strong, PhD, MPH, National Cheng Kung University
Food and Nutrition Security across communities: Findings from a Statewide Survey
Poster Number: D89Time: 11:00 AM - 11:50 AM
Topics: Health Disparities , Diet, Nutrition, and Eating Disorders
Background: Economic hardships combined with social and structural barriers limit access to affordable, nutritious food. Yet, food security (having access to affordable and nutritious food) and nutrition security (consistent availability of foods that promote health and well-being) have significant impacts on health and overall well-being, and disparities across vulnerable populations persist. This study aimed to assess the prevalence of food and nutrition security across diverse neighborhoods in Connecticut.
Methods: A cross-sectional survey was conducted between March-July 2025 among adults accessing local food pantry services. Data collection took place during on-site pantry visits in 17 randomly selected pantries. Random selection occurred using a tiered approach based on pantry size (i.e., pounds of food distributed and number of households served each month). The survey was administered in Qualtrics and took about 20 minutes to complete. Food pantry guests were invited to complete the survey either using their personal devices or tablets provided, and received a $20 electronic Amazon gift card for their participation. Food insecurity was assessed using the USDA’s ten-item household food insecurity tool, and nutrition security was assessed using a four-item validated tool by Calloway et al. The data was analyzed using SPSS version 30.
Results: A total of 524 responses were recorded. Findings show that over 73% of the sample experience food insecurity, with 45% reporting very low food security. Similarly, 77% of the respondents reported experiencing nutrition insecurity. Participants younger than 50 years old demonstrated better nutrition security compared to older adults (p <.001). Food insecurity was more prevalent in households with children under 18 (p <.001) and households experiencing housing insecurity (p <.001).
Conclusion: Food and nutrition insecurity remain critical issues in the United States. These findings warrant the urgent need for policy reforms and community-driven and evidence-based strategies to address immediate needs. In the long term, multi-level and multi-sector strategies with a life course perspective are critical to promote sustainable solutions to alleviating disparities in food and nutrition security risk among older adults and young children.
Keywords: Health disparities, DisparitiesMethods: A cross-sectional survey was conducted between March-July 2025 among adults accessing local food pantry services. Data collection took place during on-site pantry visits in 17 randomly selected pantries. Random selection occurred using a tiered approach based on pantry size (i.e., pounds of food distributed and number of households served each month). The survey was administered in Qualtrics and took about 20 minutes to complete. Food pantry guests were invited to complete the survey either using their personal devices or tablets provided, and received a $20 electronic Amazon gift card for their participation. Food insecurity was assessed using the USDA’s ten-item household food insecurity tool, and nutrition security was assessed using a four-item validated tool by Calloway et al. The data was analyzed using SPSS version 30.
Results: A total of 524 responses were recorded. Findings show that over 73% of the sample experience food insecurity, with 45% reporting very low food security. Similarly, 77% of the respondents reported experiencing nutrition insecurity. Participants younger than 50 years old demonstrated better nutrition security compared to older adults (p <.001). Food insecurity was more prevalent in households with children under 18 (p <.001) and households experiencing housing insecurity (p <.001).
Conclusion: Food and nutrition insecurity remain critical issues in the United States. These findings warrant the urgent need for policy reforms and community-driven and evidence-based strategies to address immediate needs. In the long term, multi-level and multi-sector strategies with a life course perspective are critical to promote sustainable solutions to alleviating disparities in food and nutrition security risk among older adults and young children.
Authors:
Author - Kritee Niroula, Phd, University of Connecticut
Co-Author - Richard Bannor, University of Connecticut
Co-Author - Brittney Cavaliere, Connecticut FoodShare
Co-Author - Olivia Rua, Connecticut FoodShare
Chair - Kristen Cooksey Stowers, PhD, UConn Allied Health Sciences
Parenting Behavior Moderates the Association between Cancer Predisposition Genetic Testing Results and Child Distress
Poster Number: D9Time: 11:00 AM - 11:50 AM
Topics: Cancer, Stress
Objective: The growing use of germline genetic testing in pediatric oncology has led to more frequent identification of cancer predisposition (CP) during childhood, which results in distress for a subset of children. However, little is known about modifiable risk and resilience factors influencing children’s emotional adaptation to learning about their genetic cancer risk. Therefore, the present study examined whether parenting behavior (i.e., overprotection, care) moderated the association between genetic test results and children’s genetic test result-related distress.
Method: Pediatric patients with cancer (N=89; ages=8-20 years; 71.9% non-Hispanic White; 32.6% <$50,000 household income) self-reported their genetic test-related distress (Multidimensional Impact of Cancer Risk Assessment distress subscale) and perceptions of their parents’ parenting behavior (Parental Bonding Instrument: overprotection and care subscales) 1.0-3.9 years after germline genetic test result disclosure. Moderation analyses using the PROCESS Macro in SPSS assessed whether parenting behavior moderated the association between genetic test results (i.e., a cancer predisposing variant vs. non-clinically actionable results) and children’s distress.
Results: Parental overprotection and care both significantly moderated the association between genetic test results and distress (b=.38, p=.02; b=-.38, p=.03). Specifically, children with CP endorsed significantly higher distress only under conditions of low parental care or moderate to high parental overprotection.
Conclusion: Findings suggest that higher parental care may buffer children’s CP-related distress, with higher parental overprotection perhaps accentuating children’s distress. Overprotection may accentuate distress by restricting children’s autonomy and heightening their perceptions of vulnerability. Future research should develop and evaluate family-centered interventions in pediatric healthcare that specifically target parenting behavior to further support children’s emotional adjustment to CP genetic testing. Developing family-centered interventions to target parenting behavior may promote children’s positive adaptation to their genetic cancer risk.
Keywords: Cancer risk perceptions, StressMethod: Pediatric patients with cancer (N=89; ages=8-20 years; 71.9% non-Hispanic White; 32.6% <$50,000 household income) self-reported their genetic test-related distress (Multidimensional Impact of Cancer Risk Assessment distress subscale) and perceptions of their parents’ parenting behavior (Parental Bonding Instrument: overprotection and care subscales) 1.0-3.9 years after germline genetic test result disclosure. Moderation analyses using the PROCESS Macro in SPSS assessed whether parenting behavior moderated the association between genetic test results (i.e., a cancer predisposing variant vs. non-clinically actionable results) and children’s distress.
Results: Parental overprotection and care both significantly moderated the association between genetic test results and distress (b=.38, p=.02; b=-.38, p=.03). Specifically, children with CP endorsed significantly higher distress only under conditions of low parental care or moderate to high parental overprotection.
Conclusion: Findings suggest that higher parental care may buffer children’s CP-related distress, with higher parental overprotection perhaps accentuating children’s distress. Overprotection may accentuate distress by restricting children’s autonomy and heightening their perceptions of vulnerability. Future research should develop and evaluate family-centered interventions in pediatric healthcare that specifically target parenting behavior to further support children’s emotional adjustment to CP genetic testing. Developing family-centered interventions to target parenting behavior may promote children’s positive adaptation to their genetic cancer risk.
Authors:
Presenter - Gabrielle Armstrong, BA, St. Jude Children’s Research Hospital
Co-Author - Jessica Flynn, MS, St. Jude Children’s Research Hospital
Co-Author - Missy Robinson, MAT, St. Jude Children’s Research Hospital
Co-Author - Rose McGee, MS CGC, St. Jude Children’s Research Hospital
Co-Author - Alise Blake, MS CGC, St. Jude Children’s Research Hospital
Co-Author - Kim Nichols, MD, St. Jude Children’s Research Hospital
Co-Author - Lynn Harrison, MPH, St. Jude Children’s Research Hospital
Co-Author - Niki Jurbergs, PhD, St. Jude Children’s Research Hospital
Co-Author - Katianne Howard Sharp, PhD, St Jude Children's Research Hospital
Perceived Barriers and Facilitators to Engagement and Behavioral Enactment in Weight Management Interventions Among Racial and Ethnic Minorities
Poster Number: D90Time: 11:00 AM - 11:50 AM
Topics: Health Disparities , Community Engagement
Background: Obesity disproportionately affects racial/ethnic minorities in the US. Weight management interventions delivered remotely hold promise for improved access and efficiency; yet it is unclear whether such benefits can close disparities. We explored perceived barriers and facilitators to engagement and behavioral enactment during weight management interventions among a national sample of racial/ethnic minorities in the US.
Methods: Thirty-eight self-identified racial/ethnic minority participants who completed the active intervention phase of a decentralized weight management clinical trial were invited to participate in semi-structured interviews (N = 38) via Zoom. A codebook was developed a priori and updated with inductive codes emerging from the analysis. Transcripts were analyzed using NVivo, and themes were categorized using an adapted version of the Social Determinants of Health framework, further sub-grouped as barriers or facilitators.
Results: Participants (n = 26) completed interviews between April and August 2024. Participants were mostly female (88.5%), non-Hispanic (76.9%), and Black/African American (53.8%), with a mean(SD) age of 50.3(10.1) years. Participants noted factors that were barriers for some, yet facilitators for others. In particular, some participants noted unique identities, such as immigrant status, that impacted engagement in study components like dietary self-monitoring. Overall, participants identified cultural, environmental, social, personal, and study-related factors as important to success in the intervention. Cultural factors included beliefs and perceptions about weight, food, and health carried on as family traditions. Environmental factors included access to convenient exercise spaces and a healthy food environment. Social factors included both physical and online support systems, social norms, and stigmatization. Personal factors included self-motivation, readiness, time constraints, physical health challenges, and family history of chronic illness.
Conclusions: While remote-delivered behavioral weight management interventions may increase access, factors influencing successful participant engagement are complex and are likely impacted by personal needs and the context of participants, underscoring the need for multilevel, tailored interventions. Furthermore, immigrants, who are typically categorized with other racial and ethnic minority groups, may have unique, unaddressed needs requiring special attention.
Keywords: Health behavior change, Health disparitiesMethods: Thirty-eight self-identified racial/ethnic minority participants who completed the active intervention phase of a decentralized weight management clinical trial were invited to participate in semi-structured interviews (N = 38) via Zoom. A codebook was developed a priori and updated with inductive codes emerging from the analysis. Transcripts were analyzed using NVivo, and themes were categorized using an adapted version of the Social Determinants of Health framework, further sub-grouped as barriers or facilitators.
Results: Participants (n = 26) completed interviews between April and August 2024. Participants were mostly female (88.5%), non-Hispanic (76.9%), and Black/African American (53.8%), with a mean(SD) age of 50.3(10.1) years. Participants noted factors that were barriers for some, yet facilitators for others. In particular, some participants noted unique identities, such as immigrant status, that impacted engagement in study components like dietary self-monitoring. Overall, participants identified cultural, environmental, social, personal, and study-related factors as important to success in the intervention. Cultural factors included beliefs and perceptions about weight, food, and health carried on as family traditions. Environmental factors included access to convenient exercise spaces and a healthy food environment. Social factors included both physical and online support systems, social norms, and stigmatization. Personal factors included self-motivation, readiness, time constraints, physical health challenges, and family history of chronic illness.
Conclusions: While remote-delivered behavioral weight management interventions may increase access, factors influencing successful participant engagement are complex and are likely impacted by personal needs and the context of participants, underscoring the need for multilevel, tailored interventions. Furthermore, immigrants, who are typically categorized with other racial and ethnic minority groups, may have unique, unaddressed needs requiring special attention.
Authors:
Presenter - Iyanuoluwa Oyetunji, MS, The University of Tennessee, Knoxville
Co-Author - Madison Tinsel, MA, The University of Tennessee, Knoxville
Co-Author - Samuel Battalio, MS, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Co-Author - Angela Pfammatter, PhD, FAHA, FSBM, University of Tennessee, Knoxville
When Quality Care Isn't Enough: How Structural and Mistrust Barriers Condition PrEP Attitudes Among Diverse MSM
Poster Number: D91Time: 11:00 AM - 11:50 AM
Topics: Health Disparities , HIV/AIDS
HIV disproportionately affects men who have sex with men (MSM), yet pre-exposure prophylaxis (PrEP) uptake remains suboptimal despite proven efficacy. While healthcare provider experiences are known determinants of prevention behaviors, limited research has explored how structural and mistrust barriers condition their effects on PrEP attitudes. This study examined whether healthcare barriers moderate the association between provider experiences and PrEP attitudes among racially diverse MSM. We hypothesized: (1) positive provider experiences would predict favorable PrEP attitudes, (2) healthcare barriers would predict negative PrEP attitudes, and (3) healthcare barriers would attenuate the benefits of positive provider experiences at higher levels. 310 MSM from New York State (130 Black, 180 White, 98 Latino) completed validated measures of healthcare provider experiences, structural and mistrust barriers, and PrEP attitudes. Mean-centered regression and moderation analyses tested main and interaction effects with simple slopes probing effects across barrier levels. Contrary to hypotheses, provider experiences did not predict PrEP attitudes (β=-.02, p=.765). Healthcare barriers strongly predicted negative attitudes (β=-.37, p<.001) and significantly moderated the relationship between provider experiences and PrEP attitudes (β=-.20, p<.001). Simple slopes revealed barrier-contingent effects: provider experiences positively predicted attitudes at low barriers (p=.016), showed no association at average barriers (p=.765), and negatively predicted attitudes at high barriers (p=.007). Among MSM facing elevated healthcare barriers, positive provider experiences coincided with worse PrEP attitudes, suggesting structural marginalization and institutional mistrust may act as psychological filters distorting the perceived credibility of quality care. This paradox challenges assumptions that patient-provider rapport alone can improve prevention engagement in marginalized populations where systemic disenfranchisement has eroded institutional legitimacy. Provider-focused strategies may be structurally constrained in high-barrier contexts, limiting relational approaches when systemic deficits persist. Effective HIV prevention requires multilevel interventions integrating institutional accountability and structural reform into trust-centered models, reflecting the lived realities of communities bearing the greatest HIV burden.
Keywords: Health disparities, HIVAuthors:
Presenter - Katie Wong, UCLA Department of Psychology
Author - Sarah Hazma, UCLA Department of Psychology
Author - Patrick Wilson, PhD, UCLA Department of Psychology
Lessons Learned from an Exploration of Person-Level Factors Associated with Retention of Young adults with HIV in an mHealth Alcohol Use Study
Poster Number: D92Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Substance Misuse
Excessive alcohol consumption is a significant concern among young adults with HIV (YAWH). YAWH with reduced self-regulatory ability have higher levels of drinking and experience more alcohol-related consequences. Yet, interventions designed to promote self-regulation in this population are limited. Mobile health (mHealth) interventions that combine digital tools like wearable monitoring devices and smartphone applications offer an innovative approach to alcohol self-management that has the potential to improve real-time self-regulation and adherence to behavior modification strategies. However, poor retention is a major barrier to the development of an effective mHealth alcohol use reduction intervention. Person-level factors may predict when a YAWH is more or less likely to stay enrolled in an intervention. This study explored person-level factors, including individual differences (e.g., personality, sensation seeking) and sociodemographic (e.g., race, income) characteristics, associated with retention in an mHealth alcohol use intervention for YAWH. 49 YAWH (ages 18-29; Mage 26.7 ± 2.3; 40 Men) residing in Florida were enrolled in a 30-day mHealth study. Those who completed the baseline assessment are included in this analysis. 21 participants dropped out following baseline or onboarding and 4 did not complete the final alcohol assessment. Of these participants, 11 stopped responding to the study team, 3 reported unstable housing (e.g., lived in a shelter, changed addresses mid-study) leading to lost or stolen equipment, and 4 reported a difficult financial situation or were concerned about the compensation schedule. The remaining participants who were not retained had low compliance with the intervention, difficulty setting up sensors and/or smartphone apps, or did not provide a reason. Exploratory results suggest that a lower annual household income, higher sensation seeking, substance use, worse sleep quality, and higher extraversion were associated with a greater probability of a participant not being retained. Recommendations will be discussed for improving retention of YAWH in future mHealth intervention studies by considering personality, health, and life factors.
Keywords: Alcohol, HIVAuthors:
Presenter - Stephanie M. Carpenter, Ph.D., Arizona State University
Co-Author - Stuart Case, University of Pittsburgh
Co-Author - Mia L. A. Lustria, PhD, Florida State University
Co-Author - Laura Marks, PhD, Florida State University
Co-Author - Elizabeth Gerwe, University of Florida
Co-Author - Karen MacDonell, PhD, Florida State University
Co-Author - Sylvie Naar, PhD, FSBM, Florida State University College of Medicine
Co-Author - Yan Wang, PhD, University of Florida
Chronology Counts: Examining Associations With Major Depression Onset Chronology in People Living With HIV
Poster Number: D93Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Mental Health
Background: Major depressive disorder (MDD) disproportionately affects people with HIV (PWH), with severity and chronicity of symptoms linked to poorer health outcomes. As HIV and MDD can be risk factors for each other (e.g., MDD increasing risk behaviors and HIV transmission, HIV-related neuroinflammation and stigma increasing risk for MDD), timing of MDD onset relative to HIV diagnosis may provide insight into HIV and MDD prognoses. This study explored whether timing of MDD onset, relative to HIV diagnosis, is associated with differences in MDD history and current MDD characteristics.
Methods: Participants were 404 PWH with current MDD (18-70 years old, 77% male, 51% white non-Hispanic, 70.3% on ART, 67% virally suppressed). Timing and severity of lifetime and current MDD episodes were assessed using the Composite International Diagnostic Interview (CIDI). PWH were split into two groups based on chronology of initial MDD episode and HIV onset: MDD Before HIV (Before, n=212), MDD After HIV (After, n=192). Historical frequency and severity of lifetime MDD episodes (Single or Recurring; Mild or Moderate/Severe) per the CIDI were used to represent MDD history and the Beck Depression Inventory-II (BDI-II) assessed total depressive symptoms in the current MDD episode. Multiple regression was used to explore differences in historical MDD and current BDI-II symptom scores between the Before and After groups, controlling for covariates that were significantly different between groups.
Results: The After group had 2.4 higher odds [95% CI: 1.21, 4.63] of experiencing a lifetime Single Mild MDD (X2(1,N=403)=7.23, p=.007, whereas the Before group had 3.33 times higher odds [95% CI: 2.10, 5.38] of experiencing Recurring Moderate/Severe MDD (X2(1,N=403)=25.36, p<.001). No group differences were found between the Before and After groups on BDI-II symptoms.
Conclusions: Findings suggest onset of MDD relative to HIV is associated with distinct MDD characteristics, with MDD before HIV having a greater likelihood of Recurrent Moderate/Severe MDD and MDD after HIV having a great likelihood of Single Mild MDD. Better understanding psychosocial and biological influences on timing of MDD in PWH may inform prevention and treatment strategies to better address prevalent comorbid MDD in PWH.
Keywords: Depression, HIVMethods: Participants were 404 PWH with current MDD (18-70 years old, 77% male, 51% white non-Hispanic, 70.3% on ART, 67% virally suppressed). Timing and severity of lifetime and current MDD episodes were assessed using the Composite International Diagnostic Interview (CIDI). PWH were split into two groups based on chronology of initial MDD episode and HIV onset: MDD Before HIV (Before, n=212), MDD After HIV (After, n=192). Historical frequency and severity of lifetime MDD episodes (Single or Recurring; Mild or Moderate/Severe) per the CIDI were used to represent MDD history and the Beck Depression Inventory-II (BDI-II) assessed total depressive symptoms in the current MDD episode. Multiple regression was used to explore differences in historical MDD and current BDI-II symptom scores between the Before and After groups, controlling for covariates that were significantly different between groups.
Results: The After group had 2.4 higher odds [95% CI: 1.21, 4.63] of experiencing a lifetime Single Mild MDD (X2(1,N=403)=7.23, p=.007, whereas the Before group had 3.33 times higher odds [95% CI: 2.10, 5.38] of experiencing Recurring Moderate/Severe MDD (X2(1,N=403)=25.36, p<.001). No group differences were found between the Before and After groups on BDI-II symptoms.
Conclusions: Findings suggest onset of MDD relative to HIV is associated with distinct MDD characteristics, with MDD before HIV having a greater likelihood of Recurrent Moderate/Severe MDD and MDD after HIV having a great likelihood of Single Mild MDD. Better understanding psychosocial and biological influences on timing of MDD in PWH may inform prevention and treatment strategies to better address prevalent comorbid MDD in PWH.
Authors:
Author - Victoria Chentsova, MS, San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
Co-Author - Crystal Wang, PhD, Department of Psychiatry, University of California San Diego
Co-Author - Jennifer Iudicello, PhD, Department of Psychiatry, University of California San Diego
Co-Author - J. Hampton Atkinson, MD, Department of Psychiatry, University of California San Diego
Co-Author - Mariana Cherner, PhD, Department of Psychiatry, University of California San Diego
Co-Author - Igor Grant, MD, Department of Psychiatry, University of California San Diego
Co-Author - Robert Heaton, PhD, Department of Psychiatry, University of California San Diego
United Voices: A Randomized Waitlist-Controlled Pilot Trial of an Online Group-Singing Intervention for Older People with HIV
Poster Number: D94Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS, Aging
People with HIV experience a wide spectrum of health conditions, including loneliness and social isolation, that compromise the quality of life in later years. Group-singing interventions are efficacious in improving psychosocial well-being among older people. We conducted a randomized, waitlist-controlled pilot trial of the United Voices (UV), a group-singing intervention for older people with HIV, to evaluate the feasibility and acceptability of procedures and protocols during COVID-19. People with HIV 50 years of age and older were recruited remotely using community-engaged research methods. Twelve, 90-minute intervention sessions (i.e., rehearsals) were held via Zoom during the pandemic. Assessments at baseline, 6- and 12-weeks evaluated feasibility and acceptability of intervention procedures, and semi-structured exit interviews were conducted. A total of 41 individuals screened over 13 weeks, 23 randomized into immediate- (n=13) or delayed-start (n=10) arm, 18 completed baseline assessment and 17 completed 6- and 12-week assessments. Enrollment (M=6.8/week) was on par with a priori threshold indicating feasibility, proportion randomized was 85%, lower than threshold (100%). In the immediate-start group, proportion attending at least 10 of the 12 weekly sessions was 77.8%, lower than threshold (80%). Most participants gave moderately high to high ratings for: overall experience with study (4/7), satisfaction with UV (5/7) and UV community (5/7), ease of participating in UV (5/7), confidence in ability to participate (6/7). Most also gave moderately high to high ratings for satisfaction with: level of information provided (6/7), level of staff support (7/7), study website (6/7), rehearsal structure (6/7), technical assistance (4/7). Exit interviews indicated that while participants would have preferred to sing in person and was at first skeptical regarding online group-singing, the experience was enjoyable, providing a social outlet during shelter-in-place. Participants appreciated getting to know and supporting each other over time. The professionally rendered concert recording was a source of pride. Some of the study procedures met a priori feasibility thresholds, and satisfaction with intervention content and implementation was moderately high to high. Future research may examine the comparative efficacy of an online versus an in-person group-singing intervention for older people with HIV in a large randomized controlled trial.
Keywords: Aging, InterventionAuthors:
Presenter - Judy Tan, Ph.D., Cedars-Sinai
Understanding Antiretroviral Treatment Adherence in Pregnant Women with HIV: A Latent Profile Approach to Stigma, Food Insecurity, and Social Support
Poster Number: D95Time: 11:00 AM - 11:50 AM
Topics: HIV/AIDS
Background: Adherence to antiretroviral therapy (ART) during pregnancy is essential for maternal health and the prevention of vertical HIV transmission. In Uganda, where HIV prevalence remains high, pregnant women living with HIV (WLWH) face intersecting psychosocial and structural barriers, including HIV stigma, food insecurity, and limited social support. While each factor has been independently linked to nonadherence, less is known about their co-occurrence and combined impact during the perinatal period.
Objectives: This study applied latent profile analysis (LPA) to identify psychosocial vulnerability profiles among pregnant WLWH in Uganda and examined their associations with ART adherence.
Methods: We conducted a cross-sectional study of 167 pregnant WLWH recruited from six health facilities in Uganda between June and December 2020. Participants completed validated measures of experienced HIV stigma, internalized stigma, household food insecurity, and interpersonal social support. LPA was used to identify psychosocial profiles, and linear regression models assessed associations between profile membership and ART adherence, adjusting for age, marital status, educational status of both PLWH and their partners, religion, place of residence, partners’ HIV status, and perceived financial status.
Results: A two-class solution provided the best fit. The higher-risk profile (45.1%) was characterized by elevated experienced stigma (M = 1.97), higher internalized stigma (M = 2.66), severe food insecurity (M = 7.53), and lower social support (M = 2.06). The lower-risk profile (54.9%) reported significantly lower stigma, minimal food insecurity (M = 0.82), and slightly higher social support (M = 2.14). Membership in the higher-risk profile was associated with significantly lower ART adherence compared to the lower-risk profile (β = –0.43, p = .023). Marital status also predicted adherence; widowed women reported lower adherence compared to unmarried participants (β = –3.40, p = .019).
Conclusions: Psychosocial vulnerability profiles are strongly associated with ART adherence among pregnant WLWH in Uganda. Multicomponent interventions that simultaneously reduce stigma, strengthen social support, and address food insecurity may enhance adherence and improve maternal and child health outcomes. Person-centered approaches such as LPA offer valuable insights for tailoring interventions to high-risk subgroups and advancing Uganda’s progress toward 95-95-95 targets.
Keywords: HIV, Health outcomesObjectives: This study applied latent profile analysis (LPA) to identify psychosocial vulnerability profiles among pregnant WLWH in Uganda and examined their associations with ART adherence.
Methods: We conducted a cross-sectional study of 167 pregnant WLWH recruited from six health facilities in Uganda between June and December 2020. Participants completed validated measures of experienced HIV stigma, internalized stigma, household food insecurity, and interpersonal social support. LPA was used to identify psychosocial profiles, and linear regression models assessed associations between profile membership and ART adherence, adjusting for age, marital status, educational status of both PLWH and their partners, religion, place of residence, partners’ HIV status, and perceived financial status.
Results: A two-class solution provided the best fit. The higher-risk profile (45.1%) was characterized by elevated experienced stigma (M = 1.97), higher internalized stigma (M = 2.66), severe food insecurity (M = 7.53), and lower social support (M = 2.06). The lower-risk profile (54.9%) reported significantly lower stigma, minimal food insecurity (M = 0.82), and slightly higher social support (M = 2.14). Membership in the higher-risk profile was associated with significantly lower ART adherence compared to the lower-risk profile (β = –0.43, p = .023). Marital status also predicted adherence; widowed women reported lower adherence compared to unmarried participants (β = –3.40, p = .019).
Conclusions: Psychosocial vulnerability profiles are strongly associated with ART adherence among pregnant WLWH in Uganda. Multicomponent interventions that simultaneously reduce stigma, strengthen social support, and address food insecurity may enhance adherence and improve maternal and child health outcomes. Person-centered approaches such as LPA offer valuable insights for tailoring interventions to high-risk subgroups and advancing Uganda’s progress toward 95-95-95 targets.
Authors:
Presenter - Setor Sorkpor, PhD., MPH, MSN, BSN, Florida State University
Co-Author - Jerry John Ouner, PhD, RN, Department of Family Health Care Nursing, School of Nursing, University of California
Co-Presenter - Ibrahim Yigit, PHD, Florida State University
Teachers’ Perspectives on the Adaptation of Paper-Based Education Programs for Online Delivery
Poster Number: D96Time: 11:00 AM - 11:50 AM
Topics: Implementation Science , Physical Activity
Adapting evidence-based interventions (EBIs) for digital delivery in schools is a promising way to promote physical activity (PA), improve nutrition, and support cardiovascular health, as digital programs can increase reach, effectiveness and overcome barriers like cost. We conducted formative research to better understand the barriers and facilitators to using digital strategies to promote physical activity and healthy eating in schools, which will inform the adaptation of two paper-based EBIs delivered through Extension for schoolchildren in Texas. Interviews (n = 18) with teachers and Extension Agents (i.e., health educators) were conducted online via Teams, transcribed, and deductively coded using the Consolidated Framework for Implementation Research and Atlas.ti software. Four themes were constructed: (1) Prioritize a simple design and material— participants suggested that clear support materials are needed, which are easy to follow and require little preparation time, along with activities making it better suited to the school environment; (2) Include strategies for engaging parents—this was supported by teachers and agents with teaching experience, who emphasized the importance of the home environment for promoting students’ health; however, they also said that engaging parents in school activities can be challenging; (3) Shorter length of the program—teachers and agents with teaching experience emphasized daily time and too much tasks (e.g., tasks, tests, and activities) as the major barrier throughout the school year and suggested that the program should last fewer than six weeks to maintain student engagement; (4) Include motivational activities—Most participants reported that a digital intervention would be well-suited for both school and home, as students enjoy using devices and are more likely to stay engaged when the program includes enjoyable and challenging tasks (e.g., games). Using these results, we plan to adapt the two curricula to create a simple, short-duration, and digital program that incorporates activities to foster motivation and engage parents, aiming to promote cardiovascular health among youth.
Keywords: Dissemination, Physical activityAuthors:
Author - Gabrielli T. De Mello, PhD, Texas A&M AgriLife Research
Co-Author - Andrew McNeely, PhD, University of Texas at Dallas
Co-Author - Cassandra Beattie, PhD, Texas A&M AgriLife Research
Co-Author - Brian Oldenburg, PhD, Baker Heart & Diabetes Institute
Co-Author - Jacob Szeszulski, PhD, Texas A&M AgriLife Research
System-Level Interventions for Implementing Psychedelic-Assisted Psychotherapy: A Systematic Review
Poster Number: D97Time: 11:00 AM - 11:50 AM
Topics: Implementation Science , Mental Health
Title: System-Level Interventions for Implementing Psychedelic-Assisted Psychotherapy: A Systematic Review
Background: Psychedelic-assisted psychotherapy (PAP) has shown promise in treating challenging mental health disorders like posttraumatic stress disorder and depression. With growing interest from both the public and the government to provide access to these therapies, it is essential to address the gap between research findings and their implementation in clinical settings. This review focuses on understanding the system-level factors influencing the implementation of PAP to facilitate effective integration into clinical care.
Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Six databases were searched using keywords related to 'implementation,' 'psychedelic (MDMA, psilocybin, LSD, ketamine),' and 'psychotherapy,' along with relevant synonyms and expansions. Peer-reviewed articles reporting on the implementation of PAP were included. Data extraction and synthesis were guided by the Practical, Robust Implementation and Sustainability Model (PRISM), focusing on system-level implementation factors.
Findings: From 2406 identified articles, 2074 were screened after eliminating duplicates and irrelevant sources. Forty-seven articles underwent full-text review, and 20 studies met inclusion criteria. The majority of studies (15) employed surveys and interviews to explore organizational perspectives on PAP implementation. Remaining studies examined patient perspectives (2), infrastructure requirements (2), and patient characteristics (1).
Implications for D&I Science: The review reveals a significant gap in system-level research necessary for effectively translating PAP from academia to real-world clinical programs. Addressing this gap is critical for the safe and effective integration of PAP into clinical settings, thus advancing the field of dissemination and implementation science. Enhancing system-level protocols and infrastructure supports the broader goal of optimizing mental health care through robust implementation strategies.
Keywords: Implementation, psychedelic-assisted psychotherapy, systematic review, MDMA, psilocybin, ketamine, LSD
Keywords: Mental health, Clinical applicationsBackground: Psychedelic-assisted psychotherapy (PAP) has shown promise in treating challenging mental health disorders like posttraumatic stress disorder and depression. With growing interest from both the public and the government to provide access to these therapies, it is essential to address the gap between research findings and their implementation in clinical settings. This review focuses on understanding the system-level factors influencing the implementation of PAP to facilitate effective integration into clinical care.
Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Six databases were searched using keywords related to 'implementation,' 'psychedelic (MDMA, psilocybin, LSD, ketamine),' and 'psychotherapy,' along with relevant synonyms and expansions. Peer-reviewed articles reporting on the implementation of PAP were included. Data extraction and synthesis were guided by the Practical, Robust Implementation and Sustainability Model (PRISM), focusing on system-level implementation factors.
Findings: From 2406 identified articles, 2074 were screened after eliminating duplicates and irrelevant sources. Forty-seven articles underwent full-text review, and 20 studies met inclusion criteria. The majority of studies (15) employed surveys and interviews to explore organizational perspectives on PAP implementation. Remaining studies examined patient perspectives (2), infrastructure requirements (2), and patient characteristics (1).
Implications for D&I Science: The review reveals a significant gap in system-level research necessary for effectively translating PAP from academia to real-world clinical programs. Addressing this gap is critical for the safe and effective integration of PAP into clinical settings, thus advancing the field of dissemination and implementation science. Enhancing system-level protocols and infrastructure supports the broader goal of optimizing mental health care through robust implementation strategies.
Keywords: Implementation, psychedelic-assisted psychotherapy, systematic review, MDMA, psilocybin, ketamine, LSD
Authors:
Author - John Gault, LCSW, VA Center of Excellence for Stress and Mental Health
Co-Author - Erin Almklov, PhD, VA Center of Excellence for Stress and Mental Health
Co-Author - Shirley Tang, BS, Palo Alto University
Co-Author - Borsika Rabin, PhD, VA Center of Excellence for Stress and Mental Health
Co-Author - Brian Huynh, BS, VA Center of Excellence for Stress and Mental Health
Co-Author - James Pittman, PhD, VA Center of Excellence for Stress and Mental Health
Ethnic Differences in the Association between Problematic Internet Use and School Engagement and GPA: Findings from a Diverse High School Sample
Poster Number: D98Time: 11:00 AM - 11:50 AM
Topics: Implementation Science , Social and Environmental Context and Health
Background: Adolescents’ problematic internet use (PIU) is a public health priority with nearly all U.S. teenagers (96%) reporting 7 or more hours of daily online activity. PIU is not solely defined by excessive screen time; it involves the same characteristics as substance use disorders such as withdrawal, tolerance, neglecting personal relationships, and continued use despite negative consequences. Although significant evidence has demonstrated adverse effects of PIU for mental health and academic achievement, far less research has focused on ethnic differences in the association between PIU and GPA and school engagement. The present study assessed the association between PIU and cognitive, affective, and behavioral school engagement and academic achievement and investigated potential ethnic differences across race/ethnicity.
Methods: Data are baseline surveys of high school students (N=2,306) enrolled in a school-based study assessing school, health and developmental outcomes. GLMs tested the hypothesized association between levels of PIU, and students’ GPA and cognitive, affective, and behavioral school engagement. We also explored ethnic differences, adjusting for age, sex, state, and neighborhood disadvantage.
Results: Half of the sample was female (52%), 31% identified as non-Hispanic White, followed by African American (29%), Hispanic (24%), Multiracial (9%), and Asian (7%). Over one third of students (36%) reported mild and 26% reported moderate to severe levels of PIU. Every standard deviation above the mean of PIU, was associated with significantly lower GPA (β = -0.07, 95% CI: [-0.11, -0.03]) and lower behavioral school engagement (β = -0.30, 95% CI: [-0.45, -0.15]) but not affective or cognitive engagement. In regard to ethnic differences, non-Hispanic White students with higher than sample average PIU had significantly lower behavioral school engagement scores than students from all other ethnic backgrounds (p<0.05).
Conclusion: Our results demonstrate that PIU is associated with lower GPA and lower behavioral school engagement, with the most detrimental effect among Non-Hispanic White students. Limiting students’ screen time and integrating routine screening into student health and academic advising could be beneficial approaches to reducing problematic/risky internet use among adolescents. Future research will benefit from investigating what protective cultural/family factors could offset the negative consequences of PIU.
Keywords: Adolescents, InternetMethods: Data are baseline surveys of high school students (N=2,306) enrolled in a school-based study assessing school, health and developmental outcomes. GLMs tested the hypothesized association between levels of PIU, and students’ GPA and cognitive, affective, and behavioral school engagement. We also explored ethnic differences, adjusting for age, sex, state, and neighborhood disadvantage.
Results: Half of the sample was female (52%), 31% identified as non-Hispanic White, followed by African American (29%), Hispanic (24%), Multiracial (9%), and Asian (7%). Over one third of students (36%) reported mild and 26% reported moderate to severe levels of PIU. Every standard deviation above the mean of PIU, was associated with significantly lower GPA (β = -0.07, 95% CI: [-0.11, -0.03]) and lower behavioral school engagement (β = -0.30, 95% CI: [-0.45, -0.15]) but not affective or cognitive engagement. In regard to ethnic differences, non-Hispanic White students with higher than sample average PIU had significantly lower behavioral school engagement scores than students from all other ethnic backgrounds (p<0.05).
Conclusion: Our results demonstrate that PIU is associated with lower GPA and lower behavioral school engagement, with the most detrimental effect among Non-Hispanic White students. Limiting students’ screen time and integrating routine screening into student health and academic advising could be beneficial approaches to reducing problematic/risky internet use among adolescents. Future research will benefit from investigating what protective cultural/family factors could offset the negative consequences of PIU.
Authors:
Co-Author - Rasmey Gomez, MPH (c), California State University, Northridge
Co-Author - Xiao Zhang, MPH (c), California State University, Northridge
Co-Author - Mikaela Rojas, MPH, California State University, Northridge
Chair - Myriam Forster, PhD, MPH, California State University, Northridge
Comparing Artificial Intelligence to human-generated retention messages for a family healthy weight program
Poster Number: D99Time: 11:00 AM - 11:50 AM
Topics: Implementation Science , Child and Family Health
Text messaging has been shown to improve session attendance and participant retention for community health programs. However, message development can be resource-intensive. The purpose of this study was to explore the extent to which human and AI-generated retention messages in a family healthy weight program differed in terms of time to create, quality, clarity, appropriateness, and alignment with behavior change principles.
Two experts in Building Healthy Families (BHF), a CDC-recognized family healthy weight program, developed content-aligned retention messages to follow an information session and 12 weekly sessions. A non-BHF-content expert created an AI prompt to generate two messages for each session using the same guidelines. Message development was timed for each stage (e.g., prep, writing, editing). Participants with behavior change expertise (n=21) responded to a survey about the quality, clarity, appropriateness, and alignment with social cognitive theory for a random sample of messages and rated them on a scale of 1-5 (strongly disagree to strongly agree). Raters were unaware that some messages were created with AI and others by program experts. Qualitative feedback was obtained from message developers on their experiences creating the messages.
Content experts spent an average of 248 minutes to prepare (50 minutes), write (81 minutes), and edit (117 minutes) their messages. The non-BHF-content expert spent 240 minutes reviewing program materials (90 minutes) and writing and editing the prompt (150 minutes) to generate 26 retention messages. Content expert messages averaged a Flesch-Kincaid score of 4.8 and wordcount of 95 with AI averaging 4.9 and 60, respectively. All messages achieved an average score >4 for quality and clarity, appropriateness, and alignment with social cognitive theory. However, the AI messages had significantly higher ratings compared to content expert messages in 9 of the 15 evaluation domains (p’s<0.1). Content experts found that editing the messages to meet grade level and length requirements took longer than drafting initial messages. The non-BHF-content expert found background research and gathering program information to be the most tedious.
Despite similar time to create theory-informed messages, AI may be an efficient tool given that the prompt could be used to create hundreds of messages in a few minutes. Conversely, time to create additional human-developed messages with this same scalability does not apply.
Keywords: Health behavior change, Children's healthTwo experts in Building Healthy Families (BHF), a CDC-recognized family healthy weight program, developed content-aligned retention messages to follow an information session and 12 weekly sessions. A non-BHF-content expert created an AI prompt to generate two messages for each session using the same guidelines. Message development was timed for each stage (e.g., prep, writing, editing). Participants with behavior change expertise (n=21) responded to a survey about the quality, clarity, appropriateness, and alignment with social cognitive theory for a random sample of messages and rated them on a scale of 1-5 (strongly disagree to strongly agree). Raters were unaware that some messages were created with AI and others by program experts. Qualitative feedback was obtained from message developers on their experiences creating the messages.
Content experts spent an average of 248 minutes to prepare (50 minutes), write (81 minutes), and edit (117 minutes) their messages. The non-BHF-content expert spent 240 minutes reviewing program materials (90 minutes) and writing and editing the prompt (150 minutes) to generate 26 retention messages. Content expert messages averaged a Flesch-Kincaid score of 4.8 and wordcount of 95 with AI averaging 4.9 and 60, respectively. All messages achieved an average score >4 for quality and clarity, appropriateness, and alignment with social cognitive theory. However, the AI messages had significantly higher ratings compared to content expert messages in 9 of the 15 evaluation domains (p’s<0.1). Content experts found that editing the messages to meet grade level and length requirements took longer than drafting initial messages. The non-BHF-content expert found background research and gathering program information to be the most tedious.
Despite similar time to create theory-informed messages, AI may be an efficient tool given that the prompt could be used to create hundreds of messages in a few minutes. Conversely, time to create additional human-developed messages with this same scalability does not apply.
Authors:
Author - Kayla Norton, MS, RDN, The University of Utah
Co-Author - Ryan Burns, PhD, University of Utah
Co-Author - Kathryn Heelen, PhD, University of Nebraska at Kearney
Co-Author - Guilherme Del Fiol, PhD, University of Utah
Co-Author - Caitlin Golden, PhD, University of Nebraska Kearney
Co-Author - Ali Malmkar, University of Nebraska at Kearney
Co-Author - Paul Estabrooks, PhD, University of Utah
Socio-Technical Insights and Lessons Learned from Implementing an AI Chatbot for Health-related Social Needs Navigation
Poster Number: D158Time: 11:00 AM - 11:50 AM
Topics: Digital Health, Social and Environmental Context and Health
Conversational agents (chatbots) have been used for digital behavioral interventions. With our research, we found that they can narrow the gap between identifying unmet health-related social needs (HRSNs) and connection individuals to care and community resources. Drawing on a mixed-methods evaluation of an AI-enabled HRSN navigation chatbot among low-income caregivers (n=128), in this abstract, we synthesize lessons learned from the perspectives of human-centered research practices. First, we observed stigma-aware recruitment language improved enrollment and retention, such as, framing the study as “resource navigation” rather than “social needs screening”, indicated that neutral, action-oriented messaging lowers perceived stigma and defensive responding. Second, clear expectation-setting at consent proved to be important. Explicitly articulating what the conversational agent can and cannot do reduced misconception, prevented overreliance on automation, and may have improved perceived satisfaction with engagement and referrals. Third, ecological validity increased when participants articulated a self-defined goal before any scripted tasks; brief goal-priming yielded richer, more actionable exchanges and fewer disengagements than scenario-first scripts, indicating that user-declared intentions anchor subsequent interaction and decision-making. Fourth, interaction-level analytics guided design more effectively than summary scores. Tracking button-based vs. text based chatbot engagement and help requests revealed cognitive strain points and informed wording, flow, and recovery refinements, while global metrics like system usability scale were too coarse to act on. Fifth, a privacy-by-design approach was essential for both feasibility and community trust. Limiting data collection (e.g., using ZIP-level rather than full addresses) and implementing transparent consent processes clarified data stewardship responsibilities and reinforced user confidence. Collectively, these process-derived insights foreground human factors (expectation management, stigma-sensitive framing, goal-setting) and operational infrastructure (fine-grained measurement, privacy-by-design) as prerequisites for equitable, scalable, and behaviorally effective navigation to help with unmet HRSN via conversational agents.
Keywords: e-Health, SocioeconomicAuthors:
Author - Emre Sezgin, BBA, MSc, PhD, Nationwide Children's Hospital
Co-Author - Daniel Jackson, BSc., Nationwide Children's Hospital
Co-Author - Syed-Amad Hussain, BSE, Nationwide Children's Hospital
Feasibility and Acceptability of a Cultural and Family Resilience Program Among Black Adolescents with Overweight
Poster Number: D149Time: 11:00 AM - 11:50 AM
Topics: Child and Family Health
Black adolescents and families navigate complex individual, social, and structural conditions that shape opportunities for regular physical activity, nutritious eating, and shared family mealtime routines. These conditions can contribute to increased risk for overweight and obesity, and long-term health consequences, including chronic disease and early mortality. Few health promotion programs have demonstrated effectiveness in improving health behaviors among Black adolescents and families. Chronic and racial stress may reduce engagement in and the impact of health promotion efforts. Limited family-based programs have integrated cultural and family resilience curriculum components to address such stressors among Black families. However, these existing resilience trials have only included a narrow set of core resilience resources, often overlooking racial identity and cultural assets, few have targeted health promotion behaviors as outcomes, and few have been evaluated for process evaluation. Therefore, the current study aimed to fill these gaps and evaluated parent and adolescent feasibility, acceptability, and engagement of a 5-week cultural and family resilience intervention for Black families. Quantitative and qualitative process evaluation data were collected from Black adolescents and their parent/caregiver (n = 31 dyads; M adolescent age = 13.4 years; 58.1% female; M BMI% = 96.3%). Overall, 71% of families attended at least 4 of the 5 sessions. Findings demonstrated high feasibility and acceptability of the resilience curriculum well above the a priori goal of ≥3.5 mean scores (1=never useful to 5=always useful; adolescent M=4.14, SD=0.24; parent M=4.47, SD=0.25). Further, findings showed moderate family engagement with key curriculum (80% completion of stress coping task; 73% completion of physical activity task; 94.5% of families present for full session). Follow-up qualitative feedback highlighted strengths of the program (e.g., approached challenging conversations about race, increased family bonding, increased stress coping tools) and recommendations for improvement for future resilience trials (e.g., culturally salient coping, discuss more health inequities). These findings provide notable insights that informed the curriculum of our team’s LEADS NIH-funded health promotion and resilience trial and provide preliminary support for future family-based resilience health promotion programs conducted with Black families.
Keywords: Health promotion, ResilienceAuthors:
Author - Mary Quattlebaum, PhD, Military Cardiovascular Outcomes Research (MiCOR) Program
Co-Author - Dawn Wilson, PhD, FSBM, University of South Carolina
Co-Author - Timothy Simmons, B.A., University of Maryland
Co-Author - Vashti Wood, Ed.S, University of South Carolina
Co-Author - Pamela Martin, PhD, University of South Carolina
Co-Author - Allison Sweeney, PhD, University of South Carolina
Co-Author - Lee Van Horn, PhD, University of New Mexico
Poster Session D
Description
Date: 4/24/2026
Start: 11:00 AM
End: 11:50 AM
Location: Salon D