Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study

Digital Health Platform for Maternal Health: Design, Recruitment Strategies, and Lessons Learned From the PowerMom Observational Cohort Study

BACKGROUND

Maternal health research faces challenges in participant recruitment, retention, and data collection, particularly among underrepresented populations. Digital health platforms like PowerMom (Scripps Research) offer scalable solutions, enabling decentralized, real-world data collection. Using innovative recruitment and multimodal techniques, PowerMom engages diverse cohorts to gather longitudinal and episodic data during pregnancy and post partum.

OBJECTIVE

This study aimed to evaluate the design, implementation, and outcomes of the PowerMom research platform, with a focus on participant recruitment, engagement, and data collection across diverse populations. Secondary objectives included identifying challenges encountered during implementation and deriving lessons to inform future digital maternal health studies.

METHODS

Participants were recruited via digital advertisements, pregnancy apps, and the PowerMom Consortium of more than 15 local and national organizations. Data collection included self-reported surveys, wearable devices, and electronic health records. Anomaly detection measures were implemented to address fraudulent enrollment activity. Recruitment trends and descriptive statistics from survey data were analyzed to summarize participant characteristics, assess engagement metrics, and quantify missing data to identify gaps.

RESULTS

Overall, 5617 participants were enrolled from 2021 to 2024, with 69.8% (n=3922) providing demographic data. Of these, 48.5% (2723/5617) were younger than 35 years, 14% (788/5617) identified as Hispanic or Latina, and 13.7% (770/5617) identified as Black or African American. Geographic representation spanned all 50 US states, Puerto Rico, and Guam, with 58.3% (3276/5617) residing in areas with moderate access to maternity care and 16.4% (919/5617) in highly disadvantaged neighborhoods based on the Area Deprivation Index. Enrollment rates increased substantially over the study period, from 55 participants in late 2021 to 3310 in 2024, averaging 99.4 enrollments per week in 2024. Participants completed a total of 17,123 surveys, with 71.8% (4033/5617) completing the Intake Survey and 12.4% (697/5617) completing the Postpartum Survey. Wearable device data were shared by 1168 participants, providing more than 378,000 daily biometric measurements, including activity levels, sleep, and heart rate. Additionally, 96 participants connected their electronic health records, contributing 276 data points such as diagnoses, medications, and laboratory results. Among pregnancy-related characteristics, 28.1% (1578/5617) enrolled during the first trimester, while 15.1% (849/5617) reported information about the completion of their pregnancies during the study period. Among the 913 participants who shared delivery information, 56.1% (n=512) had spontaneous vaginal deliveries and 17.9% (n=163) underwent unplanned cesarean sections.

CONCLUSIONS

The PowerMom platform demonstrates the feasibility of using digital tools to recruit and engage diverse populations in maternal health research. Its ability to integrate multimodal data sources showcases its potential to provide comprehensive maternal-fetal health insights. Challenges with data completeness and survey attrition underscore the need for sustained participant engagement strategies. These findings offer valuable lessons for scaling digital health platforms and addressing disparities in maternal health research.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03085875; https://clinicaltrials.gov/study/NCT03085875.

Exploring the relationship between sleep patterns, alcohol and other substances consumption in young adults: Insights from wearables and Mobile surveys in the National Consortium on alcohol and NeuroDevelopment in adolescence (NCANDA) cohort

INTRODUCTION

The use of psychotropic substances has negative short- and long-term health outcomes, including complex direct and indirect effects on sleep and sleep-cardiovascular function. Here, we investigate daily relationships between self-reported substance use and objective measures of sleep and sleep-related heart rate (HR) in community-dwelling young adults.

METHODS

Fifty-five healthy young adults (Mage = 23.1 ± 2.29 y, 30 female) in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study completed a 28-day ecological momentary assessment protocol, including remote sleep and HR measurements via Fitbit devices, as well as daily app-based self-reports of alcohol and other substance use.

RESULTS

A total of 1459 days of data were collected. Caffeine was the most frequent substance used, followed by alcohol, cannabis, nicotine, and other drugs. The analysis showed that substance use was associated with delays in sleep start and end time, reduced sleep duration and efficiency, and increased wake after sleep onset. Increases in sleep heart rate were associated with prior-day alcohol use.

DISCUSSION

Substance use negatively influences sleep and sleep HR. These preliminary data highlight the potential value of using remote multimodal data collection to investigate the daily relationships between substance use and sleep in young adults, in an ecological setting.

Telehealth for rare disease care, research, and education across the globe: A review of the literature by the IRDiRC telehealth task force

The International Rare Diseases Research Consortium (IRDiRC) Telehealth (TH) Task Force explored the use of TH for improving diagnosis, care, research, and education for rare diseases (RDs). The Task Force reviewed related literature published from January 2017 to August 2023, and identified various models and implementation strategies of TH for RD. The Task Force highlighted the reported value and benefits of using TH for RDs, along with the limitations and opportunities. The number of publications sharply increased since 2021, coinciding with the onset of the COVID-19 pandemic, which forced the rapid adoption of TH in many healthcare settings. One of the major benefits of TH for RDs lies in its capacity to surmount geographical barriers, which helps in overcoming the constraints posed by limited numbers and geographical dispersion of specialists. This was evident during the pandemic when TH was used to maintain a level of continued medical care and research when face-to-face visits were severely restricted. TH, through which clinical research can be decentralized, can also facilitate and enhance RD research by decreasing burden, expanding access, and enhancing efficiency. This will be especially beneficial when coupled with the adoption of digital health technologies, such as mobile health (mHealth) and wearable devices for remote monitoring (i.e., surveillance of outpatient data transmitted through devices), along with big data solutions. TH has also been shown to be an effective means for RD education and peer mentoring, enabling local health care providers (HCPs) to care for RD patients, which indirectly ensures that RD patients get the expertise and multidisciplinary care they need. However, limitations and weaknesses associated with using TH for RD care and research were also identified, including the inability to perform physical examinations and build relationships with HCPs. Therefore, TH has been recommended as a complement to, rather than substitute for, face-to-face consultations. There is also a concern that TH may lead to an amplification of health disparities and inequities related to social determinants of health for those with RDs due to lack of access to TH technologies, inadequate digital literacy, and geographical, socio-cultural, and linguistic barriers. Finally, the Task Force also discussed evidence and knowledge gaps that will benefit from future research efforts to help advance and expand the use of TH for RD care, research, and education.

Patterns of depression symptoms in relation to stressors and social behaviors during the COVID-19 pandemic among older youth and emerging adults in the United States

Substantial increases in depression at the outset of the pandemic were previously reported in NCANDA, a longitudinal sample of adolescents and young adults. The current NCANDA study examined depression symptoms before and during the COVID-19 pandemic. It evaluated the influence of stressors and social behavior (e.g., in-person and online socializing) with linear mixed effects models. A strong, positive association between COVID-19-related stressors and depression symptoms was observed. The frequency of in-person socializing did not account for the totality of the changes in depression observed during the early COVID-19 pandemic. It may be that pandemic-related stressors counteracted the benefits of in-person interactions during the early stages of the COVID-19 pandemic. Future studies can continue to elucidate the interactions among psychosocial, genetic, and behavioral factors contributing to depression symptoms in the unprecedented context of the COVID-19 pandemic.

A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study

BACKGROUND

Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists.

OBJECTIVE

This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices.

METHODS

To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country's capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use.

RESULTS

Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001).

CONCLUSIONS

This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria.

How Do Anger and Impulsivity Impact Fast-Food Consumption in Transitional Age Youth?

Introduction

Consumption of fast food has been linked to psychiatric distress, violent behaviors, and impulsivity in adolescents. The relationship between eating fast food, anger, and impulsivity has not been widely investigated. The National Consortium on Alcohol and Neurodevelopment in Adolescence community-based cohort consists of 831 youth, half at elevated risk factors for substance use disorders during adolescence, followed annually.

Methods

Impulsivity using Urgency, Premeditation, Perseverance, and Sensation Seeking Impulsive Behavior scale from annual assessments was examined in relation to self-reported fast-food consumption frequency and mobile application questions of anger. This study tested the hypotheses that youth anger may be predicted by fast-food consumption frequency and impulsivity using multiple regression, in addition to whether adolescent fast-food consumption frequency may be predicted by anger and impulsivity.

Results

Among youth, higher anger levels and impulsivity predicted greater frequency of fast-food consumption, and greater fast-food consumption frequency and impulsivity predicted higher anger levels.

Conclusions

This study's longitudinal findings are consistent with those of other studies that have found fast-food consumption and anger associated with impulsivity and also reveal a bidirectional link between anger and fast-food consumption. These results may point attention to food selection considerations for those at risk of anger and poorer psychiatric outcomes.

Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder.

OBJECTIVE

This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices.

METHODS

We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics.

RESULTS

The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026.

CONCLUSIONS

Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55039.

Associations between nicotine product use and craving among stable daily and non-daily users

Nicotine craving typically develops shortly after last use and is conceptualized as essential to the development, maintenance, and treatment of nicotine dependence. Previous research has primarily examined the relationship between craving and use among individuals trying to quit smoking, and less is known about this relationship among active users, particularly e-cigarette users. The current study evaluated the association between craving and use by assessing both constructs twice daily over 7 days in a sample of daily (n = 80) and non-daily (n = 34) users of combustible tobacco and e-cigarette products. We used negative binomial regression modeling to analyze the relationship between nicotine craving and use in two ways. First, we evaluated a lagged model in which craving at the time of assessment predicted use during the next time period. Next, we evaluated a model in which maximum craving since the last assessment predicted use during the same time period. Maximum craving was significantly and positively associated with nicotine product use (p <.05) while craving at the time of assessment was not. These associations did not differ depending on use frequency or on specific products used. Findings provide evidence that self-report ratings of craving are associated with greater nicotine and tobacco product use for both frequent and intermittent users. Furthermore, these results may be useful in developing or modifying interventions for a wide variety of nicotine users, including those who are not yet intending to make a change to their nicotine use.

Associations between alcohol use and sex-specific maturation of subcortical gray matter morphometry from adolescence to adulthood: Replication across two longitudinal samples

Subcortical brain morphometry matures across adolescence and young adulthood, a time when many youth engage in escalating levels of alcohol use. Initial cross-sectional studies have shown alcohol use is associated with altered subcortical morphometry. However, longitudinal evidence of sex-specific neuromaturation and associations with alcohol use remains limited. This project used generalized additive mixed models to examine sex-specific development of subcortical volumes and associations with recent alcohol use, using 7 longitudinal waves (n = 804, 51% female, ages 12-21 at baseline) from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA). A second, independent, longitudinal dataset, with up to four waves of data (n = 467, 43% female, ages 10-18 at baseline), was used to assess replicability. Significant, replicable non-linear normative volumetric changes with age were evident in the caudate, putamen, thalamus, pallidum, amygdala and hippocampus. Significant, replicable negative associations between subcortical volume and alcohol use were found in the hippocampus in all youth, and the caudate and thalamus in female but not male youth, with significant interactions present in the caudate, thalamus and putamen. Findings suggest a structural vulnerability to alcohol use, or a predisposition to drink alcohol based on brain structure, with female youth potentially showing heightened risk, compared to male youth.

Chinese Version of the mHealth App Usability Questionnaire: Cross-Cultural Adaptation and Validation

Background

Mobile health (mHealth) apps have shown the advantages of improving medication compliance, saving time required for diagnosis and treatment, reducing medical expenses, etc. The World Health Organization (WHO) has recommended that mHealth apps should be evaluated prior to their implementation to ensure their accuracy in data analysis.

Objective

This study aimed to translate the patient version of the interactive mHealth app usability questionnaire (MAUQ) into Chinese, and to conduct cross-cultural adaptation and reliability and validity tests.

Methods

The Brislin’s translation model was used in this study. The cross-cultural adaptation was performed according to experts’ comments and the results of prediction test. The convenience sampling method was utilized to investigate 346 patients who used the “Good Doctor” (“Good Doctor” is the most popular mHealth app in China), and the reliability and validity of the questionnaire were evaluated as well.

Results

After translation and cross-cultural adaptation, there were a total of 21 items and 3 dimensions: usability and satisfaction (8 items), system information arrangement (6 items), and efficiency (7 items). The content validity index was determined to be 0.952, indicating that the 21 items used to evaluate the usability of the Chinese version of the MAUQ were well correlated. The Cronbach’s α coefficient of the total questionnaire was 0.912, which revealed that the questionnaire had a high internal consistency. The values of test-retest reliability and split-half reliability of the Chinese version of the MAUQ were 0.869 and 0.701, respectively, representing that the questionnaire had a good stability.

Conclusion

The translated questionnaire has good reliability and validity in the context of Chinese culture, and it could be used as a usability testing tool for the patient version of interactive mHealth apps.