Nisha C. Gottfredson

Eating disorders (ED) are most prevalent in women of reproductive age. EDs affect fertility, maternal BMI, and obstetric outcomes. During the early postpar

Objective: This synthesis of reviews and meta-analyses delves into the landscape of behavior change techniques (BCTs) employed in digital interventions designed to help individuals abstain from or reduce consumption of substances (including alcohol, tobacco, and illicit drugs). This review considers the “black box” problem in mHealth programs by using Michie et al.’s BCT taxonomy to describe BCTs that have been used in intervention literature and to explore potential active ingredients that may contribute to intervention effectiveness. Methods: We synthesize findings from 49 systematic reviews and meta-analyses. While individual studies often express inconclusiveness for the effectiveness of specific BCTs, this review uncovers promising avenues for future research. Our analysis focuses on mobile health (mHealth) just-in-time adaptive interventions (JITAIs), with a specific emphasis on substance use reduction. Results: Eleven BCTs were studied extensively in these reviews, including self-monitoring of behavior, feedback on behavior, goal setting, social support, prompts/cues, and behavior substitution. Our synthesis of evidence points to prompts/cues as particularly promising and highlights a handful of BCTs that demand further investigation, including self-monitoring, goal setting, and feedback on behavior. Conclusions: This review identifies specific limitations in each step of review formulation and provides nuanced suggestions to enhance the efficacy of future research endeavors.

Objective: Engagement with self-monitoring is crucial for success in digital behavior change interventions for weight loss, but little is known about trajectories of engagement, nor valid predictors of these trajectories. This exploratory trajectory analysis identified engagement patterns based on multiple trajectories of engagement with self-monitoring of weight, diet, and activity in a website-based weight loss intervention over 12 months among adults with overweight/obesity ( N = 363). Methods: Latent class growth modeling with a mixture layer used self-monitoring data including number of days tracking weight, diet, and activity on the study website, summed across four 3-month intervals, to identify groups based on engagement trajectories. Regression models examined the association between engagement patterns, demographic variables, and percent weight loss at 12 months. Results: Four engagement patterns emerged: never-engagers (23%), low/declining engagers (48%), early-engagers (13%), and sustained-engagers (16%). Trajectories of engagement were similar across self-monitoring behaviors within the same class. Age, race, and baseline body mass index were associated with likelihood of engagement class membership. Percent weight loss was clinically significant at 12 months for both sustained-engagers (−10.4%) and early-engagers (−5.1%), but not for low/declining (−1.3%) or never-engagers (−0.5%). Conclusion: Promoting early self-monitoring engagement may be of equal or greater importance than promoting sustained engagement to achieve desired weight loss outcomes in a digital behavior change intervention for weight loss. Given the high proportion of low/declining engagers who did not achieve clinically significant weight losses, there is a need to characterize and identify these participants early on to promote engagement with self-monitoring.

Background. The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising dimensional framework to understand psychopathology, but its developmental applicability and the placement of eating disorders (EDs) within it remain unclear. This study aimed to map the hierarchical structure of youth psychopathology, with a specific focus on EDs, across late childhood into early adolescence. Methods. We used data from the Adolescent Brain Cognitive Development (ABCD) Study, to conduct exploratory (BassAckward) and confirmatory factor analyses on symptoms of 13 mental disorders at ages 9-10 (baseline; N=11,867), 11-12 (2-year; N=10,972), and 13-14 (4-year; N=8,355). We examined the hierarchical factor structure and tested for sex invariance at each timepoint.Results. A higher-order structure with Internalizing and Externalizing factors was identified across timepoints. However, the lower-order structure showed developmental differences. EDs consistently emerged as a distinct lower-order factor nested within the Internalizing spectrum. The phenotypic association between ED and obsessive-compulsive disorder (OCD) factors was notable (r ≈ .45–.50). While some specific factors such as oppositional defiant disorder, attention-deficit hyperactivity disorder, depression, and OCD were identified, the composition of anxiety-related factors changed across timepoints. Notably, the derived factor structures demonstrated measurement invariance across biological sex at each timepoint.Conclusion. Our findings support a developmentally sensitive HiTOP model in youth, where ED constituts an Internalizing subfactor by late childhood, with stronger symptom associations in early adolescence. The hierarchical approach captured both stability and meaningful developmental differences, underscoring the importance of integrating a developmental perspective into structural models of psychopathology.

A quarter of 11-year-old children in the USA have tried alcohol, typically provided by parents. Parents are the primary source of alcohol socialization for preteens, yet many are unaware of their influence and lack tools to discourage early-onset alcohol involvement (EOAI). We piloted BIPAS Alcohol, an mHealth intervention grounded in social cognitive theory, to prevent alcohol socialization. In this two-arm randomized waitlist control trial, 132 parents were randomized to receive BIPAS Alcohol immediately or after a 3-month delay. Self-reported outcomes were assessed at baseline and at 3 months. We analyzed intent-to-treat (ITT) effects using generalized linear models. We also tested moderation of intervention exposure by parental alcohol use frequency. BIPAS Alcohol improved parents’ alcohol prevention beliefs, attitudes, and behaviors, including parenting self-efficacy, permissive beliefs, communication with other caregivers, alcohol socialization, and allowing sips. In moderation analyses, parent alcohol use frequency was associated with weaker effects on alcohol access and stronger effects on allowance of sipping. Moderation analyses suggested stronger effects on permissive beliefs and allowance of sips and weaker effects on alcohol access among parents who drank more frequently. BIPAS Alcohol is a promising preventive intervention for delaying EOAI. Its long-term effectiveness should be confirmed using a larger, more diverse sample.

Background: Early-onset alcohol use (EOAU), or drinking before the age of 14 years, is a serious but highly preventable risk factor for later alcohol use. EOAU often begins at home, with sips of alcohol provided by parents. Few scalable interventions are available to engage parents in EOAU prevention. Objective: This study aimed to evaluate the feasibility of Better-Informed Parents Keeping Adolescents Safe From Alcohol (BIPAS Alcohol) , a digital family-based intervention for parents of rising middle schoolers. Methods: In 2023‐2024, we delivered BIPAS Alcohol to US parents (N = 132) of 10- to 12-year-old children. The intervention consisted of a 3-month SMS text messaging curriculum and multimedia website. Guided by Bowen and colleagues’ framework, we surveyed parents to evaluate our intervention on its feasibility, including acceptability, integration, demand, and adaptation. We interviewed a subset of parents (n = 11) to probe survey findings. Results: Parents rated BIPAS Alcohol highly on acceptability, with almost all agreeing the intervention kept their attention (117/123, 95.1%), offered useful information (121/123, 98.4%), and helped reduce chances of underage drinking (119/123, 96.7%). Most parents indicated plans to integrate the intervention into family life by referring to content in the future (113/123, 91.9%) or sharing content with others (107/123, 87.0%). In interviews, parents expressed high demand for SMS text messages, due to their short, “digestible” format, while finding the website more cumbersome. Although we designed the SMS text message curriculum for adults, some parents reported adapting the intervention by sharing texts with their children. Conclusions: Our digital family-based intervention demonstrated feasibility and warrants additional evaluation in a larger-scale trial with a wider audience.

People who inject drugs (PWID) experience stigma related to drug use and HIV prevention, which can impede engagement with the HIV prevention continuum. Resilience may buffer against stigma’s harmful effects, but limited research has examined how resilience operates across different social contexts and stigma types among PWID. Using qualitative interviews and cognitive interviews, we adapted the 10-item Connor-Davidson Resilience Scale to measure resilience to drug use-related stigma and HIV prevention-related stigma among PWID in rural Appalachian Ohio in three contexts: medical, social, and employment. To validate the scale adaptations, we administered a quantitative survey. We assessed internal consistency using Cronbach’s alpha and fit Poisson regression models to test the association between high resilience and pre-exposure prophylaxis (PrEP) awareness and overdose response training. Among the 250 PWID who completed the quantitative survey, the six resilience scales demonstrated strong internal consistency. Examining frequency distributions, Bland–Altman plots, and factor analysis, we found the resilience responses varied by stigma type and context. Results of regression models indicated high resilience to HIV prevention-related stigma in the medical context was associated with PrEP awareness (adjusted prevalence ratio [aPR]: 1.37; 95% CI 1.05, 1.80) and overdose response training (aPR: 1.31; 95% CI 1.07, 1.61). Our study provides a novel approach to measuring context-specific resilience to stigma among PWID. Findings highlight the importance of tailoring interventions to both individual resilience and structural stigma, particularly in medical settings. Enhancing resilience and reducing stigma may support greater engagement with HIV prevention and harm reduction services in rural communities.

Objective: There is limited evidence on the effects of various types of intervention messages on achievement of daily behavioral goals in mobile weight loss programs. Nudge, a 12-week pilot microrandomized trial among young adults, tested whether 7 types of intervention messages based on behavior change techniques (BCTs) increased the likelihood of daily goal achievement. Methods: Participants received lessons, tailored feedback, self-monitoring tools, and daily messages, and had daily behavioral goals (weighing, active minutes goal, and red foods limit). Four times/day, participants (N = 52, aged 18–35, body mass index 25–40 kg/m ² ) were randomized to receive or not receive 1 of 7 types of BCT-based messages. Generalized estimating equations evaluated the effects of receiving a message versus not on daily goal achievement, and of receiving and viewing a message versus not viewing a message. Results: Randomization to receive any message (vs. none) did not impact likelihood of meeting daily goals overall but was associated with fewer red foods tracked (odds ratio (OR) = .96; 95% confidence interval (CI): .94–.98). Randomization to receive (vs. not receive) a social comparison message about red foods was associated with fewer red foods tracked (OR = .92; 95% CI: .85–.99); no other message types were associated with daily goal achievement. Receiving and viewing any message (vs. not viewing) increased odds of achieving daily goals for all 3 behaviors: weighing (OR = 1.91; 95% CI: 1.06–3.43), active minutes (OR = 1.63; 95% CI:1.20–2.20), and red foods limit (OR = 2.09; 95% CI:1.46–3.01). Conclusions: BCT-based messages may nudge achievement of daily goals when participants view them. Further research should explore how to increase and maintain engagement in mobile behavioral interventions. Trial registration: Precision Public Health: Enhancing Connections to Develop Just-in-Time Adaptive Intervention Strategies (Nudge); https://clinicaltrials.gov/study/NCT03836391 ; ClinicalTrials.gov ID: NCT03836391