Kayla Nuss

BACKGROUND Positive parenting practices foster optimal child development, yet traditional program delivery (in person one-on-one or group) of behavioral parent training (BPT) faces scalability and access barriers. Digital BPTs expand reach but struggle with retention, whereas hybrid models, pairing digital content with facilitator support, significantly increase engagement. However, scaling hybrid delivery remains limited by time-intensive facilitator training. OBJECTIVE This protocol describes Phase 2 of a trial evaluating the implementation and effectiveness of the *ez*Parent Bundle (asynchronous facilitator training (*ez*Training), a monitoring dashboard (*ez*Dashboard), and hybrid BPT program (*ez*Parent)) on parenting self-efficacy, parent-child relationship quality and child behavior in Head Start Head Start/Early Head Start (HS/EHS) settings. METHODS Using a cluster randomized trial, 16 HS/EHS sites in the US are randomized 1:1 to the *ez*Parent Bundle or usual care. The target sample is 516 parents (~32 per site) of children aged 2-5 years. Intervention parents complete 6 digital *ez*Parent modules and 4 group sessions led by facilitators at the HS/EHS site trained via *ez*Training. Outcomes evaluated at baseline, 10–12 weeks, and 24 weeks after *ez*Parent participation include parenting practices, parenting self-efficacy, parent-child relationship quality, and child behavior. Implementation is evaluated using RE-AIM. RESULTS Site partnership began in early 2026, and parent recruitment was initiated in August 2026. As of October 2026, 13 sites are engaged and randomized, with 3 in process. All (n = 18) engaged facilitators successfully completed *ez*Training and hybrid *ez*Parent began in October 2026. Parent recruitment is ongoing in control sites. CONCLUSIONS This study evaluates a scalable, community-embedded model to expand facilitator capacity and optimize delivery of evidence-based parenting interventions. Findings will inform strategies for increasing adoption, implementation, and sustainment of hybrid BPT in community settings while reducing training burden and supporting broader reach to families. CLINICALTRIAL ClinicalTrials.gov NCT07417930

Background: Physical inactivity is highly prevalent among women with overweight or obesity, compounding their risk for cardiometabolic disease. While physical activity (PA) offers many health benefits, clinical recommendations and sociocultural pressures heavily emphasize weight loss and appearance, fostering poor body image, weight stigma, and appearance-based PA motivations rather than enjoyment or health related ones in adult women. Body image represents a key mechanism linking these pressures to PA behavior; it influences engagement in PA while PA simultaneously influences body image. Mobile health (mHealth) interventions, including smartphone-based PA applications, are effective tools for promoting PA; however, most emphasize similar weight-loss or appearance-related outcomes. To address this gap, we aimed to develop and test the formative acceptability and perceived usability of a of a mobile app prototype using body neutrality, a body image framework that shifts focus away from appearance towards body functionality and self-worth, to promote PA. Methods: Women with overweight or obesity who did not meet PA recommendations of 150 minutes of moderate-to vigorous-PA were recruited for 6 focus groups (n=39) and usability testing (n=17) using Trialfacts. Potential participants were screened using a survey. Eligible participants completed a study information meeting with a member of the research team to ensure eligibility, review study procedures, respond to participant questions, and obtain informed consent. After completing the consent process, each participant was scheduled for a focus group, or a usability testing session, both of which were hosted using the Zoom with a moderator. Focus group findings were then used to develop a clickable wireframe or prototype of the NoWeigh app, which was then assessed in usability testing. Results: Focus group participants showed a high level of enthusiasm for the NoWeigh app and interest in different approaches to PA and less weight-loss-centric messaging in PA promotion apps. In usability testing, participants were satisfied with the app prototype’s features, resulting in an SUS score of 88.24±11.07. Sixteen of 17 participants (94%) responded affirmatively that they would use the app if developed. Participants rated the user-friendliness of the app as 5.88±0.49 out of 7 (84%). Conclusions: These findings suggest that body neutrality may represent a promising and underexplored framework for digital PA interventions targeting populations who may feel alienated by traditional weight-centric messaging. Future research should evaluate the efficacy of the fully developed NoWeigh app for improving PA engagement and examine whether changes in body image and autonomous motivation serve as mechanisms underlying sustained behavior change.

Nearly half of adult women in the United States do not meet recommended levels of moderate-to-vigorous physical activity (MVPA), despite well-established health benefits. Sociocultural pressures emphasizing thinness and appearance may promote controlled, appearance-based motivation for physical activity (PA), a motivational orientation that has been associated with less sustained engagement. This pilot study examined whether a 6-week, self-guided body neutrality workbook intervention was associated with changes in MVPA and psychological mediators of PA among insufficiently active adult women. Twenty participants who did not meet PA guidelines at baseline completed pre- and post-intervention assessments of MVPA, motivation, basic psychological needs, body image constructs, and PA intentions and planning. Results indicated a moderate increase in MVPA. Improvements were also observed in autonomy, competence, intrinsic and integrated motivation, body functionality appreciation, body compassion, and PA intentions and planning, alongside reductions in introjected regulation and appearance-based social comparison. These findings suggest that a body neutrality approach may support more autonomous motivation for PA. Although limited by small sample size and lack of a control group, this study provides preliminary evidence that body neutrality-based interventions may represent a promising, scalable strategy to promote both psychological well-being and PA engagement among adult women.

Background: The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the web-based spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer. Objective: This study aimed to develop and pilot test a theory-based intervention via the web to reduce 6 cancer risk factors among rural emerging adults (EAs) through community-engaged research. Methods: This mixed methods evaluation describes the development of a web-based cancer prevention intervention aimed at rural EAs aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and cocreated with EA and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. We report on 3 formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development. Descriptive statistics were applied to the surveys and pilot intervention baseline results to produce means and SDs using R. Results: We developed posts (n=400) for a Facebook feed aimed at reducing 6 cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the EA and stakeholder advisory boards. Formative surveys with rural EAs (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material. Conclusions: This web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural EAs. We offer key insights into the design and implementation of web-based cancer prevention interventions for EAs by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging EA and community stakeholder partners are presented, and we discuss how their involvement resulted in modifications that strengthened the intervention. Finally, we highlight the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability. Trial Registration: ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 International Registered Report Identifier (IRRID): RR2-10.2196/50392

BACKGROUND The rapid growth of user-generated web-based health information increases the complexity of cancer information seeking. One promising strategy for promoting high-quality cancer information consumption is through targeted interventions that are intentionally designed to reach individuals in the web-based spaces they occupy. However, there is a paucity of evidence-based information on the best strategies for designing and implementing web-based health behavior change interventions to improve individuals’ cancer-related knowledge and prevent cancer. OBJECTIVE This study aimed to develop and pilot test a theory-based intervention via the web to reduce 6 cancer risk factors among rural emerging adults (EAs) through community-engaged research. METHODS This mixed methods evaluation describes the development of a web-based cancer prevention intervention aimed at rural EAs aged 18-26 years in the United States and delivered in Facebook private groups. The intervention was guided by behavior change theory and cocreated with EA and Stakeholder Organization Advisory Boards to ensure relevance, accessibility, and appropriateness. We report on 3 formative surveys, a pilot intervention, protocol development, and the community-engaged process for intervention development. Descriptive statistics were applied to the surveys and pilot intervention baseline results to produce means and SDs using R. RESULTS We developed posts (n=400) for a Facebook feed aimed at reducing 6 cancer risk behaviors (unhealthy diet, lack of physical activity, tobacco use, alcohol use, sun exposure, and human papillomavirus infection) with iterative input from the EA and stakeholder advisory boards. Formative surveys with rural EAs (n=297) and a pilot study of the intervention with this population (n=26) were conducted. In the pilot study, the intervention reached participants across rural counties, with sustained engagement (post views=1060, reactions=346, comments=72) over a one-month period. Key modifications to the intervention content and design emerged from both advisory boards, the formative surveys, and the pilot intervention, focusing on using perceived reliable sources and direct links to source material. CONCLUSIONS This web-based cancer prevention intervention is scalable and delivers engaging, evidence-informed health information to rural EAs. We offer key insights into the design and implementation of web-based cancer prevention interventions for EAs by describing the resources, timelines, and expertise needed to design and implement the intervention. Considerations for fully engaging EA and community stakeholder partners are presented, and we discuss how their involvement resulted in modifications that strengthened the intervention. Finally, we highlight the importance of theory-based health-behavior messaging, digital messaging skillsets, and platform-tailored dissemination strategies for maximizing web-based intervention acceptability. CLINICALTRIAL ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 INTERNATIONAL REGISTERED REPORT RR2-10.2196/50392

Background: African American men are at a higher risk for serious health conditions such as cardiovascular disease, diabetes, and stroke compared to non-Hispanic White men. Physical activity (PA) is a modifiable health behavior that has been shown to decrease chronic disease risk; yet, PA engagement is alarmingly low in African American men. Interventions to improve PA engagement are effective in a number of populations; however, very few have been tailored to the unique needs of African American men. Even fewer have leveraged mobile health apps, despite African American men’s interest in and willingness to use such technologies for health improvement. Objective: This comparative effectiveness trial aims to evaluate MobileMen, a PA promotion app tailored to the needs and preferences of African American men. This trial will compare the MobileMen app to a commercially available PA promotion app with similar features but lacks culturally tailored components. Methods: We will recruit a sample of “low active” (accumulating 30 years from Baton Rouge, Louisiana, and the surrounding communities. All participants are given a Fitbit Charge 6 wearable activity tracker to assess daily PA and steps and are randomized to either the MobileMen intervention app or the comparator app, which is a commercially available PA tracking app called Stridekick. The Stridekick app has features similar to those in the MobileMen app but was not intentionally designed for African American men. The intervention period is 6 months during which participants will interact with their assigned mobile app. MobileMen includes features such as digital badges earned for PA; tangible prizes like exercise equipment; challenges among participants; goal setting; nutrition; PA; and behavior change educational information in text, audio, and video formats. Participants will complete assessments at baseline and at 6 months post randomization. Assessments include objective measurements of daily steps and minutes of moderate to vigorous PA, quality of life, dietary measures, self-efficacy for fruit and vegetable consumption and PA, and autonomous motivation for PA. Results: This trial is in the start-up phase. The MobileMen app development and usability testing was completed in August 2024. Participant recruitment efforts began in October 2024. The trial and associated data analyses and interpretation are planned to be completed by fall 2025. Conclusions: Mobile apps are a widely accessible means to disseminate culturally tailored PA promotion interventions to various populations, including African American men. MobileMen has the potential to impact PA engagement in African American men, which would dramatically improve the overall health and chronic disease risk in this underrepresented group. Trial Registration: ClinicalTrials.gov NCT05621044; https://clinicaltrials.gov/study/NCT05621044 International Registered Report Identifier (IRRID): PRR1-10.2196/67809

BACKGROUND African American men are at a higher risk for serious health conditions such as cardiovascular disease, diabetes, and stroke compared to non-Hispanic White men. Physical activity (PA) is a modifiable health behavior that has been shown to decrease chronic disease risk; yet, PA engagement is alarmingly low in African American men. Interventions to improve PA engagement are effective in a number of populations; however, very few have been tailored to the unique needs of African American men. Even fewer have leveraged mobile health apps, despite African American men’s interest in and willingness to use such technologies for health improvement. OBJECTIVE This comparative effectiveness trial aims to evaluate MobileMen, a PA promotion app tailored to the needs and preferences of African American men. This trial will compare the MobileMen app to a commercially available PA promotion app with similar features but lacks culturally tailored components. METHODS We will recruit a sample of “low active” (accumulating 30 years from Baton Rouge, Louisiana, and the surrounding communities. All participants are given a Fitbit Charge 6 wearable activity tracker to assess daily PA and steps and are randomized to either the MobileMen intervention app or the comparator app, which is a commercially available PA tracking app called Stridekick. The Stridekick app has features similar to those in the MobileMen app but was not intentionally designed for African American men. The intervention period is 6 months during which participants will interact with their assigned mobile app. MobileMen includes features such as digital badges earned for PA; tangible prizes like exercise equipment; challenges among participants; goal setting; nutrition; PA; and behavior change educational information in text, audio, and video formats. Participants will complete assessments at baseline and at 6 months post randomization. Assessments include objective measurements of daily steps and minutes of moderate to vigorous PA, quality of life, dietary measures, self-efficacy for fruit and vegetable consumption and PA, and autonomous motivation for PA. RESULTS This trial is in the start-up phase. The MobileMen app development and usability testing was completed in August 2024. Participant recruitment efforts began in October 2024. The trial and associated data analyses and interpretation are planned to be completed by fall 2025. CONCLUSIONS Mobile apps are a widely accessible means to disseminate culturally tailored PA promotion interventions to various populations, including African American men. MobileMen has the potential to impact PA engagement in African American men, which would dramatically improve the overall health and chronic disease risk in this underrepresented group. CLINICALTRIAL ClinicalTrials.gov NCT05621044; https://clinicaltrials.gov/study/NCT05621044 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/67809

This study used a daily diary approach to examine associations between day-level physical activity (PA) behavior, PA-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months (April–June 2020) of the pandemic. A total of 468 US adults (M_age = 34.8 y, 79% female) participated in a 28-day smartphone-based daily diary study assessing PA. A baseline survey assessed PA and motivation for PA using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time (days since the US March 13, 2020, COVID-19 national emergency declaration) on daily PA minutes. Latent profile analysis identified 4 distinct motivational profiles for PA among this sample: profile 1: high amotivation (n = 100, 21%); profile 2: low controlled motivation (n = 55, 12%); profile 3: high external regulation (n = 47, 10%); and profile 4: moderate autonomous motivation (n = 266, 57%). After controlling for baseline PA, there were significant interactions between profile and time on daily PA (−0.21, P < .01). Profile 2 showed greater decreases in daily PA minutes over time than profile 1 (b = −0.29, P < .01). Profiles 3 and 4 did not indicate significant decreases in PA compared with profile 1 (b = 0.14, P = .31 and b = −0.16, P = .05, respectively). Contrary to previous research, individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in PA over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. These findings suggest that external motivation may have provided short-term protection against declines in PA observed during early months of the COVID-19 pandemic.