Ramon Durazo-Arvizu

Background: In response to the COVID-19 pandemic, governments around the world enforced stay-at-home orders and social distancing guidelines that amplified the use of screen time among pediatric populations. Excessive screen time may negatively impact mental health by increasing depression and anxiety. Objective: The first aim was to conduct a systematic review of articles examining screen time and mental health outcomes among children and adolescents during the COVID-19 pandemic from 2020 to 2023. The second aim was to determine the combined effect sizes for the associations of screen time and depression and/or anxiety among children and adolescents during the COVID-19 pandemic from 2020 to 2023 and whether gender or age influenced outcomes. Methods: Bibliographic databases were searched including MEDLINE (Ovid), Embase (Elsevier), Cochrane Library (Wiley), CINAHL Complete (EBSCO), and PsycINFO (EBSCO). There were a total of 6462 nonduplicate studies that were screened. Study inclusion criteria included children ages 0 to r =0.175, 95% CI 0.124-0.226, P <.001 and r =0.157, 95% CI 0.0994-0.214, P <.001, respectively) during COVID-19. Meta-regression revealed that screen time measured in problematic use of electronic devices had a 0.15 higher correlation with anxiety compared to screen time measured in duration of electronic device use. Conclusions: During the COVID-19 pandemic, children and adolescents with higher levels of screen time had increased depression and/or anxiety. Findings suggest the need for ongoing parent, professional, and self-monitoring of youth screen behaviors and habits as well as activities that promote social connectedness during global or national health emergencies.

Background: Pediatric obesity continues to be a national health crisis. Parents play a critical role in obesity interventions. Digital health interventions, such as personal activity trackers, can help better engage parents in pediatric obesity interventions and improve outcomes. Objective: This study aimed to (1) assess the feasibility and acceptability of implementing personal activity trackers as part of a comprehensive family-based lifestyle intervention for pediatric obesity (BodyWorks) in a Federally Qualified Health Center; (2) evaluate the impact of personal activity trackers on parents’ engagement, participant anthropometrics, and the overall program; and (3) examine the associations between steps per day and usage (minutes) with body composition outcomes. Methods: A total of 158 families were randomized to the control (BodyWorks) or intervention (BodyWorks + physical activity tracker) arm. Mean levels of weight-by-height outcomes, including BMI, BMI z scores, and BMI percent of the 95th percentile, were compared between the 2 groups. Results: There were no differences between study arms at baseline. After adjustment, there was a significant group difference in children’s BMI z scores from baseline to the postintervention time point ( P for interaction=.01). Conclusions: Families in the intervention group that completed the program had slightly better weight outcomes than the controls. Engaging parents through digital health interventions may be an effective way to enhance existing pediatric obesity intervention programs.

Background: Pre-exposure prophylaxis (PrEP) is a powerful tool to prevent the transmission of HIV. Interventions promoting PrEP must focus on populations most impacted by systemic barriers to uptake. Historically, young sexual minority men and transgender women have the highest demonstrated rates of new HIV diagnoses, but prevalence within other gender minority populations is now being studied. Few interventions have focused on addressing PrEP uptake with sexual and gender minority (SGM) youth, particularly through mobile health (mHealth) technologies. Built on the successful foundation of the HealthMpowerment Platform, PrEPresent aimed to engage SGM youth across diverse gender, racial, and ethnic identities in the Greater Los Angeles area. Objective: The aim of this study was to evaluate the feasibility and acceptability of a digital peer patient-navigation PrEP uptake app. Methods: PrEPresent incorporated patient activation theory into an mHealth intervention. The study took place over a 6-month period with visits at baseline, 3 months, and 6 months. The intervention period lasted from baseline to 3 months. Control participants received an information-only app. Intervention participants received an enhanced app and access to an interventionist, the PrEPresentative. Intervention participants could meet with the PrEPresentative four times over the 3-month period via phone, Health Insurance Portability and Accountability Act–compliant videoconferencing, or an in-app text messaging. PrEP uptake was measured through survey responses and the UrSure rapid urine test of tenofovir. Results: PrEPresent comprised of 147 sexual and gender-diverse participants—75 participants were randomized into the control arm and 72 into the intervention arm. A total of 48% (71/147) were Latinx and 18% (27/147) were Black or African American. Most (98/147, 67%) were transgender or gender diverse, and the remaining (49/147, 33%) were cisgender men. PrEP was initiated by 25% (14/56) of intervention participants and 19% (11/58) of control participants. In total, 50% (36/72) of intervention participants completed two or more sessions with the interventionist. Intervention participants had an average of 15.93 (SD 15.85) logins compared to 6.31 (SD 9.27) logins for control participants. Average use of the mHealth platform was 9.51 (SD 11.47) minutes for intervention participants and 3.03 (SD 5.70) minutes for control participants. Conclusions: PrEPresent met primary outcome measures of feasibility and acceptability. Despite this, PrEP uptake was low, and use of the platform was low compared to other HealthMpowerment projects. While mHealth offers promising HIV prevention outcomes, fostering active app engagement is crucial in promoting behavior change. Mixed success in initiating PrEP uptake across mHealth interventions involving SGM youth warrants further inquiry into how these platforms can address prevention barriers with this population. Interventions targeting uptake and adherence will need to adapt as the landscape of PrEP delivery evolves with the adoption of on-demand and long-acting injectable modalities.

The burden of diabetes has disproportionately impacted Hispanic/Latino residents in the United States, with diet recognized as a major modifiable risk factor. Outcome-dependent dietary patterns provide insight into what foods may be associated with the increased severity and progression of diabetes. However, the ethnic and geographical heterogeneity of US Hispanic/Latino adults makes it difficult to identify and distinguish differences within their diet as risk increases. Supervised robust profile clustering (sRPC) is a flexible joint model that can identify dietary patterns associated with diabetes, while partitioning out those defined by their ethnicity and geography. However, sRPC has only been applied to binary outcomes. We extend the existing model to develop the ordinal sRPC. Using baseline dietary data (2008-2011) from the Hispanic Community Health Study/Study of Latinos, we illustrate the utility of our model to identify dietary patterns associated with the three-levels of diabetes status (i.e. normal, pre-diabetes, diabetes). Simulation studies confirmed that ordinal sRPC improved identification and characterization of these patterns compared to a standard supervised latent class model. Results indicated that participants who had greater consumption of fruits, snack foods, and refined grain breads may be more likely to be associated with an increasing severity of diabetes status.

BACKGROUND Pre-exposure prophylaxis (PrEP) is a powerful tool to prevent the transmission of HIV. Interventions promoting this medication must focus on populations most impacted by systemic barriers to uptake. Historically, young sexual minority men (YSMM) and transgender women have the highest demonstrated rates of new HIV diagnoses, but prevalence within other gender minority populations is now being studied. To date, few interventions have focused exclusively on addressing PrEP uptake with sexual and gender minority (SGM) youth, particularly through mobile health (mHealth) technologies. Built on the successful foundation of the HealthMpowerment (HMP) Platform, PrEPresent aimed to engage with SGM youth across diverse gender and racial and ethnic identities in the Greater Los Angeles area. OBJECTIVE The aim of this study was to evaluate the feasibility and acceptability of a digital peer patient-navigation PrEP uptake application. METHODS The PrEPresent intervention took place over a 6-month timepoint with visits at baseline, 3 months, and 6 months. The active intervention period lasted from baseline to 3 months. Control participants received an information only version of the app. Intervention participants received an enhanced app with additional features and access to an interventionalist, the PrEPresentative. Intervention participants could meet with the PrEPresentative 4 times over the 3-month period via phone, HIPPA-compliant video conferencing, or in-app text messaging system. PrEP uptake was measured through survey response and UrSure rapid urine test of tenofovir. RESULTS PrEPresent comprised of 147 sexual and gender diverse participants – 48.3% (71/147) were Latinx and 18.4% (27/147) were Black/African American. Most (66.6%, 98/147) were transgender or gender diverse and the remainder (33.3%, 49/147) were cisgender men. PrEP was initiated by 14/56 (25.0%) of intervention participants and 11/58 (19.0%) of control participants. 50% (36/72) of intervention participants completed two or more sessions with the interventionalist. Intervention participants had an average of 15.93 logins compared to 6.31 logins for control participants. Average usage of the mHealth platform was 9.51 minutes for intervention participants and 3.03 minutes for control participants. CONCLUSIONS PrEPresent met primary outcome measure metrics of feasibility and acceptability, demonstrating that mHealth-based peer-navigator support has potential to increase PrEP uptake in racially and ethnically diverse SGM. Despite this, PrEP uptake was low across both arms and usage of the platform was low compared to other iterations of HMP projects. While mHealth offers promising HIV prevention outcomes, fostering active participant app engagement will continue to be crucial in promoting behavior change. With the widescale adoption of on-demand and long-acting injectable PrEP, interventions targeting uptake and adherence will need to adapt as the landscape of PrEP delivery evolves. Larger trials powered for efficacy are warranted to understand how mHealth platforms and peer-navigation systems can address barriers related to PrEP uptake. CLINICALTRIAL ClinicalTrials.gov NCT05281393; https://clinicaltrials.gov/ct2/show/NCT05281393 INTERNATIONAL REGISTERED REPORT RR2-10.2196/50866

Context Supplementation with vitamin D has the potential to both reduce and increase risk of falling, and parathyroid hormone (PTH) may contribute to fall risk. Objective To assess the associations of intra-trial mean circulating levels of 25-hydroxyvitamin D [25(OH)D] and PTH on incident falls in healthy older adults. Design Observational within a clinical trial. Setting The Bone Metabolism Laboratory at the USDA Nutrition Center at Tufts University. Participants 410 men and women age ≥65 years who participated in the 3-year Boston STOP IT trial to determine the effect of supplementation with 700 IU of vitamin D₃ plus calcium on incident falls (secondary endpoint). Intra-trial exposures of 25(OH)D and PTH were calculated as the mean of biannual measures up to and including the first fall. Main outcome measures Incidence of first fall. Results Intra-trial mean 25(OH)D was significantly associated with risk of falling in a U-shaped pattern; the range associated with minimal risk of falling was approximately 20 to 40 ng/mL. PTH was not significantly associated with risk of falling. Conclusions The findings highlight the importance of maintaining the circulating 25(OH)D level between 20 and 40 ng/mL, the range that is also recommended for bone health. At PTH levels within the normal range, there was no detectible independent association of PTH with fall risk.

Background: Evidence suggests that subjective (perceived) social status (SSS) may predict health outcomes more strongly than objective social status, but little is known about the relationship between SSS and cardiovascular health (CVH). This study focuses on this relationship among diverse Hispanic/Latino adults because while poor CVH profiles are prevalent in this population, immigration complicates attempts to measure their social status. Methods and Results: We analyzed baseline HCHS/SOL (Hispanic Community Health Study/Study of Latinos) data on 15 374 Hispanic/Latino adults aged 18 to 74 years in 2008 to 2011. SSS was assessed using the McArthur Scale, a 10‐rung “social ladder.” CVH was based on levels of 7 metrics defined by the American Heart Association. Linear and logistic regressions were used to examine cross‐sectional associations of SSS with CVH (overall and single metrics) after adjusting for objective social status, demographic, and health factors. Less than half of the population (46%) had Ideal scores in ≥4 metrics of CVH. In multivariable‐adjusted models, an increase in SSS was associated with a higher overall CVH score (β=0.04; 95% CI, 0.01–0.06) and greater likelihood of Ideal levels of body mass index, physical activity, and fasting blood glucose levels. Nativity and time in the United States modified the association between SSS and Ideal smoking. Conclusions: Subjective measures of social status can enhance an understanding of CVH among Hispanic/Latino people. Future studies should explore the stability of SSS over time in comparison with objective social status and the mechanisms through which SSS may influence CVH.