PURPOSE:The purpose of this trial was to assess the feasibility, acceptability and safety of a 10-week hybrid (in-clinic and virtual) resistance exercise training RET program with or without CrM in individuals treated for colorectal cancer. METHODS:Twenty-seven participants were randomized to RET plus 5 grams/day of CrM (EXSUPP; n = 13) or 5 grams/day corn-starch maltodextrin placebo (EXPLA; n = 14). RET was performed three times per week. Feasibility was assessed through recruitment, retention and fidelity (percentage of prescribed RET and supplementation completed). Acceptability was evaluated using a 5-point Likert scale, and safety was monitored through adverse event reporting. Secondary outcomes (body composition, muscular strength, physical function) were assessed pre- and post-intervention using baseline-adjusted ANCOVA models and focus group interviews. RESULTS:Registry-based recruitment identified 1378 potentially eligible individuals and 27 of 410 assessed (6.6%) enrolled, highlighting recruitment challenges. Retention was high (24/27; 88.9%). Adherence to RET and supplementation was strong (both > 85%) with no serious adverse events reported. Participants reported high acceptability for both in person and virtual components. No significant between group differences were observed for secondary outcomes; however, both groups demonstrated modest improvements in muscular strength and short physical performance battery (SPPB) scores. CONCLUSIONS:A hybrid RET program with CrM was feasible, acceptable and well tolerated in individuals with colorectal cancer who were previously treated with chemotherapy. IMPLICATIONS FOR CANCER SURVIVORS:Hybrid supervised RET is safe, acceptable, and associated with modest improvements in strength and physical function among individuals treated for colorectal cancer. While creatine supplementation did not demonstrate clear additive effects in this pilot trial, further adequately powered studies are warranted. Trial Registration: NCT06420726.

Food marketing has increased volume, precision, and reach to influence viewers' food attitudes, beliefs, and eating behaviors. What and how much people eat has implications for health. While many countries regulate food advertising to protect consumers and encourage healthy eating, Ghana has none. Understanding the content and framing of food and beverage advertisements can inform the development of effective policies and practices that encourage healthier diets. This content analysis examines the foods and beverages advertised, their timing, and marketing techniques on Ghanaian television. From February to May 2020, 486 hours of advertisements were recorded. Advertisements with ≥1 actors were coded for food type, actor characteristics (i.e., body size, gender, age, race), and marketing techniques (i.e., promotional characters, premium offers, goal frames). A total of 607 advertisements with 2,043 actors were analyzed. Two-thirds (66.8%) promoted foods categorized as unhealthy. Sugar-sweetened beverages (22.6%) were most frequent, followed by grains high in sugar and low in fiber (13.2%), recipe additions (13.1%), and supplements (10.2%). Half (52.9%) of advertisements used persuasive marketing strategies. Most actors were classified as underweight (72.1% v. 20.5% normal weight, 7.4% overweight/obese) with a balanced gender distribution (49.1% female). Most advertisements aired during evenings (37.7%) and weekdays (69.5%). Morning advertisements promoted more healthy foods, whereas evening and night advertisements promoted more unhealthy foods. Gain goal frames were most common for healthy foods (p < 0.001), hedonic frames for unhealthy foods (p < 0.001), and normative frames showed no difference (p = 0.54). Underweight actors frequently appeared in unhealthy advertisements (68.3% v. 56.0% normal weight, 59.0% overweight/obese), whereas normal-weight (44.0%) and overweight/obese actors (41.0% v. 31.7% underweight) appeared in healthy advertisements. Persuasive marketing strategies were frequently advertised with unhealthy foods (59.9%) and overweight/obese (54.9%) and male actors (53.6%). This study highlights the need for effective policies to regulate food marketing, promoting healthier diets and realistic body expectations.

Assessing behaviors related to food choice at individual and household levels is essential for improving household diets, but assessment tools are limited. We conducted a scoping review to identify gaps in existing assessment tools for food acquisition, preparation, and household consumption practices in South Asia, where diets are rapidly changing. We undertook systematic keyword searches of 3 databases (PubMed, Scopus, and Web of Science Core Collection) to identify studies assessing food acquisition, food preparation, and household consumption practices in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka, published in English between 2000 and April 2025. Two reviewers independently screened titles, abstracts, and full texts and extracted data on study characteristics and the assessment tools used to examine the food choice behaviors. Of 13,160 unique articles identified, 50 were included for synthesis. Food acquisition behaviors (e.g., what and how often food is purchased, changes in food purchases) were assessed by 26 studies, food preparation (e.g., cooking habits, intrahousehold distribution of responsibilities, preparation methods) by 9 studies, and household consumption practices (e.g., timing, snacking, meal skipping, eating away from the home) by 30 studies. Most studies used quantitative methods (n = 34), some used qualitative methods (n = 13), and few used mixed methods (n = 3). Likert scales and semistructured interviews were the most used tools for quantitative and qualitative assessments, respectively. Across the 50 studies, 40 different tools were used to assess food-related behaviors, and only 14 studies claimed to be using validated tools. Few studies included a full tool in the text or supplemental material (n = 23). Currently, there is little alignment on how to assess food choice behaviors in South Asia, highlighting the need for a contextually adaptable repository of tools. Adapting and validating existing tools, rather than creating new ones, could improve efficiency, continuity, and comparability. This study was registered at Open Science Framework Registries as https://doi.org/10.17605/OSF.IO/5GPEF.

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.

Abstract BACKGROUND Living with Ulcerative Colitis (UC) is accompanied by physical and psychosocial burdens that significantly detract from quality of life. To accommodate, individuals employ multiple treatment and management methods to mitigate gastrointestinal (GI) disease symptoms, reduce pharmaceutical dependence, and respond to the daily challenges of living with UC. This study examines why and how patients choose to utilize treatment and management methods, with emphasis on patient perspectives and experiences. METHODS Adults living with UC for at least 5 years, who had experienced at least one disease flare, were recruited to participate in individual, semi-structured qualitative interviews (N=21). Verbatim transcripts were thematically analyzed using emergent coding with Nvivo12®. RESULTS Decision making about the use of treatment and management methods was shaped by participants’ sources of information, attitudes toward self-management, and personal motivations. Participants rarely expressed feelings of personal responsibility for the unpredictable course of illness. However, some believed that they could, to varying degrees, take charge of their UC experience. A few individuals described an active approach to managing their illness through self-adjusting treatment methods, health behavior change, and self-advocacy towards satisfaction with treatment options and enhanced patient-provider communication. The poor quality of life associated with the daily burden of living with UC emerged as a primary motive for exploration and utilization of treatment and management methods. Participants drew conclusions about diet’s impact on disease activity by observation of immediate GI symptoms. While most patients aimed to mitigate UC symptoms by taking medications, reducing stress, and avoiding perceived ‘trigger’ foods, participants reported primarily utilizing treatment and management methods as reactive responses to flares instead of as preventive measures against disease activity and disease progression. DISCUSSION Results provide insight into patient decision making and may inform individualized patient care, improve patient-provider communication, and guide interdisciplinary efforts to support self-management among patients with UC. Findings highlight a need for greater focus on promoting preventive self-management lifestyle behaviors to protect against disease activity and progressive impairment. This research supports the promotion of disease prevention and self-management both inside and outside of the clinical setting.

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi-structured interviews with mid-level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi-sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non-reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid-level actors are government officials and service providers at the subnational level who represent the frontline of government policy. Interviews focused on political commitment to and policy coherence in nutrition, and contributors to nutrition changes. Responses were coded to capture themes on the changes and challenges of these topics and compared between reduced and non-reduced districts. Descriptive statistics described district characteristics. Political commitment to nutrition was high in both reduced and non-reduced districts. Respondents from reduced districts were more likely to define commitment to nutrition as an optimal implementation of policy, whereas those from non-reduced districts focused more on financial commitment. Regarding coherence, respondents from reduced compared to non-reduced districts were more likely to report the optimal implementation of multi-sectoral nutrition planning meetings, using data to assess plans and progress in nutrition outcomes and integration of nutrition into the agriculture sector. In contrast, respondents from non-reduced districts more often reported challenges in their relationships with national-level stakeholders and nutrition and/or monitoring and evaluation capacities. Enhancing the integration of nutrition in different sectors and improving mid-level actors' capacity to plan and advocate for nutrition programming may contribute to reductions in stunting.

In Liberia, children are exposed to multiple forms of adversity which can negatively impact their health and development. Research is needed to examine the feasibility and benefits of integrated interventions that can be incorporated into existing health delivery programs to simultaneously address low responsive stimulation, undernutrition, and infection. This study assessed the feasibility of an integrated intervention promoting psychosocial stimulation and improved child feeding by the provision of eggs and fish. The integrated intervention was incorporated into an existing government health program. Thirty female caregiver-child dyads were randomly selected from two rural communities in Liberia. Participants received fortnightly group parenting sessions and weekly eggs and fish designated for child consumption, for four weeks. Trained community health workers delivered the intervention. Assessments were conducted before and after the intervention using quantitative surveys and qualitative interviews. At baseline, we examined the home environment, caregiver-child interactions, diet, and infection control practices. At endline, we assessed the feasibility of the intervention. Descriptive analyses were conducted with quantitative data. Qualitative data were analyzed using conventional content analysis. Baseline findings indicated uncommon responsive parenting, inadequate early learning opportunities, high food insecurity, and high child morbidity. Mixed methods indicators of feasibility, including acceptability, adoption, and fidelity were high. Qualitative data from this feasibility study informed several future modifications to the program, including engaging fathers, supplementing group sessions with home visits, and broadening facilitator eligibility. This integrated intervention is feasible and can be incorporated into existing health programs to support early child development.

Patients with Ulcerative Colitis (UC) seek a variety of methods to manage the physical and psychosocial burdens of illness on daily life. This study examines how individuals with UC: (1) utilize treatment and self-management methods and (2) make decisions regarding their use of these methods throughout the disease course. Adults living with UC ≥5 years and experienced ≥1 disease flare, participated in individual, semi-structured qualitative interviews. Transcripts were thematically analyzed using a constant comparative approach in NVivo12®. Participants (N = 21) described their decisions to utilize medical, lifestyle, and complementary methods, which were shaped by sources of information, attitudes toward self-management, and personal motivations. The poor quality of life associated with the daily burden of living with UC emerged as a primary motive for exploration and utilization of treatment and management methods. Participants reported primarily utilizing treatment and management methods as reactive responses to flares instead of preventive measures. Results provide insight into patient decision-making and may inform individualized patient care, improve patient–provider communication, and guide interdisciplinary efforts to support self-management among patients with UC. Findings highlight a need for greater focus on promoting preventive self-management lifestyle behaviors to protect against disease activity and progressive impairment.