Social support has been identified as an important component of diabetes care plans. Mobile health (mHealth) applications have emerged as valuable tools for diabetes self-management, serving as a supplementary support resource. This study explored the associations between perceived social support, the use of diabetes management applications, and diabetes self-management, particularly, how these relationships varied between app-users and non-app users, focusing on the differential impact on individuals with Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D). Participants (N = 391) were recruited via Prolific, an online service, and met criteria including being over 18 years old and diagnosed with T1D, T2D, or another form of diabetes. Participants completed a 15-minute online survey, which included demographic questions, health status, application use history, perceived diabetes self-management, eHealth literacy, social support levels, depressive symptoms, and interest in receiving support from an application. Data analysis revealed that higher levels of traditional social support were significantly associated with greater social support needs and better diabetes self-management. App-users reported higher support needs from applications, with stronger associations observed in individuals with T1D. The current study provides preliminary evidence demonstrating positive attitudes about the use of support features in diabetes management applications and their perceived benefit, particularly for participants that engaged in current or historical use of an application. Additionally, participants identifying as having T1D reported higher levels of application support received than those with T2D, indicating an area of growth for diabetes management software.

Objective: A variety of interventions have been developed to target problematic college student drinking, with minimal long-term effects. Several interventions incorporate alcohol protective behavioral strategies (PBS); however, these remain underdeveloped and underused. Counterfactuals (thoughts about what might have been) can strengthen causal links between behavior and outcome. Recent research has demonstrated counterfactual's effectiveness to increase PBS use. This study examines the effects of brief counterfactual and personalized normative feedback (PNF) interventions to increase PBS use. Method: Undergraduates (N = 239) completed an online 6-week intervention. Participants completed baseline demographics, PBS and alcohol use, and alcohol consequences measures. Participants were randomly assigned to condition: negative event only (Control), negative event with details (Sham), negative event with counterfactuals (CF), and PNF (PBS-PNF). They reported alcohol use, alcohol consequences, and PBS use weekly for 6 wk. Results: PBS use declined in both Control and Sham conditions. By the study's conclusion, CF (d = 0.54) and PBS-PNF (d = 0.46) conditions reported significantly higher PBS use (vs. Control). The Control, Sham, and PBS-PNF (but not CF) conditions had increases in alcohol use across time. In the final week there were indirect associations between alcohol consequences and both CF and PBS-PNF conditions from five weeks prior. Conclusions: This study provides some support for the use of both personalized normative feedback and counterfactual interventions to increase PBS use in college students. The personal relevance of the counterfactual intervention may produce sustained positive outcomes.

Healthy eating is often necessary to improve health outcomes, but many individuals don't consistently make healthy food choices. Previous intervention work has found that personally relevant interventions that identify actions to achieve goals are effective in changing behaviors. Counterfactual thinking (e.g. "if only … then …") can be utilized to identify causal relationships and personally relevant behaviors to achieve health goals. Additionally, counterfactual thinking has been shown to increase goal-relevant domains such as motivation and intentions. The present study developed and evaluated an eating-based counterfactual reflection task that incorporated protective behavioral strategies (PBS) and measured capability, opportunity, and motivation to eat healthy. The results indicated that counterfactual thinking (vs. control) significantly increased self-efficacy and intentions to use specific PBS. Additionally, those in the counterfactual condition with less capability had a larger increase in their willingness to change their eating habits. Future research will refine the counterfactual task to be more relevant and effective for a wider range of individuals.

Background: Diabetes self-management plays a vital role in improving clinical outcomes and the quality of life of individuals living with diabetes. Despite considerable research on its impact on clinical outcomes, diabetes self-management continues to be challenging for many individuals living with the condition. As part of the growth in digital health technologies for diabetes care, smartphone applications present potential opportunities to bridge the existing gaps in self-management and improve patient outcomes. Method: Participants ( N = 3241 people with diabetes) were recruited to answer questions about diabetes self-management, including their use of digital tools, their preferences for smartphone applications for diabetes, and the preferred functions of these applications they found useful. Frequency distributions and chi-square analyses were performed to examine the demographic differences among users of diabetes and general wellness applications. Results: Among participants, 30.2% reported using health applications specifically made for diabetes management, while 33.9% reported using health applications that were not diabetes-specific. Considerable differences in demographic characteristics were found between users and nonusers of both diabetes-specific and general health applications groups. The most preferred applications provided the opportunity to engage with continuous glucose monitoring data (i.e., continuous measurement; 47.4%) followed by glucose monitoring (i.e., single reading measurement; 20.9%), food intake trackers (23.6%), and fitness goal trackers (22.8%). Conclusion: These findings suggest that the use of digital health technologies is popular for people living with diabetes, but more needs to be done to ensure wider adoption and sustained use.

Background: E-cigarettes have become a popular form of nicotine use. The use of protective behavioral strategies (PBS) has been associated with less use of alcohol and fewer alcohol-related consequences. However, the relationship between PBS and e-cigarette-related outcomes have been understudied. Guided by the Theory of Planned Behavior, we examined the associations between the use of PBS for vaping (PBSV), perceived behavioral control over using PBSV, the frequency of past month e-cigarette use, and e-cigarette dependence. Methods: Adults who reported using an e-cigarette for at least once a day were recruited and completed an online survey (N = 298). Results: The path analytic model with e-cigarette dependence as the outcome fit the data well. Greater perceived behavioral control was associated with greater use of PBSV, greater use of PBSV was associated with less e-cigarette use, and less e-cigarette use was associated with less dependence. Conclusions: Our findings contribute to understanding e-cigarette use harm reduction strategies in the context of confidence over using PBS, frequency of e-cigarette use, and e-cigarette dependence. Results highlight the need for continued research and exploration of the potential clinical and public health benefits of PBSV as an intervention for e-cigarette use behaviors and dependence.

This study sought to examine the predictive utility of the theory of planned behavior (TPB) for mask wearing behavior. Data was collected during the Texas public mask mandate (October 11-November 24, 2020) and post-mandate (March 25-April 29, 2021). University students were recruited through the department’s online subject pool. Participants during the mandate ( N = 579; M = 18.70, SD = 1.17; 60.8% female) and post-mandate ( N = 236; M = 19.15, SD = 1.02; 50% female) completed identical TPB measures and demographic measures. Using structural equation modeling (SEM), attitudes, subjective norms and perceived behavioral control were associated with stronger mask wearing intentions. Intentions were positively associated with mask wearing behavior. Perceived behavioral control also had a direct positive association with wearing a mask in public. These findings suggest that the TPB is successful in predicting mask wearing behavior, which could have implications for prevention programs and public health campaigns.

The Sexual Discounting Task (SDT) was developed to evaluate the effects of delay on decision making as it relates to sexual risk-taking behaviors. Though previously validated with other populations, including urban emerging adults, the current study sought to validate the SDT with adolescents. A sample of adolescents ( N = 155; 61% female) between ages 14 and 21 ( M age = 19.5 years) was recruited to complete the SDT (involving choices between immediate unprotected sex and delayed sex with a condom with hypothetical sexual partners) and the Delay Discounting Task (a delay discounting task for money outcomes). Additionally, they completed several self-report measures assessing demographics, sexual behavior, and sexual history. If the condom was readily available, respondents were more likely to use a condom for partners who were judged “most likely to have an STI” and for those that participants were “least likely to have sex with.” Moreover, when a condom was not immediately available, greater self-reported sexual risk-taking was related to greater sexual discounting (i.e., greater effects of delay on decreasing condom use). Furthermore, sexual discounting was greater among partners deemed more desirable and those judged “least likely to have an STI.” Differences in sexual discounting were significant after controlling for immediately available condom use. Findings from the current study suggest that the SDT is clinically meaningful for adolescents and is sensitive to factors that influence real-world decisions to use condoms. Future treatment and prevention should consider delay discounting as an important variable affecting sexual risk behavior.

The surge in electronic nicotine delivery systems (ENDS) usage, particularly among young adults, poses significant public health concerns. This study aimed to identify predictors of e-cigarette use, quit attempts, and frequency among undergraduate students in a Hispanic-serving university in Texas. A cross-sectional study was conducted between August 1 and October 26, 2023, recruiting undergraduate students through the Sona system, an online experiment management platform. Participants completed an online survey that covered demographics, educational status, vaping status, initiation age, reasons for first and current e-cigarette use, frequency of past usage, intentions to quit, and quit attempt frequency. Statistical analysis included descriptive statistics, multinomial logistic regression, and multivariable linear regression. Among 316 participants, 33.9% reported current e-cigarette use. Junior and senior students, as well as prior tobacco users, were more likely to be current vapers. Prior vaping experience was more prevalent among Hispanic individuals and those with a history of tobacco use. Notably, 74.3% of current users attempted to quit in the past year, with a higher frequency of quit attempts among females, Hispanic students, and those with vaping acquaintances. However, the vaping behavior and quit attempt patterns were similar across other categories. This study highlights how various factors influence e-cigarette use among college students. It suggests that prevention and quitting programs should consider the specific needs of different groups. Future studies will continue to look at different student groups to find the most effective ways to help them quit vaping.

With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. Each of these design methods requires a deliberate effort by practitioners to infuse health equity into the approach. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors. We conclude with a call for shared rigor around designing digital health tools that deliver equitable outcomes for members of underserved populations.

Objective: People with diabetes (PWD) have limited access to healthcare professionals. To provide PWD with the support they need, there must be a comprehensive understanding of the daily burdens associated with self-management. Methods: An on-line questionnaire using the dQ&A US Patient Panel was created to understand the daily burden associated with self-management. Respondents from this survey (n=3,241) included adults with type 1 diabetes (T1DM), adults with type 2 diabetes (T2DM) on intensive insulin therapy, adults with T2DM on non-intensive insulin therapy, and adults with T2DM not on insulin. The sample included demographic and health characteristics. Results: 1,204 respondents had an annual income of less than $50,000. PWD in this income category are more likely to have housing and food insecurity and problems with paying their bills. Both PWD with an annual income of less than $50,000 and PWD with T1DM are more likely to report experiencing severe psychological and practical diabetes management burdens. PWD with T1DM are more likely to think about the impact of their diabetes on future events and experience sleep disruptions on a weekly basis. Conclusion: Concerns about long-term health and food choices are the leading causes of distress for all groups. Respondents have more difficulty ‘affording’ rather than ‘accessing’ items/facilities. There are many burdens related to diabetes, many caused by SDOH. Disclosure K. Yehl: None. S.A. Fields: None. F. Lee: Employee; Sanofi. Stock/Shareholder; Sanofi. E. Shoger: Other Relationship; Dexcom, Inc., Abbott, Tandem Diabetes Care, Inc., Beta Bionics, Inc., MannKind Corporation, Insulet Corporation, Medtronic, Association of Diabetes Care & Education Specialists. R. Smallman: None. K.A. Ellbogen: None. D. Kerr: Advisory Panel; Abbott Diagnostics. Consultant; Sanofi, Better Therapeutics, Inc. Stock/Shareholder; Glooko, Inc. Funding Sanofi US (77230685)

Background: Iron Deficiency (ID) affects two billion people worldwide, predominantly adolescent girls, and may be associated with increased psychopathology. The associations between ID and symptoms of depression and anxiety in adolescents were examined using data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of a nationally representative sample of non-institutionalized Americans. Methods: The current analysis included survey cycles where both iron-related markers and mental health-related outcomes were collected in adolescents 12 to 17 years old. Acute and serious medical conditions, acute inflammation, and abnormal birth weight led to exclusion. Linear multivariable regression analyses examined the association between ID status (defined based on the total body iron model) and (1) total Patient Health Questionnaire (PHQ-9) score, (2) one item examining anxiety severity, and (3) one item examining overall mental well-being. Covariates included age, sex, race and ethnicity, body mass index, household income, head-of-household marital status, and psychotropic medication use. Sensitivity analyses examined the robustness of the findings when ID was defined based on the ferritin model. Results: In 1990 adolescents (age [mean ± SD]: 14.5 ± 1.7 years; 85.7% females), ID with and without anemia was significantly associated with a higher PHQ-9 score in multiracial adolescents (Cohen’s d = 1.09, p = 0.0005 for ID without anemia; d = 0.92, p = 0.0395 for ID with anemia). Moreover, ID with anemia was associated with more severe anxiety (d = 3.00, p = 0.0130) and worse mental well-being (d = 2.75, p = 0.0059) in multiracial adolescents. The findings remained significant after adjusting for psychotropic use and in the sensitivity analyses. Conclusions: Iron deficiency is associated with poorer mental health in adolescents of multiracial background. Future studies should confirm these findings prospectively and examine the underlying mechanism.